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HomeMy WebLinkAboutBP21-330PERMIT #� (SECTION Z TYPE OF WORK JOB LOCATION OWNER CONTRACTOR EST, C%ja I W$t/CO # Trod # �! 30 DATE: a/ EXP:/ BLOCK LOT _ r)ri Ve&)Q 4 e17ch FEE FEE�lI I� DA FEE DATE INS TCE IP ON RECORD DATE F00T4NG FOUNDATION FRAMING RGH FRAMING INSULATION ED PLUMBING RGH PLUM13INNGG GAS SPRINKLER 0 ELECTRIC 0 LOW -VOLT 0 ALARM AS BUILT FINAL INSP �a%/7 aJ�66oreage a] J pb 24Qe 06ce� OTHER APPROVALS ARB BOT PB ZBA OTHER 0 fi ttv�uJa� . '9 40A amtlLwwaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING&FIRE INSPECTOR. Susan R. Epstein 11icbael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 28,2022 Harriet Klein 4 Pine Ridge Road Rye Brook,New York 10573 Re: 4 Pine Ridge Road, Rye Brook,New York 10573 Parcel ID#: 135.41-1-18 Building Permit#21-330 issued on 12/22/2021 to Install Driveway Trench Drain This certifies that the driveway trench drain at the garage,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to (r-; � ---;: R For office use onh: f ' BUILD ENT PERMIT# V-3.30 VIL OF RYE OK ISSUED:/off—olol—Q1 L�; 438 KING STRE VE BROOK, ' YORK 10573 DATE:/-/Q-a a JAN 19 2022 > 9 -06 U/' FEE:t& //o.- PAIDjk VILLAGE OF RYE BROOK r BUILD_IN,— -r 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 #t}44ff4f4t##f####4#f4444##f4#i##i###rt#44f44}f4#4f#f######4ff#4f i4##4tf##############4}#f#4f4ff44##ff#i#####f4f4t##fff 444f444 Address: N` loi Occupancy/Use: /�F/4!'y Parcel ID#: _ — Zone: — 12 Owner: �yti( Le,�- oc_t�n Address: IY. P.E./R.A. or Contractor: AiA(M% i (,-I177f, Address: Person in responsible charge: IN �h A� 2Zt Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: --11 L&M Ain V1 being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (Naand reel) in V�J I Ej(p K in the County ofWtLkNp&+c� in the State of 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:$ �L ?j.00) _ 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§250-10.A. of the Code of the Village of Rye Brook. —7 Sworn to before me this —14-V% Sworn to before me this 1 day of Y\Uo , 20 22 day of JCftAAAA 20272 Signature of Property Owner S azure o Applicant Notary Public of f NewYork Print Name of Property Owner _Rog.No.p1KL7295502 Print Name of Applicant CoTtrissionExpres 0&3 IP022 Notary Public N trlfl Notary Public,State of New No.01 BR61 59985 Qualified in Westchester County s,12 2021 Cnm nission Expires January 29,20_ QyE BRajk. O� Zm 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR XSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : (J2-1 1 "� ` DATE: hL— PERMIT# ISSUED: `2 SECT: B OCK: LOT: LOCATION: ��� OCCUPANCY: 21 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION `U -1 - \ 1,,•-•. REQUIRED ❑ FOOTING \ (JV ❑ 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 O c+� • � � o w „ � o N s n1 N N � � •� � � a1 >WIX � �, A a 0 ° 6 '~ F yr 3 -d h �. > � = c a96 V b m � M � M ❑ oar. " � o C Q a m IFS--�1 O > a � � � ■ qQQ � w' a v0 y3 5. u 5•Q J i t � ■ � ^ W 3 � � �! "'7 � r, cam. •C � W � O �'' � � � Q ap r_ 0 'x t a� O. ' � ■. 00 c w kn o w a r � ICI _ ` 00 M W nV v o = o O ■ ( C� Q W Q Z m G7r A z -5 c .� v o044% O 0.0 O o > Z ■ 00 0-4 C E� m � a ►�-� O a, � NNN � r;, o � � � � � � In pz A rs W Z r3 Q ftf ca st C V w Q 3 Z V G6� ICI s W 7 PC •• dA W '� o � b > v m � MMR L� V `� d � F" L� � cs• a, I F•�I � � W � x � E-' � � A m a C� ra'C� BUILD TMENT DEC, 15 2021 DD VIL C? +' OOK 938 KING ,N GEY 10573 VILLA OF h(Yc BROOK + 6 BUILDING DEPARTMENT • �7V F . ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK W1110E1 DOES No-r REQUIRL VILLAGE ARCIl1]ECTURAl,REVIEW B0ARD Ai,PR0N'AL FOR OFFICE USE ONLY: APPROVAL DATE: RMIT#: APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: D 0 • h H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated:I'- ';�`��—� ' 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,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: �QA00 l01:�7 3 2. Parcel lD#: 3�j . �} — VA Q Zone:___R-_I Z 3. Proposed Improvement(Describe in detail): QarQA_C�r_rue I1 Llvt] 'an a- a r U w4, t 4. Property Owner: Address: 23Ramapp 1V 1 NUJ jQq Phone# gIG-�3�'-tip 3Z Cell# QILi_37Z^ TsK'5zt e-mail M146in tb, M 16VI. ems List All Other Properties Owned in Rye Brook: no-AL Applicant: G T 6" Address: I \ Phone# "i14-t3<_ �•jZ{37 Cell# 4114 - 7"7-- k 6S y e-mail ri1�CiV►CJ,VY11 IC1G„.CmN^ Architect: Address: Phone# Cell# e-mail Engineer: _ Address: Phone# Cell# e-mail General Contractor: I I UG Z Address: _6V "Piot N� Phone# Cell# � �- 293-43Q� e-mail ()A QI 2 I (-hV C.I(. (QI?A (I) an 2t2021 5. Occupancy;(I-Faro.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: l 6. Area of lot: Square feet: 2_ 3'CA Acres: 0• W 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: f Q, 9. Area of proposed building in square feet: Basement: Y1� I"fl: 2"d fl: 31d fl: 10. Total Square Footage of the proposed new construction: () __ 1 I. For additions,total square footage added: Basement: A hN I-fl: 2"d fl: 31d fl: 12. Total Square Footage of the proposed renovation to the existing structure: SQ SQ,.�.{ 13. N.Y.State Construction Classification: \j N.Y.State Use Classification: 14, Construction Type&Location:()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; O Pre-engineered wood[PW];Located;{)Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: n)q- Overall Height: Median Height: 16. Basement to be full,or partial: YL/A 1 finished or unfinished: 17. What material is the exterior finish: 'rA 1 Q --T 18. Roof style;peaked,hip,mansard,shed,etc: 1A,Q Roofing material: 19. What system of heating: ~U-� 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 autom tic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No: (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 Stortnwater Management Control Permit as per§217 of Village Code? Yes:_No: V Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: ✓� (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 Welland bit r zone must be properly depicted on the survey&site plan) 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►he flood 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: ✓ (ifyes, 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 I: TIER It: TIER Ill: (ifyes,a Home Y5 Occupation Permit Application is required) 29. What is the total estimated cost of construction: S J f i I g.cc Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equtpme p,professional fees, including any material and labor which miry be donated gratis. Ifthe final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: U y Q e+ (2) 811212021 BUILD MENT VIL OOK DEC 15 2a21 938 KING ,NY 10573 VILLAGE OF RYE BROOK 4 BUILDING, DEPARTMENT w - -_ -- ---- . - xxxwwwxwxxwwxwwwxxxxxxwx,txxxxxwwwxwwxxxxwxw,�+**,c*w+.*xx*xxxxw*+*�wxxxxxwwxwxxxx,�rww*ww,rwwwwwxxxwxxxxx+x* 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: 31, 1 ld� Vjd" ,residing at, . 2 N� (Print name) (Add ess"here you like) 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; ?I V1 dd0 t� �I! -EV10k, �)�1 10513 , Rye Brook,NY. (Job ddress) 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. (Signature of Property Owner(s)I y) (Print Numc of t'roperty fhrner(s)) Sworn to before me this l day of Daeynbc✓ , 202( T� (Notary Public) MILTON KLEIN Notary Public,state of Newyork Reg.No.02KL7295502 Qualified in westct�w County Cvr nis m Exp rw om i r= (3) 9/t 212021 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. S TE OF NE ORK,COUNTY OF WESTCHESTER ) as: Vj( U y\ _ _ , being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) a d further states that (s he is the le al 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 applicatio . (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 Cade,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. Swam to before me this 11" Sworn to before me this IMS-14,1 day of Dccem ?t✓ ,20 Zl day of (J(sCmbf✓ , 20 Zl JP_Q�— dj-C_ - ' Signature of Property Owner Signature of Applicant ,Lvne�- Oiciv\ kvnu� k6cin Print Name of Property Owner Nnt Name of Applicant 'k ✓ v � `- "' Notary Public MILTON KLEIN Notary Public MILTON 44E1?3 Notary Public,State of NewYodt Notary PuNic,State of NewYo* Reg.No,02KL7295502 Reg,No.02KL7295a02 Qualified in Westct)estei County Qualified in Westdtester Canty Corntnls.i Expires t38131r2t322 Commission E*ces G&3112= (4) 8l12r2021 Building Permit Check List&Zoning Analysis Address: (/"Pz �S�L— lZD SBL: 3 •Lt — l — (, Zone:2^t Z Use: 1113 Const.Type: Other: Submittal Date: l 2 S� 9-1 Revisions Submittal Dates: Applicant: �t cs-\ Nature of Work: 1 14,'�TA LL- A-T �- II,- Reviews:ZBA: o E c 2 3 2021 PB: BOT• Other. QK ( ( ) FEES:Filing. BP: too. — C/o, Legalization: ( ) (-�"APP: Dated: ­' 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: c/Sealed: Copies: Z Electronic: Other. License: ✓ Workers Comp: Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Perris 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: Perris 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: REQUIRED EXLSTING PROPOSED NOTES APPROVED A Cir FFrronQg� Frona Front Si : fir. Main Cov Accs,Cov Ft.HS : S .HS • Tot.Img: F I p: Park�ne Height/Stories: notes: [/I 0.0=Plueda8essawV I=.iolaafadLMbWzxN WNfjtbXUJXAw jm_4gfdaddNMQNi3/Xo9ui#/I/n/I!ew/woa•alSooB•1!ew//:sd114 • ti ,��b 1 � y ♦'1 � 3� � k aA�" SSS. I ,. �:. L i•, 'G.. CV b.., 4 7 j r.a L' 0 rLo Qsotectlon U 0 Z f �" CJ :D v `�- oo u77 L3 �tsr O Kt j Y iLr Z LLl 4 ' + �.• ry� r co C4a Va Ir 8` c; TT "fit �1��+' e°wi'•���i�i����ai `�4pyy{; t 5•,Fr",' 'x����u. -" !,5� �. us yr+ra I a4Jil i��a� 3 .ar�s$:�4�11f 1 `a:,.:41�i♦;—•a <( �` -. Q) o c L ttt f E � � � m o ° aa) �adf 0aJmu i WV Z17:6'1 Z/S I/Z I AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MMI)D/YYYY) �4-� r 12/15/2021 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(lee)must have ADDITIONAL INSURED provisions or be endorsed. H 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 endomement(s). PRODUCER NCONTACT AME: House - George Thompson Agency PHONE (845)744-3074 — � No IAhC_Noi: (845)744 6054 2708 State Route 52 alicia(Qgtahvoom P.O.Box 667 -- - INB I AFFORDING COVERAGE N= Pine Bush NY 12566 IIIstIRERA: Allegany Co-Op Insurance Company INSURED - INSURER a: Giui Construction Inc INSURERC: 8 Stony Brook Road INSURERD. INSURER Pine Bush NY 12588 INSURER F COVERAGES CERTIFICATE NUMBER: CL21121513594 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. LTR TYPEOFINSURANCE NS Iwyp --- POLICY NUMBER L4 MMJDD'rrrYI 1MMID00 LNIM x COMMgtCY1L GENERAL LIABILITY l�J .. -. FaCHOCCURRENCE i 1,000,000 CLAIMS-MADE ©OCCUR ES.0 = 500,000 MED EXP one $ 10,000 A ACEIID0002324 03/09/2021 03109/2 222 PERSONAL6ADVIW,RIRY f 1,000,000 GENLAGGREGATE LIMITAPPLIES PER: OE NERALAOGREOATE : 2 000,000 POLICY EEC ❑LOC 2,000,000 PROtx1CTS-COMPpPAGG >; OTHER: S AUTOMOME LIABUTY C�OMBI ED LIM s ANY AUTO M INn OAMED SCHEDULED BODILY INJURY(Per Peron) f AUTOS ONLY AUTOS BODILYIWURY(PerexJ ' HIRED PROPERTY DAMAGE AUTOS ONLY A y PeracrJden:- $ UMBRELLAluB OCCUR s EACH OCCURRENCE _ EXCESS LMB CLAIMS-MADE AGGREGATE _ DED RETENTION i WORKERS COMPENSATION : AND EMPLOYERS'LIABILITY YIN STATUT TH- ANY PROPRIETORIPARTNER/EXECUTIVE NIA E.L.EACH _ OFFICER/MEMBEREXCLUDED4 ❑ (Mandatory In NH) If yes,despWe under E.L.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS i VEHICLES(ACORD 101,Additional Remerlcs Schedule,may be mdachad if more space to requIred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN V11age of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 Kings Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 9)1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD t NYSIF Now York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS'COMPENSATION INSURANCE O � AAAAAA 141768054 GEORGE THOMPSON AGENCY 2708 STATE ROUTE 52 PO BOX 667 PINE BUSH NY 12566 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GIZZI CONSTRUCTION INC. VILLAGE OF RYE BROOK 6 STONY BROOK ROAD 938 KINGS STREET PINE BUSH NY 12566 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2, 249080 01/04/2021 TO 01/04/2022 12/15/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2406 708-4, 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:If WW.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 ANTHONY GIZZA V.PRESIDENT MARIANNE GIZZA SEC 2-0E-2-GIZZI CONDTRUCTION INC. 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 ST71he SU NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:736042632 U-26.3 p C C IE M E DEC 15 2021 ! VI L AGE OF RYE BROOK e' DING DEPARTMENT PERMIT#� /"- 3 3� SBL# 'q- - t - � -:,D DATE APPROV D 40EC 2021 OA — 2- ,Vi BUILDING INSPECT R age of Rye Brook,NY EXISTING PATIO 15'EXISTING EWER DRAIN RIGHT OF WA EXISTING HOUSE INSTALL DRAIN 8' ROM GARAGE DOOR ND ACROSS ENTIRE IDTH OF AND FLUSH WITH THE TOP OF RIVEWAY Fl E COPY TUNNEL UNDER WAL WAY 2S PROPERTY LINE INSTALL 3"DRAIN UNE T END EFO R ADWAY CAP THE N F PIPE WITH PE T CONTROL GRATE EXISTING DRIVEWAY 4 PINE RIDGE ROAD, RYE BROOK, NY