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HomeMy WebLinkAboutBP21-067PERMIT # � DATE:_ � IXP,,;..:� � `��"' SECTION l3 * �� BLOC LOT ' �' TYPE OF WORK �-�,��os �-'�yVc? �� e v � •' 10B LOCATION CONTRACTGR�U!, �• (�� .f�L/I l�Pls .�f'>� �T. COST � O VCO# �' �C��� Tea # FEE DATE. _- . _ _ �NSoECT10N RECORD DATE FOOTt NG FOUNDATION FRAMING RGH FRAMING INSULATION �/ PLUMBING I—YJ RGH PLUMBICN]G GAS SPRINKLER _/ _ ELECTRIC uQ LOW -VOLT O ALARM AS BUILT 0 FINAL INSP OTHER APPROVALS ARi� BOT PS /y� 3 9/- 7��o zaA OTHER P,AoI i- �`'S8%KA �l1 CoSQn'�'vab ���im 6�n� � 7�� ��'�i'�QO�I�QZ�� ��eC7�'iC'c�t/ �pr►�Gt�-`7t��S �<.+�i ,� VILLAGE OF RYE BROOK WESTCHES COU , NEW YORK NO: 22-010 Certificate of eccupaucp This is to certify that G1� � AL Ca - of, � , having duly filed an application on Albylember 3, 20 requesting a Certificate of Occupancy for the premises known as, ,5J O, Ayo r? Oi r C l-e , Rye Brook, NY, located in a RA- I Zoning District and shown on the most current Tax Map as Section: /35- 75 Block: ,2 Lot: /' and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. o�2 /-()JP -7 , issued 4/li d 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 New York State Use Classification of. /�C- ' Z ol-7 e - FcL/TJ 1 IN ,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 in heig t sh e-made,nor-s al`I the building be moved from one location to another until a permit to accomplish such change has b n b in uil mg Inspector. Building Inspector,Village of Rye Brook: Date: JAN. 19 2022 BUILD R NT For office use onl U, PERMrr# `GICP 7 VIL1I1 ` '. OK ISSUED: aoal NOV - 2021 938 KING STREE Yl 'k YORK 10573 DATE: /" (914)9 ` y �t, 939-5801 FEE: PAID 21/ i o .ore APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBbffTTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION rrwsstwsstttt►sstsnett***rww*swrst***st**ttttt+twt*+tt+tsws**t+t+sttstr++**ar**+trsttttw#wtttttt+*+t++*+*+*++*+++++**++t**++ Address: 52 Avon Circle, Unit C Occupancy/use: Res Parcel iD#- 135.75-2-67.2 Zone: R-A 1 Owner: Donna Duca Address: 52 Avon Circle, Unit C P.E./R.A.or Contractor: NRD Builders Address: 138 Beechmont Dr New Rochelle Person in responsible charge: Nick Demeo Address: 138 Beechmont Dr, New Rochelle 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/constrtiction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: Kenneth Santelli being duly sworn,deposes and says that he/she resides at 166 Brixton Rd. S (Print Name of Applicant) (No.and Street) in Garden City ,intheCountyof Nassau County in the State of NY that (Ciryfrown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost ofthe 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:$ 12,000 f for the construction oralterationof _Apartment kitchen cabinet installation, bathroom finishes, washer/dryer installation 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 Sworn to before me this day of t ZtS f , 20ZL _ day of 40yiF'wow209L— Signa re o operty er Signatu of Applicant Donna Duca Kenneth Santelli Print Name of Property Owner Print Name. t Notary Public Notary P. S I'c LUKIC CRISTIAN G. LANZA Notary Public-State of New York NO.DILU6311072 Notary Public, State of New Yotk 3/21/19 Qualified in Westchester County NO.01 LA6144776 My Commission Expires Sep 8,2022 Qualified in Westchester Coun Commission Expires May 1,20 QyE BRC��. w � 19b2 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 : DATE: PERMIT#� � � .1 �J� ISSUED: 2 SECT: _ LOCK: LOT: LOCATION: }v � U , j ) OCCUPANCY: Q r ❑ VIOLATION NOTED fE WORK IS... �I ACCEPTED REJECTED/ REINSPECTION El SITE INSPECTION1 / 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 /p OTHER E BR(Zj,�. w � 1932' BUILDING DEPARTMENT ❑BUILDING INSPECTOR ` $SISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET . RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www acbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : � � y V� ' ( 9 d DATE: 1312 o- � PERMIT# + ISSUED: 5I�VSECT: BLOCK: LOT: LOCATION: t� ( 6'-�t'`I C)c� OCCUPANCY: a ❑ VIOLATION NOTED ` THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION SITE INSPECTION 1 v REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE l� ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �,��X6 l.^�,/� ❑ NATURAL GAS LJ l���1 A-' `4 �� Cl`�- (.0 1 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a OD 0 N fV N 000 ��TT.•I 0 �; r� �' g oq L o O C kj W w O W a a a © Q W p w U � c p w � 1 C/) 0-0 A o IN �.,.� z wo Qe J 3 w Q x vim, � S (1 U w z a, 6e ° oc ECENE BUILI3I/ -p MENT VILLAGE OF RYE OK APR - 8 2021 938 KING��ET RYE B ,NY 10573 VILLAGE OF RYE BROOK (914)93; f 939-5801 BUILDING DEPARTMENT W*wn or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required Q FOR OFFICE USE ONLY BP#: G �' {�La -7 EP#: c a FS— Approval Date: APR - 21 Permit Fee: $ Of Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated,�-4 E 0 ! is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an 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 conformance with all applicable Federal, State,County and Local Codes. 1.Address:_5 2 kb� C I l r-- SBL: /3j.7(p Zone: q,4—I 2.Property Owner: DCG►1 V\C' �t>,C Address: Phone#: Cell#:�05 46 / email: t� 3.Master Electrician: "Cj hA Address:-,B2 L59 mic*v �Uc �C lc T10 Lic.#: C 1 Phone Cell#: email: (Ly^ C9 fl Company Name: C') El'-- Address: � 1 5 4.Proposed Electrical Work/Fixture Count: y '—l - Cl— LIMA L,c 1 STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: b ,.being duly sworn,deposes and states that he/she is the applicant above named,and does fitrther (print nanoofindividual as"theapplicant) state 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,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.ILI Sworn to before me this Sworn to efore m this 5 day of 120 day o 20a( �C Signature of Property Owner Signaturarof Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. , a Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 �4�c \\ BUILDING PERMIT NO. TEMP N DATE CITY OR VILLA ZIP CODE TOWNSHIP COUNTY STR£EF'AND ISO,OR ROAD POLE NUMBER (- rat CAC BETWEEN MAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LQT OCCUPANT'S NAME BUILDING OCCUPANCY i OWNER'S NAME AND ADDRESS- TOME TELEPF ONE NUMBED !r \ CURRENT SUPPLIED BY FROM THEIR OFFICIS WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO,OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO, H.P EACH NO, WATTS EACH INSPECTION OUTSIDE BASEMENT nj f FL. ADD �7 2'FL. Vf kGE OF Y MO 3'�FL. OK SUL REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 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 AS PROVIDED BY THE APPUCANT.THE APPLICANT DECLARES THAT THERE 15 NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WR.EIS,INC.IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL FI EXPOSED F. CONCEALED O MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ Icl Cj 1 cs c--\ I :d AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION,ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. "" -OF COMPANY DATE OF APP ATION SIGNATURE OF APPLIC `t'C�-zr--'L'-- STREET ADDRESS ��11 I� _ TELEPHOW� IF--{ 1, COiD�' �/ DBiIE NO.WHEN APPLICABLEC-- CITY OR POST E LICENSE `- 17- AM WESTCHESTER ROCKUNO WRE la ELECTRICIL INSPECTION SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Gazda Electrical Contractor Inc Donna Duca 453 Bonnie Court NY,Yorktown Heights 10598 Located at:52C Avon Circle Rye Brook, NY 10573 Certificate Number: 1029609 Section: 135.75 Block:2 Lot:67.2 BdC: Permit Number:EP:21-085-BP:21-067 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located inlon the premises at: 52C Avon Circle Rye Brook,NY 10573 Basement list Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 11/09/21 Name Type Quantity Switch Single Pole ------- 2 Fixture-Luminaire Incandescent ------- 2 Receptacle GFC1 ------- 2 AFCl/GFCI combo ------- 1 Receptacle Convenience ------- 3 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. `��4 G ' This certificate is valid for work performed before date of inspection only. i i i m in O of O C a N old M E, %wo IT, co • L C4 00 -let w z jolkib ' M a z 4 .� U yr w '3 0 o Q W o a ° � t REC EOV BUILDING DEPARTMENT APR 2 7 2021 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 BUILDING DEPARTMENT (914)939-0668 FAX(914)939-5801 www.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: _. p/'o67 PP#: C;) "dJ e Approval Date: A P R 2 6 Permit Fee: $ 1 u'— r--'0L Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, c�7 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/6r remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in c'onnf�or 1mance with all applicable Federal,State,County and Local Codes. l.Address: C --_ __11�'n \\ 1� 't CA it SBL:� ,4,7,S— cy— 7, �ne: � 2.Proposed W ork:�~r_.x:�l C) R<% ' 1 en tf CICA'^ 3.Property Own . Mr"5:b e)f1 q y�Sp Address: vClu C+r L C' C Phone#: Cell#: 119 —3R I-']�s� ^�email:A 0) %'r`CAer z Q ^'%•:l 4.Master Plumber: lP� Goc7e^�`i n Address: ry I` '14` L'tAr K'?,�. �U�V Lic.#:1Z'22• Phone`#>�J ; �67� Cell#:� i __6456 email: GC�+1 1A0 � 1 , e—.0% Company Name: G16)i,Gjo-w i,Y o��H — Address: c'SL.- INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water J6rkvk Drinking Sinks Showers Bath Domestic Fire Sanitary Natural/ Other* Total Closets Fountains K�4 Tubs Service Service Sewer LP Gas Basement a •r 1 st Floor 2nd Floor Yd Floor 4°i Floor 51,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: '�O rlAg +yc". ,being duly sworn,deposes and states that he/she is the applicant above named, (print name ofindividual 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 '\Vi rk rL)e . 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 ( �-- Sworn to before me this ?)44 day of 20_21_A__ day of_Pf 20 &— �A Sign a Property er Sign aturf of Applicant 't'nd A�lf D C t G ZW �b Print ame of Property O Prin a of A licant KIRSYS LANGLEY /liotary Public Notary Public-State of New Yor of PubiiC NO.01LA6322877 Qualified in Westchester County DIANNL ROJAS My Commission Expires Apr 1 3,2023 Notary Public-State of New York NO.01 R06127547 Qu din West hest rWCo�u3n�_� properly y p nnyc t!a? t b ro erl completed in its entiretyand 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- 3l21/19 BUILDING DEPARTMENT �COVE VILLAGE Off'RYE BROOK APB 7 7 Z021 938 Knvc S�rREET RYE B><tom,NY 10573 (914)939-0668 FAX(914)939-5801 VILLAGE OF RYE BROOK www.ryebrook.om gU�LD1NG QEPARTMENT 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: kJ 0 n r1 C, L u C C, , residing at, (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; C-)5� ,Rye Brook, NY. (Job Addr ss) 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. A-4�1�-- (Sily(ature of Property Owner(s)) bo,jwA Dkcq (Print Name of Property Owner(s)) Sworn to before me this DIANNE ROJAS day Of ' 20 Notary Public-State of No,Ynrk NO.01RO6127542 QuaGflcd in Westchester Coumy My Commission Expires May 23,2021 (Notary Pub -3- 3/21119 Building Permit Check List&Zoning Analysis .- J Address: J Z- - G �Vo ram► 2Lc�P SBL: 1 - Z - C07 . Z Zone A-4 use.. q i _Const.Type: Other. Submittal Date: l Z� 1 Z 1 Revisions Submittal Dates: Applicant: :�C A. Nature of Work: I t A I E-12,2(A- f iy 0 V Reviews:ZBA: APR - 6 2021 PB: BOT: Other. OK ( ( ) FEES:Filing:��BP: 20. 'P-r7 C/O: Legalization: O O APP: Dated: / 'Notarized: ✓ SBL: Truss I.D. Cross Connection: '� H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO: Long Shorn Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other: ( ) ( ) SURVEY:Dated Current: Archival; Sealed: Unacceptable: ( ) (.� LANS:Date Stamped: Z Sealed: f Copies: Electronic: Other. ( ) { License: ✓ Workers Comp: ✓ Liability: V7 Comp.Waiver Other. ( ) ( ) CODE 7S3#: Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permir 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. { ) O 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. O O Other. ( )ARB mtg.date: approval: notes: { )ZBA mtg. date: approval: notes: { )PB mtg. date: approval notes: REOUIRED EXISTING PROPOSED NOTES APP59VW9021 Area: Date. Circle: Frontag_a F:r n Front Sides: &Uxr. _Main Cov Accs,Cov Ft.H Sb: Sd.H S : GFA. Tot.j D: E W: Ear : Height/Stories: notes: j1JIL �r� (t��'• wi uj�., �I o �Ifi�� `'ii'��Si � i'+f1��11'� � +'i1i1�' P ii��l/���'.�"t_r: �. ,+i'►111ii1�r,: ` �iirflfir' ,_� � Z '= 1 c� \b \� p - H ca W N s� (� 1 Cd .•_ 'M•� O d Q �• Ntl tssY t••r U O O gars) ui f t) W W Q p. o Qw T— o •'� r, p W Co Of 0 -0 wd-ied 1 �" ►� 00 / W U f4 %• 1\ � co f U 4 00 .�., `dl/f� - -i1 ►` i1r •. ` ili ;11' � r1r r / r � .. '-+I/c��ecll�;,- A �-"'P�f�f�����• 'Ifcf�fci� c�icr -- 4 ,' � ffi� �A .-i rc�c►c++ � =• Ilc�ffc'+ � \ A ® DATE(MMIDD/Y1'YY) /'-1 CERTIFICATE 4F LIABILITY INSURANCE 03/2512021 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 Angela Smith NAME: AssuredPartners Northeast,LLC. PHONE {914}761-9000 FAX (914)761-3749 AIC No Ext: AIC,Nc 445 Hamilton Avenue E-MAIL angela.smth@assuredpartners.com ADDRESS: 10th Floor INSURER(S)AFFORDING COVERAGE NAIC If White Plains NY 10601 INSURERA: Merchants Insurance Group INSURED INSURER B NRD Builders,Inc.,DBA:Homestead Remodeling INSURER C: 138 Beechmont Drive INSURER D: INSURER E:. New Rochelle NY 10804 INSURER F COVERAGES CERTIFICATE NUMBER: CI-2112966068 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 MAYBE 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 ALILIL15UNH POLIC EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM1D0 MMIDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000.090 DAMAGE TO RENTE CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 500.000 MED EXP(Any one person) $ 5,000 A CTRID03387 01/02/2021 01/02/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 2,000,000 POLICY [g�ECT IRI F LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLAL[AB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE NIA AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y I N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? - - - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) EVIDENCE ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Rye Brook Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 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 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �. "rr '0 ^^^^^" 133401151 � ASSUREDPARTNERS NORTHEAST LLC 445 HAMILTON AVE 10TH FLU WHITE PLAINS NY 10601 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER NRD BUILDERS INC RYE BROOK BUILDING DEPARTMENT TA HOMESTEAD REMODELING 938 KING STREET 138 BEECHMONT DRIVE RYE BROOK NY 10573 NEW ROCHELLE NY 10804 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2147 717-9 375214 05/13/2020 TO 05/13/2021 3/25/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2147 717-9, 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:I/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. CYNTHIA DEMEO-V PRESIDENT NRD BUILDERS INC 1 OF 2 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:390053504 U-26.3