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HomeMy WebLinkAboutBP21-132PERMIT #/ SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTOR EST. V/CO # 1►] DATE:- ���'1-�-- EXP: BLOC LOT r% o/0� Pfn0Va o.� �� MP�dO�•cJ/c7/fC JrCO �/- 1)0r1 C000 - IZ411- COST TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOWVOLT O ALARM C L-7 AS BUILT � FINAL INSP /I Y. 91 Dg33 �939-0997 OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE.OF RYE BROOK WESTCHES `4 COi bmY, NEW YORK �> NO: 22-022 Certificate of Occupanrp This is to certify that_ Ell Cholf ku4-h Choi 1'ri of, ��'L L/I lJC1 I having duly filed an application on PID VIJ a K fc 20 c�dL requesting a Certificate of Occupancy for the premises known as, 3a mmdow lar k— , Rye Brook,NY, located in a K a Zoning District and shown on the most current Tax Map as Section: ! , p� Block: I Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. ; J - )30 , issued c-�- 20 c:;l , 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: - f`)'1 d ,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 hei t sh II be made,not shall the building be moved from one location to another until a permit to accomplish such change has ben ine ding Inspector. Building Inspector,Village of Rye Brook: Date: FEB 1 0 2022 LI BiUILDIN TMEIT For office use on! PERMIT# -f3a U..± VI kI 'A E OF RYE BROOK ISSUED: FEB —o�— f - 1 2022 938 KING STREET RYE BROOK, I YORK 10573 DATE: (914)09466$.- '939-5801 FEE: PADA VILLAGE uF R' CE BROOK BUILDING DEPAP-i MFNT w�vvv io .or 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 iissq►ts#fis##fMti#tt#tt#ttitt#tut##tt##4itit##ttfiq#titit4t#ttlt!lttiglsisissssgt►►i#►iftit►tiititsstsfsissgsftRiittti Address; c V,- R I Q Occupancy/Use: h c.s A_"Parcel ID 07 e —/- Zone: 00 Owner: Address:j3Z 1S-L J,.J,Jr.�Toicl P.E./R.A.or Contractor: Address: $�t i tA Ie,,, A. Person in responsible charge: Address: Ste , 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: m I 1�u� u a, V'x being duly sworn,deposes and says that he/she resides at 3-Z 1' I f-0. d .,_i (Print Name of Applicant) II (No.and street) in .0 u ,in the County of o i'St'c_k' c� 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:S 2 g for the construction or alteration of. t. ,-p — k tt r, v (2,,C 6 by u 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 thereofhereafter 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 V , 20 day of , 20 Signattire of Property Owner Signature of Applicant Name of Property Owner Print Name of Applicant Notary Public Notary Public SHAM MEULLO Notary Public, State of New York 3l21/19 Oualifiea in Westch.•_ter County ���� Commission Exoires January 29� 2t2_? 1' �E BR(��, O�` tim 1962 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# � ISSUED: �t ` 1�'L SECT: BLOCK: LOT: `�C�S � ; LOCATION: ` ` + ��` - OCCUPANCY: f ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/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 ❑ ,CROSS CONNECTION p FINAL ,,❑ OTHER QyE QR(�v�, Q 198.2 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.or - - - - - - -- - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - -- - - - - - - - ?;D� 6�' ADDRESS : DATE: t f PERMIT#_V7 ` " � ISSUED: SECT: 1 �' BLOCK: LOT: LOCATION: U,< <� - OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ,[3-ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION 1 REQUIRED FOOTING u ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: r_,O ROUGH PLUMBING ❑ ROUGH FRAMING `'INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER i Ch r qq i 04 r' 1 N clq N w v go oz � M � � •C p a C 1 V KI PLO CD C ■ Q, w94 t- co or c cc t4 ~ F= ao W W 1 w o v r a w t Zo c7s U �-.. z F- W ° O u ©04 IRA U p W z 460) 9171' ° dl Cam. mz* O=4 fs = � p [E C IE E BUILDING DEPARTMENT SEP 3 0 2021 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914) -0668 BUILDING DEPARTMENT www.iVftdok.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: cD l' EP#: L?l I- Q f 9 Approval Date: SEP 3 021 Permit Fee: $ :50 ^ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, -Z 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 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: 3?_ Lme_4.1 r'w jk lu• SBL: i_A: 2,!Fi -7 Zone: 2.Property Owner: &�' (Z.Jtl., t"'(nR i,Ft%^ Address: 37 Q. Phone#:_ J 93? -a ii3 3 Cell#: email: 3.Master Electrician: IdAag. t �'t C j Address: 5 no Wt7 U_-Jcte_ 3e6_Qn✓A q-t-IvSO(, Lic.#: 0,� Phone#: �f 14-7(n-Cr IZ"5� Cell#: .3 -q%R email: (Ml\'�j lctS Q cD OT"o tti��1 n2.Nv1 Company Name: P� F,"'L `�, Address: ���� C3 mwtc.- SN rt�u rf LCy-/tf (1r y 4.Proposed Electrical ork/Fixture Count: 1053 - 11 n, STATE OF NEW YORRK,COUNTY OF WESTCHESTER ) as: `'\C y c4 d- —( '?Xe✓e C—,' ,being duly swum,deposes and states that he/she is the applicant above named,and does further (print name of ind ual 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 eren.//LC..1�,_ 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. Swom to before me this Sworn to bpfore me this day of ,20 day of ,20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Public ALEXANDRA H.MARSHALL Notary Public,State of New York No.01FR6363711 Qualified In Westchester County Commission Expires August 28,20 8/12J2021 INSPECTIONSTATEWIDE Service With Integri(v 181 Main Street,Fishkill, NY 12524 1 emod:office@swisny.com SWIS JOB APPLICATION ;. 1 914.219,1062 • • • 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 ❑ 1st FG. ❑2nd FL ❑3rd FI. ❑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 Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information V 3 0 2021 DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by sWls.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 applicatlon. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services CA--> 1080 Main Street Fishkill, NY 12524 T '11� 845 202-7224 Phone 0 0 TO 914-219-1062 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: Post Electric Inc Eli& Ruth Chalfin 450 Commerce Street 32 Meadowlark Road Hawthorne, NY 10532 Rye Brook, NY 20573 Located at: 32 Meadowlark Road,Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 21-249 135.28 Certificate Number: 2021-5048 Building Permit Number: BP 21-132 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:32 Meadowlark Road, Rye Brook, NY 10573 The Second Floor Master 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 2nd day of November 2021. Name _Quantity Rating Circuit Type GFCI 02 Switches 03 Air Tub 01 Electric Floor Heater 01 Officer: Frank 1. 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 � f Pi o N o a ak Qn 96tn z Z Z • �"' © 0 w c �en z va c W ¢ qT co I--- R V oo w F v z en I/ r Q w F C6.. fift r, JD BUIL P E MENT viL ` E of RYEooT� SEP 3 0 2021 938 KING ET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK -IV-_ 6 BUILDING DEPARTMENT wwtiu ll'R�t53 cio�.orb PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLI BP PP#: --f 5 Approval Date: SEP 3 0 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 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. I.Address: -;2 MEIAD OU)d RR1Z J)tpD SBL: Zone: _ 2.Proposed Work: 1�C N'o VA7 E M4S7tc2, 'BA-W 3.Property Owner: 1 4Mi) NJTg c 1�4i Hlj Address: 2 &RD R E 6 1 Phone#: cqlq) n3 -bw; Cell#:f StS9—6611 email: MOM P'U-1.1=S 4.Master Plumber e(Z )D SO y���./ Address: q3 S eyll/4 4T-14 Vir D C t yt.l O D tL Lic.#: 77 'K Phone#: Cell#: 74y- 31-a-u email: et? l o /3a-tf G ®G'm/; 1�•c�r Company Name: r44,L ST A it P14 i her�G Go Address: SA M c 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 1 st Floor 2nd Floor 1 i 311 Floor 41 Floor 51 Floor Exterior 5,*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 STATE OF NEWYO`LRK, COUNTY OF WESTCHESTER ) as: 907 S e ig ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual tviv�ual is fining 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 L O N TI AC rD K 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. Sworn to before me this U Sworn to before me this day o 20,-i day of ,20 9 Si nature of Property Owner Signature of pplic nt Print Name of Property Owner Print Name of Applicant ison ao P Public,State of New York oia4No. amNo.02HA4956574 State of New York 02HA4956574 Qualified in Westchester Countyi Comrtussion Expires September 25,20 Qualified in Westchester County Commission Expires September 25,20,,L 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- 8/l2/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 3 0 2021 938 KING STREET RYE BI 06k,NY 10573 ! (91<4)939-0668 VILLAGE OF RYE BROOK ' BUILDING DEPARTMENT vyv�w:r�'ebrul11:.1►1•'� �__..._._.___.... 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: 31, P_,U 7H5.0 RALf , residing at, 3 2- AleCA yl*-f4 r I, "Q 119 (Print n;1111C) (Addl,:., ,:au hVC) being duly sworn, deposes and states that(s)hc 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; Rye Brook,NY. 1Job Adds-ess) Further that ail 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. — rP� 5 I�wna Irc or l'loperr�N l)wncrfsii P T S-C l-1-A L F I i Print Namc of Propertti F)wncr(s)} Sworn to before me this day of 20�_ fNt>tar r,i,ii�, Julie Harrlsat Notary Public,State of New York No.02HA4956574 Qualified in Ulestchester County MMmission Expires September 25,20?�' -3- 9/12/2021 Building Permit Check List&Zoning Andl sis Address: 7 FiAQ 0 v * �Z ��� SBL.: � Zon 7-2 Use: Const.Type: Other. Submittal Date: —L 0 Z Revisions Submittal Dates: Applicant: G H✓S L;%N Nature of Work: I —t�P.CLia n-- �� evi w :ZBA: J if N — 1 2021 PB: BOT: Other: QK ( ( ) FEES:Filing.�� BP: ���+ � r C/O: Legalization: : ✓( ) ( } APP: Dated Notarized: SBI. Truss I.D. Cross Connection: L-" 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: Sewed: Copies:Electronic: Other. ( ) ( License ✓ Workers Comp: ,✓/ Liability Comp.Waiver. Other. O O CODE 7S3#: Dated: N/A: (Jf ( ) 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: Pemmr 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: C ) C ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plans: Other: C ) C ) BP DENLA.L LETTER: C/O DENIAL LETTER: Other. ( } ( ) Other. ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg. date: approval• notes: APPROVED FIB REOUIRED EXISTING PROPOSED NOTES Date: IIIAI A= Sarsle: Fssn� Sri Main Cov Accs.Cov Ft.H Sd.f I SE6: TotIM Ft.imp p H�6' f Stories: notes: —"�+{_ `.i'" "Wig.✓ 4�'l".-...�i'�° ''C .Nrj�+� 'k� � leA�'r?� A, -r';; A. A F:��>� A �'.ry\�y+'r�';tf ?+�?yn �+_.�. _,..,�-�'iL\A,:d Y:• eel,:: n ft�r� p'� .% A.��r � �:�fey?v yam+ le�,� '�•� '•q�•,, ,���G}'�'� -�..�.�-/e /� +�:_, :*y} �', l5y i ii r•Yi.- ra eySrpr` ``�� I''rr�',"" .,H rpr: ,.t i...,:.,. 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L 1 Z�•` O N QJ ff - ' v ct;on CL ilk w w ljj LLI u i Mr lw v) x r�-.11► > a )f ~ h X ° z cd �� C` � ►� � Y III \ t F-i ° e 111�11 ;-; 9c•:111111 I Ill li 111/1 1/1/1� •E qg� $gg di111 3 � ,, "� �aT3A0.:.,Cf •i -- q A i ♦♦ .� y A 1 !/� �}��3.A8$�� _.�i1� d `is4'i11 R� �i:.. •♦ 13. ;,� � i iiY .Ip?SrII�yiw�,&4�tl.:.:.i�4 i � �'�� v�z lF,. \�' N% r{.,7,,! �r �l .4y .1 i+4 i�le•�,,,{y ,IAr �!{��gp4�;W,�q}'N97 1�SSi,i: "� .V:`� i p)'N�� 9� f p yn^pP`: e�r'AiYr�+yyt+Ftiyy� � ��[E�� i' �D ?� � � �{�� Y• ��+Nti_�• .� �t � "� ':: '� v�jS.M +�_V SY _ f'i t5� 5 } Vy I AC40RDO DATE(MMIppIYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/28/2021 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 endorserent s . PRODUCER UOWA�T Joyce Knizeskl Scavone Insurance PHONE 914 47&7111 a (914)428-7764 470 Mamaroneck AvenueINC.rim E-MAIL lseavone@scavoneins.com Plains,NY 10605 - INSURER S AFFORDING COVERAGE NAIL i INSURER A: EVANSTON INSURA WE COMPA NY 35378 INSURED EL Dan Corp ------- INSURERS: ---- 7 Sleepy Hollow Road INSURER C Rye Brook, NY 10573 - INSURER D: 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 POLICEES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL TYPE OF INSURANCE ER POLICY NUMB POLICY ' POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY (Y 3FZ8M 10/01/2020 �1 010 1/-021 EACHOCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR II PREMISES(Eaorcurrencel $ 2,000,000 MEDEXP Anyoneperson) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,ODO J POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea eccide nt AHYAUTO BODILY INJURY(PerPerson) S OWNED SCHEDULED I AUTOS Y AUTOSI BODILY INJURY(Per accidenl) $ HIRED NON-OWNED PROPERTY&WAGE S AUTOS ONLY AUTOS ONLY D ; .... __UMBRELLALL40 OCCUR EACHOCCURRBJCE i EXCESSLIAB ,CLAIMS-MADE,, AGGREGATE $ Df15 I RETENTIONS $ �All KERS COMPENSATION STATUTE EREMPLOYERS LIABILITY Y!N ANY PR'OPRIETORIPARTNER)EXECUTME NIA E.L.EACHACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1� i � I i i l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES WORD U",AddRiomt Remarks Schedule,may be anached if more space is required) Village of Rye Brook is included as additional insured under the General Liability Pblicy for License&Plerrrd Purpose only. Designated Operations Onty:General Contractor Job Location- 32 Meadow lark Road, Rye Brook, NY 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 Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVEt03 ' /" i 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016108) The ACORD narne and logo are registered marks of ACORD 4 \1 N YS I F 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 (RENEWED) �. � 'M ^A^A^A 134049309 .� EL-DAN CORP. ;'� 7 SLEEPY HOLLOW ROAD Dim - - RYE BROOK NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER EL-DAN CORP. VILLAGE OF RYE BROOK 7 SLEEPY HOLLOW ROAD 938 KING STREET RYE BROOK NY 10573 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2048 215-4 486235 10/02/2020 TO 10/02/2021 4/30/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2048 215-4, 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:INVM.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. AMIR LESHEM PRESIDENT "EL-DAN 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: 532923517 U-26.3 �i. MAY 2 8 2021 — i� a ------- VILLAGE OF RYE BROOK BUILDING DEPARTMENT FILE COPY -- N - vi H PERMIT aBL#_ 1 DATE APPR JUN - 1 2021 BUILDING INS illage Of Rye Brook,NY MAY 2 8 2021. VILLAGE OF RYE BROOK BUILDING DEPARTMENT � _ M � W a `t It W � d W� U � V DID ah 1Pd l000Ul;feU0 H=,rg