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HomeMy WebLinkAboutRP22-033PERMIT # DATE: �O a SECTION Jam. BLOCK TYPE OF WORK JOB LOCAN OWNER YL Cori I Qh1//1 f co CONTRACTO EST. COSTS VCO # _ a pC TCO # r INSPECTION RECORD I DATE INSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC Low -VOLT O ALARM 0 AS BUILT O FINAL OTHER APPROVALS ARB aoT P8 ZBA OTHER �t ti 4 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 ChristopherJ. 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 October 19,2022 Benjamin Tapper&Erica Tapper 4 Deer Run Rye Brook,New York 10573 Re: 4 Deer Run,Rye Brook,New York 10573 Parcel ID#: 135.65-1-39 Roof Permit#22-033 issued on 8/10/2022 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector to + f',R '> For office use onI BUILDINC�D �ARTMENT PERMIT# '_; JbOK OCTVIL�1ItuA OF RYE ISSUED:,�—/Q--�1. C 1 1 2022 38 KING STREk1 "KYE BROOK lrW YORK 10573 DATE: VILLAGE OF RYE BROOK �` 9 - i _>;' FEE: �y' /,Q PAfD B BUILDING DEPARTMENT ° Or 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 it#####►tiiitttitt#t}}}}##i#it#tttitiiititi Fiii#i4##}4#tiitiittitii tiii►#t4iiiti#44i#itii#ttiti4iiiti Yi4}}i#4i#4##it#it}iif#} Address: Occupancy/Use:'�ReS Parcel ID#: ����� �S —�— 3 9 Zone: /�- Owner: TQ.�#� Address: 4 becr a,+4 P.E./R.A. or Contractor:brow-dw Address: qVi Person in responsible charge: W4xVjo Address: l t incy 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: W We,rlel,Q���,r being duly sworn,deposes and says that he/she resides at4Vt -C&U IA44, aA e, (Print Name of Applicant) o.and Street) in 1MaAM rD"AK{L ,in the County of Naa[,KQ yer— 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:$ for the construction or alteration of: "Re--RoDE 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 10111 Sworn to before me this day of jbz. — , 20 �'�— day of , 20 2Zi Sign eofPropert Ow r Signatur Applicant LPrmtme of Pro rty dOwner m��res t Print Name of A licant e1 De RK r "am M�chG Tr OF'.4EW YO t1t34� .;,� 0 �F Wk7Y09 Notary Public y ' ,nty � n •, ,023 otary Pgryllgam Michael Demares Quu;i4,c P'• �' NOTARY PUBLIC.STATE OF NEW YORK Commis Registration No.01 DE6173009 Qualified in Wesicnester County R/I r2u21 Commission Expires August 20,2023 �E BR(�v/r o`` tim 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT 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 - - - - - - - - - - - - - - - - - - - - L. `lam \' \y n DATE: (-A ' ADDRESS PERMIT# \ 1 ISSUED: SECT: BLOCK: LOT: LOCATION: \' \e o-� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION / REQUIRED ❑ FOOTING Q FOOTING DRAINAGE ❑ t'OUNDATION ❑ 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 ■ i i H M N v w v � o eeq as ■ N ` o v old, > � eo 00 x a� � 0 W W o i o ` Cs a1 N i M a O r Lr) LO Sl ■ O M� I--•I A M M o � b O a �, ` v ^ lyr (vim W Zg N o z �/ W [ ■ Lfj J µ cv J W oo y3 - zow �, o °' ■ w i v = W ~ cn t� © M U �" W W j. o ( � ; d � N A .� a e 00 M � Val In, wA ' O o o = o: H w a 0 W U Q V v z � °' � .� N o a � y � A z x W W ° ° � W. H 0 U W a s QRYE BUIENTVIQK Al�G9 ZC�?938 K[NGNY 10573VILLAGECFR� €3ROOK BUILDING DER6,RTMI idT FOR OFFICE USE ONLY: Approval Date: AUG 1 U 202 it Application,/�� —� Application# Approval Signature: ARCHITECTURAL REVIEOARI): Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# _ Secretary: ZBA Approval Date: Case# Other: Application Fee:1 / � Permit Fees: -� p Q ROOF PERMIT APPLICATION Application dated: t7 ' /'�� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. p 1. Job Address: 4 Rv" SBL:/35't& -'J �3 Zone: Property Owner: �nnc r Address: y- 12t►&jut lgreok 11NJCp$']3 Phone#: Cell#: gJ,•V4-VAD email: redbWt 8e'h •Up 2. Applicant: U)frldhrpt"r (bu jj-j0jq .% �RCpAL4�i_ Address: 4y, 49a,t�K out M6mxa ftl< q /0543 Phone#: q/4.34Z).1522 Cell#: email:C1/S�n1erSCt vtr tQ WQr1(h� r� 3. hoofing Contractor:WerOttsrt &A,.PItNj Qcy(uNe Address: 42JP t. GWe. al aolams" w4 M+:S Phone#:gh} * 4522 _Cell#: email: 4. Job Description,list all Methods&Materials: rww..a exiSiiie&S Qcc� C MaAWAA LtJ.O (-eiDIAN- S 5. Estimated Cost of Job:$ '00 (NOTE:The estimated cost shall include all site improvements,labor,material,scatfolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: 8. Number of stories: Height: 9. Is garage being re-roofed:No:( )•Yes:( )Attached No:( )•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: SK l L410 W 11. Estimated date of completion: -t- 8/12/2021 Nease 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. STATE OF NEW YORK,COLINTY OF WESTCHESTER ) as: ufew S. (.U8irlCit,4" ,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 architec ontractor gent,attorney,etc.) That all statements c ned herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this I Sworn to before me this 71 day of , 20 Zy day of , 202,2, Sign re of Prop rt3'Owner Signature of Applicant Print Ttlime of Pr Ow Print Name of Applicant . _ t otary Public _�. Nota j@IjWPUBLIC,STJEOFNEVVYU (;•,,r�, �t Registration tyo.71DE6173009 V.'ill,cn ;,1 (C)RK Quaiilied in Westcnester County 5'fATf• NOTAt"•� ''t�l '+ Commission Erpires August?.0,2023 4 ; , •tin.f,' .y _�� 2h23 -2- 811 212 0 2 1 6/29/22 Mr. Ben Tapper 4 Deer Run �, (Z Rye Brook NY 10573 CELL (917) 544-5350 Project Manager: Doug Malen SCHEDULE FOR SOMETIME IN SEPTEMBER *** MUST COORDINATE WITH SOLAR PANEL CONTRACTORSASS� EXTENDED WARRANTY OPTION Skyliaht Purchases (5) units: Drop ,.• Source and supply (3) 45"x45" fixed glass, low-e skylights with copper stepped or < flashings. LV611 �• Source and supply (2) 14"x72" fixed glass, low-e skylights with copper stepped flashings. Roof Replacement- • Remove all layers of asphalt roof shingles to expose bare wood decking. • Inspect existing sidewall flashing for re-use or replacement and advise. • Inspect roof deck for rot and/or damage. CDX—5/8" OR '/s" • Inspect existing gutters and advise if repairs or replacement are recommended. • Inspect fascia board behind gutters for rot and/or damage. • Remove existing skylights. • Assess structure for ventilation. • Install a double course (approximately 6 ft.) of ice and water shield at all gutter edges. • Install ice and water shield to skylights, plumbing vent pipes and other roof protrusions. • Install ice and water shield to all rake edges. • Install roof underlayment to all roof surfaces. • Install brown heavy duty ode (overhang drip edge) metal edging to perimeter edge of roof. • Fabricate and install new custom 16oz copper clad flashings to existing plumbing vent pipes. • Install Certainteed of GAF Architectural shingle to entire roof. Homeowner will choose color. • Install Five (5) new low -E glass skylights with copper stepped flashing to match exiting sizes as closely as possible. • Install ridge vent to all ridges. • Install hip and ridge shingles. • Install (6) new 10" static roof vents as existing to upper half gable roofs on left side. • Fabricate and install new custom brown aluminum half gable capping. • Shingles will be installed by hand with 1-1/2" galvanized roofing nails. COMPLETED BY: DATE: 1Ft _ .. ,. ''i r. �J;�,x•art+ •mot � .'� f ..: '1y; irk. ♦ /�� ..°'., s� '.^' „ 4t , �`i.1 �il�' t�����i r r �:• • I{ri"1' „.t. rt.. MrI��!.r� �y, . to 117 t.fid ,�.• •fir 1• `s► �.x��v' = .•'_.N �.' 4 ti.` •ir ,j•!'t � S -xyTr Yr �; 4F14�.a�. Mr ,1. •i r i'fYaf ,Y "' !• r, S •��11 't�`it t} r�S+ty I st 1: #.• •••, 'a `•s Ply -3 Ads .., , .+.Y '- �f�ir."}y�� _ �. !•.,e �' - P . � �+�,��Jt��y�,° .i+�,�y'�.,� _'�+, _�yt'��i��p�,'i�1�'� tt.Al14 mr��ji!=,wsly 4. 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Specifications for Timberline 30 Standard Weight Design ^` 30 Year Ltd.Transferable Warranty 4J� �{VV,I Smart Choice®Protection for the first 5 years rr, .� 70 mph Ltd.Wind Warranty —`"" A& Fiberglass Asphalt Shingle Class A rating from UL Algae-EaterTm Protection available in certain areas (check sample board for details) 13-1/4"x 39-3/8" Passes UL 997 Wind Test Metric CSA A123.5-M90 and CSA A123.5-98 12"x 36-15/16" _ ASTM D3018 Type 1 English ASTM D3161 Type 1 ASTM D3462* Meets Wisconsin Administrative Code Approx.64 Pieces/Sq.(Metric) Approx.78 Pieces/Sq.(English) 3 Bundles/Square Approx.264 NaiWSq.(Metric) Approx.312 Nails/Sq.(English) Timberline®30 5 5/8"Exposure(Metric) shingles 5"Exposure(English) are available nationwide \ *Product is manufactured to meet or exceed ASTM D3462; values from subsequent testing may vary depending on storage conditions. o • • Directory Search . ..._. _... ._ NFRC Codes New Search Detailed Product Ratings INFORMATIONGENERAL Manufacturer: Supreme S41ighls Inc. Series Name: Copper Metal Skylight Operator Type: SKOP Air Leakage: Ventilation Rating(Standard Screen): Ventilation Rating(Enhanced Screen): INFORMATIONRATINGS �e ue?;E.I;art �c:m eau ducM F.'e .-First -Previous,Next>19 'Last>> Manufacturer Product Code I Product®®m Description SSK-M-1-00030-00001 "E272/ARG90I CLR(3Mf4/3M1.1)-I-IG" 0.55 0.37 0.64 51 Aluminun vinyl Composite/Aluminum/Vinyl Composde,Fifl 1:ARGlAIR(90/10),LowE,CL,No Grid SSK-IA-1-00031-00001 'E272/ARG90/CLR(4MM/4MM)-1"IG" 0.55 0.37 0.63 50 AluminuMVinyl Composte/AluminurivVinyl Composite,Fill 1:ARG/AIR(90/10),LowE,CL,No Grid SSK-r.t_1-00032-00001 "E272!ARG90/CLR(51,1R1/5I,11.1)-1^IG" 0.56 0,37 0.63 50 Aluminum/Vinyl Composte/AluminunyVinyl Composite,Fill 1:ARGIAIR(90/10),LowE,CL,No Grid SSK-1.1-1-00033-00001 'E366/AR090/CLR(3MM/3MM)-1-IG- 0.54 0.25 0.58 51 Alumnum/VMyl Corrpwsde/AtuminumnAnyl Composite,Fill 1:ARG/AlR(90/10),LowE,CL,No Grid SSK-1.1-1-00034-00001 'E366/ARG90/CLR(51AI4/51AId)-I-'IG-' 0.55 0,25 0.57 50 AluminumrVinyl ComposilelAluminumNinyl Composite,Fill 1:ARG/AIR(90110),LowE,CL,No Grid SSK-IA-1-00035-00001 "E366/ARG901189(31AM.3MM)-1"IG" 0.50 0.24 0.56 50 Alumnurn Vinyl Composila/AluminumlVinyl Composite,Fill 1:ARG/AR(90/10),LowE,CL,No Grid SSK-I.1-1-0002,E-00001 "E366I ARG901 i89(51.11.1:51.11.1)-1--'IG" 0.50 0.25 0.55 50 Alumnun✓Vinyl Composite/AluminumNinyl Composite,Fill 1:ARG/AIR(90/10),LowE,CL,No Grid SSK-IA-1-00037-00001 'BRZ/ARG90/E272(3MM/3MM)-1-10" 0.55 0.32 0.41 51 AlumnumlVnyl Composde/AkiminumrVnyl Composite,Fit 1:ARG/AIR(9g/10),LowE.BZ,No Grid SSK-I.1-1-00038-00001 "BRZ/ARG90!E272(5141/51.11.1)-I-IG" 0.56 0.32 0.41 50 AlumnumNinyl Composde/AluminurnlVinyl Composite,Fill is ARG/AIR(90l10),LowE,BZ,No Grid SSK-M-1-00039-0oC01 -E272/AR090/CLR-LAMI(3MIA2.7MLg030 P/812.7611A)- 0.55 0.37 0.63 5o AluminumlVnyl Composde/AluMnurMlnyl Composite,Fill 1:ARG/AR(90/10),LowE,CL,No Grid SSK-IA-1-00040-00001 1272!ARG90/CLR-LAW(5141,10A141030 P/8131.11A)-1" 0.56 0.36 0.62 49 Aluminum?Vinyl Composde/Aluminunn/inyl Composite,Fill 1:ARG/AIR(90/10),LowE,CL,No Grid IG" SSK-IA-1-00041-00001 "E272/ARG90I CLR-LAMI(3MM2.7MMI030 BRZ 0.55 0.35 0.37 5o AlumnumNnyl Composite/Aluminum/Vinyl Composte,Fill 1:ARG/AIR(90/10),LowE,BZ,No Grid P/BI2.7MM)-1-IG" SSK-1.1-1-00042-00001 -1.-"27 1GlwHRG90/CLRdA1.11(SI,11.1f31,11.11030 BRZ PVBI31AI,1) 0.56 0.35 0.37 50 AluminunJVinyl Composde/AluminunWinyl Composite,Fill 1:ARGJAIR(90/10),LowE,BZ.No Grid SSK-14-1-00043-00001 -E3�IARG901 LAMLi89(3MM2.7MM1030 PVBI2.7MM)- 0.50 0.24 0.55 5o AlumnuMVinyl Composile/AluminumNlnyl Composite,Fill 1:ARG/AR(90/10),LowE,CL,No Grid SSK-M-1.0004440001 -E366/ARG901LA1,11-189(51.11.1/31,11,11030 PVB131.11,1)-1" 0.50 0.24 0.55 50 AlumnunVVin ICo G- y mposite/AluminumlVinyl Composite.Fill 1:ARGlHIR(90110),LowE,CL,No Grid SSK-M-1-0004540001 -E366/ARG90I CLR-LAMI(3M1.V2.7MMl030 PVB12.71AIA)- 0.55 0.25 0.56 51 n Alumurn Vnyl Composits/Aluminum/Vinyl Composts.Fill 1:ARG/AIR(90l10),LowE,CL,No Grid 1-IG" 5SK-1,1-1.00048-00001 1G366I ARG90/CLR-LAIAI(51.11.1l3I.Ih11030 P/B131AIA)-1" 0.55 0.25 0.56 50 AluminurnVinyl Composde/Aluminumn/Inyl Composde,Fill 1:ARGIAIR(90/10),LovrE,CL,No Grid SSK-1.1-1-00047-00001 CLR-LAM165?C/ARG90J SNX 62274-AMI(31AMI047 0.54 0.13 0.06 50 AlumnumNm PVB 65?C13MM/3MMl045 FVE43MM)-1-1/16-IG" yl Co mpositelAluminurNVmyl Composite,Fill1:ARG/AR(90l10),LowE,Cl,No Grid SSK-1,1-1-00048-G0001 -CLR-LAI.115?C/ARG90/SNX 62/27-LAI.11(31.11.11047 PVB 0.54 0.28 0.43 50 AlumnumrVin ICe 5?G3MI.1/31,11A1045 PVB131/1.1)-1-1/16'-'IG' Y mPosAelAlu minurtJVinyl Composite,Fill 1:ARGIHIR(90110),LowE,CL,No Grid ° LC) m N Y Of UI m � � W ro Q U rnLL- a LL- 0 � v J o �- N rn U 0 co 0 n _ LLJ Z IX = L� LL U D� DLL. 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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 endorsements . PRODUCER ONTACT DANIELLE ROBERTS NAME: SABINE SCHENK _ PHONE 426 North Main Street (Atc._N2,gxt,.L666�329-0103 A/c Nol: (860)620-0504 E-MAIL ---' _ Southington,CT 06489 MR s sabIne.schenk a a mericansnatIona_I.com _ INSURERRR�IAFFORDING COVERAGE _NAIC>f_ INSURED -- — —-- —---- ——__ INSURER A: FARM FAMILY CASUALTY INSURANCE 040a-138B3 WERKHEISER HOME MAINTENANCE INC INSURERS: — DBA WERKHEISER PAINTING & ROOFING iNsuRERc;______ 426 FAYETTE AVENUE INSURER 0D;__ MAMARONECK NY 10543 INSURER E NY 10543 INSURER F: COVERAGES -- CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMIEOD 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, rEXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. —AD L SUBR TYPB OF INSURANCE POLICY NUMBER MO pY EF POLICYEX�X COMMERCIAL GENERAL LIABILITY MM/OD/1'YYY LIMITS CLAIMS•MADE UOCCUR — EACH OCCURRENCE S 1,000,000 AI�A�E f0R€NTE1�SES(Ea occurrencel_ S 100000 MED EXP(Anne person S S.000— Y 316OX0655 , 03/29/22 103/29/23 PERSONAL&ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES-ER: I -- __1,000,000 fX POLICY PRO I I ECT Cl LOC I I GENERAL AGGREGATE S 2 UOO U00 — r._r OTHER: i PRODUCTS-COMP/OP AGG S 2 OOO,QOO AUTOMOBILE LIABILITY $ ANY AUTO COMBINED den SINGLE GLELIMITE&L s 1,000,000 A OWNED SCHEDULED I I I BODILY INJURY(Per person) S AUTOS ONLY X AUTOS I 316000659 03129/22 03/29/23 (Per accident) $ X HIRED V NON-OWNED I BODILY INJURY AUTOS ONLY /� AUTOS ONLY PROPERTY DAMAGE Per acciden,�. S UMBRELLA LIAR S OCCURS• i EXCESS LIAR ILA MMADE EACH OCCURRENCE S DED , RETENTION I i AGGREGATE $ WORKERS COMPENSATION I S AND EMPLOYERS'LIABILITY I PER O H- ANY PROPRMTOR/PARTNER/EXECUTIVE Y/N STATUTE ER OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) I I E.L.EACH ACCIDENT S — If yes,describe under II E.L.DISEASE- RIPTION OF OPERATIONS below E DESCA EMPLOYE S E.L.DISEASE-POLICY LIMIT S 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 CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 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 ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All rights reserved. NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^^^^^^ 133349570 WERKHEISER HOME MAINTENANCE INC DBA WERKHEISER PAINTING&ROOFING 426 FAYETTE AVENUE a a MAMARONECK NY 10543 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER WERKHEISER HOME MAINTENANCE INC VILLAGE OF RYE BROOK DBA WERKHEISER PAINTING& ROOFING BUILDING DEPT. 426 FAYETTE AVENUE 938 KING STREET MAMARONECK NY 10543 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 805 742-4 43256 06/29/2022 TO 06/29/2023 6/27/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 805 742-4, 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. WARREN SCOTT WERKHEISER PRESIDENT WERKHEISER HOME MAINTENANCE INC T/A WERKHEISER PAINTING AND ROOFING THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S7NCE FUND V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 990209422 U-26.3