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HomeMy WebLinkAboutBP21-215PERMIT # SECTION TYPE OF WORK JOB LOCATION CONTR EST. �CO # DATE: 7 � BLOCK� eo)4erin/ /C1; A0*007 .a! A�":�YiciI Lail TCO # FEE bA7E I.«ocrT10N RE�nRD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL INSP 0 7- 37oS �QCCO✓no(914)937L 4Vc)79 and . Sca /yoj es)r'c kI efts 0 6�eAo ,Lei iQ 'Pal. % 51y1me tiw/2 s /eG�►dnir� CO �-.i Cam! cwwoJ — �l q/�-/P�'u�a� �e�•,a li �G OTHER APPROVALS OTHER FF VILLAGE OF RYE BROOK WESTCHESTIER COUNTY, NEW YORK f; NO: 21-190 ( Certifirate of Orcupancp This is to certify that re rt &VI'sRLh-l'ofac) vl of, K _ K IN y , having duly filed an application on requesting a Certificate of Occupancy for the premises known as, (�>?Ll PljI6 P' 00e, , Rye Brook, NY, located in a Zoning District and shown on the most current Tax Map as Section: Block: _L_Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. )`r�? , issued E� /7 20 02', such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the New York State Use Classification of �'>3 Gr)-e - Fc Y,? / / �,/ , for the following purposes: Subject to all the privileges, requirements, limitations and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in heighl sha be m de,-n shall the building be moved from one location to another until a permit to accomplish such change has be bt ilding Inspector. Building Inspector,Village of Rye Brook: M, Date: DEC — 3 2021 V BUILCIVEBROOK, ENT For office use onl : PE MIT# a/- a1S VIL K ISSUED: —1 —3/ DD38 KING STRE YORK 10573DATE:NOV 2 2 2021 /r- -of 0 FEE: 4r-)3�jPAIDVILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 ##iR###ittfilt#!#ft##!!!!#ffiillfi#!Ri#►itiitili#i►i#it►iiRiRiRRtiRtR►►itit3iRiitRitiR■RiR►#i#i#►►iiititltiit•#liltlli##!i#ii Address: n e t D r;e- 17 d� V P WS rC C)t z 3 Occupancy/Use: f �j�✓+7 Parcel ID#: /135. 3 — — Zone: —� Owner: �rP�, PA jV[ r b ©A t/, S Address: I y P r,.e— a 06e— 116 /l e 6/c j!r P.E./R.A. or Contractor: Do"-Uc 49 Address:1-52 ILL, A -A4 Aw Ptitj CA.,4, A.1 Person in responsible charge: Address:Z �� I�',a�p � jik�lyc Qfzc' k 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: j / T-a IC 1'JQ 0 A ✓ t N being duly swom,deposes and says that he/she resides at -fine A o&t 1?l (Print Name of Applicant) (No.and Street) in �g.vt 6Yp d A-- ,in the County of_ in the State of f Y that (Citygownr Villago he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S Goo , for the construction or alteration of: k ;-re YEN 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 a1� Sworn to before me this day of NOV t'c� sf' , 20_,?\ day of , 20 nature- of Property Owner Signature of Applicant -'*'PAje<<i e /Q P` Name of Pro pertyy Owner Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public, State of New York No.01 PNAE6160063 O,Wi ied in Westchester County Commission Expires January 29,20 �E BRCvk_ 1982 BUILDING DEPARTMENT ❑BIiILDING 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 - - - - - - - - - - - - - - - - - - - - NSPECTION REPORT - - - - - - - - - - - - - - - -- - - - ADDRESS :— v ATE• PERMIT# ISSUED: �SECT:T BLOCK: }C' LOT: lz LOCATION: V, C 0Ck OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... .[T ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION (� REQUIRED Cl 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 Q', FINAL ❑ OTHER s + _ c m N = N N N F`I = U m m x a y 96o s v F S Q = Z s . 0.0 r zlot QCw� r E-= oo �+ O wI.-C 44 06 at 9 + MCI � � 0 Q oUC e � � � '�'��► r = F O Q Q tf, tn 96 • W � Z � W � © o e : r �I m a 41 m IJ6 _ � �; BUIL MENT VIL E OF-kI E OK SEP 1 22021 DD 938 KIN ET RYE BROO ,NY 10573 (914)9 x(914)939-5801 VILLAGE OF RYE BROOK h _ k—.or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Ql- .D l 1 Approval Date: Permit Fee: S �C� -,►'�� Approval Signature: ky— Other: Disapproved: (fees are nun-refundable) Application dated, 9 :S 2-) is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/ rem ve 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: 7 q 191 r7 t. /u u� A,,III SBL: /3.5.3 y /_ y Zone• 2.Property Owner: GfL4 11xyi's Address: SAW)t Phone#: j1 N- 9 37 31 o p Cell#: email: 3.Master Electrician: ��,r-q,�dl �4trnR Address:-3-7 'fe-m f1G Lic.#; _Ib0 Phone#: 9iY-931!IjS" Cell#: 10-Y10 -y101 email: Ve-or17o,t,' e Ve,rnaUinc. •tour Company Name: &exxtrA Ve n" rAC. Address: 37 7-zen,r l t S fwVr -i �}pt+-r;.f o✓%,NY IUS'2,! 4.Proposed Electrical Work/Fixture Count: to i r< STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Q 1 ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of in ividual signing as the applicant) N state that(s)he is the Iegal owner of the property to which this application pertains,or that(s)he is the `�cky 1 G•ti, for the legal owner and is duly authorized to make and file this application. (indicate arc itect 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 m this z day of ,20 day o 20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Name of Applicant Notary Public �t_ \,.��x.•..� Notary Public SHARI M'ELILLO Notary Public, State of New York No. 01 ME61 o0C' 3 O_lalified in Westchester County Commission Exnires,1anupr,29 20122i b/1/I8 Westchester Rockland Electrical Inspection Servlces Inc. r= Phone: 914-347-3595 DO NOT WRITL"HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 ' Elmsford, NY 10523 BUILDING PERMIT NO. TEMP sf CITY OR VILLAGE ZIP CODE _ TOWNSHIP COUNTY �-� t � �.: �-r'� �(.)`� � ✓ y,,��.J f irk e:��<'' . STREET AND Ir ROAD (( POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OGCUPAN7 NAME BUILDING OCCUPANCY -I( I),:I /I OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER C �rT LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTaRS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDFWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION t OUTSIDE 1 BASEMENT FL SEP 3 2� 1 Lj 2-FL 3'FL. El ILDING DEPARTMENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: / r THIS APPLICATION 4S 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. SITE OF SERVICE FEEDERS „ U © /0191 U CHARACTER OF WORK NEW'? ADDITIONAL F� EXPOSED F1 CONCEALED p MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD LY; UNDERGROUND❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME O(F'COMPANY DATE OF SIGMA C STREET ADDRESS TELEPHONE NO. ,� 7 fir..i, )® J,/- CITY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE WESTCHESTER ROCKLANO ELECTRICAL INSPECTION VREIaSEIVICES'Imc. 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: GERARD VERNALI INC. Greg Davis 37 TEMPLE ST NY, HARRISON 10528 Located at:24 Pine Ridge Road Rye Brook, NY 10573 Certificate Number: 1031499 Section: 135.34 Block: 1 Lot:4 BDC: Permit Number: EP:21-219-BP:21-215 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 inlon the premises at: 24 Pine Ridge Road Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage 0Attic 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 11101121 Name Type Quantity Receptacle Convenience ------- 8 GFCI Circuit Breaker ------- 4 Switch Single Pole ------- 4 Fixture-Luminaire Incandescent ------- 2 Dishwasher ----- 1 Hood Line ----- 1 Double Oven ----- 1 Microwave ------ 1 Fixture LED Under the counter 4 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. r r Ln p� O M �N �. �' '` M c M M, _ N al Q, � Qti iaa7 cc tn ce. W r w W s co 00 � O M Oki A z ^ zj� zm 000. P6o Q L � O N as 16 �r �r r I)R CI D [E E V L BUILNG DE MENT SEp 2 3 2021 VILLAGE OF RYE OK 938 Knvd. riz > T RYE B ,NY 10573 VILLAGE OF RYE BROOK (g14}� BUILDING DEPARTMENT or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: ��r I PP#: LY — S 7 Approval Date: SEP 2 Permit Fee: $ �tl ')4j6 Approval Signature: Other: Disapproved: (fens are non-refundable) Application dated, �4 FLI 1 11 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 work will be in conformance with all applicable Federal,State,County�an1d Local Codes. 1.Address: d Pt (� c �► � I,'�d a SBL: Zone: !C/� ,T —� 2.Proposed Work: 3 0 S I_ V-4 L' V►k 4 AS UQ k-- 'b 12 G-h _ i C4 0-6.14L P U ice- A S VX L-419f�4' 3.Property Owner: ev ex y t S Address: �1 i u �`"�j j I'l d e4- , Phone#: rr Cell#: C3 Y 3 91 - 910 A y email: 4.Master Plumber: t 6 m vre Address:al* KNIIln✓r -r-_ Lic.#: 231 Phone#: (c R g •Z l 1 Cell#: N' D 3 email:"W S& O O to h( vu ''tJ4 Company Name: t ► l Q Address: Z6b kt44 401 *11�t rn 11 h+fYi� �'] 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 2nd Floor 1 31 Floor 41 Floor 5t°Floor Exterior 5.*List Other Equipment/Provide Details: 28,A 1 LC rr,&- (Notarized Signatures Required Next 2 Pages) en 2/2021 STATE 9F NEW YOM COUNTY OF WESTCHESTER ) as: 9N t being duly sworn,deposes and states that he/she is the applicant above named, (print name of individ 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 ce>'x r1-L�4/ 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 " - f Sworn to before me this p z day of V ` ,20 _ 0) day of CDC5 ,2a_ r Signature of Pr5pcAy Owner Z Signature of Applicant 0 Print Name of Property Owner X rt o ? Print Name of Applicant CD f1i o C: -C Notary Public N d N Public Christine olcorrpr N Notary Pubbe-Staa of New York No.010Cg418189 QWified in Rocidland Cowrty Conwrd"Ogxom This application St DC PI-Of"12Wipleted 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 BUIQRYE MENT VILOOK SEp ZO21 938 KING ,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: 31, 61�5 o rn 1JOl V t S , residing at, `� I �"t+C �� P y (Print name) (Addy",v�herc y„u live) ft� 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; R c"— , 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. (SIimtUrC ah PropCrty O IlL (S)i v Y'- /of-I �C7�111 S (Print Name of Property Owner(s)) Sworn to before me this a r day of <S�I�� , 20 -2- (Notary PuM0 Christine Monnor Notary Public-Stew of New York No.01 OC6418189 Qualified in Roc Wand County z R",y Commission Expires 407AM 8/12/2021 Building Permit Check List&Zoning Analysis Address: ZL�- �'( N ��CF �� SBL: 3 Zone -t J Use: Const.Type:, �s Other. Submittal Date: (0 Z t Revisions Submittal Dates: Applicant: _12,4y I S y Nature of Work t�Mir+-lZ t O 2� tt tTr_otcN — 24;r�-Q VGA*Zno%�3 Reviews:ZBA: PB: BOT: Other. OK ( ( ) FEES:Filing : - BP: C/O: Legalization;, ( ) ( ) APP: Dated Notarized SBI- ..-`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. ( ) ( } SURVEY:Dated: Current: Archival: Sealed: Unacceptable: ( } ( } PLANS:Datt Stamped: Sealed. Copies: Electronic: Other: License: y Workers Comp: ✓ Liability -- Comp.Waiver. Other. ( } O CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Pemut: 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: ( ) ( } 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: REQUIRED EXISTING PROPOSED NOTES APPRUVLU p u G 1 7 O 1 Arga D_-a Cu : Fr n g Front Front Sides Rgar. Main C�v Accs.Cov Ft.H S S .HS : QFA: Tot Trn : FG hw: Par ' . Height/Stories: notes: Laura Petersen From: Greg Davis <gjdavis.gd@gmail.com> Sent: Tuesday, August 17, 2021 8:51 PM To: Laura Petersen Subject: Re: Building Permit Application - 24 Pine Ridge Road Attachments: MAJESTIC KITCHENS CERT OF INS - (DAVIS) VILLAGE OF RYE BROOK.pdf, MAJESTIC KITCHENS WORKERS COMP (DAVIS).pdf Hi Laura, I have attached the insurance documents from Majestic Kitchens.We worked with Roberto.See below for his phone number. Let me know if there is anything else you need. Thanks, Greg Roberto Leira 914-579-8290 Majestic Kitchens On Tue,Aug 17, 2021 at 1:25 PM Laura Petersen<LPetersen@ryebrook.ore>wrote: Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office, 1. General contractor's contact name & phone number (from Majestic Kitchens) 2. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 3. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $300.00 (due once permit is issued and ready for pick-up) This information can be emailed to me Thank you Laura i v a George Latimer James Maisano Westchester County Executive Director,Consumer Protection Department of Consumer Protection Home Improvement License MAJESTIC DISTRIBUTORS INC. MAJESTIC KITCHENS i 700 FENIMORE ROAD 1. MAMARONECK,NY-10543 This license is issued in accordance with Article XVI of the Westchester Cotmty Consumer Protection Code and is valid only upon presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. NOT FOR FEDERAL PURPOSES ¢��ot Gons�,hP License Number r� o Date of Expiration m m WC-21390-H09 0 01/13/2023 ter Co��` r <,r f e aoEe feel lltlq N u iw MAJES-1 OP ID: MS ACQQQ M/DDIYY CERTIFICATE OF LIABILITY INSURANCE 08H DATE(MMIDDNYYY) 712021 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 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 CONTACT MARY SCHARF _ The Faley Corporation PHONE FAX 2116 Central(Park Avenue AIc No 914.337-5207 No:914 337-5039 Yonkers,NY 10710 ADDRESS:MSCHARF FALEYCORP.COM Michael Faley INSURER(S)AFFORDING COVERAGE NAIL/ INSURER A:Main Street America Assurance 29939 INSURED MAJESTIC DISTRIBUTORS,INC INSURER 0:National Grange Mutual 14788 DBA MAJESTIC KITCHENS 700 Fenimore Ave. INsuRERc: Mamaroneck,NY 10543 INSURERD: 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS L POLICY NUMBER MWDD WDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,0001 CLAIMS-MADE X OCCUR Y Y BPU3262K 04/1512021 04/16/2022 PREMISES Ea occurrence i 500,00 X CONRACTUAL MED EXP(Any one Person) $ 13,00 PERSONAL&ADV INJURY $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 POLICY[K dEGT LOC PRODUCTS-COMP/OP AGG j 4,000,00 OTHER: $ AUTOMOBILE LIABILITY IRA('aeddaMBINEntD SINGLE LIMIT : 1,000,00C F B X ANYAUTO 131U52740 04/15/2021 OVIS12022 BODILY INJURY(Per person) i AALL UTOS OWNED X SCHEDULAUTOSED BODILY INJURY(Per accident) S X X NON-OWNED PROPERTYOAMAGE $ HIRED AUTOS AUTOS Per eoolden4 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESSLUIS CLAIMS-MADE CUU52740 "IW12021 04I=22 AGGREGATE $ 2,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? El NIA (Mandatory In NH) E.L.DISEASE-EA EMPLO $ If yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ A PROPIEQUIPMT SPU3262K MIM021 04111Y2022 RCV 1,040,40 MATERIALS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addlflonal Remaft Ill maybe allwhW N more space Is required) RE: PATTI&GREG DAVIS,24 PINE RIDGE ROAD,RYE BROOK,NY 10873 CERTIFICATE HOLDER CANCELLATION VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING STREET RYE BROOK,NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /;m� NYSIF New York State Insurance Fund 199 CHURCH STREET,NEW YORK,N.Y. 10007-1100 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE r, r AA A AAA 131942739 LEVITT-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FIL f TARRYTOWN NY 10591 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MAJESTIC DISTRIBUTORS INC VILLAGE OF RYE BROOK 700 FENIMORE ROAD 938 KING STREET MAMARONECK NY 10543 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 468 674-7 680222 06/29/2021 TO 06/29/2022 8117/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO, 468 674-7, 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, IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/IWWW.NYSIF.COMICERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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: 953773353 U-26.3 r G di ;NNE = C G r Q L � S.. •� 72 ' a ` 7E L y w �i M � :s W W ownown Z r = C �+ W 0' W } h O�gCt10l� L a > Z ui '^ E W W O > d = J W X W Q ai cr- _ ...� = W a ai w m <= } J t " = cri r; £ 6 r = �' * e. ` � ti AC R® (MMIDDIYYYY) 778, 1-i CERTIFICATE OF LIABILITY INSURANCE 1�/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER NAME:U Michelle Seeley Marenco Insurance Agency Inc. FHUNF Arc No Ed): (914)235-3144 (A/C No): (914)235-1571 36 Church Street It MIL ADDRESS: michelle@marencoinsurance.com INSURER(5)AFFORDING COVERAGE NAIC# New Rochelle NY 10801 INSURER A: UTICA FIRST INS CO 15326 INSURED INSURER B: ARC Home Improvements Corp INSURER C; DHA Double R All Home Improvements INSURER D: 439 Willett Ave INSURER E Port Chester NY 10573 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 AFFORDFD 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. LTR TYPE OF INSURANCE IN50 Z. POLICY NUMBER (MMIDD/Y"I (MMIDDNYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FRI OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A Y ART512873700 05/06/2021 05/06/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JE� [—]LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILnY $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ ORKERS COMPENSATION ND EMPLOYERS'LIABILITY YIN STATUTE ER JIM- NY PROPRIETOR/PARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT $ FFICERIMEMBER EXCLUDED? Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ f yes,describe under ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace is requ Ired) Certificate Holder Also Named As Additional Insured With Respects To General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rir Ank A Msrtwm Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 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 (RENEWED) � f Z = ^^A^^^ 133940830 MARENCO INSURANCE AGENCY INC 36 CHURCH ST ■ NEW ROCHELLE NY 10801 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARC HOME IMPROVEMENTS CORP VILLAGE OF RYE BROOK DBA DOUBLE R ALL HOME IMPROVEMENTS 938 KING STREET 439 WILLETT AVE RYE BROOK NY 10573 PORT CHESTER NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2358 628-2 459191 04/16/2021 TO 04/16/2022 8/16/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2358 628-2, 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:IMlWW.NYSIF.COMICERTICERTVAL.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. PRESIDENT FRANK J VERRASTRO TREASURER RALPH CACCOMO ARC HOME IMPROVEMENTS CORP TWO 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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