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HomeMy WebLinkAboutCVS Fire Safety Certificate 2025-2028 M x z J, O �4 q aoww � w °� o W Z �+ � 0NAH � 00 O � F� Ln zwa � z [j] a � a o Z Z xj p A W w F < a 1-4u A A o0 � z c c a A O w x z x Q N N H WAw ' N N z N O ►—� w wwUw � 0-4A H W o w 0-4 P z V w A w 04 A M w a xCA a A o w u CA A w x E BW1 o � t� 1982 BUILDING DEP TMENT ZLDING IN SX11tCrolt l,&TAnrr Buir,DxN(;Y.rsurrrox VILLAGE OF RYE BROOK ❑COPE FM oitcjVvM rr O.rrlrcnit 938 Kmcv Sr.RrB7C a RYE BROOK,NY 10573 (914) 939-0663 IAA,(914)939-5501 www ry roo ort-, ------ INSPECTION REPORT -- ---- - ----- - - -- ----- FlJDbRE5S: S 3 ,�1� DATE: p z.3 - Z oe7.S� SSUra: y.g•40;grC'r:_/yl.A!r BLOCK:.,—Lo r: A.6)CArrom OCCUPANCY' ❑ VIOLATION No-rum 3.`.u.jt WORK is... ZcCIEPTEiD ❑ lu ll..eren/ Rowskt:crTON SITE INSPECTION ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNIDNrION ❑ UNDE.RGROUNiD PLUMBING Na7'1"ES COIN INSPBC'I`IGN: ❑ ROUGH PLUM DING ❑ ROUGH I RAXRgG 0 INSUi NrioN l NA:AvRAI.GAs ❑ 1L.9.'.Gas ❑ FUEL TAN] t ❑ FINAL PLUMBING ❑ GLOSS CONMECTIOIST ❑ RNAL jrerlo m BUILDING DEPARTMENT VILLAGE OF RYE BROOK Initial Inspection Date: ❑ Fuss STEVEN E.FEWS 938 KING STREET,RYE BROOK,NEW YORK 10573 A/' O BUILDING&FIRE INSPECTOR (914)939-0668 -www.ryebrooknv,gov Re-Inspection Date: ❑ has, s f'cws(rrIrvebrooknv.gov ❑ Fail FIRE INSPECTION REPORT, NOTICE OF VIOLATION & ORDER TO REMEDY SAME Site Address: 253 _ �p� R.1 S 1fwj Zone: SBL: /y/.+� _ 1 -S'1 Occupancy: V ] + ?h R r-74 "r-LIL-IL 14q.0 State Use Classification: Business Owner: CV S ALbA _ Phone: 'S 01 - 7(PS*-/S"Od Building Owner: W A A6i J PION IC- PIA L,4 Phone: 917- y/9- ,31&(0 Emergency Contact: X&q i m A I) Phone: 9/y- 7 3 y- 9(V 1 f Building Representative in Attendance: /rIA4460 le&l'� sl e,Z, -------------------------------------------------------------------------------------------------- Take notice that the following violations of the New York State Uniform Fire Prevention&Building Code and/or the Code of the Village of Rye Brook were found to a ist at, Z S3 50t4 4,6 -e 1 A. 51r in the Village of Rye Brook,NY on, A 9A i L 20 2-5- .The person or entity served with this Order to Remedy shall immediately commence to correct all listed violations and shall completely cure each violation described herein by no later than A LO ,which is thirty(30)days after the date of this Order to Remedy.Furthermore, upon curinj any listed violation(s),you shall immediately contact the Building Department during normal business hours to schedule a re-inspection of the premises to confirm full compliance with all applicable codes,laws,rules&regulations. BE ADVISED I'IIA'I'YOUR FAILURE TO COItREICT ALL VIOLATIONS IS A CRIME PUNISHABLE BV FINE,IMPRISONMENT OR BOTII. -------------- -------------------------------------------------------------—------—--------------—------------------------------------- 1.PORTABLE FIRE EXTINGUISHERS PFEIS No Yi?ti N/A a.906.1. Are P E's installed throughout the space&on the premises as required by code. a. b/ b.906.3.1.Is th _maximum travel distance to a PFE 75 feet or less. b. ,ol' c.906.5.Are PF 's conspicuously located&readily accessible. C.— d.906.6.Are PF 's unobstructed/unobscured from view. d. e.906.7.Are PF 's properly mounted as per the manufacturers instructions. e._ Volf.906.9.Are PF 's properly installed:<40 lbs.max.5'above floor;>40 lbs.max.3.5'above floor. f. 17 2.FIRE ALARM SYSTEM&SMOKE DETECTORS a.901.6.1. Is th fire alarm system inspected,tested&maintained in accordance with NFPA 72. a._ ✓ _ b.907.4.2.1.An manual pull stations located within 5 feet of exits&within 200 feet of each other. b-_ _ c.907.4.2.2. Is t ie height of the pull station handle located between 42&48 inches above the floor. C. d.907.3. Is a fi alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d._ 3.FIRE SUPPRE ION SPRINKLER SYSTEM&FIRE HYDRANTS a.901.6.1.Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a. ✓ _ b.901.6.1.Are t ie main valves secured against tampering in the open position. b. c.901.6.1.Ares ifficient clearances maintained from fire sprinkler heads to fixtures or materials. C. d.901.6.1.is a s ipply of six spare heads&a wrench maintained on the premises. d._ _ e.901.6.1.Ares rinkler heads&cover plates unfinished or of factory applied finish only. e. f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f._ _ g.913.5. Is the re pump inspected,tested&maintained in accordance with this section&NFPA 25. g. h.507.5.2.Is the fire hydrant system properly maintained,operational,compatible wMST&tested annually. h. i.507.5.4.Are fie hydrants&fire protection equipment unobstructed. i. _ j.507.5.5.Is a clear space of not less that 3 feet maintained around all hydrants. j._ k.901.8.Are all fire protection systems in place and maintained untampered. k. •7 INSPECTOR: �I DATE: -I- R,,i,cd all/7U31 No Yvs N/A 4.STANDPIPE.CABINETS&FIRE DEPARTMENT CONNECTIONS a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b. _ ✓� _ c.912.2.3 Are standpipe FDC threads compatible with fire department standards. C. ✓ _ d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d. __ ✓ _ e.905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e. ✓ _ f.912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f _. _ ✓ g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g. 5.EXITS.MFANS OF EGRESS&OCCUPANCY a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b. c. 1031.6.Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... C. d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. e. 1010.1.Are egress doors provided and maintained as required by this section. e. f. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g. h. 1013.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1.provided as required by code. j. 1013.3.Are all exit signs illuminated at all times. j k.1008.I.Are the means of egress&exit discharge illuminated at all times the building is occupied. k. _ 1. 1018.3.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides. in. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least 28"wide,or at least 36"wide where serving 50 or more people. 6.COMBUSPIBLF STORAGE&WASTE MATERIALS a.304.1.Is the building(s)and premises maintained free from accumulated combustible waste material. a. b.304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C. d.315.3.Are combustible materials properly stored&separated from ignition sources. d. e.315.3.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e. _ ✓ _ and 18"or more below sprinkler head deflectors in sprinklered buildings. f.315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f g.315.3.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g. h.313.1.Is building maintained free from stored fueled equipment.(motorcycles,mopeds,mowers,etc...) h. _ ✓ 7.ELECTRICAL a.604.1.Is the building free from modified/damaged wiring,devices,appliances,equipment a. and maintained free from electrical hazards. b.604.2.Are electrical service equipment areas properly illuminated. b. c.604.3.Are proper working space clearances provided&maintained for electrical service equipment. C. d.604.3.Are electrical service equipment working spaces free from any stored materials. d. e.604.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. e. _ f.604.4.Is the building free from unfused multi-plug electrical adapters. f A_ _ g.604.5.Are electrical extension cords being used in a safe manner as per code. g. X h.604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h._ ✓ _ i.604.6. Is the building free from open-wiring spliced electrical connections. i. _ j.604.8.Are electrical motors maintained free from accumulated oil,dirt&debris. j._ ./ k.915.1.Are Carbon Monoxide Detectors installed&maintained as required by this section and by 1103.9. k._ _ INSPECTOR: �"'�. �L�� DATE: J/- D a O a s -2- Revd 6/1/2024 No Yrs 8.ELEVATORS,DUMBWAITERS&ESCALATORS N/A a.[mi 603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a. b.606.3.Are approved standardized,pictorial signs posted adjacent to each elevator cal[station on all b. floors reading; IN FIRE EMERGENCY,Do NOT k1w ELEVATOR USI'Farr STAIRS c.606.7.Are keys for elevator car doors&fire department service kept in an approved location. C. d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. e.[B]3005.1.Are elevator machine room doors maintained unobstructed at all times. 9.COMMERCIAL KITCHENS a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a. _ V4 b.904.12.5.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b. _ c.904.12.5.2.Are automatic fire extinguishing systems serviced at least every 6 months. C. _ _ ✓ d.904.12.5.3.Are fusible[inks&automatic sprinkler heads replaced annually. d. _ e.[RB]122-5.13 _.Are grease traps provided and installed as required by Village Code. e. f.[PC]1003.10.[RB]122-6.Are grease traps properly maintained as per State and Village Code. f. _ g.[RB]122-6.C., 122-9.Are all service,maintenance,&repair records for grease traps and related plumbing maintained on the premises as required by Village Code. g. 10.HEATING SYSTEMS a.[PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a. b.[PM]603.2.Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. _ c.[PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C. d.[PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d. _ Pe _ e.[PM]603.5.Is the fuel-burning equipment provided with adequate combustion&ventilation air. e. 11.MOTOR FUEL-DISPENSING FACILITIES&REPAIR GARAGES a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a. _ _ ✓ in an approved location within 100'of,but not less than 20'from fuel dispensers. b.2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. _ _ ✓ c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C. d.2305.5.Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. _ _ ✓ 2-A:20-B:C provided&located not more than 75' from pumps,dispensers&fill-pipe openings. e.2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e. _ _ ✓ f.2305.7.Are weeds and other combustible materials kept at[east 10' from fuel-handling equipment. f. _ g.2306.4.Are above-ground tanks provided with vehicle impact protection. g. h.2306.5.Are above-ground tanks provided with secondary spill containment. h. 12.HAZARDOUS MATERIALS(HAZ-MATS) a.407.2.Are S.D.S.Sheets for all haz-mats readily available on the premises. a. _ b.407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b. c.5004.2.Are stored haz-mats provided with approved secondary spill containment. C. d.5003.7.1.Are proper No SMOKING signs provided as per this section. d. 13.MISCELLANEOUS a.403.1.Is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b. _ c.405.5.Are records of emergency evacuation drills kept&maintained on the premises. C. ice. d.505.1.Are approved address&building numbers property placed&plainly visible from the street. d. _ e.506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e. _ _ f.703.1. Is all required fire-resistance rated construction properly maintained as per code. f. _ g.703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g. h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h. i.5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. 1. — 14.GENERAL HOUSEKEEPING a.Good b. Fair c. Inadequate '-�� 4 ~LG7 d. Poor INSPECTOR: DATE: — Z GJ -3- R­ 16dirzoza ITEM NUMBER REMARKS e ' aCy.1 meav s o l' SS o_'S . �a sc or I S a � d Or ems, d �Q S St' G S a LC Tifyiee,s . 5To rd;�_ A rew E d ojrs 4-0 C LC rim s . .s i a 1 s 41 gcn� lu r�7 i o� a 2AC,lc se- Rum u j de& m e L -i is rkj w'A G j . Nee u. h7 wl I .rCo r bo k N e e ar 8 - A C.. a N . r r S i aV.J. c.C, }' o 0 2 Cw o r S Jo re MA ' X) C a ,� t - SMo L a m1QA �/ ly?o � clu A ►� li i �:,� off 1 p r► INSPECTOR: DATE: 0+ _ 0 OC2,s-- 4- Revised 6/1/2024 coll OS�� �L6 �yE BRcb 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 : DATE: 2 `- PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION i ❑ NATURAL GAS ❑ L.P. GAS 4/0 7 c, c4 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING i ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER vc _ /i Ma� o�C I�S`�c�✓► cl/ �- �S �-•?o 60 VCVSHealth RE: License Renewals Dear Sir/Madam: Enclosed please find completed applications) and/or appropriate payments)) for the License Renewal(s). Pfease note any changes made on the applica�tion(s). When the new license(s) is/are issued please send it to Mail Code #1160 at the address below. After making the necessary copies for my files I will forward the originals to the store for posting. Thank you for your cooperation in this matter. If you require additional information or have any questions, please contact me at 401-770-2816 or email nonpharmacypermits@cvsheaItn.com. �a SIG Sincerely, �ak4 -5tw)4y Kathy Strojny Licensing Coordinator One CVS Drive MC 1160 Woonsocket, RI 02895 Enclosure(s) CVS pharmacy / caremark / minute clinic / specialty i a a �Q o • Y � iV ' ) r' 1 'i�Q V • m KS fi n¢ m � W �� ���/\ m a° Fo m r. m �❑❑❑❑❑ nano kLnL annn na) a Tan) !#§ «( a� {k\{ [§ {$�/\ f k7; 4){!&I+#f ■ ' k!/2 �Ik(, k/ ��)[ \� \ /)k(��}\ , ;&2J 77k �; - !®-a|!`lf:=®� `9 £=z■§® �)27\/%�� E§fi®®^� fa`�2■)\\ § § )e f2=2{k{f)f\{§7 )#777772� E . . . k 9 \ \2t■ t� 5} ) z \ 33 ■= ! %f «9f;2a o .§`; #\!|;7Z6.2 kJ 2 @ ,- _ - - « � . , . !. -,_�_ # ««« kRt4 ;r ;£;<%PE§af®!!� + �{f ! ;z§ A §,2)/ §2�§)«,,2{(22 �2#tea ©+It»m—E3:E `tea ■ )\\� �\} k\ \\kj2))\}){\\k{§k f y V C C t N O O n mf ¢ E E 0 a�— CD 'a o � Z wra ca of t co T r �,"fn Nm m m�2 t C C O E 3r 1 CiCc¢o nun¢ E 0 m 000 ❑❑ EoN` , r c > co c 2 _ y O a) p u m cL n R m O 2. ac of y - ¢ s m � ro�; ¢ d m ari in �(D a ca C C c t r> 7 0D01 p VI CJ p aS NN 0 c EL N —_ N t Q = rn o a) p E � Ln 0 — c) t C Y \ CY) U IU c 0'O O.:tN (\\ill Q p M o, ¢ YE o p 0 (D CO 1_ v E p c two ro� L0 � � p c a F- c N � O a O -_ NC\J r rn rorij C I (/1 � O Nca R C to "`// I C O V O / Q, T W w T a o3 �L Va (^ � � zo r lI Ln m U a ° Q `o a \ � a L ■ ■ ■ �� N c a _ w o ZL a m°6 6 m � Z N U L m o 'E a co o U) - LLa:Da v —_ N M m u O z W -`0o C Wx m LLJ O W } m Xn' (ni u- C) OZ p z 1 a, W ZYY f't E O co O ru < E5co 0 m l Lnm W ( m n_ } o- =_ Ln KA o Ln Er- Co r fU N U occ a)a) o -a �a ` o uy l�t` r Vb V. VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher j.Bradbury Nnww. ,cbrookay.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Few% Stephanie J. Fischer David M. I Iciser Salvatore W. Morlino September 23,2024 Via P,Class Certified Mail C:VS I lealth 2^"Notice c/o Lease Administration One CVS Drive Woonsocket, Rhode Island 02995 Re: CVS#490,253 South Ridge Street, Rye Brook,New York 10573 Dear lease Administration, It has conic to the attention of the Building Department that it has been over three years since the premises located at the above captioned address has undergone and successfully completed a Dire Inspection. Please note that you arc required by Rye Brook Village Code 591-4.13,to undergo and successfully complete a Dire Inspection for this location at least every thirty six (36) months. In order to avoid a violation,please complete and submit the attached Dire Inspection/ Operating Permit Application form, remit the correct application fee,and schedule your triennial Dire Inspection with the Building Department by no later than, October 23.2024,which is thirty (30)days after the date of this notice. Please note that the property owner's notarized signature,as well as the business owner's notarized signature must appear on the application form in the appropriate spaces. Upon successful completion of the Dire Inspection,you will be tssuetl a Dire Inspection Certificate valid for three(3)years. Please remember that you must schedule your lire Inspectum cvcr�, three(3) years by filing a Fire Inspection/ Operating Permit Application,remitting the applicable fee,and scheduling your Dire Inspection with the Building Department at least thirty (30) days prior to the expiration date listed on your Dire Inspection Certificate. Thank you. /9A �11 Steven li. Dews Building&Fire Inspector stevefewa(@tycbro_ ok org cc: Alfredo DiVitto,Assistant Building& Dire Inspector Laura Petersen,Office Assistant Ntartha Levy,Managing Agent /to c o 0❑ ❑ ❑ 2� o I. r LD E 3 a¢ acc 4 aunn UU i 2k C tt v L u LD � - > co U) cr N= d X �;anbonnan ai � c Q� (� � 4 ` E O c o _ `� f T O r Cf) 8 � LO N � LO 1 V co o _ 3 � r U) a b > � L 4 � m WAW .tj 0206 h606 2000 02L-2 120z 0206 h606 2000 02Z2 T20L nano kLnL annn naya Tan) ai f OEM O .Fi rc W now , ,TA �tt4 l+bYY�J G�GtG+ Jr VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher.j.Bradbury www.1yebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan It. Fpstcin Steven E. Fews Stephanie J. Fischer David M. I leiser Salvatore W. Morlino September 23,2024 Via 1•1 Class Mail CVS I lealth 2^d Notice c/o Lcase Administration One CVS Drive Nv(x)nsocket,Rhode Island 02895 Re: CVS#490,253 South Ridge Street,Rye Brook,New York 10573 Dear Lease Administration, It has come to the attention of the luilding Department that it has been over three years since the premises located at the above captioned address has undergone and successfully completed a lire Inspection. Please note that you are required by Rve Brook Village Code§91-4.B,to undergo and successfully complete a Dire Inspection for this location at least every thirty six (36)months. In order to avoid a violation,please complete and submit the attached lire Inspection/ Operating Permit Application form, remit the correct application fee,and schedule your triennial Dire Inspection with the Building Department by no later than, October 23,2024,which is thirty (30)days after the date of this notice. Please note that the property owner's notarized signature,as well as the business owner's notarized signature must appear on the application form in the appropriate spaces. Upon successful completion of the lire Inspection,you will be issued a lire Inspection Certificate valid for three(3)years. Plcasc remember that you must schedule your lire Inspection every three(3) years by filing a Fire Inspection/Operating Permit Application, remitting the applicable fee,and scheduling your Dire Inspection with the Building Department at least thirty (30) days prior to the expiration date listed on your Dire Inspection Certificate. 'Iliank you. Steven I Dews Building& lire Inspector steyefewY�,ebro cc: Alfredo DiVitto,Assistant Building& Dire Inspector Laura Petersen,Office Assistant Martha Levy,Managing Agent /to r� o (� c i O M t1J I C W co 1 OEM V O O ` NOO �n x r� c K b G r � � M t. V•f Y c ® r� m z •aEW y�•4 W m` 66. cc V � Q � o0 � C Y co M Q+ BUILDING DEPARTMENT D [E C IE N E VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 NOV - 7 2024 (914)939-0668 wwv",.ryeb rook.org VILLAGE OF RYE BROOK BUILDING DEPARTMENT FIRE INSPECTION / OPERATING PERMIT APPLICATION �^ FOR OFFICEUSE ONLY: ��i,3O�i1 Fee Paid: $_ 5 —AL Inspection Date& Time, l GIQJ��T r4��1 ��a5 FEE SCHEDULE: Re-inspection Date & Time: Triennial & Private School Annual Inspection: = $450.00 Public Assembly Annual Inspection: <100 People= $525.00/>100 People= $775.00 *********************************************************************************************************** Application,dated:_ is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business, private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform Fire Prevention & Building Code, Title 19 NYCRR Part 1201, ana ali other applicable local, County, State & Federal iaws, rules & regulations,as per detailed statement described below. 1. Addrep: 253 South Ridge St. SBL: Zone: 2. Business/Occupancy Name: CVS/pharmacy#490 NYS Use Class: Washington Park Plaza Associates LLC-CMP178 41 Hewitt Ave., Bronxville, NY 10708 3. Property Owner: Ad3d7ress: Phone# 914-419-3166 Cell # email: martha7087@aol.com 5. Business Owner: CVS Albany, L.L.C. Address: One CVS Dr., Woonsocket, RI 02895 Phone# 401-765-1500 Cell # email: non pharmacypermits(cD_cvs health.com 6. Emergency Contact: Xavier Gilbert Address: Phone# 914-934-9619 Cell # email: Xavier.Gilbert(cDcvshealth.com Inspection Escort: Matthew Ramirez Title: Store Manager Phone#: 914-937-2301 Cell #: email: FS00490@cvshealth.com 8. Provide a brief description outlining the current and/or intended use of the property: Pharmacy 9. List all Hazardous Materials: none 10. Occupant Load: Existing: Proposed: Other: 11. Date& Disposition of Previous Fire Inspection: ❑ Pass ❑ Fail i 8/12/2021 This application must include the notarized signature(s) of the legal owner(s) of the above mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. ********************************************************************************************************** STATE OF NEW YORK COUNTY OF WESTCHESTER as: 1 L being duly sworn, deposes and states that he/she is the applicant above named, (print a of individual signin appli tion) and ,fi/arther states that he/she is the legal owner of the property to which this application pertains, or that he/she is the V , for the legal owner and is duly authorized to make and file this application. That all (indicate architect,busine s owner.attornev.anent,etc.) statements containe 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 this day of , 20 j�W day of �JW , 20c�- Notary ub ' Nota blic Signature of Property Owner SikiAture of Applicant 12IAJP Print Name of Property Owner � Af4 Print;Name of Applicant' /� /V / UseMciohxYrs M GREGM K RNERA `,``'a 6 t dun Notary Public,State of New York OP No.01R16441398 Notar Qualified In Westchester County --.4bUl y Commission Expires September 26,20 y AUbI i` bOde 2 ai12/2o21