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HomeMy WebLinkAboutRP22-035PERMIT #�` SECTION �� TYPE OF WORK JOB LOCATION _ CONTR EST. COST �0 #� �� ���� � �a ��: J TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING L RGH PLUMBING GAS C� SPRINKLER ELECTRIC C� LOW -VOLT O ALARM Q AS BUILT 0 FINAL I NSP OTHER APPROVALS OTHER 1Ls4.dy aJ v 19 '^fie 406 anniumaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.t ebrook.or� TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE October 26,2022 Jean Follansbee 57 Greenway Circle Rye Brook,New York 10573 Re: 57 Greenway Circle,Rye Brook,New York 10573 Parcel ID#: 129.84-2-46 Roof Permit#22-035 issued on 8/31/2022 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 For office use only: BUILDINE `I MENT PERMIT# OCT 2 �22 VILLAGE OF RYE�ROOK ISSUED:S3/o7a 9 8 KING STREET?RYE BROOK,.NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)),9 -0668 FEE: 4 /JO — PAID)& BUILDING DEPARTMENT w*Vv t e 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 ►►►►rsttrtsrrsssr■s►rss►tttstrsrrr►rsrrstrwrrsrsrrrrrrrssrtrwrrrsrsrrrrrssrsrt•rrs►s►ssr►srrrstrrrrser►err►rsrrss►rrsrrssrr►r Address: 57 Greenway Circle Rye Brook, NY 10573 Occupancy/Use: one family residential parcel ID#: 129.84-2-46 Zone: PU16 Owner: Jean Follansbee Address: 57 Greenway Circle Rye Brook, NY 10573 P.E./R.A. or Contractor: Franzoso Roofing, Inc Address: 33 Croton Point Avenue Croton on Hudson NY 10520 Person in responsible charge: Peter Klatt Address: 33 Croton Point Avenue Croton on Hudson NY 10520 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: Peter Klatt being duly swom,deposes and says that he/she resides at 33 Croton Point Avenue (Print Name of Applicant) (No.and Street) Ii proton on Hudson in the County of Westchester in the State of NY 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:$ 10,707.00 for the construction or alteration of: Re-roof existing building 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 Swom to before me this 9 day of , 20,2,2_ day of _�°ffembG✓ , 2027-- ign rIe of Property r ignature of Applicant P ' t e of Property Owner Print Nameof Applicant Notary bait SHARI MELILLO Notary Public sotary Public,state of New York Michael Babit No.OiME6160063 Notary public,State of New york Zualifled In Westchester County No.01BA6331102 imission Expires January 29,20_Z Ouallfled In Westchester County Commission Explres September 2a,2023 ,4�E BRC�k. BUILDING DEPARTMENT ❑ UILDING 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: ✓ �C �-�l "�"G DATE: PERMIT# rre),C�7'\ � ISSUED: SECT:` ` I LOCK: LOT: L� LOCATION: t n P) ` k OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... pr 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 ■ encLn NV N W v = v a e Q O N E N \ W eq : 000 00 44 cu a W U = ■ F' A a T C > 'qq" CL4 s 'a v cn a C O _ O \ 0-4 oCJ 11 ■ o ■, � � '� � as `� � v, � I--I $ �-1 ■ ObtF a w _ LL z HCR C ' p 5 a§ o � . l�il1 CQj N Q v '4 � > 26 W �—I '� O Y� •a� u ca v CAz o W U U a h"I ■ V z z. fT� F—Y 0 r•�1 \ O V E �1 W E�n 6/ C •a e`a A C7 � z N w � � o CN CN p sg'i n a U W ■ 1.0 oc M--I FBI di u o A 1� 1 ,v to V 0`� � = Q GC�G I'i C rn o O W W W W a o bp z o oz ■ A W z oA � � a 0. W W A � ] o ED BUILDING DEPARTMENT D [E C E � ° VILLAGE OF RYE BROOK AUG 3 U 2022 938 KING 9T ET RYE BROOK;NY 10573 (PI 4 Q39,0668 VILLAGE OF RYE BROOK ww..rYe4kOrs;. 1 BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: AUG 3 0 20A--Perm__ 5 ; Application # Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# : Secretary: ZBA Approval Date: Case# Other: Application Fee: Permit Fees: C. l - ROOF PERMIT APPLICATION Application dated: 4u .30 2q?a 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 Bulkling,as per detailed statement described below. 1. Job Address: 5 F-e�m(Gt,U 01 -C�e SBL: ' Property Owner: �Q� p�1 SYj� `� Address: Phone#: ( Q Cell#: email: \C� t 5 n1�og.n,efi 2. Applicant: Address:_q r71-6-en /at4 c1cgl _ Phone#: _-I[4 305194 0 Cell#: email: 3. Roofing Contractor:—&-q.n 1z©5Q C0 0. Address: 3 3 1 e 6 ©I Phone#: qkq Zq 1 —t151 Z Cell#: email: 4. Job Descrip "on, list all Methods& Materials: Rf31'�G (,1(,( [ p ��1 o a -e—!5 det°k C' b d- a5r1 t(1 yrp �► �` er1 ti n e n s ia�- d 5. Estimated Cost of Job:$ 1 O, 1c`} _ (NOTE:The estimated cost shall include all site improvements.labor.material,scalTolding.fixed equi rrlent.professional fees,and material and labor which may be donated gratis.) (� 6. If comer property,indicate street frontage: / 7. Construction Type: ti C Yp U a NYS Construction Class: � 8. Number of stories: Height: 9. Is garage being re-roofed:No:Qv•Yes: ( )Attached No: O•Yes:( }Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: 62 Q ++ 11. Estimated date of completion: S 551 f7 -1- 811212021 Please 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,COUNTY OF WESTCHESTER ) as: (print name of individual signing as the applicant) being duly sworn, deposes and states that he/she is the applicant above named, and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the (indicate architect,contractor,agent,attorney,etc.) for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and bel ief,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 Sworn to before me this day of c , 202:;L day of , 20 re of Pro Ow Signature of Applicant 77, Q 5 � Print Name o Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County Commission Expires January 29,2Q� -2- 811212021 Work Scope JOB: PRJ#49634:Follansbee,Jean: Roof ADDRESS: 57 Greenway Circle, Rye Brook, NY 10573 CONTACT: I Ms.Jean Follansbee, 57 Greenway Circle, Rye Brook, NY 10573 USA PHONE VS: (914)305-1940 Roof Replacement: • Roof Area Covered in Scope of Work: ENTIRE ROOF. • Install permanent OSHA approved stainless steel single D-Ring fall protection anchor. • Loosen or remove existing gutters and leaders,as necessary. • Remove existing roofing(_2_layer(s)-as determined at initial inspection)down to the wood deck. • Inspect, remove and replace any damaged or rotten sleepers with new 1"x2"pine ®$1.00 per foot;only as necessary. • Inspect, remove and replace any damaged or rotten plywood with new comparable thickness CDX plywood sheathing ®$_100.00 per 4'x8'x 1/2"; 0$_110.00_per 4'x8'x 5/8"sheet installed; only as necessary. "'NOTE: Due to market fluctuations, plywood pricing is guaranteed for one week only. • Install GAF D Weather Watch®leak barrier protection "Ice and Snow Shield" impervious rubber membrane behind gutters on the fascia board,continuing up onto the roof decking 6 feet and AROUND EXISTING SKYLIGHTS. • Install all new perimeter drip edge. Color:_Brown_. • Apply Titanium roof deck protection across remaining portions of exposed sheathing, fastened with button type nails. • Install GAF®Pro-Start starter shingles to roof area. • Install GAF®Timberline HDZ with LayerLock technology shingles, Lifetime manufacturer warranted architectural shingles to roof area according to manufacturer's specifications. • Color- Barkwood. • ' Includes a GAF"System Plus" limited warranty which gives you 100%repair coverage for any defect in materials for a full 50 years non-prorated coverage. Also includes a Franzoso Roofing, Inc. 10 year workmanship warranty. • Note: GAF shingles to be installed using 6 nails per shingle to provide wind warranty with no maximum wind speed limit. • Roof to Wall Flashing: Re-Use existing step and apron flashing at roof meets wall locations. • Install Lifetime Vent Pipe Flashing:the Ultimate Pipe Flashing features premium silicone& UV stabilized molded PVC compression collar with Kynar PVDF coated 24 ga. galvanized sheet metal perimeter flashing. • Install new copper chimney flashings/counter-flashings. • Install GAF®Snow CountryTm ridge vent to existing ridge vent opening. • Install GAF®Timbertex'" ridge hips to peaks. • Inspect, remove and replace any rotten or damaged fascia with new 1x6 primed pine fascia 0$7.00, 1x8 0$9.00, 1 x1 0 @$10.00 or 1x12 0$12.00 per foot installed, only as necessary. • Repitch, rehang or tighten existing gutters,WITH NEW HIDDEN HARDWARE AND SCREWS. • Proper disposal of debris;complete site restoration. PehM�ri f1AMONXM9 Franzoso Contracting, Inc. 33 Croton Point Ave Croton On Hudson, NY 10520 Phone: (914) 271-4572 FRANZOSO Fax: (914) 271-8644 www.franzoso.com 14, i• � 1 ' _ GAF Fiberglass Asphalt Sliingle Specifications" APPROXIMAIL PHYSICAL ATTRIBUTES GOODr WARRAMY' HOUSEKEEPING o i 5taln (=_--_--__-� I���J�JJ]� s5 7 20 t.s• 17'x34%' cauieinl G1111't1 r ��-�F--i GStttAaffl�0 - -- =-==- s u0 as 6 191 o' Cd Counttyanson W ( Slain == .13 6 152 7.5' V'x40' o Grand Slates' (Guard �J���]JJ] a 1.u�ac:.trr.� I Stain I I )p 6 30 S' 17x 40' Urand Canyon' OUR Stain !' Grand Segnola Gllard'. - ------ �1 �7J]J t' 40 W II.VS.p.a of Camelot` 11 GSl1rl�i =-_:-------- /x t" Stain �.-_ —� o( Country Mansion II GuaC1ILLLLJJ- W W �— >W GrandSlate''ll Guarti " '° U. Stain ------------ �� ��JJJ]� Slateline Guard; Timberline°Ultra Illy'' Stain _-------- ��jjlJJJ]y „ <• s: 13; 1? Timberline®American Harvest", Stair _.__ I�j3I]J]] s. 135, It A: W z — - I&I °ArmorShield 11'"' Stain Guard Timberline Timberline°Coal Series vulaal � n--(�---^�--r� � � J] " 13v,.39:. I I 11.�IJ Thnherlineg HD" Gutaril� >,11WIiJJ 0 i" 5 13%'xZ. Thnborline-Natural Shadow" --- --"- s 11, 17'x36 AM,irntl u, w For the cunent speciricatlons on TwSfalo•,crlvcll is gerwine slate(not an asphalt shingle),visit en•nv.gal.can. Periodlc�iy tested by Independent and internal labs to ensure compliance with ASTf.1 0.T4B2 al hnw of tlwnulacture. NI=,,Ics vrilh a Lifetime lid.warranty,also have a 110 mph ednd warranty. Howaver,it tho shingles are(a)installed with six rtaile per shingle end(b)InslaNed using GAF starter ship txoducls installed at the ' -._•__ .__•-... -.-._- _.r...tw...."./....M...+-..M....•...i..�M�in•I,nlrnalgnC• l ccessory Paint COD'.:, SPE-CIAL IIFi �'rllfi' IIOt(' ?f6105'l i'I:A(IIRFS TLI ._ r •= u. g � K Ji - 4 C ■y G O G U U V U U U U ` G U 4U O U ti U v U u a r^ Accessary t'uhii- Will help to u • u r) U o u 0 o j hide unsicthlly protrusions on the roof, including vent pipes, exhausl w-111S, (Ind flclShIIKjS. 11fitltllul,l VS'EVAPI1,I11008 U U U U U 1 10 U Can Size: 12 oz. Cons Per Case: 6 Cases Per Pollet: 128 U O u U o U u v o u • .+ ii Bark%vood, Birchwood, Chorcoal, Dri(hvood, u U t: o cr o U u U Fox Hollow Gray, Hickory, Hunter Green, Mission Brown, Pewter Groy, Shakewood, Slofe, and Weathered Wood II U • O O u U tS U U u O U O O G O O U ') U O O O U o e v t• � „ v .) • • a Applies to somo plants(that make referenced product). '- - o Applies to while only, l� ----� •]Stecper slopes and maximum rind warranties ntay require more nails. Applies to product ao!d In Canada only. Application submitted and approval is pending. . AC i SEP - 9 2022 iD VILLAGE OF RYE BROOK BUILDING DEPARTMENT 1731/2 Ivy Hill Crescent Rye Brook. NY 10573 914-939-2440 .J September 7, 2022 Jean Follansbee 57 Greenway Circle Rye Brook, NY 10573 Re: Entire Roof Replacement Dear Jean Follansbee, The Architecture and Grounds Committee (A&G) has reviewed and approved 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_ Work on the project may not begin until you receive written notice of receipt of your permit 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 andror work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Property Manager �. ,d'v��. tK ^ •ik1 n� a d..� tr A ^r. ,r .A _4r.,w .itrx A �;h 4�v .,�,�.._�,�f�chTi'a7t},r k' 1 -s S!!Ik r•'!�.�A S`.n,tij 1}•�. r'1 '� Kv '�tS.Mw-4fJ .r+•U>,„^' '.' , ;� Y/i�h �7 1 � �/. ,�j(4�;,�� Y J"'`�_yny�.` �`R Y�'1�'ti(rA �� q,t4gM�•j ;�. � h S. vy� �.:Ar � OR Y r Gj r,� v:� ,'i '�:7�'+i^ I'?^' v a•,�,\i3'- sv :"8�y. .r t i'�'�'iavYtf ti r .1�'�y, '� �t'@�,S ,� .... . / t Y ♦ ri �. �•�♦ �t11 4•��� ; v i� r'� r 'b< � t/fs• v r�'s vy v `. ����s`�ct,,��,l��,� r;y� t#r '�')yt� <;�. ��b�I(1���+� � t i�itllii•{t; '� �! r I�t;i%'���a sr�,�� u�e��v`i,�s_'�1�� :•ii����� }<'tsi)�.L z�'�.♦�ai+t ��lk•11��.I1 lnt oia .11 �� _ �llyl/ f•. ':t`�1 1ll��r�,� _ / = E cl a log _ p_ ,y • ui toI AN v o- �' '��.-.-�,,•;';� pia '°m' z z r- U - � {� '� W z >' . faction z o Quo •L�, ! .;:: .. •.��. /�� fit/ �t _ °� ._ pie. � V LJ.. 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DATE(XI*fDWYYYY) AC R® CERTIFICATE OF LIABILITY INSURANCE oensr2622 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(les)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 g c Certificate Team ROBERT T.KIRKWCOD.INC. PHONE FA,a (814)789.8070 (914)769.4706 91 Washington Avenue ADDRESS: eeRifleates@kl+icwoodinsuranee.com INSURERM AFFORDING COVERAGE NACi Pleasantville NY 10570 INSURERA: Sutton Specialty Insurance CO. 16848 DISURED INSURERS: Franzos0 Roofing Inc. INSURER C: 33 Croton Point Avenue INSURER D. INSURER E: Croton On Hudson NY 10520 INSURER F COVERAGES CERTIFICATE NUMBER: 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 TOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA TYPE OF INSURANCE POLICY NUMBER �� OOArItw=u GENERAL LwuLRY EACH OCCURRENCE 1,�0,000 CWM34AADE ®OCCUR P q $ 300,000 MED EXP ora s 10,000 ISC01000000009-00 12/21/2021 12/21/2022 PERSONAL a A V 11UR1 s 11000.0w GerLAGGREGAn UMITAPPLIESPER. GENERAL AGGREGATE s 2.000.000 POLICY®� ❑LOC PRODUCTS-OOMP/OPAOO f 2,000,000 s OTHER AUTOMOBILE IJABIIJTY (Ea= NED SINGLE LI IT s ANY AUTO BODILY INJURY(Per pmw) i OWNED SCHEWLED BODILY DWRY Mw aedde d) f AUTOS ONLY AUTONOS HIRED �NED E : ALTOS ONLY q AUTOS ONLY I f UMBRELLAIJAB OCCUR EACH OCCURRENCE E1tCESi LWB HCLAMAS-MADE AGGREGATE DED I I RETENTION f -I OT4* S WORKERS COMPENSATION AND BIPLAYERV uAwLrry YIN ANY PROPRtETORfPAMER'EXECUT VE -1 NIA E.L.EACH ACCIDENT t OFFICERIMEMBER EXCLUDED? wwwwwry In►M E.L.DISEASE-EA EMPLOYEE S Eyes,d 1aa4be wMer DESCR[PRON OF OPERATIONS below E.L.DISEASE'POLICY LIIUT DESCRIPRON OF OPERATIONS I LOCATIONS/VEK=M(ACORD tot.Aditanal Remarks Sch We.maybe aeaelyd N moll epee Is rpobed) Village of Rye Brook Is additional Insurance under general liability per blanket endorsement as respects work performed at 57 Greenway Circle.Rye Brook, NY 1 D573. 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 A,. ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 41kN NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �. R A"^"^" 200742207 LOVELL SAFETY MGMT CO.,LLC 110 WILLIAM STREET 12FLR _ NEW YORK NY 10038 • ig . SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FRANZOSO ROOFING, INC. VILLAGE OF RYE BROOK 33 CROTON POINT AVENUE 938 KING STREET CROTON ON HUDSON NY 10520 RYE BROOK NY 10573 POLICY NUMBER CERTIF ICATE NUMBER POLICY PERIOD DATE Z2435 833-5 189067 01/01/2022 TO 01/01/2023 8/29/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2435 833-5, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/ANWW.NYSIF.COM/CERTICERTVAL.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 MARK FRANZOSO FRANZOSO ROOFING,INC. 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 SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 760501262 U-26.3