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HomeMy WebLinkAboutBP22-143PERMIT #SZ SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTOR_ , COT. COST #-C20 TCO # ,3 DATE. ci� EXP: glalm 3 BLOCK LOT 8 .�e ize 105 c /P4p 1;zvel� FEE DATE jNcjFrTION rll; Q DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT ALARM AS BUILT 0 FINAL 1leVGcQ%ok T4Sf 9 a70 C9/4q 423y 1660 P8 OTHER APPROVALS ARB BOT - ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-117 Certificate of Occup ucp Ehis is to certify that 1 1 y (�/ mer, QS -tyas�e e of � Cyi lrr�er ��S'�hCZ���r &mi/y IYZ-eYC)0db/e of, P ,�Y N y having duly filed an application on C{as,/ � 20 :x'79 requesting a Certificate of Occupancy for the premises known as, ( �Y-P V L.IZhe _, Rye Brook,NY, located in a �U Zoning District and shown on the most current Tax Map as Section: /c''/. Block: �2 Lot: 79 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. , issued 20 ?a 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: �-� ��e' (�'r//��, Construction: , for the following purposes: Leno I I Z e ac me-h'C deck. 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 been obt ' e e m Inspector. Assistant Building Inspector,Village of Rye Brook: DateAUG 1 6 2022 office l use on BUILDIF: ARTMENT For o PERMIT# �-/y,3 VIL>' ' OF RYE'Bji6OK ISSUED: -$-z;>a FAUG - 9 2022 938 KING STRE YE BROOK,*� YORK 10573 DATE: 8 -tea 9 -0 FEE: PAIU$ VILLAGE OF RYE BROOK Y BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION t;#;iif#;ii;itffi###ktf#fi;t;;tt##f#it#tttf#tifiitifttfiiftFkkitk###f##tkf#ki###itf#it#ifftt#ff###itttfit#tfk#tif#ifif#iff##f Address: 9q 6reenNay Lane,, Rye Srook, NY 10573 Occupancy/Use: ` Parcel ID#: J'a6l. 3�L" a- '79 Zone: Owner: Ron CG►imp-r & Carrie-, SCkCX4er Address: 99 Vre,?.nWa Ln. R e, .gook P.E./R.A. or Contractor: T dMOCCi PCtt/l+t j Pf US Address: ? 436A 3 ; Ll(i✓hC.lse} Y 577 Person in responsible charge: S+e Vert TaM U CCi Address: SCt_M e, c t S (LbC U e . Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF/NEW YORK, COUNTY OF WESTCHESTER as: / PO4 l7!�lmej ' being duly sworn,deposes and says that he/sheresidesat ,N Greei1"a Lcu e- (Print Name of Applicant) (No.and S eet) ��// in Rye, t3rG c in the County of PS-Fc l�e5�er in the State of-N y ,that (City/Town/Village) I 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:$ — for the construction or alteration of: Deck - Creafe, l`ala r4 u a r o�� cc re L 0 j a 3 Mat a IT 'JJ Iree✓s 4-c Pl u V,'df-f�-3� 4 ,H(,r r�a OLN j��.0 +Te 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§250-10.A. of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of 2dj- day of , 20 i R of Properly Owner Signature of Applicant l �e of Property er Print Name of Applicant N blic SHARI MELILLO Notary Public Notary Public,State of New York No.OIME6160063 8/12/2021 Qualified In Westchester County Commission Expires January 29,2003 QyE DRa?-- 1982 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 :_ �� �� ��� DATE: ,� � PERMIT# , � \ \� 4 11,1 r1 ISSUED: SECT: BLOCK: LOT: LOCATION: 1� F" 1 L�C : \ OCCUPANCY' ❑ VIOLATION NOTED THE WORK IS... c� 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 ❑ OTHER s a W S � .. e N \ � p. o 00 E�+ h W I ly1 1 ,� G3 W M / 64 11 � w ° C/) tLl 1-CAi O o a� : FBI R W a y W Nw w A � 0 � W � ,4 � w � W u s O z ® \ A 0 o p « W F-I 0.4-4 - W 14 oz W .� r7 o- � •: , O "Q NLn O A av yyi 00z 0 a p O. '� w n ►n p Q o -d v e u O 0 O J Ln � Wzb a _ W Cn ' C/) M v w � Q A �z o bcCA u � w A0 �;) "U 0CY w 00 A . W � z F�1 " WWWW 1~M � Q �0o*, zCAp Q 6�1 11 cz o o c How -5 .y 0 A z o arp > a G� Z u P. c qq H o ti BUILD -_ TMENT � ETC L�" E1 gel ' VIL OF R�`\ OOK � J � , 938 KING ET RYE BR NY 10573 JUL 8 � i 14)939-Od VILLAGE OF RYE BROOK BUILDING DEPARTMENT ADMIMSTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: APPROVAL DATE: AUG — 2 2022 PERMIT#: �--1' APPLICATION FEE: APPROVAL SIGNATURE: Z, PERMIT FEES: 1 ' 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. 1. JobAddress: Wq �U r .t CL La n c R � B' ('(}j� 1+ Aly 1 J I 2. Parcel ID#: �aq•0 T" o��'�g `�4'k I q rN Zon� 3. Proposed Improvement(Describe in detail): eaf-e a r4 ctai1 U o I ar0UnA ,3 ad U,W fr r'o n o i< o Our to r - o- d ck. P c nub fi lI Openlha With mu Icy . Pid rat irrXtd.i-l'eS�on--top of dec +o Confao Ae im lc�. 4. Property Owner: Ron Gr'Ing ,r om& Calf ig Schaf e'rG1ime_r Address:. C! 1 G egi')'way L-anet R�2 t3rock, At( 10,511.3 Phone# q - Cell# e-mail RCEC-1 L 140L•CaIV1 List All Other Properties Owned in Rye Brook: n G 1'1 i?,. Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# / e-mail General C70- actor: GrCC'/ i-27'7 L!S 1s'P� i'I'1 UCf2 Address: X S ue-aA S2 A 057 7 Phone# 7/ —6Q-5— c)7V Cell# e-mail (1) 8/12f2021 5. Occupancy;e 2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 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: _ I"fl: 2nd fl. 3rd fl: 10. Total Square Footage of the proposed new construction: 2qS _,ware_-fie_& 11. For additions,total square footage added:Basement: Id fl: rd fl: 3`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: are tec( rectah©ular open,.nq in drpuM-1eve1 deck-to Drwilefor-tree, � �. 15, Number of stories: Overall Height: Median Height: yrotJ+ 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 au tom c fire suppression system? (Fire Sprinkler,ANSL System,FM-200 System, Type I Hood, etc...)Yes: —No:7 (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 Jo impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: —No: Area: 23. Will the proposed prof ct require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No:V (if)vs, 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: fif yes, the area of wetland and the wetland buffer 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: V (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: (if yes, applicant must submit a Tree Removal Permit Application) 2& Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER I: TIER H: TIER III: (if yes, a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ 11 000 -- Note:estimated cost shall include all site improvements, labor, material,stay ffblding,.fixed equipment,professional fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost, an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: 6/29, �U (2) 8112nu21 BUILD MENT U VIL E OF RY OOK 938 KING ET RYE BR NY 10573 J U L 2 8 2022 + VILLAGE OF RYE BROOK BUILDING DEPAR T MF�JT rt**rtrt*******rt*******************rtYf**k***R***st lart*aF*1k k*rtk ab**aF at r;**f;***R?.•*a'e*R*Y<*1tYf*itY(Y.fi et tk****ft lt*i;at t•R•k 7F**Y:rtlk AFFIDAVIT OF COMPLIANCE VILLAGE CODE &216 • STORM SEWERS AND SANITARY SEWERS 'PHIS 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: N ���f \ residing at, L7.'�� � 'Ul ILIc (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; ` fi l`--— -I -� ` r , Rye Brook,NY. (Job Ad ress) 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. S'8'attre of Properly Owaer(s)) Tint Naive of Property Owner(s)) Sworn to before me this ay of c� �� , 20 a-a 1 otv� Public 1 SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County (3) ^ommisslon Expires January 29,202� 8/12/2021 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 OF NEW YORK,COUNTY OF WESTCHESTER ) as: , being duly sworn, deposes and states that he/she is the applicant above named, (print name of indir'idual 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. 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 �a day of , 20 Sig aw'r'-of Pr Signature of Applicant Pfint Name of Property Owner Print Name of Applicant Notary public Notary Public SHARI MELILLO Notary Public,state of New York No.01ME6160063 Qualified In Westchester county commission Expires January 29.20 Z (4) 8/12/2021 Laura Petersen From: Laura Petersen Sent: Tuesday, August 2, 2022 2:09 PM To: rcegil@aol.com Subject: Building Permit Application - 89 Greenway Lane 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; 3. General contractor's contact name & phone number. S7eve17 -UN'll(CC/ ✓2. General contractor's valid liability insurance (the Village Of Rye Brook must be the �_ certificate holder) , +3.) General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $100.00 (due once permit is issued and ready for pick-up) 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 Ioetersen(Wrvebrook.org Q 12 ,l i • �' w 1r r z 14 V �I t� :J 40 7 .ci (n cLon fi r Z_ p uj E 3 s 1 � r ..r w ` ud < :Z rr Oft 3 C i ao yT �" Y r4i r ACORO 08/0 /2022® CERTIFICATE OF LIABILITY INSURANCE DATE(M3/2022 Y) �� 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 Tennille McKernan NAME: George J.Smith and Son PHONE (203)878-4641 FOX (203)876-9886 A/C No Ext: AIC No 247 Broad Street EMAIL tmckeman@gjsins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p Milford CT 06460 INSURER A: Utica First Insurance Company 15326 INSURED INSURER B: 9 Pro ressive Casualty Ins.Co. 24260 TAMUCCI PAINTING PLUS INSURERC: 665 GILBERTAVENUE INSURER D INSURER E HAMDEN CT 06514 11INSURER F: COVERAGES CERTIFICATE NUMBER: Master 21/22 term 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IN SIR ADDLISUBR POLICY E POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYFF MM/DDlYYYY LIMBS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A ART509367405 11/17/2021 11/17/2022 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 03986320 11/19/2021 11/19/2022 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB Ll CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER 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 below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/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 The 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 fNEW ii :STATERK Workers' Certificate of Attestation of Exemption Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Home Improvement Steven Tamucci DBA:Unme i Painting Plus From:Village of Rye Brook 66S Gilbert Ave Hamden,CT%S14-2664 PHONE:914-S25-9270 FEIN:XIOM4091 Workers'Compensation Exemption Statement The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is owned by one individual and is not a corporation. Other than the owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Steven Tamucci,am the Sole Proprietor with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. HERE I Signature' Date: 08/04/22 Exemption Certificate Number Received 2022-054587 August 4, 2022 NYS Workers'Compensation Board CE-200 01/2018 From: rcegil@aol.com, To: arbors.d.barnett@gmail.com, Subject: Re:#89 Greenway Lane-A&G Approval? Date: Thu, Jun 23, 2022 7:54 pm That's great news! Thanks again for all your help. ��-- -Carrie G„ #89 -----Original Message----- I� JUL 2 8 2022 From: Daniel Barnett <arbors.d.barnett@gmail.com> To: rcegil@aol.com VILLAGE OF RYE BROOK Cc: manager@arbors-ryebrook.com <manager@arbors-ryebrook.com> pBUILDING DEPARTMENT Sent: Thu, Jun 23, 2022 7:09 pm Subject: Re: #89 Greenway Lane - A&G Approval? It was approved. On Thu, Jun 23, 2022 at 4:59 PM <rcegil@aol.com> wrote: Hello Ashlee, We'd like to ask if you can please help us find out asap whether A&G approved the work we have to do on our deck during their meeting last night, 6/22. We really need to tell our contractor by the end of the week when he can start the work. He already had to postpone our work several times during the 4 weeks during which we'd heard nothing from A&G, and we are under a time crunch with him. Please reply and thanks in advance for your help, Sincerely, Ron & Carrie Gilmer, #89 As'�,1 ec = Ashi f e, Pa sV cd c,) A rba r5 -P(-Op6rj MlWaler nje) 130tirneft = President Arbors Ha �. 10Boom— ` _T„ J■ O*f" z ♦ 7•l3 V �I. 1 �- �/ �,�, ILK t. .-�•t���+'k�� 1 "� gl r I •R�`, s It A f{ _ �. `t �� '�� ,� s � � � j 1 f o t � �� �, ® s r� �` 6 f �+ � `i t*\ � ■ /f `'F � � ( / A! �. � � f ,� � � F 3 �� � � i f f re , / � - � 1 � � \� �. L �` � � � •� ,. L y - -._._� �� � .. t �, ..w: ,.r-. w `. . .,;� _ .j ;`''� �a=