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HomeMy WebLinkAboutBP22-151PERMIT# AO 5/ DATE: d m c of IXP: .O.)3 SECTION & BLOCK / LOT TYPE OF WORK % Ce�'rIQ�� %�O�pZaS ACP/ ��!"c T/o ��%' 4 v7'T�'rti �Qr114( JOB LOCATION 42je7e OWNER % /`A 4 O /' 7,3y- hod CONTRACTOR 1.l 112 __0/h2 �r't1,0rOVeJY-&V A� (f 040 ,La (j /Q�CO (91 ` ) 93 7- 11)79 �u Ma 40•670 'TCO �i F£E DATE INSPECTION RECORD I DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS 0 SPRINKLER ELECTRIC C� LOW -VOLT CI ALARM O AS BUILT O FINAL OTHER APPROVALS ARB BOT PB ZBA OTHER DR (ta VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J. Bradbury ,A-%ti-%v.ryebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE March 15,2023 Mark Kibel&Shari Kibel 248 Tree Top Lane Rye Brook,New York 10573 Re: 248 Tree Top Lane, Rye Brook,New York 10573 Parcel ID#: 129.76-1-73 Building Permit#22-151 issued on 8/18/2022 for 3 New Replacement Windows&1 Patio Door This certifies that the three new windows and one new patio door,installed under the above captioned permit has been satisfactorily completed. Sincerely, /t Steven E. Fews Acting Building&Fire Inspector /to 3D For office use onl BUILDING DEPARTMENT PERMIT# o') FEB 2 4 2023 VILLAGE OF RYE BROOK ISSUED: — a a- 938 DING STREET,RYE BROOK,.NEW YORK 10573 DATE: —Ql — )�3 VILLAGE OF RYE BROOK (914)939-0668 FEE: /,C Ive _T1WAID 13 BUILDING DERARTMENT _ wwwxyebirpokm 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 tttfftttff►►►ff►tiRttfffttfifftitftifttiiitttttttttftittftt■titittit■•►ttftfttttfitttt►ttftftttfftfttitfttttttffffttiYttt►tti Address: Occupancy/Use: 1/4:WM Parcel ID#: 76 /— 73 Zone:AL1� Owner: Shy /�, c / Address: P.E./R.A. or Contractor: —4 X Address: L/ 7 G,A e ff/�, r. �y� C l�✓�t Person in responsible charge: (( Address: 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: being duly swom,deposes and says that he/she resides at (Print Name of Applicant) '^ / (No.and Streety in �� C 6 6�C ,in the County of {�v{1 h f r 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:$ `/t O _ U� 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 before me this Sworn to before me this day o �C 20 Q I day of , 20 -A -- 6 If-f S ature of Property Owner Signature of Applicant x 1w t Name of Property owner Print Name of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.O1ME6160063 s/l2/zoz i Qualified In Westchester County Commission Expires January 29,202:7 �E BRIXtN. o`` tim 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# ISSUED: <' ' ' -JECT: \-,• I�BLOCK: LOT: LOCATION: ,r C 5 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 'p/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 . _ : a = : Ln N N W a a N 0 00 00 . aa MM o° °O � � O En a W o r - v M © a -c: o u o .4 A oob : : s 0 a w w °: 00oa.� rs: 00 q z 04 00 W � L' �W °�° `r W a V 4 ° 0 0.0 _ O " 0-4M w O z .d O Cn ° ° 00 � � �� O a O go Joi wA �3 E " Q Q O z ° 7 � w 5 IR o U o W - w O cn A � cno = z o a 00 �...� f d' z C .a U a v OHSp, � .0 .n -o ' s BUILDING DEPARTMENT D [ECIEWLE D VILLAGE OF RYA$ROOK AUG 17 2022 938 KING STREET'RYE BRUU3�,NY 10573 (914)939-0668 , ' VILLAGE OF RYE BROOK BUILDING DEPARTMENT -- ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REOUlltE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: APPROVAL DATE: AUG I 8 20 2 PERMIT APPLICATION FEE: Ile f+YGI APPROVAL SIGNATURE: PERMIT FEES: �ajjee H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: *rw***************************«******r****s*****at**ss***r***•***s**********.«*rss*s•**ssr****rs»*«*s***r** Application dated: X-1 7--Q4" 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: Wi C Test e SAP L g l C. 2. Parcel ID#: Z Q 2, 7&—I—73 Zone:_OL4zy b 3. Proposed Improvement(Describe in detail): J4 ('Q 2 c.,i�,.f rs i/.), `!rn T/k-ft."-1 Z .t / I!► /''a'l��r� {1r{ v�fF�1 Yc?D .I!/IZJ '1�rd' �Y L.1/ t��.il f//,I—, g-wWl- --G re-A'-, cl—S `a"7 .w./y �►-Yl +w`� r.i,,,.t/-h,.u.-„�.-, .?� .f-u'�r� .-,:�� f f%�--. ' Sly c�.�a.- . 4. Property Owner: K-"AG1 Address: -?Ng _ U,6/p t,e- Phone#_(I I'Lf) `I 3'+ oIl I_'�_Cell# �`1/3� a-3 `t e-mail MS/�:bCI�V,c��o,cv�-rt 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: U/ b,J'►o � �pVe -I- Address: G��-��� r -�� A) t�s 73 Phone# - <2 7/ Cell# e-mail iI) sn 2/2021 5. Occupancy;(1-Fain.,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 comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: P,fl: 2"d fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: V fl: 2nd 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:()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; O Pre-engineered wood[PW];Located;{)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: IT 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:_/ (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: f Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: // (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: (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 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: f (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) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER I: TIER 11: TIER III: (ifyyes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ & -I to , uz� 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.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: Df o-e►AX- t 2Q.2a (2) 8/12/2021 BUILDING D►EFARTMENT I - VIL ,a GE OF RYE BROOK AUG 17 21022 938 KING ST ET RYE BRgoN,NY 10573 (91.4)939-0668 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: 3, s g-i L• k .kill , residing at, �2 `ir 17-c-,�P L'i^e- ��� fS,�•k � 1 aS�3 (Print name) (Address where you li e) 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; �Hc /�j,--.,i: , Rye Brook,NY. (Job 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. J� " 15- (Si of Property Owner(s)) J4W'-f f�, x' (Print Name of Property Owner(s)) Sworn to before me this V) day of �s , 20'a a (Notary Public) SHAR1 MELILLO Notary Public,State of New York No.o1MEU60063 Qualified In Westchester County (3) Commission Expires January 29,2p� 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: 's 1'a.-i & A"Iy I ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. 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 1 I Sworn to before me this \ day of c , 20_� day of , 20 Sigfiature of Property Owner S' ature of Applicant h1� Print Name of Property Owner Print Name of Applicant r t2�LA�� yAka—' Notary Public Notary Public SHARI MELILLO SHARI MELILLO Notary Public,State of New York Notary Public,state of New York No.OiME6160063 No.01ME6i60063 Qualifled In Westchester county Qualified In Westchester County Commission Expires January 29.20-23- Commission Expires January 29.20-3 (4) 8/12/2021 AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF /, Y COUNTY OF WQJ-1-rXesj're— J�ndii,' rLr be / (insert name),being duly sworn, deposes and says 1. I am the applicant for uilding Permit 'Certificate of Occupanc Demolition Permit E ec ca Mit/Plum >ng ermit/Fence& Wall Permit Mechanical Permit/Pod Permit(circle all that apply) 2. I am the legal owner of property located at 7rr.c4co t a n c.I jeVe 1,-,4( N V Rye Brook,New York(insert street address) OR I am the (Architect/Contractor/Engineer/Attorney) (circle one) for the legal owner of property located at ,Rye Brook,New York and I am duly authorized by property owner to make and file the accompanying application. 3. The following is a description of(1)the work to be performed under the permit for which I am applying; and(2)how the work arose as a direct result of Hurricane Ida, )n k'w"A ..� �•••i( ,.Ji 1 of a-i ;1 1 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. Sworn to before me this Notary Public n �,_�"' C � W E SHARI MELItLO �"'� Notary Public,State of New York 17 ID No.01ME6160063 AUG Za22 Qualified In Westchester County Commission Expires January 29,20 VILLAGE OF RYE BROOK I BUILDING DEPARTMENT 173'/2 Ivy Hill Crescent 4 Rye Brook, NY 10573 914-939-2440 July 27, 2022 AUG 17 2022 Shari Kibel VILLAGE OF RYE BROOK BUILDING DEPARTMENT 248 Treetop Lane _ �- Rye Brook, NY 10573 Re: Window Replacement to Match All Windows Dear Shari Kibel, The Architecture and Grounds Committee (A&G) has reviewed your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained. a copy must be provided to A&G for final review and consideration. Work on the project may not begin until you receive written notice of acceptance from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Property Manager • ••- • • -. . •• . • • • • • •.: CASEMENT, = i AWNING& = WQU i �� � e GLIDING WINDOW o���W o°a���� = o°Oa 2 2tl FEATURES pUQ V, a� aQW� pro N_15 \ Low-Maintenance Exteriors ~ , _ Whit" Canvas Swwtone Casement and awning window Tenatom replacement made easy. Forst Green - - If you're replacing old casement or awning windows, Dark Bronze • • • • • Andersen makes replacement windows specifically • • • • • -- -- for the job. They come fully prepped for easy Buck installation with the nailing flange removed, holes Interiors predrilled,and a convenient installation kit including Pine • • • • • screws,shims and flexible foam backer rod to help • • • • • • you install like a pro. Whits Grilles Full Divided Light • r OPENING CONTROL DEVICE KIT' Simulated Divided Light Window opening control Flnelight'1�e1...1 devices for windows Seriesftk • • • • • • casement windows feature a Rf11111011ab1e Interior Grilles simple,orange push-button Performance Options clearly Identifying the release Stormwatch•Probction mechanism of the device. all and an innovative flip cap High-Performance Glass Options that shields it from accidental Additional glass options are available.See page 19 for details. release. Made of corrosion- io I Low-E4� _— • • • • • resistant stainless steel,the opening control device can operate with the insect Low-E4 Sun screen in place and automatically reengages Low-E4•SmartSun- when the window closes. Low-E • Low-E Sun SINGLE-ACTUATION LOCK Low-E SmartSun -- • This Andersen" lock is Unit Sizes engineered to secure { casement windows firmly at (Minimum Width r-5• 1'-5• 2'-0 Va" 2'-0 Va" 2'-11 Vr' 2'-11 1/, multiple points with just one Maximum Width T-0 Ve" T-0 5/a• 5'-11 iya" 5'-117ia• 5'-11 yr s'-n 112• handle.The single-actuation IMinynum Height2'-0 ire' 2'-0 Ya r-Y 11-5• r-to ra• 1'-5 iy7- lock also features a"reach- --- — out"action that pulls in the Maximum Height 5-11'ie" T-n Ya 4'-0" a'-o° 4'-11 iy.• 4'-11 iv sash for a weathertight seal. li r Custom Sizes A 'See your loca�code official for specific requirements."Window opening control devices may provide a potential alternative(compared to a window guard)to meet minimum sill height code requirements contained in the 2006.2009 and 2012 editions of the International Residential Code(IRC)and International Budding Code(IBC).Check with your local code official for local code requirements as well as to determine if the minimum window sill height code has been adopted in your area and if this device is accepted as an alternative to the minimum sill height requirement. 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W W a >(60 i O u' cr = r. F t_ v: > ujImp L o LU a C� Cr c: c� _•, wb Opp, a sY f 1 ry 4.a Acd CERTIFICATE OF LIABILITY INSURANCE 7EIMWDDfYYYY) /02/2022 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 polioy(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 Gerard Seward NAME: Borrelli Partners Insurance Agency A .No Ext: (914)939-7900 aIc No): (914)407-5088 287 Bowman Avenue E-MAIL ADDRESS: Suite 406 INSURER(S)AFFORDING COVERAGE NAIC p Purchase NY 10577 INSURER A: Evanston Insurance Company 35378 INSURED INSURER B ARC Home Improvements Corp. INSURER C 439 Willett AVe INSURER D: INSURER E: Port Chester NY 10573 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 MSTR REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS RR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDOIYYYY MMIDD7YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 3AA550197 04/01/2022 04/01/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L EACHACCIDENT $ 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 I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Included as Additional Insured when required by written contract: Shari and Mark Kibel 248 Tree Top Lane Rye Brook,NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF vow York Stite Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 133940830 MARENCO INSURANCE AGENCY INC 2525 PALMER AVE SUITE 1 a Aloo NEW ROCHELLE NY 10801 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARC HOME IMPROVEMENTS CORP VILLAGE OF RYE BROOK DBA DOUBLE R ALL HOME IMPROVEMENTS 938 KING STREET 439 WILLETT AVE RYE BROOK NY 10573 PORT CHESTER NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2358 628-2 876874 04/16/2022 TO 04/16/2023 5/5/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2358 628-2. 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 FRANK J VERRASTRO TREASURER RALPH CACCOMO ARC HOME IMPROVEMENTS CORP TWO PERSON CORPORATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND �Y r 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 864645330 U-26 3