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Home My WebLink AboutBP21-035PERMIT # SECTION TYPE OF WORK 1�3 OWN CON7RACTOf� EST. COST �C4 #� O VQT% O /) C�O�� ,. . � . �z•� ��C � y Se�eZQ TCO # FEE DATE ... .- ......_._ ��i•1:1! {NSP FpOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBINnG GAS SPRINKLER � � ELECTRIC LpW.VOLT Q Ak-ARM AS QUILT 0 � r FINAL � r - " � !)1s93 - a 7�0 �9iy)�a7-os�o8 �/_ J�s��rei�S OTNI=R APPROVALS FIRS BOT �� z�A C�TNER VILLAGE OF RTE BROOK WESTCHESTER COU , NEW YORK NO: 22-163 Certificate of ®ccupacucp . 1 This is to certify that of, 9VC-. NY htor , having duly filed an application on QC]�) 7, 20_,2a requesting a Certificate of Occupancy for the premises known as, C1a! c , Rye Brook,NY, located in a K—Ja Zoning District and shown on the most current Tax Map as Section: 65,5 Q Block: ) Lot: 50 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - , issued a 20 ;2 1, 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: i2- /; y Construction: /� l L for the following purposes: l_��Vt0✓� %Y C��S� 'T Q ,4iree_ 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 in hei ht sh be made,nor shall the building be moved from one location to another until a permit to accomplish such change has a ob a ]ding Inspector. Building Inspector,Village of Rye Brook: � Date: NOV - 12022 U For office use onl : BUILDING DEPARTMENT PERMIT# -�3� OCT ZO22 VILLAGE OF RYE BROOK ISSUED: - -3/ 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: -if //0— PAID0 BUILDING DEPARTMENT www.aebrook.org 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 ■tr►r►twwr►r►•►r►►■•tttrr►►►►t►rut►ttr►rr►r►►►►►►tt•trtrt►ttwl►n►►►•►►►rtrrr►rtwtt►rrtr►ttttttrwwwwrr►►►►►►trrwtwtwrr►r►►r►ttrret Address: Occupancy/Use: I F,4,44 Parcel ID#: 7C) -' - sCD /r Zone: c Owner: Iy A M l M- 4- &P-1 S.Asso W I� Address: s PQ kS/c�5 OE LA)• 9YE 139ePK-A 7 P.E./R.A. or Contractor: RISC' /2E V 0V ))QeJ C09PAddress:/oN 1 AQ�7-64D * 6710 Person in responsible charge: �V '! Ce � Address: A)ElzI So J IJ. 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: (- I tl l u.S)U w4 being duly swom,deposes and says that he/she resides at 7 (Print Name of Applicant) 1/� / c (No.and Street) in i `f e " ✓L V[. 1�-- ,in the County of t/)' in the State of that (City/Town/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:$ 7 000 , O U for the construction or alteration of. C 0—3 J PEA , 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 1 1'0 Sworn to before me this 2 day of U ,20 LZ day of /G� i , 20 2 Sign a of perty c r c ignattue of o Prin ame of Property Owner t Nam of Applicant Pr'7 o Frances Sena ° NOTARY PUBLIC.STATE OF NEW YORK Registration No.02SE6313883 ANA M SALAZAR 8/12/2021 Qualified in Westchester County NOTARY PUBLIC.STATE OF NEW YORK Commission Expires 1 0/2 712 02ZZ Registration No.01SA6365173 Qualitcd in Westchester County Commission Expires 10.02.2025 o`` tim cu � 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT 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 : C�V lG ��C � �� DATE: )'J 2(" PERMIT#_ I [�/ O�� ISSUED:_=�� ECT: - B K:�LOT: V LOCATION: CCUPANCY• ❑ VIOLATION NOTED THE WORK IS... �AcCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION i REQUIRED ❑ FOOTING w Y--,C)` I ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Q FINAL ❑ OTHER E BRCv�. 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK rJ CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : J� `� T DATE: 2 PERMIT# I ISSUED: �� 'SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Ef ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING w ' ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: . ROUGH PLUMBING ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER <h 01 r•1 1 •„ N ;v N (4 O N O,C Cie �a = Qs � ICI O U � ..� NCD c Q ZO O LZz' N W NO g � F W a w w R Qr w 5 Q W 3 � � , co�G 0 A w � � � o O o s� ; s � � z c Q W �o > C m 00 w .. z M � w 3 a sA � OG v� W ac a z F o o f F- C/� C z 0 � G LWI Q � t=r, U w z C. w Z U G Q OC •• O W a W CO C, .4 rz., Mi W, = �EBRCv SCENE BUIIL MENT VIL OK JUL 3 0 2021 938 KINo' fiT` NY 10573 (914)Sill 939-5801 VILLAGE OF RYE BROOK org I BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: �� 03.5- EP#: cnx—/ 93 Approval Date: A U G - 2021 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, 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. The applicant & property owner, by signing this document agree that all electrical work performed will be in cogformance with all applicable Federal, State,County and Local Codes. 111.Address: 5f SeS o 4?— k%x -r— SBL: W i 5D` i — S( Zone: A—/c 2.Property Owner: D�6'6 S SOWN — 1%16 Address: Vj7 "D rSe-slXo a % qy%,e Phone#: `Z D I- 69 2) 2? '7 O' Cell#: email: `I 3.Master Electrician: �JIS A • tN 1p Y\OYI• Address: t.0 1{00X Lic.#: I S 1 Phone#: rr 11 Cell A4•'703 EOq tf email:�p r�iw�r a� ova 1,00k.t��yv1 Company Name: " k 1V (OWQX �Jl eAc, > L Address: .'O 100k \jU1I i.At\C-t N4 , 1 O su 4.Proposed Electrical Work/Fixture Count: Y\q YINJ 11 &ynn vv\ 1 vie , 2 G tz . 2 C-:F 4JNtA OAA A L e-c1,a � . ls ,, STATE OF W YORK,COUNTY OF WESTCHESTER ) as: o dlClir� being duly swom,deposes and states that he/she is the applicant above n ed,and does further (print name of individual sigdng as the applicant) �' f state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the U CI Y1 . for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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 befo e me this day of ,20 day o J014 20 Signature of Property Owner Signature of Applicant 11 S &L i Print Name of Property Owner Print Name of Applicant Notary Public otary Publ c ALEXANDRA H.MARSHALL Notary Public,State of New York No.01FR6363T11 Qualified In Westchester County Commission Expires August 28,20a5 3/21/19 STATEWIDE • Service With bitegrity 1080 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOB APPLICATION tel845.202.7224 I fax 914.219.1062 1 SWISNY.com I SWISTraining.com Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1 st Fl. ❑2nd FI. ❑3rd Fl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑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 1P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information D [EC�EN JUL 3 0 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 applicant 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. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 a 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: M&JP Power Inc. Damian& Kori Sassower Luis Estupinan 5 Horseshoe Lane 134 3rd St. Rye Brook, NY 10573 Verplanck, NY 10596 Located at:5 Horseshoe Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 21-193 135.50 50 Certificate Number: 2021-3828 Building Permit Number: BP 21-035 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: 5 Horseshoe Lane, Rye Brook, NY 10573 The Second Floor Bathroom 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 10th day of November 2021. Name Quantity Rating Circuit Type GFCI 02 AFCI 01 Switches 03 Luminaires 04 ,. � - 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. in N �-i ooc ' c NIT 46 Essssl w OC • O �.r t� w � M � � F i r o Q =. � m S < 0 r p w od C F. i CO O > N_ W r A W6 N o z N �v U i isss oc Z z Q M w 3 � � O v u prc 9 a LN ° F. x J F v o dso �i _ 41424 vattotlt +A.4tat,t4144s4;4f4. t;CAA ECENE D BUILDING DEPARTMENT AUG -2 2Q21 VILLAGE OF RYE BROOK 938 KING�TREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-,QW6 �AX(9j4)939-5801 BUILDING DEPARTMENT 1 wW } ' -OA.org PLUMBING PERMITT APPLICATION FOR OFFICE USE ONLY BP#: 0/—O3J PP#: Approval Date: AUG — 3 Permit Fee: $ /C=1 Approval Signature: Other: Disapproved: (fees are non-refundable) *** ****** ************************************************************************************** App icatton dated, ?L,'et AA, 6sc^,jyhereby 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 described 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. 1. 7y,Q��Address: � / S!r` /- � ^ Af} SBL: 135SO 15-0 Zone: #Q-ia.. 2.Proposed Work: �ac�Gf l �b12 �,� c3A T�f{Zih 3.Property Owner: Mc)D l' S S D(,J:2 Address: Syt-M I- Phone#: Cell#: COI-6 93—c-)77a email: J 4.Master Plumber: /�t Wzge A /�f��Gi¢u�G Address: yO �u tr Q1i /�i¢'eoPA L /U Y Lic.#: I o s I /ye2Y Phone#: g/y-5 3S-03 8`y Cell#: email: Company Name: . Ti¢S P�/� Address: 2 Y7/ PW", C/7,sR..?t,4f d r- P INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor ' 3 Floor 419 Floor 5 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ate; 4�Sc%+-c 'eori ,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 -n t r-s EA— for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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 �► '2Q Sworn to before me this day of 4LIS 1 20 day of ' 209, i SIgnature of Prop Owner Sig7nTtdW of pplicant g&-C PrIame of Property Owner Not l b1NNE ROTAS Print Name of Applicant Stat No,01RO610 Of Now Yorit Quel4d In MY Commlaait wstcheeter County N ary Public A'P'rr"411y23,2025 o�AA *blic, State of New York No. 01 ME6160063 Qualified in Westchester County Commission Exnires,Januar,29 2023 This application must be properly 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- 3/21/19 p EC IEEE BUILDING DEPARTMENT AUG - 2 2021 ID VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)93 b 39-5801 BUILDING DEPARTMENT 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 YOM COUNTY OF WESTCHESTER ) as: residing at, 5 ✓ �' �_ �� (Print name),, (Address where you live) 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; '6"�— 1A vl'o , ?� /'� (fS Rye Brook,NY. (JA Address 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 Property Owner(s)) (Print Name of Property Owner(s)) �D Sworn to before me this day of -P�J'L J S 1 , 20 Z 1 (Notary Pubhc) Anthony Bozeat Notary Public of New York I.D.01BO6417066 -3- COMMISSION EXPIRES 05/03/2025 3/21/19 Building Permit Check List&Zoning Analysis Address: 40a� S t4-o F t_� SBL: i 3 S'-, �D — 1 - S'J Zone:2 - t 'Z -Use: Z a Const.Type: Other. Submittal Date: Z IZZ I Z( Revisions Submittal Dates: Applicant: S A.C S A w'E- . Nature of Work. CO ti u F-X,-; 2^' C-E- C�s F-Z A L Reviews:ZBA: F E B 2 2 2021 PB: BOT: Other. OK ( ) FEES:Filing. 7S- BP: # 3 7S 4 c/o: Legalization APP: Dated: ✓ Notarized: ✓SBL: -runs 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. ( ) F(KPS. Y:Dated: 5urrena Archival• Sealed: Unacceptable: ( ) Date ed Sealed Copies: Electronic: Other A Workers Comp:s�Liability ��Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (_Y ( ) HIGH-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. PLUMBING:Plans: Permit: 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: APPROVED A REOL ED EXISTING PROPOSED NOTES F E B 2 2 70?1 Cir : Fr n Front Front: Sides: sr. Main Cov Accs.Cov F HS : S&H/S : Tot Imp: EL IMP: Height/Stories. notes: Laura Petersen From: Laura Petersen Sent: Tuesday, February 23, 2021 11:41 AM To: KORI.SASSOWER@COMPASS.COM Subject: Building Permit Application - 5 Horseshoe Lane The building permit application has been approved by the Building Inspector, before I can issue the building permit the following items must be submitted to our office, v1. General contractor's contact name & phone number. j6d1 91 y-9 q3 1ply 3 a Copy of general contractor's valid Westchester County Home Improvement License. v#1. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) +/� General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) Vt. Estimated cost of construction to determine the building permit fee ($15.00 per $1,000.00) (due once permit is issued and ready for pick-up) This information can be emailed to me. 4 3 7 5-4 e. Thank you and have a good day! Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax (914)939-5801 1 Ipetersenervebrook.org 1 ^'• ��1 l hl i�N�%�'� r, flN��111� 'Arc'�cr,��N��Ij�',�ti4' ��, � � o N :1'• 2 o L.] H C1 ` co iti •am :J P '•� CL p o > c ection r O O } v �` 06 w Y c z � • N 72 4.0 ;. to \ ''ram ° � w � � > .��'_ ••' cc CO ZV � y1�/1 rr \ WAhf.111 1-lot All �....►� ,ll,.�d 'k�1.� (rla�1 .�.• r+v d� 1 �J A '1��yd/• A '/� ,( ACO' CERTIFICATE OF LIABILITY INSURANCE DATE IMM GC +�Y 2i182020 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 CONTACT Janet DiGennaro NAME. BNC Insurance Age- PHONE (914)937-1230 'AC',.) (914)93%-1124 90 South Ridge Street E-MAIL Idl nnaro bnca en corn ADDRESS. g CY INSURER(S)AFFORDING COVERAGE NAIC■ Rye Brook NY 105-3 INSURERA Southwest Marine and General Ins Cc INSURED INSURER B Merchants Mutual Insurance Company 23329 The War)arn Group.Ltd INSURER C 4 West Red Oak Lane INSURER D Suite 325 INSURER E WH'te Pla-ns NY 10604 INSURER F COVERAGES CERTIFICATE NUMBER: CL208597632 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 LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER MM/D POLICY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000 000 CLAIMS-MADE ®OCCUR PREMISESEsocoorence 5 100.000 MED EXP(Any one person $ 5,000 A Y GL202ORLH00394 08/10/2020 08,1012021 PERSONAL 6ADVINJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2.000000 POLICY ®ECT PRO. F LOC PRODUCTS-COMP;OPAGG S 2000.000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 1 000 000 Ea scawM ' - BODILY:INJURY:Per Dersoni 5 B 0eINEr SCHEDULED CAP1043756 07192020 07'19,2021 BODILY NJLRY,Pw amoenP $ A_T05'• AUTOS HIRED X NON-OAMED PRO R DAMAGE AJTOS C`._� AUTOS ONLY Per $ c UMBRELLA LIAB OCCUR EACH(CCLRPP.:E S EXCESS LIAR HCLAIMS-MADE AGGREGATE 5 DED I I RETENT ON S S WORKERS COMPENSATION PER STATUTE ERTH AND EMPLOYERS LUIBIUTY Y/N ANY PROPRIETOR.'PARTNER/EXECUTIVE ❑ NIA EL EACH ACCIDENT S OFFICER,MEMBER EXCLUDEDI (Mandatory In NH) EL DISEASE EA EMPLOYEE S If yes describe under DESCRIPTION Oc OPERATIONS bakm E L DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Scheauie may be attached if more space is•equiredl V age of Rye Brook is included as Additiona!Insured as required for licenses and Der^-'cs CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook N't 1 c 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY. 10TH FLOOR WHITE PLAINS,NY 106014411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "^^^^^ 204330959 BNC INSURANCE AGENCY 90 S RIDGE ST . RYE BROOK NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER THE WARJAM GROUP LTD VILLAGE OF RYE BROOK 4 WEST RED OAK LN SUITE 325 938 KING STREET WHITE PLAINS NY 10604 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1435 362-7 843322 10/15/2020 TO 10/15/2021 12/18/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 1435 362-7 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 POLICYHOLDERS 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:INVWW.NYSIF.COM/CERT/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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION WILLIAM RIEHL-PRESIDENT THE WARJAM GROUP LTD ONE PERSON CORPORATION 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 STATE INSURANCE FUND DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER. 571149938 U-26 3 Laura Petersen From: Laura Petersen Sent: Friday,July 23, 2021 4:11 PM To: Kori Sassower Subject: RE: 5 Horseshoe Lane, Rye Brook change of contractor Hi Ms. Sassower, Thank you for the email. At your earliest convenience, please send the following items for your new contractor Rise Renovation Corp, V/1. General contractor's contact name & phone number. /�-�-�n y � e— V Copy of general contractor's valid Westchester County Home Improvement License. �. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) /4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) Thank you and have a nice weekend! Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 1 Ioetersenaryebrook.org From: Kori Sassower<kori.sassower@compass.com> Sent:Thursday,July 22, 2021 3:44 PM To: Laura Petersen<LPetersen@ryebrook.org>;Tara Gerardi<tgerardi@ryebrook.org> Subject: 5 Horseshoe Lane, Rye Brook change of contractor Please be advised that we have switched contractors from Warjam to Rise Renovation Corp for our bathroom addition. Let me know if you need additional information. best, kori sassower i.r u ILI r � W •� C:) Zi X CD Cj OD LU � CD WIlk i Q 0 z > Q v 4 s O ay ' AN � N O > O w -� . _ _ .b : > r..c ;�w . Qj •b ■.r I�TI to V -'••� ICI P" y OJ 0 . C" V O r • . »a fii a 'n W 3 N N 00 ZZ, <lv> 3 -• -g .�, • "a. . . . . . . .,- sc . .- cm� \Jrr�.., ...1j .-,�,•- �j�•1-11 I .•• -� �-7 r t :: 1 tse as 11 1 1 h 1 1 /'1 1 y 1 I t !(t>•)> 1fT tyt'.76ij 11�111t.a j 1l1 1 1, /1/ 111 11/11111 tug 11�11 f:> n 111. : `�{}f 1111�1i1/11 Sr t. 111111,1 ..,{ �c-_ l Ii1i1i�T�`g1 _ •• ,,.U ►�ll: •• I,� 1 r.. �/�,�9'�w•(4• A1 �AW" ��• ��7(^ 1 '�� ♦y1Q�T, N iA� t i%'J Qe■ y .. • .. a' DATE(MWDDIYYYY) ACORO" CERTIFICATE OF LIABILITY INSURANCE �� 07/27/2021 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 CONTACT Michael J Donnelly NAME: Donnelly Insurance Center aoNN Ert (914)347-6500 FAX : (914)347 6303 6 North Lawn Ave. E-MAIL INFO@ DONNELLYAGENCY.COM ADDRESS: P O.BOX 880 INSURERIS)AFFORDING COVERAGE NAIC S Elmsford NY 10523-0880 INSURERA: RUTGERS CASUALTY INSURANCE CO 41378 INSURED INSURER B: Rise Renovation Corp INSURER C: 129 Halstead Avenue Apt.2W INSURER D: INSURER E: Harrison NY 10528 INSURER F: COVERAGES CERTIFICATE NUMBER: CL20111029705 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 CONTRACTOR 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 INBRR TY EXP PE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDY/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ ,00,000 MED EXP(Any one person) $ 5,000 A Y SKP250377816 11/03/2020 11/03/2021 PERSONAL&ADVINJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 X POLICY JET LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s Ea..dent ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE s AUTOS ONLY AUTOS ONLY Par.ccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ S WORKERS COMPENSATION SPER OTH- AND EMPLOYERS'LIABILITY Y/N TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 0 more space is required) CARPENTRY CONTRACTOR NO ROOF REPAIRS NO ROOF REPLACEMENT. CERTIFICATE IS SUBJECT TO TERMS,CONDITIONS AND EXCLUSIONS OF THE ACTUAL POLICY AT THE TIME OF ISSUANCE.CERTIFICATE HOLDER IS/ARE ADDITIONAL INSURED WITH RESPECT TO WORK PERFORMED BY NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING ST AUTHORIZED REPRESENTATIVE RYE BROOK NY 10573 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD fi \\ NYSIF New York State Insurance Fund WESTCHESTER ONE.44 SOUTH BROADWAY, LOTH FLOOR,WHITE PLAINS, NY 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 471984498 MICHAEL DONNELLY DBA DONNELLY INSURANCE CENTER Rml PO BOX 880 i ELMSFORD NY 10523 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER RISE RENOVATION CORP VILLAGE OF RYE BROOK 129 HALSTEAD AVE. APT 2W 938 KING ST HARRISON NY 10528 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2379 825-9 731147 01/12/2021 TO 01/12/2022 7/27/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2379 825-9, 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://WWW.NYSIF.COM/CERT/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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DANILO SERENI RISE RENOVATION CORP 1 OF 1 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 STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 793008194 U-26.3