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HomeMy WebLinkAboutBP21-285PERMIT # �/ ��- DATE. I S&L ©(P: SECTION /cD9► ►% & BLOCK LOT TYPE OF WORK JOB LOCATION _ OW NERwAL�tll CONTRACTOR,_ EST. COST vc0 # y Ik,JM#_ DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CI RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT C� ALARM 0 AS BUILT L7 FINAL i FEE DATE INs F m �vj�-L, Tex OTHER APPROVALS ARB BOT PB ZBA IOTHER VILLAGE OF RYE BROOK WESTCHESTER %KNTY, NEW YORK No: 22-102 (certificate of ®ccupaucp This is to certify that /' 11%1P1r)! A-? of, 9)(e, FDr6nk , 7 having duly filed an application on '/y �� 20 22 requesting a Certificate of Occupancy for the premises known as, o? / / Ye>- In-o J aIl e , Rye Brook,NY, located in a PU0 Zoning District and shown on the most current Tax Map as Section: 7 Block: Lot: 74 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.C�I" , issued 1 20 c�2/, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: P - FCJJn1 Construction: for the following purposes: de-'Ck-( rq Oki fX1,73 1,?0 CAI PC'I. w 4 h 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 buil%P-Zde,,e e exit facilities shall be mad�dtfti o enlargement, whether by extending on any side or by increasing in height sh nor shall th building be from one location to another until a permit to accomplish such change has been o7Date: Assistant Building Inspector,Village of Rye Brook: �U` 1 1 20�2 ID BUILDING DEPARTMENT For office use aril PERMIT# JUL - 7 2022 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: "7- 7 as VILLAGE OF RYE BROOK (914)939-0668 FEE:_ //p— PAID BUILDING DEPARTMENT wµw ryebrook.ora 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 ftftifttt•►ttft►t►tf►•►ttttitttR\tttttff tilt/tiiiitittifit tt►►►tifift•lift\i•tf•t►ttt\►tft►ft►►t►►titttf►tttt►iititttt••titft Address: 247 Treetop Lane; Rye Brook, NY 10573 ,�F'q Sec. 129.78 Block 1 Lot 74 Pub Occupancy/Use: esiderniaUPersonal Parcel ID#: Zone: Owner: Emily L. Weinstein Address: 247 Treetop Lane, Rye Brook, NY 10573 P.E./R.A.or Contractor: Richard Mohririg/Robert James contracting Address: PO Box 134; Glen Head, NY 11545 Person in responsible charge: Richard Mohring Address: `SQ/n4-�-' 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: Emily L. Weinstein being duly sworn,deposes and says that he/she resides at 247 Treetop Lane (Print Name of Applicant) (No.and Street) in Rye Brook in the County of Westchester in the State of New York.that (Cit}/T'o%Nn 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:$ 4,032.00 for the construction or alteration of: Replacement of deck planking with Trex 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-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this Z Sworn to before me this day of �� , 20 22 day of 920 22 Signatur o roperty Owner Signature of Applicant Emily L. Weinstein Emily L. Weinstein Print Name of Property Owner Print Name of Applicant '�?� '�- �11 No Public Notary Public SHARI MEULLO Notary Public,State of New York No.O1ME6160063 Qualified In Westchester County Commission Expires January 29,20 Z& BUILDING DEPARTMENT CTOR ANT 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 : \ `� ATE: PERMIT# l\,� � \ ISSUED: 1 SECT:1-�-)(J BLOCK: LOT LOCATION: �`"`- 1 �/ ` OCCUPANCY: -%-\, ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ry n OD .I W " �••� N Q I N eV U a 04 � a 05 old ej .., c u xi e W _ 41 co d4 3.. O 0!).S b10 " W � � �-I � V � � � Ems— •= a� � � o�C - 00 en WAN 0 OF u '�o 5 w . 01* w O rG a Uric � � Z EZ-� < s ~/ A � o [� �•/ a i © � w aGs � Lbw n t W ^ ~ (4 > O ° A "0-4 04 00 Orn = CDPOI 61ro OEM ro- er O 0 A Z Z IW6 C. Q. BUILDING DEPARTMENT R � LIP" '�I Lc VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 OCT 29 2021 (914)939-0668 "'WW.t-vyhrooN.org VILLAGE GE RYE BROOK BUILDING DEPARTMENT � ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: + > Q APPROVAL DATE: NOV — 2 21 PERMIT$I`:/�P���" � APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: "gip H.A.A. APPROVAL: DATE: DISAPPROVED: OTHER: ***************sssssssss*ssssssss***s*ssssss*s*s*ssssss******s*s**s*s*****sss***sss*s**ss*ssss**ss*ss*s**** Application dated: 1 Cl is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,struTadditions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 217 T r C C toe LA n c, R a voo k P CIS 2. Parcel ID#: .2 9 . 71, - 1 _ 74- Zone: )04 3. Proposed Improvement(Describe in detail): Fe p I c c rn(ni ccf t t)p 60-nmI t:1` alt C* P I in kq wl JAI 11 P(( q 1 rzua,� x 1 S 1`s ejg [) n0 A I ht r.t t I e•r t% d l j eLs lie r t o d(,ilk 6r f6vnct61-111„r\ . 11} c r wrc-o►.v-,2_- 14 4 t Y 1 cl x 2 0 f l I tt I n�! A P 4. Property Owner: �(YFlly L- INCInStCln Address: -214 7 TY(d p A n C. j R y c B yp 0 - NV 10 5 7.3 Phone# (J-1-1) b eS hoJ--. Cell# e-mail EZW1W4 2AOL,.LQM List All Other Properties Owned in Rye Brook: N1 A Applicant: Sam c e4J rryp(vty Awrl cf Address: Phone# Cell# e-mail Architect: A4 Address: Phone# Cell# e-mail Engineer: /VGA Address: Phone# Cell# e-mail General Contractor: R t l 06 R 0 M C H 2 I N 0 b C r t J Am t l Cv n7let 0h rR Address: 8 C1)( 1 3 4- , 61(r, f='r' N y / 1 S'`7- S Phone# Cell# 51 H 63 7 " 176 7 e-mail he,rr1 M O�,rf (I) 8/12/2©21 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: ( F A M Post-construction: - A�•� 6. Area of lot: Square feet: J 1� c J V -V CM Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: NIl4 rear yard: N eft right side yard: N/A left side yard: N/r9 other: "I rl 8. If building is located on a corner lot,which street does it front on: TI'c t t O P L A N-C. 9. Area of proposed building in square feet: Basement: N I A 1-fl: P1 A 2"d fl: NJ I A 3Td fl: 10. Total Square Footage of the proposed new construction: N A 11. For additions,total square footage added:Basement: N1 i-in: N j A 2"d fl: fJ / A 31 fl: A 12. Total Square Footage of the proposed renovation to the existing structure: �pwx Z i(n �J ^ 13. N.Y.State Construction Classification: N.Y.State Use Classification: 14. Construction Type&Location: O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: M/A 15. Number of stories: 1 A Overall Height: Median Height: 16. Basement to be full,or partial: f1/ -1 A , finished or unfinished: 17. What material is the exterior finish: D e(-'k' bu j)( 6-C, tYCX, I r) J h c4 A 1 t l 01 C� 18. Roof style;peaked,hip,mansard,shed,etc:4=4 Roofing material: N 1 3q 19. What system of heating: (31 1 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No: X (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. Will the proposed project disturb 400 sq.ft. or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:X Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: N (if yes,applicant must submit a Site Plan Application, &provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No:)( (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) yy 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No:!\ (if yes,the area and elevations of the)lood plane must be properly depicted on the survey,&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (f yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER 1: TIER II: TIER III (if yes,a Home Occupation Permit Application is required) °J 29. What is the total estimated cost of construction: $ 3' 5C)(} Note:estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: 2 vv e[ 1.4 c n (,, (2) 8/12/2021 BUILDING DEPARTMENT �VILLAGE OF RYk OOK QCT Z 9 Z021 938 KING STREET RYE BROOK,NY 10573 - {9l4)93�-(}5b8 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: 3, E M 1 l V N C ►n S tt I rn , residing at, J-4 7 I rG c top 1,A rg- k y( 8)-pc k, NY I OS 73 (Print name) (Addres \e here y(iu Ii\c) 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; 24 TrCc ion Ldrc RV( l�ryok, Illy )C; S 73 , Rye Brook, NY. (.lob 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. A;A um_kk�� (Signature( 'ropertyO%%neds)) Ernlly L VV( tnS HI-A (Print Name ol'Property Uwner(s)) Sworn to before ,-m ¢l 'e this o day of 64� it I , 20 Q. ,I , l'uhh, i—I-" 4 I---- " ALEXANDRA H.MARSHALL Notary Public,State of New York No.01FR6363711 Qualified In Westchester County Commission Expires August28,20 8/12/2021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: E M i 1 V We l m s I-C t . ,being duly sworn,deposes and states that he/she is the applicant above named, (print nam6 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. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stornlwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. 441 Swom to before me this Sworn to before me this � 1 day of V C_-06Q-.(- , 20 A day of Signature roperty Owner Signatur f pplicant C-mi►>t1 Wtlrlslctn Cml l•� wctv�s �� - Print Name of Property Owner Print Name of Applicant tary Public otary Pub, ALEXANDRAWMAI!tSV#U ALEXANDRA H.MARSHALL notary Public.State of hlewY** Notary Public,State of New York No.olFR6363711 No.01FR6363711 gUallfled In Westchester 2 2� Qualified In Westchester County oarnmuoft Expires AugustCommission Explres August 28,20�L5 (41 8/12/2021 Building Permit Check List&Zoning Analysis Address: VA 7 Ise C^ " SBL: S',? C� — 7 41 Zone: U]� Use: 2, O Cont.Type: Other. Submittal Date: c> —L -Z Revisions Submittal Dates: Applicant: w �� ►•� STE rJ Nature of Work GF I Srt tJ Reviews:ZBA: NOV - 1 2021 PB: BOT• Other. OK ( ( ) FEES:Filing. S- �, BP: I Legalization: (J� APP: Dated. ✓ Notarized. y_SBL: ,"Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Shorn 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: Electronic Other. ( ) (,,y License: ✓ Workers Comp: ✓ Liability. —Comp.Waiver. Other. ( ) ( ) CODE 753#: 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. ( ) ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plan: Permit: N/A Other. ( ) ( ) FUEL TANK:Plan: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plan: 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: APPROVED REQUIRED EXISTIN PROPOSED NOTES NOV - 2 2021 Date: Cir e FFr n Front: F� 13� Main Cov Accs.Cov Ft H Sd.H/Sb: ff&. To Imp: Ft Imp Parking: Hight/Stoaes: notes:/�, Z >d+ 0 Q rt�� I-R P i V Fo (,l t l t Z.c Laura Petersen From: Emily <elw1976@aol.com> Sent: Tuesday, November 2, 2021 9:13 AM To: Laura Petersen Subject: Fwd-. 247 Treetop Hi, It was a pleasure speaking with you this morning. Please see below from the email from my HOA approving me to go ahead and get the permit. Additionally, as discussed, the $3,500 was the quote my contractor provided me for the work being done for the project. We are not altering the structure or changing anything on the deck. . we are simply replacing all of the top boards which are currently wood, with Trex. Let me know if you need any additional information and I would be happy to provide. Best, Emily Weinstein 917.861.4282 -----Original Message----- From: Arbors Property Manager <ma nag er@arbors-ryebrook.com> To: Emily <elw1976@aol.com> Sent: Fri, Oct 1, 2021 12:46 pm Subject: Re: 247 Treetop Emily, please see the revised email below. I was writing an email to another homeowner named Emily today, and utilized the wrong last name! 10/1/21 Emily Weinstein 247 Treetop Lane Rye Brook, NY 10573 Re: Deck Dear Ms. Weinsten, The Architecture and Grounds Committee (A&G) has reviewed your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained. a copy must be provided to A&G for final review and consideration. Work on the project may not begin until you receive written notice of acceptance from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions. please contact me at: Property Manager. Sincerely, Bryan Martinez The Arbors Homeowners' Association, Inc. 1 P: (914)939-2440 Sincerely. Bryan Martinez The Arbors Homeowners' Association, Inc. P: (914)939-2440 On Fri, Oct 1, 2021 at 12:29 PM Arbors Property Manager <manager@arbors-ryebrook.com> wrote: 10/1/21 Emily Salter 247 Treetop Lane Rye Brook, NY 10573 Re: Deck Dear Ms. Salter, The Architecture and Grounds Committee (A&G) has reviewed your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G for final review and consideration. Work on the project may not begin until you receive written notice of acceptance from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Bryan Martinez The Arbors Homeowners' Association, Inc. P: (914)939-2440 On Fri, Sep 24, 2021 at 3:56 PM Emily <elw1976(d,)aol.com> wrote: Geri/Bryan, Attached, please find the updated application for the deck for 247 Treetop. Geri -- I am going to walk over and drop off a copy in your mailbox as well. Additionally the Trex samples were delivered to our house today. How should we get the samples over to you to review/look at? They are a little cumbersome/heavy. Geri - -thank you again for all of your help navigating this process. Hopefully, I have updated the application to get the committee what they need. Please let me know if any additional changes/updates are necessary. Best, Emily Emily Weinstein 917.861.4282 -----Original Message----- From: geri depinto <gerikurls(d-)msn.com> To: ELW1976(c)aol.com <ELW19762r-,aol.com> 2 Sent: Thu, Sep 23, 2021 8:59 am Subject: 247 Sorry to bother u. When your application is finished. Send a copy to pm and me gerikurls(a2)msn.com Call me so I can pick up copy or leave In Mailbox at my house. Number 1 1 want to make sure I have it If the sample color doesn't come In and application is done give it to me.anyway While waiting for color sample, committee can consider application Get Outlook for iOS 3 tit 1WA CO j u _ o o .z �IL c <c 1 F . .r r. �a�¢ction ;P C coO x vo , O r U O w L a J y (GM)b w Z p, 2 w y — >w � Iw y H`Yu ROBEMOH-01 BGRAHAM :4COR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) `—� 5/26/2021 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: Libardi Service Agency Inc. PHONE FAX 100 Stewart Avenue (A/C,No,Ext):(516)333-3611 (A/c,No):(516)997-0816 Hicksville, NY 11801 E-MAIL ADDRESS:i11fo libardl.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Falls Lake National Insurance Company 31925 INSURED INSURER B: Robert James Contracting Corp INSURERC: 325 Glen Cove Avenue, Unit 1 INSURERD: Sea Cliff, NY 11579 -- 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. I LTRNSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS I D (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,00�r��o CLAIMS-MADE X OCCUR CPP 1205929 11/9/2020 w9no21 DAMAGE TO RENTED T$ 50,000 MED EXP An --- 5,000 _ PERSONAL i1 AOV INJURY $ _ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JET X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 H OTHER: ____ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO _BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BOOILYMURYiPer accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY (PROPERTYP nt)DAMAGE $ UMBRELLA LIAB OCCUR ! EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE ___ $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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/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 Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Robert James Contracting Corp 516-351-1535 325 Glen Cove Avenue,Unit 1 1c. NYS Unemployment Insurance Employer Registration Number of Sea Cliff,NY 11579 Insured 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 27-3939347 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Sirius American Insurance Company Village of Rye Brook Building Department 3b. Policy Number of Entity Listed in Box"'Ia" 938 King Street Rye Brook,NY 10573 WC6124100 3c.Policy effective period 11/10/2020 to 11/10/2021 3d.The Proprietor, Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) 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"1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 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: William Libardi (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 1�(G��,1`•�,�.�iY. 5/26/21 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 516-333-3611 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 KNOWN AND DESIGNATED AS LOT 247 ON A CERTAIN MAP ENTITLED AMENDED SUBOMSION OF BERCO RYE TOWN CO.. SRLATEO IN THE TOWN OF RYE, WESTCHESTM COUNTY, NN.' AND FILED IN THE WESTCHESTER COUNTY CLERK'S OFFICE ON NOVEMBER 23, 1977 AS MAP NO. 19322 WHICH MAP WAS SUPERCEDED 13Y A MAP FILED JANUARY 27. 2014 AS MAP NO. 28740 ENTITLED 'FINAL SUBDIVISION PLAT THE ARBORS KINGS STREET AND HUTCHINSON PARKWAY, VILLAGE OF RYE BROOK, WESTCHES.IFR COUNTY, _NEW YORK" PURSUANT TO NOVEMBER 12, 2013 ORDER/JUDGMENT IN THE MATTER OF CURTIS ET AL V. ARBORS HOMEOWNER'S ASSOCIATION, INC. ET AL INDEX NO. 11740/11 TREETOP LANE OCT 2 9 2021 Cam, UD O m` STREET LINE CURB VILLAGE OF RYE BR K r' BUILDING DF ' N 09'58"W 42.00' ° 88.7 ii m z I ro ASPHALT 0.8 DRIVEWAY 9 PAVERS ONE RETAINING z o O WALL ram, 3 r E � N - •8.1'e W �j w m 1MR1 1 STORY GARAGE FRAME . CV u� I5 0 N ce 1 0 rn w vLo N •:•:•:•: •:'•••••'•••••••-•-••-- r 'fGp t Q N p o ui C c 0 z y F,Ut t 1�% I() � a N o 0 0 0. :.;•:. :.;2. .STORY7ANK °� z W . . . FR1AM E. W I a . . 00.1 yyam� 1- N W O N . . . . . . . . . . . . . . . ��°O� o . . . . . . . . . . uN�r . 02 4WR . . . . . . . 0 1 I� .1 STORY I I 10 "� M1 STORY FRAME 7 3. ._ FRAME WOOD DECK �•, 11 'C1- Qa 0.1 Ld z 4 ,e 1.0• � �z 00 EFE m 0.5 N spur RAIL FENCE r°tom �a� 5 5.7'w MASONRY�NING w `"'`L •8'fw lco g��• zz MAS R�vNGVG w 0/ IV09 "E 30.17' rl N y 1 2 3 Sy z aa�N r ORIGINAL SIZE IN INCHES CERTIFIED :. DATE SURVEYED: MARCH 21. 2014 TITiEVEST AGENCY. INC. DONAL A. O'BUCKLEY �01 N� CHICAGO TITLE INSURANCE COMPANY PROFESSIM LAND SURYEYOR 107-17 45M AVENUE rtL WD.W 11355 lu-917-317-W92 TAX MAP FILED MAP FAX 715-=-023 Ei7.1�oowaanYonca .cw SECTION 129.75 SECTION VILLAGE OF RYE BROOK BLOCK 1 BLOCK COUNTY OF WESTCHESTER TITLE N0. CH—W-397551 LOT 74 LOT STATE OF NEW YORK NEW 050+1