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HomeMy WebLinkAboutBP22-113PERMIT # ��� - �� � DATE: � IXP: � �© SECTION / BLOCK LOT TYPE OF WORK / � QC'��� / ®�� JOB LOCATI N �� V2���. OWNER Qr/� 1 � 31 l! Q�I / CONTRACTOR _ S � � E�T. COST i ` ,, FEE �/CO # C'�'� �`� � FEE ��I©��� DATE TCO # FEE DATE INSPECTION RECORD � DATE INSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CJ RGH PLUMBING GAS C7 SPRINKLER ELECTRIC L� LOW-�`OLT 0 ALLtRM AS BUILT CJ FINAL 'oil- �ln �y (�o3)9y�--���5 OTHER APPROVALS ARB BOT PB ZBA OTHER - 4 4e to�d� C�44 W Lj kpW"y . 19 404 ann umaW VILLAGE OF RYE BROOK MAYOR 938 Ring Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.iyebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan K Epstein Michael J. Izzo Stephanie J.Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 9,2022 Mario Dattilo&Susan Dattilo 14 Hawthorne Avenue Rye Brook,New York 1.0573 Re: 14 Hawthorne Avenue, Rye Brook,New York 10573 Parcel ID#: 135.83-1-74 Building Permit#22-113 issued on 6/30/2022 for 10 New Replacement Windows This certifies that the ten new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to 8:20 .a ^ 40—Cr final inspection pr... 6 " [EcF=�YEI DD R1 - .0 NOV 10 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT BUILDING DEPARTMENT Pt Nvtll VILLAGE OF Rvk.BROOK Issul:D:_(, —� 938 KING:STREET,Ri E BROOK,NEM PORK 10573 DAfE:�� �_aa (914)939-0668 www.rN throulc.ure APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETIIO�NOr ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address.. .. F .... 1�/' " .. ./�...=........................................ Occupancy Us,c�: _ P-1 ID#: 5� k3 —/ —Q Zonc:------------ Owner..4�-i �.�.. l Address: P.E.rR.A.or Contractor: . �L�_ css: 'cm in rcsptmsibl�chrgc: � �*�:�J� Application is hereby and submitted to the BuildingInspector • l-�g tS�rl(<'y�B"q-1f1.T fR��tjjC•r'�. !!'t�/Gl�r"f[[!�1i���1/�_�,»�J�of the Vil c c nx v aissuanc of a Ceatilicale of Occupancy-Certificate ol'Compliance for the structure construction'alteration herein mentioned in accordance with law: STATE OF N POR COUNTY OF WESTC'11ES7'ER as: Ir�i A AtJ !lMerer ing duly sworn,d'sand says that he:she resides as `J) t/PnnN.W 5tmt1 in _ _ in the Countyof W_t��CU4-Snl—inthestvaeof_� .dat eiry 7'uxn\'a6tr� he:she has supervised the work at the location indicated above,and that the actual total cost ofthe work,including all site improvements. labor,nuterials,scaffolding,fixed equipment.professional tees,and including the monetary value ofany materials and labor which may have beendonated gratis was:S _. 9aP4[. for the construction or alteration of: J.� ��'.fs�--•+�-�.I �)t h�L)1 - _ tcporem further states that he:she has e\anuned the approved plans of the structure work herein referred to for which a C cilificate of Occupancy C'omphane is sought.and that to the best of his Iry knowledge and belief.the stnn ture'w irk has been erected completed in accordance with the appm\ed plans and am amendments thereto except in w far as variations thcrclbrc ha%c Ron legally authorized,and as erected-completed comples with the taws govcming building eonstruation,tkyrment further understands that d shall be unlawful loran owner to use or permit the use ofany building or premises or pan thereofhercaller created.eructed,changed.c.nvennl orenlargnL wholly or pardy.in its use or structure until a C'crtificatc of lccuparey or('ertifwalc of(bmpliame shall hay c been duly t wed by the Building Inspntnr as per§?51)-ID.A.of the(l d�f the\illa�geaonf Rve Bnnk. Sworn to before me this �D V1 Sworn to bef re me this h Jay of Q' 20 2(— day of 20/'In \irnerurc M P.Wny kkag SrprNr dr Apyucrt ',in,N u,vw, (n� P—% T oar A) GREGORY M.RRR:RA NANDHINI SUNDARAM N"` • `'ubi c., 1. ` "` 1 OTARY PUBLIC STATE OF NEW YORK '.vied to 1' .,tc' (;. .:;.n-y ROCKLAND COUNTY Commissian Empires Septemcet z;►,20' LIC.#01 SU6192 40 � Comm.FXP. � aE/j, �yE BR(�k. O� 2m 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 : Cl DATE: PERMIT#,3e ` ISSUED: �hllVSECT: BLOCK: I LOT LOCATION: 4 � w " a�� OCCUPANCY: -2-t y ❑ VIOLATION NOTED THE WORK IS... ❑ 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 FINAL / u OTHER e x x x C O w 0 ^ N C W s ° � oo p .� .d , o • H Lin fn v i O A o y72 y w s A 0 Fil a � .� p W et o0 0 3 a a1 ° O z � c v � y 'v ■ OQ 4 U u q a � s a �" 00IND O W ai 0 i x AFir w z � cs . 00 c w b a C7 w � W F A g o ,0 IC 0 M N ro , a F+y ~ W V✓' A Er U cy N . 7 F o A W U Q a V - a a � W O FOB ° z U o a d u►) H x 0 A z o w > o x z a' W F O � L� >1 0 z 4 5 nb .. a u MMa ^^ U w � � A �°❑❑ � � s : BUILD TMENT D E C I 11 DD VIL OF R. OOK 938 I{I1vG ET RYE SR ,NY 10573 U 2 3 202� )1 939-06 VILLAGE OF RYE BROOK BUILDING pEPARTMENT 19t32 ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REy1E*Ar BOARD APPROVAL FOR OFFICE USE ONLY: l � APPROVAL DATE: jU ER MIT#: / I '` APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: it 0 H.O.A. APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: (''QP(ar� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance ofa Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobA.ddress: 2. Parcel ID#: Zone: 3. Proposed Improvement(Describe in detail): e vv-u\k Ct �ca vttiL S; Z� I V\v - -t,� Kre.. 4. Property Owner: 0"r 1 0 I t G Address: 04 4vLtnJ4+\a*-vxC l�tlC �r� ,C N Y t c S13 Phone# 1q- �F%-( - �keq Cell# e-mail List All Other Pr ies Owned in Rye Brook: Applicant: �-,�'`✓��4- Qr'V�t Address: �O �,. o►-br f l (� . (1�cx C-T- 0Cro 3 Phone# G� �l�l lrf—��'gS Cell# e-mail peg rn ��gc pt!��►-� rr� Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: �tp CA- Address: c3� � c 1"er A c3 3 j Phone# - ��- Cell# e-mail 43e f m'l S �j fy tin,'+f, rW (1) 8/12/2021 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: Post-construction: th 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 comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I"fl: 21 fl: 314 fl: 10. Total Square Footage of the proposed new construction: It. For additions, total square footage added: Basement: I"fl: 2nd 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: ()Typical Western Lumber Frame;O Timber Frame[TC];()Wood Truss[TT]; ()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: Roofing material: 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 I Hood,etc...)Yes:_No: u (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 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 (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: k (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: jO (if yes, the area of wetland and the wetland by er 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 the,hood 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: (fyes,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 1: TIER IT: TIER III: (if� s, y}es,a Nome Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ VC:11 Note:estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis. f the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: (2) 8/12/2021 BUILD MENT D 4;� VIL OF�.I OOK 938 KING RVE 8 ,NY 10573 JUN 2 3 2022 -c 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 OF NEW YORK, COUNTY OF WESTCHESTER } as: 0 t 014-r_O d , residing at, t ` { �nJ k�c�r n-(, )�N c. . (Print name) (Address�khere YOU Ii%'ct 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; Rye Brook, NY. (Joh 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. 'k-,- (Signature of Property Owner(sii ) 0 DA-T T ) L 0 (PrintNamcuPProperh 0,Ancr(s11 Sworn to before this day of t ���n.Q oco- NANDHINI SUNDARAM NOTARY PUBLIC STATE OF NEW YORK ROCKLAND COUNTY f�otan l'uL�i�� LIC.# 1SU6)19264Q I LCOMM.EXP (3) 8/1 212 02 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. 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. STATE QF NEW YORK,COUNTY OF WESTCHESTER ) as: —�^►'t,.t, C�-_a ,being duly swom, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and fin-ther stAes that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the �'t 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. 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. Swom to before me this 0-1 Swom to before me this day of � , 20_ day of 24 St�r Owner ,c of Property .� Signet of Applicant ri�ame of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State et New York SHARI MELILLO No.01ME6i60063 Notary Public,State of New York Qualltied in Westchester County _commission Expires January 29,2Q•1 No.01ME6160063 Qualified In Westchester County commission Expires January 29,20"� li Home Improvement Agreement: Page 1 ku Home Depot License#'s - For the most current listing visit www.Homedepot.com/LicenseNumbers Rocco Defeo Salesperson Name Registration # (Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. 1. Service Provider Contact Information The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (914) 347-6900 1 customercancellationnortheast@hom Phone # 98RPWRvider Email Address Service Provider License #(s) 2. Customer Information Dattilo Mario Westchester 1-1ZVZ91L3 Customer Last Name Customer First Name Store #/Branch Name Customer Lead/PO# 14 Hawthorne Avenue Rye Brook NY I 10573 Customer Address City State Zip / (914) 804-8644 mdatt24@icloud.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 6 Skyline Drive Hawthorne NY 10532 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: 06/16/2022 Customer's Signature Date 460 Sumdard Form HIA(21 Jul.21)(E) Generated Dale Qe/1 g.jq n 7 7 Lead/PON 1 1 Z V Z 911 3— v 0 1 12 Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work,Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 12/13/2022 Approximate Finish Date: 01/12/2o2s All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy,your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 19284.98 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable, total amount of taxes included in Contract Price) *Maximum deposit ONLYapplicable in MD, MA,ME(33%),.NJ, WI(9991o) Deposit% 1100.0 Deposit Amount$ 9284.98 Remaining Balance $ 10.0 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9. Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that: (i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer" above; and(iv) Electronic signatures will be deemed originals for all purposes. 06/16/2022 Customer's Signature Date X I/s/The Home Depot 06/16/2022� The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (914) For any other concerns, contact The Home Depot at 1-800-466-3337 460 Standard Form HIA(21 Jul.21)(E) Generated Date nr,/16/2 022 Lead/PO4 1_1 7 v 7 91 L 3 �' WINDOW SPECIFICATION SHEET - Spec.Sheet+: t-lZVZ9IL3 Sheet:I of 2 Customer:Mano Datlilo Job N:1-IZVZ91L3 Consultant Rocco Deleo Date: 06/16/2022 New Window E-i,ng Window Hinge Locations Measurements finds Product Options labor Options From outside. Left to Rot Bays,Bows Location Color Rough Opening a of bars a of oars Csmnls.I Pnl. use L.AorS GIa55 MISS Items Hardware Screens C.. For doors use LL�d FF — MUII 'S-=stationary or w Style Wrapsg g F — LL m & 9 4 'A'=operating Room Floor Code (Yrt) Style Code Serves Code 3 5 vi > ?'5i FULL SCR,STD,White, WRAP.LSR 1 DINE III, SH-A Y DH 6100 WH WH 32 62 94 TMP:Botlom, Glass Pack:Standard FULL SCR,STD,White, WRAP.LSR 2 DINE In SH-A DH 6100 WH WH 32 62 94 TMP:Botlom, s P G1aaack:Standard FULL SCR,STD,While, WRAP,LSR 3 Llv isl SII A Y DH 6100 WU WH 24 62 BE TM Bottom. Glass Pac k.Standard FULL SCR,STD,White, WRAP,LSR A LIV Isl SII-n Y DH 6100 WH WII 24 62 86 TM P Bell— GI...Pack:Standard STD.White,GI—Pack. WRAP.LSR 5 LIV 151 PW-A Y PW 6100 WH Wt1 60 62 122 Standard FULL SCR,STD,Whit,, WRAP,LSR 6 BED 2nd SH-A Y DH 6100 WH WH 32 62 94 TM Botlom, Gla,,Pack.Standard FULL SCR,STD,White, WRAP,LSR BED 2nd SH-A DH 6100 WH WH 32 62 94 TMP BP110 m, Glasa Paok-Standard FULL SCR,STD,While, WRAP,LSR 8 BED 2nd SH-A Y DH 61DD WH WH 32 62 9A TMP Botlom, G lass Pack:Standard SPECIAL CONSIDERATIONS'. 1:White,2'.White,3:While,<'.Whits,5:White,6:White,7:Wlllte,8:White Wrap color senor Casing Type Ray or Bow window: ealhoard malenal(vmyl only-Blmh or Oak) ay Protect Angle(30 or 45) ay Flanker Type(DH.SH.or Csmnt) Top of window to soffe(mmest f Iled to soffll,celor of SOhit material I have reviewed and agroe ,in all the too specllicallons above and the plslrecl Root(Yes a No)' Special Terms and Conditions on the following page Garden Wlr>dow ealteoard Material(vinyl only While Pallile,Birch on Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet a. t-IZY291L3 Sheet:2 of 2 CustOme,Mario DattilR Job M.I-12V291L3 Consultant Rocco Deko Date. 0 6/162 2 0 2 2 New Window E-Mg WurW. Hinge Localions Measuremems Grids Product Optbns Labor Options From outside. Loll to Right Bays,Bows Location Color Rough Opemny N of bars a of bars Csmnls,I Rol, use L.RorS Glass Misc Items Hardware Code Screens For doors use m Mull "S'-slalronary or w o SI lo Wr s g g L a LLy�+m E 4 N 4 Y -%-=operating C Series ode (YIN) Style Code Ses Code w 3 Z TA.— F., L m L > Z Z FULL SCR,STD.White, WRAP,-SR 9 BED 2nd SH-A Y DH 6100 WH WH 32 62 94 TMP:Bottom, GlassPack.Standard FULL SCR,STD,White, WRAP.LSR 10 BED 2nd SH-A Y DH 6100 WH WH 32 62 94 TMP:Bottom, Glas.Pack:Standard SPECIAL CONSIDERATIONS'. 9 White,10.White rap Color oleror Casing Type Bay or Bow w,nWw. ealboard matenal(vinyl only-Birch or Oak) Bay Prolad Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Op or window to sof l lurches) I two to soffit,color of soBn matenal I love reviewed and agree weh all the lob spec�fica laps above and the onSVupt Roo((Yes or No)- Special Terms ano Com,bons m the following page Garden Window. ealbuaro Material(vinyl only Whee Piomte.Burch or Oak) �Sa d• 813 Awning is a rp9ir su� aseinent .........m,,,,,,�., 6500 Rasp P15orar Transom �«........®�................,,�. . ..a $uF9rcept 7r8 0'2� Q� •; m �f; _ t230013 ., .. 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" i zzw�y 1� >�t` A Ys +•:' � A ! ♦• � A � ♦♦ � 1�A 1 - �� . � ri• 't S - ..Yi'ry ���: ^.:�'C i15� 5 � ...��z'R'��,��E9.:i 7 :,Y1� �� 't°"�: ,Kt .�r d� h+��;�•4ti�a ...' ,r�E41'S��� t �3�5�J h�� 1 �1'' 1��f p } � - •..�� ',,/'(gQ :�`t��ii' e;. O it%� Q •'x Y.�1 D ' `1�.. � ,�.1 � t_,1��1 CD '"'i: �`:(i t 3h,a3 V•I ytL�''. f iT II '` a', ,.t�' ��,tt v��u��L�„'`:T,c il}�y i{...', �'6:�.(t�(V ,J y'' t'+t!..'��r4V � tr.��`r,� � -- \�y ��tf���Ls(FN"j°JLi� \,. si�� ��' ... l / 1�"1 ��b�dr� �%`_ ���1Y %`�-r �\`)�1�,>�jt l' v'''�i\\;�v/�147�•� f, J' � " DATE(MWDD/YYYYI AC"R CERTIFICATE OF LIABILITY INSURANCE 11 - 0310112022 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 INSURERS), 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 MARSH USA,INC. NAME: PHONE FAX TWO ALLIANCE CENTER (A/C No Ext): C No). 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC A CN101642069-HomeD-GAW.-22-25 INSURER A: Old Republic Insurance C 24147 INSURED THE HOME DEPOT,INC. INSURER B: New Hampshire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER C: ACE AfTlermCan Insurance CoMpany 22667 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL 004348037-16 REVISION NUMBER: 1 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 ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER MO DDY YYY MMEFF LDDY E XP LTR YY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 316648 03/01/2022 03/010025 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X� OCCUR PREMISES Ea occurrence $ 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO- POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWTB316649 03/01/2022 03/01/2025 (CEO accdent INGLE LIMIT $ 1 000 X ANY AUTO SELF INSURED AUTO PHY DMG BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A UMBRELLA LIAB X OCCUR MWZX 316647 03/0112022 03/01/2025 EACH OCCURRENCE $ 10.000.000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10.000,000 DIED RETENTIONS PER $ B WORKERS COMPENSATION WC 065886029(WI) 03/01/2022 0310112023 X STATUTE ER H AND EMPLOYERS'LIABILITY C ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N N/A (Mandatory in N WLR C68916409(AZ,IL) 0310112022 03101/2023 E.L.EACH ACCIDENT $ 5,000,000 OFFICER/MEMBER EXCLUDED? ❑N Continued on Additional Page E.L.DISEASE-EA EMPLOYEE $ 5.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD INEWR Workers' CERTIFICATE OF ATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured Home Depot USA, Inc. 770433-8211 2455 Paces Ferry Rd.,C-20 Atlanta,GA 30339 1 c. NYS Unemployment Insurance Employer Registration Number of Insured 76011130 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 58-1853319 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) AIU Insurance Co. 3b. Policy Number of Entity Listed in Box"l a" WC 065886028 Village of Rye Brook 938 King St 3c. Policy effective period Rye Brook, NY 10573 03/01/2022 to 03/01/2023 3d.The Proprietor,Partners or Executive Officers are ❑✓ included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Michael Price (Print name off authorized representative or licensed agent of insurance carrier) Approved by: 4 ut April 05, 2022 (Signature) (Date) C.E.O. North America Title: Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov