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HomeMy WebLinkAboutBP22-044PERMIT # CL;Q'0 7 DATE: 3 3) L< EXP: 3 3 3 SECTION a�. �j� BLOjhtF, LOT TYPE OF WORK �I'% '// ►o er)OVQA D � JOB LOCATION dolt) G7/ doeQCZ& OWNER Co_ _ T0A4V0r7-Z r z CONTRACTOR ,L ap `So,�7 (2a/ r lo(,^Ja EST. COST 000 FEE — v0 OfFEE b DATE TOO # FEE DATE INSPECTION RECORD DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKL ELEC C 0 L -VOLT F1 _ ALARM m AS BUILT 0 FINAL �973)7a3-Q�3v :9�4)439-33 YJY OTHER APPROVALS ARB BOT PS ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-036 Certif irate of ®rcupaucp 'This is to certify that of, �Y'�� A rn 6 having duly filed an application on /7 20�requesting a Certificate of Occupancy for the premises known as, 315 MP ' r k �(��� , Rye Brook,NY, located in a Zoning 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 "0- , issued / 20 , 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: 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 shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has bee ained from the Buil Inspector. Acting Building Inspector,Village of Rye Brook: Date: MAR 1 3 2023 D FEB 17 2023 lit Il itlm-Df.P.ktt[Niv\ I �orrtce VILLAGE OF RYE BROOKc�—/J�-{� BUILDING DEPARTMENT `11 I `(.1 "' it'1 Krs""" 3--3J-aa N-kl t.%I Rl I-I.R\I IlRtAlk.Nit% l t,rtt.1(K't 1 t o7-/ 7-a3 NMt+.rti�irt,ukan11 .Xrrl.I( \7111\}uk C-l.k I It R-1,1 1. 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I1 hr tiaaac of.L. %-a,.nea. �... w.we- S TO ( '-P- 2 $TAW"M.FUCHS Public, State of New York 3"l FU4725322 Oualified In Nassau County Commission Expires Sept.30,20 QyE BRk O� F:iV cu '9� 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: � � "'�'- � ` � y� DATE: PERMIT# ISSUED: I JECT: �I� BLOCK: LOT:'\ LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS. . ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION �\ ^'n'� 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 N M ■ Ry M s W Q O ■ ■ � e� A o � o � '� N R. ■ V 0�0 p ti a� O ' to O Lr) ■ p h+�l \ 'o 0 y o� Q O I1 a p Cl, ■ O W © H c ° 4c 272 � ■' ■ „ v o r00 {� � a� v Z iil � � z .b �,b a �, � ■ P o V ■ � � W d � Q w u � -� � 9J :" V y o 0 M W 0 So � " Z ■ V . , ■ " x E0 I -g ca o W J-1 q � , �� - U ■ ~ �� ¢ O w WAS 0 lz FBI CA O z O E" Owp .N '� M w cn > M z W W. uaa z x19 d o ti O W W a v °' o 0 � � 5 � v BUILDING DEPARTME NT D E C E V E VIL SV OOK MAR 2 5 2022 938 KING ,NY 10573 VILLAGE OF RYE BROOK Z BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: j Approval Date: Permit#: C)k)'04 Application Fee: $ �� f Approval Signature: Permit Fees: $ too. Disapproved: Other: Application dated: 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 e�isting buiilld,,in,�g,or for a change in use,as per detailed statement described below. 1. Job Address: J"11Z9r4 k QlO a-at SBL I��1' 1) ( —t— S�_ Zone: -1-?_ `z 2. Proposed Improvement. (Describe in detail): �)p baNw At cC&(l m • M sAykAwts a arse i n +iv" ex a& swne A� . �r i i�c�9► l vd(4� it t`g o 5o W�I��QC �tOlha ILtC��_il�yl�.11 arm/` 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:� Yes: If yes, indicate: TIER 1: TIER 11: TIER III: 4. 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...) :No:�_Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application& 2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner:_ �t a�trt <f`��ZitM YlMuo^e Address: « 64 e Phone# 9 1-73 " 3© Cell# email: .c S. Applicant: Address: Phone# Cell # email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: jo r- Lev r V`to Y,Address: k� � [�� -'e Ic c( Conqcr-s��y (Oct a� Phone#q N- �f 34 - 3 3 4`i Cell# `I1 12. Estimated cost of construction $ 006) (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: h� Finish: S (l) 8/1 21202 1 BUILD� r.' f ATtTNIENT M AR 2 5 2022 - VILGIIJ O RYA OOK 938 KING )'�RET RY&BR i�~ ,NY 10573 VILLAGE OF RYE BROOK 1( c BUILDING DEPARTMENT Ilao� �, *w*:rww,r**ww,�w*w*w,vwer,�ww+�+aww***ww***wwww****:rw**w,rwwww*www*www:�wwww*w*,>•wwww*,rw*ww,r**w*,rtwwwww*wwww*****+� - _ _ 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: j6za--\7 , residing at, A w14r�< QZQQJ (Pritd ncunc) (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; 5- JAI kad�Cc�� (�� _- - , Rye Brook, NY. (7ub 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. (Sigmatire ol'llvoperly Ownct'(sI) S SC (F'rittt Name of Plopetiy C?wner(s)) Sworn to before n e this .%3-, day of 20 STANLEY M. FUCHS York ' Notary Public, State of New f No.30-01 FU4725322 Qualified in Nassau Count ,I;Nolr�,'y Public) Commission Expires Sept. 30, P0" ' -3. ®/12/202 t 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, CQUNTY OF WESTCHESTER } as: 2,,,kAL0 , being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to snake 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 perfonned,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 stonnwater 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 its 2- day of /�1 , 20 � Z- day of ��` , 20 Signature of Properly Owner Signalur of A�p+plicant Print Naine of Property Owner Print Name of Applicant Notary Public Notary Public j STANLEY M.FUCHS Notary Public, State of New York o.30-01 FU4725322 Qualified in Nassau County 7 Commission Expires Sept.30,20 (4) 8/12/2021 e i M s O a+ � x p ►r r ON V x c ' w r z LA W ^ V O z o z A ' N-14 z 8 � ;, ` O ww ON N A A L w dob ten O � W � H z x N A � 0--.4 oo cr 1� z z ►� v z N +� O-W W N F g � c x • �} Lo M q w z q oo , a+ a W p a r r r . BR BUIQRYE ENT VELOFOK i J U L 2 8 2022 93 8 K1NNY 10573VILLAGE OF RYE BROOK BUILDING DEPARTMENT _-- PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: (� I 27 PP#: D 9 9 Approval Date: J U L 2 8 2Q22 Permit Fee: S Approval Signature: AjOther: Disapproved: (fees are non-refundable) Application dated, 8'ol is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 3 S I'I�(AL�(ilwlLup�� �O SBL:�p( l ,O y — — Zone:)C7;�O 2.Proposed Work: 3.Property Owner:S'e> Address: !�� p Phone#: Cell#: I 3 '��3- o email: s C kW 1 Al (- � 4.Master Plumber: `,' tya% �.oy w ,445 P��✓p��W' ddress: j 9O �C�� "0(-0 tMU" bi r Lic.#: 9�P one#: Cell#: / f�/3G email: S+tVtA C(S' IPIvK -n s Company Name: P�Ut4�d eot Address: r0 y0 Ne(' N� W i AM V y Id 6&3 INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement n 3 1 st Floor "(,r 2nd Floor 3'Floor 0 Floor 5t6 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 STATE OF NEW Y RK,COUNTY OF WESTCHESTER ) as: 5+e v e"-J W q-(\ 0 14' lU-21 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual sigVing 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 0,0 h�'�f for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this �P��r't —�•+� day of SO L ,20 Z day of ,20 ?Z, Sign'—arm o Prope Ow r S. ature of Applicant e(/{N 441^'011A6 Prin ame of Property Owner Print Name f Applicaift /Atul N 1 Notary"tibli otaq Public,State of New York No.01MO6234649 Qualified In Westchester County o Commission Expires 1124120P-3 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. STANLEY M. FUCHS Notary Public,State of New York TVo.30-01 FU4725322 oualified in Nassau County Commission Expires Sept.30. 202-y -2- 8/12/2021 BUILD MENT �!� VIL OF RY OOK Li 938 Knvc ET RYE BR ,NY 10573 JUL Z g 20,22 , a 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 OFNEW YORK, COUNTY OF WESTCHESTER ) as: r_r CS� 6�4a_�_ , residing at, � �lS�1J (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; K —\-�4 , 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. (Signature oV roperty Owner(s)) 3 '- I-L-. (Print Name ot'Property O%vner(s)) Sworn to before me this ,4_ day of . �� , 20 22-- STANLEY M. FUCHS Notary Public,State of New York No.30-01 FU4725322 (NotarN Pn ic) Qualified in Nassau County 2 Commission Expires Sept.30.20.= -3- 8/12/2021 Building Permit Check List&Zoning Analysis Address: 3 S P�S� ri;z{-c_ —�A - SBL: S�— Zone: ::�j2 -Z c Use: 7-0 Const.Type: Other. Submittal Date: 3 Z Z Revisions Submittal Dates: Applicant: S C i-4w q CL-'r Z_ Nature of Work: N Y k o 4-- ON-.I Reviews:zBA:MA R 2 5 2022 PB: BOT: Other. i( OK ( ) FEES:Filing•. 7 BP: 4 Ao 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 tamped Sealed Copies: Electronic Other. ( ( License Workers Comp: Liability: ✓Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated N/A: (J1 ( ) 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.: 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: APPROVED REOUIRED EXISTING PROPOSED NOTM Date: MAR 2 5 209� Cir Fs� Fig Main Cov Accs.Cov Ft.H/Sb: Sd.H/Sb: SOFA: Ft.Imp Hag /Stoaes: notes: Laura Petersen From: Laura Petersen Sent: Wednesday, March 30, 2022 2:33 PM To: igorlevchuk34@gmail.com Cc: scottschwartz11 @gmail.com Subject: Building Permit Application - 35 Meadowlark Road Good afternoon, 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. Copy of general contractor's valid Westchester County Home Improvement License. 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 IgetersenCa)rvebrook.oro 1 / Qe p, Q�I �R i Er r/• ;i(��,1b� Tf O Fg^ O �,, •' vnm �S 1 �1 1 ,��!_�i Sfj11it1 S Y" � •• v.. ,�'�, k" I v r r J v I '�'�,i v 11111111111,E ,* - 1111111� - Il/liln j€���)k,' ♦♦ 'h �1�St ��♦ 3d�is.�p@ •• >I�� � ���f� 1, � •• •r _ aFc�_- r��ll(tlli ��S:,c�cs i'\IIII/1s111` "�V_.:VJfi. ll�ll{II� �� ?df1 Ijl/i/11t111 t;4 Fl�f'{�Iltltitll s ��.11111��11 f i.11111''11 Illlilt/l l �111 �1 a<`'"et�_�111,�111.��±s.y 4..9�111�111 ... . -- hlllpf ._�;..lillll���$Y-�r fir..h► 111�h,��i 's3-�::hllllll tir-. >�_11111,===`' T George Latimer ((;� �(��'�(��' James Maisano Westchester County Executive ��),I,C(N I Director,Consumer Protection Department of Consumer Protection Home Improvement License IL&SON CORP. 15 OLD LAKE ROAD CONGERS,NY-10920 This license is issued in accordance with Article XVI of the Westchester County Consumer Protection Code and is valid only upon presence of the official department seal. Proof of citizenship or immigration status is not required for issuance of this license NOT FOR FEDERAL PURPOSES `oI�,onst M. Fool License Number �F�c Ao, Date of Expiration � ro � WC-28197-H 15 d 0 11/17/2023 �sfQheSter Cove — - --- — - - ter- Tom" li'Oftgtv�aq111�1�. _ :.�1j�j11� §t./i1�111111 _:;y .IS11111t sg" q�1 11111/11 ::111 111�� s --111111h --. ^ •.1 iy!' Atf ".yy.`l'. `.�•',.F�wiQ(✓.�,. 1/��/ ''S �w44v��••1�/��!`" np°On``ele7g /"1///ri11�� &q�l, 1 111/11� g'y�-7 -d1111111h�� p 111/1 ) �{ 1IIII d:. ,yj� y uN, u •• R ��jw�d4r7('� •• ��i� !1 �1 �r� ♦1• .� 0 ;._;. '^rgyr I�"^I 11SI{�fy',�y ���� I a. y 1 A t W f/+�IPIi�w" v1`.! `v` rl�5�t y 'v #? •a:i; �A ;V t000 LITHO IN U S A l DATE(MM/DDNYYY) ACORO� CERTIFICATE OF LIABILITY INSURANCE F3/23/2022 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). CONTACI PRODUCER NAME, CHRIS JANUSKI Wasiczko Agency Inc AI°,No,Ext: (914)968-1344 (vC,No): 9 LOCKWOOD AVE ADDRESS: chris@wasiczkoagcncy.com INSURER(S)AFFORDING COVERAGE NAIC# YONKERS NY 10701 INSURER A: UTICA FIRST INS CO INSURED INSURER B IL&SON CORP INSURER C 15 OLD LAKE RD INSURER D INSURER E CONGERS NY 10920 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. AUULLTR TYPE OF INSURANCE INSD WVD TNSR POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 ART513691000 11/20/2021 11/20/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ 2.000,000 JECT $ OTHER: COMBINED SINULE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ILH DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N I A Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE 938 KING ST Ja-u,Sk i RYE BROOK NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) 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 (RENEWED) ^^A A^^ 464258816 WASICZKO AGENCY INC 9 LOCKWOOD AVENUE [ id:lic YONKERS NY 10701 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER IL&SON CORP. VILLAGE OF RYE BROOK C/O IGOR LEVCHUK BUILDING DEPARTMENT 15 OLD LAKE RD 938 KING ST CONGERS NY 109202425 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2369141-3 148927 04/10/2021 TO 04/10/2022 3/23/2%2 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2369141-3, 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:/IWWW.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 IGOR LEVCHUK VICE PRESIDENT SERHIY LEVCHUK 2 OF 2 IL&SON CORP. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S7NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 578073952 NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 0 �AAAAA 464258816 WASICZKO AGENCY INC 9 LOCKWOOD AVENUE Qi taii YONKERS NY 10701 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER IL&SON CORP. VILLAGE OF RYE BROOK C/O IGOR LEVCHUK BUILDING DEPARTMENT 15 OLD LAKE RD 938 KING ST CONGERS NY 109202425 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2369141-3 697369 04/10/2022 TO 04/10/2023 3/23/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2369141-3, 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 IGOR LEVCHUK VICE PRESIDENT SERHIY LEVCHUK 2 OF 2 IL&SON CORP. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATESUR NCE FUND �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 415348791 <�zSo N > po '� —IN )qv Sayw� � � Sa�pw► �� i.�6ryy S �vol Y2�l