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HomeMy WebLinkAboutRB25-0079 1.0 M c N n 0� N c a O � O L a N a) r 0 � � M 4, Z a) w Y Q E a c .C: c 0 v 'n y c Y O0 v au E CL m a•N L v E O O N >` E o v moo N o as v I*-� v m — '^ y Q E •M LU > .� 2 � c m Q L M CC -0 N a d o coZ w m a; " Q X w o a o w ou y > cn O > o ` er ar � a Q a-I M n LU u_ ^ ems Z N C: w � t Y 7 0 LLI ° N F Y� 3C4 O - °u sv -MMv> c N QOQ N CY) O � C aoYWo N LU or3 0E � O C O Y Ul) Y $ voco ZGOC � cu am ov $ vvv v y ac a i -i W i L J V) E o o E o ai c - o m � J t - Q ,a Y W — E �W 00 O Z CA u CA O c > OWaO a = N UQ pc o cE � a O N CL a Y .0 a� v m N v W (' O� JN Z0 3 LLI i 0 0 c CL Z Cl)O` O > > C y 3 �, ++ v � YV ° a w0 oou o � u�, Lu LL Co e-1 a) CO o w v E L O co O, m e CL w, Z o e Lu L M N CL ai I 'p a� O ^ 0 y c c y 'c U1 O G W y Q E E -. E _ z > = > UmC) a t CL' O Z r+ o 4� O LU >- � � Y a=+ c a co L O a s Ear 0 � ^O O n 3 c� Zm NOU Viz ' 3m O � .L -p O u = QD x v v OI N N a +� c0 HQ c � o c Qy In ¢ Q J L(1 CL� r-I (y o o o m � a g -04) n .. o a W o o a '� V u � � v � � o � o � � r- N�wYa 000 _ � v Q * > E CU -8 > E � Gto W J�N ~ N O a} '� o a� aci cJ 'cC a, W W O E , u co Q V H N a`r .� a uu �d W 0 < > > T yQD9d��\C d Q �a a 2LAF- v � o 44 R Y. Exterior Building Permit Application Village of Rye Brook 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Property Information Property Address: Property Owner Name: 1200 King St Atria Assisted Living Exterior Building Permit Application,page 1/3 Project Information Zone N.Y. State Construction Classification N.Y. State Use Classification Occupancy Pre-Construction PUD AL Occupancy Post-Construction AL Proposed Improvement Re Do front sidewalks and curbs, reconfigure ADA accessible parking spots to add 3 more. Must comply with signage and spacing to code. Area of lot Dimensions from proposed building or structure to lot lines Lot Square Feet 50000.0 sq.ft. Front Yard Acres 0 Rear Yard Right Side Yard Left Side Yard Other Is building located on corner lot? ❑ YES 0 NO Area of Total Square Footage of the For additions, Total Square Footage of the proposed proposed new construction: total square proposed renovation to the building in footage added existing structure: square feet(0 if (0 if N/A) N/A) 00 Basement 0.0. Basement q' sq.ft. 0.0 1st Floor 0.0 1st Floor sq.ft. sq.ft. 0 0 2nd Floor 0.0 2nd Floor q' sq.ft. 0.0 3rd Floor 0.0 3rd Floor sq.ft. sq.ft. Construction Type Located Number of stories Overall Height Median Height Basement Basement ❑ Full ❑ Partial 0 N/A © Finished Unfinished ❑ N/A What material is the exterior finish? Roof style Roofing material What system of heating Exterior Building Permit Application,page 2/3 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 0 No 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 0 No Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? ❑ Yes 0 No Will the proposed project require a Steep Slopes Permit as per§213 of Village Code? ❑ Yes 0 No Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? ❑ Yes 0 No Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? ❑ Yes 0 No .Will the proposed project require a Tree Removal Permit as per§235 of Village Code? ❑ Yes 0 No Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? ❑ Yes 0 No What is the total estimated cost of construction: Note:estimated cost shall include all site improvements, labor, 35000 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 11/21/2025 Exterior Building Permit Application,page 3/3 o��y BR VILLAGE VILLAGE OF RYE BROOK ■ ■ 938 King St Rye Brook,NY 10573 YE Q Phone:(914)939-0668 1 www.ryebrook gov t ��• 02• t Building Department Commercial/Exterior(New) Permit Permit Set 1200 KING ST P#RB25-0079 R#124.73-1-1 PERMIT INFORMATION Address Permit number Date issued 1200 KING ST RB25-0079 10/23/2025 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 Cover page 1 Building Permit 2 Required Inspections 3 Site plan 4-5 Application Materials 6-11 Exterior Building Permit Application 12-14 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 1�0 BR040 VILLAGE OF RYE BROOK k(T�� ti 938 King St Rye Brook,NY 10573 W Q fE Phone:(914)939-0668 1 www.ryebrook.gov > �O ��. Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURI NG THAT ALL REQU IRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE L a� REQUIRED INSPECTIONS Name Description 161ow uj cr HIM 99, 9. , !io i""��;!}iiiiiii� IA — i,Iti �,l!_ .�.iiti IL.-_� , • ii! 9_ 1 Z tii ir fill, I }'� is ii� i i d 3 s k � i Az 3F let qi li?EQy t�It1Ip`� Iig!4 �i 4 ���} i tr�a}j=ti•�r � g �%I}!�tiIl l�is 5 Ift larF^G��i � � l fill¢ o;la ,� � �� i•!it i- ; 1 ail 11i'M g s a} fit'"3l !; s} INp10 � t'i jtm � ,� } A�jl aP €d. i3E i# Elit III, i ;� W o©J I M °• j3 ## r ° i {� f {� �a• lFi I �13 - { �{p { +d a7 a� t ��t �. �d ^} 9j �; ! � I , �j - t F t • �t °1 1 �6 e� i ' III 9 i j��t { , t � I j777I' 1 t• t j I g II77 F I• , j j� , $ flI jj77 s 1 f�f fis fI ij }} # ii = � # } # I! ' 1}•• � ;� ' it , } # } } } f� , , i• SiiE {1 lj ; is = • , _ ,° 1 { t �l' I t }t };I r, �, 1i�3 � q�i IM I�Iii}� 9 �I 7�` ipp�p�ngg1ly� 1' ssss i '� };� pfi �bi�` fi;� � � msii� �{ ii �. _ A «t} « .. .ri g %1 }i It _s ..m ^�1 Il�J'Fr 9 �-,.ffiQ•f8 yt� �� K 6 b f i g it l M1 toes...A _ 8 \ Ll lih iON , b fill _ t, r------------ it I --' / �. --� — — ----- ------J L -- -- ' j r t r ■ �ii ■ , ----- -------- ter'■\\V"� '3 to I Mu LL� s �s e' a BUILDING DEPARTMENT VILLAGE OF RYi'ROOK 938 KING STREET RYE BRM114,NY 10573 (914)939-0649 www�rySbrUokny.¢ov 1-01t ill l It i. I `f O\IA: Appro%al Date: Pelmil 0 Application# _ approval Signature: : ARCHITECTURAL REVIEW BOARD: Ui.appr„�cd: : Date: BOT Approval Date: cue# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: Permit Fees: ....................so*.......*see.............................(...........................u•............. EXTERIOR BUILDING PERMIT APPLICATION Application dated: is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. I. JobAddress: Sao o kk.nC W�( tO 5 7 3 2. Parcel[D#: Zone: 3. Proposed Improvement(Describe in detail): 0.tgt,Gg- e 4a caV.,. y ,5.4,sk..nj -! (�. �C QS� cor+cr+'c�rt, •-�J t n�tk a' ('c,b� f�i _ Qv�_�s.. tkii•.`+. A.✓(�.'.. I.s} f` �w 0111/t `��-cicwn••tPl�a,. 4. Property Owner. Address: Phone# Ccll# email List All Other Properties Owned in Rye Brook: Applicant_ Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer. Address: Phone# Cell# n e-mail General Contractor: ��c t:t✓J,. Gh fQ f SC& 4.A t-- ! 0? So" �+ ♦vi�L• Address: X I S ..AL--a(A N-0 O c e,N e:J t 1 7 Phone#Slfa-GOY•Oyt 1 Cell# 5 16-C44'u7 3 3 e-mail C.ow. ll) 61112024 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also 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 NENW 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 legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect.contractor.agent.atuttne%.etc 1 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 am 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 signing 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 for sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this t" Swom to before me this day of , 20 � day of . 20 4,W,, Signature of Propem Owner Signature of Applicant Z_ iti3,�- ftU� Print Name of Property OHner Print Name of Applicant Notan Public Notan Public (x) 6/I/2024 A��® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/17/2025 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 CONTNAME HOWARD HOWARD M LANE PHONE 845- -8801 FAX HOWARD M LANE PHC,No,E4S) 738 (MC.N.t: e45-395-0011 EMAIL PO BOX 1014 ADDRESS. H4hhiandmillsoffice@american-national.com 500 ROUTE 32 INSUREII AFFORDING COVERAGE NAIL• HIGHLAND MILLS NY 10930 INa11R®tA: UNITED FARM FAMILY INSURANCE CO 29963 INSURED AIMIIREItB; FARM FAMILY CASUALTY INSURANCE CO 13803 A ACCARDI ENTERPRISES INC NMRMiRC: _ DBA A-TOP ASPHALT PAVING Nip; 2641 SOUTHARD AVE INSURER1: Oceanside NY 11572 WSURERF: 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 - ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I TVPEOF INSURANCE AI POLICY NUMBER MD MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY X X 3102X8788 2/28/25 2/28/26 EACH OCCURRENCE $ 1,000.000 4—�- DAMAGE TO REN _ CLAIMSMADE X OCCUR PREMISES_(Ea occurrence) $ 100,000 X SELECT 13USINESS PCKG MED EXP(Any am person) III _ 5,000 PERSONAL 6 ADV NJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L`II jE T Ii LOC PRODUCTS-COMP/OP AOG S _..._ 2,000,000 OTHER: $ A AUTOMOBILELIABILIrY 3102C2085 2/28/25 2/28128 AA soa�o SINGLE LIMITl _ { 1,000,000 ANY AUTO iBODILY INJURY(Per person) S OWNED SCHEDULED l ce i BODILY INJURY(Per aWent) f AUTOS ONLY X AUTOS X - HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY _ f $ B UMBRELLA LIAR X OCCUR X X 13101 E6294 2/28/25 2/28/26 EAdtOCCURRENCE : 1,000,000 EXCESS WB _.. CWMS44ADE AGGREGATE----- S 1,000,000 DED X i RETENTIONS 10.000 S A WORKERS COMPENSATION 13104WB776 06/01/25 06/01,26 AND EMPLOYERS'LIABILITY YIN X TATUTE _- ANYPROPRIETORIPARTNEP-FXECUT,VF EL EACH ACCIDENT S 1,000,000 OFFICFRMEMBEREXCLUOED� Y❑ MIA ---- (Mandatory In NH) E L DISEASE-EA EMPLOYEE S 1,000,000 M yec deVeunder -- DESCRIPTION OF OPERATION$txtow E.L.DISEASE-POLICY LIMIT S 1 000 000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.AddMonal Remarks Schedule,may ha attached If mom spa")s re cared( VILLAGE OF RYE BROOK is listed as additional insured. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Y"oaK Workers' CERTIFICATE OF sTATe Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board I Legal Name 8 Address of Insured(use street address only) 1b Business Telephone Number of Insured 516-608-0442 A ACCARDI ENTERPRISES INC A-TOP ASPHALT PAVING 2641 SOUTHARD AVE 1c NYS Unemployment Insurance Employer Registration Number of OCEANSIDE NY 11572-1528 Insured Work Location of Insured fOnly required if coverage is specifically limited to 1d Federal Employer Identification Number of Insured or Social Security certain locations in New York State i e a Wrap-Up Pobcyi Number 20-4530646 2 Name and Address of Entity Requesting Proof of Coverage 3a Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) UFFIC VILLAGE OF RYE BROOK 938 KING STREET 3b Policy Number of Entity Listed in Box"1a" 31041 J8776 RYE BROOK,NY 10573 3c Policy effective period 06101/25 to 06101/26 3d The Proorietor Partners or Executive Officers are Included (Only check bcx if all partners'officers ncluded. 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 entity 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 mall I 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 HOWARD M.LANE )Print name cf authorized representative cr I-ensed agent of insurance carrier) Approved by 410117/2-5- Sgrat�ra (Date) Title AGENT Telephone Number of authorized representative or licensed agent of insurance carrier 845-738-8801 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www wcb ny gov