HomeMy WebLinkAbout1299 VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
Certificate of Occupaucp
This is to certify that CD /a,? 710 Lj v),n
Of, ale &-00'k I / V 7 , having duly filed an application on
14 7F 20 c-�2t� requesting a Certificate of Occupancy for the premises known as,
//L_ q li?iVrO< �'e , Rye Brook,NY, located in a Imo— Zoning
District and shown on the most current Tax Map as Section: 135•(D7 Block: <:;2 Lot:
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. IC2 L?C) , issued 913 19 4 5, such authority and permission is hereby granted
to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following
New York State Classifications,Use: )",3 'e � Construction:
for the following purposes:
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 building or in the exit facilities shall be made,and no enlargement,
whether by extending on any side or by increasing i ig t shall be ,nor s ll the building be moved from one location
to another until a permit to accomplish such chang as b ob In
f m th uilding Inspector.
MAY 2 9 2024
Building Inspector, Village of Rye Brook: Date:
DR �.
jai V W v
VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J.Bradbury
www.ryebrook.org
TRUSTEES BUILDING & FIRE INSPECTOR
Susan R.Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
May 29,2024
Colasanto Living Trust
21 Valley Terrace
Rye Brook,New York 10573
Re: 21 Valley Terrace,Rye Brook,New York 10573
Parcel ID#: 135.67-2-32
This document certifies that the work done under Mechanical Permit#24-056 issued on 4/30/2024 to legalize
the existing condenser has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
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FmAR2 7 2024 BUILD ���T PERMIT# /d y
I {r••
VIL
�4?D ,1 OK ISSUED:9
1 78 KING STRE
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.,
� VILLAGE OF RYE BROOK �:1���?.'� j( � 'YORK 10573 DATE:� -a 7-a�
BUILDING DEPARTMENT > O FEE:4� // U — PAIDA
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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
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Address: Z-i Va`le-j �{no1C, --
Occupancy/Use:) Fc4m)/ Parcel ID#:_ f 3St 67 —Z — 3 2 Zone: F-1
Owner: G o\CA,5 ci--.- zo L N vtvt Address: Z I Va 0-e�,j Tleri-Qce,
P.E./R.A. or Contractor: 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:
being duly swom,deposes and says that he/she resides at
(Print Name of Applicant) (No.and Strcct)
in in the County of in the State of ,that
(CilyiTowtt/Village)
he/site 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:S J�x--� , C 0
for the construction or alteration of. p a r
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 firrther understands that itshall be unlawful foran
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 die Code of the Village of Rye Brook.
Sworn to before me this Zk Sworn to before me this
day of (� ,201 day of 20
d�� c a �
Signature o0roperty Owner Signature of Applicant
AMV 0 iggat10 d1
Print N� Propen Owner Print Nnmc of Applicant
Notu I' Notary Public
sue_ P6 ` RISTEN RAY
Notary Public-State of Florida
3 12/ 021
A_ Commission#HH 12075S
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My Comm.Expires Apr 22,2025
�E BR(�k•
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1932 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: ' Y Gt.�l 1� ' C'N C 9 DATE: I Z 02 Y
PERMIT# `,% �\1 C JD1 ISSUED: `� �� SECT: BLOCK: LOT:
LOCATION: ���Q C��- �� OCCUPANCY:
❑ Violation Noted THE WORK IS... ] PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: "
.0" ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER -(�
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL L(71lS ` �LSi'l1SS�CS s �t-`x'��CSL �Q CZSI\Sra l rY
❑ OTHER
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BUILDING DEPAP4,,MENT ? MAR 2 6 2024
jD
VILLAGE OF RYE*_" K R
938 KING WMET RYE ID NY 10573 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
www: ore
ELECTRICAL PERMIT APPLICATION
Westchester C/ountyy Master IeMri is License Required
FOR OFFICE USE ON 1' BP 1f: �/ / -J 3 EP
Approval Date: �� �- Permit F err.•S _Approval Signature: Other;
DO NOT START WORK or CONSTRL•C'TION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR
THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED!L'ITHOUT A PERMIT IS 12/OF THE
TOTAL COST OF CONSTRUCTION WITH A MININWINI FEE OF 7-%.e()
r�
Application dated. ,7 016 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.
I.Addtess:,11 ?*e- IV 16-rZ79' SBL:_���,�e�'�I-30� Zone:/'07
2.Property Owner: Ira.Ca,1To L ttillvTNU!r Addressr_QpxarUle
Phone#: Cell#:t:FC- 9—&4,W email-
3.Master Electrician/Licensed ltsstaller.3-4 o_ Addresc:4SSDt�lY►Mt)t..t.rt SE f� l.Vl�l—C.'
Lic.#: -.Phone#. _Cell#: 0 a email: < _ p < tN
Company Name: A 1 Q� rt��nO Address:1 41 S�. OAT
4.Proposed Elecocal Work/Fixture Count:
5.3rd Party Electrical Inspection Agency: -�_
t#**#tA**##**fk it**irk**#a!#,tt*71t#tlFlflA33�tf*tAlf,t,txx+x��*te��r�e,t*tsa:xtate++rr+++rrt•.w,rs xaxst eke*ktrakr ke.t
STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as:
3exr`4 LQ..i�e do— .being duly sworn,deposes and states that he/she is the applicant above named,and dues further
t print name of nWi%,dual i nm�g�>�th,;�af ant t
state that(s)he is the�;JK/ �aty 1 ti ClLtn for the legal owner and is duly authorized to make and file this application,
%1a>tcrt-Wtr:.ian Li"m-dln.tallrn
The undersigned fwthcr states that at state
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.ordinance,and regulations.
Sworn to before me this AW6Swom to fore me this rJ(;M
day of __ .20am daY 20
Sign re of Property Ot nee i re of Applicant
Yrmt a of Pr Own 2--t275-
y 1�UNIC
Nciary Fublic State of Fro^d: 1013(12023
Freda Mae Thgrptr
1111 Mr Commission Mh
Expires 9/6/2026
Lft new*
MW PUNC,State Of New Yolk
Regl*atlon No.01 D14819030
Qualified in Westchester Cou
Commission Expires 07/31/20�
om
STATEWIDE •
Service With liztegrit-y
181 Main Street,Fishkill, NY 12524 1 email:office@swisny.com
SWIS JOBAPPLICATION84 12.7224 fax914.219.1062 • • •
Office Use Elect.Permit# Date
Bldg Permit
9 / ) Utility ID#
S�P�- 3, 96 s
Final Certificate#
City Village Zip TT
nship County ,
Address Cross Street Section Block Lqt
Owner Name/Address(if different than above) I, Contact Number
Basement r'Q�1 st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Ff. ❑Garage ❑Attic Outside AResidential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
+ Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage I 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
he. ►n'EfieQ_,66h 0;1 i- ID VI
ABC
2 6 2024
[FFMAR
iLLAGE OF ;RYE BROOK
UILDING DEPARTMENT 1
This application is valid for one(1)year from the date received by WAS.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 applicant declares that there is no open applications for the above address with arty other inspection company.The appl icant,owner
or aut odmd agent agrees to all the above terms and conditions as set forth for the application.
Inspector Date Finalized Inspector#
Company Name 1 f Date { Signature '
Address ; City/State - Zip Code
i
License# Phone# r
Dv State Wide Inspection Services
1080 Main Street
MAY — 6 2024 Fishkill, NY 12524
Tow' 845 202-7224 Phone
STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK 914e0a swi ny. Fax
BUILDING DEPARTMENT Email: officeCa�swisny.com
------DE - Website: www.swisny.com
Service With Integrity
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
La Bella Electric Inc. Arthur Colasanto Trustee
Jerry La Bella 21 Valley Terrace
145 South Main Street Rye Brook, NY 10573
Port Chester, NY 10573
Located at: 21 Valley Terrace, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP24-056
135.67 2
32
Certificate Number: 2024-2810 Building Permit Number: BP-1299
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: 21 Valley Terrace, Rye Brook, NY 10573
The Basement, First Floor, Bedrooms, Bathroom, and HVAC System was 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 3rd day of May 2024.
Name Quantity Rating Circuit Type
Receptacles 10
GFCI 02
Smoke Detectors 02
C/O Smoke Detectors 01
Luminaires 02
HVAC System 01
A Visual Inspection of existing conditions was performed on May 3`d 2024, of the Basement, First
Floor, Bedrooms, Bathroom,and HVAC System and Conforms to NFPA 70-2017 NEC. No Defects Were
Noted.
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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BUILPI �DE� MENT MAR 2 8 2024
VILt E OF RYEP , K VILLAGE OF RYE BROOK
938 Klrvd St ET RYE B ,NY 10573 BUILDING DEPARTMENT
w
PLUMBING PERMITAgPPPLICATION
FOR OFFICE ( SE ONLY BP d\\ / 7 PP#:
Approval Date: \�\� Permit Fee:S
Approval Signature: Disapproved:
ssssssssssssss�ssssssss�sss�ss�����ass�a��aRa�sas�asssa�ta�t�a�Rt��tos��a+tare eass4sflawlable) �ay�*»•
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE Bt'ILDING
INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PR RESSE OR COMPUTED W'ITfIOI'T \
PERMIT IS 12°/.OF THE TOTAL.COST OF 0 STRtiCTION WITH A MINIMl1M FEE OF S750.00
Application datedsta,11 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 descn-bed 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.
I.Address: �K�(c r'aDt• �U� �Ctf7� SBL:_�3J 1p�.—g�3c�
Zone:�_
?.Proposed Work:
3.Property Owner: Address:
Phone x: c cll#: f- �, _(�e 'y►i email
4.Master Plumber. Q n� r v �C.'N U, r n rl�¢-
Lic.#: Address:�1 �- '�t U 1�:'� �� + r'- (_
S Phone#: cell#�i I ,-✓y'i,°r+ , -
` v email: r:aMi. \�'
Company Name:?t y,vi \'� `!.• t �t>. � Address:
INDICATE FIXTURES At LINEST 1 `i
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic
I `•
Closets Fountains Tubs Tubs e
Basement Fi Natural/ Other- Total
Service Sa vor LP Gas
1 si Floor \ \
2nd Floor
3'Floor
4'Floor
5"Floor
Exterior
5. *List Other Equipinent/Provide Details:
(Notarized SiQrlaturea
Re4uisrd "at a
4-
VV202s
1TnTl OF NI--W YORK,COUNTY OF WESTC'HESTER
being duly sworn,deposes and states that he/she is the applicant above named,
r Arwr of w6vqiult�.rwc�r�cMr l
:md further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and rile this application.
That all statements contained herein arc true to the best of his/her knowledge and belief,and that any work performed,or use
conduc(ed 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 R Huilding('ode,the Code of the Village of Rye Brook and all other applicable lawn,ordinances and regulations.
Sworn to before me
this Swt. to beft c yne this J 9
J` day of-1!% � , 20 day of (' ,20 a
Signs c of Property Owner Signature of Applicant
�C' �'l�tHorr T►-tcsr'e, ''�C , s � c dPrnintNeofPrope Owner Print Name of Applicanttic _
N i ,State of New York
No.01ME6160063
Notary Public stag of Florida Qualified In Westchester County
Freda Mae Thorpe Commission Expires January 29,200
My.commission MH 309487
.ItBxpll93u�b6fD>��-uper 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-
r : ►or3p12023
3D
BUILDING-1111gPARTMENT MAR 2 8 2024
VILLAgE OF RYiNEIROOK
938 KING StAKET RYE BR60114.NY 10573 VILLAGE OF RYE BROOK
(9t4) $wr lr.or BUILDING DEPARTMENT
toftftaftlrww[ttarffasifflfrf+frfafaffftataffffiiifiiiiarrw►aaaalarwa►rfffaawwarrtaawaaarwwwwwwafwwwwaw
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:
21L.CD12Sailt'7 ti d i na Trwsl ,residing at, (lo Koyuul G 81t1 IJ-14 h I avld. uy 1�a8'
IPnni n.im.l U i Wdre
being duly 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;
.21 11 &&& 7' �L�T{r o�V /O,r't7 .Rye Brook.NY.
tJ b Addrr»t
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.
(Signature of'PrrPert, lhNner(,)I
- C. li'la.non I ,rast�G ---
(Print Nanteof Proper(,. 0,Atier(,)i
Sworn to before me this
dayePIl",
M , 20 02�
. sitar.
Notary Publlo stale of Florida z_
Frods Mae Thorpe
�lfl My Commlaslon HN 308487
Expires 9/e/2026
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D WE
VILLAGE OF RYE BROOK R I jD
BUILDING DEPARTMENT APR - 1 20241
938 KING STREET,RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 vw,rVebrook.orQ BUILD)NG DEPP RTf41E 1T
APPLICATION FOR PERMIT TO INSTALL MODIFY AND/OR
gP a S REMOVE MECHANICAL E UiPME T
OFFICE USE
!��Permit#: / 'O�CL Building Inspector:
Application Fee: nn Date of Approval:
Permit Fee:A� Bldg/Use Class:Res. O;Comm.( );
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 MINT M FEE
OF$750.00
REQUIREMENTS FOR RELEASE OF PERNIM (A CERTIFICATE OF COMPLIANCE is REQurRED TO CLOSE OITr THIS PERMIT
1.Properly Completed&Signed Application.
2.Payment of Application Fee: Residential=$100.00; Commercial=$250.00 Dees are non-refundable)
3. Site/Staging Plan as required by the Building Inspector.
4. Sealed Constructionfinstallation Documents&Specifications as required by the Building Inspector.
5.Copy of Licensed Contractor's Liability Insurance.(Village of Rye Brook must be listed as certificate holder)&.
Workers Compensation Insurance on a NYS Board form
(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver)
6.Payment of Permit Fee:
Residential =$18.00/1000.00 of Construction/Materials Cost with a minimum fee of S 100.00.
Commercial=$25.00/1000.00 of Construction/Materials Cost A7th a minimum fee of S275.00.
7. Inspection by Building Department for removal and/or installation. (48 hour nonce required)
8.Any electrical work requires a separate Electrical Permit and Electrical Inspection.
9.Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection.
Application dated, is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit
for the installation,modification,and/or removal of the specific Mechanical 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 the
approved plans,and with all applicable Local,County,State&Federal laws,codes,rules and regulations.
I.Address! ' 3 1 V41 I,e!j `rf2/t- • R B 1J Y /0S73 SBL:/3Si -a 3 Zone: /
2.Property Owner: Co 1 a c rs�a �i v i Ng C�sl' Address: I.
X 1G 120X 4A.1v 13l V P. gicti �ly % /t�So
Phone#: Cell'#: gyS- gyq-bb7l email:
DIV a Or
.r .,VQ
3.Contractor: f Y��,(', Address: -
Phone#:9/y—/35-pj/d Cell#: N l�
-ZLY-310 -YA16? email: F/75A UC S3 ",V r Coo
4.Scope of Work:New In Ilation( )•Re lacement( )•Removal( )•Other(�
5.Type of Equipment:
6. Location of Equipment:
7.Cost of Equipment including Installation Cost: S eqG�
r
M
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 legal owner of the property to which this application pertains,or that(s)he is the
(indicate architect,convector,agent,attorney,etc.) 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 W/7 Sworn to before me this `—
day of ,20 day of 20
Signature of Property Owner Signature of A scant
Y P-MaRaq, Tr�
Print N a of Property Owner Print Name of Applicant
No Public `
Notary Public
Notary Publle Statt,of Florida fntMes�t>
Freda Mae Thorpe
My Cornmlaalon MH 309417
T atldmtpli MSMItKPftper-I completed in its entirety and must include the notarized signature(s) of the
1 a o e s o e su ject 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 1 W3012023
.a�oizo� CERTIFICATE OF LIABILITY INSURANCE DATE(MMroomrY)
02/27/2024
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 endorsements.
PRODUCER CONTACT Gia Barletta
NAME:
OeChrlstopher Keating Insurance Agency Corp PHONEEat, (914)737.1259 FAX Ne: (914)737-1273
1099 North Division Street EMAIL ADDRESS: infoaplrutuancedk.com
INSURERS AFFORDING COVE RAGE NAICN
PEEKSKILL NY 1056&5816 INSURER A: Utica First Ins CO 15326
INSURED
INSURER B
Benny Baldo INSURER C: _
DBA Ben's HVAC Service INSURER D:
222 Mortimer St INSURER E
Port Chester NY 10573-3113 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 POLICY EFF POLICY EXP
TR TYPE OFINSURANCE POLICYNUMBER DrfYYY) (MWDDNYYYI LIMITS
x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
CLANS-MADE O OCCUR DAMAGE TO TED
PREMISES(E occurrence) S 50.000
MED EXP(Any one person) S 1,000
A X ART3000251390 06/06/2023 06/06/2024 PERSONAL is ADV INJURY S 1,000,000
GENL AGGREGATE LIMITAPPLIES PER: I GENERAL AGGREGATE S 2.000,000
X POLICY n LOC S 2,000,000jE�
OTHER 5
AUTOMOSILELIABILITY COM13INED SINGLE LIMIT
(Ea awdenit S
ANY AUTO BODILY INJURY(Per param) S
OWNED SCHEDULED AUTOS ONLY AUTOS cd BODILY INJURY(Par adaM) S
HIRED NON•OWNEO PROPERTY DAMAGE S
AUTOS ONLY AUTOS ONLY (For acd 1
$
UMBRELLA LIAR OCCUR I EACH OCCURRENCE S
EXCESS LIAR HCLAIMS-MADE AGGREGATE S
DED RETENTIONS $
WORKERS COMPENSATION OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANYPROPRIETORIPARTNCRIEXLCUTIVE [:] NIA E.L.EACH ACCIDENT S
OFFICERIMEMBFR EXCLUDm7
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S
If yas,desuibe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD tot,Additional Remafks Schedule,may be attached If more space Is required)
AIR CONDITIONING/HEATING SERVICES.
EXCLUDES ROOFING,EIFS,SNOW REMOVAL.
certificate holder Is additional insured.
CERTIFICATE HOLDER CANCELLATION
Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
938 Kin St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g ACCORDANCE WITH THE POLICY PROVISIONS.
Rye Brook NY 10573 AUTHORLUO REPRESENTATIVE
Richard Saraceno
01983-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
NYSIF
New York State Insurance Fund PO Box 66699.Albany,NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
AAAAAA 421748402
DECHRISTOPHER-KEATING
INSURANCE AGENCY CORP
[ME
1099 N DIVISION ST � t
PEEKSKILL NY 10566 SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
BENNY BALDO DBA BEN'S HVAC SERVICE VILLAGE OF RYE BROOK
222 MORTIMER ST 938 KING ST
PORTCHESTER NY 10573 RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2376 963-1 354727 11/25/2023 TO 11/25/2024 2/27/2024
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2376 963-1. 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:/NVWW.NYSIF.COMICERT/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 THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY,
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.
NEW YORK STAT SUR NCE FUND
�Y l/
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER:240542460
U-26.3
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