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HomeMy WebLinkAboutBP22-178PERMIT #k C>vc DATE. 7 EXP: a 7 SECTION 1354f 003 BLOCK LOT TYPE OF WORK Q fA) JOB LOCATION P 4ee7L OWNER ► /� �/ L Q�SC1t'�40 0 CONTRACTORC Q� e7LC EST. COST .ef��ic� _ FEE4 / — %/CO # 0 Lo FEE I DATE TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS O SPRINKLER ELECTRIC 0 LOW -VOLT ALARM C� AS BUILT FINAL OTHER APPROVALS ARB 3 O �t4 la C ic, C VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.iyebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Michael J. izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 4,2023 John Boctor&Basem Boctor 45 South Ridge Street Rye Brook,New York 10573 Re: 45 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 135.83-1-59 Building Permit#22-178 issued on 9/27/2022 for 6 New Replacement Windows This certifies that the six new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to .......D __...._--... Ct3 T, For glee us rIv: BUILD ? _ R`I'ii l✓I'r C PERh11T# —17c VLL c . 01� M'>. Rt)C)K IssuRn: _ _C DEC 2 2022 3 KING S1"RE ;`It 4'C: I3Rt?t)K, Y PORK 10573 DATE: c i r FL F;: PAID IC ,914) )3.)-llfibti VILLAGE OF RYE BROOKRr�. IB� 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 Address: Occupancy 1 Use: -3,twrrfi +Marcel ID#: t3 Lane: A-21—. � h Address: N Y Owner: �?tl `ri 15s a`c�rl " P.E./R.A, or Contractor: � Address: `' Person in responsible charge: . ,�..��4- Address: lC j(`' 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 WESTCIIESTER as: clNN v,* . r being duly sworn,deposes and says that he,she resides at S ' (No.acid Street) (Print amc Of Applicant) in r v-o k- ,in the County of in the State of + that (Cif,/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:S e� - 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 erectedicompleted 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 comp]ies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner b, .ase 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 /5 7V- Sworn to before me this-�2-nn day of ,L�CCe-wl IX r 520 day of l ( , 20 1 1 V% t4 .tgnature of Property Owner ,���` �N N O E�, �i� Si�matur.of Applicant a p 7 A ip y; C��� :'NO.oeNOSIsaora*•O` : Pt` ame of Property Owner �._. _ ' QUALIFIED IN q Print Name of Applicant - =U KINGS COUNTY Z COMM.�XP. i 'A '�9� VBL1G•• O�: Notary P ti 1116 ry Public �. �. ' y %% GR ORY M.RfVERA �� 0 Fr N E �.�` Nehry Public,State of New York k 1 No.01 R16441398 ') I Qualified In Westchester County Commission Expires September 26,2 �E DRC�v� 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 - - - - - - - - - - - - - - - - - - - � � 5 � � � \ -1.2o� ADDRESS : DATE.. 4 PERMIT#��� I ISSUED: SECT: LOCK: LOT: ' LOCATION: �J \ `��'�J b 1� "`—'\� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ElREJECTED/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 z 00 CPS ON V1 0 VI a o Ey I CU e M a °~' p to • 00 O Y ■ '� � O oo z .° w a NLn o moo x 41 "grON co O • V GO � �+ p �p v +° y w° � s O W Vr W —03 N O O v PLO e W ICI G; h�•i .�� CA en O z '000w ,�'I o 1:1 a. uu z cn CZ au' vw , oc4ftwft4p, H F. O � �wo . 43 H _ A v � � � a � U "A u W '�„� Cn A z O av� g xi r" ,Ln A z W W ,� a � , � a " a a W 0 � BUILD �D_ TMENT r VIL OF R OOK 938 KING T RYE BR ,NY 10573 � .14)939-0 SEP 2 a 2022 ; !' .i VILLAGE OF RYE BROOK BUILDING DEPARTMEWT'_J ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REOGIRF VILLAGE ARCHITECTURAL REVIEW BOARD APPRO\ :%I. FOR OFFICE USE ONLY: -745DOL \ � APPROVAL DATE: ---PERMIT M -Z 79 APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: ©�'H.O.A. APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: is hereby made to the Building Inspector of the Village ofRye 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: LAS �l c C' QQ 2. Parcel ID#: � ts S - - Zone: r 3. Proposed Improvement(Describe in detail): 1��� G�`cc ��C'C_ �Q 4. Property Owner: Address: -"( Phone# ot1`{ -g Cell# e-mail �'a� l�J h��~t -C" List All Other Properties Owned in Rye Brook: Applicant: GLV,\- �C r r�t Address: to s� �y� ��c� UA. 1- Phone# 3 03 V -g(O$S�_ Cell# e-mail C*('✓1 Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: tC 'tL CA. Address: a ouss P L'-t e-S �c ��-�-8- ►� 3 33 Phone# 3c-�'-Ci t. ko -8(0&19 Cell# e-mail rvt t t-4� (11 81112021 5. Occupancy; (1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: VA 6` I Post-construction: "."` '—V,` I 6. Area of lot: Square feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: lefl side yard: other: 8. If building is located on a comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I ,fl: 2"d fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions, total square footage added: Basement: 1 St fl: 21'fl: 3'd 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]: ( )Pre-engineered wood[PW]; Located;O Floor Framing[F];O Roof Framing[R];( )Floor& Roof Framing [FR]: Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full, or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System, FM-200 System.Type 1 Hood, etc...)Yes:_No: (dyes.applicant must submit a separate Automatic Fire Suppression Svstem 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: N1 Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (i(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: Y (ifyes. 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)es, 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: (if ves, the area and elevations of theflood 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: `c (if yes, applicant must submit a Tree Removal Permit Application) 29. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: �` Indicate: TIER I: TIER II: TIER Ill: (if yes,a Nome Occupation Permit Application is required) 29. What is the total estimated cost of construction: S �SC� Note:estimated cost shall include all site improvements, labor, material,scaffolding,fixed equipment,professional fees, including any material and labor which mqv he 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: of y t 8/12/2021 BUILD�✓ MENT VILL' E OF RY OOK 938 KINGJET RYE BR ,NY 10573 a 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: 31, �d�. +r1c C , residing at, �-�S S - ` CJ' C . {Piint name) (Address vsli � ui li�et being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Rye Brook. NY. flab 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. ifI'rnp�ot. � _ Jok Qc,�Dr (f'r.:n I'nqierh t)Wner(slt %����� Sworn to before me thisNO.e+Noe+sAo�iw, - _ QUALIFIED IN % / Z = U KINGS GO{INTY da Of Y , ZO GOMM EX'� / A. w (\r,tarr 1 ubhi fit? ' i�rr F rr IInnnN (3) 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: 3a I--%-�— C , 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 e�er��4-- for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney.e1c.) 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 stor mwater 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�Z day of , 20 tgnature of Property Owner Signature of Applicant JO hn ,�cior Print Name of Property Owner Print Name of Applicant otary Public Notary Public .0 N O O Tq Q NO.DIN G8164074 1n QUALIFIED IN V ' BC U TY Z IG MM.EXP. I ;r '��A iOb8 L lG.•{0 -. � 11,11111110 (4) 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. •k%*****************}****fir}*****************************},p**Ir}**rlc******#*****#*#********#*####*#**$******** STATE OF NEW YORK,COUTiTY OF WESTCHESTER ) as: ,being duly sworn, deposes and states that he/she is the applicant above named, Iprini nano 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 ahlilIcation. i indic:nte 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. S%vurn to before me this Swom to before me this ZV day of , 20 day of Sep Ytm X✓ , 20 2 Jl 5irnattu•c ol'Property Owner Si nature f Applit tint J- Print Name of Property Owner Print Narne of Applicant NMar Public ` Nolan, Public !' SHARON A. STRAIN Notary Public,State of Connecticut My Colntnission Expires Dec.31,2024 I (4) x i?.�oTl Home Improvement Agreement: Page 1 Home Depot License#'s - For the most current listing visit www.Homedepot.com/LicenseNumbers Rocco Deleo Salesperson Name Registration#(Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. 1. Service Provider Contact Information The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (914) 347-6900 customercancellationnortheast@hom Phone # R M i vider Email Address Service Provider License #(s) 2. Customer Information Boctor John Westchester F28190772 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 45 South Ridge Street (Port Chester i INY 10573 Customer Address City State Zip 914 320 7318 (914) 525-8215 jbfx21@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 6 Skyline Drive Hawthorne NY 10532 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: 09/17/2022 Customer's Signature Date 460 Standard Form HIA(21 Jul.21)(E) Generated Date 0911719099 Lead/PO# F 9 p 19R7 Z2 V °1 12 Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 03/16/2023 Approximate Finish Date: oa/15/2023 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have ss o a puter that can receive and open emails and PDF documents. 7. Contract Price and Pa ent Schedule Payment of the Contr Price is due upon signin unless a different payment schedule is required by law, specified below or in a pay nt addendum. % Contract Price: $ 5592.27 ncludes all applicable taxes. Excludes finance charges.* Sales Tax: $ o (If applicable,total amount of taxes included in Contract Price) *Maximum deposit ONLY applicable in MD, MA,ME(3391o),.NJ, WI(99%) Deposit% 125.0 Deposit Amount$ 11398.07 71 Remaining Balance $ 4194.2 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9. Acceptance and Authorization ` By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting informatio nee rovided to You later.)By signing,you acknowledge that: (i)You have read,understand, and ac t this A eement in rts a including the General Conditions and State Supplement, if any; (ii) You are r eiving a complete copy of this Agre ent; (iii) all rights and interests under this Agreement are solely vested in a person listed as"Customer" above; an iv)Electronic signatures will be deemed originals for all purposes. 09/17/2022 Customer's Signature Date /s/The Home Depot 09/17/2022 he Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (914) For any other concerns, contact The Home Depot at 1-800-466-3337 460 Standard Form HIA(2)Jul.21)(E) Generated Date C)q/17/2r71 2 2 Lead/PO# F 9 R 1 qn 7 7 2 " WINDOW SPECIFICATION SHEET - Spec.Sheet N:F28190772 Sheet:1 of 1 Customer:John Boctor ,Job#:F28190772 Consultant: Rocco Date. Date: 09/17/2027 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor OpBons From outside, Loh to Right Bays.Bows Location Color Rough Opening I of bars N of bars Csmnts,1 Pnl, use L,R or S Glass Hardware Mis;Items Screens CoOe For doors use _ g Mull "S"=stationary or wTP� FWr style wraps cw x_operatag E Code (YIN) Style Code Series Code MULL,STD,White, WRAP.LSR 1 LIV 1st DH- Y DH 6100 WH WH 28 48 76 F, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard HITILT G8G H MULL,STD,White, WRAP,LSR 2 LIV 1st DH- Y PW 6100 WH WH 59 48 107 GlassPack:Standard HITILT STD,White,GlassPack:WRAP,LSR 3 LIV 1st DH- Y DH 6100 WH WH 28 48 76 F, WH,W C ALL 2 1 ALL 2 1 Standard HITILT GBG H MULL,STD,White, WRAP.LSR 4 LIV 2nd DH- Y DH 6100 WH WH 28 46 74 F, WHW C ALL 2 1 ALL 2 1 Gill a ssPack:Standard HITILT GBG H MULL,STD,White, WRAP.LSR 5 LIV 2nd DII- Y PW 6100 WH WH 59 46 105 GlassPack:Standard HITILT STD,White,GlassPack:WRAP,LSR 6 LIV 2nd DH- Y DH 6100 WH WH 28 46 74 F, WH,W C ALL 2 1 ALL 2 1 Standard HITILT GBG H SPECIAL CONSIDERATIONS: 1.White,2:White,3:White,4:White,5:White,6:White Wrap Color nterior Casing Type Bay or Bow window: alboard matenal(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Flanker Type(DH,SH,or C-0 op of window to soffit(inches) I tied to soffit,color of soffit material I have reviewed and agree with all the lob specifications above and the anslruct Roof(Yes or No)- Spada]Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Pionite,Birch or Oak) Home, Depot - Thermal Value ts Manufactured by irrionton v V1Ciih� rids i r Yi Ip�SV� lot 71 h' g 6.5,00 E3ase ProSolar Supercept 7/8rr 026 0.�3 , v 9:: .� q> `:Casement 4 0o ease Pro,Solar SuperceRt 71,8 A.9 , 0 2 e r e ':oY Q s, •� p s Transom . .. 5P•0,r3as@:: ,. 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V) roll (��{ffiissDi�; "",yp • � � }n� z � co O ` r : , . +-► �Q�y ,fin} o ��,� ♦ kection f1 \� s X+ tr1 V l r•1 I .1 O p � Yj p � Q o •� u, °''�liJte Q �ey � ' yam. �>,, TZ 00 qj co Is WVA � U v dap.' � �4s.►_�` ��' � (� 't. \�2(bnplF} aa-eft.►► :�j'+4f ► ;q�^N.i.:'.l+{�t}+1L♦�{,''`4T+1;hI'�RP$["t.':�.pi�a>.. .`�em$ � As,E'4.I ` '.1R, � �7t'�f'�!t.B i•�,';nII� ? iJ, y , if K \ r rf �!`ft Ji.1+rJ,ems. t.- ,�l''•vlt Vi4�5� � V.;�+ �;+�V i��,c� .��� \, t,('! �+f�Y ti f11 �,Yr„Y�y\,7° •�L f V p' Y�V \ '� ' 1 ® DATE(MMIDD/YYYY) ACOOORO CERTIFICATE OF LIABILITY INSURANCE 0310112022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 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 MARSH USA,INC. NAME: PHONE FAX TWO ALLIANCE CENTER c No Ext: C No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# CN101642069-HomeD-GAW.-22-25 INSURER A: Old Republic Insurance Co 24147 INSURED INSURER B: New Hampshire InCo 23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C: ACE AmeriCan InSuranCe CoMpany 22667 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004348037-16 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER MO DDY EYY M DD FF POLICY E XP LTR YY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY316648 03/0112022 03/01/202S EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence $ 1,000,000 X SIR:81,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER: $ A AUTOMOBILE LIABILITY MWTB316649 03/01/2022 03/01/2025 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO SELF INSURED AUTO PHY DMG BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A UMBRELLA LIAB X OCCUR MWZX 316647 03/01/2022 03/01/2025 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION WC 065886029(WI) 03/01/2022 0310112023 X STATUTE ER H AND EMPLOYERS'LIABILITY C ANYPROPRIETOR/PARTNER/EXECUTIVE NIA Y/N WLR C68916409(AZ,IL) 03/01/2022 03/01/2023 E.L.EACH ACCIDENT $ 5,000,000 OFFICER/MEMBER EXCLUDED? N❑ Confinued on Additional Page E.L.DISEASE-EA EMPLOYEE $ 5,000,000 (Mandatory in NH) 9 If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. �1 :�� ZLSTr m 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD IN W Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured Home Depot USA, Inc. 770-433-8211 2455 Paces Ferry Rd.,C-20 Atlanta,GA 30339 1c. NYS Unemployment Insurance Employer Registration Number of Insured 76011130 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State, i.e., a Wrap-Up Policy) Number 58-1853319 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) AIU Insurance Co. 3b. Policy Number of Entity Listed in Box"1 a" WC 065886028 Village of Rye Brook 938 King St 3c. Policy effective period Rye Brook, NY 10573 03/01/2022 to 03/01/2023 3d.The Proprietor, Partners or Executive Officers are ✓� included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) Approved by: P4 April 05, 2022 (Signature) (Date) Title: C.E.O. North America Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov