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HomeMy WebLinkAboutBP21-291PERMIT # � - DATE: dc? EXP: // hit SECTION � ,7 BLOCK LOT TYPE OF WORK 10B LOCATIO OWNER / CONTRACTOR,; E COSTT� �41� 0#__� TCO # INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS SPRINKLER LOW VOLT ALARM AS BUILT FINAL INSP 0 00P/fy (f ri j/ 47) 76o0 9 775 no how"*z- OTHER APPROVALS ARB ' BOT ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-103 Certificate of ®ccup ucp This is to certify that NRldoe AIfyC of, �{ YL� N y having duly filed an application on by I ' I 1 20 0!e9 requesting a Certificate of Occupancy for the premises known as, IZRC 30U#? ����� �� , Rye Brook,NY, located in a 07—P 7onim-Y District and shown on the most current Tax Map as Section: , � / Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. , issued `, 20 Q 1, 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: Construction: for the following purposes: � f✓JQy /Ock V 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 shal be made,nor shall the building be moved from one location to another until a permit to accomplish such change has bee obta ed fr Inspector. Building Inspector,Village of Rye Brook: Date: JUL 18 M2 p EC ENE APR 11 2022 J ,I TMENT For office use on1 Or RYE BROOK BUILDIN , PERMIT# J-a'9i � 941 LALLANG DEPARTMENT VIL1tAt OF RYE I�I ISSUED: J- - c9./ 938 KING STREur))'RVE BROOK,N W PORK I0573 DATE: — -aOo-2 _� 9 -06�Q�j. FEE: PAID wrFa leer 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 •ssssrrsssssssssssssssssrrrrrrrrrrssasssss♦ssrrrrrrrsrrsssrsssssssssrrssrrrrrrsssssssrssssrrrsrsrsssss•sssrarrr•►rrrsssssssss Address: Occupancy/Use: k„( i10'f A% ,n ``Parcel ID#: 1 `� z 7 �/ Zone: C P—J- Owner: l�l ti OWS.L 1�'(I b-f, Address: P.E./R.A. or Contractor: V 14 i t Address: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE `OF�NEW YORtK,,YOUNTY OF WESTCHESTER as: D - . } ,/' p ` ) being duly sworn,deposes and says that he/she resides at '�` W' n 0-&f�! r (Print Name of Applicant) (No and Street) v in yL 5 fi icier in the County of N @ S 5 0-j in the State of tJ I 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:$ 90 0C 0,0 0 for the construction or alteration of 6NA Z Si Jl �� G�.I`h�l(o..� 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 pme this 2- Sworn to before me this 2 day of N`711�W ,20 2 Z- day of (��/-v 20 ZZ �--�— Z�::) ' ' - ignatur f Prope ty 9wAer' �,, p. �,,,�ye,(� �'� Signature of pplic t Print Name of Property Quaw Print Name of Applicant Notary Public No ublic THOMAS J CURTIN Notary Public,State of New York Reg.No.OICU6341697 EUGENE M PARISI Qualified In Westchester County NOTARY PUBLIC-STATE OF NEW YORK- Commission Expires May 9.2024 No.01 PA6337741 Qualified in Nassau County __n7_A7_9n9d dye DRZJk. cu � BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :_ DATE: y� O I PERMIT# 1 ' ISSUED: SECT: � LOCK: LOT: LOCATION: 0 `U OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS...1✓--' ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION ` ! REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS V� \"� oNy\n�jc'!S ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER : N N ■ clq N N v G 45 zo 0-0 72 MMC�II � Y Il-i�Il I�1 d vl I�i 0 Q ed a p C 9z4. s -CCU `J N r�1 t� 0 ;5 z W L/ I C p W - aVi a . � a 9zU O r-4 inO, � ff3 vy u 0 C �," U cmISOc -W o -J o U El Vl 11 Y I oc ■ a W a O [ i ■ ~ � Q1 /� � V1 U r+l � h+y O � < z r� 1 c s �= -on °, � W O • M CC '" g Q Ud @ UIT p 'a a CL 'A 40 O ri z Z � w Oo ,o •� � � d a O O �" � °� � EE A a > ' A W z O -v d p4 La W W z � °��' BULL MENT Q ECM V E VIL E'OF RY OOK 3D OCT 14 2021 938 K NG ET RYE BR ,NY 10573 4 70 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Late: OCT 1 Pernvt Application Fee: �OF-46J Approval Signature: Permit Fees:$ Z SD -t>jq — Disapproved: Other: Application dated: 24Z4 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing buig d r for a change in use,as per detailed statemeent d sctbe�jpw. Vi(Al1. Job Address: r Cam/ SSA ;AeeAk //�� � BL: I�{��Z� "—Zone: Zone: 0 C� 2. Proposed Improvement.(Describe in detail): "k Gt^f o f wee drr•SS� � o�-e' e 3. Does t proposed improvement involve a Home-Occupation as per§250-38 of the Code the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an exis ' g automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression SysU'AouvAP4_4�bJ Permit application&2 sets of detailed engineered plans) n:5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Constructio After Construction:_;�X&*%#%4,J-C4 6. MY State Construction Classification: N.Y.States Use Classificatio ptllbw 7. Property Owner: i�►t �d' U �• Address: [ �. IQ NY ,r 1 Phone# 0(' oD Cell# 4-701-W o�_emaiL CC Khan P.o�• 8. Applicant: r,6^ " S Address: I rt--A 1< Phone# No - aD ll# (gyp / a 7 l 73 �� ( S ! email: 9. Architect: I phr Address: Phone# Cell# email: 10. Engineer: Ne Address: Phone# rA Cell# email: 11. General Contractor: Imo /r"► Address: r fG 1a(d'� /� 'e Phone# 7l `T "76� "( 7?,� Cell# ?1 /���977J _email: �0— �N{ ( 01 12. Estimated cost of construction $ ,9j 0'040 r d 0 G (NOTE:The estimated cost shall include all labor,material,; of folding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: �Z Z Finish: (1) 8/12/2021 BUILD MENT ViL of RY` OOK OCT 14 2021 938 Kmrc ET RYE BR. NY 10573 Q � ' VILLAGE 4F RYE BROOK 4 -0 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 BUIL➢ING 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: o residing at, 2-4" F_�-JC �5b&z i U.*-A (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 2' CS.. ��R- , 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. ( ' re of Pro ty OevneY(s)} AbW r- WVJ a- 9 lAC (Print Name of Property Oereerfs))Ab1274 Ft , ! Sworn to before me this day of OGIDhT , 20 2-1 "'A (Notary lic) J C] :ew York C(,unty (2) C:,,, .. : ;III E"+Ilub ivid!ch 6, 20ZZ 8/12/2021 r • This form must be properly completed &notarized by the Design Professional of _ record and the Property Owner. Failure to provide this completed f 3fl permit application will delay the permitting process. — lJ OCT 14 2021 3D VILLAGE OF RYE BROOK BUILDING DEPARTMENT Notice of Utilization of Truss Type, Pre-Engineers odd; or Timber Frame Construction. Title 19 Part 1264 & 1265 NYCRR To: The Building Inspector of the Village of Rye Brook. From: B j , Subject Property: �W� JUJ 0 SM-1 1 i � Zone: Please take notice that the subject; ❑ One or Two Family; Commercial, ❑ New Structure ❑/Addition to an Existing Structure ; Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction (TT) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction (TC) in the following location(s); ❑ Floor Framing, including Girders & Beams (F) ❑ Roof Framing (R) ❑ Floor Framing and Roof Framing (FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Date Design Professional Date Property Owner Date Notary Public (3) 8/12/2021 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. 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. C©M STCHESTER ) as: X " ��being duly sworn, deposes and states that he/she is the applicant above named, (print individual signing as the applicant) and further states that (s)he is the.leaal a er of the property to which this application pertains, or that (s)he is the U fie,,-V1J (M 1) (��for the legal owner and is duly authorized to make and file this application. (indicate architect,contract agey,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 stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of d p - 20 t day of , 20 7A ith 01— '"6991--�M 9-Q� R i�L Sign pplicant e of Prop Print Name of Property _ W 1 j wI N t 1LJ_ Print Name of Ap - til�,� 7��w Notary Public Notary Puhlic KFLLY SANIM-ER Notary Cr.,r.e c�; New York QlmlIfif�:.i in County EUGENE M PARISI Co,nmi:.,sion Expires March 9, 20 NOTARY PUBLIC-STATE OF NEW PORK No.01PA6337741 Qualified in Nassau County My Commission Expires 03-07-2024 f-l) 8/12/2021 Building Permit Check List&Zoning Analysis Address: t 2 d . ���� �� sBL: <41 ,Z Zone `Z Use: Const.Type Other. Submittal Date: 12 Z-( Revisions Submittal Dates: Applicant: M t ►.� S 7- Nature of Work: Lt-ka-p -c s, l - S Reviews:ZBA: PB: BOT: Other. OK ( ( ) FEES:Filing. Z.S��.D BP: 7 SD ' C/O: Legalization: ( ) (J/APP: Dated: ✓ Notarized. ✓ SBL: c-Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Shore 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. (� ( 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.:_Batter):_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. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval:- notes: REQUIRED EXISTING PROPOSED NOTES APPROVED A Date- OCT 1 4 2021 Circle: -- Fron e Front Front Sides &W. Main sv Accs.Cow Ft.H Sb: Sd.H/Sb a& Tot.!my: Ft bnp Pazkm� Hcight/Stories: notes: Laura Petersen From: Laura Petersen Sent: Tuesday, October 26, 2021 10:21 AM To: firstfutureinstallers@yahoo.com Cc: jedwards@shopmixology.com Subject: Building Permit Application - 120 South Ridge Street Good morning, 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, 1/1. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 2. Building permit fee $750.00 (due once permit is issued and ready for pick-up) Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 1 IoetersenOryebrook.org 1 ..:� >:� . 44 A..��'��'tv::K'1"'',� --`''�:��-• � Sly � � NI Ll IL ryq (��>j _V � j. O � r t. Q � •r raP�sN r > ^ ' �"+s + ►`. y CD ' { aaac.No i 1. 4.0 � r II••+I I �'+� z . L W O c a(�s)►; r" ' � Q ~O Q�pkcCtiOn "M':ry r Q W '�.;, �� Q ♦ LLJ Z W ni _ U ,► a�i a(acs)►` Z J Zui LL Now Ism- k � _ ! Q J a• v `� J � f r `�! FIRSINN-01 BEGELI ,a►CORO CERTIFICATE OF LIABILITY INSURANCE FDATE(MMlDDIVYYY) 9/28/2021 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 cT Ellen Goldman(egoldman@butwin.com) Nathan Butwin Company,Inc. PNx 60 Cutter Mill Rd.Ste.414 (ucONE,No,Et):(516)466-4200 Faac,No:(516)466-4213 Great Neck,NY 11021 .info@butwin.com INSURER(S)AFFORDING COVERAGE NAIL i INSURER A:Utica First Insurance Co. 15326 INSURED INSURER B: First Innovators Corp INSURERC: 3 Elaine Terrace INSURER D: Yonkers,NY 10701 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERALLIABILITY Jim VVVD1,000,000 EACH OCCURRENCE —71 CLAIMS-MADE l X OCCUR ART501853610 8/20/2021 8/20/2022 DAMAGE TO RENTED SES Me occurrence) $ 50,000 MED EXP(Any one 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY❑jpeT LOC PRODUCTS•COMP/OP AGG 29000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Perperson) E OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident AUTOS ONLY AUTOS ONL� PReOPEanRTYt AMAGE UMBRELLA LIAB HOCCUR PEACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ 'WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N SI&T-UIE ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L EACH ACCIDENT WFICER/MEMgER EXCLUDED? N/A (Mandatory in NN) E.L.DISEASE-EA EMPLOYE If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace 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 9 y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE t0-2 &V -n ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 823930009 f FIRST INNOVATORS CORP 3 ELAINE TERRACE fC YONKERS NY 10701 , SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FIRST INNOVATORS CORP VILLAGE OF RYE BROOK 3 ELAINE TERRACE 938 KING STREET YONKERS NY 10701 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2423 994-9 973536 08/02/2021 TO 08/02/2022 11/5/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2423 994-9, 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://WWW.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 ARBEN BEQIRI FIRST INNOVATORS CORP 1 OF 1 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 STAT SU NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 54943268 U-26.3