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HomeMy WebLinkAboutBP21-148OTHER APPROVALS PERMIT # OI— 1 / DATE: c EE(P: 7 . SECTION / 3 5'r BLOCK LOT TYPE OF WORK z;)» d r OO r w za?A E= p lra 1 d•#7 10B LOCATION / �`� OCX) d OWNER �% jjC� C / M2 e/ok�/�301�3 �I�O- 3b/�iI CONTRACTOR �7�Mu %!/✓1 or -,C �iS el V Jy)%��i—dll 7 EST. COST ,/Co #� D TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT L7 ALARM AS BUILT M FI NAL INSP �i-1011ris, ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHES COUNTY, NEW CORK was Na: 21-195 ( Certif irate of (9ccupautp This is to certify that G :F. Invne of, Arco k i /\j 7' , having duly filed an application on 20 02/ requesting a Certificate of Occupancy for the premises known as, .�9 MrOM Wood koad , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: Block: Lot: c2 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.c�k / 0 , issued LO / 7 20 a� 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 Class ficati n of: -6Lone " (.(.// ///l,/ ,for the following purposes: d m 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 be b ed frv--tlre B ilding Inspector. Building Inspector,Village of Rye Brook: 2 Date: DEC - 9 2021 �' R For office use only: [� Y BUILD E ENT PERMrr# VIL OF RYE .R K ISSUED: &47t-3� DEC — 3 2021 ING STREE 1'F BROOK, 3 YORK 10573 DATE: /a—3—a (914)9 (9 939-5801 FEE: I10.0,0 VILLAGE OF RYE BROOK 0 BUILDING DEPARTMENT o 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 ***********+******+**++*++++++++++++*w**w+++ww+*ww*w*wwww+*r+wwwwww*wwr+w*w*www****w*w**wwww************************ww*ww***s Address: 36) W.j IS D j NJ& J Occupancy/Use: [ �(Ly Parcel ID#: � '�(p Z _Zone: —� Owner: Address: 3CJ W)kD W(o IA M to. P.E./R.A. or Contractor: I Uvt W]LD]rl(o l ,p Address: h-2.9 brN RP. s ro eD CT 06 3 Person in responsible charge: CAWW2 Address: 11 r (f 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: (� 1 bi-MAQW:� S6 I4eIo�&g duly sworn,deposes and says that he/she resides at 39 W 1NUlw&woa10 f4 (Print Name of pplicant) (No.and Street) n W5��who IL— ,in the County of Wb�2T�61t&12, in the State of��,that (Cityfrown/Village) _ie/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 M},c , for the construction or alteration of: 2-imy r-Lw 9— &pMA gwo%j ATi*A 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 MA%.c.'-� , 20 :,-->)l day of M,�L l , 20 Signature of ProperVOwner Signature o Applicant (f� I ,, l S"4 , , fGar-✓ Print Name of Property Owner Print Name `o..ffAApplicant Notary Public u is State°f Notary Public Notary public, •GEORGES Reg•No New'Yor* State of New york Qualified in0yye 6381102 R� NO.02GE63gy1Q2 C°7nmi st County Qualified in West County 3/21/19 ssion Expires p9/24/ Commission 2022 Expires 09/24/2022 QyE BRC�v� BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK /11 CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS.:- ` - P DATE• C5 Z r PERMIT# `� ISSUED: 1Iq r SECT: BLOCK: LOT: LOCATION: C �- � OCCUPANCY: ❑ 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 (j, ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER 6 BRC�k. w � '931* 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.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : C,1 �'�+Y DATE: 't) �� f PERMIT# ISSUED: rSECT: �� BLOCK: LOT? LOCATION: ' OCCUPANCY: 2 t0 ❑ VIOLATION NOTED THE WORK IS... ,0 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 ❑ FINAL OTHER a JL {� 0 C;r, ON t Rn a, ON oC c r >rc Lip �^ N N V °1 rA Gzi Oi7 ro z o rffl = CNA ri L9, En 0 co ;D = 0 � � W� o © 3W p7 all � uf c � oc V o © o a F~ O ;g i win U C 3 W t C a, V 0 0 0 � Q yF- BR Q BUIL MENT VEL t OK JUN 2 9 2021 938 KIN tIT_Y ° ,NY 10573 (914)9 939-5801 VILLAGE OF RYE BROOK • or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 1 /� FOR OFFICE USE ONLY BP#: �/-1 /e O EP#: Q�) Approval Date: 2 9 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated,/14 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 er�Federal,State,County and Local Codes. I.Address: _9 iJ C�i poi Wood 11- o A G SBL:/3 5,2(9 Zone: 2.Property Owner A(3pj e.L-f JTA-Y e- S&iye 1 J OL, Address: S fl-r-"-' Phone#: Cell#: 30 I- 3 Y 6- 36 1 y email: 3.Master Electrician:-,rt) h ti rY 2t e cc Address: . .S U v Sea` I"I ! ,e ►J'tO a/, 42 41gv Lic.#:E539_Phone#:91 Y- qJ9-a t/a Cell#:'?/Y- . 2 e)'SYa `T email: Cta f� fj. j.,"' Company Name: WesT- no 2_ ILC.YCkc- Address: r- St.(USe-T -1� C)P -P 6Zocic /V ylDs--)-4 4.Proposed Electrical Work/Fixture Count: 2.t P l Ta-u ,h)Z:� FL c}D K- Ft't 3 .1 DJ t,� -- P"S r G Fe,1� L lug u 1- 1 F A19 s_ STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .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 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this CT ct day of 20 day of 20 Signature of Property Owner S' ature of Applicant Print Name of Property Owner kFhtkName of Applicant Notary Public Not"%EUUA Notary Public,State of New York No.01 ME6160063 »+lUallfled In Westchester Courttyr Commission Exnires Januanj 29 m 3/2T/19 Westchester Rockland Electrical Inspection Services, Inc. phone: 914-347-3595 DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue` Fax:914-347-3596 • Elmsford NY 10523 ' � BUILDING PERMIT NO. TEMP# DATE CITY OR VILLAGE zIP COD TOWNSHIP COUh71Y W Q f " STREET AND NO.OR ROAD POLE NUMBER A , f f �(1��` BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT I 36 C OCCUPANT'S NAME BUILDtNG OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES SIDEWALL SWITCH INCADE FLUORE NO. H.P,EACH N I OUTSIDE 4 q` �.1r1 BASEMENT j U 2 9 L0L I 1" FL 21FL. T UILDIN DEPARTMENT 3"°FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: _ ( X. 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 APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS, 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 ,n c'_j �: x! -t!y6 CHARACTER OF WORK NEW ' ADDITIONAL Ll EXPOSED f1 CONCEALED 7 MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD L;' UNDERGROUND L -t I AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. SIGNATURE OF APPLICANT NAME OF COMPANY 11 DATE OF APPLICATION STREET ADDRESS ONE NO. { ' C R POST OFT F � ZIPD LICENSE NO.WHEN APPLICABLEAl WESTCHESTER ROCKLAN1 J, WEI ELECTRICAL 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: Westmore Electric Gabriel &Jayme Schneider 6 Sunset Road NY Rye Brook 10573 Located at:39 Windingwood Rd Rye Brook, NY 10573 Certificate Number: 1030283 Section: 135.26 Block: 1 Lot:2 BDC: Permit Number: EP:21-156-BP:21-148 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 in/on the premises at: 39 Windingwood Rd Rye Brook,NY 10573 Basement 1st 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 06/19/21 Name Type Quantity Switch Single Pole ------- 3 Receptacle GFCI ------- 3 Fixture-Luminaire Incandescent ------- 5 Exhaust Fan Bath ------ t This Certificate has been approved by Westchester Rockland Electrical Inspection Services, This certificate may not be altered in any way. �W This certificate is valid for work performed before date of inspection only. ''lf _ rq ,q fV N t raj N CID 25 Z N N pCL FBI �O 02 CC rA A z R4 cc i � Q M z e co cc I CQ Or W ECEWE BUILDING DES R MENT DID] VILLAGE OF RYE BlQOK JUL - 6 2021 938 KIN %'''LF,,r RYE BROO ,NY 10573 (914)9 6' 1 �}939-5801 VILLAGE OF RYE BROOK w 'v1t .or BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: o^^)I— A)e? PP Approval Date: JUL ' 7 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 an or remove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that sai'd-`plumbing work wri'llf be in conformance with all applicable Federal, Started,County and Local Codes. n 1.Address: O w f'�1 �lJ 1/� SBL: 135-p(0-1-a Zone: K-6 2.Proposed Work: 3.Property Owner:� L jtD Address: 1 fS (J W co iS Phone#: 9 0-9 39 - 3 Z23 Cell tV: 301 ' 34(,0 - S 6 }3_email: 4.Master Plumber: 62%X'C ascd / r Address: Lic.#: Phone#: S �� Cell#:,q4j ,Q2C r( email:JSc.Q�_ Fvu., c za[' g�7 1 d.Ka� Company Name:���i IA-ih T T k�-A� Address: 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 ( d 31 Floor r 41'Floor 5a'Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 9- 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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. 1+} T� Sworn to before me this Sworn to before me this 2 J5 day of tv E 20 -2, day of `!�u ry E ,20;� Si of rop O ier S' of Applicant Print Name of Property Owner Print Name of Applicant 04 Notary Public ROBERTW,GEORGES Notary Public Notary Public,State o ew York Notary Public,State of New York Reg.No.02GE6381102 Reg.No.02GE6381102 Qualified in West County Qualified in West County Commission Expires 09/2412022 Commission Expires 09/24/2022 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 BUILD MENT E CC C 0 V E VIE OF IZY OK JUL - 6 2021 .3D] 938 KING Fr RYF Bit( ,NY 10573 (914)9='00kof"a (91 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 YORK, COUNTY OF WESTCHESTER ) as: 2A&A �G' 1 ��a , 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; 9 v 0 �3 . , 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. (Signatur of Property Own C�- (Print Name of Property Owner(s)) Sworn to before me this r" day of Q ,4 Z (Notary Public) ROSERT W.GEORGES !Votary Public,State of New York Reg.No.02GE6381102 Qualified in West County Commission Expires 09/244,2022 -3- 3/21/19 Building Permit Check List&Zoning Analysis Address: ?��1' I r-r�[ t.1�-, k,�d D jZ-P, SBL: Z— Zone 12- Use: Z Const Type: _7EI�, Other: Submittal Date: Revisions Submittal Dates: Applicant S G 4V-1 r,l h E' Nature of Work views:ZBA: J U N 1 7 2021 PB: BOT Other OK ( { } ES;Filing: '� BP: 3-90- - 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. Shots Fees: N/A.- SITE PLAN:Topo: Site Protection S/W Mgmt: Tree Plan Other: ( } GURVEY:Dated: Current Archival: Sealed Unacceptable: LANS:Date Stamped: ✓ Sealed: Copies: -2— Electronic. Other. ( } (• License Workers Comp: Liability- Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A.- HIGH-VOLTAGE ELECTRICAL:Plans: Penns N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit I-W.I.C.: Battery:_Other. (� ( } PLUMBINC-k 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: Ocher ( ) ( ) 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 REOUIRED EXISTING PROPOSED NOTFS A=&- pate; J U N 17 2021 Circle: Front E Sides: ]3sar: Main C Acc&C � Ft H Sd.H/Sh: -GE6: Hcigb&/stories notes: Illilio Q Q 14�i(�(ih i Ih►OP01 i Iq'P�4'1 t� 1' IIA0�1',_ 1 ly►IO�p, t 1 14'OOP,. { !f .144'OPI t�t� „�s; cq f e, v ti N Iu cif -Y-1 j a p. ; •� O == '/ � I Y I Itpl V CL M 0 w o o oction LU m� Z u a �btQ V o„* l ;'W3 , T>w Caa � u y .coi;J .. ` O U 4-4 � c•y o e eu IL O � cow:. y - 4) c Wiz;,: CY) k •�.; ato» c avv c o ao ?' to y •_ o � 0 4 r,,: lorW. ' ..,, . TF: 111 H�a ti, .. T;F_1 1 '-it�F.' 11 (1-.4'c� �•z 11j�j11 1'�1,j11 to)►y $t „ 1 'iz `fury' 1 ly l c.,{z���`"(z�?x,11�14' 4�i/q'• p1�111�11 y�g y I�II�NjI 'I/.Qb/' . ) �).f (//\/`� Q ills"i(��11////� �1�( ^'11�'11111' .l {iU''II/i/�111�1(^ji, „„/�i11t1 IIIw .�1�/ w �.• �\ '�P,�'j � "wF DATE CERTIFICATE OF LIABILITY INSURANCE DATE(YYWONYYY)05117 121 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 twTvw and conditions of the policy, certain policies may requlim an endorsement. A staWtnent on this certificate does not confer rt hts to the certificate holder in lieu of such endorsemen '. PRODUCER GACT NAW TONY C_IRINO Anthony Chino puuc°N+�,E�w.—tWP"0103- _-- _ - 426 North Main Street EMAIL n gees;_ Ins u�y®sol,com Southington, CT 06489 PMREFk 11AFFORDIING COVERAGE MAIC/ usuRIM A: FARM FAMILY CASUALTY INSURANCE 0404 03 INSURED OPTIMUM BUILDING CORP N/UIIEII s: 70 PROSPECT STREET Ian D kFURERa: PORT CHESTER NY 10573 NY 10573 INIw 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. MMR TYpEOFaIauRANCa POLIcrrIUMBEA PoiltrEFF voucv"ice Lis — — — X COMMERCIAL GENERAL LIABLrlY EACH occumoom I— 1 100000 CLAYS-MADE X OGGUR I 100,000-- _ AGED EXP Q"was paean) I A Y Y 3101 LS417 02/01/21 02101/22 PERsoNAL i ADv INJURY S 1 010L000 GEN'L AGGREGATE UMR APPUEB PER; (GENERAL AGGREGATE ZOOO.000 PRO- X POLICY Q JEECT F�LOC PROOUCTS_COMPWAM — 2,900,000 OTHER- --- _ yrE LWALITY COURRED 1 ' IF�@_II�L_ _.. ANY ADO BODILY INJURY Fer PWW* S SCHEDULED I ONLY AUTOS BODILY INJURY(PW aoalanQ = � MWED NON.OWNFD I I F AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCIIYIBJCE I EXCESS LIAR CI.AWS-MAnE AGGREGATE DIED I f RETENTION ¢ MIORKERS COM/ENsarioN PEA O �AND EiLDYEW LIABILIIY YIN .. $TAT . .IFIRANY PROPRrBTORIPARTNERIEXECUT(VE E.L.EACH ACCIDENT OHRFXCLUDFDT ❑ NIA If Y", be un0ar EL.DISEASE=FA DESCRIPTION OF OPERATIONS bole. EL DISEASE-POLICY LIMIT $ DESCRIPTw*OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.AdASwul Remarks Scheduls,may As Ntadied M more space Is regw1nmo VILLAGE OF RYE BROOK IS INCLUDED AS AN ADDITIONAL INSURED ON GENERAL LIABILITY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF RYE BROOK THE EXPIRATION DATE THEREOF, NOTICF WILL BE DELIVERED IN 938 KING STREET ACCORDANCE WITH THE POLICY PROVISIONS. RYE BROOK NY 10573 AUTHORIZED REPRESENTATTVE A ©1989-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF Naw♦Orh State kwuramm Fund WESTCHESTER ONE,44 SOUTH BROADWAY,10TH FLOOR,WHITE PLAINS,NY 100014111 1 nyslt.com CERTIFICATE OF WORKERS'COMPENSATION INSURANCE a. o A A A A A A 133887956 OPTIMUM BUILDING CORP CIO CHRISTOPHER SCELFO O 429 DEN ROAD STAMFORD CT 069033811 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER OPTIMUM BUILDING CORP VILLAGE OF RYE BROOK CIO CHRISTOPHER SCELFO 938 KING ST 429 DEN ROAD RYE BROOK NY 10573 STAMFORD CT 069033811 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1478 290-1 549875 04109=1 TO 04109I.= IYI& Y1 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 14T8 260.1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK TO THE POLICYHOLDERS REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEOSITE AT HTT"IMW1M.NYs(F.COWCERTICERTVALASP.THE NEW YORK STATE INSURANCE FUND 13 NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM 130DILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. CHRISTOPHER SCELFO-PRESIDENT OPTIMUM BUILDING CORP ONE PERSON CORPORATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. 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