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HomeMy WebLinkAboutBP22-077- - a • +. PERMIT Z.DATE: BLOC SEc-nON LOT TYPE OF F • _ L JOB LO ION. • : 0�/1 noeebh ///�•&os ♦. INSPECTION RECORD DATE INSF FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLER ELECTRIC f LOW -VOLT fi] ALARM 2 AS BUILT FINAL (ems 02 OTHER APp OVALS BOT PB ZBA OTHER REQUIRED PRIOR 7( FINAL INSPECTION C BRnv�A O y4,a la i'� Y t yli(i aJJ V r�C[CJ J y V�J Q V aLC`V JVJ VyW V 990 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.cycbrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 11,2024 Matthew Koslow&Allison Koslow 108 Old Orchard Road Rye Brook, New York 10573 Re: 108 Old Orchard Road, Rye Brook,New York 10573 Parcel ID#: 135.43-1-18 Building Permit#22-077 issued on 5/25/2022 for a New Fence This certifies that the new fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to i i For office use onl BUILDING DEPARTMENT PERMIT# "77 JD v Ut MAY 1 6 2024 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: '/ --Il VILLAGE OF RYE BROOK (914)939-0668 FEE: () PAID001, BUILDING DEPARTMENT www•ryebrook.orl! 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 rsrrrrr+ssrrsr+srr+♦+srrrsrrsss+rr++*trr+stt**t+*t*ttt*www*swtwwrrwwswwtrwsstww**srtwrwtwrrtwtrrrrsrstsrss*ssrrsss*ss*tr***tt Address: ' Q O (d O r Gk a r (,o Occupancy/Use: Parcel ID#: Zone: Owner: o I S6 in Ko S I O w Address: P.E./R.A. or Contractor: & Ve Fie C.P Address: Person in responsible charge: Nkrq 0 G I Address: Application is hereby made and sub fitted 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: rtrt I A l I f S V h K[)• I Q(/� being duly swom,deposes and says that he/she resides at V Q (d Ir c4a'r1 koad ( not Name Applicant) ! L (No.and Street) in ��/e roo ,in the County of UV�iS T(�" 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:$i (a1166 • 0 V for the construction or alteration of p t tn.) R C.e Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of Inrod day of , 20 akoL�tjvj Signature of Property bwner Signature of Applicant AlJ� Soyi KaS1o� Prif pame of Property Owne Print Name of Applicant blyoqwNotary b is Notary Public GREGORY K RNERA Notary Public,State of New York 1'- 021 No.01RI6"i398 Qualified In Westchester County Commission Expires September 26, �E BRC�uk 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 : I l J V 0 1 `r d DP r4,c"r,i.`: DATE: 4 - 7 " 2 0l f 'gyp --�— PERMIT# j 12. — p 77 ISSUED: �- 1-5--2 SECT: / ✓' BLOCK: LOT:�� LOCATION: P 9 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 9-'ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION B 'FINAL 0- OTHER �yE BRCv� 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR [:J'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: �D O O c/ D)e G�fit. c/ DATE: 2 7 - 7O2lp-l' PERMIT# O 7 �7 ISSUED:, 2J--ZZ-SECT: q-5 BLOCK: LOT: LOCATION: n 0 OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED / REINSPECTION SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 5 fC /n�5/PF C 7/�' 'J k 'J /A1 O'JC ^, cl No �� C P c� ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER � u Y N � Ln • day *k vi 1�' 1• a 4.4 � a u z � y �y o ch 14 O a 00 D4 cn p. uu w N �.J cz bp OI W Cn 00 C F © '0 Q M of Oy a ^O d o 'C 0 O �j G16. F�"S W ~ ��.� v U O w © ai o § g ��yy Cn 3 z c E " � � � O n cj �oo o _ � O ✓ � (� z p�. � o � x W j..{ 00 w d w o • Q � N O 00 oa O a w � � � � b M..� w o w �, a � vv � oc C H � v � w v a� a •� � a. �° � al V V z o w N vO� 4C0 H 7 ° r�r V O id i FBI uH O C 1+ �i O G m � !—I A w H O MM �• S �_ 1+1 O v O U CIL 0- � U z x = 1hWZ O W W 07� .� � � ° o � � .� o z d " C � � 0 .0 w0.0 e BUILDING DEPARTMENT R[ECEIVIE ID VILLAGE OF RYE BROOK MAY - 2 2022 938 KING STREET RYE BROUK,NY 10573 (914)939-066$ VILLAGE OF RYE BROOK wwwn r,ookbrg BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: MAY 2 5 Permit# 7 7 Application# b J Approval Signature: y ` A►RCMTECTURA►L REVIEW BOARD: �A Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary (� ZBA Approval Date: Case# Other: Application Fee: — 6 Permit Fees: FENCE / WALL / GATE PERMIT APPLICATION Application dated: � is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Job Address: 108 Old Orchard Road �/ p 2. Occupancy/Use:/ )=4m S.B.L.#: J.35, Zone: Is 3. Proposed Fence/Wall/Gate(describe in detail): Install 200'of 4'H black aluminum fence, 64'of 6'H gray tongue and groove PVC fence 225'of black welded wire mesh, and two aluminum 5'W walk gates. 4. Property Owncr: Allison Koslow Address: 108 Old Orchard Road Phone# Cell# 917-653-6286 email: allison koslowQyahoo.eom Applicant: Allison Koslow Address: 108 Old Orchard Road Phone#J 1-1-6��--9 1 b Cell# 917-653-6286 email: _,allison_koslowayah©o_corn Architect/Engineer: Address: Phone# Cell# email: Contractor: Future Fence and Painting, Inc. ` Cf"_rt! So C C,I Address&Phone: 336 Fayette Ave, Mamaroneck, NY 10543-914-698-0150 5. if building is located on a comer lot,which street does it front on: 6. What is the estimated cost of construction $16,200.00 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: Approximately three weeks after permit is issued I 8/1212021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STjXjOF NEW Y(?M COUNTY OF WESTCHESTER ) as: 1 i S O r1 KO S �0 WI ,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 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. 7�J Sworn to before me this Z Sworn to before me this day of IQY ,201_Z day of , 20 01 � L �� 6_�� Signature of Property Owner Signature of Applicant Print N f Pro Owner Print Name of Applicant Notary Public Notary Public CHRISTOPHER J.BRADBURY Notary Public, State of New York No.01 BR6159985 Qualified in Westchester County .!^nrfln� 29,20�� 2 Il/t2/2021 Alfredo DiVitto From: Alfredo DiVitto Sent: Tuesday, February 27, 2024 4:22 PM To: 'allison_koslow@yahoo.com' Subject: EXPIRED FENCE PERMIT BP-22-077 Attachments: expired permit Ietter0001.pdf; CO-CC-Application-8.2021.pdf,fence permit for 108 old orchard road0001.pdf Good afternoon, Mrs. Koslow our records show your fence permit listed above has been expired and we have not performed a final inspection.Village code requires you as the homeowner fill out the application for certificate of compliance and return to the building department with payment and payment for the expired permit is also required . Since this is for a fence on the property you are also required to have an as-built survey done and supply us a copy prior to final inspection. I will add a copy of both the application and letter explaining the expired permit fee. I will also mail you a copy if that is more convenient.You can speak to Laura or Tara for the amounts owed. Thank you, Alfredo (Freddy) DiVitto Assistant Building Inspector Village of Rye Brook 938 King St. Rye Brook,N.Y. 10573 Office:914-939-0668 1 Building Permit Check List&Zoning Analysis Address. SBL. L Zone:2- l 5� Use: Z l Const.Type: Other. Submittal Date .S Z Z Z Revisions Submittal Dates: Applicant: k O S U o w Nature of Work �J F�> Reviews:ZBA MAY 5 2022 PB: BOT: Other. OK ( ( ) FEES:Filing. 7 -� �L BP: `�� � -C/O: Flood Plane: 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:Dat Stamped Sealed Copies Electronic: Other. ( (✓Y License: Workers Comp: '� Liabili `j Comp.Waiver. Other. ( ( CODE 753#: 0,5,X5 4—QQZ)—9 9— 00 Dated 7 —a S— N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING Plans: Permit Nat.Gas: LP Gas: N/A/: Other: ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: 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. GARB mtg.date: r 1 -z approval notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval:- notes: APPROVED REQUIRED EXISTING PROPOSED NOTES Aga Date: MAY 25 2 Circle: Fromm Fzont Sides: P.Mr. Main Cov Accs.Cov Ft H/Sb: Sd.H/Sb: -GEA, Tot.Imp Hcigk/Stories notes: r BUILDING DEPARTMENT VV VILLAGE OF RYE BROOK 938 KING STREET RYE BRooK,NY 10573 MAY - 2 2022 (914)939-0668 VILLAGE OF RYE BROOK www.ryw'00we BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: 108 Old Orchard Road Date of Submission: Parcel ID#: 135, '13-1"12 Zone: R JS Proposed Improvement(Describe in detail): 200'of 4'H black aluminum fence. 64'of 6'H gray tongue APPLICANT CHECK LIST: and groove PVC fence. 225'of 4'H black welded wire mesh. MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building Two 5'W aluminum gates. Department by the applicant-no exceptions. Property Owner:Allison Koslow 1. (,--)Completed Application 2. ( )Two(2)sets of sealed plans. (one full size(maximum Address: 108 Old Orchard Road allowable plan size=36"x 42")and one 1 I"xl7") 3. ( ,<Two(2)copies of the property survey. Phone#�17-653-6286 4. ( )Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. (v.(One electronic/disc copy of the complete application materials. Allison Koslow 6. (. Filing Fee. Address: log()Id Orchard Road 7. (v)"Any supporting documentation. 8. ( )HOA approval letter. (if applicable) Phone# 917-653-6286 9. ( Photographs. Architect/Engineer: 10.( )Samples of finishes/color chart. (a sample board or Phone# model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this Sworn to before me this day of ,20 2-('- day of , 20 ow, KAI ) Signature ofProperty,`Owner Signature of Applicant �tl�rset� ►1as�� Print Name of Property Owner Print Name of Applicant J A�� Notary Public Notary Public CHRISTOPHER J.BRADBURY Notary Public,State of New York No.01 BR6159985 Qualified in Westchester County Commission Expires January 29,20-U- 8/12/2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Page 1 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, May 18, 2022 ANNOUNCEMENT: PER THE GOVERNOR'S EXECUTIVE ORDER THIS MEETING WILL BE HELD VIRTUALLY THROUGH THE ZOOM PLATFORM. THE PUBLIC CAN ACCESS THE MEETING THROUGH THE FOLLOWING LINK: https://us02web.zoom.us/o/81417970741 OR BY OPENING ZOOM AND ENTERING THE MEETING ID: 81417970741 NAME &LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 75 Woodland Ave Roof Top Solar Array Consent 5694 (Mutino) 17 Talcott Road Replace Original Consent 5695 (Bennet) Decking/Railing On Agenda Existing Deck W/Trex Brownstone 257 Betsy Brown Roof Top Solar Array Consent 5696 Road(Mauriello) System Agenda 40 Hillandale Rd New 5Ft High White Consent 5697 (Johnson) PVC Privacy Fence Agenda 20 Magnolia Drive Roof Top Solar Array Consent 5697 (Lubin) System Agenda 108 Old Orchard New Fencing Rear Yard Consent — 5698 Road(Koslow) Agenda }�(� 11 Candy Lane 6' Privacy Fence Rear and Consent (Gordon) Partial @ Side Yard Agenda 165 Betsy Brown Install New Stone Veneer Consent 5699 Road Over Existing Stucco Agenda Finish(Front 44 Lawridge Drive Re Appearance-Partial 5686 (Bauer) Second Story Addition, Interior&Exterior Renonovations ML NM MR SE JM SF AC MI KC N ' cuCN o p N . 3 O L 0 0 a � O FBI Z w •� ��� �:: �.I V ch o cn •�o Q�otection W � .. �D v J 0 C) y o � 17 W W p C p., � c : O 4��� as /► M Q v F- ..I x ° o <( p M�q1 i��y1LL .. dc.�i. E y o t co t: A (o Al I a a v U V1 2• F- y • d(ts)1 � 1� 1�►►1;1 II,��►►l�lll - I��/►loll 1,�1►1�►11 1'!,►•►,�1�1 .. .'I 1►�1►1�1 /` <(�' 1 Aco01/26/2022 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ �� Y) 022 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 NAMEACT Evelyn Valentin-Soracco BNC Insurance Agency aD"N F� (914)937-1230 FAXF" No: )(914 937-1124 90 S Ridge St Ste UL-2 ADDRESS: esoracco@bncagency.com INSURER(S)AFFORDING COVERAGE NAIC# Rye Brook NY 10573-2836 INSURER A: Selective Insurance Company of the Southeast 39926 INSURED INSURER B: FUTURE FENCE&PAINTING INC INSURER C: 336 FAYETTE AVE INSURER D: INSURER E MAMARONECK NY 10543-2305 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2212004372 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. INSRR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY EFF MPMVD YNEXPY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AITED 500,000 CLAIMS-MADE 19 OCCUR PREMISES Ea occurrence S MED EXP(Any one person) $ 15,000 A X Contractual Liability Y S 2152994 01/27/2022 01/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ®PRO- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 JECTOTHER AUTOMOBILE LIABILITY E08BINdeDt SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S 2152994 01/27/2022 01/27/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAR EACH OCCURRENCE $ 5,000,000 OCCUR A EXCESS LIAB CLAIMS-MADE S 2152994 01/27/2022 01/27/2023 AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS belo v E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as an additional insured when required underwritten Contractor Agreement. 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 Street AUTHORIZED REPRESENTATIVE 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 � 0 ^^^^^^ 205724763 BNC INSURANCE AGENCY 90 S RIDGE ST 0 ' RYE BROOK NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FUTURE FENCE&PAINTING INC. VILLAGE OF RYE BROOK 336 FAYETTE AVENUE 938 KING STREET MAMARONECK NY 10543 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2366 499-8 679841 07/02/2021 TO 07/02/2022 1/26/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2366 499-8, 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 CARY SOCCI VICE PRESIDENT RAMIRO REYES 20F2 FUTURE FENCE&PAINTING 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 STAT SU NCE FUND T �/ DIRECTORJNSURANICE FUND UNDERWRITING VALIDATION NUMBER:806157849 U-26.3 Laura Petersen From: Mike Izzo Sent: Wednesday, May 25, 2022 4:03 PM To: Laura Petersen; Steven Fews; Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, May 25, 2022 4:03:12 PM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 05/25/2022 16:02 To: VIL RYE BROOK PRIMARY Transmitted: 05/25/2022 16:03 00008 Ticket: 05252-002-999-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 108 To: Name: OLD ORCHARD RD Cross: From: To: Name Offset: ------------------------------------------------------------------------------ Locate: ACROSS THE BACK LEFT SIDE AND ACROSS FRT, LEFT SIDE AS FACING FROM STR, CORNER OF OLD ORCHARD AND WINTHROP WILL BE WITHIN 10' OF OLD ORCHARD : RD NearSt: WINTHROP DR & BIRCH LN Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: FENCE WORK Estimated Work Complete Date: 06/03/2022 Depth of excavation: 2 FEET Site dimensions: Length 260 FEET Width 10 INCHES Start Date and Time: 06/01/2022 07:00 Must Start By: 06/15/2022 ------------------------------------------------------------------------------ Contact Name: CARY SOCCI Company: FUTURE FENCE & PAINTING Addrl: 336 FAYETTE AVE Addr2: City: MAMARONECK State: NY Zip: 10543 1 • Phone: 914-698-0150 Fax: Email: futurefence@aol.com Field Contact: CARY SOCCI Alt Phone: 914-698-0150 Email: futurefence@aol.com Working for: MR AND MRS KOSLOW ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/WSCHSTR CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR 2 0 c > 3 OA ii w CL < .q r > FUu IT U ml ri ni, u !j > Lf cm C--.: =--D C�/ I M 0 1, 0 C) Z. 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