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HomeMy WebLinkAboutBP21-159PERMIT # !f" SECTION _ TYPE OF WORK., JOB LOCA ION _ OWNE ft/ CONTRACTOR_ EST. COST TCO # ' V -I59 DATE• Exp. • % / a • 71v 13LOCK LOTc Jr Dc 17 -- FEE 7 • FEE DATE_ FEE DATE INSPECTION RECORp DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING `fit GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL p,�, / 7316asincAjes>�c/ccyy�/c OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER CouNTY, NEW YORK No: 22-037 Certificate of Occupoucp This is to certify that ��(/I i ' Samar-4,60 4 /l-I of, v 8 /V having duly filed an application on KGL 7, 20 requesting a Certificate of Occupancy for the premises known as, NO( IV V M OrESC el-7 , Rye Brook,NY, located in a PUL) Zoning District and shown on the most current Tax Map as Section: Block: J—Lot: 4�21- _. and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. , issued 20 c2 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 following New York State Classifications,Use: "� l✓ &Construction: , for the following purposes: In C 1/0 J7 6J-?A , k l4eheli s -hlvo ha4h raarr?s 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 s all be made,nor shall the building be moved from one location to another until a permit to accomplish such change has b e Building Inspector. Building Inspector,Village of Rye Brook: Date: MAR 1 4 2022 R [E C IE � V E3D BUILDWd&__'YAkTMENT For office2=�� PERMIT# MAR - 7 2022 VILLAGE OF RYE BROOK ISSUED: 7-/—a" j 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE:y�-'7_a a VILLAGE OF RYE BROOK (914)939-0668 FEE:jl� f 10-- PAMJ9 BUILDING DEPARTMENT www,aghrook.org 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 #it###►iiiiiiiiiiiiii#,t./iiitiiitiittttt►ttt►itt#ttttttt#tttttttttttttttttitttiitttttttiiiiiitiiitiiiiit#iiii#ii#iiiiti######it Address: I�1 Z IVY /VI Occupancy/Use: J—d! W Parcel ID#: a 9, -7& —Zone: Owner: 'JA,v\ft,1 1-0 Address: t,1 Z 10 1 I-�11 P.E./R.A. or Contractor: x '�11-+5 ,J���: %r�c� Address: /a 0 •,VAifS�4�2Aw #ax {AQ/-�5d4 k joy Person in responsible charge: _I C r-z A I FA-Q, ASS: . o/ /= - `6� - l �91 �0y3C 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: C 44;5 S' �k 177tL being duly sworn,deposes and says that he/she resides at 15 2 �V r l�I( C ce S Name of Applicant) (No.and Street) in Z-YE in the County of ����G�R-S /� in the State of N 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:$ 1 S00• r 2 for the construction or alteration of �,r,�, o-c� ��a.l A-ci�,�S�l G: G►l Pad `� o� ' }}f��'✓►�`S 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§250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this VA Sworn to before me this day of C"C-C�Y ,20' day of ,20 Sijnature of Pr erty er Signature of Applicant ame of Property O e Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public, State of New York No. 01^i1E6160CS3 8/12/2021 Qualified in Westchester Countyn n Commission Exnires January 29.20s -- ,; QyE BRC�,�. 1932 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: ` ` PE: J �62-a PERMIT# ISSUED: I� SECT: \-E) 16BLOCK: LOT:2' LOCATION: ` O� C1 �n ` C K OCCUPANCY: ❑ VIOLATION NOTED T E WORK IS...XACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION t REQUIRED ❑ FOOTING w v Q ❑ 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 QyE BRC�k cu � 1932 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: Z Z PERMIT#�ZI - 1 t� :'/L ISSUED 6 Z SECT:I 7q �6 BLOCK: I LOT: LOCATION: k tc4er--- 4- ITT OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... } ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION i REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑,,UNDERGROUND PLUMBING NOTES ON INSPECTION: A ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ( �� ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 1n 1Pi s O Os m fs. 3k ' F OL LY" O [� = C • _ d S H � M > � � w ►��. .� Z U Z I s Z O F- NG rA : F W a o w Zcc gz < T a O U o Z �% o a M°c V Z M••� � o, � z M Q u � < ' U >0-0 ON o m oc Q f Q+ W *� d Z E" LT M�•d L+ U V p = h+l U W pZ Z v: Z U � Q C w �.. U w z P1 V Q V � � W Fw Z < •• � a W W 0 IC'AI All zi 41 m • D EC EWE yE aRnv� BUILDIG DEPARTMENT VILLAGE OF RYE BROOK JUL 15 2021 938 KING ST EET RYE BROOK,NY 10573 (914)93"-6 ' (q,14)939-5801 VILLAGE OF RYE BROOK - BUILDING DEPARTMENT wvkiNll��czcak.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required J FOR OFFICE USE ONLY BP#: cL� L EP#: �/'—/ 73 Approval Date: Permit Fee: $ �U"—��J Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 6191is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of m a Petit 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: I7� �/I, PI�e SBBL: AN.76- I" .2 1 Zone:�1) 2.Property Owner: / %Q R/6 SSA U S-r )e Address: 1!o? l✓N rT/dLi'eS�P<� Phone#: �ji1i'�dfo Cell#: 9/y S l%' y36(v email: . C . 4> 3.Master Electrician: c. SCIS 'i� htti�l Address: Y Lic.#:' C Phone#: Cell#: email: f 1A0(je-f-rP-1e"r-,c , co m Company Name:I 1C{12 f'/ Q�lil L J� Address: / 1 Ai JAJ 5r 4.Proposed Electrical Work/Fixture Count r ve re ce s.,aza b�k)ts STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 7:3;�`5nt4 Vie being duly sworn,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'A�'CIC I CJAL l tJ-ri< Cif o 4 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 13 day of 20 day of ,20_l„1_ Signature of Property Owner Signature of Applicant T Print Name of Property Owner Print Nam of Ap Notary Public No Pu lic JA N STONE NOTARY PUBLIC-STATE Of NEW VWK No.01ST6262444 Qualified in Westahestet COUrlty 3/21/19 My Commission Expires 08-25-2024 Westchester Rockland Electrical Inspection Services, Inc. ��� Phony: 14- 47-3595 Z.y DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue ( �� Fax: 914-347-3596 1 Elmsford, NY 10523 1-in BUILDING PERMIT NO. ct TEMP k _7DAT , j, _ �- CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD / ` I POLE NUMBER AA IiA BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING 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 ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1"FL. 2—FL. JUL 15 2 21 3'FL. QUILDINQ DEPARTMENT 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 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 CHARACTER OF WORK NEW❑ ADDITIONAL C7 EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C' UNDERGROUND[-' AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT STREET ADDRESS/ !. TELEPHONE NO. CITY OR POST ZIP CODE LICENSE NO.WHEN APPLICABLE —=aac+ -- F lift WESTCHESTER ROCKLAND ELECTRICAL INSPECTION WRE111SERVICES,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: Eastchester Electric Craig & Samantha Shuster 187 Main St. NY, Eastchester 10709 Located at: 192 Ivy Hill Crescent Rye Brook, NY 10573 i Certificate Number: 1031050 Section: 129.76 Block: 1 Lot:21 BDC: Permit Number: EP:21-173-BP:21-159 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: 192 Ivy Hill Crescent 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 10/07/21 Name Type Quantity Receptacle Convenience ------- 2 Replace Receptacle(s)Convenience ------- 2 Fixture-Luminaire Recessed replaced 3 Fixture-Luminaire Incandescent ------- 2 Switch Single Pole ------- t This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. /--7��L This certificate is valid for work performed before date of inspection only. i r S �0 i 16 Q 3 N _ ' "V E- a y y Q W � o 0 Ono r � - w •' w."� MCI 07 mw oc z 0. V w o¢ w o ^ ° F• - c woo wq i .LD N V r p if Q\ Z F z p C Y ry MMr C M/r f(w 'Y i = i ` R BUILDING DEPARTMENT L�C�L�OML� VILLAGE OF RYE BROOK JUL. 2 3 2021 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 FAX(914)939-5801 BUILDING DEPARTMENT w\ti\\.►vebrook.org PLUMBING PERMIT APPLICATION Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ####*###*T*m#;T* #yy••y� •Y#t##*##*:h•#�I:T#�K##*##t*#############:k#;k##*##*##m*#*#####�Yt######*#**#**m#* 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. 1.Address: 192 Ivy Hill Crescent SBL:/c)9, 7b--I—c)I Zone: 2.Proposed Work: Plumbing work for two bathrooms and kitchen all rough plumbing same location. 3.Property Owner: Graig Shuster Address: 192 Ivy Hill Crescent Phone#: Cell #: 914-522-4366 email: shuster.graig@gmail.com 4.Master Plumber: Salvatore W Morlino Address: 1 Bonwit Road Rye Brook NY 10573 Lic.#: 725 Phone#: Cell#: 914-260-1592 email: salvatoreserious@gmail.com Company Name: Westchester Plumbing And Heating Address: 1 Bonwit Road Rye Brook NY 10573 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 1 2 2nd Floor 1 1 1 3,d Floor 41 Floor 51 Floor Exterior 5.* List Other Equipment/Provide Details: Plumbing work for two bathrooms and kitchen all rough plumbing same location. (Notarized Signatures Required Next 2 Pages) -I- 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Salvatore W Morlino ,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 Contractor 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 7 Sworn to before me this 7 day of July ,20 21 day of Jul 20 21 x Signature Property Owner Signature of Applicant x 0,6-A� ��ST-'re_ Salvatore W Morlino Print Name of Pro y Owner Print Name of Applicant Notary Public Notary Public TM p �SAO 44 New Y I�quy 0�1. t4*8 Y�.01 119 tau y lW.41 rt>e ls W 3,20� rum in '- t 444-kfliw -2- 3/21/19 BUILDING DEPARTMENT F.C IE 0 Y E VILLAGE OF RYE BROOK JUL 2 3 2021 D] 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 FAx(914)939-5801 VILLAGE OF RYE BROOK N%wwxvebrook.oruy BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §2 16 • STORM SEWERS AND SANITARY SEWERS STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, Salvatore W Morlino , residing at, 1 Bonwit Road Rye Brook NY 10573 t Print n;um�i (Address%%'here you lire) 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; Re /9 a ✓V 4 e e's ce--14 , Rye Brook,NY. 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. 1 x (Signature of I'm7_(54 cr(- l ( not Name olProixrt� Uner(s)) Sworn to before me this 7 stow 44 OW Pµ0 day of July , 2021 Notary p1M0ep11c; � OUSA d"6�W� s,31i�� "".'We n (Notarc Public) -3- 3/21/19 a Buildin Permit Check List&Zonin Analysis Address: ` i,1 S SBL: Zone:Q• Use: 1 Const.Type: v Other. Submittal Date: 2 \ Revisi ns Submittal Dates: Applicant: Nature of Work (244-2 � Reviews:ZBA B- �i ' BOT Other. ZIEF.>z OK Q— ( ) ( ) FEES:Filing. `> BP: �V C/O Legalization: ( ) ( ) APP: Dated: Notarized. SBL: ✓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 ped: Sealed Copiesj`Electronic~ Other. f ( ) (4"luense: Workers Comp: Liability- Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. Plans: Permit: N/A Other. FIRE ALARM/SMOKE DETECTORS:Plans: Peratier 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 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. ( ) ( ) Other. ( )AM mtg.date: approval• notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval: notes: REQUIRED EXISTING PROPOSED NOTES 0 Ate. Ck&. FropW Front:Front.- : R.Cur. Main Cov Accs.Cow Ft.H/Sb: Sd.H/Sb: !FA.• Tot.!-y F IMn : P n • H�ighht/Stories: notes: FjJ• f �oY: '4•ti' r 5 0�5�...• _- .Q�hOin\ - _ e O#�rr _'�•. esA ti___; 'N^fG r• �rA'1,�f`�-1 s• ^ s�',5. A \_- '� ;•,i f•1.1'1�r ;r; r (• i r, r �• t .�: . � (• r y; r�• .t - t e tF,fA N"�E�.S 'r Gr��� M 3�s r. ��-; w. �(0)> �� ;':ti'•'11�111. :: -�.".Ill�ll' s�,,III�III:a9F:3g ��s�s+;.11) 11�dc.`c. ,:-:d;.1 1.•, .111,11111.-.. sFEallll�lllll -c.��11 i• <(0)►Null A � �I (0)> - ni rrC••� ar is «S (V ��. sr N ; 4-0 uj un �� '' U 'U � w ♦mac. ' �;� ►... �' � � o � rx Quo e n MR- LU co �y J Li jell Qui X O O G� 4� C) o ACZ U Y `_ DO • ZILE es'e:. _FE:11'11/�/�11�' _��� `II'jl/�lllll��"``a —_=�`�IIII fill�S'o ,y%• AN 1 1� �iti� fir► �b�Jl . 1.' e ll; s 1(If�l 11'I� Ill�ff/�yl -� 3 ^ .,` ��^ ,.!' �+1 ^ trig •1��lra ^ � ♦♦ Ate, ♦• � i •• fr p�`� FIXTHIS-01 BEGEL1 ACORO CERTIFICATE OF LIABILITY INSURANCE DAT/20/2 02DIY � 1 620I21 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 Ellen Goldman(egoldman@butwin.com) NAME: Nathan Butwin Company Inc. 60 Cutter Mill Rd.Ste.414 (A/C,No,Ext):(516)466-4200 (A c,No):(516)466-4213 Great Neck,NY 11021 E-MAIL ADDRESS:info@butwin.COm INSURER(S)AFFORDING COVERAGE NAIC t INSURER A:Utica First Insurance Co. 15326 INSURED INSURER B: Fix This Now Inc. INSURERC: 120 E. Hartsdale Ave Apt 21 INSURERD: Hartsdale, NY 10530 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR MM/DD/YYYY M A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR ART129820515 3/10/2021 3/10/2022 DAMAGE TO RENTED 50,000 I S(Ea occurrence) $ MED EXP(Anv one rson) $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY�i,j LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT owdeMl $ ANY AUTO BODILY INJURY(Per person) $ OWNED RTU EONS ONLY _ SCHEDULED SyUyLNEEDp BODILY INJURY(Per accident) $ AUTOS ONLY _AUU% ONLY rS er OPERTYMDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION PER OR EMPLOYERS'LIABILITY Y/N R 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 LIMB DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Carpentry,Interior Painting There is a roofing exclusion on the policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook, Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE C_i%�f{�1I) ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: renealfani renealfani@gmail.com Subject: Date: June 21,2021 at 9:10 AM To: rene alfani renealfani@gmail.com '� Workersro�ac I Certificate of Attestation of Exemption sT1tiE Compensation from New York State Workers'Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **Ybis form caneot be used to waive t*e warkas'compesrsadoa rq*&or obugariolas of otrp part}t•' Ile applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State spocific wotitcn'compensation and'or disability and pad family leave benefits Insurance is not requitzd The applicant may BM use dais form to show,another business or that bu irmcss's insurance caincT that such insurance is not required. Please provide this form to the government entity from whack ven are requesting a permit,liceose or contract This Certificate will not he accepted by government oQlelals one year after the date priated an the forru- In thr Appficiation of Business Applying For: (Lagal Endh Name andAdtitns): Building Fertak ns;This Now'.Inc. I2a Bit Hartsaak An. From:Mate of Rye Brwh1:Building DrpurtnstM Hatqask.My I" PRONV 111-'►2241252 FM!X7tXXYJM The location of w1lim week will be verincmed is 192 Itry Ills Ctreoeat,Ryt Itrodt,NY 18573. Estimated dates necessary to complete wart associated with the buiklmg pesmrt are liom Jane 21L 2t21 to August 15.2a21, The estimated dollar amount of pre)ect is f 10,t101-US,00a W efr�a•a'fy�sarsrusYr Kyw�nrfew Sssaavasat• The above tamed bullilm"is certifying drat it is NOT REQUIRED TO OBTAIN NEW PORK STATE SPECMC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a une person owned corporation,with that individual owning all of the stock and holding all offices of the corporation. Otter than the corporate owner,there are no employees,day labor,leased employees,borrowed employers,put-tine employees,other stockholders,unpaid voltmteers(including family members)or subcontractors. Diabil1t and raid Faaly Leave Benefks Exemption Statement The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW VORK STATE STATL'TORI' DISABILrfy AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either 1) owned by one individual, OR 2) is a partnership(including LLC.LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 31 is a one or two person owned corporatkw with those individuals owning all of the stock and boittitng all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 41 is a business Witt no NYS location- In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law:) L Rem Altani,am(be President with the above-usmad legal entity. 1 affirm that due to my potation with the above-mooed busmcou I have the knowledge, information and artlturity to make this Certhrtcac of Anepabon of Exemption. I bereby affirm diet The statements mode herein we true,that I bets not made any materially false Antemonis and 1 make this Catiticase of Amestabon of Exemption under the penalties of perybry. I furiber affirm that t understand that any false statement,repreaeatarioo tic cuncealtrtent will subject me to felony criminal pnshecaboo,iseclufiag jail and civil liability is acconhhoce with die N+arkers'Compensation Law and all other New York State lawn. By submitting this Certificaee of Atrestabua of Exemptim to the government entity haled above I also hereby affirm thot if t:acuostastces change so that wurkem'compensation in innance andror disability and paid family 1mve benefits coverage is reyured a above-named legal entity witl immediately acquire apprupuiale New York Stye specific mortars' compensation i ounuiee audror daub d paid family lave bendrts covYrage and also immedwely forms h proof of that coverage an forms splim ed by the Chair of the NbK&UwA a'C Board to!�gnerror entity listed above. 3IfiIN ' HERE it.' A-0Date: Exemption Certificate Number Recei ed 2021-038835 June 24 2021 NYS Workers'Compensation Board c><2ta ol,Zar• C� o z 3000 ONIaiins SAN O ui a3d Sd a3HinD3b NN m Sa0103130 3NOWS J' }Q r ! W cc u �' 0 o tr Wo. LL01 tn o x0� o zc 0 ZQLLJ 7- c Qp o 3 �NWU J_ CC -�� a v Z CC >m 71 1- 6 s� o � caua � I 15t? 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