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HomeMy WebLinkAboutRB25-0003 � O N } \ � Q .Q O \ 00 (U \ e2E U z \ / 0 y 0 f OL / a / w 5 .. c / cm: w {ate § w � E _ ± x k ( \ R � u ^ -0 E m o E > \ t , ± w k w z w ego 04 Z ) \ /\ >. q N O = / ) , / a 2 � � D ° ± / \ % k ) f1z 0 o � $ G o E \ z2 � 2b jwU -0w -jw � � / J / § / 5 \ m k � � K � / p R 1 \ \ / ■ I e , Yw — w Z 2 $ , ` / % § � � k (n om -J § j \ \ $ } (no m b \ \ r \ 2 2 p § \ \ \ } /\ a w 0 m u o = o > OLL % os � \ q ƒ / } � / / -0 w _Y � 2 , « § }/ L 2 \ LLJ 3 \ EEE j ? 4 § 2 § \ \ 2 'o \ > z LL \ ? R � \ w � U ! ( 2 � O W Q) M ° ° Q) � oJ\ O � \ � 2 m_ O kZ \ \ \ d O U L - U e u �\ § / ƒ ) q q \ u q � 12 m0 � G / Ey2 / \ � 00OL LU Ukm (U> o , b © ± o ® < , f 2 E f G � D � \ ƒ ± / g V � k / ƒ® \ co � 0 � o U \ � 0 ) Q ® 0 = = t a/ < a a 0 A—) Project Information Parcel ID# Zone N.Y.State Construction Classification N.Y. State Use Classification Occupancy Pre-Construction 135.26-1-16 R15 Occupancy Post-Construction Proposed Improvement Area of lot Dimensions from If building is located on a 1) Replace existing front proposed building or corner lot, which street does walkway with new pavers. Lot Square Feet structure to lot lines it front on: The pavers of the existing walkway are Front Yard crumbling/cracked/etc. Acres There will be no change in the size of the walkway. 2) Rear Yard Replace existing back walkway with new pavers. Right Side Yard The pavers of the existing walkway are crumbling/cracked/etc. Left Side Yard There will be no change in the size of the walkway. Other Note: I,the homeowner, will be the permit owner. Area of proposed Total Square Footage of the For additions,total Total Square Footage of the building in square proposed new construction: squarefootage proposed renovation to the feet added existing structure: Basement Basement 1st Floor 1st Floor 2nd Floor 2nd Floor 3rd Floor 3rd Floor Construction Type Located Number of stories Overall Height Median Height Basement Basement ❑ Full ❑ Partial ❑ Finished ❑ Unfinished What material is the exterior finish? Roof style Roofing material What system of heating 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...) ❑ Yes ❑ No Administrative Exterior Building Permit Application,page 2/3 Will the proposed project disturb 400 sq.ft. or more of land, or create 400 sq.ft. or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? ❑ Yes ❑ No Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? ❑ Yes ❑ No Will the proposed project require a Steep Slopes Permit as per §213 of Village Code? ❑ Yes ❑ No Is the lot located within 100 ft. of a Wetland as per§245 of Village Code? ❑ Yes ❑ No Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? ❑ Yes ❑ No .Will the proposed project require a Tree Removal Permit as per§235 of Village Code? ❑ Yes ❑ No Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? ❑ Yes ❑ No What is the total estimated cost of construction: Note: estimated cost shall include all site improvements, labor, 4200 USD material, scaffolding,fixed equipment, professional fees, including any material and labor which may be donated gratis. If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. Estimated date of completion 09/30/2025 Administrative Exterior Building Permit Application,page 3/3 �yE 13R— VILLAGE OF RYE BROOK 0 0 938 King St Rye Brook,NY 10573 # W � Phone:(914)939-0668 1 www.ryebrook.gov 198 Building Department ❑ Other Structures/(New) Permit Permit Set 11 CHURCHILL RD P#RB 25-0003 R#135.26-1-16 PERMIT INFORMATION Address Permit number Date issued 11 CHURCHILL RD RB 25-0003 08/08/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Steven Fews stevefews@ryebrook.org INSTRUCTION AND ATTENTION It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection. TABLE OF CONTENTS Coverpage 1 Building Permit 2 Required Inspections 3 Survey(Required Recent Survey) 4 Architectural drawing 5 Photograph 6 Contractor's Workers Compensation Insurance(Showing Rye Brook Cert Holder 7 Administrative Exterior Building Permit Application 8-10 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 E 13Rnv� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W � Phone:(914)939-0668 1 www.ryebrook.gov 1982 Building Department INSTRUCTIONS THE PERMIT HOLDERAND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQUIRED/APPLICABLE INSPECTIONSARE SCHEDULED AND THAT THE PERMIT IS COMPLETE ❑E ❑0 I. REQUIRED INSPECTIONS Name Description Final Inspection Completion of all required items under the permit including the site grading and the surveyor's final grading certificate. 0 z° o N r N _ z p RD m a or zo �J -.6LDaacHAR - - U` W 0 O ww m� =o< o a wo - o wio VD- El Ln E o0 LLJ CHURCNILL ID rco w U O Q z d Ln _ 0 oa VIN01V, m - - - 0 Q opK tlo,�� WC� 4�Z TH Cl O� o ��— �fV1S L1G�d�0 3ry"�Y �^k0 11,15, zc�v+LLm 3NId..bZ 4�jUm \ ��a r_ zzz A• - d a w o o zz p� P IG k o % , F [ o m Zia _ w, o of3230 77 0 s # s ns�X� R PERMIT 0 W - 3BLN DATE AP _OJ 2e75- BUILDING INSPECTCR. V ilage of Rye Brook, NY .. I IoR Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Home Improvement COLIN MCGOVERN From: RYE BROOK BUILDING DEPARTMENT 11 CHURCHILL ROAD RYE BROOK,NY 10573 PHONE:914455-0941 FEIN:XXXXx2402 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The applicant is a homeowner serving as the general contractor for a primary/secondary owner-occupied residence.The homeowner has ONLY uncompensated friends and family working on his/her residence or is hiring individuals a total of less than 40 aggregate hours per week and has a current homeowners insurance policy that covers the property. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The applicant is a homeowner serving as the general contractor for his/her primary/secondary personal residence. The homeowner has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,COLIN MCGOVERN,am the Homeowner with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true, that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers'compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN � HERE Signature: ��lGv�/ � = Date: 8/5/2025 Exemption Certificate Number Received 2025-061850 August S. 2025 NYS Workers'Compensation Board CE-200 01/2018 Administrative Exterior Building Permit Application Village of Rye Brook w � �'79b2 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Administrative Exterior Building Permit Application,page 1/3