Loading...
HomeMy WebLinkAboutRP21-057PERMIT # / �" �DATE: /� >c� �% ©(P: `f� %c3 SECTION JLOCK �LOT�,�.S TYPE OF WORK P - f0n 4 IS /)G Ai ejId;1?Cl JOB LOCATION OWNER CONTRACTOR_,, EST. COST ✓co #_ CC _A FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT C] ALARM AS BUILT O FINAL OTHER APPROVALS lt)Cxxy ARB BOT eLC Koeelw ,. (q/y)57e &cD4YQ'- ZBA nFEE % - / OTHER ' C FEE.11 d'"!DATE / b D�coca INSPECTION RECORD DATE I NSP DATE_ O {LUC L4°+ �Jy. [L '1 19 404 lVLwz4wm rW 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 1Z Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 26,2022 John Winston&Lisa Winston 23 Boxwood Place Rye Brook,New York 10573 Re: 23 Boxwood Place, Rye Brook,New York 10573 Parcel ID#: 12959-1-25 Roof Permit#21-057 issued on 10/12/2021 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building& Fire Inspector /to For office use only: BUILD NT PERMIT# -oS7 DEC 2 0 2021 VIL OF,)RVX OK ISSUED:/O 938 KING STRE YE HR oft, YORK 10573 DATE: VILLAGE OF RYE BROOK FEE: lT //p— PAIDIE 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 itti\liftiiiititittittiiitiitlillllil►►►flit►t►t►li►►l►►\f►t►►t►f►►t►►►l►►►►1►►►\tlft►►lftf/\►►tt\\\l\lll►t\llil\\lift•►t►\\\ Address: Z" f UXIN UUc1 .t Le FAt)a L Occupancy/Use: Parcel ID#: / o-)9. 59 _ 1_co'T Zone: le—A5— Owner: v V l tit S�UV1 Address: 23 g x wo C e l�rt3U E_ P.E./R.A. or Contractor: VC VVjr,,U , L(� Address: l Z Ce tit-�t f- S .� Person in responsible chargeP"-rsq 1/C'yXX)V\._f_ 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: C z"r'-U'^C. being duly swom,deposes and says that he/she resides at l ( t Name of Applicant) (No.and Street) in��s'a"-'j I I Q_ i r�,, ,in the County of �IJ �4 r kv2 in the State of ti� ,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:S I , U J uU , for the construction or alteration of: 1-U D 4' 6'2 V1 yti 0j 4 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 20_ da r f 04 o iae. ,20 2 w^ A, �t nature of Property Owner i store of Applicant �t1111111b1/��,/'' ``�ttllll//// �r' V `✓��C. O iO F�WIYB crrr .L1 10 amof A iOF t1✓aY 7 8/12/2021 �E aRO 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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- Z3C. �J�CJ ram- DATE: v L Z PERMIT# 2�2 Z -ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: I ❑ 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 Z �2 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ INAL OTHER D f � � 0W Perry Verrone, LLC OCT - 8 2021 12 Center Street ------------- VILLAGE F RYE BROOK Pleasantville, NY 10570 BUILDING DEPARTMENT infon erryverrorieroofing com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 10/5/21 John Winston Prepared by Perry 23 Boxwood Place Rye Brook NY 10573 (914)255-3600 lbwinston290gmail com PROPOSAL )< OPTION 1: FULL ROOF ROOF REMOVAL AND REPLACEMENT • All existing asphalt roofing removed and carted from job site • All rotted plywood replaced at$110.00 per sheet • GAF Weather Watch Ice and Snow barrier installed on all gutter edges, valleys and around skylights (6 feet up) • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • Aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges • Copper chimney flashing fabricated and installed • Rye Brook permit included The price for the aforementioned work,which includes labor and material, (but excludes any additional plywood) to be added to the sum of: $15,900.00 Page 1 of 5 Initial & DatC. -'V PRICE EXPIRES 90 DAYSAFTER ESTIMATE DATE ❑ OPTION 2: RE-ROOF ONLY • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • GAF Weather Blocker starters installed on all perimeter edges • Copper chimney flashing fabricated and installed • Rye Brook permit included The price for the aforementioned work,which includes labor-and material, totals to the sum of: $12,200.00 PRICE EXPIRES 90 DAYS AFTER ESTIMATE DATE Payment schedule is as follows: 50% 3 Days Prior to Start 45% Due the day of substantial completion 5% Retention may be held for resolution of unresolved issues Any monies not paid as specified above will be subject to accrue interest at a rate of 1.5% monthly, and 18% per annum. All material is guaranteed to be as specified above. All work to be completed in a workmanlike manner according to the standard practices.Any alteration or deviation from the above specification involving extra costs will be executed upon a written change order and will become an extra charge over and above the proposal.All agreements are contingent upon strikes accidents or delays beyond our control. i Page 2 of 5 '� +L} Initial & Dato�_ Notices to Owner Right to stop work: If any payment under this agreement is not made when due, Perry Verrone, LLC may suspend work on the job until such time as all payments due have been made. Notice of Lien: The contractor or subcontractor who performs on the contract and is not paid may have a claim against the owner which may be enforced against the property in accordance with the applicable Lien Laws. Cancellation: The owner has an unconditional right to cancel the contract without penalty until midnight of the third business day after he/she signs the contract. Cancellation must be done by giving Perry Verrone, LLC a written notice indicating the owner's intention not to be bound. Upon cancellation,any property traded in, or payments made under this contract will be returned within 10 business days following the receipt of the cancellation notice by Perry Verrone, LLC. Acceptance of Proposal: I have read the introductory packet along with this document and accept the specified conditions as stated, and the prices associated with such. I understand that upon signing this proposal, all documents presented becomes a binding contract. You are authorized to do the work as outlined. Payment ill be made as indicated above. 4ature Date I Page 3 of 5 Initial & Date: Roof Replacement Instructions for Homeowner INSIDE THE HOME 1. Any precious items in the attic can be either moved to a secure place within the attic or covered and secured to protect from the vibration of the roof removal process. 2. Dust and/or sawdust may be generated in the attic due to the roof removal process, securely covering belongings is advised. Clean- up of debris in attic is outside the purview of this contract. 3. If your home has high hat lights located in the cathedral ceiling, you may want to tape the fixture to the ceiling (construction activity on the roof may cause these to come loose). 4. If you have cathedral ceilings, although it is not common, on occasion, some nails may be prone to "pop"-thus exposing the head of the nail through the sheetrock. This is unfortunate but is not the responsibility of Perry's Roofing. 5. If by chance you have opted for a skylight replacement, please consider that the skylight manufacture dimensions have changed over the course of the years which may alter interior placement of your new skylight. There may be interior trim work required to remedy this condition. This is not part of the roofing contract, but we can give you an estimate for this work. OUTSIDE OF THE HOME 1. Outside your home we make every attempt to ensure that we protect your shrubs and belongings. You can help us by removing smaller objects that you can handle, or that may be valuable, to a secure place. Any larger items, such as picnic tables, our men will move to a secure location and replace upon completion. 2. Let us know if there is a power source outside that we can use. 3. Let us know if there are any special precautions regarding any item, or situation, that we should be aware of outside, prior to starting. Si ature Date Page 4 of 5 Initial & Da P,1 W New York State Department of Taxation and Final" ST_ New York State and Local Sales and Use Tax Certificate of Capital improvement (2/12) After this certificate is completed and signed by hoth the customer and the contractor performing the capital improvement, it must be kept by the contractor. Read this form completely before making any entries. This certificate may not be used to purchase building materials exempt from tax. Name of customer Iprrnt or type rJae of contractor(print or type) - � �� m Perry Verrone, LLC Address mum ar;andstmerj (� Address fnu,nt,e,and sn BeO 12 Center Street city rate ZIP cod . City Stale 71P code Pleasantville _ New York 10570 Sates tax P ertrficate of Authority number(if any) I ;ales tax Cartificate of Authority number if any) I 26-2754386_ To be completed by the customer Describe capital improvement to be performed: Roof removal and replacement ---------------- ------ I -- Pralect Warne--�-' Street address(v,,here the is IQ be performed) n City State ZIP code I certify that. �I • I am the(mark one) owner _J tenant of the real property identified on this form.and • the work described above will result in a capital improvement to the real property within the guidelines of This form;and • this contract(mark one) D includes Z does not include the sale of any tangible personal property that.when installed.does not become a permanent part of the real property(for exampl ,a free-standing microwave of washing machine). I understand that: • I will be responsible for any sales tax. interest, and penalty due on the contractor's total charge for tangible personal property and for labor if it is determined that this work does not qualify as al capital improvement;and • I will be required to pay the contractor the appropriate sales tax on tangible personal property(and any associated services) transferred to me pursuant to this contract when the property installed by the contractor does not become a permanent part of the real property;and • I will be subject to civil o riminal penalties (or both)under the Tax Law it I issue a false or fraudulent certificate. Signa re, f frustomer Title /1 To L completed by the contractor I,the contractor,certify that I have entered into a contract toerform the work described by the customer named above,and that I accept this form in good faith.(A copy of the written contract)it any, is attached.)I understand that my failure to collect tax as a result of accepting an improperly completed certificate will make me)personally liable for the tax otherwise due, plus penalties and interest. Signature of contractor or oft car ! Title Date i �— ---_— — I President This certificate is not valid unless all entries are completed. Initial tk Uate: QuickMeasure 23 Boxwood PI, Rye Brook, NY 10573 September 28, 2021 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N Contents Measurements Overview 1 Roof Area 2,849 sq ft Top View 2 Roof Facets 13 Side Views 3 Predominant Pitch 6 / 12 Lengths 4 Ridges/Hips 121 ft Pitches 5 Valleys 93 ft Areas 6 Rakes 190 ft Summary 7 Eaves 114 ft Materials 8 Bends 0 ft GAF VA • a 41 �` �, � `t��.` . . I' • °�;� '•~ •ter y. _ r •k ry ' f do Ak J yy�� •� • � . s x f • e: • i r - •/♦ r 1 • • � r I .,.• * r 1 • � r -•• -• - •• • Z ••• . •• QuickMeasure Side Views Roof Reports in Under an Hour 1, .�4,4 Ftix .�" .r. ,. Prepared For: Perry's Roofing QuickMeasure Lengths Roof Reports in Under an Hour A Flash Step Drip I . N y4 13 1 1 ■ Eave Rake Ridge Valley 114 190 121 93 Lengths in feet Prepared For: Perry's Roofing 23 Boxwood PI, Rye Brook, NY 10573 QuickMeasure Pitches Roof Reports in Under an Hour A N 7 7 6 6 6 7 b 7 7 6 6 6 Pitches in inches per foot Prepared For: Perry's Roofing © 23 Boxwood PI, Rye Brook, NY 10573 QuickMeasure Areas Roof Reports in Under an Hour A N 246 239 69 160 62 6 236 67 67 200 707 783 Areas in square feet Prepared For: Perry's Roofing 23 Boxwood PI, Rye Brook, NY 10573 QuickMeasure Summary Roof Reports in Under an Hour Pitch 6 7 Area 2,218 631 Percent 78% 22% Waste 0% 5% 10% 12% 15% 17% 20% Area 2,849 2,991 3,134 3,191 3,276 3,333 3,419 Squares 29 30 32 32 33 34 35 Aii� OL Roof Area 2,849 sq ft ARoof Facets 13 N Predominant Pitch 6 / 12 Bends 0 ft Eaves 114 ft Hips 0 ft Rakes 190 ft Ridges 121 ft Valleys 93 ft Flash 13 ft Step 38 ft Drip Edge 303 ft Leak Barrier 447 ft Ridge Cap 121 ft Starter 303 ft parapets 0 ft Notes:1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped roof edges.3)Eaves are defined as level roof edges.4)Flashing pertains to level roof edges and excludes valleys.5)Step flashing pertains to sloped roof edges and excludes areas around penetrations.6)Drip edge=eaves+rakes.7)Waste table excludes additional materials needed for ridges,hips,valleys,etc. Prepared For: Perry's Roofing 23 Boxwood PI, Rye Brook, NY 10573 QuickMeasure Roofing Materials Roof Reports in Under an Hour Waste 0% 10% 15% 20% Timberline Products HDZ, HD, Natural Shadow, American bundle 87 96 100 105 Harvest, Reflector, Royal Sovereign, and Cool Series Starter WeatherBlocker bundle 4 4 4 4 Pro-Start bundle 3 3 3 4 Quick-Start roll 10 11 11 12 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 3 4 4 4 Shingle-Mate roll 8 8 9 9 VersaShield roll 9 9 10 10 Leak Barrier StormGuard, WeatherWatch 2 sq roll 7 8 8 9 WeatherWatch 1.5 sq roll 9 10 11 11 Ridge Cap Seal-A-Ridge bundle 5 6 6 6 TimberTex bundle 7 7 7 8 Z-Ridge bundle 4 5 5 5 TimberCrest box 7 7 7 8 Attic Ventilation Cobra 4' Plastic Ridge Vents foot 38 Master Flow SSB960 Metal Slant-Black vent 12 Master Flow High-Capacity Dome Vent vent 5 Cobra IntakePro Rooftop Intake foot 76 Notes:1)These approximate quantities are based on estimated measurements and are for guidance purposes only. You should always confirm quantities prior to ordering and ensure you are following local building code requirements. 2)For Timberline.3 bundles=0.984 squares. 3)Starter=eaves+rakes. 4)Leak barrier=bends+eaves+flashing+hips+rakes+step+ valleys. 5)Ridge cap=hips+ridges.6)Estimated quantity of attic ventilation products based solely on exterior roof area and Intended for estimating purposes only. Installer must verily attic floor square footage,roof design,local code requirements,quantity/type of vent products,and conditioned space under the roof. Always have a balanced attic ventilation system. In no case should the amount of exhaust ventilation exceed the amount of intake ventilation.For more info,visit gaf.com/ventcalculator. Installed coverage will be less and depend on quantity and width of side and end laps. Prepared For: Perry's Roofing 23 Boxwood PI, Rye Brook, NY 10573 Timberline'HD""_`,­ . .: Shingles GAF LAYERLOCK" America's #1-selling shingle just got better! ;; TECHNOLOGY t + • same shingle • • • • love, now with LayerLock'" which powers the industry's • nailing area. r IF •�a n Timberline®HDZm Shingles Benefits: Product details: is LayerLock'Technology—Proprietary durability, strength,and exceptional Product/System Specifics technology mechanically fuses the wind uplift performance. ■ Fiberglass asphalt construction • Dimensions(approx.):13'/:x 39 common bond between overlapping IsStainGuarde Algae Protection— ( ) 337 x 1,000 mm shingle layers. ■ Exposure:5 SA'(143 mm) Helps protect the beauty of your ■ Bundles/Square:3 ■ Up to 99.9%nailing accuracy— roof against unsightly blue-green ■ Pieces/Square:64 The StrikeZone'"nailing area is so algae discoloration' ■ StainGuard"'Algae Protection ■ Hip/Ridge:TimberTex®;TimberCrest easy to hit that a roofer placed 999 "': ■ High Performance—Designed Seal-A-Ridge•;Z®Ridge;Ridglass® out of 1,000 nails correctly in our test. with Advanced Protection'°Shingle ■ Starter:Pro-Start®;6luickStart®; WeatherBlocker' ■ WindProven' Limited Wind Technology. Warrant When installed with Applicable Standards&Protocols: y ■ Seamless compatibility—The new UL Listed to ANSI/UL 790 Class A the required combination of GAF ■ State of Florida approved Accessories,Timberlines HDZ°" Timberline HDZ'Shingles are com- ■ Classified by UL in accordance with Shingles are eligible for an industry patible with traditional Timberline HDs ICC-ES AC438 g g y Shingles for the same look and feel a Meets ASTM■ D7158, , first:a wind warranty with no Meets ASTM D3161 Class Fhomeowners and contractors rel maximum wind speed limitation.2 4 y ■ Meets ASTM D3018,SType 1 on for beauty and endurance. ■ Meets ASTM D3462 ■ Our legendary Duna Grlp" sealant is ICC-ES Evaluation Reports ■ Perfect Finishing Touch—For the ESP-1475 and ESR-3267 pairs with the smooth microgranule best look,use TimberTex®Premium ■ Meets Texas Department of Insurance surface of the StrikeZone'nailing Requirements Ridge Cap Shingles or TimberCresr ■ ENERGY STAR®Certified(White Only) area for fast tack.Then,an asphalt-to Premium SBS-Modified Ridge (U.S.Only):Rated by the CRRC;Can asphalt monolithic bond cures for Cap Shingles. be used to comply with Title 24 cool roof requirements Colors & Availability: Results based on study conducted by Home Innovation Research Labs, on independent research lab.comparing installation of Timberline HD" Shingles to Timberline®HDZ"Shingles an a 16-square roof deck using standard 4-noil roiling pattern under controlled laboratory conditions. Actual results may wry. '15-yeor WindProven'"limited wind warranty on Timberline°HDZ'" Shingles requires the use of GAF starter ships,roof deck protection, ridge cap shingles,and leak barrier or attic ventilation.See GAF Roofing •• Birchwood • At r Biscayne _ Chatcoal Copper Canyon System limited Warranty far complete coverage and restrictions.Visit gaf.com/LRS for qualifying GAF products. 'StainGuard"algae protection is available only on shingles sold in packages bearing the StainGuord"logo.Products with StainGuard" algae protection are covered by a 10-year limited warranty against blue-green algae discoloration.See GAF Shingle&Accessory Limited - Warranty for complete coverage and restrictions. To be mixed on one roof.Timberline"HDZ"Shingles and Timberline HD" ■ •• Fox Hollow Gray Golden Amber Hickury Hunter Green Shingles must have matching 6-digit codes found on the end of the bundle. When mixed,always use Timberline HD"installation instructions. -- °Periodically tested by independent and internal labs to ensure compliance with ASTM D3462 at time of manufacture. Lifetime refers to the length of warranty coverage provided and means as long as the original individual owner(s)of a single-family detached residence[or eligible second owner(s)]owns the property where the qualifying GAF products ore installed.For other owwnershtructures,Lifetime • Oyster Gray Patriot Red Pewter Gray - coverage is not applicable.Lifetime coverage on shingles requires use of GAF Lifetime shingles only.See GAF Shingle&Accessory Limited Warranty for complete coverage and restrictions.Lifetime coverage on shingles and accessories requires use of any GAF Lifetime Shingle and any 3 qualifying GAF accessories.See GAF Roofing System Limited Warmnlyforcomplete s coverage and restrictions.Visit gaf.cofrVLRS for qualifying GAF products. o z Note:It is difficult to reproduce the color clarity and actual color blends _ Sunset _ d Wood White of these products.Before selecting your color,please ask to see severot full-size shingles. ® a P We protect what matters most" • , ,1 =u ,-, r,.,n ,-li I"' Y 'Y 'i=1 l+`i 1 rt 1"' Ilti 1' 11 = 1( = Iql ;= 1 N PL.,I•. = YdU , 1 I, I , !.1 1 I , 1 !I II i !It 1 i11 ` t iI!,� ilY I I{ !I 1II ( II!I y�{(! il� III Ill ll {!11i11t j�'1 11,!i il{il;{�I�i(YP !I I'ii((t�lj '���t Hill�� I' i III(I' it,f 1 II{ I!i ;tl,lilj , i•tt'}( `!'ll�� '!lril{ I i nib III I Pp I 1 II `�(!j� i YiI lii�1 { � 1+ hi l'rlHl:,i�'1�' 1.I I il: ta•I r ! 1 c [ t t +' !•tll.Itkll� 1� li 11 T lI! ; I � (!� ;li•,,1 v!S (l�!I,j` i.rlt 'i'Y � iii�`,I;��;'�1 iIN G� � j , fil{ ,, r U ! , ■`� , tt;,l;l�l. Nr'rt{I i. ,11, I'Irl �,Y'lii 1 IY II{ � !I i;I•i�, i }tI+r(1 l!P�'!,;�jij,�{{I{j1 i�l �litii�'i I(!'I I lIIi!l �•! '�! � ( �1!t,'i','p1"•,(1!•qI!Y t q i . SHIM !1jp!t=te',ltdl'ii,_i.th�Y;t liI.Nr[��.t]l,!•lI;i.l;iq'jt,�1i �Ji►.+i�p'!lN,•''+Fy�'l c'1.t•!t•�i+'Y tl,;,ji'1;li(lt I�ll,lll I!.t►��Iilfi it1YltYi 1,,.il 1i(tIi1�1�.�1(!Y!+,rry,!ir t l !r''i(F P■! TIIi tj' 1!;•!!i tll�(,ul l 1ai�i�iti' '�'�IUI II ''t 1 I I t i•,1 cA 1 i 1' 11'�� (( (tt t t 1 r j'1 1. t , 1 it = It :i+ ► i 1 } rl jilt = c !; I'•1 iii; t.tl ilP, c► iht�ii l''_ ! , 't t 1U{I itl{<y'pt If p ll, ii i!i! + ';_�;i� .. ° lilt !i! II{'( I; Y�•'j it !1 I I i I!(i Y rl ii{ iI `'it {ti t 11, tjl'i Itl I i i I�' I•`[`_{1• ' 1 (l ill! l li' IG'I 11 , , Fi, i t, , 1.. ;.r' I 1 " n. l� '1 , l j i t. {! 1: I' I t' i 1 II•.►� I !, i, 1 ji ,!, ,t ., hi +! t ;i , t '{ ;:! !P! , 'll ! 1 (,,.t;!{It ;• .--++'} I''c,Y( t.1 of III is II i t I I t j 11 1 itI 1 { I t ll=' if 1,Gy Ftj.i rNt l 11'ilI illll i,llll 111 i l••11!( I 1 1' 1'i I1Pit 1 v ,r ,, r + ,,� ,.r l 'l��l 1 = f {' t ! 1 if ! n!N' 'i= Il I�i,- #{ il. Itliil!1!lll II „ ,, n t k1il Y 411filil q IIl '•t'It�1>I (�..''If4 IN tl I,tI ,.! 1.1!,• i �■ l ' ''li I l '!! r l• I , t c 1 t:r_ F ( i t !i iii' !I+I ll i (,i : till �!� 1 � I � � li' i,ll1'I•li�l�itrtp 1 it III',r- ! Ill (:•it I"i II ,p .I € ,{I.r !ii�c ••!i '+r r,l,il. c;flli,1•{Fll�j'+ii! i l i�iliil�l'� {' '•I I j°Il!iCllrl(r{;I�,i.l�! =11ii►.Nj�p!h� i Y t�I i t , i 111 ly { ! I'•1 (I!{• l,i,f..l i ,III i.I,ir'1' I I ! Ii1 lei tl 1�I `i 11I i i��j1 RIyIINi�.•sii�G(Nil!�;=1ti(�{�i j 11����;iiii'��,I�I�I! if t� ,t r(=l;tl''lr'!=•(liiij�( j 1';(i h'Pti(!I itllr,l !I;] I r r I;�� ill P!l r ,t (• !r i� ,l�:tl`Illi` p'.� F (I 'I(• i i�f it,{!{{II:1�1c9-l�• l,.r I .. :.;':.•�- (c�: !! I( 1 1,I!�lii iii t 'i ti ►.i ,Il1I i l i..;!(Y'• (f '•'u RPM `li t n' i is• �'� i •III r R r[,. ,I(1{ i111 Il� ! j{(II i!I 6! iff(Il I:!t1( i I'lii ►!{{I 1 !{, I;!► t �` I I I I 1, I(y r{t Y.,pt t I iNi it ,1(.11"I il'i If 1'! (II ii! l! i! I► I; • II1 d (h 1 I<i (IYtI'i i j��!{ I.( 1•i I• ! I Ili I (ii�lj(�!!f j;l►!lIi;rl,�i!;{ iIlI!Ii'i(ii�i�((rr (,�,lP I�l(j,{(�i;{(1!�;i I{1,��I' !j�i! 11,1 ,1.((�1tllisi•Jill! 11 t H{�.+ Ij(iS ;ti i�clP!i! 10 !I(l I +I!;`I ,i!j j1,i;l n{,Yti't!niilIl!•l E .�= I�illi;{±l 1, li '. , I iii (s,!(• Ijt , II!Ili({t{il!(fI ,iii! ��;a•tl�l 1! l , � II i!'i la �i�i(ii}�{! !►�!i! Ilj�i!( 1�(�Iilli� ^ ti i ! ! lil It#. I,I !11 1'fl { i i't +n•1: t` i j i, fi} �;il 1' bi; N q l r i ii t Ill I lI f I 1 + i is H II iI!!rJrl I!(�( � r Ijrl I.ttr {til 3 ,i ,,I I 1 ,jl Ii., y`M'.,ua ,i I'i; +•�'1 a 1• ' y , illI, 11, it rl' .0 •11,r!r li,,�I i r .`<i� I! i1J '�� .. 1 I l,�i t i;+ i I.P i 4 ri 111 iI illl i i'i' I, G ,.1. 1!• i {I Willi{. i!f•.• _ !!9 1 C!i11 `Yi H I+'r i 1 !r.li.ii!�iuli i it F, j1 { iY 1 I I .i i! P �.' .• (i•• I L, +RHI+�1li!=1jYl gi1' 11!Il.jll. r ,tl.h ij'1•�„ 11,1 I!1 PI t11 �I�I ( �a� , (,.IIIN II1.11{` Yli(,r'Yllll!yi ■c 1'li I I •,;l"l,l Ir�i I = 11 „ !! ,n'iY,a 1�{, Ill 1 � I { ;i, 'l I =iI i I r{,• It I I l (hY I�' 1' c�� I�„II, I' ,{II, ,l l I ti!l(i1+i I'A,I'i�I� j! d Pllii.',,ir13 I'I ' 'It! t n li ;•j �!(! ,( I I, � � �+•; ,,,,II i r!j +l)h�j I!�l tlj i i.� Illl;li. !I n i l IN I;,i'y c �I, ,I I ii 1 ,�•I�' ! ri Ili ! + \ jlil� 'Ii1�1�i1Y (t� j,,•ij '_�h hlj: I��, ; III I li�l!•I�((( ul !�11;il! ;Il,�, i• j, t, � � ,{i { di P I I,I•i I I !1j1 , i h•1 L1 i II'I I + ,1 � � II'l ��� 1r' !1,1;Y1!I{TYlil Itl ■ r{�I,i I ,!jl I I ;1•,i 1 t 1{i ,.r I�P'• t .r(., � aa P ( il{! (IiI ll!Ilrl;l+ill + l H 1=!4(I IIII�I 1 1''I!II'I ri"i;,!I � h 1 ( •�/ = iE ill '{Ii{l:li+!ij'�lii ,i�lllit,Il Ili:I,H j I�l•!1 11' I�,i ll{ Pi! I i I 1 y, = I' I I 'i I ' i (` t : i!I l(Iltr i jillt1 I Ill;!i 11j I a Hit = LL I 11 I , + I„ i I ! ! E i!,;ij;l" I'[i ;;I I;lji 111•It U�I i;, , hill I,! 1,•; !�!!!!i l j i � li I I . , ' 11 ,r j ;llll r yii(I ,I!!; i 1, . ;'1, •,n I i i !I�'(! ll i II ► t-_ ,i r; + +,, u. II :I I II f =•1�i' 1 I i 1.1 t11ti i1 Il'i i 'I,I.I!i)itllilt 1 rN{,_) i I i 1.1'rl+ ►` j{; I� t •fl .f,Y4 itc l(111tifill Is ' Y , {. c,l r, I o o y• � A �• S y rain (D � a De r 'T' N D N m O • o < tw 0 w cram. s s� ' rr1 L r A c C3 pv e s;' 1 � DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 10/8/2021 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(s). PRODUCER CONTACT NAME: Erich Courant&Company PHONE 201-226-1200 FAX NC No):201-226-1201 25 East Spring Valley Ave Suite 270 WC.Maywood NJ 07607 ADDRIESS: INSURERS AFFORDING COVERAGE NAIC N _ License#:BR525310 INSURER A:Evanston Insurance CO _ 35378 INSURED PERRVER-01 INSURER 8 Perry Verrone LLC 12 Center St INSURER C: Pleasantville NY 10570 INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1 61 0964 384 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 ADDTYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MWDDPOLICY LTR /YYYY MWDD/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY 3AA409339 7/1/2021 7/1/2022 EACH OCCURRENCE $4,000,000 CLAIMS-MADE FXI OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA A E.L.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 105736 . �.IJ T3 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 914-867-1747 Perry Verrone LLC DBA Perry's Roofing 1c.NYS Unemployment Insurance Employer Registration Number of 12 Center Street Insured Pleasantville, NY 10570 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e., a Wrap-Up Policy) Number 26-2754386 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1a" 938 King Street 46-884191-14 Rye Brook,NY 10573 3c.Policy effective period 03/01/2021 to 03/01/2022 3d.The Proprietor, Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) X❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box-la"for workers' compensation under the New York State Workers' Compensation Law. (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Steven Diamond(President) (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 10/08/2021 (Signature) (Date) Title: Licensed Insurance Broker Telephone Number of authorized representative or licensed agent of insurance carrier:516-488-3040 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www,wcb.ny.gov