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BP25-140
PERMIT K)6 c oA 01y � SECTION BLOCK LOT TYPE OF WO JOB LOCATION OWNER CONTRAC1Ui:i T. COST �Q at4oep /71i'aly &I S � , E'orc� J'J - 07 TCO FEE DATE DATE FNT1NG FOUNDATION FRAMING INSP RC:H FRAMING iNSUlAT10N PLUMBING L]0 RGH PLUMBING / X'sw & GAS IV LQ=z SPRINKLER ELECTRIC .f Z • ? Z Z S _�n��5 LOW -VOLT ALARM 4S BUILT Q FINAL �fc:;o o /oar ,�c� o�c � I /��cl / Jezo y (f 57/eC44 C (200?0 OTHER APPROVALS ARB BOT PS ZBA OTH�f� YnP9s--psil.)(,4,pye.. a.e;- -cc VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 26-023 Certificate of ®ccupaucp Ehis is to certify that a t7f-1'1,6y- J of, �(,,� � rQa,�, having duly filed an application on 20 c>J 10 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a K—/V Zoning District and shown on the most current Tax Map as Section: Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.p�S-' � , issued Cl/ 7 20 --x)5, such authority and permission is hereby granted to the property owner to lawfully occupy oruse said premises or building or part thereof listed under the following New York State Classifications,Use: 1�3 - C121721'1�1 Construction: , for the following purposes: r /' v T H Y bQ/71' Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the uilding or in t facilities shall be made,and no enlargement, whether by extending on any side or by increasing in h 'ght hall be nor s all the building be moved from one location to another until a permit to accomplish such change has bee ed fr the uilding Inspector. FEB 1 9 2026 Building Inspector,Village of Rye Brook: Date: BRA VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E.Fews David M. Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE February 19,2026 Dylan Fijor 8 Beacon Lane Rye Brook,New York 10573 Re: 8 Beacon Lane,Rye Brook,New York 10573 Parcel ID#: 135.66-1-65 This document certifies that the work done under Mechanical Permit#25-151 issued on 10/15/2025 for the installation of a new condenser and a new furnace has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to DR3 L� [G� G •uV V�4:4,. 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrookny.g_ov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 19,2026 Dylan Fijor 8 Beacon Lane Rye Brook,New York 10573 Re: 8 Beacon Lane, Rye Brook,New York 10573 Parcel ID#: 135.66-1-65 This document certifies that the work done under Plumbing Permit #25-161 issued on 10/15/2025 for the installation of a new gas water heater has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to For office use only; BUILD MENT PERMIT# P ZS—/40 JAN 6 LUZO VILad OF RYE K ISSUED: (o Z L-) • Z� 938 KING STREET,RYE BROOK, wV PORK 10573 DATE: (914 6 , FFE4.�• [X� PAID ww r �. ov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ••r••»+•rr.r++.+++++••••••+•.as.•••r•+•++++••+•+••••.+++•.++++++•+++r•r•••••.•r••••••r+•••••••••+rr+•u•+++•+++a•r+•+r•q•++ Address: ALQ N LAB t p.�E__ �d0 � IJ�1.� 0 4115 Occupancy i Use: Parcel ID#:_------- __ Zone: Owner: bYLGh)...._ EljC2 Address: k\ _ eTl)� W. P.E./R.A.or Contractor:_, rq Address: '916 j9(-d��i V'L Person in responsible charge: Address: _ Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: C�_ - " J. STATE OF NFW•*4�6R!4.COUNTY OF WE�•STeHESTER as: - - ,L7t Na F 1p^icp being duly sworn,deposes and says that he/she resides at g �� tPnnt Name of Applicant) +No and Street) in ?YE r7�p,(� )th ,in the County of W1�TC�Ht�T�� in the State of 01( that (City:Town.Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including dmonetary value of any materials and labor which may have been donated gratis was:S 4;0 coo ' for the construction or alteration of F0 )�'r,Cinr VUo� re VG1 Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.oithe Code of the Village of Rye Brook. Sworn to before me this Sworn before me this��_ day of ,20 2L. day of 'L . 20C) i Signature of Prop Owner Sig . re of A &1164bo j Pant Na a of Properlyl7� er Print Name oC A �licant i,_ Notary Pu cSW MONICA ELLIS svutrty panic,state of Connecticut JOFRYMALALVAREZ GUERF'tERO p 8 NOTARY PUBLIC -y- ^---'� "-- STATE OF NEW JERSEY ID#50117272 MY COMMISSION EXPIRES NOV.22,2029 QyE DRCZj,�. - s_ 198'2 BUILDING DEPARTMENT ,A BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - ----- INSPECTION REPORT - - - - - - - - --- - - - - - - -- - ADDRESS : x c✓c DATE: �7 PERMIT# v ISSUED: SECT: BLOCK: LOT: LOCATION: 1-C� •�.QS 1 (�C- � C�<1 OCCUPANCY: -.Z`D ❑ VIOLATION NOTED THE WORK IS...,,Z ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER eBRC)�oa'4t-i Z� 1982 BUILDING DEPARTMENT ❑B LDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook, NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org, - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :_$_-&PNC-QA3 1-_A-�SS- ---- DATE: 10 - 2-9 ZOO-J' PERMIT# , ��- - ISSUED: /S-_2SI?C'1': �i�1��` •�p_ BLOCK: � LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION L]-�atural Gas ?n4,ss ,u r ❑ L.P. Gas ❑ FUEL TANK 1 idl CIIJ a 6� 19'�P L��^'✓"�V r ❑ FIRE SPRINKLER ❑ FINAL PLUMBING !SS •• /o- Z -zoe ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER !r>D a * o * * •tv u -�4 N * Cd c> >. O w O DO13 �* z �4 o 0o � V1 W o z W a 14cc U S Z w 0-4 a o� M 011 * z � � t * a * 14. t/ * a a) LLI } to * " -� v C * -p0 � � � � �O• � to E E ¢ a a. a ,l l T r� y r i QyE BRC�k w � 0 '9°2 � BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook, NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 0-- e-ac,Q J DATE: d - Z Z02 PERMIT# _O�V LT o ISSUED: &Ly-ZrSECT: jjr-(o(,o BLOCK:_ LOT: Cr LOCATION: (L �i y 1/ 7/rd G� OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ,ErINSULATION ❑ Natural Gas S c--rl /^J.%q, ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER i o E C .� O C T 2 4 2025 U VILLAGE OF RYE BROOK The Home Insulators, INC BUILDING DEPARTMENT The 276 Joes Hill Rd Brewster, NY 10509 www.TheHomelnsulators.Com Ho e Estimatesaa.thehomeinsulators.corn INSULATORS 914-272-8915 THE HOME INSULATORS, INC Installed Insulation at 8 Beacon Ln, Rye Brook, NY JOB DETAIL: 2x6 EXTERIOR WALLS: 5.5" OPEN CELL SPRAY FOAM R-21 2x4 EXTERIOR WALLS: 3" CLOSED CELL SPRAY FOAM R-21 NOT SHEETROCKED ROOF RAFTERS: 12.5" OPEN CELL SPRAY FOAM R-49 2x6 SLOPED ROOF RAFTERS: 5" CLOSED CELL SPRAY FOAM R-35 2x8 SLOPED ROOF RAFTERS: 7" CLOSED CELL SPRAY FOAM R-49 LOW EXPANSION FOAM ON ALL WINDOWS & DOORS THERMAL BARRIER PAINT ON ALL EXPOSED FOAM IN ATTIC AREA INSTALLER: Patrick Harter MATERIAL: THERMOSEAL 500; SWD QUIK SHIELD YETI; IFTI DC-315 Date: August 21st,2025 Certificate of Installed R Values Big Tows Inc 8 Beacon Ln, Rye Brook, NY 10573 OCT 2 4 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Insulation is applied to the following areas: Application R-Value Closed and open cell spray foam to 2012 sq.ft. of R-53 concrete floor. Note: Applied 6 inches open cell spray foam to 2012 sqft on top of 4 inches closed cell foam.. Closed cell foam VPC- HFO High Lift R=7.43 inch Open cell foam VPC-50 NM is R=3.75 per inch Sam Joseph President Joseph(Aug 22,2025 11:36:13 EDT) Signature: Energy Evolution Inc. 6 Harriet Ln Spring Valley NY 10977 845-262-6313 440 POB 179 Pomona, NY 10970 EnergyEvolution Office:845-262-6313 Fax:845-224-3969 Big Tows Inc - Certificate of R Values Final Audit Report 2025-08-22 Created: 2025-08-22 By Energy Evolution Office(energyevolutionoffice@gmail.com) Status: Signed Transaction ID: CBJCHBCAABAABQQ8hUX-5lnQpNoRuzpbQ5E8AdKdgJiw "Big Tows Inc - Certificate of R Values" History Document created by Energy Evolution Office (energyevolutionoffice@gmail.com) 2025-08-22-3:29:20 PM GMT C, Document emailed to Sam Joseph (sam.energyevolution@gmail.com)for signature 2025-08-22-3:29:24 PM GMT Email viewed by Sam Joseph (sam.energyevolution@gmail.com) 2025-08-22-3:35:15 PM GMT &o Document e-signed by Sam Joseph (sam.energyevolution@gmail.com) Signature Date:2025-08-22-3:36:13 PM GMT-Time Source:server Agreement completed. 2025-08-22-3:36:13 PM GMT Q Adobe Acrobat Sign �yE BRC�� w � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR �SISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 7 Q��;QJ t�1� DATE: 1 O ZOZr P E R M I T# Z ci0 ISSUED: b-Zy ZS'SECI:-J& G• C•BLOCK: ( LOT: (015- LOCATION: MACH( &-L •up OCCUPANCY: ❑ Violation Noted THE WORK IS... 6? PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ �OUGH PLUMBING ROUGH FRAMING ❑ INSULATION ❑ Natural Gas M 6 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER /V e iPt ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL NO v ❑ OTHER Q0C BR 0 y� W � �� �O �� '9�2 � BUILDING DEPARTMENT ❑BBuILDING INSPECTOR [J ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook, NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- W , ,A V'� __ --- DATE: 10 I Ll Z OZS_ PERMIT# T._Z.. " J O `. ISSUED: SECT:_L?6- 4f BLOCK: i LOT: (AS— LOCATION: "ts"- 4-1-0 OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED D FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: .ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas �' U ZL WAS ¢ ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER � C�' MAA4 ry An . cza l 1 � Nee C-JrAIJ • E BK( O tim w � '98? �VAs BUILDIDEPARTMENT ILDING INSPEIA-okSISTWu BUILDING INSPECIOR VILLAGE OF RYE BROOK ❑CODE,I:NFORCEMI:NT OFFICER 938 King Street • Rye Brook, NY 10573 (914)939-0668 FAX (914) 939-5801 ww WW sy-v Ib ru.qL0 rg - - INSPECTION REPORT - - - - - - - - - - - - - - - - ADDRESS : 3e�,CO3_1 fz�� DA',',.:.._10 - I - t o t S PERM IT# 1 ` 2 ,- )o ISSU1:1): _._ SECT: 13�y V(�BLOCK:_...._._._� LOT: Ur LOCATION: N\0, 8- ,, (�►, 0�a /p J _,_____ _ ____._ OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED id TAILED / REINSPECTION ❑ SITE INSPIiCTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTIS ON INSPECTION: 2"11000H PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural C;EIs ?p �Lad-%L;a ❑ I,.I> Gas � (�►E,��,. � � � l� - a. ❑ 1�U E L TA N K Iv�1 �P�S/�.._ .� ❑ FIRE.SPRINK1,1: 4 , L_LJ �w ❑ FINAL PLUMBING ❑ CROSS C:ONN1:(TION ❑ FINAL ❑ 01'11ER e_o, ^j&%- eA. —_ �yE DRC�k '9a2 BUILDING DEPARTMENT ❑�BUUILDING INSPECTOR p ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook, NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : s �QC.O�) L,`!'P DATE: 7' I8 "ZO'LS PERMIT# "f 1 �,.�� I I ISSUED: _SECT: /S.5 BLOCK:_ LOT: ,Sr LOCATION: `�}(�_���_ jZQ�,C . OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED AILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas r+ny,gypp /t�J c Q /) S 1. ❑ L.P.Gas S70 Ick -1 W nM1I� ❑ FUEL TANK ❑ FIRE SPRINKLER a I-J" ❑ FINAL PLUMBING ❑ CROSS CONNECTION /-jS L fJ✓ ❑ FINAL ❑ OTHER Syr QR(��• cu � BUILDING DEPARTMENT ❑BUILDING INSPECTOR f3TSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914)939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: V -6ccLG.Oj -- - �...-- -- DATE: 1- Is - ZOZs-- PERMIT# W T 1 440 _ _ ISSUEDi-Z7-tSSECT: 13r BLOCK: LOT: t.S LOCATION: =zj 1!` N'0 • OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED IS t'AILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a N O d Ln N \ W CV n p 4-4 0-4 E. s O Ln 19 Oz j rq �4 `D O a W 1 z 00 M w � ao 01 O .-4 v ° o _ a �..� � F� � � G4 N O ti LrJ � � � � '� ►-� . oo p rpi ° w q w W w O LC) 0 0-4 O OZ W A z O z O b w v _ F' .. ° �con , za ICI c� a, ►-+ W .It killo 't Q ,w V _ 1-4 ►-� �+ r' � � �-� A � O � � � � �° � `� o can 00 W A s � az � vL°IC � o z Q z o a a b L= p p ° q � v x � 0-4 � a o � _ W W Off' � � .� _ �� 11 00 A 0-4 PLOW ✓ xm � b a BUI ;Q' a MENT VILOOK 938 KiN. ,NY 10573 MAY 2 9 2025V VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:Approval Date: JUN rt i _7c J application Fee:$��,0 Approval Signature: Permit Fees:$4 Cad Q Disapproved: Other: **x�xxx,.,:xYxxxxxxx\xxCxxxxM�uxx**,�* Application dated:�—CJ /'0 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an existing building,or for LA change in use,as per detailed statement described below. / J / 1. Job Address: wn LA -+ ,S'�BL: /3- J 64%MCP�� Zone: 2. Proposed Improvement.(Describe in detail}: ry (1(l iatti Vdl 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER[1: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system (Fire Sprinkler,ANSL System, FM-200 System,Type I Hood,etc...) :No: Yes: please submit a separate Automatic Fire Suppression System Permit application R 2 sets or detailed engineered plans)( 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: fam After Construction: 1 74 A 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: Dylap, or Address: 0 Lnr Phone# A. ©l D Cell # 4 email: 8. Applicant: .�06Pi /1, ba f a}C& S Address: S ra A N Phone# JI, `4�8 _M i` Cell# email: basa`k% J a5C (@gnat,C,0/'1 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: II. General Contractor: 13; dia5 Address: Phone# 14 "Q 3q -��'$� Celt# email: I e440'C 60r ('0 M 12. Estimated cost of construction $ 60,000 (NO 1'1::The estimated cost shall include all labor.material.scaffolding,fixed equipment,professional tees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (l) 6/1/2024 E. � Vf MAY 2 9 2025 VIL F RYE BROOK BUILDING DEPARTMENT— BUIL MENT VIL E OF.IR OOK 938 KING ET RYF tR ,NV 10573 -c �� ov rr+air+arrrarat►tNafaa++►aa►fala►aafaar+i+a+air+trial++a rarraaaraaaf+arf+ai►faarfifNariaarrrrrrrrNa♦ AFFIDAVIT OF COMPLIANCE VILLAGF, CODE 521 fi+STORM SEWERS AND SANITARY SFWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE DF THE LEGAL PROPERTY OWNER AND BE sunBaTTED ALONG WITH ANY BUILDING OR PLUMING PERMT APPLICATION. ANY BUILDING OR PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RET TRNED TO THE APPLICANT. STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: 1. Wqn r 1IAr residing at, 4? 19 J-41 (�Vt' st-odg) rinl=no IAddns°,°1w.rrt°ou li,.i being duly sword,deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; �j�Af pn Ln ,Rye Brook,NY. (!oh Addrw) Further that all statements contained herein are true,and that to the best of hislher knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains,sump pumps,or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State. County and Village Codes. 4�" icr ur:of Pn,pert� „ncr(ill (Prim M�,:of Pn,pcny ancr(%)) 27�� Sworn to before me this r�� day of a ��2 JDFRYMALALVAREZ GUERRERO NOTARY PUBLIC STATE OF NEW JERSEY ID#Nl 17272 MY COMMISSION WRHI NON .l "hi `,wµttvlr'`,r MAY 2 9 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This form must be properly completed¬arized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type,Pre-Engineered'Wood, or Timber Frame Construction.(Title 19 Part t264&1265 NYCRR) To:The Building Inspector of the Village of Rye Brook, SuNectProp M: n SBL: Zone: Please take notice that the subject;}(One or Two Family;o Commercial, o New Structure ❑Addition to an Existing Structure )(Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑Truss Type Construction(TT) ct Pre-Engineered Wood Construction(PW) ATimber Construction(TC) in the following location(%); ,Lt'Floor Framing,including Girders&Beams(F) a Roof Framing(R) ❑Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type,pre-engineered wood,or timber construction must be posted with a Truss Identification Sign,installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§12.65 for One&Two Family Dwellings. Sv om to f rc me this swore+to b f me this darof A ?p day ZNo Owner S' of fessimal purer Print Nuns of Design fessional • Notary Public 90 LALVAMGUERRERO `'N07ARYPUBLIC r31 STATE OF NEW JERSEY ID Mi17272 MY MMMWION E7(PIRES NOV.22,2129 This application must be properly completed in Its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property,and the applicant of record in the spaces provided.Any application not properly completed In its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE Of Et� v�YORK, OUNTY OF WESTCHESTER ) as: _ 'U AVOW m(W-5 _being duly sworn,deposes and states that he/she is the applicant above named, fPI;t aarrtc of WWI"Swung a dW v'-) and further states that (s}�te is the legal owner of the property to which this application pertains, or that (s)he is the L 5S1144 {f I for the legal owner ark is duly authorized to make and file this application. (mdicYc-+dea cmh-ar,xWeK*Wnw).ere.) That all statements contained herein arc true to the best of hislher knowledge and belief,and that any work performed,of use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By slgning this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains.sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to fors me this " fy Sworn to before me this 7--7'h day or a ,20 25 day f � )0 2.5 Siansum of NWMy nWVW5i ofA ]L, IQn �tvr -so flT0 tl a's PMN orProperty ��Nmnc of A,ypU navy Public �� JOFRYMALAL.VAREZ GUERRERO JOFRYMALALVAREZ GUERRERO NOTARY PUBLIC NOTARY PUBLIC STATE OF NEW JERSEY STATE OF NEW JERSEY ID 060111272 ID#50117272 Wy 0o iwlN 1MR11 NOY,m M My COMMISS10N a(ARES NOV.2Z 2M cn . . dtna:♦ 110 �2 1 N f Q ( x 0-4 f W oo Q �" R-, ., W w U z00 � � A . v t0c� - 00 f. 5 _ .. f � w �. w W a3 w w N L Ecf. .-� z z �" 5 C.O') r., V z x 7 ^ � � Q � W cv�.•. .�.,7 W � a JD MAY 2 9 2025 t VILLAGE OF RYE BROOK BUILDING DEPARTMENT �-DR C�v BULL s:.. I3y MENT l� VtL iPkR`(t'E K 938 KIN t'RYE13 NY 10573 %V nV,'QF ELECTRICAL PERMIT APPLICATION \Vestchester County Master Electricians License Required FOR OFFICE USE.t);��Jury1(�' 2�_2ji �. f;p q; � �t✓(l Approval Date. Permit Fee:S Approval Signature: Other: sr•rrrrt►►•►ry r►...-........ t 111t111t _tttf ............►►......►►►►..►.. HNp►p1•►••.► DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED By THE BUILDING INSPECTOR. THE ADMINISTRATIVE FFE FOR WORK PROGRESSFD OR COMPI ETED WITHOUT A PERMIT IS M OFTHE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750 00 Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document,the applicant&property owner agree that all electrical work performed will in conformance with all applicable Federal,State,County and Local Codes. /.' i _ 1.Address: &,,o l Ln QSBL: S1 l0� I Zpone: �`/ Z.Property Owwnrelr: /1 10 _Address: O GQ( n Law VPr/ B W Phone k: (1 75'qZU—0q Uh Cell u: email: �j I 3.Master Electrician/Licensedlnstaller: F'fQnUS('J fQ.�4S Address: 27 WA1,),4 NU eb Lic.M: 116$ Phone A: 14, - ell a: email: Info QL tL f1�0/ LOML�N Company Name:_ R C7 151 t G fl(' � Address: DIFm n o I &,/ afk4k try 4.Proposed Electrical Work/Fixture Count: oov VAf; oVQ id" 5.3°Party Electrical Inspection Agency: rrrsrrrrrrrrr+rrrrrsrrrrrrrrrrrrrrrrwstirrarrrarrrrrr:r••r••..•....r••r.a•.......*..................... STATE OF N YORK,COUNTY OF WESTCHESTER )as: Frae)aSCQ MkS �duly savor I deposes and states that he/she is the applicant above named,and does further (priman nr of individual sr^1^^ t state that(s)h,is the Mn16,r L jt,4MQ;TA for the legal owner and is duly authorized to make cord file this application. (N TrMrwan/Licenscd[Willa) The undersigned further states that all statements contained herein ate true to the best of hisher knoss ledge and belief.and that any work pufonne&or use conducted at the above captioned property w ill be in eonforataneo with the dvwils as set forth and contained in this application and in any accompanying approved plans and specifications.as well as in accordance Kith the New York State Uniform Fire Pre%cntion S Building Code,the Code of the V illuge of Rye Brook and all other applicable laws,ordinances,and mplalions. Sworn to before me this 27 il' Sworn toAcfore me this 274h �f 20 day 20 '4b Si ture of o Owner Signature of Appltcart �Q� iioC JOFRYMALALVAREZGIkfRERO Fr .1 . . gL'ta0S NOTARY PUBLIC Prim Name of Ap t V Print a e' f (hmer STATE Of NEW JERSEY ID M117272 COMMISSION E(PIRU NOV,22 3= Pos _ slno2s STATE WIDE INSPECTION SERVICES, INC. Service It ith Ittlegrit). 080 • • SWIS . : APPLICATION tel ^ 914.219.1062 1 SWISNYcomj SWISTRAINING.COM Office Use Elect. Permit u / /�, Date Bidg Permit a -��� — / �J Scl Ft Plumbing Permit rr Final Certificate u City/Village Boo Ic Zip i 05 737B.dding Dept. County wl� Gt L er Address �R Lis Cross Street Section Block Lot Owner Name/Address i If different than above) Q n t Contact Number 0 l� rj 41,7Z oqjW 1 ❑Basement ❑1st FI. ❑2nd FL ❑3rd FI. ❑More Than 3 FL ❑Garage ❑Attic ❑Outside Iff Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/Q Detector Hood Trash Compact Z O 6 Amt Amps `Q 18 8 7y`Tl/1 1 Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Swttch SERVICE Amperage ArPanels iP 3P z Meters u Disconnect ❑Underground ❑ New ❑ Reconnect ❑Repair Overhead ❑ Upgrade ❑ Disconnect Utility IDx []Con Ed ❑NYSEG ❑Central Hudson ❑Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center I PV Monitor Energy Storage System DC Disconnect 11 Legalization ❑ Safety Inspection ❑Consultation Scope of Work Ud fan J MAY 2 9 2025 ; VILLAGE OF RYE BROOK BUILDING DEPARTMENT . I his application is valid for one I year from the date received by SWIS this application is intended to cover the above listed items to be inspected,H at any time of inspection additional items have been installed.you are authorized to make the inspection and adjust the fee for the additional items mspected.I he applicant deciders that there is no open applikations for the above address with any other inspection c ompany The applicant.owner or authorveo agent agrees to all the above terms and condrtions as set forth for th[e'applicanon. Email Address t n t L rl Name Frrj/)(, s(j,, �Gl GJ License a 15 61, Date Siglnatur Address ZN I 6 City/State I1 o el1j) NY I Zip Code I O$ I Company Y t/ C It �,t� Phone +t - 3b -D� Gt U (1 KE � State Wide Inspection Services LJJ 1080 Main Street Fishkill, NY 12524 a A 845 Phone 914-2194-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com VILLAGE OF RYE BROOK Website: www.swisny.com Service With Integrity BUILDING DEPARTMENT BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: JBG Electric Corp Dylan Fijor 24 Walnut Street 8 Beacon Lane New Rochelle, NY 10801 Rye Brook, NY 10573 Located at:8 Beacon Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-161 135.66 1 65 Certificate Number: 2025-9021 Building Permit Number: BP25-140 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 8 Beacon Lane, Rye Brook, NY 10573 The Kitchen, Master Bathroom and Bedroom were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 22"d day of December 2025. Name Quantity Rating Circuit Type Receptacles 26 GFCI 08 AFCI 10 Switches 18 Smoke Detectors 08 Visual Inspection Only; Not Tested BY SWIS C/O Smoke Detectors 08 Visual Inspection Only; Not Tested BY SWIS Hood 01 Oven 01 Dishwasher 01 Refrigerator 01 Disposal 01 Microwave 01 Luminaires 35 Officer: Frank J. Farina This oertificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. rl N N W N \ W O "' Z ^M � �-■r �i C � w $ f x 6P 1 W U _ C r M c� r z � � ` w ►...� � � Z � Q * a w � z as 00 z of w Ln o � w N c c Q` U 't w a z w �" � F o F" c 4 �+„� • . w ■ s a BUILDI DE TMENT VI EOFRYE K [ECIE0 V E 938 Klm;* 1:1 RYk BKMNY 10573 f91�31 � JUN 10 2025 VILLAGE OF RYE BROOK PL I !N(; PERMIT APPI. CATIO, ' BUILDING DEPARTMENT FOR OFFICE I SE ON I fill Approval Date: Permit Fee: S Approval Sigutrre: Disappmed: 41M a.v gas-w ed"k) IX) t tiHLA YFKtIIT NA% BE0 POO Flo N1 IM BUILDIN', 1"��I'�-;CTOIL TlIl:AD1NINI�T ATIY . 1`14 FOR WORK 1'K/N:KitiSll►t►Kt�t►h11'l 11 IF 1)M'1111t►ltT +� f'F RIMIT 1S 12% OF TNI TOTAL(-(Ysl t►F CtN1sTTiUCTH)N WIT" A MI*41MI M FFF OF$'.t►tltt A ,ticatnm dat�1l, — C7 � p1 _ it huelry, mrde k,ttir liurhlms Ing ccla of the Viilape or Ryc Hri * NY. fa the iasnancc W' a PCImit tt,in tall andr'c>r mumve Ptmbk*a.per&Uikd%taaomal drwnhed hdirw. The appliew a pnTcrty aww.by siattiltg this & umcm aRrcc tlwt widQp�luumhing work will l.c in amFamamc with all aMlicable I;vdcmL%tale,Unmt, and Lncd Cotles. 1 Ad�eas T121ACL'A�► L ♦RI j3S'i4�0:�—�,.� _ /onc. �o 3.propcny(►wr p Y Ml,keaa; Phane N: Cell•: cavil: 4 Mastcr Plannhcr. /td�c L ic. r: lfinnc«: e}1'I . 4. 02����cxa a' _ _ctwil: ft Gmeplury gat,►e: t�l1i P-- --. VNI&LATE. FIXTURLS a LL 1M TO K INSTALLED A% MA THE FOL. A)V1ING SCHFD(AL& larm1%Q VI ma urinal. Waking Sills Slum s Ili lAund, 1knootr/ie Fire Srilan Na/issL UTher• T�1 ( I�+eb I aarairn l min T Ube den we sm . (P c1•. t J4 Fum 4 F'laix fluor Exlcricti S.• List()Ihct I-Apripcncnt'Pn,vi lle Details: (Notarised ligtsat eras RequLred Mast 2 Pages) . 1r tl200s BUILD XRTMENT 1 OF KY OOK 938 Kttic RV&Bit NY 10373 JUN 10 2025 �.-. VILLAGE OF RYE BROOK BUILDING DEPARTMENT •iiiilNiiiiNiH����.•������..������.•��ifiiNNfiNii••�..•�..•��iN����iM�NiiN��iM��iii�fMii�i• AFFIDAVIT OF COMPLIANCE V11 LAW: CODr. 4216 • STORM SEWTRS ANQ SANITARY SE W1:RS TNT$ AFTIDAVr? NufT &A" TM WYT"11= 111G><AMM Of Taa LaGAL ~MART 0"WX AM tl sysrrlTTLD AL AWO Qtlf! WT avt u>1 ra. OA PLLXO 1 Mt K wit T APPLICATION. ANIi Out LD t AM Cw ►Law r oa Vale"? Arnic xicip WftaT WITWOUT TNT$ CQKPLBTW AMID OUTARI99D e06W WILL as PSIM= To sa "TLIC"" . STATE OF NEW YOM COUNTY OF WESTC 14ES TE R ) as. bila h filvAl , a, beacon ti __. (Pfw 0=41 (wYn...t m)sm Inc1 being duly aw m deposes and states that(s)hc is the applicant above nanvdL and further states that(s)iw is the legal o%ner of the prvpCrty to%hich this Affidavit of Compliancae pertains at; b &aLon Ln . Rye Brook, NY. F wthcr that all staterltents ootntsined hCMin are Mx.and that to the best of hiAw knowkdgr and beitiet.that there aze no known iikaal crass-connections concerning either the storm w%%vf or sanitary kaer,and feather that there are no roof drains, sump pu: M or other prohibited stoernwater or groundwater connections or sources of inflow or irLf tn6m of any kind into the unitary sewer from the subject property in accordance with all Stue. County and Village Codes DU14A F4j0(_ owd%any T4M(JIA 06)) ----- Sworn to before me this day of ( JOFRYWL ALVAFMZ GUMW4 `'' ,. •'.' �"� NOTARY PUBLLC STATE OF WW BEY hwe'ANMI1.000cn caws++ kwl ?PvNc&x 1&M=MMg~10=c 2 Ili 79 lZi WWk0Q N OMM An A3i1W M3N 40 31V18 owakw Z3mlv jur3ilddw Ni of poum3a xl III/^ puv pto,% put llnu Nwi* N I"p Ms Ap.*4wd Iou io•puu .tiNntu.) sli ut p»>ldwn ,{js;dad IOU wonvollWV paPAQW Lands Ap ui puo--Qj jo ymolildde ay► lwr '(Na"go(gns iyl io (s�m,%o Ie3:11 ayl ►o(s)# !sp ou xp apnl xn> >tnw pue Aw► s>> ui pot>ydhuoo rdo q.r"'�i>,; ��1` • ��.-!+ = ` 3`Jsdaylo'1 s�aH/NH I W ld& lwwo 9ZbZ AaW scm&3 uOlss u!Pay!lua Ounoo jai 'ON uO}egs 086L6Z9V10 71?101 M3 ' d Jl sr� 111 i���� assrMQ yw p�jwNC 1�1y =K !o UP )8 x.o 14 1 moo ow sw 443q a wa..S 014 Iw isww""'a""q"Oh P Pw V"047A P 014MA aV)o VO.J-04 )M IOMr^A $uotIua:wd aRJ M"Mf1"+S 40A 4JW Pan vMd px%s h ftM=6a3,3•Am u Fan ue'I""*wap w pwwrquK+x pus I"w w smom IMP WA UMMM)60 w*q III w (uidcud PXW4 "&t"sqt 1•pounpaoo M m p04Ju0#JJd]Po« 4u I"Pw I"Pw 810404"AJ%94410 3" PV of rw a» A xsay p -a uu xui-wu IM wll ` MMO&ry alli Dw a#al Msowom Am i Po im"Idal '40 10)old uu*W up a omits)Iq1 I"y pw so- oft p.ry.qm as0"f KnMtdch Op s, aW*V pr%p g3m PM os a 'wows.({nF tulaq. "' -3,L, � a { >l:115�11.71S81M!O 1'la[11 .3.N-40 V.,—.- • �i����r�l�p��i�r�p� 'I�ipw��i�i �'ii'�i����ii�'��tr�nia�w���ia�i � �l��` �I s. = a, ' a u, � � eq O O a 1INV ■ kn 09 t N \ \ o < W a GNP (Ax C ►• u ' z U VJ O �7 a a: w Ln ►� oW, � W �-+ z a t ►� � e `" v H a0z ^ wen oo Q O W G w° U a z O � v o z � Z ' z V Cr) W C., C� C� N u �, 'A V ' ►� � � z Q � .� � � o w � � � Ln � . o ~ 00 �• ° zz U W w Ln o � N z V Q w w W a U o o 66 x t z BUIL 13Rr1v� MENT v VIL E OF RYE OK OCT 15 2025 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK Y.gov BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: a O PP#: r2s_AJ2 I Approval Date: �CT 16 Z 25 Permit Fee: $ a�D � Approval Signature: Disapproved: (fees are non-refundable) ************************************************************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, /.i-•/,; 1 S is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will/be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: B o. L.4 � SBL: / �• ��Zone: 2.Proposed Work: �;.d C. IL/,p rik 3.Property Owner: !�/� ( Address: Phone#: ell#: email: 4.Master Plumber," ,A t & Address: y� Lic.#: Phone#:e;�4 f Z-1y' Cell#: email: Company Name:- , 6�,1� 2�Lo Address: 21-D j'� "bi��✓ I! Cam' //te�� rr �����GGjj�� INDIC TE FIXTURES&LINES TO BE INSTALLED AS PER T1ia6 I;OWII&SCHEDU1L Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 3"Floor 4i°Floor 5'Floor Q 177 F,Yi4rtu? 5.*List Other Equipment/Provide Details: /ty, e-- .v � f- j!& / zrx 6,# s L,� r oT S't•J v /sue o f (Notarized Signatures Required Next 2 Pages) -I- 6/1/2024 STATE OF N15W YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Z Sworn to before me this ) 3 Ll-�- day of ,20 day of 20�r Signatu o roperty Owner Signatur of Applicant IVLP ��N FIWIL Print Name of Property Owner Print Name of Applicant LUDWINA TORRES Notary Puhl c-State of New York ar .G Notary Public No. 01TO0016082 Yotary Public Notary Pub'e,S to of New York `�unilfied in Westchester County NO.O A6182422 Commission Expires Nov. 11,2027 Qualified in Westchester County My Commission Expires Feb.25,20 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/1/2024 BUILDIY fR MENT D E CC IE M VIL�' E OF RY OOK 938 KING ET RYE' BR ' ,NY 10573 OCT 15 2025 ov VILLAGE OF ;?YE BROOK BUILDING 1, r�ARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE �216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: i 31, l ,� �� , residing at, (Print name) V ( s where you live) being d y sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 0/, I i � v �4 /V3 , Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signawrc o r rmr , vNncrm) bgt-o J FIz00. (Print Name of Property Owner(s)) Sworn to before me this LUDWINA TORRES day of O cow , 20 _ Notary Public•State of New York No.01 T00016082 Oualified in Westchester County F)�k7N/- My Cornrriiion Expires Nov. 11,2027 (Notary lic) -3- 6/1/2024 , N \ Ln c CL Ln �, f 3: p �O '� �3 x 7 O t� Lf) ow w 7 77S O O "} O " W c � z044% (� A cn c', oc Now N n ' v ��b � ` 00 (� Z A o Q QC-Q x i [ L x - 2 [ T L z x x S L 2 ■ Ef L L L g- �tiI BUILD MENT VIL E OF RY OOK R E C E 0 n n 938 KING ET RYE BR T ,NY 10573 `J a , 0V OCT 15 2025 VILLAGE OF,,pyL BROOK APPLICATION FOR PERMIT TO INSTALL IREMOVE�RTM i ENT HEATING,VENTILATION AND/OR AIR CONDITIONING EQUIM PE FOR OFFICE USE ONLY- PERMIT #: fi?A�5—t 15 Approval Date: Permit Fee: $ q66 Approval Signature: Other: Disapproved: (fees Lire non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 REOUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Contractor's Westchester County Home Improvement License,Liability Insurance. (Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form (Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL =$200.00/unit• COMMERCIAL =$450.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation.(48 hour notice required) 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, 10 J! t� is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. j �y 1. Address: t-L Dl po", SBL: —/--&JZone: v 2. Property Owner: (��[�qp? r t �. Address: Phone#: 1� S~ ,?_ Cell#: /email: 3. Contractor: y 4: f- ar"ye, p/i _&Wzn /A,�- Address: (a5 r��CAZ*zc e- NY Phone#: �!bS 3 ?-0 Cell#: email: 4. Scope of Work:New Installation•Replacement( )•Removal( )•Other( ): 5. List Equipment: (M_&/kA,-7 C D/-G°t-, 12 ),I U H. h Ff1Z1P1i C 6. Location of Equipment: -1d Q� ANI k6& 7. Method Of Installation/Removal(list all equipment needed to perform job): ns?�.� /l✓�-ryy6,� An 6 VC-7.f-i t 7/l/2025 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me Ihis i y day of 120 day of V� �j ,20 o++J Signature of Property Owner Signature o Applicant y0%ki D AG /01 ly S Print Name of Property Owner %awme of Applicant Notary Public No Pt9►liigfil MEULW Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20 Z-I This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 ail i2o2s GLXS38 Air Conditioning&Heating ENERGY-EFFICIENT CLASSIC R-32 SPLIT SYSTEM AIR CONDITIONER UP To 15 SEER2 1% To 5 TONS Contents Nomenclature........................................2 Product Specifications...........................3 Expanded Cooling Data.........................4 Performance Data...............................18 Dimensions..........................................20 Wiring Diagrams .................................21 Accessories..........................................23 032 Standard Features Cabinet Features • Energy-efficient compressor • Removable grille-style top design • Fully charged for 15'of tubing length compliant with UL 60335-2-40 • Copper tube/enhanced aluminum • Venturi for increased velocity of airflow fin coil-5mm diameter • Attractive Architectural Gray powder-paint • Factory-installed filter drier finish with 500-hour salt-spray approval • Sweat connection service valves • Wire fan discharge grille with easy access to gauge ports • Steel louver coil guard • Enclosed contactor • Top and side maintenance access • High-pressure switch • Single-panel access to controls with space • Ground lug connection provided for field-installed accessories • Capacitors with extended life • When properly anchored,meets the 2023 Florida • AHRI Certified Building Code unit integrity requirements for • ETL Listed hurricane-type winds(Anchor bracket kits available.) 10 PARTS a ® oo�•varr•atH rwrw•Y wanr LIMITED c ua ° t1�� •�•Y•t� cerr•ato avows c�tr�ngwa , YEAR wu•ANTY _���• •p++�• Intertek � Complete wa rants deta,ls tnn you-oval dealer o, www goodmanmtg.com.To recewe BBB the lbvear parts Limited Warrantv,orvne reestratvxr must be completed vnth,n 60 days c• installation.online registranon is not required in California or Qufbec.TThe dwa coverage in Texas and Florida differs in some cases. SS-GLXS4B-R32 www.goodmanmfg.com 07/24 NOMENCLATURE G L X S 3 B N 36 1 0 A A i 1 2 3 4 5 6 7 8,9 10 11 12 13 MINOR REV BRAND A G-Goodman'Brand MAJOR REVISION TYPE A L R-32 Splits System Variation Our000R TYPE Electrical X Condenser 1 208/230 V,1 Phase,60 Hz Z Heat Pump NOMINAL CAPACITY COMPRESSOR TYPE 18-1%Tons 42-3X Tons S Single-Stage 24-2 Tons 48-4 Tons T Two-Stage 30-2 Tons 60-5 Tons 36-3Tons EFFICIENCY(SEER2)NOMINAL 13.4-13.7=3 16.0-16.9=6 REGION 13.8-14.5=4 17.0-17.9=7 N North 14.6-15.9=5 18.0-18.9=8 S Southeast&North 19.0+=9 A All Regions FEATunE/APPIICATION B-Standard M-Multi-Family C-Communicating(Top Flow) 2 www.goodmanmfg.com SS-G LXS3 B-R32 PRODUCT SPECIFICATIONS 181 r• .. r r• r• r• O• r r• --L COOLING CAPACITY Nominal Cooling(BTU/h) 18,000 24,DCO 30,OCO 36,OCO 42,000 48,OCO 60,0CC Decibels(dBA) 73.0 74.0 74.0 69.0 73.0 71.0 74.0 COMPRESSOR RLA 8.2 8.2 11.2 13.4 14.4 19.4 23.9 LRA 41.2 41.2 52.5 83.3 112.2 127.7 148.0 Stage Single Single Single Single Single Single Single Type Rotary Rotary Rotary Scroll Scroll Scroll Scroll CONDENSER FAN MOTOR Motor Type PSC PSC PSC PSC PSC PSC PSC Horsepower(RPM) 1/8 1/8 1/8 1/8 1/4 1/4 1/4 FLA 0.70 0.70 0.70 0.7C i.4 1.4 1.3 REFRIGERATION SYSTEM Refrigerant Line Size' Liquid Line Size("O.D.) W. W, %" /." /." W, Suction Line Size("O.D.) W, /." '/." Y. 1Y." 1Y." 1X" Refrigerant Connection Size Liquid Valve Size("O.D.) X" W, X" Y., Suction Valve Size("O.D.) X" X" W. Valve Connection Type Sweat Sweat Sweat Sweat Sweat Sweat Sweat Refrigerant Charge 53 53 60 60 74 84 91 EIECTBIGt DATA Voltage-Phase 208/230-1 208/230-1 208/230-1 208/230-1 208/230-1 208/230-1 208/230-1 Minimum Circuit Ampacity' 10.9 10.9 14.7 17.5 19.4 25.6 31.1 Max.Overcurrent Protection 15.0 15.0 25.0 30.0 30.0 40.0 50.0 Min/Max Volts 197/253 197/253 197/253 197/253 197/253 197/253 197/253 Ele-cal Conduit Size X"or%" %"or%" X"or X" '/:"or W X"or W Yi"or Y." W'or%" E4uIPMENT WEIGHT(LBS) 114 114 134 136 180 188 229 SHIP WEIGHT(LBS) 129 129 149 151 195 203 244 Line sizes denoted for 25'line sets,tested and rated in accordance with AHRI Standard 210/240.For other line set lengths or sizes,refer to the Installation Instructions and/or the Long Lane Set Applications guide. ' Any suction line adapter will need to be supplied by the field. Unit is factory charged with refrigerant for 15'of%"liquid line.System charge must be adjusted per the Final Charge Adjustment procedure found in the Installation Instructions. • Wire sae should be determ,ned in accordance with National Electrical Codes;extensive wire runs will require larger wire sizes ' Must use time-delay fuses or HACR-type circu2 breakers of the same size as noted. NOBS •Always check the S&R plate for electrical data on the unit being installed. SS-GLXS3B-R32 www.goodmanmfg.com 3 DM%VC / DC%VC Heating Input: 45,000-113,000 BTU/h TWO-STAGE ■ Standard Features VARIABLE SPEED GAS FURNACE • ComfortNet"Communicating Systems compatible UP TO 96% AFUE • Stainless-steel dual-diameter, tubular heat exchanger • Stainless-steel secondary heat exchanger • Two-stage gas valve provides quiet, economical heating ■ Contents • Durable Silicon Nitride igniter Nomenclature...............................2 • Quiet two-speed draft inducer Product Specifications..................3 • Utilizes ComfortNet'4 communicating,two-stage Dimensions..................................4 or single-stage thermostats Airflow Data................................ • Self-diagnostic control board with constant memory fault code history output to a dual 7-segment display Wiring Diagram...........................11 • Color-coded low-voltage terminals with provisions Accessories................................12 for electronic air cleaner and humidifier Thermostats...............................12 • Efficient and quiet variable-speed airflow system gently ramps up or down according to heating or cooling demand • Multiple continuous fan speed options offer # � quiet air circulation r' • Auto-Comfort and enhanced dehumidification modes available • All models comply with California Low NOx emissions standards ■ Cabinet Features i • Designed for multi-position installation— �) DM96VC: upflow, horizontal left or right DC96VC: downflow, horizontal left or right • Certified for direct vent (2-pipe) or non-direct vent(1-pipe) • Easy to install top venting with optional side venting 0 • Convenient left or right connection for gas and electrical service • Cabinet air leakage(QLeaF)s 2% • Heavy-gauge steel cabinet with durable baked-enamel finish • Fully insulated heat exchanger and blower section • Airtight solid bottom or side-return with easy-cut tabs for effortless removal in bottom air-inlet applications - Now rrailur local dealer or at www.d Lncomfort.com To rece-ve the Lifetime Heat Exchanger Lmited Warranty (good for as long as you own your homel, the 12 YearLimited UnitWarranty. Replacement Limited Warranty and the co 1etyear Parts _ (00 Limited Warran online ty. reg�stranon must he completed wghin 60 days of installation.Additional requirements for annual maintenance are ,� required for the Unit Replacement Limited Warranty. Online registration and some of the additional requirements are not required,n California or Quebec SS-DM96VC www.daikincomfort.com 9 13 PRODUCT SPECIFICATIONS NOMENCLATURE D M 96 V C 045 3 B x A A 1 2 314 S 6 7,8,9 10 11 12 13 14 Brow Minor Revision D Daikln A hnnal Release 0 1s1 Revision M-Upflow/Horizontal Major Revision C-Downflow/Horizontal A Initial Release K-Dedicated Upflow, B-1st Revision D-Dedicated Downflow Nox AFUE N-Natural Gas 97-97%AFUE x Low NO. 80-80%AFUE Cabinet Width Gas Valve A-14" C 2 r M Modulating B-17h" D 24h" V-2 Stage H Convertible 2 Stage S Single Stage Maximum CFM 3 1200CFM Motor 4 1600 CFM C-Variable Speed/ComfortNet S 2000 CFM E-High Efficiency S Single Speed MFTU/h 040 40.000 BTU/h 060-60,000 BTU/h 140-140,000 BTU/h 2 www.daikincomfort.com SS-DM96VC PRODUCT SPECIFICATIONS SPECIFICAMNS DM96VC I DM96VC DM96VC i DM96VC DM96VC DC96VC DC96VC DC96VC 0453BXAA 0704CXAA 0905CXAA 0905DXAA 1155DXAA 0714CXAA 0915DXAA 1155DXAA HEATING CAPACITY High Fire Input' 45,000 68,000 90,000 90,000 113,000 68,000 90,000 113,000 High Fire Output' 43,200 6S,300 86,500 86,500 108,600 64,600 85,500 105,100 Low Fire Input' 31,500 47,600 63,000 63,000 79,100 47,600 63,000 79,100 Low Fire Output' 30,300 45,700 60,500 60,500 76,000 45,200 59,900 73,600 AFUE' 96.1 96.1 96.1 96.1 96.1 95 95 93 Tons AC@0.S""ESP 1.S-3.0 1.5-4.0 2.0-5.0 2.0-5.0 2.0-5.0 1.5-4.0 2.0-5.0 2.0-5.0 Temperature Rise Range(°F) 30-60 30-60 30-60 30-60 35-65 25-55 25-55 40-70 CIRCULATOR BLOWER Size(DxW) 10"X8" 10"X10" 11"X10" 11"X10" 11"X10" 10"X10" 11"X10" 11"X10" Horespower-RPM % % 1 1 1 '/. 1 1 Speed Variable Variable Variable Variable Variable Variable Variable Variable Vent Diameter' 2" 2" 3" 3" 3" 2" 3" 3" No.of Burners 2 3 4 4 5 3 4 5 Disposable Filter(in')` 422 657 844 844 1,079 749 961 864 ELECTRICAL DATA Min.Circuit Ampacity(amps)4 8.8 11.6 14.4 14.4 14.4 10.6 14.4 14.4 Max.Overcurrent Protection 5 15 15 15 15 15 15 15 15 SHIP WEIGHT(LBS) 123 142 150 155 165 139 158 160 Natural Gas BTU/h DOE AFUE based upon Isolated Combustion System(ICS) Installer must supply one or two PVC pipes:one for combustion air(optional)and one for the flue outlet(required). ent pipe must be either 2"or 3"in diameter,depending upon furnace input,number of elbows,length of run and installation(1 or 2 pipes).The optional Combustion Air Pipe is dependent on installation/code requirements and must be 2"or 3"diameter PVC. Minimum Circuit Ampacity=(1.25 x Circulator Blower Amps)+ID Blower amps.Wire size should be determined in accordance with National Electrical Codes.Extensive wire runs will require larger wire sizes. Maximum Overcurrent Protection Device refers to maximum recommended fuse or circuit breaker size.May use fuses or HACR-type circuit breakers of the same size as noted. *Permanent air filter size is based on 600 FPM velocity.Check with filter manufacturer for specific details. NOTES • All furnaces are manufactured for use on 115 VAC,60 Hz,single-phase electrical supply. • Gas Service Connection Y,*FPT • Important:Size fuses and wires properly and make electrical connections in accordance with the National Electrical Code and/or all existing local codes. SS-DM96VC www.daikincomfort.com 3 M W a a••a• � ~ Q O� �W� �� N O tilt- M. 46' ai e I � '2 • � J ° ` 4 �. pp fJ =a° _ b V 4oe � i, �qt Building Permit Check List&Zoning Analysis f Address: clec"Q1 V SBL: Zone _l Use: �l Const Type: Y Other. Submittal Date: 2 R ' ions Submittal Dates: Applicant: i Nature of Work \ 4 cj\ G Reviews:ZBA & BOT: Other. NEED WOK (� ( ) FEES:Filing ` , _ -,C/O: Flood Plane: Legalization: ( ) ("P: Dated: ~-Notarized: SBL: Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long Short: Fees: N/A.- SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival: _Sealed: Unacceptable: ( ) k�LANS:Date Stamped: --ped: Sealed: Copies: 2-- Electronic Other. (�/ ( ) License: Workers Comp: Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. (� ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H W.I.C.:_Battery:_Other: ( ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A Other. (��( ) V.A.C.: Plans: Permit N/A Other. ( ) ( FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg. date: approval: notes: ( )ZBA mtg. date: approval notes: ( )PB mtg.date: approval notes: APP12WED REQUIRED EXISTING PROPOSED NOTES 2.3 Date. . 20- Area: Circle: Fie Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot : Ft.Im : Pgj;kjW. Height/Stories: notes: Generated by REScheck-Web Software Compliance Certificate Project 8 BEACON LANE - SINGLE FAMILY DWELLING ALTERATION & NEW DORMERS Energy Code: 2021 IECC Location: Rye Brook, New York Construction Type: Single-family Project Type: Alteration Project SubType: None Climate Zone: 5 (5832 HDD) Construction Site: Owner/Agent: Designer/Contractor: 8 Beacon Lane Dylan Fijor Thomas Mesuk R.A. Rye Brook, New York 10573 8 Beacon Lane Thomas J. Mesuk Architect Rye Brook, New York 10573 197 Valley Boulevard (845) 422-0948 Wood Ridge, New Jersey 07075 dylanpersonalmail@gmail.com (201) 438-0595 tom@tjmarchitect.com iCompliance: Passes using UA trade-off Compliance: 0.0%Better Than Code Maximum UA: 222 Your UA: 222 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Slab-on-grade tradeoffs are no longer considered in the LIA or performance compliance path in REScheck. Each slab-on-grade assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements. Envelope Assemblies Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter 1st Floor Flat Ceiling: Flat Ceiling or Scissor Truss 257 38.0 0.0 0.030 0.024 8 6 2nd Floor Flat Ceiling: Flat Ceiling or Scissor Truss 150 38.0 0.0 0.030 0.024 5 4 2nd Floor Cathedral Ceiling: Cathedral Ceiling 220 38.0 0.0 0.027 0.024 6 5 1st FI Cathedral Ceilings: Cathedral Ceiling 540 38.0 0.0 0.027 0.024 15 13 2nd Floor Walls:Wood Frame, 16" D.C. 745 21.0 5.0 0.043 0.045 28 29 2nd Floor Windows:Vinyl Frame 90 0.280 0.300 25 27 1st Floor Walls: Wood Frame, 16"D.C. 1,215 21.0 5.0 0.043 0.045 41 43 Entrance Door: Solid Door(under 50%glazing) 20 0.250 0.300 5 6 Side Door:Solid Door(under 50%glazing) 20 0.250 0.300 5 6 Project Title: 8 BEACON LANE - SINGLE FAMILY DWELLING ALTERATION & NEW DORMERS Report date: 05/05/25 Data filename: Page 1 of 2 Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter Rear Door: Glass Door(over 50%glazing) 38 0.280 0.300 11 11 1st Floor Windows: Vinyl Frame 185 0.280 0.300 52 56 Floor-Slab on Grade: Slab-On-Grade(Unheated) Insulation depth: 4.0' 205 21.0 0.630 0.640 0 0 Insulation position: Horizontal Insulation Energy Credits Not applicable Compliance Statement. The proposed building design described ere' e the building plans, specifications, and other calculations submitted with the permit application.The propose b ed to meet the 2021 IECC requirements in REScheck Version : REScheck-Web and to comply with the man l] ajr6lWts the REScheck Inspection Checklist. Thomas J. Mesuk R.A. 05/05/2025 Name-Title na re Date • I • e Project Notes: It is acceptable to install sprayed foam closed cell insul of the equival alue in lieu of batt insulation throughout the project including areas of reduced depth K its er cavity shall be non-vented where sprayed foam insulation is installed tight to the underside (0 �Qq en roof rafters. Project Title: 8 BEACON LANE - SINGLE FAMILY DWELLING ALTERATION & NEW DORMERS Report date: 05/05/25 Data filename: Page 2 of 2 ACC) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I`� 10/01/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jason Quick NAME: C.Quick Insurance Agency PAHic No Ext: (845)497-1119 7008 ac,No): (845)533-1179 13 W.Main Street E-MAIL ason @c uickinsurance.com ADDRESS: i g q INSURERS)AFFORDING COVERAGE NAIC p Washingtonville NY 10992 INSURER A: Main Street America Assurance Company 29939 INSURED INSURER B: NGM Insurance Company 14788 Supreme Air Comfort Inc INSURER C: Property and Casualty CO of Hartford 68 GRANT ST INSURER D: INSURER E: PORT CHESTER NY 10573-4450 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2521307026 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SIR ADDL SUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE F OCCUR PREMISES Ea occurrence)TO RENTED $ 500,000 IVIED EXP(Any one Derson) S 10.000 A CP0016912 09/10/2025 09/10/2026 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2.000,000 X POLICY ❑PRO ❑ 2,000,000 JECT LOC PRODUCTS-COMPiOP AGG $ OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 300,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED CA0053366 08/20/2025 08/20/2026 BODILY INJURY(Per accident) S AUTOS ONLY /� AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED I I RETENTION$ S WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y/N 100.000 C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 16WECAAODOF 12/03/2024 12/03/2025 E.L.EACH ACCIDENT S (Mandatory inOFF NER EXCLUDED? (Mandatory in BE) E.L.DISEASE-EA EMPLOYEE $ 100,000 It Yes describe under 500.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Rye Brook Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers' CERTIFICATE OF voaK Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE STATE Board 1a Legal Name&Address of Insured(Use street address only) 1b.Business Telephone Number of Insured Supreme Air Comfort Inc 68 GRANT ST (203)919-9918 PORT CHESTER NY 10573-4450 1 c-NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,re a Wrap-Up Policy) 1 d.Federal Employer Identification Number of Insured or Social Security Number 821499190 2.Name and Address of the Entity Requesting Proof of Coverage 3a- Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Nationwide Exclusive Rye Brook Building Department 938 King St. 3b.Policy Number of entity listed in box"1 a'. Rye Brook NY 10573 16WECAAODOF 3c. Policy effective period: 12/03/2024 to 12/03/2025 3d. The Proprietor,Partners or Executive Officers are. included (Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entitv listed above as the certificate holder in box 2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Jason Quick (Print name of authorized representative or licensed agent of insurance carrier) Approved by1 10/1/2025 (Signature) (Date) Title Authorized Signature Telephone Number of authorized representative or licensed agent of insurance carrier`4�-497-1 1 19 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov MMY 21 rs 0 C) C%4 Lj C14 E@ 3C) E (U CJ rA C) 0 LLI 00 V, 96m z 4k a LLI o c LU >_ w D z > On 0 Z LLJ > _j V) E LLJ "o in".1 0 �5 Lu m Lor) a-LLI LL. LLJ < 0 vi C4 14, cu tF 4. a 0 0 T_ 00 U) co ONO Q z 0 z X E CN C M: a s .2 E -.0 '—*- 0 =3 Gj aj C:L i R 401 Alin TO lz.Q knr.; CERTIFICATE OF LIABILITY INSURANCE 5/22/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAMEO Cohan Associates,Inc. PHONE FAX 27 Cleveland Street (AIC,No,Exc): (914)422-0500 (A/C,No):(914)220-1440 Valhalla,NY 10595 E-MA'L ,CohanAssociates@Optoniine.net INSURERS AFFORDING COVERAGE NAIC# INSURER A:Evanston Insurance Company 35378 INSURED INSURER B Barajas Home Improvement Corp INSURER C 88 Drake Ave,Apt 1 INSURER D: New Rochelle,NY 10805 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X] OCCUR X 3AA844106 11/19/2024 11/19/2025 MISDAMAGE TO RENTED PRE ES IE $ 100,000 ME EXP(Any oneperson) $ 10,000' PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY❑ JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �Ean $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS WN BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY ParOacEcidentDAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION S�TE OTH- AND EMPLOYERS'LIABILITY Y/N T ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A E.L EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Additional Insured:Village of Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 4-9 "A A^^ 352794764 COHAN ASSOCIATES INC 27 CLEVELAND ST VALHALLA NY 10595 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER BARAJAS HOME IMPROVEMENT CORP VILLAGE OF RYE BROOK 88 DRAKE AVE#1 938 KING STREET NEW ROCHELLE NY 10805 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2636 042-0 274798 11/20/2024 TO 11/20/2025 5/22/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2636 042-0. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:NWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT ANTONIO BARAJAS SOLE OFFICER OF BARAJAS HOME IMPROVEMENT CORP THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. 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