Loading...
HomeMy WebLinkAboutDP21-006imERMIT # _J/ SECTION TYPE OF WORK JOB LOCATION COST _ DATEo? y a ©cP: r 35 BLOCK_ LOT OTHER APPROVALS ?27L ARB 17 N �� C rz 63 7- tDc PBT Ger'le�n� �C�� a�n �' r / iO�rruJ oC9�y��O1i� ZBA C oo FEE —' / OTHER FEE++4`ZOJO A6 DATE 15 DJal TCO # FEE DATE INSPECTION RECORp DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CJ RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT ALARM AS QUILT FINAL INSP f.�tta VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE Susan R. Epstein INSPECTOR Stephanie J.Fischer Michael J.Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE December 15,2021 215-217 South Ridge Street LLC 215-217 South Ridge Street Rye Brook,New York 10573 Re: 217 South Ridge Street, Rye Brook, New York 10573 Parcel ID#: 141.35-2-40 Demolition Permit#21-006 issued on 9/24/2021 to Demolish Tenant Space This certifies that the tenant space, demolished under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building& Fire Inspector /tg EB D E C E N BUILDIN TMENT For office use only: PERMIffiji DEC _ 7 2021 VILLAGE OF RYE BROOK ISSUE93 KING STREET,RYE BRooK,NEw YoRK 10573 DATE: U ( VILLAGE OF RYE BROOK (914)939-066H FEE: PADA BUILDING DEPARTMENT n2M.ar&regk.org 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 Address: Lyz /Y �f�� fT�l '✓✓�� Occupancy/Use:&I YI Parcel ID#: ) — Zone: Owner: Address: P.E./R.A.or Contractor: Address: , Person in responsible charge' �' �'��` .�✓v �ddress: ") Application is hereby made and submitted to the Building �ispector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: ,J 71'a &r e/Xe ( tbeing duly swum,deposes and says that he/she resides at (frintNLic o Applicant) (No.and Street) in "e- ,in the County of in the State of X1 y ,that (City/Town/Village) I 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 equip t, r!fessional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ � ✓ */ for the construction or alteration of: 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-I0.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to/nbeff-ore me this 71* fday of�•ej& u , 20�L day of 40 t �20 Signature of Property Owner Signature f Applicant ,✓ I�j Print Nam f P rly Cr Print Name of Applic No Public 11 Notary Pub RICHARD BOLOGNA NOTARY PUBLIC RICHARD BOLM (RAIL MY COMMISSION EXPIRES DEC.31,2024 NOTARY PUBLIC MY COMMISSION EXPIRES DEC.31,2024 QyE BRcb,,- C� 2� w � .Fo 1987 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.or - - - - - - - - - - - - - -- - -- - - INSPECTION REPORT - - - - - - - - - - - - - - -- - - - - ADDRESS: V 1 J \ lG ` DATE: PERMIT# \ / ISSUED: +SECT: ' BLOCK: �- LOT: LOCATION: � `" tv ' ��T y1 CCUPANCY: ❑ VIOLATION NOTED THE WORK IS... - ' ACCEPTED ❑ REJECTED/REINSPECTION © SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: p ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CRASS CONNECTION 'VINAL �] OTHER �E BRC�� 04 '2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK �J CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 1 �t v ` 1 �. DATE: t1 IZ ' J� ��o PERMIT# � 2 C.)--�3 ISSUED: SEE C : BLOCK: LOT: LOCATION: Vw tiu( L1. OCCUPANCY: ` v ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSFECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING Cl ROUGH FRAMING ❑ANSULATION ❑ NATURAL GAS M IJS I,\� �C► ( i -Q�. �` - =-Qr-��`� Cl L.P. GAS FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ = O O (U o x W ;: o r u O e ai 6, r.i 00 �Tiy a � o 'T� 'o Q W � ►�+ ° j2 M M 9 O rig w 9 , en PLO gz 00 C1 .a o "ot W =' Ir OO w �I w p W r a c - PLO 96 � .. a, .. c c -C aoi r�r 0 d U 0 : x C� 4. wl > BUILDING DEPARTMENT Q v>I LAGE OF RYE BROOK SEP212 21 938 KING STUET RYE BRoox,NY 10573 ` 14)939-0668 VILLAGE BROOK BUILDING TMENT DEMOLITION PERMIT APPLICATION FOR OFFICE USE ONLY: �/� Approval Date: SEP 2 2021 Petit a �� d Application Fee: �$ Q15-0`16 Approval Signature: �. Permit Fees: $ 9 6 —�)u e- Disapproved: Other: Application dated: i� �a 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 building,or for a change in use,as per de led statement described below. I. Job Address: V ,+` I SBL: ` Yf ne: 2. Proposed Demolition.(DescribeZdetail): D /0 t" /V 3. Property Owner: Address: �1 / 2 f Phone# Cell# email: 09 Applicant: l/ / 1)� ( /"' Address: q d Phone# J ell'# q1 email: Architect/Engineer: Address: r Phone# Cell entail: ?$3' General CQntmcWr. C/elIX G�p /' Address: i Ad0 /X J,) AA Phone# i) Cell# u L) email / 4. Estimated cost of construction $ (NOTE:The estimated cost shall include all laboVmnieriaL scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis) 5. Type of construction: wood frame,masonry, t _ YP ( nry,steel,etc...) 6. Method(s)of Demolition: 7. Number&Location of Fuel ail Tanks to be Removed: S. Number of Stories: Height to Highest Ridge: To Highest Chimney: 9. Estimated date of completion: _ 1 812/2021 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 YORK,COUNTY OF WESTCHESTER ) as: �12 ,being duly sworn,deposes and states that he/she is the applicant above named, f individual s as the applicant and further state that )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&BuiIding Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Z 91-d ,_ Sworn to before me this a 3 day of 4701e444ee 20:,� _ day of �F r , 20 21 Signature of Property Owner Signature ofAppiicso 1 4-r e t 1-1c `�o o ,ir w tv /`yl, �1.1zo Print N �rtntame of Applicant Notaie Public Notary Public RICHARD BOLOGNA ANA M SALAZAR NOTARY PUBLIC NOTARY PUBLIC-STATE OF NEW YORK My COMMJSSICN EXPIRES DEC.31,2024 No.i71 SA6365 t 73 avalified in Westchester County My Commission Expires 1 b•42.2021 2 811 212 0 2 1 CCCCCiCCCCCi`rCCCCC+�CCCCCCCCCCCCCCCCCCCCCi'iCGCCC a cl O cn tn a H M W � o jof F- w [� if,fool low v; s M l� © r4 W O 4 N M M u Z < R or .. ,e„ CO) ' aw V` o z A te al ICI Z A Y 00 MCI F� c7N �-• E- Q F. O Lt w — U U p i 0 woo z v01 c a Q U w z CZ a � 4 r � i i t to 4CCCCC 44 oto464i`i4444C4641941CCCCC414144444444444 i BUILDING DEPARTMENT R D L w[ VILLAGE OF RYE BROOK SEP 2 8 2021 938 KING STREET RYE BROOK,NY 10573 1 D (914)939-0668 VILLAGE OF RYE BROOK wrvw.tyebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 0 0�0 Approval Date: SEP 3 p 1 1 Permit Fee: $ 3 S Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, -a-LI 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 and Local Codes. 1.Address: kJ -a1'7 SBL: 1 22 � ` 2L D Zone: 2.Property Owner: �Z(S'-).l"1 So44 I`Lt ���� 4 r LCC Address: Phone#: 2A 3-6 3?—,Z2a,7 Cell#: email: 3.Master Electrician. ?tPnO Sr-Two _ Address: a4 S WeA-0 M ST 64 CT JGY3J Lic.#-. 7 q( Phone#: Cell#: email:S4S7142JAbf-A) ko y-C-0719 Company Name: _S L >°0�C e-1 (° _Address: ofPa2 ST ar a wt f 1 C-T/'6 3I 4.Proposed Electrical Work/Fixture Count: :::�_/V 5 T4-(,1 may[�iel 5�� N g� / UtA,e I y LT/ St.'ra a,tI__� L 5TX9 F 2- x y LC A �� 5 L 7's 04yy D l.tllr e S /� STATE OF NEW YORK,COUNTY OF WESTCBESTER ) as: f !(f r O :5 4-T No ,being duly swom,deposes and states that he/she is the applicant above named,and does fir tber (print name or individual 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 Ccmj-r124�a 702. 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 wiU 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 8 Building Code,the Code of the Village of Rye Brook and all other applicable lases,ordinanccs and regulations. Sworn to before me this Sworn to befor me this day of 20 day of ,20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print N of Applicant Notary Public Notary Pu is THONY M. VOVENZANO Notary Public,State of New York #4869239 Qualified in Westchester Coun&v,— Commission Expires September 8,—W 2n021 Westchester Rockland Electrical Inspection Services, Inc. Phane: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue �.� Fax: 914-347-3596 Elmsford, NY 10523 $UILDING PERMIT NO. TEMP# 1VCQ CITY OR VILLAGE ZIP CODE__ TOWNSHIP COUNTY -11t �s:l C�v� 5 f 5 ST'REET rAND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OGCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS r, HOME TELEPHONE NUMBER CURRENT SUPPLIED BY AROM 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 lNCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE - -- .. BASEMENT II FL. 21 FL. 3'FL VOLAGEPFRYE RQQ— qyILDINq DEFA MENT I REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ASOVIS: err 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�1 ADDITIONAL R EXPOSED❑ CONCEALED d MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD UNDERGROUND 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 SIQNATURE Of APPLICANT STREET ADDREW TELEPHONE NO. CITY OR POST OFFICE _ ZIP CODE LICENSE NO.WHEN APPLICABLE I.A WESTCHESTER IOCKLINO ELECTIICIL INSPECTION WREISSFIVICES'1111C. 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: PS Electric Inc. 215-217 South Ridge Street LLC 245 Weaver Street Apt 5G CT,Greenwich 06831 Located at:215-217 S Ridge St Rye Brook,NY 10573 Certificate Number: 1032150 Section:141.35 Block:2 Lot:40 BDC: Permit Number:EP:21-243-BP:DP 21- 006 A visual inspection of the electrical system at this premise described as a Commercial occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located inlon the premises at: 215.217 S Ridge St Rye Brook,NY 10573 Basement 22 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 12110121 Name Type quantity Exit!Emergency Light ---- 3 Fixture-Luminaire Recessed --- 8 Fixture-Luminaire Closet - 4 Fixture-Luminaire vanity Light ------ 1 Receptacle GFCI ------ 2 Receptacle Convenience — 8 Switch Single Pole -- 8 Smoke Detector I Co2 Combo — 1 Smoke Detector ---- 2 Fixture:Outdoor ....... 2 Exhaust Fan ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in anyway. Y`­7 � This certificate is valid for work performed before date of inspection only. p C 'M� Vr E SEP 2 4 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT PrOpOSdI Sergio General Contracting PROPOSAL#81621 "No job is too smatl or too big" DATE:SEPTEMBER 16,2021 22 Norias Rd, Greenwich, CT 06830 Phone 203.532.5264 Cell 914.804.2022 Sergiocontracting@hotmail.com Licensed in NY& CT To: William Mancuso JOB LOCATION: JOB TYPE South Ridge St, Rye Brook NY JOB DESCRIPTION • Demolition of the entire place including the floors, ceiling, and walls • Remove the closet close to the front door • New electrical work according to code • Install new insulation in the exterior walls by code • Install 5/8 fireproof sheet rock in the walls • Install new vinyl floor, waterproof + Install new shingles to match the existing • Paint the entire room • Install new metal double door in the back of the building • Remove the shed behind the building TOTAL $28,000. 00 Signature:X Signature:X Thank you for your business! 1 Building Permit Check List&Zoning Analysis r L� Address SCXIA\n (__Yt 64CQ - SBL: _ — x- 1 d Zone:_ L 1. Use: Const.Type: 04a Other. Submittal Date: Z- 'ZD?-�Revisions Submittal Dates: Applicant `j2 c �-%CZ a� op G- Nature of Work O -on AC-� Reviews:ZBA:�C g D422 PB: BOT: Other. NEED OK :�> n ( ) ( FEES:Filing. P: 4 C/O; Legalization: ( ) ( ) APP: Dated: i/ Notarized: 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. ( ) ( ) License: Workers Comp: Liability. Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated: N/A: ( ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ] ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other: (a ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.LC.:_Battery._Other. ( ) ( ) PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other: ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other.- FUEL TANK:Plans: Permic 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 xntg. date: approvaL notes: ( )ZBA mtg.date: approvaL notes: ( )PB mtg.date: approvaL notes: /� REQUIRED >XIMNG PRQPQSED NOTESAF' RCNE921 Circle: F P= Front: Ste: Accs.C F ov Sd.H Sb: Sf: Tom Et.Imp Parking: /Stories: notes: 1 Vito- -:i:� r. y,,� .►I:tu t , �t 'ufkt, y d r_w_ �; ", '] 1 If 4'� C �� � • - �I Or. � 5• s � t: . O b .. O M �\.� s. \1 fis�� � L 0 .O II ti ♦.' N aI 1� Uiw t ss)s a 1 �W w a ° ° affect tan � 'W Of <(tf)1 W s�. p ` 44) v Q Q w S w J r o.OF I— a ' ' � ►-�` C � w � p ° � H wire a �''� ,< �[b)?• t A' :y� �/ O � 1,; `dye••Ye iF LLJ cis» yu' p 71 i 1 9 U OI y 1 r� � 4A( o y 2 3 JJ aml� r rrFy,,114f1, s§ cris•,! �111a.Fa/,Il�lll 1{y}11�';i4�,.tas 4 a,p�g� 1,4/{,{(`II •$ .. 111 8 ' I� /'1 �Ag/ 1�)�{�j11 i1 L 1,1,{(44I J�(I3 A Y's,1' h e 1 �.s•. 9�0� �• '��� 'Pr e�A�'+/}' ♦♦ ,�; � ^Y � r. \• ?�.t-.A 6:. '^ �:.Rprlyt"Y ��'� AA �if�A'��/IY��4�.,�. M 1,:��i'1y1�1j����N�� A �.k.��y1j, �il Q VI '� ra �. '�l_! :"� .,' � � 11ti r�\ V,,Y�}k,�\',."4', O� 7Y � !'Site' � � \ a •� � •N V }Y�- vS��:.,`-. '£1E� 11►�t1 i?'rityl ' `� ' >.cv�p..' - \�rr .4sr,: r�EirS --.,� t$�r�lL�s //1 - j/�` Y ./'/�'y-y�\•;a Y'• :+may. v.`•"� ."a'���( f�`�c•'�ys -'u�:.1 \L'�w"7L• 1,.s.�,. t� v J/ ACC)R"® DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 324/2021 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: Ken Libuit Joyce Insurance No Ext: 8459427200 (A/e,No). 2 Joyce Plaza ADDRESS: service@joyceins.com INSURER(S)AFFORDING COVERAGE NAIC a Stony Point NY 10980 INSURER A: EVANSTON INS CO 35 178 INSURED INSURER B SERGIO GENERAL CONTRACTING CORP INSURER C 22 NORIAS RD INSURER D: INSURER E: GREENWiCH CT 06830-6916 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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, LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDNYYY) (ILiu EXP IDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE 4)(1 OCCUR PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) $ 5,000 A Y 3AA459355 03/22/2021 03/22/2022 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S 4,000,000 X POLICY PECT l]LOC PRODUCTS-COMPIOP AGG $ 4,000,000 OTHER: $ 5INULh LIMIT AUTOMOBILE LIABILITY Ea accident) $ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED TMOPER77TIAMUE $ AUTOS ONLY AUTOS ONLY Per accident) $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION ND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTNE❑ E.L.EACH ACCIDENT S OF EXCLUDED? N!A Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace is required) Certificate holder named as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St AUTHORIZED REPRESENTATIVE r3ai r 4q lyri Jo1arp. Ryc Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS,NY 1 0601-441 1 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) NJ 0 a A A A A A A 522454246 JOYCEINSURANCE 2 JOYCE PLAZA E STONY POINT NY 10980 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SERGIO GENERAL CONTRACTING CORP. VILLAGE OF RYE BROOK 22 NORIAS ROAD 938 KING STREET GREENWICH CT 06830 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2275 662-1 732145 04/20/2021 TO 04/20/2022 7127/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2275 662-1, 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://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 SERGIO ARAUJO SERGIO GENERAL CONTRACTING 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 5 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1059180272 U-26.3