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HomeMy WebLinkAboutBP21-214• � • .� � i • = • �� � - „, INSPECTION RECORD I DATE INSP FOOT) N G FOU N DATI O N FRAMING RGH FRAMING INSULA710N � 4 PLUMBING RGH PLUMBING GAS O SPRINKLER � _ .� `-������ ELECTRIC LOW -VOLT � _- _.� ALARM 0 ______._.,�� AS BUILT � FINAL -�r�-OO'7/��GrM 1�-il%ul LLG ����- �l1o�GQ1�s�io� �/ec�iC.. OTHER APPROVALS ARB BOT PB ZBA OTHER Expired Letter Sent ��� �� 10/6/2022 VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-193 k: . Certificate of ®ccupaucp This is to certify that of, having duly filed an application on NOVem ber c2 20—a—a requesting a Certificate of Occupancy for the premises known as, pBelbe &'r ,hi leyard , Rye Brook,NY, located in a r to D Zoning District and shown on the most current Tax Map as Section: 4 73 Block: -- f Lot: a 5 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - , issued g 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: P-6 160e- f—am//� Construction: for the following purposes: hi tjfro' r 4/ kheh V( T/�JYj Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in heig t sh 11 be made nor shall the building be moved from one location to another until a permit to accomplish such change has be o ro the Bui g Inspector. DEC 1 4 2022 Building Inspector,Village of Rye Brook: Date: � `�n �'� I ���`� For office use onl V I� BUILDINt' YRTMENT PERMIT# �/ VILLAGE OF RYE BROOK ISSUED: - &-aJ NOV 2 3 2022 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-066 d FEE: /�S- PAIDJit w BUILDING DFPPP7 1ENT 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 s++►s++ss+++ss►ss+++sssssss++s+rsst+sssss+►rs++s++s+s+►s+rss+ss++►►ssrss►ssr++ss»»+++r+s+ss++t»+s+s++ss►s+s+ss++++s►tst+tss»t Address: LO Occupancy/Use: I `� Parcel ID#: Zone: Owner:�Q-u'P- 4 � Address: �� � P.E./R.A. or Contractor: V-420Address: 7� UP 9 /l /rOQdLJ7C1 'd C/ Person in responsible change:�QQ'fI/LJU/YI ldI4 6//-Xddress: 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: T(/,�'�_�i. being duly sworn,deposes and says that he/she resides at U (Print of pplicanu (No.an treet) � in v Cr. in the County of DLL n the State of that (Citc/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,i ding all site impro ments, 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 `I 6-2')-o for the construction or alteration of: tn-&� �d�Q 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 j J7, , 20 'Z day of , 20 Sign ture of ProNdy Own Signature of Applicant vL- 17. TY _ Print Name Proper Owner of Property Owr Print Name of Applicant ���,�� a, Notary Public Notary Public MnM�tpk me"01 16, 2 3 O� Zm '9a2 BUILDING DEPARTMENT UILDING 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 aebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: C� � J V� DATE: z 1� - PERMIT ISSUED:�`SECT: `"l � LOCK:�L LOT: LOCATION: OCCUPANCY: Zr� ❑ 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 ❑ FINAL ❑ OTHER , ' N i N l• 1+1 \ � is ►. _ r C � ON � I•� W o � �,,,,� F, U_ � g Q G r ,G L OC aoto — F 0 t > . M� ;, 7j C cc 0. r WV6ut ✓� Z U 2 � W Q 3 w Q � oo .. t- OC cc ,`, IECIE E • BUILDINGDEPARTMENT VILLA13E OF RYE BROOK SEP - 7 2021 938 KINGS` ET RYE BRoox,NY 10573 (914)939' )939-5801 VILLAGE OF RYE BROOK �, rra BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 0 J� FOR OFFICE USE ONLY BP#: o> EP#: �— J�cp Approval Date: SEP - 021 Permit Fee: $ I Approval Signature: Other: Disapproved: (r!!s are DOD-refUDditltl) Application dated,iO jaa 2c�I 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: l L:/Z%i 73 —c;)- oY Zone:P/4 2.Property Owner: . A�A4 LA f dA— Q Address: go Phone#: LP � I-7 �I iU 271 2--Cell#: - 1 14 3 24 email: 3.Master Electrician: n f� t ) C��� c Address: Sq ki -PT Lic.#: iq7 5Y Phone#:Q1 y �I S -2 Cell#:qj 61 97cl S"Y °/ email: CA- qn tj 46 1. e?l Company Name: MOL12 'F( -�t4 t= Address: ( &y 4.Proposed Electrical Work/Fixture Count: L/ .S �V r T u ``�J �1 ���--Id/ I c.c �Lrc l %N lIF STATE OF N W YORK,COUNTY OF WESTCHESTER ) as: d /ti ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signi g 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 ZA Sworn to before e this day of JLc� 120 S�17, of Property Own ature of Applicant et r, e� o&z Print Name of o e' Printf Applicant , k ij Not �N ary Public ��H.MA SHALL MICHAMA.NAPOUTAW Notary Public,State of New York 1 1"C� Ii No. Westch3711 ester qualtflei!In Westchester County rO11f1Q On N �� �-�3 Commission Expires August 28,202a 3/21/19 Westchester Rockland Electrical Inspection Services, Inc Phone: 914-347 3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue r Fax: 914-347-3596 ' Elmsford, NY 10523 't 1 7�1 BUILDING PERMIT NO. TEMP# DATE ___YiJ r,A1 `of Il CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER C 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. 3'FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: F SEP - 7 2021 OF RYE BReel( THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF I Ng7gnE LED,VOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED ASP 11 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 0 EXPOSED❑ CONCEALEDfQ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND[] 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 DATE OF APPLICATION 7EIIFT�WRIESS p TELEPHONE NO. �I C POST OFFW ZIP CODE LICENSE NO.WHEN APPLICABLE J�/ 'JL- WESTCHESTER ROCKLAND ELECTRICAL INSPECTION IME15SERVICES.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 Paul&Linda Tyler 6 Sunset Road NY, Rye Brook 10573 Located at: 16 Bellefair Boulevard Rye Brook, NY 10573 Certificate Number: 1031535 Section: 124.73 Block:2 Lot:25 BDC: Permit Number: EP:21-216-BP:21-214 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: 16 Bellefair Boulevard 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 11/03/21 Name Type Quantity Switch Single Pole ------- 1 Receptacle GFCI ------- 6 Beverage Refrigerator ------- 1 Fixtures Pendant ------- 2 Dishwasher ------- 1 Disposal ------- 1 Refrigerator ------- 1 Range Hood ------- 1 Oven Gas or Electric ------- 1 Fixture-Luminaire Undercabinet ------- 4 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. r This certificate may not be altered in any way. / This certificate is valid for work performed before date of inspection only. N W N N N W U VJ W U i : W N F� M u C �1 N u T 0 8 �R en tn co , o C�nj m z ot 0-4 00 � ¢ oc o� a c j z 8 w J A. w c� � ^W •; Lri cn W w < 64 H U V471 x i, BUILDING DEPARTMENT VILLAGE OF RYE IRROOK JAN 2 0 2022 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939;966 AX(914)939-5801 BUILDING DEPARTMENT NN� w'llc .o r� PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: C;I—Q l y PP#: —7 Approval Date: JAN 2 0,20V Permit Fee: $ 5p& Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, v I 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: �Q qA)) r y SBL:!a c 7 3—c),A Zone: 4U 2.Proposed Work: 3.Property Owner E4 14 L4 ntali Address: Phone#: j `1 1 lo?)71 2.-. Cell#: 14 3 2,ie2 email: 1 4.Master Plumber: �v�., �_r S C Address: —F l� �2��6�' Lic.#: t-[E C Phone#: `(� G 2 C Cell#: (S6 D-�-AL t If email: Company Name: (,cJ Address:2�7 /}^ -)CAve- A, >',1o,4 }-( t -Ip.a;L INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWIN�SCDULE: G 0 14" Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement Ist Floor 2nd Floor 3'd Floor 4'"Floor 5d'Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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. N� (1 Sworn to before me this Sworn to before me this o day of gut ,20 day of 20� rl —' 1 Signature of Property—Owder a of Applicant Print Name of Property OADIer P6t Name of Applicant Notary Public MI W4EL A.NAPWTANO Kota BIJM MELILLO N0WyPUbft8hMdNMV" Notary Public, Statc of New York "Paq. No. 0' "t ,`'`;3 �� mot. Z Qualified in Vves`icr _: r County``��'�� Commission Expires Janup.r/29.20_1 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 Bum MENT r�U VI EOFR K D ECE " 938 KING ET RYE BR NY 10573 J A N 2 0 2022 (914)9 9 ' 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 OSTORM 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: %, residing at, I r�P � l 1 ;J (Print nam (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; n� LP P Rye Brook, NY. (Joy Addrr,$) 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. (Signature of Property Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this day of -J 20 -2 (Notary Public) MICHAEL A.NAPOUTANO Notary Pubk,State of New York Rep. No. 02NA4888695 oualMW In Westchester County 3 Commission Expires March 16, 20';, 3/21/19 QyE DR LIE, u 7. 1q 40A annft maW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING&FIRE INSPECTOR Susan R Epstein Michael J. Izzo Stephanie J.Fischer David M. Heiser Salvatore W.Morlino October 6,2022 Dear Rye Brook Building Permittee, It has come to the attention of the Building Department that your Building Permit has not been closed out in accordance with Village Code and is now expired.All Building Permits have a twelve(12)month lifespan starting from the date of issuance,and the permit expiration date is noted on the front of the permit. Please note that there is a non-waivable Expired Permit Fee of$500.00 now due in connection with your expired permit. Once payment is received,your permit will be reinstated for a period of six(6)months. Please be advised that it is a violation of Village Code to fail to close out a permit,and that a court summons could be issued,and fines may be imposed on the permit holder and/or property owner for failure to apply for and obtain a Certificate of Occupancy(C/O) or Certificate of Compliance(C/C),in accordance with Village Code section 250-10A. Please note that Temporary C/Os&C/Cs are available in accordance with Village Code section 250-10B should you require more time to perform whatever work remains in order to complete your project. Thank you for your attention in this matter,and please feel free to contact this office should you require any further information. Michael J.Izzo Building&Fire Inspector mizzo(2rryebrook.org /to cc: Steven E. Fews,Assistant Building Inspector Tara A.Orlando,Planning&Zoning Secretary Laura Petersen,Office Assistant 0 U) O ` W O Qil iflo co 7O G D ",cc, -Mn _ .• j -4. M r Ln a., O O � v z F' v CA m M r� Y c ® r � Z m ,;� DC m` W 39`�'11\r 66 W y V Q J aD J C Y M O� Building Permit Check List&Zoning Analysis Address: -/—� 4�2 —Ztv� SBL: l Vj .?3 — Z-2S Zone._Use: Const.Type: Other. Submittal Date: S?--) Revisions Submittal Dates: Applicant: �r, t�4=d1� r- Nature of Work `I��-C �0 2_ �L%_IZA� Reviews:ZBA: AUG 1 5 2021 PB: BOT: Other. ( ( ) FEES:Filing 7s, BP: 1S- 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. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mg= Tree Plan Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic Other. ( ) ( 4--license: ✓ Workers Comp: ✓ Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (✓S ( ) 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: 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. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval notes: REOLMED EXISTING PROPOSED NOTES AUGAPPRUV'1 5 021 Ar Plata. Cir Froa e Front: Front: Ste: >3&ar. Main Cov Accs.Cov F S Sd,HS : S� Tot,Imp ELImp: Prig Hight/Stories: notes: t ClOtla►AD "j sNu/rY�hn�l�n.u► are r M r�l=.+..�.ewf..er......•r.'V 1M...r. .W er I.-meow I .[tfn AN n11l e.. .d(w. I., mm.,wI@owVb►dc a/r"'1 suiwa%,Ildwl somm oa�aaulad jawn.on i p, inawlaodad yyy + Men.N.► � uM ACC> CERTIFICATE OF LIABILITY INSURANCE DATE"110V°° ' ik.. � 1 05/17/21 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(les) 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 statament on this certificate does not confer fights to the certificate holder in Ileu of such endorsements. PROWLER CT HAM: _TONY CIRINO ME Anthony Chino (w�.N,Ew;-t860L=!!Q103 _ _FA7C OO d204M4 426 North Main Street EMAIL ADDaEss. Ins ol,com Southington,CT06489 _ _- uaErtLs1AFsoRMOCovERAGE INSURM A: FARM FAMILY CASUALTY INSURANCE OIM-lisp INSURED a ----- — OPTIMUM BUILDING CORP - ----- 70 PROSPECT STREET INSUREIl0: - PORT CHESTER NY 10573 NY 10573 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 W rH 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. alsR TYPs of a+sURANCE—- - - 1.4.0 Em -— POLICY NUMBER -- vOliCr eFF VOLICr ExP LMM X COa1M9lCIAL GENERALL LIABILITY EACH OCCURRENCE Ii_ 1,000,000 CLAYS-MADE !X J OCCUR DAMACE 7d RtWEU - !LfflSES1tA 00cumIlMdi 100,000 MED EIIP(Ate Orr person) S _ S-y000 A Y Y 3101 L6417 02/01/21 0=1122 PERsowL s Aov INJURY $ ___ 11000,000 .GENT.AGGREGATE UMT APPLIES PER: GENERAL AGGREGATE f 2 000 000 ❑� X POLICY L7 J LOC [PRODUCTS-COM1ProP,G i 210001000_OTHER: —-—-- : AUTOMOBILE LIABILITY COOMINED SINGLE ANY AUTO BODILY NJURY(Per person) S OWNED SCHEDULED I 900LYai,aJRY(PeraodtlellQ S _ _. AUTOS ONLY AUTOS HIRED NON-OWNED I POP RERTY--- AMK : - - AUTOS ONLY AUTOS ONLY ' _1par a—C99 lO >< 000MLLA LAB f OCCUR EACH OCCURRENCE f EXCESS W tNM a C:AS- ^r)F AGGREGATE _ DED i RETENTIONS WOR—COMPENSATION PER AND EMPLOYERS'LIABILITY YIN $TA,. ANY PROPRIETORIPARTNER/EXECUTiVE E.L.EACH ACCC=ff S OFF10ERAIEMBER EXCLUDED? U N/A - -— (Mandaloryln ler) E.L DISEAK-EA IIIR yea,deeQibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLCY LVAT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACCORD 101,AdOtlonal Remarks Schedule,may be attached M more spew Is repulred) 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, NOTICE WILL BE DELIVERED IN 938 KING STREET ACCORDANCE WTTH THE POLICY PROVISIONS. RYE BROOK NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF NOW VOtk State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY,10TH FLOOR,WHITE PLAINS,NY 10601."l i I nysN.com CERTIFICATE OF WORKERS'COMPENSATION INSURANCE O 'O AAAAAA 13W879M OPTIMUM BUILDING CORP C10 CHRISTOPHER SCELFO Q 429 DEN ROAD STAMFORD CT 069M3811 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 :A�TE M 478 NO-1 %1075 04A9R021 TO 0410 rA= SH 1 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1478 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 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 WESSITE AT HTTPS:I WWW.NYBIF.COWCERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND 18 NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTTFICATKRA. THIS POLICY DOES NOT COVER CLAIMS OR SUBS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. CHRISTOPHER SCELFO-PRESIDENT OPTIMUM BUILDING CARP 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. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:309976624 U46.3 I� I