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HomeMy WebLinkAboutBP21-055PERMIT #6;I0Q I " O DATE: y no SECTION 71 BLOCK__ TYPE OF WORK 4e"Y Or /7Cgp/+4) JOB LOCATION OWNER, e /.SSQ /65heil)he� A CONTRACTOR4/yq/n�/�SEST. COST COST �o s FEE V/CO # - FEES r D DATE„ / / a I TCO # FEE DATE �wicP TIF ON RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 1 RGH PLUMBING GAS SPRINKLER _/ ELECTRIC �]�' LOW -VOLT Q ALARM 0 AS BUILT FINAL l OTHER APPROVALS lw VILLAGE of RYE BROOK WESTCHESTE'R CouNTY, NEW YORK NO: 21-187 Certificate of Occupancp This is to certify that ,k ' hed ' / e 1 s' ja Snelnhed of, RVr y having duly filed an application on Vf M)Der 5,-20 requesting a Certificate of Occupancy for the premises known as, � Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 135. Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. issued 24�, such authority and permission is hereby granted to the property owner to lawfululllly occupy or use said premises or building or part thereof listed under the New York State Use Classification of: // for the following purposes: inifror kl'kheei-7 � ba-fhrW)9--7 re oYa416J.-? 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 height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change ha been tamed-fie the Building Inspector. NOV 18 2021 Building Inspector,Village of Rye Brook: Date: D For office use onlv: BUILDING DE 'ARTMENT PERMIT# )/-OT,5' NOV — 3 2021 D VILLAGE OF RYE BA00K ISSUED: — -al S KING STREET,RYE BROOK,NEW YORK 10573 DATE: —3—a 1 VILLAGE OF RYE BROOK (914)939-0668 FEE:,aa35- PAm lr BUILDING DEPARTMENT I wr�rw,ryebrea ors 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 r♦ssrsss♦r s»ass►»sss»ss»s»ss»sss»s sssssrssssssrssssssssrrrrrssrrsrrisirirrtrttt•tst•ttttttstsstsstsssssssssitiissis•+sstrrrrs Address: 0 Occupancy/Use: Parcel ID#: 11315r IV 30 Zone: -/Q Owner: 55 ch, {� Address: ] R vM hgg5 (05 P.E./R.A. or Contractor: iC vy � , NIT �„s�_5. Address: 2V ► Person in responsible charge: m l C�e ,CL Address: D _L'tdG.4_' C e-'- Vo zf,,,,,,� 1C)S& Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a [Ci63t Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: }S�T,}A�TE OF NEW YOM COUNTY OF WESTCHESTER as: } being duly sworn,deposes and says that he/she resides at C'4 1„1t 'C"V, r• (Print Name of Applicant) , .and Street) in ;1 jc, l�� ,in the County of�,/,_4c Ve,S�e—r in the State of ,that I (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:$ -�W , for the construction or alteration of 't 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. 12 Sworn to before me this Sworn to before me this day of t��l \3 f , 20Q day of , 20 Signature of Property owner Signature of Applicant t Name of Property owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public, State of New York 8/12/2021 No.01 ME6160063 Ouatilied in Westchester County Commission Expires January 29, 20O BR(�j� 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.ryebrrook.org - - - - - - - - - - - - - -- - - --- INSPECTION REPORT - - - - - - - - - -- --- - - - - - - ' �u ll �� V r ADDRESS • C DATE:+ 1 C PERMIT# ISSUED; SECT: ' �4 \BLOCK: LOT:�93 LOCATION: , "A �La � � �+ ` "� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTfON REQUIRED ❑ FOOTING ❑ 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 • '9�� 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: V f DATE' E� i PERMIT,# � � �"� ISSUED: 2 SECT: BLOCK: LOT: LOCATION: t �rV3 Z : `� c1-G�r— OCCUPANCY: 2 6 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION y� REQUIRED ❑ FOOTING Iiyf� ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING /-'❑ ROUGH FRAMING ❑ INSULATION NATURAL GAS L.P. GAS Q FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER = C1 N N a •+� �� QC C�'iL clq 1-4 � C r 16 rs q .4 " Al� eY. 7 �" r W61 co LIZ v �p Id z W 0 ad o ° � _ W T Z r 00 W C6 W S BUILPJI G DEPARTMENT LVILLAGE � `� VILLs��E OF RYE BROOK 938 KING STREET RYE BROOK,NY 105731 2021 (914)939-066 'Ax(914)939-5801 %%AV 4°.t�iehiook.or, RYE BROOK PARTMENT ELECTRICAL PERMIT AFPLICATTO - Westchester County Master Electricians License Required FOR OFFICE USE ON] v RP #: C�1 — � � EP #: /y 9 Approval Date: P 2 2 Permit Fee: $ /6-0 Tf� Approvai Signature: Other: Disapproved: (fees are non-refundable) Application dated, c3 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an 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 conformance with all applicable Federal, State,County and Local Codes. I.Address: 31 ft)i1pVvit 4,of ` SBL: 17j .`-41' � " Zone: 2.Property Owner:-,& e/1 SSq I /7 Q�/�JIj2r7� ,frA I�ddress: 3 g�r�/1�Q.--? �_a/7,e Phone#: Cell #: /�—c�77 t� Q email: 3.Master Electrician: LDV IS t),, Ir- Address: A';Z {-flAk( Ayr_.. Ilk' � 'D(.hr� �e 15y io I Lic.#:E-2t)'A Phone#:q td COIN: email: yz2%, ' C9�LY'r�Pc rxtic�y+n�.n.['nt/Y� Company Name: IN- PC Y-fit'!-# 0`6nnra(-\ Address: -N'S ?0 if t' .) 1. J'kD(w-tL 'r+►. A %U P I 4.Proposed Electrical WorklFixture Count: �1?'1k iey11f \r^f. q�.V L,-Iti k c 1 e.y, - Cd anlii," 6'i 1. k -IZA-� 1jeAq r 1-re r o l-rrn tieeilulczo�-. 1 tJ�+e n 1 rye re 1o[ �c { SP`� s i�ICL`5 ( tr ee' sP� hr.�rt.13. ['t1�1�t�/ � 1 EaF - sP5 !- vreCc55Pd l h>� tiyK u STATE OF NEW YORK.COUNTY OF WESTCHESTER 1 as: Lt) ZS 1 t v&rik ,being duly swum,deposes and states that hc,she is the applicant above named and does further iprint name ot"individtsal.igning t+t licit pplicant) �vj _ ,�ry state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the V+ for the legal owner and is duly authorized to make and file this application. i indicatc archiiect.cunrracrur.agcni.ammic%.etc i 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�k regulations zl- Sworn to before me this �� Sworn to before me this day of 20 1 _ day of I ,20 -11 5igrt;1ure of Property Owner Sigttaturir of Applicant Print Nait of Prope ty Owne Print N e of Applicant i Not ry Publi �C�i�H J.BRADB Notary Public,State of New York L ARRY MFR©FNTIME No.01BR6159985 Notary Public, State of New York Qualified in Westchester County No.02ME6088108 COmrnisgion Exr)ires January 29,20_--3 Oual4ied in Nassau County 321 l4 Commission Expires June 20,2023 STATE WIDE INSPECTION SERVICES, INC. Service With Integri(v 0;0 . • SWIS JOBAPPLICATION0. Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Sectr, Block Lot Owner Name/Address fit different than above) Contact Number ❑Basement ❑1st Fi'. 0 2nd Fl. ❑3rd Fl. ❑More Than 3 FL ❑Garage ❑Attic ❑Outside [:]Residential [:]Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps I Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P I 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-inspection ❑ Safety Re-inspection ❑ Re-inspection Additional Information C IE ly FS `. APR 2 1 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(l)year from the date received by SW15.This application is intended to cover the above listed items to be Inspected,if at any time of Inspection additional hems 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.Theapplicant,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 =ZipCode License# Phone# State Wide Inspection Services ok(�> 1080 Main Street Fishkill, NY 12524 CS 2 Phone 914-219-119-1062 Fax STATE WIDE INSPECTION SERVICES Email: officeCaswisny.com Website: www.swisny.com Service With Irrtegrlty BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: A Perfect Goldman Electric Melissa & Ian Sheinheit 48 Potter Avenue 39 Mohegan Lane New Rochelle, NY 10801 Rye Brook, NY 10573 Located at: 39 Mohegan Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 21-097 13s.a1 1 3a Certificate Number: 2021-5286 Building Permit Number: BP 21-055 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: 39 Mohegan Lane, Rye 'Brook, NY 10573 The First Floor,Second Floor, Kitchen, Master Bathroom, and Hallway Bathroom 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 18th day of October 2021. Name quantity Rating Circuit Type GFCI 06 AFCI 03 Switches 07 Hood 01 Cooktop 01 Oven 01 Dishwasher 01 Refrigerator 01 Luminaires 03 •f Officer: Frank). 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. : s © iti r cawoo 14 00 w u J e co rn * x © � c ° S 3 � F .. U a a, ZZ ���� 13R�v�. D �� BUILD MENT APR 77 2O21 VIL E OF RYE OK 938 K N ET RYE B. ,NY 10573 VILLAGE C7E RYE BROOK (914)9 939-5801 BUILDING DEPARTMENT W r ar PLUMBING PERMIT APPLICATION �1 FOR OFFICE USE ONLY BI'#: tl r PP#: �d I Approval Date: Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, A/ 2-1 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 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.�y�, 1.Address: 39 M D�e q o-v'l L o-,, ,e SBL: 35, 1 1 30 Zone: 2.Proposed Work: Fix 1121C IE rp-el c�CE m e,a ' - Lvl 2- 5 .,abC d- cre-c-ie t'S SioK, E'-locg-fe �,-LS CooKt6pt teSt : f�` '(S SyS�Zvt'i. 3.Property Owner: M P. JI-Al trS, S e;n�,e i ~}" Address: /Vl1lhPAG,n Phone#: Cell#: g/y -5-5 , Q email: 4.Master Plumbcr: A A✓t � Address: J.M ;4616 11?G,6-_�at?;� _ Lic.#: X-C Phone 01 `3 2,j 9-C7 Cell#:q, f 7-807-25f 72 email:eCOttioi►nyAjV mb,.A J RCAJf, C 6 Ao l Company Name: d- Address: 3k'15 �dr" Lt / I SP2>�'!,t -,`l` 113 7 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 Ist Floor f 2. 2nd Floor 2— 1 3'Fluor 4'Floor 5`r"Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 3/2vi9 STATE OF NEW YORK, {COUNTY OF WESTCHESTER ) as: r%)aS 150► ,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 0�eZ A♦r- 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. T� rrA Sworn to before me this C Sworn to before me this 4- day of A Ret rl ,20� day of �&r t� ,2001 2 ! d. .4 Signature of Property Owner Signature of Applicant mt�lslscl� SA4; L-L $ ' L M P 7 Print Name of Property Owner Print Name of Applicant A,)/)I'A & '-'" � NC,oualifladInQueensCountY �^' IRMA i MEDINA IRMA I MEDINA Public-State of New York Notary Public-State of New York NO.01 ME4964522 NO.01 ME4964522 Qualified In Queens County rnission Expires � CommissionExp.ires 7--7& lZTh c leted in its entirety and mu f 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- 3121119 ro D BUILD MENT D, VIL E OF R OK APR 0 7 2021 938 KING ET RYE BR NY 10573 (914)9 39-5801 VILLAGE OF RYE BROOK 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: J ., �U's S A S ' tlri � , residing at. �l a LrA av%a, (Print name) {Addre.s w rc von 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; 3-1Lv�� , Rye Brook, NY. (Job 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 of Property Owner-(s)) (Print Namc of Property Owncr(�)i Sworn to before me this day of 6 , 20 A ` {Nc�ary public) IRMA I MEDINA Wary public-Stote of New York NO.01 ME-4964522 Quollfred In Queens County 3 MY COMMIWOn Expires - -a �'` 3/21/19 Building Permit Check List & Zoning Analysis Address: S�j ti P 4 - ,A 0 SBL• I t a Zone:iL-1 Z Use: Comr. Type: =1, Other: Submittal Data Revisions Submittal Dates: Applicant: t `.. Nature of Work: k L Z .9 2— MAN 2021 Reviews:ZBA: PB: BOT: Other: F OK f (✓/( ( ) FEES: Filing. ?S- *Rz, BP: i e Ll 7­9 C/O: Legalization: { ) { ) APP: Dated Notarized: SBL: Truss 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:Topes Site Protection: S/W Mgmt.: Tree Plan: Other: { ) ( ) SURVEY: Dated: Current: Archival: Sealed: Unacceptable: PLANS: Date Stamped Sealed -/ Copies: -Z Electronic: Other. � ) ( License: ✓ Workers Comp: ✓ Liability: Comp. Waiver. Other. { ) { ) CODE 753#: Dated: N/A: { ( ) 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. {v ( ) 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 Area: REQUIRED EXISTING, PROPOSED NOTES �t9 t_ Dates , MAR 2 2 2 Circle: Frontage Front: Front: Sides: Dear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot.Imp: FU Imp: PP Height/Stones: notes: rr ' y, w r11w PW C -u�; r° p -•^t; Jr ntd � .rtiY.' � Y•:li it f'i VII,+� tfftYrM"S''4° .h„ � i .Y. 1 I� f. 3' �' lid.:.,. f rll 7p •;Y` 14 .I ly yy a s1..+'fie d' •• ,tr r, d ♦w 1 . sR t i�eh r $ r►+ . # � I �i�+r �; }1!1}f� r �.. � 1 I.r. w: 1 I-::� s_ •� # a c � .,�(I�Ill�,i+�a -'. s.:,1¢¢}�411 raF��f}IQ llf.it .fit.1 +ill :FF to'� I I «� �.�.. 1{all :.� :-. I+rl¢ . $��ry.:._ 1l►r ��.;, 1 r tJ p k G O YJ y N !•, G chi �L} O p O u2R ! 4p«�)� ,41N • n d LG cl LO ♦.+ (� C RIi) r U `� o`�ection rop ❑_ � c3 yN �' Q LL] yK s cr " 4. CL 7 : 6+ 00 ma`s CL m 4 M . z-••,�a �, •,r s� r ' •l o / s . . . . . . r agii 4tflta�)1� � 111 11¢ '{ ..__� 111+l¢¢ ax.� '1'1�f'1 ; _ ��t,`l}II}`+}`If s'.'- a��.,fll'1{rl¢I¢�s_x.', r�%'fl}¢111F¢}I} r ll{#1#1#¢¢I -- 41¢,{+#111 c� I/#11#Ib ' `� t�}111##1 j IS+#1 1#1#� ¢� ► f; x ,rJ; r' =��ySFeA ♦• A ♦iA ;r t. All, A '1A4�r ♦♦ gAGx1t ��A'$�' i ", Vk xR 1 ''',y r 4��, � r�� .�.}{eA■ - i' ' �'ay�'. �s"+�E� +� j}W49 �.g•r," a Jj •e. �,1�?;�` jlNr>! ,�iJ"f��`:Fh- tiA �}" (�!� -a`Y,fZ '. � � J�,YHA ,.,r } � S � �'^f�y\:.J _ • .h.�Je��t .-'�' ;f4w� M1.•rJg • K? '`�CORL7® CERTIFICATE OF LIABILITY INSURANCE DATE(M1 0311812021 021 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 Chuck Greenberg NAME: Insurance Connectio-e Via= _ PHONE (914)576-5050 F°x (914)315-7211 AIC No Eut: AfC,No: PO Box2078 F-MAIL CHAZM ERE@OPTC N LI NE.NET ADDRESS: INSU RERIS)AFFORDING COVERAGE NAIC M Lerehmont NY 10538 INSURERA: American European Insurance Cc 23337 3MRED INSURER B: _ Buildings Work Inc. INSURER C 1 Rockrldge Road INSURER D INSURER E: Larchmont NY 10538 INSURER F COVERACES CERTIFICATE NUMBER: CL2131801786 REVISION NUMBER: THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITiSTANDINGANY 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. IN SR -- AWL POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE I POLICY NUMBER MWD0 MWDD COMMERCIAL GENERALLtsa1LrrY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1 OCCUR PREMISES Ea occurrence) S100,000 MED EXP(Any one person) $ 5,000 A Y SKP0006060 02/26/2021 02/2612022 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [:] E LOC PRODUCTS-COMPIOPAGG $ 2,D00,000 OTHER _ $ - AUTOMOBILE LIABILITY GOMBINED SINGLE LIMIT $ Ea accitlem ANY AUTO BODILY INJURY(Per person) S {OWNED SCHEDULED BODILY INJURY IPer accident) S AUTOS ONLY AUTOS HIR--D NIMNED PROPERTYDAMAGE S AUTOS ONLY AUTOS ONLY Per accidan4 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSI PER OTH- AND EMP:.OYERS' YIN LIABILRY STATUTE ER ANY PROPRIETOWPARTNERiEXECUTIVE ❑ NIA E.L EACH ACCIDENT $ OFFiGER1MEMBER EXCLUDED? i(Yar,datcry in NH) E.L.DISEASE-EA EMPLOYEE S kf yes,da�w�a w�da� DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schadule,may be attached i1 more space is required) 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 NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 17- N YS I F New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, IOTH FLOOR,WHITE PLAINS, NY 10601-4411 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) w4j.4w AAAAAA 133430410 BUILDINGS WORK INC1 ROCKRIDGE RD LARCHMONT NY 10538 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER BUILDINGS WORK INC VILLAGE OF RYE BROOK 1 ROCKRIDGE RD 938 KING STREET LARCHMONT NY 10538 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2204 792-2 270014 04/25/2021 TO 04/25/2022 3118/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2204 792-2, 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:/IWWW.NYSIF.COMYCERTICERTVAL.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. MICHAEL DICK BUILDINGS WORK INC 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:635443278 U-26.3