HomeMy WebLinkAboutBP22-179PERMIT # ��=��07- � /,.,� DATE: 7 ci7 c�a EXP: 9 �� a3
SECTION I' �� B/LOCK LOT
TYPE OF WORK � � / h LUi'I/� e./1 � �/ ✓4 C� Q,
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradburt
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
December 21,2022
Philippe Ledesma&Tonella Ledesma
7 Bell Place
Rye Brook,New York 10573
Re; 7 Bell Place,Rye Brook,New York 10573
Parcel ID##: 135.66-1-40
Building Permit#22-179 issued on 9/27/2022 For a New Fence
This certifies that the new six foot high white vinyl privacy fence along rear yard,installed under the above
captioned permit has been satisfactorily completed.
Sincerely,
Michael J. Izzo
Building&Fire Inspector
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BUILDING DEPARTMENT
VILLAGE OF RYF 1$ROOK M AUG 2 9 2022
938 KIN06'REET RYE BRoa ,NY 10573
(914)939-0668' VILLAGE OF RYE BROOK
www.rVebrook.org BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
SEP 2 2 20 2 �'Q�_f 7
Approval Date: Permit#� / Application# 75
Approval Signature: ARCHITECTURAL REVIEW
BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: ` J��� Permit Fees: too.
FENCE / WALL / GATE PERMIT APPLICATION
Application dated: -!-
D9 is hereby made to the Building Inspector of the V illage of Rye Brook,NY,for the issuance of a Permit
for the installation,constriction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of
Rye Brook,as per detailed statement described below,._Swim Swimming pool fences must conform to the State Code.
1. Job Address. 7 e iY � 1� - �7 //�K , �"f 0'5 7�
2. Occupancy/Use: l��� S.B.G.#: �3Silyf? -y�"70 Zone: —JO
3. Proposed Fence/Wall/Gate(describe in detail):
4. Property Owner:
Address: (b-5 7
Phone# g4L)I- qj j- j OLOO Cell# 6?(4 - 4(7i -1 V 10b email:
Applicant:
Address:
Phone# Cell# email:
Architect/Engineer:
Address:
Phone# Cell# email:
Contractor: I`1 - 7-�11Z,,d�
Address&Phone: (o Q ' 11U �[ �i Ol-4/'Qla, nPcAz i a71 O
5. If building is located on a corner lot,which street does it front on:
6. What is the estimated cost of construction A 3,)5 DO
(NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and
material and labor which may be donated gratis.)
7. Estimated date of completion: LP49— S2NV_All a;k Z& Ee:u �sr U" L a 0-ts)-
t
811212A21
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:
,being duly sworn, deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and f irtber 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,
Sworn to before me this 1 Sworn to before me this
day of L 0 _ , 20 day of , 20
i
Signature of Property e n( �� Signature of Applicant
Print Name of Pr6p-eYty Owner Print Name of Applicant
N_��,�
Notary Public Notary Public
SHARI MELILLO
Notary Public,State of New York
No.OIME6160063
Qualified In Westchester County,
Commission Expires January 29,20
2
811212021
D C L�O V E BUILDING DERA& MENT For office use onl
PERMIT#4W.
V OF RYE BROOK ISSUED: -a7-,Q9
DEC -6 2022 8 KING SIRE YE BROOK,NEw YORK 10573 DATE: -(p-
9 -0668 FEE: PAID
VILLEAPPLIRCATINONORIERTIFICATE
www.Akook-orii
BUI -
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
iiffiifiRRitRRiffi#tititf11Rii RttfRtftittitiiii##tif#n##iitfiiftiititiiii#iii#tfiiRifitittit►t#tRffftiffttftiitfifiifRiii#tRifi
Address: l� � -
Occupancy/Use: -rum/ L Parcel ID#: �(�(p -)—�d nnZone: /.-1 0
Owner: ?h t L L(23q5XO, Address': -7 G�Q l l 206Q, ice - QD6 k-!<5 1 57;
P.E./R.A. or Contractor:(')
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: jy
1 l - W(29W:2'being duly swom,deposes and says that he/she resides at -7
(Print Name of Applicant) o.and Street)
in ,in the County of LA in the State of V ,that
(City/ own/Village) LJ
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:$ 4 510D-°L7 1
for the construction or alteration of: LDil,S >✓�17 Q. V I N
Q
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 a ' Sworn to before me this
day of J 3 , 20 qa, day of , 20
Signature of Property Owner Signature of Applicant
an` �Q
Print N Print Name of Applicant
o bli SEPH SUNDREIM Notary Public
1NO�TARY PUBLIC,STATE OF NEW YORK
Registration No.OISU6151349
Qualified in
My Commission Expires '
�yE BR(��.
O� Zm
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: Z T: 6�BLOCK: LOT: 1
LOCATION: •(e), OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ '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
Building Permit Check List&Zoning Analysis
g/ Address: SBL
Zone Ij l Use: ::l( _Q Const.Type: Other.
Submittal Date: Revisions Submittal Dates:
Applicant: L E_C NA
Nature of Work: c� �,� L1���-/ �(af�/c, �VAC� �CF
Reviews:2BA: PB: BOT: Other.
OK
( ( ) FEES:Filing. ?S,/ BP: C/O: Flood Plane: Legalization:
( ) (� APP: Dated: --' Notarized: ✓ SBL ✓Truss I.D. Cross Connection: H.O.A.:
( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening.
( ) ( ) ENVIRO:Long. Short: Fees: N/A:
( ) ( ) SITE PLAN:Topo: S'te Protection S/W Mgmt.: Tree Plan: Other.
( ) GVEY:Dated �Z "Z Z Current ✓ Archival �ealed Unacceptable
LANS:Date tamped: Sealed: Copies:�Flectronir. ✓ Other.
( ( License: Workers Comp: ✓ Liability ✓ Comp.Waiver Other.
( ) ( ) CODE 753#: Dated: N/A:
( ) ( ) HIGH-VOLTAGE ELECTRICAL Plans: Permit: N/A: Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL Plans: Permit N/A Other.
( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other.
( ) ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other.
( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other.
( ) ( ) H.V.A.C.: Plans: Permit: N/A Other.
( ) ( ) FUEL TANK Plans: Permit: Fuel Type: Other.
( ) ( ) 2020 NY State ECCC: N/A: Other.
( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DE LETTER: Other.
G( ) ( ) Other
ARB mtg.date Z k Z Z approval• notes:
( )ZBA mtg. date: approval• notes:
( )PB mrg.date: approval:- notes: APPROVED
REQUIRED EXISTING PROPOSED NOTES
Date: SEP 2 2 2022
Circle:
Fmn e
Fmm,
Front
Sills:
R r.
Main Co
Accs.Cov
Ft.HS :
S . S
Tot,Imp:
EL Imp:
P
Hight/Stories:
notes:
BUILDING DEPARTMENT R \jg L�
VILLAGE OF RYE BROOK jD
938 KING STREET RYE BROOK,NY 10573 AUG 2 9 2022
(914)939-0668
www.ryebrook.org VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS
This form must be completed and signed by the applicant of record and a copy shall be
submitted to the Building Department prior to attending the ARB meeting. Applicants
failing to submit a copy of this check list will be removed from the ARB agenda.
Job Address: 7 oP=Qlk PJ001 Date of Submission:
Parcel ID#:�3�.�p�p��— l� Zone: C-/L7
Proposed Improvement(Describe in detail):
1 l APPLICANT CHECK LIST:
MusT BE COMPLETED BY THE APPLICANT
The following items must be submitted to the Building
Departme t by the applicant-no exceptions.
Property Owner: n 1. (�mpleted Application
11 2. ( wo(2) sets of sealed plans. (one full size {maximum
Address: "� kl CSC allowable plan size=36"x 42"} and one I 1"x17")
Phone#
(U5 7 3. (tfwo(2)copies of the property survey.
. t 4. ( )Two-(2)copies of the proposed site plan.
Applicant appearing before the Board: 5. ( ne electronic/disc copy of the complete
a cation materials.
LOX L-Q3aikka 6. ( Filing Fee.
Address: "7 l 7tajC-Q, 7. ( )Any supporting documentation.
Phone# Q 1 (p« 8. ( ) HOA approval letter. (if applicable)
4 ` 9. ( otographs.
Architect/Engineer: 10.( Samples of finishes/color chart. (a sample board or
Phone# model may be presented the night of the meeting)
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Sworn to before me this () -ttl Sworn to before me this
day of C ) , 20 )La, day of , 20
Signa of Property Owner Signature of Applicant
Print Nam f Pro Print Name of Applicant
ub c Notary Public
JOSEPH SUNDHEN-
lReswea"Na 01SU61500
My Caa>mdnion Ehpira
8/12/2021
BRnv� Village of Rye Brook
enda
„A Architectural Review Board Meeting
Wednesday,September 2t 2022 at 7:30 PM
Village Hall,938 Bing Street
1. ITEMS:
1.1. #5741 (Consent Agenda)Re-Appearance
Marilyn Ullman&Lena Vladsky
51 Greenway Lane&52 Greenway Lane
New Arbors standard design fencing.
1.2. #5753 (Consent Agenda)
Srikanth Ambati&Pranitha Mantrala
7 Talcott Road
Rooftop solar array.
1.3. #5754(Consent Agenda)
Marc Abramson&Erika Abramson
47 Hillandale Road
6'-0"high white vinyl fence in rear yard.
1.4. #5755 (Consent Agenda)
Matthew Byrnes&Helene Byrnes
7 Deer Run
New windows to facilitate interior bathroom renovation.
1.5. #5756 (Consent Agenda)
Philippe Ledesma&Tonella Ledesma
7 Bell Place
6'-0"high white vinyl privacy fence along rear yard.
1.6. #5757 (Consent Agenda)
Benjamin Tapper&Erica Tapper
4 Deer Run
Rooftop solar array.
1.7. #5767 (Consent Agenda)
Pawling Holdings LLC
261 North Ridge Street
New stone and clapboard siding.
1.8. #5768(Consent Agenda)
Ann Parkin&Jody Rasch
25 Hillandale Road
Rooftop solar array.
Page 1 of 4
1.9. #5769 (Consent Agenda)
Michael Rosenfeld&Afton Rosenfeld
56 Lincoln Avenue
4'-0"high aluminum fence along bridge.
1.10. #5771 (Consent Agenda)
Blake Silverman&Alexa Silverman
18 Milestone Road
4'-0"high fence in rear yard along BelleFair Boulevard and 4'-0"high fence in side yards.
Consent Agenda
Approvals: Motion — Second Abstention
Aye;�� Nay;_ Adjournment;
Notes
1.11. #5758
Blake Jacoby&Paula Jacoby
16 Elm Hill Drive
Rear deck and hot tub.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.12. #5759
Michael Seidenfeld&Daniella Schneider
5 Jacqueline Lane
Rear patio&retaining wall.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.13. #5760
Daniel Debari&Catherine Debari
11 Elm Hill Drive
One-story addition.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 2of4
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W C.LIC#10412-H99
Cips Fence Co. Inc.
d/b/a"KING FENCE"
Westchester • Rockland a Connecticut
48 Grassy Sprain Rd. Yonkers, N.Y. 10710 Phone: (914) 337-8700 a Fax.. (914)337-9131
The folbwmg is the Agreement between(or among)Cips Fence Cc Inc (d/bra King Fence? ("King Fence')and the customer(s)signing below(jointly and severally the
"Customer')and shall be effective upon signing by King Fence
PROPOSAL SUBMITTED TO CUSTOMER PHONE DATE
LEDESMA (914)417-1060 8/27/2022
STREET JOB NAME
7 BELL PL EMAIL LEDESMA.PHILOG MAIL.COM
Cily,state zip JOB LOCATION
RYE BROOK, N.Y. 10573
ESTIMATOR 1 JOB PHONE I JOB FAX
FRANK CIPRIANI
MATERIALS:
INSTALL AN APPROX 102' LINEAR FEET OF 6' FOOT
HIGH SOLID FULL PRIVACY WHITE VINYL FENCE...
ALL POSTS SHALL BE SET IN CEMENT
MATERIALS AND LABOR COSTS $3,500.00 PLUS TAX
** QUOTE ONLY GOOD FOR 10 DAYS DUE TO RAPIDLY INCREASING MATERIAL PRICES**
WARGESTO CUSTOM ERy PAYMENT TERMS,
The base charge for the work(including,without limitation,labor)and Specified materials shall be$__payment of which shall
be made as follow.
50%DEPOSIT AND BALANCE DUE UPON COMPLETION UNLESS OTHERWISE AGREED UPON SIGNING.
i,Title to Materials:
Until payment in full hereunder has been made to King Fences,all materials shall remain the property of and title thereto shall remain reserved and vested In King Fences.Kong Fences may,at
Its sole option,In the event of a default by Customer In any of its obligations to King Fences,remove any and all materials supplied by or on behalf of King Fences,notwithstanding,that the same
may be attached to or be part of the Subject Property(including/without limitation,the materials).The foregoing removal right is In addition to and not In substitution for any and all other rights
which King Fences may have at law,In equity,by contract or otherwise.
All materials supplied In accordance with the specifications set forth In th Is Agreement(the"Specified Materials")are guaranteed to be as specified In this Agreement All work to be performed
In accordance with this Agreement(the"Work")will be compsted In a workmanlike manner in accordance with standard practice.
Any alterations or deviations from the specifications contained In this Agreement will be subject to an additional charge to Customer war and above the amount specified In this Agreement.
Any specifications,estimates and completion times contained In this Agreement are subject to delay or cancellation by King Fences by reason of anything beyond the control of King Fences,
Including,with limitation,strikes,acaccidents,fires or acts of God.
CUSTOMER lou SPONSIRILITYr Customer agrees th&C
I.It shall located,Identify and clearly designate to King Fences the parameters of the property upon which the work is the subject of this Agreement to be done(the"Subject Property),and any
easements and underground cables,pipes and the like affecting the Subject Property and shall defend and hold King Fences harmless from any loss or liability(Including,without limitation,
attorneys few)arleing from cialms asserted against King Fences with respect to any of the foregoing;
2.It shall obtain permits,permissions(including,without limitation,permission from owners of property adjacent to the Subject Property(the"adjacent Property")to enter upon the Adjacent
Property)and variances In connection with the work;and
3.The proposal contalned herein Is based upon the express condition that all of the work can be completed without Interruption.Accordingly should the Customer cause or fall to prevent any
delays or Interruptlons In the work whether the same Is being done by King Fences,its employees or subcontractors,for any reason Including,without limitation,requests for changes a Inability
or failure to provide proper access to the Subject Property or the Adjacent Property,Customer agrees to pay additional charges covering any additional time and expenses Incurred by King
Fancas by any reason of the foregoing.
LATE PA1rMENT CNARGM
Customer agrees to pay late payment charges at the rate of 16%per annum on all amounts due hereunder more than thirty(30)days past the date of payment thereof
NON REFDNDARLE DEPOSITSr
S[CTIO NEAWIMISr The headings used here In are intended to be for convenlence of reference only and shall not define or limit the scope,extent or Intent or otherwise 3
a(fec[the meaning of any portion hereof:
Acceptance of proposal-Customer hereby accepts this proposal and agrees that all prlcet specrilcatlons,agreements and conditions contained herein are satisfactory
and agrees that the customershall be deemed a contract between Customer and King Fences.Customer hereby authatres King Fences to commence the work as speclhed in this proposal.
By: Title: Initial:
Customer's Date of Acceptance:
Agreed.Cips Fence Co.,Inc.d/b/a"KING FENCES"
By: FRANK CIPRIANI Title:PRESIDENT [nitial:_F.0
Agreed and Accepted.(if more then one customer,each Customer si atur ow hereby agrees to be jointly end severally
bound by this Agreement)?, r
Customer: r•1
Print Name: hl L
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/—sa"'111 CIPSFEN-01 LOLIVEIRA
. R CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY)
110
�� 5/10/210I2022
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 CT Liveen Nembhard
Ference Gray Insurance Brokerage,LLC PHHCONN
19 Mill Stree t ; 814 517$682 Ne:(814)686-0415
Port Chester,NY 10573 Imam
INSURE s AFFORDING COVERAGE NAIC 0
INSURER A:Erie Insurance Company 26263
INSURED -INSURERS:
CIPS Fence Co.Inc.dba King Fence
FRANK CIPRIANI INSURERC:
48 GRASSY SPRAIN ROAD INSURERD:
YONKERS,NY 10710 INSURERS:
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 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 TYPE OF INSURANCE ADDL SUa POLICY NUMBER POLICY EFF POLICY EXPLTR yYYYI LIMBS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
CLAIMS-MADE F_X]OCCUR 047-6950084 11/19/2021 11/19/12022 DAMAGE TO RENTED ISES(Ea occurrence) 1,000,000
MED EXP(Any one persoril 111 5,000
PERSONAL R ADV INJURY 11000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000
POLICY[J(jp& LOC PRODUCTS-COMP/OP AGG 210009000
OTHER
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
acciden
IxANY AUTO 011-6940010 11/19/2021 11/19/2022 BODILY INJURY Per erson
OWNED SCHEDULED
AUTOS ONLY X AUTOS BODILY
Ep BODILY INJURY r accident
AUTOS ONLY X AUTOS ONNLY sraaidsM AMAGE
A X UMBRELLA Lum JC OCCUR EACH OCCURRENCE 2 1,000,000
EXCESS LUW CLAIMS-MADE Q35-5170349 1IM12021 11/1/2022 AGGREGATE 1,000,000
DIED I X I RETENTIONS 10,000
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LL SILITY Y/N
ANY PROPRIIETgOERRIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT
OFFICE cry In NH)EXCLUDED? N A -
E.L.DISEASE-EA EMPLOYEE
If yea,describe under - -- ---
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 111H,AddWwal Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Village Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g y ACCORDANCE WITH THE POLICY PROVISIONS.
938 King Street
Rye Brook,NY 10573
AUTHORIZED REPRESENTATIVE
4LwUk'zf
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
l---I CERTIFICATE OF
NEW Workers' NY %AORKE:RS'COMPEi�SATiON INSURANCE COVERAGE
STATE Compensation
Board
Insured Detail
Ia.Legal.Name and address of Insured(Use street address only) th.Business Telephone`umber of Insured
Abel HR 11,Inc.L'C F Cips Fence Co,inc. 860-609-0400
48 Grassy Sprain Rd
Yonkers,NY 10710 lc.NYS Unemployment Insurance Employer
DBA:King Fence
Registration Number of Insured
id.Federal Employer identification Number of Insured
or Social SecurftN Number
134049913
Work Location of insured(Only required if coverage is specifically limited to
certain location in,New York State,i.e.a Wrap-E' Policy/
2.Name and.Address of the Entity Requesting Proof of Cos erage 3a.Name of insurance Carrier
(Entih Being Listed as the Certificate Bolden AmTntst Insurance Company
Village of Rye Brook 3b.Policy Number of entity listed in box"la":
938 King Street KWC1279902
Rye Brook,NY 10573
3c.Policy effective period:
3;1.2022 to 311/2023
3d.The Proprietor,Partners or Executive Officers are:
included i Onh check box if all parmem,officers included)
all excluded or certain partners/officers;excluded
This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"I 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
INFOR-NIATION 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 police'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)(hherwive,this Certificare 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 Worker%'
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 penalh of perjury,1 certify that 1 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: Matt Zender
;Pont name of authorized representative or licensed agent of.nsurancc cameo
Approved By: 5/10/2022
(Sipnaturcl (Date)
title Senior Vice President
Laura Petersen
From: Mike Izzo
Sent: Wednesday, September 21, 2022 2:59 PM
To: Laura Petersen; Steven Fews;Tara Orlando
Subject: FW: Message from UDig NY
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Wednesday, September 21, 2022 2:58:31 PM (UTC-05:00) Eastern Time (US & Canada)
To: Mike Izzo
Subject: Message from UDig NY
****REGULAR****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 09/21/2022 14:57
To: VIL RYE BROOK PRIMARY Transmitted: 09/21/2022 14:58 00005
Ticket: 09212-002-178-00 Type: Regular Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 7 To: Name: BELL PL
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: WORKING AT THE BACK YARD IN FRONT OF THE STOCKADE FENCE
NearSt: WILTON RD
Means of Excavation: UNKNOWN Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: N
Work Type: FENCE INSTALL
Estimated Work Complete Date: 10/24/2022 Depth of excavation:
Site dimensions: Length 103 FEET Width 10 INCHES Start Date and Time: 09/26/2022 07:00
Must Start By: 10/11/2022
------------------------------------------------------------------------------
Contact Name: PHIL LEDESMA
Company:
Addr1: 7 BELL PL Addr2:
City: RYE BROOK State: NY Zip: 10573
Phone: 914-417-1060 Fax:
Email: ledesma.phil@gmail.com
Field Contact: PHIL LEDESMA
Alt Phone: 914-417-1060
i
Working for: WORK TO BE PERFORMED BY: CONTRACTOR
------------------------------------------------------------------------------
Comments: CALLER ADVISED TO HAVE CONTRACTOR CALL UDIG NY
Lookup Type: PARCEL
------------------------------------------------------------------------------
Members: ALTICE USA CONED
SUEZ WTR WESTCHESTER VIL RYE BROOK
WESTCHESTER CTY SWR
2
Village of Rye Brook
0861061
roval Date:
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