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HomeMy WebLinkAboutBP21-080PERMIT # 15/ QJ Z Q ( DATE: 9 a4 EC: 9 c� SECTION BLOCK LOT TYPE OF WORK JOB LOCATION. OWNER G2�i /YI 1f�7.LJr�t/P/YI,�JiI-�C / l �' /To COST � O FEE V CO # - FEE D DATE..L1 TCO # FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT INSPECTION RECORD DATE INSP : do (9�1)77y 9oi9 :Lr. VILLAGI- OF RYE BROOK WESTCHE89 & COUNTY, NEW YORK NO: 23-067 Certif irate of Occupancy This is to certify that � (� ��Q 2a of, ��>° �/ ��7,�, Al 7 , having duly filed an application on Jali 20�requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in aRc52-,C- Zoning District and shown on the most current Tax Map as Section: Block: L? Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.c:?> /— Q�j(} , issued 20 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: Z/ Construction: L03 for the following purposes: ln6fi-jnk- 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 has been obt ' ed from- a Bui i Inspector. MAY 0 1 2023 :acting Building Inspector, Village of Rye Brook: Date: D �" BUILD R ENT For office use only: PERr�1T#� -D O VIL OF RYE K ISSUED: - -Q/ EAUG8 2022 B9 8 KING SIRE YE BRooK, YORK 10573 DATE: VILLAGE OF IRYE BROOK 9 .0 O�c FEE: A //p— PAID)N BUILDING DEPARTMENT 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 sttsysttitas►rvvsssstrtssssssrtsrt******rtsssts►s►►ss►ssssss►►tsyststttttts►ss►•stt*ttrtssrtrttttr►►i►sssrtsiv►s*******trrstvtsvi►i► Address: 31 0 1 ck1nY 1 e.W Ck v Occupancy/Use: c!). G441 Parcel ID#: 1 t-}( _ 35- g Zone: Owner: Cr-a rza c� -1—iS.N A 6 ►a Address: 3 f 6�tGµ`(tEsltJ�y�i�Y k 1V P.E./R.A.or Contractor: Address: /SrL,-she ,4y< 6ree,iw1cr C7- Person in responsible charge: A L-C.-V_ G, ►rYl 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: aA V_c L l#�N^�,-fii being duly sworn,deposes and says that he/she resides at 31 a 1"V L Ei U., A u e (Print Name of Applicant) (No.and Street) in R Y jZ4z_jo n k. ,in the County of Tr,S r c�,t S T 1=('� in the State of Y ,that (Cityrrown/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:$ for the construction or alteration of: 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 4 Sworn to before me this day of y::L-4k_) ,20 day of u C V ST ,20 Signature of Property Owner Signature of Applicant 1 . Print Name of Property Owner Print Name of Applicant No �c o rc HOPE B.VESPIA HOPE B.VESPIA Notary Public,State of New York Notary Public,State of New York No.OlVE5084028 I No.01VE5084028 8/12/2021 Qualified in Westchester Coun Qualified in Westchester Coun I Commission Expires August 25,2 i Commission Expires August 25,2 i BR • 1932 BUILDING DEPARTMENT AtUILDING 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.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:- _� V �.J DATE: 6c)-2-3 1 PERMIT# ( � - V ISSUED: SECT: LOCK: Z LOT: LOCATION: \ OCCUPANCY: ✓!' ❑ Violation Noted THE WORK IS....,,;e PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION 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 / ❑-.�ROSS CONNECTION /FINAL ❑ OTHER ' ��������� P���'i� P •f�w�.:�n�+�w �w�f�y �il�����������i����f��F��i ♦i�. w f A •: � N � pl' v i N N N r \ ■ I M � O > � cl O M � r z p ~ � O � W g `'' N !� r ■' � r, C�Lr' N F-i O O Q U O 0 O N � Ln 00 z W z ►-1 z w H w ■ x O w v %Az r ■ W w a 4, O C� w z v, � o z w , M �"� 1 N � O c7 ar O • `� x `- �, H U w mi H G4 z u A o �o � H x w N0 s r � N U U LU~Lyi x U W z C+ x M A uj z A a � �I as a Zuz as w ; itat !t 6i �/�f�a � ������p�p��, �» �� ��f �f�f �i� �i�i�����a ♦f'�Y�i \+�i�i�S�i \i� 17��� D EC���MC ��":R BUILD1I�GiiR' IMENT A U 6 12 2022 VILLAGE OF RYE BROOK 938 KINGSCREET RYE BR(*,NY 10573 VILLAGE OF RYE EY BROOK (914)939-0668 BUILDING DEPARTMENT www. G Kook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: Q1_090 EP#: C!/ Approval Date: Permit Fee: $ O Approval Signature: Other: kf2 Application dated, Z ZCZZis 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. 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. n 1.Address: 2 I H L r V W Q W 6 U L)k 42 SBL:1y 1.,_3 5__2— Zone 2.Property Owner:G A 9-0(_T6Aj /<A Address: 3 I H i G h l,l CvU F4 U e AJLl t�_2 Phone#:CI (4- �l �'1- A 996 Cell#: ft A_ email: � 3.Master Electrician: T-6 4 KI &[u e''C u Address:to .jk6 e-T g f�+ I.P /V /as-9, Lic.#:C 5 Y) Phone#://�%�3�-�Zy t Cell#4G1/V-,Q79-5,A I email: G{ / Yh Company Name: (�E��CM 0� TIC c T/b L Address:66 U)SeT W K- ,o 20d ( Q,S`"7 4.Proposed Electrical/Work/Fixture Count: Pcj Qi Qt -/v 5.31 Party Electrical Inspection Agency: .1 L) is STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 1-6)k) G Q-1 Pd-_ U ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the (-7 t�fu 2 for the legal owner and is duly authorized to make and file this application. (indicate architect agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belie, 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 t efore me ' �P day of ,20 day 3of 20 Signature of Property Owner Si / iure of App 'cant Print Name of Property Owner 1 Name o fAppli Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OIME61-60063 Qualified In Westchester County 6/23/2022 Commission Expires January 29,201z STATEWIDE • 1080 Main Street,Fishkill, NY 12524 1 emoil:/ • SWIS JOB APPLICATION ;. 1 914.219.1062 • Office Use Elect.Permit# 4— �` Date 4/4 Bldg Permit# /� Utility ID# Final Certificate# City/Village Zip I Township County Address Cross Street Section _ Block Lot Owner Name/Address(if different than above) Contact Number c- , hC ;> ❑Basement R st FI. ❑2nd FI. ❑3rd FI. ❑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 I 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information C h A �� �� ` t l.0 I� -'a% U k)LQ J pECEML ]D AUG 12 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application Is valid for one(1)year from the date received by SMS.This application is intended to cover the above listed items to be inspected;d at any time of Inspection additional items have been insta4d,you nrr 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 I Date l Signature Address City/State,- Zip Code , License# Phone# State Wide Inspection Services CAS 1080 Main Street Fishkill, NY 12524 a T 845 2 Phone 914-219-119-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com 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: Westmore Electric Carol Tanaka 6 Sunset Road 31 Highview Avenue Rye Brook,NY 10573 Rye Brook, NY 10573 Located at:31 Highview Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-186 141.35 18 Certificate Number:2022-4768 Building Permit Number: BP-21-080 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: 31 Highview Avenue, Rye Brook, NY 10573 The First Floor 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 18th day of August 2022. Name Quantity Rating Circuit Type Receptacles 04 Switches 04 Dishwasher 01 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. a s E_ in � � a �• N N_ N_ OS ^ � U s w k N N _ `r � N ' � u 4 a s LU w 3 A U w y � w , LU W C4 CD 0%4 cn U � Z cc W oo �••� W W j F � M E"" ►.� W E "z' Loa q i Ct, p, b14 d i t a., AQ c , •• � a w � Y r �i D �C� `�� BUILDING DEPARTMENT APR 15 202i VILLAGE OF RYE BROOK 938 Kwoa S*ET RYE BR(XW,NY 10573 VILLAGE OF RYE BROOK (914)939„ A•x(914)939-5801 BUILDING DElPARTMENT www aok.or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: c)/—O b C) PP#: Approval Date: APR 1 6 1 Permit Fee: $ Approval Signature: Other: Disapproved: (tees are non-rePoodabk) ################U################################################################################## Application dated, - -�S-Z7 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. 1.Address: 31_ / ,C4�V1 e G✓ //(/ SBL: '7I r 36 Zone: AQ-rn) 2.Proposed Work: /e/�G✓�7/G OG /�•'C:�✓ Al7�h — sPs t R.S O►-�G��/ 3.Property Owner:C-f--liv 1 1 4 Address: Phone#: 9� _ 9 3�'�J Cell#: email: 4.Master Plumber: %#. �/ <' � e,� Address: �/ / Lic.#:�Pho CC � Cell#: �6'7 ZZ 2 email: AV //(i /lam+ ABC'/.Company Name: /N <��c Address:('C 81.t - INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Totsl Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor 3"Floor 4'Floor 5t°Floor Exterior 5.*List Other Equipment/Provide Details: ®/S �✓ S �� (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 STATE/OF N=74C COUNTY OF WESTCHESTER ) as: C0 1/ ,being duly sworn,deposes and states that he/she is the applicant above named, (print narne of inclividu d sign*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 Xfor 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 day of /L ,20 Z> day of /f ,20 L Signature of Property Owner Signature of Applicant C'L'y Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 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 BUILDING.:. $-AitTMENT D [E C IE Q VILLA G,E OF RYkJ3R0OK 938 KING 5ikE%ET RYE BR90- NY 10573 APR 15 2021 (914)9394!668_)r; .(914)939-5801 www. ok: VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216• STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MOST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMING 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: 3,�r(���zcN l4«" , residing at, _Cc (Print me) (: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; 3 /'t/ (/I e w ac_ , Rye Brook, NY. (1oh: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. r (Signature of Property 0"ner(s)) IC-1_ei�19_�' (Print Name of Property Owner(s)) Sworn to before me this day of 920 (Notary Public -3- 3/21/19 Budding Permit Check List&Zoning Analysis Address: L 4Ja4,4u l r--W A\j F SBL: 3.SS-2` l Zon 2-' ' Use: ZZ Const.Type: Other. Submittal Date 5- "z Revisions Submittal Dates: Applicant: —1 N Nature of Work (NZ -t 9 n-- it,�'CLN � —[7.�r� \l(1� o N �.�� Reviews:ZBA R 1 6 1021 PB• BOT• Other. QK ( ( ) FEES:Filing-. 7S�BP: I Co• �; s 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. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current Archival:- Sealed Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic: Other. ( ) (• License: -"" Workers Comp: ✓ Liability ---'7"C—omp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated N/A: (v f ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Pemut: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL-•Plans: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H W.I.C.:_Batter)r_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 REOLJIRED ExisnNG PROPOSED NOTES A P R 1 6 2021 Arm �8t@: Cir Fin g� FrQn- FrQ!ij- Main Cov Accs.Cov Ft,HS : H S SFA- Tot.Img Fc Img: Par Height/Stories: notes: .A C A ;/''•{ A .k A t•'? A i+ -:/A� ^ 'y� A _ �x A b3� •'�'. ,� .• :�����i�P'_ . �_ .�h'���1���'_�.; �- .:.!4'i���i'� .�a� a,-=,.:!4'i�l�ii��.."�,-. �"�:�-•!�'i�l�i�is':�r:�. i�c�/�i�iS'" � .._'=i�ilcii�' �. «� y <0)>•/'111I1I �i Lei U <(�•� (V CN y U X O o Q r J � O U L i, 0 ..0 !L�i �I •� J U W ro-� , LLJ 00 CIO .0ectiop W Z � U ;� = 0 7N o W crA ' •r a ' > W Z:i Q J N o Q cen i «o <c G Z 3 N u� o r J W �r LO W N O Kati� fey laeda� «oi> ui, ' � MCI Q X O � � ♦f(o)> o» �flf� � •3 c <co s I y A l t �e w (m . 0) ` � o ' LO Z U-) r jcl I V d N -0" 1/7 :,a.,������ •' - :`;:f �y���) .a "�,,,/ _'s s� , -A. ` I7A ♦♦ A f ♦♦ A •♦ ^ .` .A. ♦♦ - �� ♦♦ :r�. ♦♦ ...ter i_ :J( O ``'��� O •Y� - O Or/ -,\arjpvt v� - tior a ,i pV•Y'r O o ACORD CERTIFICATE OF LIABILITY INSURANCE °03/20/2021 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION North Main Street Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 375 North Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO Port Chester, NY 10573 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Utica First Insurance CO. Ganim Improvements LLC INSURERB: 15 Leslie Ave INSURERC: Greenwich, CT 06831 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ✓ GENERAL LIABILITY 'I EACH OCCURRENCE $ 1.000.000 DAMAGE O ENT CJ0.000 A ✓ COMMERCIAL GENERAL LIABILITY I PREMISES Eaoccurence $ CLAIMSMADE ✓ OCCUR'I MEDEXP(Any one person) $ 5.000 ART 5144235 06/02/2020 06/02/2021 PERSONAL&ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2.000.000 POLICY F7PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per perms) $ HIREDAUTOS BODILY INJURY NON•OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WC STAT'U OTH WORKERS COMPENSATION ANDER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Village of Rye Brook is additional insured Job Site: 31 Highview Ave, Rye Brook, NY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Village of Rye Brook DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITT 938 King St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO S Rye Brook, NY 10573 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Genesis Mariscal ACORD 25(2001/08) ©ACORD CORPORATION 1988 Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� 04/19/2021 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 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 NAME: Genesis Mariscal North Main Street Isurance Agency PHONNo,E (914)481-5334 FAX No): 375 North Main St. ADDRESS: nmsinsurancel@gmail.com Port Chester,NY 10573 INSURER 3 AFFORDING COVERAGE NAIC S _ INSURERA: Utica First Insurance Company INSURED INSURER B: Ganim Improvements LLC INSURERC: 15 Leslie Ave. INSURER D: Greenwich,CT 06831 INSURER E: 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 LTR TYPE OF INSURANCE JNSR U D POLICY NUMBER MM/DDY EFF MM/DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 5,000 A ART5144235 06/02/2021 06/02/2022 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000.000 POLICY 71 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LUB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Village of Rye Brook is listed as additional insured if required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St. ACCORDANCE WITH THE POLICY PROVISIONS. Port Chester,NY 10573 AUTHORIZED REPRESENTATIVE Geneva 71 ao!3cc� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY,LOTH FLOOR,WHITE PLAINS,NY 106014411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 � AAAAAA 133873544 GENESIS MARISCAL D/B/A NORTH MAIN STREET INSURANCE ■ 375 N MAIN ST PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GANIM IMPROVEMENTS, LLC VILLAGE OF RYE BROOK C/O CHARLENE GANIM 938 KING ST 15 LESLIE AVENUE PORT CHESTER NY 10573 GREENWICH CT 06831 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2270 408-4 451452 04/17/2021 TO 04/17/2022 4/19/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2270 408-4, 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 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 STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1065403667 U-26.3