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HomeMy WebLinkAboutBP22-098PERMIT 06PC�)c /2DATE69 � l� � EXP: SECTION BLOCK LOT TYPE OF WORK JOB LOCATION r epl OWNE / Q /S// CONTRACTOR ZC I�2 �O/7,s*a Th '09 00 EST. vcO # TCO # FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C7 RGH PLUMBING GAS C] SPRINKLER ELECTRIC CI LOW -VOLT L� ALARM C7 AS BUILT FINAL INSPECTION RECORD DATE � INSP riQ ire �/y)93 7 OTFiLR APPROVALS AR6 BOT PB zBA OTHER INSP riQ ire �/y)93 7 OTFiLR APPROVALS AR6 BOT PB zBA OTHER 4t" (buucwsax* 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 Michael J. Izzo Stephanie J.Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 25,2022 Georgina Andaris&Melissa Antiaris 51 Lincoln Avenue Rye Brook,New York 10573 Re: 51 Lincoln Avenue, Rye Brook,New York 10573 Parcel ID#: 135.41-1-14 Building Permit#22-098 issued on 6/16/2022 to Replace Eight Skylights This certifies that the eight new skylights,installed under the above captioned permit have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to D �� (`�' t BUILDING DEPARTMENT c PERMIT# D O/� JUL 15 2022 VILLAGE OF RYE BIWOK ISSUED:lU� 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: -- (914)939-0668 FEE: 4 //Q, PAIDAK VILLAGE OF RYE BROOK BUILDING DEPARTMENT -` APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO Tkr, 9T1nMTTT9!n e)MT,Y UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ttsssss#### wwx##wrtwla##wses#wwiiil4tiiiititttMtitgt►►Miitttttttttitttttttittitttttttiiitiiitittstt►ittiii►tiittttiit7iiitiw Address: `G1� Leo t-61 e) Occupancy/Use: TZa3. /i�191V Parcel ID#: 45 5 y - y Zone: " - �- Owner: Address: 1 l t nLDtn 8-te P.E./R.A. or Contractor:.1)0JOI-``C e-1l�L M+. (DPW Address: —' 0 Person in responsible charge: I`�l a,11GL sc+I 'e- _Address: 10 Application is hereby made and submitted to the Building Inspector of the Village of Rye 3rook 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: m.a rl eL,5�j i'}o being duly sworn,deposes and says that he/she resides at I Tea&calvif (Print Name of Applicant) I (No.and Sircet) in 1Viut p3mo� ,in the County of Uv�P,L- .1 " in the State of PJ\j that —]— Wity 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: ':_ 1`7. O 0 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. Sworn to befo me this 1, Sworn to before me this r e day of , 20 day of `--� �Si ature of Property Owner Si ature of Applicant Pr t a o Prop O Print Name of Applicant ota ublic Notary Public t - ANTIIONY S TVRANCrA h 8/12/2021 Notary oobli.:-St.^.t •of.!. . Ynrl, I►. CHRISTOPHER J.BRADBURY HO.G1TE632.19;9 I,, My Notary Public,State of New York III�t':cs:cht.:r+ c our.�y I! NO.013R6159985 MyComrwvonCxpuo:. ll,n 21, 2,3'.3 ouplified in Westchester County rr,.,,—i =•inn Fxpires January 29,20 Z3 QyE BRC�k O� Zm cu � '9a2 BUILDING DEPARTMENT ❑ UILDINGINSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT �- - - - - - - - - - - - - - - - - - - - ADDRESS: DATE: PERMIT# ISSUED. �VV'SECT: hCCUPANCY: OCK: LOT: LOCATION: ,L ❑ VIOLATION NOTED THE WORK IS.. oll 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 OSS CONNECTION INAL ❑ OTHER a e. a s , ' N N � •� a M • D E i/i O W Q is n O V J u ■ '�� C. U ;r D a O N W u 4 3 bA wo p4 a� ° ... o, x IN W U zzo � oa' 0-0G� h+� M W 0.! M W d Ca v z 04 ° V oz 0 " a 9 � .6 zzb 'Wo 04 z o � n O © v N Ho C.7 p z V p ° gam V � u © a z tn W z a d 0 0 � p �iI Gq W �1 W � � a 'S .a BUILDING DEPARTMENT VILLAGE OF RYE BROOK JUN _ 8 2022 938 KING STREET RYE BROOK,NY 10573 (914) 939-0668 VILLAGE OF RYE BROOK Nv-vvNvx)-ebnmk.ol•g BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE.VI 1.AGE ARCHITECTURAL REVIEW BOARD APPROyAl. FOR OFFICE USE ONLY: n APPROVAL DATE: JUN 1 D IVi1T#: g APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: !� H.O.A.APPROVAL: DATE: 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 construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below.l 1. JobAddress: f twain 1� 2. Parcel ID#: 13i 41 Zone: 3. Proposed Improvement(Describe in detail): R,&—Pl Ctc.L S tm(SA hAs 1n V Imcl 4. Property Owner- h,��SS A c,n-H d Address: S 1l U hi[oI n Pw r 10,577.3 Phone# - 0071 Cell# e-mail (ftAtS,SQ,l.'lnl uetrISe rd•�� List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell # e-mail General Contractor: K 14 CCn—% NQ--"ltn Address: .]2 cwn [ Q,LYSG ?1{ BcppK . 1 QS773 Phone# %%4 q,30j 7) j Ccll# e-mail cWuennlxur sS & ,qp1,Lot'V► (1) s1I2ru21 fr 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,ete...)Pre-construction: ( SMA Post-construction: [Pwn 6. Area of lot: Square feet: Acres: 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: 9. Area of proposed building in square feet: Basement: 11,fl: 2nd fl: 3rd fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I fl: 2°i1 fl: 31 fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y. State Construction Classification: N.Y.State Use Classification: 14. Construction Type&Location; O Typical Western Lumber Frame; (}Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard,shed,etc: pe Rooting material: OU ghN4A* 19. What system of heating: 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 automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type 1 Hood,etc...)Yes:_No:-e- (if:yes,applicant must submit a separate Autnmatic Fire Suppression System Permit application&2 sets nj'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 Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:*' Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (y 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 ivetland and the wetland buffer zone must he 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 the 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: r (if yes,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: r Indicate:TIER 1: TIER II: TIER III: (ifyes,a Home Occupation Permh Application is required) 29. What is the total estimated cost of construction: $ 171, O(1 .0 6 Note:estimated cost shall include all site improvements,labor,material,scafjoldins fixed equipment,professional fees, including any material and labor which may be donated gratis.If theftnal cost exceeds the estimated cost, an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: 04.y ( RUG a0 aa (2) 8/1 212 0 2 1 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. tt 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 property completed in its entirety andlor 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 Mi4f 10L SOtIff— —, being duly sworn,deposes and States that he/she is the applicant above named, (print name of indAidual signing as the iippficaw) and fprthcr states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the — QAfttfV4*Vy_ for the legal owner and is duly authorized to make and file this application, (Ladica(e aruhitm-,canuuctor,agent,atwracyj etc.) That all statements contained herein are true to the best of his/hot 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, Elie 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 hisiber knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before nic this 1�4- Sworn to before the this day of 20�L� day of Signature ol'Applicant P,irl*t N- d6l'c of Properry Owncr Print Name of Applicant q4 wot:ty'Olw Notary Public DIANNE ROJAS Notary Public-State of Now York No.01ROS127547 Qualified In Westchester County My COMMIssiOn Expires May 23,2025 �4) 811 tb'202t 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. 9:is*A ki k**�:�k?,•*k�kkkkk:i k•kk***iF:kiN:ih*'.h**'.l':4k*fi:F:hk�kdckki:t�•*9;k:i•:hkA kk k9;::kk k:Pkkkk�kir'.:*k***kk:�:C kk kq;F:k?:kk:k-4 i:kkk•:::Y k•'k:h STATE OF NEW YO K,COUNTY OF WESTCHESTER ) as: MaftCL Sp (V_ , being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and ther states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the 'A 'tilir' for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,went,attorney,etc.) That all statements contained herein are ttue to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention &Building Code,the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of , 20 day f � , 20 Signature of Property Owner Si ature of Applicant -MM& 45A I Print Name of Property Owner Prin ame of Applicant Notaty Public Notat lic CAROLYN MARE CANNISTRARO Notary public-State of New York No.01 CA6177080 Qualified in Westchester County My Commission Expires Nov.5,2023 (4) 8/12/2021 LICENSE NUMBER PAGE 1 OF 3 Westchester: WC-15450-H04 Yonkers: 4017 Connecticut: 578736 Putnam: PC-2892-A New York City: 1230531 D O TC!kl 3B L E A C0NSTRON CORP . (914)939-7710 Fax: (914)939-5991 9 Jean Lane• Rye Brook, NY 10573 NAME: MELISSA ANTIARIS ADDRESS: 51 LINCOLN AVENUE CITY: _RYE BROOK STATE/ZIP: _NY 10573_ DATE: MAY 25, 2022 JOBSITE: 51 LINCOLN AVENUE, RYE BROOK, NY PROPOSAL: REPLACEMENT SKYLITES INSURANCE: All work involved within the following proposal is covered by Worker's Compensation and Public Liability. 47 INSTALL 8 SUPREME OR EQUAL SKYLIGHTS FOR HOUSE. FIXED, SIZE 30"X 72" FLUSH MOUNT—INCLUDES ICE & WATER SHIELDS AND NEW SHINGLES—COLOR TO MATCH AS CLOSELY AS POSSIBLE TOTAL S 17,017.00 *YOU MAY NEED ADDITIONAL MOULDINGS FOR INSIDE Customer initials Date PAGE 2 of 3 "ALL PLANS AND PERMITS TO BE OBTAINED BY HOMEOWNER" DOUBLE "R" TO CART AWAY ALL JOB RELATED DEBRIS. Hidden rotted wood to be priced accordingly. Please note: When a dumpster is removed there may be some wood and a small amount of debris remaining. Please use caution in this area. A job sign will be placed on property near road at start of job and shall remain on property for two(2) weeks upon completion of job. To accomplish our goals, Double"!Z", uses photographs of homes and aspects of homes in many types of media (newspapers, radio, television and the internet) and uses photos in our own publications. It is the right of the individual whether or not to consent to the use of his/her photograph for the above publicity purposes. By signing a contract with Double"R", you will hereby authorize us to use any photographs taken of your home before, during or after the project for marketing purposes. Written documentation of disapproval is required by Double"R" if you wish to exercise your right not to all us to use such materials. You, the owner, may cancel this transaction at any time prior to midnight of the third business day. After the date of this transaction, such cancellation must be made in person, at the offices of Double "R' 9 Jean Lane, Rye Brook, NY, or in writing, postmarked prior to the fourth (4)business day. If you cancel this agreement at any time subsequent to midnight of the third business day after the date of the contract and prior to the start of the work, you agree to pay us the difference of the cost of material and labor and the amount of the total sale (our lost profit). We reserve the right to cancel this contract at anytime within fifteen (15) days of this contract. If we cancel, you will be promptly notified in writing by an authorized officer of Double AR- A Construction Corp.. If we cancel, we will promptly return any down payment(s) you have made. You agree to pay cash according to the terms shown below, or, if your credit is approved, to sign a note provided by us for payment of the amount due. You also agree to sign a completion certificate upon completion of work. If you fail to pay according to the below terms and have not signed our note, the entire unpaid amount becomes immediately due and you must pay a collection cost equal to our actual costs of collection, up to 15% of the total amount you owe, plus attorney's fees and court costs. The installation will begin on or about and will substantially be completed It is understood by you that the following contingencies could materially change the estimate completion date stated above: customer's inability to obtain or qualify for financing, inclement weather, strikes or other labor disruptions; non-availability of materials; acts of God; or any other. The buyer and the seller understand that with reference to the aforementioned completion date, time is not of the essence. CONTRACTOR PERFORMANCE WARRANTY: Double -V proposes to furnish and install labor and material. All work will continue on job without stopping until completion barring any circumstances beyond contractor's control. Customer initials Date PAGE 3 of 3 All labor provided is unconditionally warranted for a period of Five years from date of installation. Any changes to the job after signing of the contract are subject to an additional cost, and shall be handled in writing on a change order. ACCEPTANCE: The below prices, specifications and conditions are satisfactory and are accepted. You are authorized to do the work as specified. Payment will be made as follows: TOTAL: $ 17,017.00 SALES TAX: $ PERMIT FEES (IF APPLICABLE): $ TOTAL SALE: $ 17,017.00 PAID WITH ORDER $ Cash Check# BALANCE DUE: $ Terms: Cash to be paid as follows $ (2°d deposit of 1/3'd is due) Half completion Financing balance $ (3'd deposit of 1/3"` is due) Day of completion CUSTOMER SIGNATURE: DATE: DOUBLE "R" A CONSTRUCTION AUTHORIZED SIGNATURE 9 x LU s �S E LU J J UJ� - U R I a :ii a a �d a a l a �c X u o Y u o gg I a u c E W U U t�i U U U U U U z z tY i E L E E E x C E C C a �. 1 z � Y ee y� ... yak� C. O yO� �Ory O O �Opp yO� O O- O O n _ X q m m � i i ' L J V a �� a O Building Permit Check List&Zoning Analysis Address: � l L t N ,_1 Vj E SBL: Zone Z Use 2 Const Type Za��Submittal Date: _Z 2-Revisions Submittal Dates: Applicant: ,2 l S Nature of Work L l,,f C Reviews:ZBA P& BOT: Other. hW OK ( ( ) FEES:Filing: BP: Z 5 C/o. Flood Plane: Legalization: ( ) ( ) APP: Dated.. otarized SBL pass I.D. Cross Connection: H O A ENVIRO:Long ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening-( ) ( ) . Short Fees: enm ( ) ( ) o: Site Protection S W M N/A SITE PLAN:T °P / gmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current Archival: Sealed. Unacceptable: ( ) ( ) PLANS:Date tam ed. Sealed: Copies: Electronic Other. ( ) ( icense: Workers Comp: `� Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H W.I.C.:_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. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter: As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER:Other Other. ( ) ( ) ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval;- notes: ( )PB mtg.date: approval:- notes: FOLD FD EXISTING PROPOSED NOTES APPROVED � IN LOLL�� q Cucle: q q —S� U�. F�c Front Fr Si Main Cov: Accs.Cov: F S • Sd S : -GEA Tot,1=: ELL-* P ' •• HH r/ ones: note /L� , 7 O U �. I f r• t`. j Qj OR" At' tt U �aca)s`JaFN `v v v cC N i y„�llao)s EL •iz L W O •il CQ 6i 'C V C1.. M � "'�• E C p CDr'. U •� N � Q00 MCom' tu ,� Si 0 a a(ao)► Nk �t w k'• Fyy u O Z � n js2 • O _•i O ;' O f O F w V/ µ J W = 0! 0x Ct10 poi e n (j Z 0 v •� y V =� . , Z Q Q U L LLIZ (o) r t ) V cn 0) COoa u p W W O a; / Z > w Co LU X o Z i p U y ;J r Q J O •4- LO CA (( t� dLn O 1 lip p H Ln U O I:t i tA y v zo I w' \ ` )' .11' -4 '�_ /1' ;.'?t; . . .3jiT,—�F,1,� ` .. .�. . ..,A R ;fll,�A� - .=3-..j./f•. ��. .I a ;e�t(0)b min • ' .. -�. / 1 DATE(MMIDDYYYYj ACORO® CERTIFICATE OF LIABILITY INSURANCE �.� 11/24/2021 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 Charles Eatman Dur-America Brokerage Inc PtX HONE 212 302-2672 No; 718 956-9731 214 W 39th Street, Suite 207 AL ADDRESS: cartMcates@duremerica.com New York, NY 10018 NSURER S AFFORDING COVERAGE NAIL• _ INSURER A: ATLANTIC CASUALTY U 42846 INSURED INSURER B: Double R A Construction Corp NSURERC: 9 Jean Lane NSURERD: _ Rye Brook, NY 10573 NSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 00003019-14S4884 REVISION NUMBER: 140 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD L SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER IMMiDDIYYM (MM/DDIYYMLMMS A X I COMMERCIAL GENERALLIABLrrY Y L302000882-0 10/15/2021 10/15/2022 EACH OCCURRENCE t 1 ODAMAGE TO RE OO OOO CLAIMS-MADE a OCCUR PREMISES Ea occ'utrurencel $ 100,000 MED EXP(Any one person) E 5,000 PERSONAL 6 ADV INJURY S 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMPIOP AGG S 1,000,000 OTHER: t AUTOMOBILE LIABILITY C0M8INFI1 SINGLE LIMS accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED P BODILY INJURY(Per accident)AUTOS ONLY AUTOS ( ) S HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY P 'd t S UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMSAAADE AGGREGATE : DED RETENTION$ $ WORKERS COMPENSATION PERTH- AND EMPLOYERS'LIABILITY YIN TATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT E OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Village of Rye Brook is included as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE (F P) 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by F_P on 11/24/2021 at 11:22AM NYSIF New York State!r,uuran(,,Fu" PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 � ^^^^^^ 061605879 DURAMERICA BROKERAGE INC 214 W 39TH ST STE 207 NEW YORK NY 10018 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOUBLE RA CONSTRUCTION CORP VILLAGE OF RYE BROOK 9 JEAN LANE BUILDING DEPARTMENT RYE BROOK NY 10573 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2336 816-0 972357 06/13/2022 TO 06/13/2023 6/2/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2336 816-0, 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 ANTHONY SOTIRE VICE PRESIDENT MARIA SOTIRE DOUBLE RA CONSTRUCTION CORP 2OF2 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 STATE SUR NCE FUND F 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 773230516 U-26.3 UPRl ME SKY1 G Is C -0 2185 5th Ave., Ronkonkoma, N.Y. 11779 Phone # (631 )738-0324 Fax # (631 )738-0325 INSULATED HIGH OW E ARGON FILLED GLASS ELASTOMERIC BUM GLAZING TAPE EXTRUDED ALUMINUM COVER FULLY WELDED (POWDER COATED FINISH) OF ASSEMBLY SCREWS a CLOSED CELL FOAM TAPE a o SANTOPRENE GASKET EXTRUDED PVC INNER FRAME EXTRUDED ALUMINUM HINGE BAR POWDER COATED 3/4" PRIMED PINE CURB FINIS �O�NSHN�J�US COPPER Y Y� ROOF STRUCTURE ��•: CE WE JUN 15 2022 VIL GE OF RYE BROOK COPPER SERIES FIXED CUT FLUSH CURB BLU I ING DEPARTMENT