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HomeMy WebLinkAboutMP21-113PERMIT •, �, y SECTION• • TYPE OF • • JOB • • •• �' • OWNER _JOE; CONT •s of • � zs • _ysj q Mow FEE DATE ,,,,Sp'RECORD DATE FOOT{NG FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C3 RGH PLUMBING, GAS SPRINKLER ELECTRIC 52,0000 LOW -VOLT Q ALARM AS SUILT 0 FINAL INSP L')qCL cfio� �o/'/o OTHER APPROVALS ARB �— BOT PB (ZBA OTHER �QyE BRCS tta.°jJ�� t �7 1 90 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 Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 30,2024 Scott Feldberg&Lindsey Feldberg 3 Edgewood Drive Rye Brook,New York 10573 Re: 3 Edgewood Drive, Rye Brook,New York 10573 Parcel ID#: 135.36-1-31 Mechanical Permit#21-113 issued 8/5/2021 for a New Generator This certifies that the 22kw natural gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to InED :AN �� BUILDING(]�RiARTMENT For office use onl : 9 2024VILLAGE OF RYE BROOK SSUED IT#93J8 KING STREET,RYE BROOK,NEW YORK 10573 DATE:RYE BROOK (914)939-0668 FEE: PAID EPARTMENT www.ryebrook.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 srssss+♦rrs++s►►srr+sr++s+srrrrrrsrrsrt►+r►r++st++►►►r►►srssrsrrssse►►srss►►►►sr►s►►s♦♦t►srsss►►ss►►ss►rrr►rss►s►ss►►srsss►►► D Address: � Occupancy/Use: — Qm Parcel ID#: f! 35., 3Lj— Jc 3 1 Zone: Owner:�C�tr- i r dye 'T::�1,44 P, Address: P.E./R.A. or Contractor: Address: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: ( � � being duly sworn,deposes and says that he/she resides at -f� � � ✓, t2rmt Name of Appl ) (No.and Street) in / ,in the County of o-tp.-- in the State of ,�/ ,that (Ci own/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:$TC� for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of , 201�— day of , 20 Signature of Pro rty Owner Signature of Applicant P n e of roperty Owner Print Name of Applicant 7u�- tv) LWO Notary Public Notary Public SHARI MELILLO Notary Public,State of New York C-1';,t,_1 No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20Z� QyE BRC��_ 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 : 3 El Ge LU oj A `�2 DATE: - G 11- Z O L y PERMIT# L ' ISSUED:,?S'Z SECT: I-3s BLOCK: LOT: .3 l LOCATION: �c t o S I tl e `1 G"� • OCCUPANCY: ❑ Violation Noted THE WORK IS... a- PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION EJIFINAL ❑ OTHER QyE BRC��. cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ol❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : rs � \ V , DATE: PERMIT# C-t"- \ ISSUED: OtZ� SECT: BLOCK: LOT: LOCATION: \ ` OCCUPANCY: J ❑ VIOLATION NOTED THE WORK IS... Q'"ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑�NATURAL GAS .f❑ L.P. GAS ❑ FUEL TANK r ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION c ❑ FINAL ❑ OTHER .d @ 7 $ � - o / cr E ] g � qk 2kq k � cr n M / % au \ Z 0-1 | @ © •- \ cd 7 2 } Ia. 2 a \ o d 7 all 7 | U + A � > f 9 k� k > •• � 2 / k © § c to * \ . U O .. , t Z - k 2 ƒ § § * a 5 E E 01 OD clq 1 ... N 14 C4 ale 6. N as � U F c ac_ ° o O H w P" F • O j 0 a � V` � � i G.. Z o00 tn • � � W p� oo , arc a pq r•� Z .a z w ;, v, w A � LT "' o • �► w � PC o a Z O °cZ W Z w �o w w � OEM r� Oo ICI ai W o w tr 4 ir 8 u 'o Z U � Q •• � a z w = 0. foc cw _ F- D CC�iOV' BUIL R ING DEPARTMENT VI E OF RYE BROOK NOV -5 ZOZ� 938 KIN ET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK `.,{ 4) 939-0668, BUILDING DEPARTMENT wDv�v:i•ychr�ok.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY B �-/r��I-1 I3 EP#: C--�, /—a V 9 Approval Date: NOV - 8 2021 Permit Fee: $ /so—/"/-) Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, /N S 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. J Q 1 1.Address: E4'e- W C C t�r ,�,- ,• Jv q SBL:J435,.3 i p—/,,-3/ zone: 2.Property Owner:_ C L' f 2 Address: Cott,r(�1� (/�' �Z. C. Phone#: 7 7 S' Cjell#: email: 3.Master Electrician: Gja54 I 14t In u[. c .fir• Address: M� Lic.#: C ) Phone#:_ /JV 7(�yl'�'� ell#: r//y S��- ��� email,:, s � n�, Company Name: '- �c' C,;k S �e4��K Address: y�� Cam/ C>C✓7"-f' +e�- �4�' B #�. A; / i/C L 4.Proposed Electrical Work/Fixture Count: _r"S z _(..^-t� rJ.r o�-n Ci QW n2-�''.,.-,t`zk �✓« .-� r,S . STAT F NEW YORK,COUNTY OF WESTCHESTER ) as: j;irtg duly sworn,deposes and states that he/she is the applicant above named,and does further fioln name t o is t e legal i g as the applthe t l state that s)he is the legal owner of the properly to which this application pertains,or that(s)he is the (/r for the legal owner and is duly authorized to make and file this application. (indieate 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,%ith 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 tie this day of ,20 day of l2✓ Signature of Property Owner ,na o Apaap�� nlica /K Print Name of Property Owner Print Kame of Applicant Notary Public otary Public ALEXANDRA H.MARSHALL Notary Public,State of New York No.01FR6363711 Qualified In Westchester County %3'S Commission Expires August 28,20`> 12120-1 I STATEWIDE INSPECTION SERVICES, INC. Service Willi hilegrily 080 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION 84 914.219.1062 • Office Use Elect.Permit# �' / J n Date BldgPemli# /�� / / � Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street S'l. f� Block Lot Owner Name/Address(If dlffe than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd Fl. 3rd FI. More Than 3 A. ❑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 �� �� �- 5 p [Ec [EDM[E f NOV -5 M], B VILLAGE OF RYE BROOK BUILDING DEPARTMENT I This application is valid for one(1)year from the date received by SWIS.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 application. Inspector Date Finalized Inspector# Company Name J, I �' iL „�. fur Date Signature Address i �ld '.� City/State L�• Zip Code J� License# Phone# L _ State Wide Inspection Services CO-" 1080 Main Street ishkill, NY 12524 j 0 5 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: offlceCcbswisny.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: Bil-Mel Construction Lindsey&Scott Feldberg Wasyl Melnychuk Jr. 3 Edgewood Drive 493 Old Chappaqua Road Rye Brook, NY 10573 Briarcliff Manor, NY 10510 Located at: 3 Edgewood Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP21-289 135.36 31 Certificate Number: 2021-6188 Building Permit Number: MP21-113 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: 3 Edgewood Drive, Rye Brook, NY 10573 The Basement and Exterior 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 29th day of November 2021. Name Quantity Rating Circuit Type Generator 01 22kW ATS 01 200AM P Officer: Frank J. 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. i i � N � N N rq O O (V N N tri (ri a 00 x O d c m � O In Q Z a U WLQcot m w Y A ooc w V � W z E■ A w '0006 of r Z Ga u O u Wc 96 Q Q o0 Q') m ate. -� ; _ R EC EWE BUILDING DEPARTMENT VILLAGE OF RYE BROOK AUG 2 5 2021 0 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT w>yyw:'t ftugkorg PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP'#"Mtep I— J/3 PP#: I / �-- Approval Date: AUG 2 4 1 Permit Fee: $ / / S'lob Approval Signature: 1111t X 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 rem ve Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing workk F will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 3 E 1Jat G1001j Dgrt SBL: /3 C7 3(o 3 1 Zone:R-e)S 2.Proposed Work: ('-I(-S L-rPE TO C tWL-- VT-01Z 3.Property Owner: S Corr PELbIRC96, Address: '3 Z)e Phone#: Cell#: 8`/S- 89 3- 3­27g email: 4.Master Plumber: fzaepr Ci?e. t g: Address: C&OTL)'j c ec mtj P'y oc-ao Lic.#: Phone#: r�9�-71-aZ to&E Cell#: ` l?Y- 7a C 0( email: 'doll a/umhe-x 4 O d,COA4 i�Company Name: ($r C/am`(;ity,P P f W tti-C_ Address: V// L4,9VT-V1-,1 ?6 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 1st Floor 2nd Floor 31 Floor 41 Floor 51 Floor Exterior 5.*List Other Equipmenv?rovide Details: 17N S—zo�(-c o C,,v L za.l> To -7 rN E e.4-To (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 • BUILDING DEPARTMENT D CcC � YC Do VILLAGE OF RYE,RWOK AUG 2 5 2021 938 KING ET RYE BR06K,,NY 10573 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: __i,4- iA 0,1, ,residing at, .? C& (Print e) (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; fFA.1 yn2,t Ar , 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. (Signature of Property Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this O day of , 20_ (Notary Public) SHARI MELILLO Notary Public, State of New York No. 01 ME6160063 0,iali led in Westchester County Commission Exoires January 29 20 3 -3- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Phorr epear'-e ,being duly swom,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. LI Sworn to before me this Swom before me this CV 1 day of `+ ,20 day of 5 l ,20�_ Signature of Properry Owner Signature of Applic nt PAnt Name of Property Owner Print of Applicant Notary 4MMY Public, State of New York SHARMW OMIMY No.01 ME6160C-63 Notary Public,State of New York Qualified in Westchester County No.01 DU5012936 Commission Exoires January 29 2001 3 Qualified in Westchester County Conlmissio0 %ires June 15,20� 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- 8/12/2021 Alfredo DiVitto From: Alfredo DiVitto Sent: Thursday, January 4, 2024 4:28 PM To: scottfeldberg@gmail.com Subject: mp-21-113 expired generator permit Good afternoon,Scott we show that your generator permit mp-21-113 at 3 Edgewood drive has expired in order to reinstate the permit and to do a final inspection we need a $500.00 fee paid and the C.O. application filled out and the $110.00 fee for us to do a final inspection. If you have any question, please feel free to give us a call. Thank you, Alfredo (Freddy) DiVitto Assistant Building Inspector Village of Rye Brook 938 King St. Rye Brook,N.Y. 10573 Office:914-939-0668 Building Permit Check List&Zoning Analysis Address: 3 F— ::6�W oo-Z:> SBL: Zonei -ZS Use: Z 1 Const.Type: Other. Submittal Date: 7 Z k Revisions Submittal Dates: Applicant: Nature of Work: Z Z VC w N ATv a A( _ G A'_E FrN .C-1 Zl`Cyl — Reviews:ZBX G — 2 2021 PB: BOT: Other. OK ( ( ) FEES:Filing. I W, BP: r C/O: Legalization: ( ) (,-YAPP: Dated:L,,' Notarized: SBL: ✓Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ),,,SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan. Other. ( ) ( URVEY:Dated: Current: Archival: Sealed. Unacceptable: ( ) (—)- PLANS:Date$tamped: ✓ Sealed: Copies Electronic. Other. ( ) (�..cense: ,/Workers Comp: '1r Liability Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated: N/A: (� ( ) 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. (LY ( ) 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: A REOUIRED EXLSTING PROPOSED NO f TES rr�•+uu& nate* AUG - 2 2071 Sci4Sa"r LLS�iJsN Sim: &&• Main COV AAccs..COV: Ft.H/Sb: srr8��4.eeC3Ls2_GE& SC: T�Imn' Hag /Stories: notes: Jl✓r Ap •y � � �1t���' D � .�i� 0�. • '��tJ0 '?�!' lSr �O `_��4y' Q 1ti'j„ttt'Ah � - :�t •� �+. -�.o ��'.0✓1' .rj.: � � y ✓�11. 'fit w-It✓rt'n4�:1 YR' ` i .,. '`'. y4; ✓sln v:_.,�,rf`w,. 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OW: y M n A co O p aurmi� cotectiun q J W W J ¢ O y / a' 73 co p , yl cs :.,tom_ � I � Q � p �•� �' •' .' <(ormD>auw i � •^ O r\wwt+q�(ir.>♦)>�I / Z rA aN_ V p S-1 x °0q♦fimn�. -� U� C , U p M 5-9 p<(A)> \�:w.:��_.�,-•MI-14 �eve -. {).7�. . 1. t -$$1 A +1 ♦�f•./ 1 $A04}.('I �. • ♦ y�i ♦ ♦ r a`A6 tCr �� y `¢fA�.,' 1}7 • ale .,G •►: �'r ••fi�t.. �u,r.. ^ r � S+Mr '"^ t.��'t �U�:.•► : y y1( ^ tir•' ��''�yy,•�,�'S,� .yyr l. �y1 S Y..74y ro �Y� � -l�O ��.titkt-• �cOy� .'A� OSOlj�rAt FO t •�, fQ �1Y?`d-�.'%5 ,1gO�` rj}'_. I � �r\ti -'_ � ir�v i -\ Ii�v741; -. fY:�r dT i� �' � �v�t --. \v��r�tv:� (F vs:'11tfi f' \:v\7♦V,�'. •_ � ---w l.r.d -. \:"r1 SV - .:,r\ Y �/` �5 �}�-� rt /RG,� ♦\ .'�l,Lr�N �.'"�'}���ti.r � � `+� 'ff�wt,'� '�NYS?;k7A'^ � �,da'�'�,.. ,.Y`•G�" ,'� '/- t •.- 'b.... MMILL-1 OP ID: Dp A�ORD CERTIFICATE OF LIABILITY INSURANCE DA07/26/2021TE Y) o7/2s/2o21 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 endorsements. PRODUCER 914-669-6000 c Nr•ME CT �wrence M Patierno Hudson Sound Brokerage Corp. PHONE 914-669-6000 FAX 914-669-4369 101 Village Square A/C,No,Ext: A/C,No): Somers,NY 10589-2305 X-pm&16,lanyghsbinsure.com INSURER(S)AFFORDING COVERAGE NAIL M ��su�E— __- ---- -- _ INSURER A:Southweet Marine&General 12294 M.Miller Development Corp. INSURER B &M.Miller Construction Corp. INSURER C: 8 Roosevelt Place Scarsdale,NY 10583 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - -- -- ----- — —-- -- -- ILTR NSR TYPE OF INSURANCE �ADDL 6UBR POLICY NUMBER POUCY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR X GL202OLHB00535 12/14/2020 12/14/2021 DAMAGE TO RENTED occuffenoe) = 100,000 ISES(EaMED EXP one $ 5'000 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY�X PRL LOC S 2,000,000 JE T PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILYBORDILY INJURY Per acddw# $ AUTOS ONLY AUTO ONLY PPeOr DAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 41000,000 REXCESS LIAB CLAIMS-MADE EX202OLHB00154 12J1412020 12/14/2021 AGGREGATE 4,000,000 ED 1 1 RETENTIONS WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory In ) E.L.DISEASE-EA EMPLOYEE S If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is listed as Additional insured when required by written contract. CERTIFICATE HOLDER CANCELLATION RYEBROO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ic e_ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD fi \\ NYSIF New York state Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY. 10TH FLOOR,WHITE PLAINS.NY 106014411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE P&A ^^^^^^ 134001930HUDSON SOUND BROKERAGE CORP 101 VILLAGE SQUARE SOMERS NY 10589 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER M MILLER DEVELOPMENT CORP VILLAGE OF RYE BROOK 29 CHASE RD, POB 123 938 KING STREET SCARSDALE NY 10583 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1271272-5 728458 02/03/2021 TO 02/03/2022 7/26/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1271272-5, 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:/ANWW.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. MATTHEW MILLER-PRESIDENT M MILLER CONSTRUCTION CORP 1 OF 1 THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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