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HomeMy WebLinkAboutBP22-197It:9IT fI SECTION TYPE OF WORK 10B LOCATION. CONTRACTOR T. COST +� CO # TCO # /oa�maImm OX /o i� a BLOCK LOT ` S re ee?7 7i- owl / / , 11 % 00% ,./� "y%q•3%%- FEES _ FEES I l_i�'' �6 DATE J FEE DATE INSPECTION RECO i DATE i NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT C� ALARM AS BUILT FINAL ,jo,,C/c, `P C) -3 /61 �3 OTHER APPROVALS I, ARB BOT PB ZBA OTHER C�4.b j Vv V G VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 17,2023 Mindy Wolman 168 Ivy Hill Lane Rye Brook,New York 10573 Re: 168 Ivy Hill Lane, Rye Brook,New York 10573 Parcel ID#: 129.76-1-45 Building Permit#22-197 issued on 10/18/2022 for Replacement Windows This certifies that the six new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, /9,4e; Steven E. Fews Building& Fire Inspector /to BUILDING DEPARTMENT PERMfT# a-d—/q EMAR 2 4 2023 VILLAGE OF RYE BROOK ISSUED: 1 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: . Q V-a3 VILLAGE OF RYE BROOK (914)939-0668 FEE: & /JQ-- PAID-O BUILDING DEPARTMENT ��wv�.ryebrook.or(_, APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION sr+r+rssstrtstrssssss+•+ss+++r+s+rstsssssssss++tst+rsrsssssttssa rssartrt+t+s++++tsrststssss++rrr+rssssrsrssssss++++ssrs+ss++t Address: 168 Ivy Hill Lane , Rye Brook NY 10573 Occupancy/Use: 1-Fam Parcel ID#: 129.76-1-45 Zone: Ms � Owner: Mindy Wolman Address: 168 Ivy Hill Lane Rye Brook NY 10573 P.E./R.A. or Contractor: Fairchester Custom Windows Address: 2041 West Main Street, Stamford CT 06902 Person in responsible charge: Kat Wood Address: 2041 West Main Street, Stamford CT 06902 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: Mindy Wolman being duly sworn,deposes and says that he/she resides at 168 Ivy Hill Lane (Print Name of Applicant) (No andStreei) in Rye Brook in the County of Westchester in the State of New York that lC�t� lnun �'�Il:r_ii 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 19,377 for the construction oralteration of: Installation of Replacement Windows into existing Openings with no Structural Alterations 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 /7 Sworn to before me this 6 day of r , 20 23 day of m 4r-C4t- , 20 g ature of Property Owner nature ot Applicant Mindy Wolman Kat wood Print Name of Propertv Owner Print Name of Applicant FRANKLIN E. BARAHONA Note ry Notary Public, State of Connecticut NotaryPub i --�- My Commission Expires Dec 31, 2027 E BR(�,�. cu � • �9a2 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. 7 PERMIT# V ISSUED: 1u `� SECT: BLOCK: LOT: LOCATION: C-� 1 I�Q J �\ P r" � w `✓ OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED 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 s ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL A OTHER M y • w N ado -o H o W C14r, > 6 aui �I „ � a :J r F Z LT. O Ln C.) � p y Ln C of �0 4 ? �f yc rl i O en ll la'a'a i a Y w3 8 c 3 x � y O O � � z z A A � � fit w � w O � � „� � r✓ L R ,F � Qr W °° a w ► ° °' W M �= C U en O M W ow E -0 ab ICI Z ^ A v OMZ E f � C W a W v to f 00 Urr) v' A } 1 u o c alla, j� +�-+ W z ° n 0 � up N H H F, Z p Na `o R :, a p on ,� � < 0-4 ►� � U 0 U U t � A W N w a a w ■ ■ W rT � td Q y L ■ o a W p �, o ti Mh� to114 W M � a ti oLn u ° o © W W ■ ' orl a v� � Q Z Q W M I14 � ° 3 � °'b p CD) U 9zb � � a w N c � � LnQ � en 04 co o �zo � co00 E � O p w o 0*4 c°� Z °' b � o rn v p y z en 11 o X O W w u .c v '� W cn v' ;, v 3 0 H W U W O a 4, o '� ca r h~ 0 " -.0 c)Z Lx� �7, . %-. a O z iLi v O M� v y� u z : D E C E o r� � BUILDING DEPARTMENT VILLE OF RYE BROOK OCT 1 3 2a22 938 KING STREET RYE BROOK,NY 10573 '--- - BROOK - (914)939-0668 VILLAGEE OF RYE B t� BUILDING DEPARTMENT www.rve roolc,oru �9f32 ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: A f APPROVAL DATE: 4 202 PERMIT# -A`W ! 7 APPLICATION FEE: �+ APPROVAL SIGNATURE: PERMIT FEES: H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: k D!S jD0 oI11c_;1, 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: t cos I / Lame-- 2. Parcel ID#: AD / 'r/— 5— Zone: u 3. Proposed Improvement(Describe in detail): r\5 \ 5 ?fit Strom�.-yCL\ Cam.\k-e--c a.�A On S _ - 4. Property Owner: W 01 Address: I t — 1 l V V t LCk__n C__ Phone# Svj-c�1 tj - 33 (p Cell# e-mail W)iO d,I k_. Imam ck(osS•ne. List All Other +Properties Owned in Rye Brook: Applicant: Address:alqk W kQIQ . Phone# a03 4M 05%�S Cell 190_� `t�d_1 e-mail &I ,o,:,c)cj12 tC tJQsoa\Qc,e Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: S+rt(11 _� _'� r- _ Address: QC� S'"\ W Nkc>-i (� ne_e� -c, o_a C�t Q CLC�0vim � / Phone#�D3 -4()(P - DS-4S Cell# ao3 `Jew 318 I e-mail�o(Q' - W r bCi uae f.c©�" rl� 8/12/2021 5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: - Y`^ Post-construction: 6. Area of lot: Square feet: a t-1'9 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 corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 11,fl: 21 fl: 3Td fl: 10. Total Square Footage of the proposed new construction: IL For additions,total square footage added: Basement: 1"fl: 2nd fl: 3rd 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];O Wood Truss[TT]; ()Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing f 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: 17. What material is the exterior finish: V4 C) ' 18. Roof style;peaked,hip,mansard,shed,etc: Roofing material: oLSQ0-\C'�.-�- 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,ANSI System,FM-200 System,Type I Hood,etc...)Yes:_No:_X (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 gf impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:_Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No:_12�:L (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:AC— (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: (if yes,1he 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:W1 Indicate;TIER I: TIER It: TIER[II: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ (p . Q-1 - a�� Note:estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees, including ary 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 CIO. 30. Estimated date of completion: u 1--)o0A-3 (2) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK RFOCT 13 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wyyw.ryebrook.org 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: t rook 4 . W O n , residing at, l ti —f V y 14► 11 l4 V 14 . I�y,r 8(W A,:, .Addis�N fO 1.IM 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; �1 (t 7J:v L, 1 4r; I I Ld n e ' , Rye Brook,NY. 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. V "V r� (Print Name Sworn to before me this *ay 20 �ub{i;i 8/1 212 02 1 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. 5TME OF NEW YORK,COUNTY OF WESTCHESTER ) as: } of '._>-)0C) Q ,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 Cc�'EY,A r Cj�_C_+'c) r 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 p� Sworn to before me this day of �PAA,&r_-2O day of OCT , 20 OZ— sequYe7Woperty Owner Signature of Applicant Print Name of Pro rty Owner Print Name of Applicant Plyr,4r - Notary Public N Public (4) 8/12/2021 BUILD;RB MENT p Q V IF VIL E OOK 938 KING ET ,NY 10573 APR 21 2023 4 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: `1 Approval Date: MAY Per 't# d Application# Approval Signature: : ARCHITECTURAL REVIEW BOARD: Disapproved: = Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Amendment Fee: Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: March 6,2023 is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. Job Address: 168 IvyHill Lane,Rye Brook NY 10573 Existing Permit#: BP 22-197 2. Parcel ID#: 129-76-1-45 Zone: R-3 Original Approval Date: 10/18/2023 3. Proposed Amendment(Describe in detail): Installation of(1)Replacement Window into Existing Opening with NO Structural Alterations. Same Specs as previous window.see attachment. 4. Property Owner: Mindy Wolman Address: 168 Ivy Hill Ln, Rye Brook NY 10573 Phone# 917-974--3346 Cell# 917-974--3346 e-mail mindywolman*access.net Applicant. Kat Wood/ FairChester Custom Windows dba Renewal by Andersen Address: 2041 West Main Street, Stamford CT 06902 Phone# 203.406.0545 Cell# 203.482.3181 e-mail Perm itsnRBAWestchester.com Architect/Engineer: n/a Address: Phone# Cell# e-mail 5. Occupancy;(I-Fam.,2-Fam.,Comm.,etc...)Prior to construction: I-Fam After construction: 1-Fam 6. Will the proposed amendment 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: X (if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes:_No: X Area: 1 8/12/2021 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: X (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment 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) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: X (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: X (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No: X (ifyes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X Ifyes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so,provide such additional footage here. n/a (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 1,708 t ,b'1S 7c)— (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y.State Construction Classification: N.Y.State Use Classification: 17. Estimated date of completion: 5/20/2023 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: Kat Wood , 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 Contractor 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. j Sworn to before me this C1 7'/1 Sworn to before me this day of 0 73 day of R�'al� ,20 23 S4!�6re of Prope Owner tgnature of Applicant Mindy Holman Kat N ood _ Pti�rira>�ttiGlNrq�ptf1lsoez Print Name of Applicant rloiary" b,. -;3ANKLIN E. BARAHONA No Public, State of Connecticut FRANKLIN E. BARAHONA Fission Expires Dec 31, 2027 Notary Public, State of Connecticut My Commission Expires Dec 31, 2027 8/12/2021 �� Itemized Order Receipt ,M DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Mindy Wolman RENEWAL N� _ L Legal Name:Fairchester Custom Windows LLC 168 Ivy Hill Ln R EN E WA L CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook,NY 10573 bYAruivnn..m.eoow SEN 2041 West Main Street I Stamford,CT 06902 H:(917)974-3346 Phone:203-406-0545 Fax:203-406-0828 1 salesOrbawestchester.com ROOM: SIZE: DETAILS: PRICE: 0 W Misc, Misc, Permit Fees, Town of Rye Brook- Estimated 0 H Permit Fees, Renewal by Andersen will faciliate the application of the building permit to the Town of Rye Brook. Homeowner is responsible for any outstanding permit applications or code violations that may prevent Renewal by Andersen from procuring permit. Renewal by Andersen is not responsible for any historical or architectural review applications and approvals that may be required as pre- requisite for a building permit. 0 W Misc, Misc, Miscellaneous Job Items, Miscellaneous, Window 0 H Opening Control Credit 200 Bathroom Tub 35 W Window, Gliding, Double, 1:1, Active / Passive, Base Frame. 23 H Exterior Terratone, Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / - 40, Glass, All Sash: High Performance, Obscure, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, None WINDOWS: 1 PATIO DOORS: 0 ENTRY DOORS:0 SPECIALTY: 0 MISC: 2 TOTAL $1,708 -'RRr Renewal by Andersen is committed to our customers'safery by complying with the rules and lead-safe work practices specified by the EPA. 02/24/23 Page 3/ 32 RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance (continued) Renewal byAndersen'O U-Factor(BTU/(hr ft2 oF))' Solar Heat Gain Coeff icient(SHGC)2 Product Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4® Full Divided Light Grilles 0.34 0.31 0.28 0.28 Low-E41'Sun Without Grilles 0.33 0.30 0.19 0.19 .40 r• Double-Hung Full Divided Light Grilles 0.35 0.31 0.18 0.17 (Full Frame) Low-E41'SmartSunTM Without Grilles 0.33 0.29 0.21 0.21 .65 Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E41SmartSun Without Grilles 0.28 0.25 0.20 0.20 .63 with HeatLock® Full Divided Light Grilles 0.28 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with Without Grilles n/a n/a n/a n/a n/a SmartSun"" Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4® Full Divided Light Grilles 0.35 0.31 0.28 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4®Sun Full Divided Light Grilles 0.35 0.31 0.18 0.18 D•Double-Hung (Insert Frame) Low-E48SmartSunt" Without Grilles 0.33 0.29 0.21 0.21 .65 Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E41SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLock® Full Divided Light Grilles 0.27 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with Without Grilles n/a n/a n/a n/a n/a SmartSunt"' Without Grilles 0.47 0.45 0.59 0.59 .82 Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 Without Grilles 0.34 0.30 0.31 0.31 .72 Low-E4® Full Divided Light Grilles 0.35 0.32 0.29 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4®Sun Full Divided Light Grilles 0.35 0.32 0.18 0.18 ' Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E4®SmartSurP Full Divided Light Grilles 0.34 0.31 0.19 0.19 Low-E40SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLock® Full Divided Light Grilles 0.27 0.27 0.18 0.18 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.28 .47 Enhanced Triple pane with Without Grilles n/a 0.19 n/a 0.18 .43 SmartSun' 'Low-E4®SmartSun^,"Low-E40,'Low-M)Sun'and HeatLock(&are Andersen trademarks for'Low-E'glass. 1)U-Factor defines the amount of heat loss through the total unit in BTU/hr/ft2.*F.The lower the value,the less heat is lost through the entire product.Window values represent non-tempered glass.Use of tempered glass can increase U-Factor ratings.See andersenwindows.com/nfrc for specific performance values. 2)Solar Heat Gain Coefficient(SHGC)defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward.The lower the value,the less heat is transmitted through the product. 3)Visible Transmittance(VT)measures how much light comes through a product(glass and frame).The higher the value,from 0 to 1,the more daylight the product lets in over the product's total unit area.Visible Light Transmittance is measured over the 380 to 760 nanometer portion of the solar spectrum. •NFRC ratings are based on modeling by a third party agency as validated by an independent test lab in compliance with NFRC program and procedural requirements. •This data is accurate as of April 2021.Due to ongoing product changes,updated test results,or new industry standards or requirements,this data may change over time.Ratings are for sizes specified by NFRC for testing and certification.Ratings may vary depending on use of tempered glass,different grille opdons,glass with capillary breather tubes for high attitudes,etc."Low-E40,'Low-E40 SmartSun-"and'Low-E4®Sun" 09-10 COMPANY CONFIDENTIAL- REVISION AA-01 RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE AND TEST DATA NFRC Total Unit Performance (continued) High Performance Glass Type Without Grilles 0.44 0.42 0.61 0.61 .82 Clear Full Divided Light Grilles 0.45 0.43 0.55 0.55 Without Grilles 0.31 0.27 0.33 0.32 .72 Low-E4® Full Divided Light Grilles 0.32 0.28 0.29 0.29 Without Grilles 0.31 0.27 0.20 0.20 .40 Low-E411 Sun Full Divided Light Grilles 0.33 0.29 0.18 0.18 Picture (Full Frame) Low-E40SmartSunTM' Without Grilles 0.30 0.26 0.22 0.22 .65 Full Divided Light Grilles 0.32 0.28 0.20 0.20 Low-E41SmartSun Without Grilles 0.25 0.22 0.22 0.21 .63 with HeatLock® Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with Without Grilles n/a n/a n/a n/a n/a SmartSunTM' Without Grilles 0.45 0.43 0.64 0.64 .82 Clear Full Divided Light Grilles 0.46 0.44 0.57 0.57 Without Grilles 0.31 0.27 0.34 0.34 .72 Low-E4® Full Divided Light Grilles 0.33 0.29 0.31 0.31 Without Grilles 0.31 0.28 0.21 0.2 .40 Low-E4®Sun Picture Full Divided Light Grilles 0.33 0.29 0.19 0.19 llnse,l Frame, Low-E40SmartSunTM' Without Grilles 0.30 0.27 0.23 0.23 .65 Full Divided Light Grilles 0.32 0.28 0.21 0.21 Low-E41SmartSun Without Grilles 0.25 0.22 0.22 0.22 .63 with HeatLock® Full Divided Light Grilles 0.25 0.22 0.20 0.20 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with Without Grilles n/a n/a n/a n/a n/a SmartSunTM' / / / / / Without Grilles 0.44 0.42 0.61 0.61 0.82 Clear Full Divided Light Grilles 0.45 0.43 0.55 0.55 Without Grilles 0.31 0.27 0.33 0.32 0.72 Low-E4® Full Divided Light Grilles 0.32 0.28 0.29 0.29 Without Grilles 0.31 0.27 0.20 0.20 0.40 Low-E4®Sun Full Divided Light Grilles 0.33 0.29 0.18 0.18 Picture (Universal Frame) Without Grilles 0.30 0.26 0.22 0.22 0.65 Low-E4$SmartSunTM' Full Divided Light Grilles 0.32 0.28 0.20 0.20 Low-E4®SmartSun Without Grilles 0.25 0.22 0.22 0.21 0.63 with HeatLock® Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced Triple Pane Without Grilles n/a 0.16 n/a 0,30 .50 Enhanced Triple pane with Without Grilles n/a 0.16 n/a 0.20 .45 SmartSunTM' "Low-E4®SmartSun"•,'Low-E4®,"Low-E4®Sun-and HeatLock(D are Andersen trademarks for'Low E-glass. 1)u-Factor defines the amount of heat loss through the total unit in BTU/hr/ft2.°F.The lower the value,the less heat is lost through the entire product.Window values represent non-tempered glass.Use of tempered glass can increase U.Factor ratings. See andersenwindows.com/nfrc for specific performance values. 2)Solar Heat Gain Coefficient(SHGC)defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward,The lowerthe value,the less heat is transmitted through the product. 3)Visible Transmittance(VT)measures how much light comes through a product(glass and frame).The higher the value,from 0 to 1,the more daylightthe product lets in overthe product's total unit area.Visible Light Transmittance is measured over the 380 to 760 nanometer portion of the solar spectrum. "NFRC ratings are based on modeling by a third-parry agency as validated by an independent test lab in compliance with NFRC program and procedural requirements. •This data is accurate as of April 2021.Due to ongoing product changes,updated test results,or new industry standards or requirements,this data may change over time.Ratings are for sizes specified by NFRC for testing and certification.Ratings may vary depending on use of tempered glass,different grille options,glass with capillary breather tubes for high altitudes,etc."Low-E4®".'Low-E40 SmartSun-"and"Low-M Sun" 09-11 COMPANY CONFIDENTIAL- REVISION AA-01 r,riff 2, Agreement Document and Payment Terms DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Mindy Wolman RENEWAL Legal Name:Signature Exteriors/Vinylume Inc. 1681vy Hill Ln WC-27205-1-114,HIC0542457 Rye Brook,NY 10573 ANDERS_EK 4041 West Main Street I Stamford,CT 06902 H:(917)974-3346 Phone:203-406.0545 1 Fax:203-406-0828 sales@rbawestchester.com Mindy Wolman 09/07/22 BUYER(S)NAME CONTRACT DATE 168 Ivy Hill Ln, Rye Brook, NY 10573 (917)974-3346 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER mindywolman@access.net PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Signature Exteriors/Vinylume Inc.d/b/a Renewal By Andersen of Westchester and Fairfield County("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL JOB AMOUNT: $16,097 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DEPOSIT RECEIVED: $0 BALANCE DUE: $16,097 Estimated Start: Estimated Completion: 8048 8049 AMOUNT FINANCED: $16,097 We schedule installations based on the date of the signed contract and secondarily on the date METHOD OF PAYMENT: Financing in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. NOTES: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 09/10/2022 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, , WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Sam Paolini Mindy Wolman PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 09/07/22 Page 2 / 21 �� Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Mindy Wolman Legal Name:Signature Exteriors/Vinylume Inc. 168 Ivy Hill Ln RENEWAL WC-27205-1-114,HIC0542457 Rye Brook,NY 10573 byANDE_R.SEN 2041 West Main Street I Stamford,CT 06902 H:(917)974-3346 w,�n..a.�ba.nnrn Phone:203-406-0545 Fax:203.406-0828 1 sales@rbawestchester.com rROOM: SIZE: DETAILS: PRICE: 000 CONTRACT 0 W Misc, Misc, Miscellaneous Item, Miscellaneous, ***Contract 0 H contingent upon HOA approval and Village permit. Down payment will be fully refunded if HOA approval not obtained or if Village (Rye Brook) does not issue permit.*** 101 Dining Room 65 W Window, Gliding, Double, 1:1, Active / Passive, Base Frame, 44 H Exterior Terratone, Interior Terratone, Performance Calculator, PG Rating: 30 1 DP Rating: + 30 / - 30, Glass, All Sash: High Performance, No Pattern, Hardware, Stone, Window Opening Control Device, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, REMOVE METAL FRAME with existing exterior casing, Based on IF install. Add filler, Trim interior with stops to match finish of new window, Choice of ext. casing-PFJ, PVC, Fibrex Bkmld. Painting by others if needed. 102 Kitchen 55 W Window, Gliding, Double, 1:1, Active / Passive, Base Frame, 44 H Exterior Terratone, Interior Terratone, Performance Calculator, PG Rating: 30 1 DP Rating: + 30 / - 30, Glass, All Sash: High Performance, No Pattern, Hardware, Stone, Window Opening Control Device, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, REMOVE METAL FRAME with existing exterior casing, Based on IF install. Add filler, Trim interior with stops to match finish of new window, Choice of ext. casing-PFJ, PVC, Fibrex Bkmld. Painting by others if needed. 09/07/22 Page 3/ 21 A�= Itemized Order Receipt ® DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Mindy Wolman RENEWAL Legal Name: Signature Exteriors/Vinylume Inc. 168 Ivy Hill Ln WC-27205-1-114,HIC0542457 Rye Brook,NY 10573 byAND_ERSEN- 2041 West Main Street I Stamford,CT 06902 H:(917)974-3346 Phone:203-406-0545 1 Fax: 203-406-0828 1 sales@rbawestchester.com • ROOM: SIZE: DETAILS: PRICE: 200 Back Bedroom 94 W Window, Gliding, Double, 1:1, Active / Passive, Base Frame, 44 H Exterior Terratone, Interior Terratone, Performance Calculator, PG Rating: 35 1 DP Rating: + 35 / - 35, Glass, All Sash: High Performance, No Pattern, Hardware, Stone, Window Opening Control Device, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, REMOVE METAL FRAME with existing exterior casing, Based on IF install. Add filler, Trim interior with stops to match finish of new window, Choice of ext. casing-PFJ, PVC, Fibrex Bkmld. Painting by others if needed., 2nd Floor Elevation , Full Frame and metal rernoval Insert Frame 2nd Floor Elevation 201 Side Bedroom 65 W Window, Gliding, Double, 1:1, Active / Passive, Base Frame, 44 H Exterior Terratone, Interior Terratone, Performance Calculator, PG Rating: 30 1 DP Rating: + 30 / - 30, Glass, All Sash: High Performance, No Pattern, Hardware, Stone, Window Opening Control Device, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, REMOVE METAL FRAME with existing exterior casing, Based on IF install. Add filler, Trim interior with stops to match finish of new window, Choice of ext. casing-PFJ, PVC, Fibrex Bkmld. Painting by others if needed., 2nd Floor Elevation , Full Frame and metal removal Insert Frame 2nd Floor Elevation G9 07,22 Page 4/ 21 ANIFFA Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Mindy Woiman Legal Name:Signature Exteriors/Vinylume Inc. 168 Ivy Hill Ln RENEWAL WC-27205-1-114,HIC0542457 Rye Brook,NY 10573 bYAND�RSEK 2041 West Main Street I Stamford,CT 06902 H:(917)974-3346 Phone:203-406.0545 Fax:203-406.0828 1 sales@rbawestchester.com ROOM: SIZE: DETAILS: PRICE: 202 Front Office 55 W Window, Gliding, Double, 1:1, Active / Passive, Base Frame, 44 H Exterior Terratone, Interior Terratone, Performance Calculator, PG Rating: 30 1 DP Rating: + 30 / - 30, Glass, All Sash: High Performance, No Pattern, Hardware, Stone, Window Opening Control Device, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, REMOVE METAL FRAME with existing exterior casing, Based on IF install. Add filler, Trim interior with stops to match finish of new window, Choice of ext. casing-PFJ, PVC, Fibrex Bkmld. Painting by others if needed., 2nd Floor Elevation , Full Frame and metal removal Insert Frame 2nd Floor Elevation WINDOWS: S PATIO DOORS:0 ENTRY DOORS:0 SPECIALTY: 0 MISC: 1 TOTAL $16,097 Renewal by Andersen is committed to our customers'safery by complying with the rules and lead-safe work practices specified by the EPA. 09/07/22 Page 5 / 21 RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance (continued) Renewal by r Productr r r . ®' r r Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Low-E4 Without Grilles 0.33 0.30 0.31 0.31 .72 ' Full Divided Light Grilles 0.35 0.31 0.28 0.28 Low-E4"Sun Without Grilles 0.34 0.30 0.20 0.19 .40 Full Divided Light Grilles 0.35 0.31 0.18 0.18 Double-Hung D Without Grilles 0.33 0.29 0.21 0.21 .65 (insert Frame) Low-E41 SmartSunTM Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4�'SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLockT" Full Divided Light Grilles 0.27 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with SmartSunTM Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.47 0.45 0.59 0.59 .82 Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 t" rrillp�Low-E4�' 0.34 0.30 0.31 0.31 .72 Full Divided Light Grilles 0.35 0.32 0.29 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4,Sun Full Divided Light Grilles 0.35 0.32 0.18 0.18 r Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E4"SmartSunTM Full Divided Light Grilles 0.34 0.31 0.19 0.19 Low-E4"SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLockT'" Full Divided Light Grilles 0.27 0.27 0.18 0.18 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.28 .47 Enhanced Triple pane with SmartSunTM Without Grilles n/a 0.19 n/a 0.18 .43 Low-E4e SmartSunl,"Low-Eit ,"Low-E4 w)Sun"and HeatLock0 are Andersen trademarks for"Low-E"glass 1)U-Factordefines the amount of heat loss through the total unit in BTU/hr/ft2.°F.The lower the value,the less heat is lost through the entire product.Window values represent non-tempered glass.Use of tempered glass can increase U-Factor ratings.See andersenwindows.com/nfrc for specific performance values. 2)Solar Heat Gain Coefficient(SHGC)defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward.The lower the value,the less heat is transmitted through the product. 3)Visible Transmittance(VT)measures how much light comes through a product(glass and frame).The higher the value,from 0 to 1,the more daylight the product lets in over the product's total unit area.Visible Light Transmittance is measured over the 380 to 760 nanometer portion of the solar spectrum. •NFRC ratings are based on modeling by a third-party agency as validated by an independent test lab in compliance with NFRC program and procedural requirements. •This data is accurate as of April 2021.Due to ongoing product changes,updated test results,or new industry standards or requirements,this data may change over time.Ratings are for sizes specified by NFRC for testing and certification.Ratings may vary depending on use of tempered glass,different grille options,glass with capillary breather tubes for high altitudes,etc."Low-B .'Low-B@ SmartSun'"and"Low-E40O Sun' 09-11 COMPANY CONFIDENTIAL - REVISION AA-01 Laura Petersen From: Mindy G.Wolman <mindywolman@access.net> Sent: Friday, March 24, 2023 1:53 PM To: Laura Petersen Subject: Re: C/O Application - 168 Ivy Hill Lane Laura, Thank you. RBA apparently subbmitted a C of O listing the cost of six windows, even though sixth window is not yet on the permit and has not been done yet. I will forward you documentation re the cost. The breakdown is as follows: $16,097 - original contract $ 1,572 - increase in cost to change to white interiors on the windows $ 1,708 - cost of the sixth window $$1 Total for six windows 377 I have con acted the sales rep. He said that the office manager added it on to the open permit. I told him that it was not on the open permit and that the Village had not received anything re a sixth window, and he is following up on it and will get back to me. > 0, /moo/ Regards, Mindy CVS -7D Q C e/I P /VJd l2 IHO Mindy G.Wolman Law Office of Mindy Wolman 168 Ivy Hill Lane Rye Brook,New York 10573 !)e neCP tie y..Q , Email:mindvwolman(cpaccess.net �/ /Iy/ �4/-0 buill C,:7/I A)"14ti CCJM�Qt�5f Confidentiality Notice:This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above.If you are not the intended recipient,you are hereby notified that you have received this communication in error and that any review,disclosure, dissemination,distribution or copying of it or its contents is prohibited.If you have received this communication in error,please notify this office immediately by replying to this message and deleting it from your computer.Thank you. On 3/24/2023 1:36 PM, Laura Petersen wrote: Good afternoon, Please see the attached C/O application received by the Building Department. Thank you Laura i I 1 Building Permit Check List&Zoning Analysis Address: C a (y Y Ht L l- SBL: 7-f , ? l -4 -K— Zone: �- Use: Const.Type: Other. Submittal Date: '-11 Revisions Submittal Dates: Applicant: Nature of Work- Reviews:ZBA: 0 C T 14 2021 PB: BOT: Other. K ( ( ) FEES:Filing.�S '_� _BP: Z S' C/O: Flood Plane: Legalization: ( ) ( ) APP: Dated: / Notarized: SBL: -` Truss I.D. Cross Connection: H O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening. ( ) ( ) ENVIRO:Long Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival:- Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed Copies: Electronic: 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. O O 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 DENIAL LETTER. Other. ( ) ( ) Other. ( )ARB mtg. date: approval notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval:- notes: REQUIRED EXISTING PROPOSED NO D O C T 1 4 A� Date. Cir e: FsQII� 2022 1=L411TN Maui Cov Accs.Cov Ft.H/Sb: Sd.H/Sb: CZa Tot.Imp: .Imp pzkiw. Hc&/Stories: notes: .wry Y9h• ,•,� A , A. ,." ,yZ?' 'i'w A " i /1 •h: 00! ;. Y f �tA �'•� / 1ti Y/y r ytif{fr `t ti r �o O vA i{"}�q a tiro>n d r�'aiit'i rrr�•P�ih; �!!�'�il�i:,'ritrMNAl1'+"�iii,.rr,�p•�,ry €!`���F1 Fn,�1�•��t���r'�Il v�i ,R���•������ �11`�i�r:Cr�i�t�����h�r•,�1�d��ilir r;i� ih 1l1���•'i' �a(t>s)) - ':�_�III�/'�Ir1/._. - r..1{`!11..._.1a41'��_._ •_::111I,1'I�t_�... 'a�xs.ri,�l)11ir 1 1ti•�,I,f1�/fir.r t°::r_s��•:'1r11 I���als ._n:=\1111v1,i1�(•t=.,. �l<o)►�/ c .I*k LLJ N t = E c c o rn _ sy 0 Mom• C� U rO •L [] 1,.1._„ :•:� � LLI rr M.,� W O c ow C z o c R j Q�okection E �a.�)J►) \ ICU o LLJQ O haw fey : " .. = C14 XZ r `l irr-r pL<L E c t f..l c atss)►; `e u j � K @ ict y N :�r• ' �d A. N cif M fr al 4:. •;.:,,,i `, b _ CJ �'tom...'{ :..,•. / _ a tr I �ltass)► �>•l',E !F.•�;•, W. Al j 'y 4 \ �\•ram �; -�\ ,�'"t _\` ^` '� y /, FAIRCUS-01 TBRAND ACORO CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) `-� 9/26/20s/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 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 Theresa Brandon NAME: MBI Company Group LLC. PA/HONE EMI:(203)288-340 IFAX 1 280 State Street ,No): North Haven,CT 06473 ' .theresa.brandonOmbi-ins.com INSURERS AFFORDING COVERAGE NAIC! INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba: Renewal by Andersen INSURERC: Fairchester - 2041 West Main Street INSURERD: Stamford,CT 06902 INSURER E: 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 SUBR 18112 POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FXJ OCCUR X IS 2516791 a/12/2022 8M 21=3 DAMAGE TO RENTED $ 500,006 F rice)MED EXP An one person) $ 15,000 PERSONAL S ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 00 3,0 ,000 POLICY I� Jl JET X LOC PRODUCTS-COMP/OP AGG 3,WO,OW OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO IS 2516791 8/12/2022 8/12/2023 BODILY INJURY Per on OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident X AUTOS ONLY X AUTNOS ONLY accdent AMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE X S 2516791 8✓12/2022 8M2/2023 AGGREGATE $ 4'�'� DED I X I RETENTIONS 0 A WORKERS COMPENSATION X PER STATUTEX OTH- ANDEMPLOYERS'LIABILITY EIR YIN C 9099063 8112/2022 8M2/2023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/M�MBER EXCLUDED? NIA 500,000 ((MMlandatory n NH) E.L.DISEASE-EA EMPLOYE S Ifyes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more s ace is required) Village of Rye Brook is Additional Insured as required by written contract per the endorsements incluSed with this certificate. 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 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE,�, ,ft.Urt- 64K&I l ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workers' s r CERTIFICATE OF e Compensation Board NYS WORKERS COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Fairchester Custom Windows LLC. 203-406-0545 dba:Renewal by Andersen Fairchester 1c.NYS Unemployment Insurance Employer Registration Number of 2041 West Main Street Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 88-2855660 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1 a" 938 King Street Rye Brook,NY 10573 WC9099063 3c.Policy effective period 08/12/2022 to 08/12/2023 3d.The Proprietor,Partners or Executive Officers are X 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"3"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 certlflcate 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: Theresa Brandon (Print name of authorized representative or licensed agent of insurance carrier) Approved o7 0 (Signature) ate) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 203-288-3401 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