HomeMy WebLinkAboutDP25-010PERMIT # ---�16
7 BLOCK LOT ..
SECTION o2
TYPE OF WORKf
JOB LOCATION 7'.. %*V.5""
OWNER --��...��,�_'
CONTRACTOR ii dig
T . COST TFEE
CO # FEE
2 - DATE
TCO #
FEE DATE
INSPECTION RECORD
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING Q
i NSP
RGH PLUMBING
SPRINKLER -----
ELECTRIC ' r�*. Vol v� ' ----
LOW4OLT Q .�--
ALARM Q —
AS BUILT 2�2
FINAL &Z 3— O `
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APPROVALS
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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 4,2026
Eric Gordon&Danielle Gordon
20 Country Ridge Circle
Rye Brook,New York 10573
Re: 20 Country Ridge Circle, Rye Brook,New York 10573
Parcel ID#: 129.74-1-23
Demolition Permit#25-010 issued on 11/12/2025 to Demolish In-Ground Swimming Pool&
Adjacent Patio
This certifies that the in-ground swimming pool and adjacent patio,demolished under the above captioned
permit has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
BUILDIN, Y,])EP'ARTMENT For office use only:
�' PERMIT#
VILLAGE OF RYE BROOK ISSUED: 11 44.
25
JAN 2 2026 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: Z.Z• ZS
(04)939-0668 FEE: A ZZr PAM
www.ryebrookny.pov
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
►►s►►►►r►►►►►►►►►►r►r s s►r►►►es►►►►►s►►s s►►►►►r►►►►►►►►r r r►s s e s sr s►►►►►s►►►►►►►►►►►►►►►►►rr►s►►►►►r►r►r r s►s►s e s s►s►►p►►►►►►►■
Address: ccL'L' y 9;A01.1 C,•r<�'ie'
Occupancy/Use: 5 c f-4 Parcel ID#: I IC(,7 A 3 Zone: —15
Owner: C , ` Oc,&. e. Gore Address:
P.E./R.A. or Contractor: FoA{{lk C6/4(-uG4✓-'v Address:
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:
STATE OF NEW YORK,COUNTY OF WESTCHESTER as:
`C,(. Gof�. being duly swom,deposes and says that he/she resides at 2 d C
(Print Name of Applicant) (N .and Street)
in Eye, &c,* ,in the County of Wt5'A G�S]] "e in the State of� that
(City/rown/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 the monetary value of any materials and labor which may
have been donated gratis was:$ 2S,O OO
for the construction or alteration of: Pao' C t M act 1
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.of the Code of the Village of Rye Brook.
Sworn to before me this .La Sworn to before me this
day of n�)ur. , 20� day of , 20
Signature of Property
Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
0�r'
N Notary Public
GR-GM M.RKRA
NOTARY PUBLIC,STATE OF NEW YORK "��
NO,OIRIG441308
QUAIJFiED IN WESTCHESTER COUNTY
OO MMIS%,uN�'M UPTEAiBER 26,20
6 BR�k
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BUILDING DEPARTMENT
❑/BUILDING INSPECTOR
,10 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
PERMIT# r ISSUEI):�1� LJ$ECT: A2�1•_,(BLOCK: _LOT:
LOCATION: _ Ra(;n _ aJ -
-- ----- OCCUPANCY:
❑ Violation Noted THE WORK IS... ASSEU
❑ FAILED / REINSPECTION
❑ SITE INSPECTION
❑ FOOTING REQUIRED
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas
❑ L.P. Gas �,A. I� n n n
❑ FUEL TANK — O t i
❑ FIRE SPRINKLER 2
❑ FINAL PLUMBING C� /
❑ CROSS CONNECTION �/�/�S
FINAL c e
,OTHER 1 V /
......................................... '
198 BUILDING DEPARTMENT
0 BUDDING INSPECTOR VILLAGE OF RYE BROOK
❑ VIl.LAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573
❑ CODE ENFORCEMENT OFFICER (914) 939-0668 FAX(914) 939-5801
- - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - -
"I y
ADDRESS: V l { i DATE:
PER # L SUED: `�Li SECT: BLOCK: LOT:
LOCATION: r ��.X� ( � OCCUPANCY: r
0 VIOLATION NOTED THE WORK IS••• CCEPTED ❑ REJECTED/REINSPECTION
" SITE INSPECTION REQUIRED
0 FOOTING
❑ FOOTING DRAINAGE
0 FOUNDATION
0 UNDERGROUND PLUMBING NOTES ON INSPECTION:
0 ROUGH PLUMBING
0 ROUGH FRAMING vvvy VV
0 INSULATION
0 NATURAL GAS
❑ L.P.GAS �%«t)� c'
0 FUEL TANK
O FIRE SPRINKLER
❑ FINAL PLUMBLING
❑ FINAL
❑ OTHER
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BUILD_k� MENT D v
VIL OF RY OOK 0 C T 31 2025
938 KING ET RYE BR ,NY 10573
4 -0 VILLAGE OF RYE BROOK
ov BUILDING DEPARTMENT
DEMOLITION PERMIT APPLICATION
FOR OFFICE USE ONLY:
Approval Date: NOV 12 Z ZC25-,�5 j Application Fee:$ o
,pd
Approval Signature: Permit Fees:$ "T,A—D
Disapproved: Other:
Application dated: 1 5 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below.
1. Job Address: 20 Country Ridge Circle SBL: 129.74-1-23 zone: R-15
2. Proposed Demolition.(Describe in detail): Demolish in-ground pool and surrounding flagstone patio
3. Property Owner: Eric Gordon & Danielle Gordon Address: 20 Country Ridge Circle
Phone# 617-872-4845 Cell# email:
Applicant: Address:
Phone# Cell# email:
Architect/Engineer: Address:
Phone# Cell# email:
General Contractor: Earthtek Contracting Corp Address:PO Box 145, Rye, NY 10580
Phone# 914-879-6945 Cell# email:
4. Estimated cost of construction $ 25,000.00
(NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated
gratis.)
5. Type of construction:(wood frame,masonry,steel,etc...)
6. Method(s)of Demolition:
7. Number&Location of Fuel Oil Tanks to be Removed:
8. Number of Stories: Height to Highest Ridge: To Highest Chimney:
9. Estimated date of completion: 2 Weeks
t
6/I/2024
f -
This applteation must be properly Completed in its antrretV and rnuat include the notorsaed
s'pnsturafs)of the lepai ownerjsl of the subject property. and the applicant of record n the
spates prOvid" Any appitcabon not properly completed in its entirety and/or not proo*rfV
signed !hall be deemed null and void and will be returned to the applicant
Please note that application tees are non-refundable
�t II c>f N1 W��\'�4Mth�.�kkM'wIV 4M'N'tsit lffSltA ) d+
f .J/JACyw _ _._.. _.buss deh .worn. �.r,pod wdc.dw b aldw is�ap�lheal aEan'r narew
m6nar/WSW*ado�4", a which ins or Ural tsthe s tAe
and herby ataar tbm Islba is ds k*W owner of the pmpert7 appYaum �
_ for die k1m)"v►we►and w dely aadumtovd to amlee ad bk the appiraaon•
,Gdmm irUtah"-unman.Om
I hat all commie d herein we uue to the best of beAkcr knnwk*man belief..d dW aoy —A performed,a rise
,ondu►W at the abtwe captiomrd prnpmq wdl be in: inkwa a with the Jetnrls as 20 fort~ad som=W I"tarn applrcateao
and m my aowmpwy*appnrved plans aid rprtifwauum awell as in accurdes-e wtlb 68 New Yank Suee llwifrswt Fes
Prevention A lllud " g Ccok.the!:(Ide f4 the V dkmc:.1 R v Hex*wW dl,Mlle►gtpbW*Iric crdioaat:es and ft9wak"m
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,%wam to trelm an 60 _�q�_. ♦wns a we taw
or
. �
Joni Lam)
CommIssio0ol l-A0025681
Notary Public,State of New Yak
My dolt Expires June 07,2029
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BUIL MENT
VIL E OF RYE K OCT 2 7 2025
938 KIN , ET RYE B ,NY 10573
VILLAGE- OF ;-'Y':= BROOK
or B U I L D;t�C YAR T PIiEiLT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY 4"f,#: 5 Q EP#: c95 a 5 0
Approval Date: NOV _U 20 5 Permit Fee: $ L2'511A
Approval Signature: Other:
Application dated, jalf 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 be in conformance with all applicable Federal,State,County and Local Codes.
1.Address: D Wtu V...9J46 C;j(J/_ SBL: 09.74/-7 oZ 3 Zone:
2.Property Owner: riL (11 he &O�GI0n Address: gp tourriya Acuji
Phone#: Cell#: email:,
3.Master Electrician/Licensed Installer: Address: ►1,5 j��'f'�1(�� iOJ 7/
Lic.#: I I Phone#: 14,1 q 31' 10 5� Cell#: 9 I!'f I t V 2 JV email: 0#iCG-(lam ,!,I 'C!►'-L,Ctj/YI
Company Name: (�)�,�IO.c�I'rj�,Ire Address: I FS e�i. �.Ig LnT l�'cj3z
4.Proposed Electrical Work/Fix a Count:
L e
5.3'Party Electrical Inspection Agency:
STATE O�F,,NEW YORK,COUNTY OF WESTCHESTER ) as:
i rY!j / ,/ //I a ,being duly swom,deposes and states that he/she is the applicant above named,and does further
(print name of individual signing a�s,tha ap Iicant),L
state that(s)he is theMLt,S2{2/1VL&(GlCL for the legal owner and is duly authorized to make and file this application.
(Master Electrician/Licensed Installer)
The undersigned further states 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 bef re e this aV
day of 120 day of 20-26
Signature of Property Owner j4_'e of Applicant
Print Name of Property Owner Print Name of Applicant
KAXW A CASINO
Notary Public Not3WRW 10t.lC-STATE OF NEW v01tK
No.OICA6022190
Ouslif led in Westchester County
MV Commission Expires 01-29.2021,.?,
�, 3/3/2023
STATE WIDE INSPECTION SERVICES, INC.'
•:0 • •
SWIS JOB APPLICATION •. •
Office Use Elect. Permit# ) Date
Bldg Permit# ,5 Scl Ft
Plumbing Permit#
Final Certificate#
City/Village J Zip Building Dept. CountyCk
Address Cross Street Section Block Lot
Owner Name/Address(if differ ntthan above) Contact Number
❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Residential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch
SERVICE
Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair
❑Overhead ❑ Upgrade ❑ Disconnect
Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/ Rockland
PHOTOVOLTAIC SYSTEM
PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect
❑Legalization ❑ Safety Inspection ,��- ❑Consultation
(� r5L'Or7rI�CT �'��� %�` `""�n � �/ ' �{7!'lc. CdF�
"T 2 7 2025
VILLAc
BUILD!; Fnl
This application is valid for one(1)year from the date received by SWIS.This application is Intended to cover the above listed items to be inspected,if 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 inspected.The appI Icant declares that there Is no open applications for the above address with any other inspection company.The applicant,
owner or authorized agent agrees to all the above terms and conditions as set forth for the application.
Email Address -)�j� 2 �/ / �G, C Name J
License# Date Signature
Address „/5 ' . City/State �J„�� Zip Code �f
Company / Phone# L — f �Q
State Wide Inspection Services
1080 Main Street
Fishkill, NY 12524
845 202-7224 Phone
914-219-1062 Fax
STATE WIDE INSPECTION SERVICES Email: office@swisny.com
VILLAGE OF RYE BROOK Website: www.swisny.com
service with Integrity R(M r)IN.' hFPA.RTkAF-NT
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
La Bella Electric Inc. Eric& Danielle Gordon
145 South Main Street 20 Country Ridge Circle
Port Chester, NY 10573 Rye Brook, NY 10573
Located at: 20 Country Ridge Circle, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 25-256
129.74 1 23
Certificate Number:2026-0026 Demo Permit Number: DP 25-010
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: 20 Country Ridge Circle, Rye Brook, NY 10573
The Garage and Exterior 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 5"'day of January 2026.
Name Quantity Rating Circuit Type
*Removal of all electrical power to swimming pool
Officer: Frank J. Farina
This certificate 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.
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STATE OF NEW YORK,COUNTY OF WESTCIW—T ER has
�Cc G am' hang duly sworn.deperccs and states that he/she is the applKartt shove named.
tlaAat arse sf ladiaxA+at�K�qr a�Yanr a
40d Attivter state+that(1)he is the kcal owner of the property to which this appl►cauon pertain,or that(%)be is the
for the legal o%mcr and is duly authorized to make and file this applicaim..
Oadkew archaect,cawim-w.agm,sn*rwy,act
That all statements contained hernn arc true to the test of hisihcr 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 am acccmnpanytng approved plans and specifications,as well as in accordance with the New Work State Uniform Fite
Pmvntion& Building Cock,the Code of the Village of Rye Brack and all other applicable laws,ordinances and regulations
1�.
Swam to before me this— 26—�— Sworn to lief me is C l
day of l l .20 day of (J G
5t�estttre of PropernY--t�vner S tare of l
Ga dL�l
etrioc Nttnee of er of Applicant
Notary Public Notary PuMeSHARI MELILLO
Mohammad Rahman Notary Public,State of New York
Commmton+r OIRA0032973 No.O1ME616OO63
Nowy Pdblio Suite of Now Yak Qualified in Westchester Count
tt ltsston FApiratton,01/1712029 Commission Expires January 29,2 y /
This application cntircty and must if
the legal owner(s)of the subject property.and the applicant of record in the spaces provided. Applications
not proptt:rly completed in its entirety and%or not properly signcd shztll be deemed null and void and will be
returned to the applicant_
C EE V E'I i Il
BU[LDMN ARTMENT 1 OF RY>
F
_ -S • oK R1 OCT 292025
l '
938 KFNC STREET RYF.BRt .NY ism
(914)9 -019_mal VILLAGE OF RYE BRGOK
BUILDIf�G UEPARl fViENT
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tifffffHfHfffffffflNflfffNff ffff�fNff����lfffffffNfNffffNffNffNfffffff ff��ffHffffflHffNfN
AFFIDAVIT OF COMPLIANCE
VRIAGE CODE 4216 f STORM SEWERS AND SANITARY SEWERS
ThIS k"--DAV2T MS: Emi+.AR TU WTAHIZED 5IQlAr.-M Or THE LEGAL PROM" OtAR AM M SUMIrTZI) AL41K
WITH ANY BUILDING OR Tl MOWN. PERKrT APPLICATION. ANY BUILDING OR FZZMUM FED= ABPI.ICATN
SUNUTTED WITBOUT TffiS COKPLZTBD AND BOIMIZED TMM WILL RZ RZ7== TO TIM A"WCA".
STATE OF NEW YOM COUNTY OF WESTCHESTER ) as:
.3, j..t L' ( ', ;r residing al. 20 COA(vf r i
Myinl aamo i ww ty-C)
being duly sworn,deposes and staters that (s)he is the applicant above P A arld further states that(s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
aw,v C) P�A ?'' Rye Brook,NY.
th,'4
Further that all statements contained herein are Z-iind 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 drauu, 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.
Sworn to before me this 26 tv,
day of 24 2�
troI tram110 AM4M
�pi�►'0�3
�r pmic Stale of New York
MyComn,issionExpirillm of/t7/2029
Building Permit Check List&Zoning Anal sis (/
Address: 504 1 1 CirCGF— SBL:
Zone:(A- -20 Use )AQ nst.Type 01 Other.
Submittal Date: 3l Z Re ' ions Submittal Dates:
Applicant:
Nature of W 1 N
`-- QaAoc-) CMG
Reviews:ZBA: NOV 12 2025 PB: OT: Other.
NEED OK cl
( FEES:Filing: ✓/O: Flood Plane: Legalization:
APP: Dated: Notarized: SBL: Thus 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.
( ) (4-'9URVEY:Dated: Current: Archival• Sealed: Unacceptable:
( ) ( ) PLANS:Date Stamped: Sealed: Copies: Electronic. Other.
License: Workers Comp: Liability:_JeL"Comp.Waiver. Other.
( ) ( ) CODE 753#: Dated: N/A:
(� WHIGH-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.
(,.YPLUMBING:Plans: Pen-nit: Nat.Gas: LP Gas: N/A/: Other.
( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other.
( ) ( ) H.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:
REQUIRED EXISTING PROPOSED NOTES 2025
Area: p ite NQV 1 Lu L
Circle:
Fie:
Front:
Front:
Sides:
Rear.
Main Cor.
Accs.Cov:
Ft.H Sb:
Sd.H Sb:
GFA:
Tot :
Ft.Imp:
Height/Stories:
notes:
---"MON EARTCON-01 M3IN_0H1
�Q. - • OE"''PICA-TE-OF:LIA-B4LtTY INgUMNCE �•� c�F�'�0�vr�".$
b1t�112626
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 INSURERIS).AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED.the poliey(lis)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the Polley,certain policies may require an endorsement A statement on
this certificate does not confer rights to the certificate holder in Neu of such endorsemonl4s)•
CONTAcT Michelle Singh
PROCUCER NAME_ ..—_ -
Acrisun Insurance Partners Servioea of NY,LLC jacNno E.tl (516)240-8816 FAX
90 S Ridge Street E MAI
Rye Brook,NY 10673 ADDRtSS mmurlOZ�aGriaYre.eOm
INSURER(SI AFFORDING COVERAGE N
INSURER A Selective Way Insurance Company 26301
INSuwFo INsuRER a SNective Inatuance CompaniM America 12572
Earthtek Contracting Corp INSURER
PO Box 146 INSURER D
Rye.NY 10680
-INSURER!
INSURER F
_COVERAGE$ CERTIFICATE NUMBER: REVISION_NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURAN;,E 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 REDJCED BY PAID CLAMS -
USSR - - ADDI 1{UaR IOLICY NUMBER EfF POLICY EXP UNITS _
.1S TYPE OF INSURANCE waD WYD �_YYYI taaa�tYYVYI- - --- ---- -
A X COMMERCIAL GENERAL LIABILITY FACHOCCLIRRFNCE S 2,000.000
CLAIMS MARL X UI:WP 1/1312026 1/13/202� DAMAGE TORFNTED 600,000
_ S Z _Pfix MISTS iF.�l S _
MED EXP Ar,one oerwnl f 16,000
PER$ChA4 8 AJy INJURY _1' _ _
_QLWL AGGRkf&Aff LNAT APPP PER -.._ GEN€RA�AG(iitEGATE f 4.000,000
POLICY X LUl PRODUCTS-COMPJOP AGG,S 4,000,000
OTHERCOMBINED
A AUTOMOBILEt1AEILITY )—E tIMR 1
_ANY AUTO _ 6 28i9N2 1 r13/2025 1113/2026 BOO-LY wJURY,Per PMw) f
OD HEDULED
AUTTOOS 014,Y X IU TOSS BODILY INJURY(Pr&CLAM ti $----
,{�p y��p PROPERTY DAMAGE
X AUTOS ONLY x WIR 011Y _Fer AG --- -----
A X UMMMuALIAe X OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS400E S 2936M2 111=026 1/13/2020 AGGREGATE f f.069,809
i -
_ _:)Lc) X ENTIONf 10,000 --- - - ----' - ------- f
B WORKERS COMPENSATION _X PR OT
STATDTE ERH_
-
AND EMPLOYERS'LIABILITY
VyC 9129i28 1113/2028 1/1312024 1,000,000
w-r r+t >✓ARThER1ExECUTIVE YIN EL EACH ACCIDENT f 1'�_
H Mf V--4 FRCL UDEO� MJA
i (Maw�aory n 1M11 F L DISEASE-EA EMPLOYEE S _
MCYSsCRIPTION OF aewO"N 1,000,000
� DESV«OPERATIONS teeter - E L DISEASE-POLICY LIMN' f
i
DES OPTON OF OPERATIONS r LOCATNXea I VEHICLES IAGOAD lO1.AeaR1eRY Relerae rNWAft,Nur be~Nod M Ieen e/ea a re*ree)
I
CEMV CAT%HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED N
Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS
938 King Street
Rye Brook.NY 10573 '—
AUTHORIZED REPRESENTATIVE
I
ACORD 25(2016103) O 1988-2016 ACORD CORPORATION. AN rlohls reserved.
The ACORD name and logo are registered marks of ACORD
Workers'
ratic CERTIFICATE OF
STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Board
I a.Legal Name&Address of Insured(use street address onh) I b.Business,rclephone Number of Insure
Farthtek Contracting Corp (914)879-6945
PO Box 145
Rye,NY 10580 1 c.NYS Unemployment Insurance Employer Registration Number of Insured
Work Location of Insured(Only required if coverage is specifically limited to I d Federal Employer Identification Number of Insured or Social Security
certain locations in New York State,i e,a Wrap-Up Policy) Number
81-4341423
2.Name and Address of Entih Requesting Proof of Coverage(Entity Being
Listed as the Certificate Bolder) 3a Name of Insurance Carrier
Selective Insurance Company of America
3b,Policy Number of Entity Listed in Box 1 a"
Village of Rye Brook WC 9126526
938 King Street
Rye Brook,NY 10573 3c Policy effective period to
1/13/2025-1/13/2026
3a The Proprietor.Partners,or Executive Officers are
Included.(Only check box if all partrers/oH-a ers 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 la"for workers'compensation
under the New York State Workers'Compensation Law.(To use this form.New l'ork(NY)most be listed under Item 3A on the
INFOILMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate
of Insurance to the entity listed above as the certificate holder in Fox"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 he 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 po lic} 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: Ronald Brunell
(Print name of authorized representatis c or licensed agent of insurance carrier)
1
Approved By: 06/24/2025
(Signature) (Date)
Title: Partner
llelephone Number of authorized representative or licensed agent of insurance carrier: 914-937-123o
Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-1115.2.Insurance brokers are\1
authorized to issue it.
00.2 0.2 (9-17) www.wcb.ny.gov
Tara Orlando
From: UDig NY Exactix<tickets@exactix.udigny.org>
Sent: Wednesday,November 12,2025 11:59 AM
To: Steven Fews
Subject: Message from UDig NY
****REGULAR****
DIG REQUEST from UDig NY for:VIL RYE BROOK Taken: 11/12/2025 11:58
To:VIL RYE BROOK PRIMARY Transmitted: 11/12/2025 11:59 00006
Ticket: 11125-000-906-00 Type: Regular Previous Ticket:
------------------------------------------------------------------------------
State:NY County:WESTCHESTER Place:RYE BROOK
Addr: From:20 To: Name: COUNTRY RIDGE CIR
Cross:From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate:ENTIRE FRONT OF THE PROPERTY
NearSt: COUNTRY RIDGE DR
Means of Excavation: MINI EXCAVATOR Blasting: N
Site marked with white:N
Boring/Directional Drilling.N
Within 25ft of Edge of Road:Y
Work Type:BACK FILL POOL
Estimated Work Complete Date: 12/15/2025 Depth of excavation:2 FEET Site dimensions:Length 40 FEET Width 2
FEET Start Date and Time: 11/17/2025 08:00 Must Start By: 12/02/2025
------------------------------------------------------------------------------
Contact Name: FRANK SANTORO
Company: EARTHTEK EXCAVATING
Addr1:PO BOX 145 Addr2:
City:RYE State:NY Zip: 10580
Phone: 914-879-6945 Fax:
Email: earthtekexc@gmail.com
Field Contact: FRANK SANTORO
Alt Phone: 914-879-6945 Email: earthtekexc@gtnA.com
Working for:MR GORDON
------------------------------------------------------------------------------
Comments:Lookup Type:PARCEL
------------------------------------------------------------------------------
Members:CON-ED SUEZ WTR WESTCHESTER
VIL RYE BROOK WESTCHESTER CTY SWR
1
42
J
00000"-
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LUILDI G INS
root, NY
Survey of property known as Lot 5 on a map
Q� y0 entitled, Section Thirteen, Subdivision Map, Country
• �-,A< �� A' S'°�y ��- Ridge Estates, Town of Rye, Westchester County,
t
Richard A. Spinelli �P F 9 Y Y�
650 Halstead Avenue * fir,,, �r New York". Filed with the County Clerk's Office on
Mamaroneck, N. Y. 10543 March 19, 1956, as Map No. 14134
(914) 381— 2357
N.Y.S. Lic. Land Surveyor �� 49240 Q� Scale 1 "= 20' Jul 26, 2019
No. 49240 y
��
January 14, 2020 (add spot grades only)
LAND S
March 25, 2024 (update)
July 1, 2025 (update)
E "COUNROCIRCLE"
0
4
Richard pinelli
650 Halstead Avenue
Mamaroneck, N. Y. 10543
(914) 381-2357
N.Y.S. Lic. Land Surveyor
No. 49240
rnUN�Y R\OGE C\RC�.E
DF NEW\
A.
49240
LANDS��
D.. 0
JAN 2 Z 2026
LAS-43U I it is'�� f:j .RT�A ENT
DQQIIMEUI.J
Survey of property known as Lot 5 on a map
entitled, "Section Thirteen, Subdivision Map, Country
Ridge Estates, Town of Rye, Westchester County,
New York". Filed with the County Clerk's Office on
March 19, 1956, as Map No. 14134
Scale 1 "=20' July 26, 2019
January 14, 2020 (add spot grades only)
March 25, 2024 (update)
July 1, 2025 (update)
January 14, 2026 (update)
C 77nr'11 r-»
L %-.vvivr\IUUlf\ULE