HomeMy WebLinkAboutBP21-271PERMIT #26?c��-/ /� DATE: o / a/ EXP:
SECTION - /d A/ % 3 BLOCK C LOT
TYPE OF WORK
JOB LOCA I N k
OWNER G Q'IL'I
CONTRACTOR 4 A4 {SOW ell 4q (20/
TCO #
INSPECTION RECORD
DATE
FOOTI N G
FOU N DATIO N
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FRAMING -
RGH FRAMING __---------
INSULATION
PLUMBING
RGH PLUMBING
GAS --
SPRINKLER
ELECTRIC
LOW -VOLT C7 - --- - __
ALARM -- - - --. AS BUILT 0
FINAL
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VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
NO. 22-007
Certif irate of Occupancy
uCv-
Ehis is to certify that Sohifl-"Rer'
of. having duly filed an application on
20�0�requesting a Certificate of Occupancy for the premises known as,
Rye Brook,NY, located in a Zoning
District and shown on the most current Tax Map as Section: 24, 73 Block: C?) Lot:
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. - , issued ( 20 >21, 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: - 1 e'_FO-t)-) / IV , 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 height s all a made,nor shall the building be moved from one location
to another until a permit to accomplish such change has been a' ing Inspector.
Building Inspector,Village of Rye Brook: Date: JAN 1 12022
D BUILD MENT For office use only:
VIL OF RYF'BROOK PERMIT#
ISSUED: I U !-,�2 f
JAN " 5 2022 38 KING STRE YE BROOK, EW YORK 10573 DATE:
Q U
VILLAGE OF RYE BROOK 9 FEE: PAID
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
_K
Address: �" (�'�1 ! 0 U� it\ Y�U
Occupancy/Use: t ';h4,Ce Parcel ID#: 3 � Zone:
Owner: ( { Address: C 1 0 fL N h
P.E./R.A.or Contractor: A — n +r 01'C ddress:
Person in responsible charge: i'+f-C o 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 YOR iK,COUNTY OF WESTCHESTER as:
ae ��� emg duly swam,deposes and says that he/she resides at r ►"��j P� ��' e
(Pi NameofAp ant) (No. trees)
in D'\ ,in the County of J in the State of that
ity/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 e i nt,profe�onal fees,and including the monetary value of any materials and labor which may
have been donated gratis was:S 0 M
for the construction or alteration of: C e
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 T� Swom to before me this
day of , 20 day of , 20
Signature of P e caner Signature of Applicant
MA Nam&of Property Owner Print Name of Applicant
Lrti
Notary Publi6tary Public,State of New York Notary Public
IV No. 0V;iE616M63
Q..ialified in Westch ester County/!1_ s'12!202l
Commission Exoires January 29.20_ Z'
c,u �
. 1982 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
f❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAX (914) 939-5801
www ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS :_ mil_ Ll 4)ATE: 1 L�
PERMIT# �� '2� ISSUED: "t \ ECT•��--IiLQCK;JLOT: S�
a
n t
LOCATION; _(1�i - V ti '�-- %�' ►� OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS ACCEPTED ❑ REJECTED/ REINSPECTION
SITE INSPECTION1 �--'C RQ REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ 'UNDERGROUND PLUMBING NOTES ON INSPECTION:
AROUGH
PLUMBING
ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
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• BUIL I)EPA MENT D 1EE C IE 02
VIL 'AGE OF RYE OK DEC .�i)ki
938 KIN ET RYE B ,NY 10573
VILLAGE OP`WE BR' OK
or BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required j
FOR OFFICE USE ONLY BP#: 'ZZ') /r EP
Approval Date: n i Inoi Permit Fee: S
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated, / 020�-/ 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 an oral Codes. 1
1.Address: I1 'e !-�►� Rye e S L: '! Zone:�Pub
2.Property Owner: 6 01- e Cyr^' Address: N 1%, P�o k
Phone#: ! 3 — Cell#: J q,„,e email: Vh SG e
3.Master Electrician: �` }Ylcal�i w Address: �` 4 , S AW-Vt11` , 10693
Lic.#: 114 Phone#: iW 2J4,:&y Cell#: email: 551 AmAki Ca G/vo&r 1 0'-N
Company Name: ,Yk,4w t Eki-4ti"O at Address: A/4 r5id Sf /Wyw->-- /dSs 3
4.Proposed Electrical Work/Fixture Count: 2 CE1.,M,-r
OL-c-DLCA-i`—n '6-'S 7`O !SG! x-c
TATE OF NErYO COUNTY OF WESTCHESTER ) as:
tTT�, eing duly sworn,deposes and states that he/she is the applicant above named,and does further
(print naiini of i dividaal signing as the applicant) )
state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the A /A
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 ri f Sworn to Kefore me this
day of 20 al day of Q c 20Q2
Si tore Proprty yore Si a f pp 'cant
Print Name of Property Owner Name of App licaRt
Notary Publr LEXAN RA H.MARSHALL NAPMAPIic, ate Of New'York
No. 01 e•lr616GC63
Notary Public,State of New York
No.01FR6363711 C-.iaiified in Westchester County
Qualified In Westchestef Count(-, Commission EXDIres January 29.20
,tmmisslon Expires August 28,2 .�
8/1212021
.. .._�_...�_s..riL t�.O�-_A-_lb... ...._ _✓_.�.JW.._ ..._i -rvT=-s..-a ... .a.-�....
Phone: 914-347-3595
Westchester Rockland Electrical Inspection Services, Inc.
DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue �. Fax: 914-347-35�6 J
Elmsford, NY 10523 Lr \ BUILDING PERMIT NO.
TEMP# �E / — lJ
CITY OR VILLAGE j ZIP CODE- TOWNSHIP COUNTY
STREET,AND NO.OR ROAD }j� / POLE NUMBER
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION _7 / LOCK LOT O
OCCUPANTS NAME BUILDING OCCUPANCY
OWNER'S NAME AND ADDRE
I. i � � •,' �,`. 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 gg
BASEMENT i
UJ-
P FL.
2N°FL.
YE 8WOK
39p FL.
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE:
—Tv jL.1 �J L�� 0 (F � /tl}c �/L/V� !t r t7 0
THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED.YOU ARE
AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS
NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS,INC.IS NOT LISTING,LABELING.UNDERWRITING OR CERTIFYING ANY EQUIPMENT,
MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO
ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION.
SIZE OF SERVICE FEEDERS
CHARACTER OF WORK NEW❑ ADDITIONAL C EXPOSED C CONCEALED❑ MUST ENTER APPLICANTS
IDENTIFICATION NUMBER
SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND C
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
NAME OF COMPANY DATE OF APPLICATION SIONATURE OF APPLICANT
STREET ADDRESS TELEPHONE NO. /
i
CITYY= ' fv ZIP CODE LICENSE NO.WHEN APPLICABLE
WESTCNESTER
ROCKLAND
ELECTRICAL
INSPECTION
WREISH1111111CH,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:
Yanni Electrical Corp Michael&Carol Scheffler
551 East 3rd Street
NY,Mount Vernon 10553
Located at:3 Meeting House Lane Rye Brook,NY 10573
Certificate Number: 1032394
Section:124.73 Block:2 Lot:50 BDC: Permit Number:EP:21-317-BP:21-271
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:
3 Meeting House Lane Rye Brook,NY 10573
Basement G 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 12121l21
Name Type Quantity
Receptacle GFCI ___ 3
Fixtures Pendant ___--- 2
Dedicated Circuit 20 Amp ___ 2
Microwave --- I
This Certificate has been approved by Westchester Rockland Electrical Inspection Services.
This certificate may not be altered in any way. 6��`
This certificate is valid for work performed before date of inspection only.
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PIREET
R-O [E C� C E V C
BULMENT DEC - 3 2021
V11RYE K
938 KINY1 B ,NY 10573 VILLAGE OF RYE BROOK
,,9 -4 -0 $- BUILDING DEPARTMENT
or
PLUMBING PERMIT APPLICATION l io N
FOR OFFICE USE ONLY BP #: s4 J- PP#: "'! / d-
Approval Date. FEE- Permit Fee: S
Approval Signature: / ther:
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 remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this
document agree that sai/d�lumbmg work will be in conformance with all applic#l)le Federal,State,County and Local Codes.
1.Address: r /e f � u re P k V'D 0 tS,BL: 7 -z- 5-Q Zone:Pu 6
2.Proposed Work: lei „/ 1 *4t1Z S c
I .
3.Property Owner: ' C�ti.e �JCke fjC Address: v I dtA e ►.e -p- ✓ jk
Phone#: — 1133 - 19 Cell#: email: sc trb*'e_,Cb0
4.Master Plumber:-gQl Address: Y14P -440 &At_-t
Lic.#: 131"(o Phone#: Cell#: y Wyk email• W4,l/•,_-2l/_,,ec64 .0
Company Name0ji2t' Addres Ao A G /
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 3
2nd Floor
3'd Floor
0 Floor
511 Floor
Exterior
5.* List Other Equipment/Provide Details: d/A -X4
t / to
(Notarized Signatures Required Next 2 Pages)
8/12/2021
STATE OF NEW YORA C4OtJl�i�7'iY OF WESTCHESTER ) as:
' { I cJ,.y0 V G he.q/"Jr]A ✓` ,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
(�/A 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 1 Sworn to before me this
day of C-AM)-Cl ,20 SO day of 3t 0 ew ,20 -)-1
S ignature rty O t
r Signature f cant
a_ f 1 t'C.�WC,/ 5�P—g)v— Ag, A , _
Print Name of Property Owner P7nnt Name of Applicant
Publi ALEX RA H.MARSHALL Notary Public Notary Public,Steft of New York
Notary Public,State of New York No. 01 L18144154
No.01FR6363711 Qualified in Westchester County
Qualified in Westchester County Comtnisston Expires Apr. 24, 20_ly
Commission Expires August 28,2021'
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-
gn2r2o21
BUILDING DEPARTMENT p E Q V F
VILLAGE OF RYE>AROOK
938 KING STUET RYE BR66K,NY 10573 DEC - 3 2021 DD
(914)939-0668
ww xyebroylc.org 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 O"ER 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 O NEW YORK, C TY OF WESTCHESTER ) as:
I ^
° Jek`g'�residingat, .. +tee
(Print name (Address where u ve)
being duly sworn, deposes and states that(s)he is the applicant above named, and finther states that (s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
Rye Brook,NY.
(Job Address)
Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, tat
there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and ftulher
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 odes.
(Signatur of Pr erty Owner(s))
)-C�C-el I I
(Print Name of Property Owner(s))
Sworn to before me this
day of P c��-� , 20__�_ �
(Notary Public)
SHARI MELILLO
Notary Public, State of New York
No. 01!',E616G'63
0,ialif�ed in Westchester County
Commission Exoires Janusry 29.202-11? -3-
8/12/2021
Buildin Permit Check List&Zoning Anal sis
Address: SBL: 2 -S J
Zone: t Use: r--.> Const.Type: Other.
Submittal Date: p Z( Revisions Submittal Dates:
Applicant:
Nature of Work: Q tin
Reviews:ZBA: Q C T 2B: BOT: Other,
('IF QK
( ) FEES:Filing. S' A BP- �Z�� C/O: Legalization:
( ) ( ) APP: Dated: r✓ 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.
( ) ( ) SURVEY:Dated: Current: Archival; Sealed Unacceptable:
( ) ( PLANS:Date Stamped Sealed ✓ Copies:_Z.Electronic: Other.
( ) (4/License: Workers Comp: Liability: / Comp.Waiver. Other.
( ) ( ) CODE 753#: Dated: N/A:
HIGH-VOLTAGE ELECTRICAL.Plans: Permit: N/A Other.
( ) ( ) LOW-VOLT GE ELECTRICAL:Plans: Permit N/A: Other.
FIRE ALARM/ ^IIE�. ermit H.W.I.C.:_Battery: Other.
(ty ( ) PLUMBING Plans: Permit Nat:.Gas: 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:
REOUMED EXISTING PROPOSED NOTES APPROVED
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[—DATE IMMODNYYYI
AC"J?" CERTIFICATE OF LIABILITY INSURANCE
`� 1010&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- it the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
tf 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 certfficate holder in Neu of such endorsement(s).
PRODUCER CONTACT
NAME. ROM,ANO
MORSTAN GENERAL AGENCY �� 914-476-7411 FAX 914-963-6138
IAIC PO BOX 9005 ronwio215Qaoi.corn
NEW HYDE PARK,NY 111343 AFFORDING COVERAGE _ NAIL&
INSURER A: WESCO INSURANCE COMPANY 2501
BOSOM —
INSURER B
ALL COUNTY REMODELING CORP wsURER c:
445 BONNIE COURT INSURER D:
YORKTOWN HEIGHTS,NY 10598 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.
ADDL alb TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP UMTTS
CONSIFRCIAL GENERAALL LIABILITY EACH OCCURRENCE Ii 1.000,000
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CLAIMS-MADE II s'ti 1, OCCUR PREMISES ffA 000Aro ce S 100,000
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A WPP1234258 06 04/04/2021 04104r2022 PERSONAL a ADV INJURY i 1,000,000
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CERTIFICATE iS SUBJECT TO POLICY TERMS,CONDITIONS 8 EXCLUSIONS
PURAOSE.PERMIT-REPLACE KITCHEN CABINETS&INSTALL TILE BACKSPLASH
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WIL1 BE DELIVERED IN
VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISKINS.
938 KING STREET
AUTHOR{EFD REYRESEPIX►TIVE.J
RYE BROOK,NEW YORK 10573
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A 1988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25(2016l03) 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 10601-4411
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
No
^^^^^ 010745785
ALL-COUNTY REMODELING CORP.
445 BONNIE COURT
YORKTOWN HEIGHTS NY 10598
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
ALL-COUNTY REMODELING CORP. VILLAGE OF RYE BROOK
445 BONNIE COURT 938 KING ST
YORKTOWN HEIGHTS NY 10598 RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2425 911-1 994572 09/01/2021 TO 09/01/2022 10/7/2021
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2425 911-1, 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 WEBSITE AT HTTPS:IIWWW.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.
PRESIDENT
CHRIS DIMIRCO
VICE PRESIDENT
JOAN MARIE DIMIRCO
20F2
ALL-COUNTY REMODELING CORP.
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
4:_:� aew_z�
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 734050382