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HomeMy WebLinkAboutRP22-049PERMIT # /-o�o� - 0 7 / DATE. I % e RUN s i i SECTION Z TYPE OF WORK JOB LOCATION OWNER �! c CONTRALTO /EST. COST Y CO #� 4z=x BLOCK *. LOT ,� i4oeoorl 1a/� /wr e 6r e gr t�i�e a,� )o/�S 3.&&6 3 C 7- 7Za/3 INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS L SPRINKLER ELECTRIC O LOWVOLT CI ALARM r7 AS BUILT O FINAL OTHER APPROVALS ARB BOT Pe ZBA OTHER 4� 0 �CL4�n� J V Y Lt4a V GG y'afiL 1./w J IX 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.or� TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 7,2023 Jacob Gebrael&Marleine Ishak 1 Hunter Drive Rye Brook,New York 10573 Re: 1 Hunter Drive,Rye Brook,New York 10573 Parcel ID#: 135.42-1-32 Roof Permit#22-049 issued on 11/17/2022 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building& Fire Inspector /to JAN 2 3 2023 BUILD MENT For office use only: PERMIT# �- '��/ 11 VIL OF RYE OK ISSUED: VILLAGE OF RYE BROOK 938 KING STRE YE BROOK, -15 YORK 10573 DATE:Z—�3 BUILDING DEPARTMENT 9 -0 0 FEE:,& //O— PAID$ 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 i##iii#t#t##4#ii#titt###fit i`it###iii#i###iitt#####ii#i#i####i###i#ii#i#####ti#iit!#iii#i#i###tii#ti#ii##!##i##ii##4#i#ii##t### Address: -} f r t ( LY r� Occupancy/Use:sm �`Q. Parcel ID#: 85,L42 - ( - 3 2 Zone: Owner: r[ k) (g ayyn Q ` Address: ll P.E./R.A.or Contractor: ( Address: L Person in responsible charge: Address: LCLAtw 'Roma 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 fNEW YORK,COUNTY OF WESTCHESTER as: A:Y�'-- Ca^MA--JZ - being duly sworn,deposes and says that he/she resides at0 CCIY ' �+ ame of Applicant) (No.and Street) in�Q 1�j D� � ,in the County of W n4cK-Q 4e-C in the State of ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ .c1 U • c R:) for the construction or alteration of: 1(7,y yp Q�1/ a Can I Q A o. 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 I 00% t I1 I r rr �.� I2A PqL ri,� Sworn to before me this Jture f 20 � �\\ � � ' �OF NEW y0 \` �` a ofJRHOU 20� 1 NOTAP' ,y$hjC of Property Owner {1� '""" / o (G\\ OttA6S47y0z / tureofApplicant i,JC0� \\ Print ame o rty Owner\ 'I-- p- STATE a f lic / F NEW YORK\\ I of Public ---_____.____1 IF o Public �1 Qu.xroei.u.a�,,.,,�. i C1 01PA6347502 8/1?2021 rrrrS,GN EXQ,Rti���� QyE 4RO �2 BUILDING DEPARTMENT ILDING 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.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: , -�� DATE: Z 2 PERMIT# +� ISSUED:- SECT: t lsC44LOCK: t LOT: LOCATION: w)()�- L s 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 KAL PLUMBING OSS CONNECTION AL HER W W 9 N N +++ N O O O cu a �� 00 ol O � o .�C 1-� H-I W �o H g o � � o.•� � o co W n N z d+z O 04. Q ' V (� U a 4/ W Vr z i—i A p p Fri '� © 0 v vlp. I~ ■ � h� O W " u� R� z w z of C� A O w x w o w � y0 .1U O y V r-� z � 00 1� M W W , 3oa H G1 I W �' y sa co .v ea Cl) ~ � C7 a' zo A O p V z vw W W p F O �zo Cl) O o o Vgb V V v z � o I.1.1 z W W 0 � .- .� w C " u p � Q Et`- M V BUILDMIMVI;NTNOV 14 2022 V OK 938 KING NY 1U573� VILLAGE OF RYE BROOK 1BUILDING DEPARTMENT FOR ()I-FICE USE ONLY: Approval Date: ,.it Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: /� Application Fee)9/�r�Ab Permit Fees: II ,1 ROOF PERMIT APPLICATION Application dated: I V�}_I Lu j L is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing B ilding((, s per detailed statemen described below. 1. Job Address: SBL: ""�� Zone: �[ 1 Property Owner: ` Address: Phone#: Cell#: ( () &C13 — i 11116 email.� r 1,iIV 1 2. Applic t: 1 ` 1` l(— Address: I I I P ►�`� �uJ Phone#: j`1 — ° Cell#: K 4 L e ail: .A Q t 3. Roofing ntractor: l'►U V Address: Phone#: �� �'1 Cell#: �� email: ? 1 4. Job Descripti�o/n,list all Methods&fMaterials: 5. Estimated Cost of Job:$ 1�L V _ (NOTE:The estimated cost shall include all site improvements,labor,material,seaffnlding,fixed yuipment,professions[fees,and material and la or which may be donated gratis.) 6. If corner property,indicate street frontage:jynt�.Ty 4 L 1(A 7. Construction Type: )At NYS Construction Class: l�ICIli�. 1 G ib 8. Number of stories: 2 Height: 9. Is garage being re-roofed:No:{ )•Yes;V Attache No: O•Yes10 Number of Cars: 2. 10. Is roof peaked,hip,mansard,flat,etc: II 11. Estimated date of completion: rapom%d -t- 811212021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. � TE OF NEW{YORK,CO OF WESTCHESTER ) as: \)t,,YL 4 L1 2 W1 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of t dividual signing as the applicant) and further states that-ts)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 14 Swornto before me this Iq day of t Nt`Jt , 20_1�_ da of W j�hQ � 201 / L Lure of Prope y O er pgnature'of1 Applicant P i t Name Prope• er r*rita pplic o ry Pubh blic �\ �/'STATE\\ i ','\` f/� OF NEW YORK\ OF NEW STAyO � NOTARY PUBLIC � IlIlfI161G y i NOTARY PLIC 1� 11 qbit2,L \ OkPA6747507 otPA63+75u2 'j +< A � -2- 811212021 Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info perryyerroneroofing.com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 Jacob Gebrael 8.20.22 1 Hunter Drive Rye Brook, NY 10573 (201) 893-6663 jacobgebraelOyahoo.com Prepared by Perry PROPOSAL ROOF REMOVAL AND REPLACEMENT • All existing asphalt roofing removed and carted from job site • All rotted plywood replaced at$110.00 per sheet- first two (2) sheets replaced at no charge • GAF Weather Watch Ice and Snow barrier installed on all gutter edges,valleys and around skylights (9 feet up) • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • Aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges The price for the aforementioned work,which includes labor and material (excluding any additional plywood),totals to the sum of: $18,900.00 PRICE EXPIRES 90 DAYSAFTER ESTIMATE DATE Page 1 of 5 Initial & Date: 1 Hunter Dr, Rye Brook, NY 10573 (1) QuickMeasure August 19, 2022 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N FILE COPY Contents Measurements Overview 1 Roof Area 3,676 sq ft Top View 2 Roof Facets 9 Side Views 3 Predominant Pitch 4 / 12 Lengths 4 Ridges/Hips 228 ft Pitches 5 Valleys 39 ft Areas 6 Rakes 0 ft Summary 7 Eaves 299 ft Materials 8 Bends 0 ft QuickMeasure Top View Roof Reports in Under an Hour ..� AW t r Prepared For: Perry's Roofing 1 Hunter Dr, Rye Brook, NY 10573 (1) QuickMeasure Side Views Roof Reports in Under an Hour i F V �� � r ` 4•p r V QuickMeasure Lengths Roof Reports in Under an Hour AFlash Step Drip N 0 30 299 61 14 1 30 1 23 22 4 22 22 Eave M Hip 0 Ridge 0 Valley 299 164 64 39 Lengths in feet Prepared For: Perry's Roofing 1 Hunter Dr, Rye Brook, NY 10573 (1) QuickMeasure Pitches Roof Reports in Under an Hour A N 4 4 [� 4 7\1 5 5 Pitches in inches per foot Prepared For: Perry's Roofing © 1 Hunter Dr, Rye Brook, NY 10573 (1) QuickMeasure Areas Roof Reports in Under an Hour A N 95 657 1v'< 603 547 254 241 s14 Areas in square feet Prepared For: Perry's Roofing A 1 Hunter Dr, Rye Brook, NY 10573 (1) • QuickMeasure Summary Roof Reports in Under an Hour Pitch 4 5 Area 2,060 1,616 Percent 56% 44% Suggested Waste 0% 6% 9% 11% 13% 16% 21% Area 3,676 3,896 4,006 4,080 4,153 4,264 4,447 Squares 37 39 41 41 42 43 45 Roof Area 3,676 sq ft ARoof Facets 9 N Pitch 41 12 Bends Oft Eaves 299 ft Hips 164 ft Rakes 0 ft Ridges 64 ft Valleys 39 ft Flash 10 ft Step 30 ft Drip Edge 299 ft Leak Barrier 542 ft Ridge Cap 228 ft Starter 299 ft Parapets 0 ft Notes.1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped root edges.3)Eaves are defined as level roof edges.4)Flashing pertains to level roof edges and excludes valleys.5)Step flashing pertains to sloped roof edges and excludes areas around penetrations.6)Drip edge=eaves+rakes.7)Waste table excludes additional materials needed for ridges,hips,valleys,etc.8)Suggested waste factor is based on the roof complexity and is provided for guidance purposes only. you should confirm the appropriate waste factor prior to ordering. Prepared For: Perry's Roofing 1 Hunter Dr, Rye Brook, NY 10573(1) QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 6% 11% 16% Timberline Products HDZ, HD, Natural Shadow, American bundle 113 119 125 130 Harvest, Reflector, Royal Sovereign, and Cool Series Low-Slope Roofing System Liberty Base/Ply Sheet roll 0 0 0 0 Liberty Cap Sheet roll 0 0 0 0 Starter WeatherBlocker bundle 3 4 4 4 Pro-Start bundle 3 3 3 3 Quick-Start roll 10 10 11 11 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 4 4 5 5 Shingle-Mate roll 10 10 11 11 VersaShield roll 11 12 12 13 Leak Barrier StormGuard, WeatherWatch 2 sq roll 9 9 10 10 WeatherWatch 1.5 sq roll 11 12 13 13 Ridge Cap Seal-A-Ridge bundle 10 10 11 11 TimberTex bundle 12 13 13 14 Z-Ridge bundle 7 8 8 9 TimberCrest box 12 13 13 14 Attic Ventilation Cobra 4' Plastic Ridge Vents foot 50 Master Flow SSB960 Metal Slant-Black vent 15 Master Flow High-Capacity Dome Vent vent 7 Cobra IntakePro Rooftop Intake foot 99 Notes:1)These approximate quantities are based on estimated measurements and are for guidance purposes only. you should always confirm quantities prior to ordering and ensure you are following local building code requirements. 2)For Timberline,3 bundles=0.984 squares. 3)Starter=eaves+rakes. 4)Leak barrier=bends+eaves+flashing+hips+rakes+step+ valleys. 5)Ridge cap=hips+ridges.6)Estimated quantity of attic ventilation products based solely on exterior roof area and intended for estimating purposes only. Installer must verify attic floor square footage,roof design.local code requirements,quantity/type/approved roof pitch of recommended vent products,and conditioned space under the roof. Always have a balanced attic ventilation system. In no case should the amount of exhaust ventilation exceed the amount of intake ventilation.For more into,visit gof.com/ventcalculator.7)Low-slope products applied to 1/12 pitch areas.8)Timberline products applied to 2/12 pitch areas and above. Installed coverage will be less and depend on quantity and width of side and end laps. Prepared For: Perry's Roofing U 1 Hunter Dr, Rye Brook, NY 10573 (1) LAYERLOCK' TECHNOLOGY r. c W414.- Now 41 i+. - ? .:: _ - , J_ Vim, ', • � e` Z; • • • • • • • 0 Timberline® HDZTM Shingles Benefits: Product details: ■ LayerLock'Technology—Proprietary durability, strength, and exceptional Product/System Specifics technology mechanically fuses the wind uplift performance. ■ Fiberglass asphalt construction common bond between overlapping ■ Dimensions(approx.):13'/a'x 39'/e' le la ■ StainGuard®Algae Protection— (337 x 1,000 mm) shin layers.g y Helps protect the beauty of your Exposure:5 /e 3 min) ■ Bundles/Square:e:3 ■ Up to 99.9%nailing accuracy— roof against unsightly blue-green ■ Pieces/Square:64 The StrikeZone-nailing area is so algae discoloration.' ■ stainGuard`Algae Protection' ■ " easy to hit that a roofer placed 999 Hip/Ridge:TimberTex'-:TimberCrest ;. High Performance—Designed Seal-A-Ridgex;rRidge;Ridglassg out of 1,000 nails correctly in our test. ■ Starter:Pro-Start;QuickStart; with Advanced Protection Shingle Weather8locker" ■ WindProven" Limited Wind Technology. Applicable Standards&Protocols: Warranty—When installed with ■ Seamless compatibility—The new ■ UL Listed to ANSI/UL 790 Class A the required combination of GAF ■ State of Florida approved Accessories,Timberline'HDZ Timberline HDZ Shingles are cant- ■ Classified by UL in accordance with Shingles are eligible for an industry patible with traditional Timberline HD`l ICC-ES AC438 Shingles for the same look and feel ■ Meets ASTM D7158,Class H first:a wind warranty with no • Meets ASTM D3161,Class F maximum wind speed limitation. z homeowners and contractors rely Meets ASTM D3018,Type 1 on for beauty and endurance., ■ Meets ASTM D34625 ■ Our legendary Dura Grip' sealant ■ ICC-ES Evaluation Reports is Perfect Finishing Touch—For the ESR-1475 and ESR-3267 pairs with the smooth microgranule best look, use TimberTex 5 Premium Meets Texas Department of Insurance surface of the StrikeZone' nailing Requirements area for fast tack.Then, an asphalt-to Ridge Cap Shingles or TimberCrest'" ENERGY STAR"Certified(white Only) asphalt monolithic bond cures for Premium SBS-Modified Ridge (U.S.Only);Rated by the CRRC;Can Cap Shingles. be used to comply with Title 24 cool roof requirements Colors & Availability: Results based on study conducted by Home Innovation Research Labs, an independent research lob.comparing installation of Timberline HD°l Shingles to Timberline"HDZ"Shingles on a 16-square roof deck using _ standard 4-nail nailing pattern under controlled laboratory conditions. Actual results may wry. ... - '15-yeor WindProven"timited wind warranty on rmberlme"HDZ" Shingles requires the use of GAF starter ships.roof deck protection, 7-,. ridge cap shingles,and leak burner or attic ventilation.See GAF Roofing Copper Canyon System bmrted Warmnryfor complete coverage and restrctons.Visit i,---.. gat com/LRS for qualifying GAF products. StainGuare algae protection is available only on shingles sold in - - packages bearing the SlainGuord"logo.Products with StainGuord` ... — olgoe protection are covered by a 10-year limited warranty against blue-green algae discoloration See G4F Shingle&Accessory limited F,, Warranty for complete coverage and restrictions. To be mixed on one roof,Ttmbedinei`HDZ"Shingles and Timberline HD- Driftwood 1, Fox Hollow - Shingles must hose matching 6-digit codes found on the end of the bundle. When mixed always use Timberline HD'installation instructions. 'Periodically tested by independent and internal lobs to ensure compliance with ASTM D3462 at time of manufacture. Lifetime refers to the length of warranty coverage provided and means I as long as the original individual owner(s)of a single-family detached r 7-. . " I residence[or eligible second owner(s)]owns the property where the qualifying GAF products are installed.For other owners/structures,Lifetime Mission Brown - : _ - = coverage is not applicable.Lifetime coverage on shingles requires use of GAF Lifetime shingles only See G4F Shingle&Accessory Dmiled Wormnry for complete coverage and restrictions.Lifetime coverage on shingles and accessories requires use of arty GAF Lifetime Shingle and any 3 qualifying GAF accessories.See GAF Roofing System limited Warmnly for complete s f ^ coverage and restrictions.Visit gat com/LRS for qualifying GAF products. o Note.It is difficult to reproduce the color clarify and actual color blends N - - - - of these products.Before selecting your color,please ask to see several full size shingles. m © r UFETOR AMERICAN '- We protect what matters most OU [ [ 1{ 1 tl t{t +I`1�+; 1 ! 1 �. +'ii Him" 1 t • Hi (U ,,o 1"! 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I�I' I 'I 'ii ,`i!'1![j��l��,l Yli (I!Ij%11j'lu1' r'i ! ,j Ij¢ ! I �;t i 1 I�I ! ° l �j�ll` lriI�;!;t;h1i;, �m j ,1 �Il,; � I`'' a�''';I 1° � i 1 � ; ` {'• „ [�''� � rit';l' Roli i 1 Il+ ;ii•`� Ih i 1 Lt t' ![p! ,a l i[it i.++ t!ly� !t. i�;GI! '� ! j� 1�' t !�1 ill i 1• l ! 1 [ 1•[i l+. ,•..! r!1 I til, !' !� t, ,t y ["la(illli!(tticq'iU i ' I 1'1'at �!a ill' !ti •+ 1 i, i�b��P, [ t i'[! i !il�ii!!�;i,t[n;iii!" �, ,.: t:[ .9 O ,.. W tf') O LO 14 O `o cr L \ G� rA L o � o cn Q� •^' L i V A . . �,, J U LU c o O w Z of >- u �o�ection Z LL Z pq 0 LQ O Z Z 3 � LQ w a w v F a a4 n p W U > A ° 0 \ 0 b u ..yam, 'y e�- ti'` Qj v C7 � � i m 0 U. DATE(MM/DD/YYYY) ACORN CERTIFICATE OF LIABILITY INSURANCE �i 81/2022 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 Levitt Fuirst Associates, Ltd. NAME: Catherine Dolce 520 White Plains Road aCNrc.EttI:914-457-4200 iac,Not:914-457-4220 Tarrytown NY 10591 ADDRESS: info@levittfuirst.com INSUR 8 AFFORDING COVERAGE NAIL• INSURER A:Admiral Insurance Company 24856 INSURED PERRVER-01 INSURERB:Accident Fund Insurance Com an 10166 Perry Verrone LLC 12 Center Street INSURERC: Pleasantville NY 10570 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1229745749 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. INPOLICY TSRR TYPE OF INSURANCE ISD N DL-SUER WVQ POLICY NUMBER MM DDY EFF MM/DD EXP YYYI LIMITS A X COMMERCIAL GENERAL LIABILITY 937258902375890 7/1/2022 7/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE I -- I OCCUR $300,000 DAMAGE TO RENTED PREMISES Ea occurrence MED EXP(Any oneperson) $5,000 _ PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $2,0D0,000 X POLICY 1:1 JPE`CT LOC PRODUCTS-COMP/OP AGG $2 000,000 OTHER : AUTOMOIMELIABILrrY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) t HIRED NON-OWNED PROPERTY DAMAGE : AUTOS ONLY AUTOS ONLY Per accdent f e UMBRELLA LIAR X OCCUR9073490723490 7/1/2022 7/1/2023 EACH OCCURRENCE $5,000,000 X _ EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DIED X RETENTIONS 9 WORKERS COMPENSATION I PER AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder and/or the entities listed below would be covered as an additional insured per attached endorsement,to the extent provided therein if required by written contract.on a primary non contributory basis on the general liability.Waiver of Subrogation applies. Primary and non contributory on the Umbrella Certificate Holder is included as additional insured when required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street Rye Brook. NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD CNE PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name 8 Address of Insured(use street address only) 1 b Business Telephone Number of Insured 914-867-1747 Perry Verrone LLC DBA Perry's Roofing 1c.NYS Unemployment Insurance Employer Registration Number of 12 Center Street Pleasantville,NY 10570 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 26-2754386 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street 46-884191-16 Rye Brook,NY 10573 3c.Policy effective period 03/01/2022 to 03/0112023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) Q all excluded or certain partnersiofficers 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 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: Steven Diamond(President) (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 02/28/2022 (Signature) (Date) Title. Licensed Insurance Broker Telephone Number of authorized representative or licensed agent of insurance carrier: 516-488-3040 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