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HomeMy WebLinkAboutDP23-002PERMIT # �/' o�� �c3DATE: do 3 3 E(P� SECTION +--MBLOCK.4 LOT TYPE OF WORK /i770 JOB LOCA to P e OWNER Ci/, Q 4' �s 4V CONTRACTOR] YO,/ Q/ Z B�EST. COST '�SQd ` FEE V/CO # c;7 �6�7F a FEE S$ l I D—J46 DATE TCO # FEE DATE INSPECTION RECORQ I DATE 1 NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS C:3 SPRINKLER ELECTRIC 0 LOW -VOLT L�7� �aLARM Jo As BUILT CI '� !:*lAL Il �ukjOfn� (...Q »ltJ4// �`ho�� eNove.411 Ti/ps /%ze PMaVa./ /C/Glen �y'�l 7�1n & 9 7 3 p�f �� ©ham �ioell: So/� c OTHER APPROVALS ARB BOT PS ZBA (OTHER VILLAGE OF P,,,'�E BROOK WESTCHESTER COUNTY, NEW YORK .� No: 23-078 Certificate of Occupancy This is to certify that n Wa�l Gza of, d -4 , having duly filed an application on 20_A�a,,requesting aSATMtRye Certificate of Occupancy for the premises known as, 7R-1U Brook,NY, located in a r?a_F Zoning District and shown on the most current Tax Map as Section: )1 I. 3 Block: C_�) Lot: 4U and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Demolition Permit No. .oD� , issued W-3 20 cZ3, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: Construction: for the following purposes: () ba y)),yn �hOLyei' S/ /�i r-e 6kc a. // plamb na z Oar It? uua&s Eloay-. 9emdw 11 �iOulxer -h),es� /�aa%ze r�rn,4Va/ 7 Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement. whether by extending on any side or by increasing in he' ht sb ame o B 'hall be made,nor shall the building be moved from one location to another until a permit to accomplish such change ha ing Inspector. Building Inspector,Village of Rye Brook: Date: MAY 17 2023 For office use onl : E C 7- W CF BUILDIN TMENT PERMIT# VILLAGE OF RYE BROOK ISSUED: MAY 11 2023 938 KING STREET,RYE BROOK,NEW YoRK 10573 DATE: ,!�-//- a 3 (914)939-0668 FEE: j9 //0-- PA>D Jk VILLAGE OF RYE BROOK �y�y�y ©Ok,org BUILDING DEPARTIVII:N' I . 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 tktittt►tf►►t►►klkttt►f►iift►tit►►tkkktkiitfiii►ittff►►►f►♦tktkitktitfiftt►t►f►kkftititi►i►ft►f►k►kiktiti►tttitt•►ttkt►ktkttt Address: 2717 S uurft i1'- 6E 1 �- Occupancy/Use: Q F4: 1Y Parcel ID#: /y/, 3,5-—Q-4? Zone:�l- Owner: M R R,T-D, k o TY-Z-A Address: l Zt P.E./R.A. or Contractor: ff G 4-lei, TIC Address: ~ !t — S ot"t P Person in responsible charge: �a,M'e-- Address: -s Q 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 YLOM COUNTY OF WESTCHESTER as: /, 11A R.r-k )SOT Y �I being duly swom,deposes and says that he/she resides at 121 WJ p�+ho�Q 141— (Print Name of Applicant) (No.and Street) in R i 6 ,in the County of GU c s. 1 -i­) in the State of N`/ ,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:$ .S Z o — for the construction or alteration of: 7-(:f"1 AZ K - 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 � \ Sworn to before me this day of 1"`�� 2��3 7j day of , 20 Signature of Property Owner Signature of Applicant _'C� TY7—A- Print Name of Property Owner _ Print Name of Applicant S' oTr C F,AI (� Notary Public Notary Public SCOTT W.CRAIG NotwY Publle Of Now York 8/12/2021 REG NO. 01CR6390567 COMMISSION EXPIRES 04115r2027 QyE BRC�uk o`` tim 1982 BUILDING DEPARTMENT f BUILDING INSPECTOR / U 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 : "� t DATE' , , �/ e PERMIT# _.f. �-� -�`"� ISSUED: 1� SECT' BLOCK: LOT: LOCATION: '� �� OCCUPANCY: 2 ❑ 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 1 .<: ` �c ;•, ❑ L.P. Gas - ❑ FUEL TANK 1 ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION []'FINAL ❑ OTHER BRC�uk O Zm w � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAx(914)939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - --- - - - - - - - - - -- ADDRESS: DATE: S '4 PERMIT# J ISSUED: I SB(.7'. BLOCK: LOT: 4 LOCATION: `L, (", 1 f' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION O STTEINSPECTTON �� ; , �� �� REQUIRED ❑ FOOTING 0 FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ----- ---- __ ❑ FINAL ❑ OTHER _ _ _ _ ■ N ar © � ■ cry N o a a P4 M Z wok CA Z ECAN q > A o N , `,-, w ao _ _ uj W 0; v N v w 4 W ■ �•+ try R, 0 b �'o� O p N "o. O p Qp' v O O o o41 � H •. o o W o 4 �) w W cn C c o � _ Q P--, c oa 4 Ij ,,b a 609. F x N W WH � - w Ln co N vco V oo U. _ W w w Vzvc'' � 8 = v A 7CN rdW a v ON Cy OE. 'Qv , U H z w o N cy w C7 o a W ■� A a„ Z pC � � � � o � _ BUILD MENT D [ i VIL OF RY OOK DD 938 KING ET RYE BR ,NY 10573 MAR 2 1 2(?3 4 -0 `0 VILLAGE OF RYE F3R0(JlC BUILDING DEPARTMENT DEMOLITION PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: MAR 2 9 Pe it#. ''��pplication Fee: $ / /- Approval Signature: Permit Fees: $_ /oo Disapproved: Other: Application dated: 3 Q/ c-2 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. ,1{� 1. Job Address: ,279 uT-+l 'Qc b CA-- CT— SBL: I�� 3 5 ��'�1 a Zone. 2. Proposed Demolition.(Describe in detail): R S M 0 V1✓ Ak\ Q�ltiCv� t ` , cw ck-q AL1 }1 L u 1".�i JUG lJ � 1 ti �sZ�'LbU� �,`, a 3_ Property Owner: P, AT a% -2—A Address: 121 WA.f fA-+�JCcA kUY P-�,N, tp R(D Phone# 1 °l�-I -(.80 !;- Cell# 914— 4 '7— 6 6 7 email: 1�01-�2c� . wtu�� g w`a I•cot^ Applicant: _55 f'1 C— Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: General/Contractor: ( G A 2O , y I�/c Address: III WA"AWee-A • Phone#�[14) 4 -7—6 G 8 7 Cell# email: d� 71t . yrngr-(r,�/[� 4. Estimated cost of construction $ S 5 Q . (NOTE:The estimated cost shall include all labor.material.scaffolding,fixed equipment..professional fees.and material and labor which mad be donated gratis.) 5. Type of construction:(wood frame,masonry,steel,etc...) b. Method(s)of Demolition: 'Pl u W%tQ T ew-le(an'4� 0 -FT 'fie -ffaw� 7. Number&Location of Fuel Oil Tanks to be Removed: 8. Number of Stories: Height to Highest Ridge: To Highest Chimney: 9. Estimated date of completion: Prl�v� f Ste'' r 2J� 1 8/1 21202 1 This application must be properly completed in its entirety and must 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: ,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 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 2-t Sworn to before me this day of Y VW-C- 2 3 day of , 20 Signature Property Owner Signature of Applicant // l(4 r-r< Print Name of Property Owner Print Name of Applicant Notary Public _ Notary Public SCOTT 1N• CRAIG NOTARY PUBLIC STATE OF NEVY PORK REG•NO.01CRro390567 COMMISSION EXPtiRES APRIL 15,2023 2 8/12/2021 Y O N n �'W 00 z Q wx x N en c H M M CZ Q ow cwn a A � � O pON O � w00 � p O z vz V z � �..� Z a w I Q O 00 en a x � � � p�c O zL4v � s ►�' � op a a A w xrA ��- n" vk BUIL DE MENT VIL E OF RYE OK APR 19 2023 938 KIN , ' ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or PLUMBING /PERMIT APPLICATION FOR OFFICE USE ONLY PP#: D'3 -0 � Approval Date: A 9 201 Permit Fee: S Z�2 Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, 'I `t/20 2 3 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: 2 -7y .Sri,vm R.I D G f ST- SBL: 141 .3 S - 2 - 44 Zone: 2.Proposed Work: 'N c u.P S H0W&f2 i IJ 13A i i<ML-iVT 'L!t f µr iosa� 3.Property Owner: r? A R T h Ko Tr--� Address: 12/ WA P/J A AO&e_A kVE. 12YE Phone#: 66 7 Cell#: e-G m C email: k-0fv,1 Z•c. �n q�>� cKa1�-w►( 4.Master Plumber: OHN i4lZ 0 C L L S-a a.0 s 1—r✓ C.Address: Z 2 81Z o O k 41 A 4.& D M44 a e . Lic.#: SI6 �hone#: `i17 1_�S'-28 S7Cell#: email: q k p h 2`[ /g oto ( . W10 Company Name: A Q k C-40 C- Address: 4,r,&v,.e, INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 3rd Floor 4ch Floor 5`h Floor Exterior 5.* List Other Equipment/Provide Details: C-x (Notarized Signatures Required Next 2 Pages) 3/3/2023 BUIJ DEPARTMENT D VILE OF RYE BROOK 938 KINGET RYE BROOK,NY 10573 APR 19 2023 4 -0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx�,�*,�,�*,�x******;�*xxxxxxxxxxxxxKxxxxxxxxxxxxxxxxxxxxxxxxxx,�xxx 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: 3J, k0T`f ZA- ,residing at, 1 Z( Ly^ PP e-A-4 A011E (Print name) (Address where N'ou Iixe) 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; 2 7 �? S O y T-N h21` D 6 E S i- , Rye Brook,NY. (Joh Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property Ov%ner(s)) A A�-7}- k4 (Print Name of PropertN O�vner(s)) Sworn to before me this C"l day of ML , 20 �3 i SCOTT W.CRAtG Notary Public of New York REG NO. 01CR6390567 COMMISSION EXPIRES 04/15/2027 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: MA-2 r A �60T-1 aA , 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 Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and 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 I Sworn to before me this nn t day of >�1P�i L 20 23 day of 20 'L Si ature of Property Ow (� Signature of Applicant PrinyName of Property Ow Print Name of Applicant Notary Public Notary Public SCOTT W.CRAIG Notary Public of New York REG NO. 01CR6390567 SCOTT W.CRAIG COMMISSION EXPIRES 04/15/2027 Notary Public of New York This application must be properly completed in its entirety and m st Inc Iudt Q1WPn41FA" 7nature(s) of COMMISSION EXPIRES OVIW027 the legal owner(s) of the subject property, and the applicant of r cord in the spaces provided. Applications not properly completed in its entirety and/or not properly sign d shall be deemed null and void and will be returned to the applicant. SCOT a-o sew %otarl Public 1,,2027 REGION pxPIRES COMMA 2- 3/3/2023 Steven Fews From: Marta Kotyza <kotyza.marta@gmail.com> Sent: Tuesday, May 9, 2023 10:36 AM To: Steven Fews Cc: Stanisla Email;Anthony B. Gioffre III Subject: 279 South Ridge/removal of shower completed Hello Steve, As requested, I am enclosing photos of completed shower removal from the basement bathroom. Thank you for sending c/o for our records. With all good wishes, 1 z t�� �Buildin Permit Check List&ZoningAnal sis � Address: SBL: Zone: "2- U e: Const.Type: V3 Ot4er. Submittal Date: 2-1 Revisions Submittal Dates: Li —z U-3 Applicant: Y,b \I z Nature of Work: QQ.lYIO �U Cc1- ke YDQ Q) -hoc o Reviews:ZBA: MAR 2 9 2023 B. BOT Other NEED O n ( ) (VFFEES:Filing: BP: I OO'r A C/O: Flood Plane: Legalization: O (,)--APP: Dated notarized: f SBL: 'Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt: Tree Plan Other. ( ) ( ) SURVEY:Dated: Current Archival: Sealed. Unacceptable: ( ) ( LANS:Date Stamped Sealed Copies: ectroniG Other. l�C 1 c y ( ) (a License Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated; N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. (c) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. PLUMBING:Plans: Permit: Nat Gas: I 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. ( )AM mtg. date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval:- notes: REQUIRED EXISTING PROPOSED NOTES PPf Arf SD 2023 Cir : Fie Front Front: Sides: Main Co Accs.Cow F S Sd.HS : S,FA: Tot imp: F I : Parking Hdght/Storm . notes: - •�� A �'.�.¢'� tti'i. 3. r �sk,- ` Y�'„�- ✓,,.k y ;F.a .. r �.,s+w, ryh •'•Y \s.-�, -^•r'"n, R " ('r "` e� C :,. All, 0 .gip O O O D rr Y '2i.G�r' M T Vtiy`i12� h1 � 2 r/ .�i•. I• Sry py�, i �119 SI t r ry \ i4� 2I'° C ,��s +C11 r. ,Il. :iW' 7" -� ti J (tf 77t� /�risv';. .4�77:,•y�'.Ji,'•v.fi -".• a i •�;i riVr\ ;v�:; 'G�f� e�s 'r t�((�� 0�1 `':��( :rc: c,""I,fr1t•r+�� 's� Z`.�"l�f'�i�; £r �� 4 !�J11///111111q ' 111�1/111 H �11/1 r ) 111II _ I1/1I :is �3c �i p, �<o��:::,►11 111�: — :..•f 1 11/ � 111 111 � - o sa.11t'111j1.:,- � ,.1�1/11j1 a 4�1111j►.:., �A��11/1111►1►�-,� �a°`w ��? ?>��i���---•••\ �'a= ,1.1 1 1 1�1�:•_:.�R._t_.. MAII s:-....1111►� _� 1�1.111:•_,a� 11111 V^tv<co) i -"off 0 � N �M v ..d rn •+� M � r y ` • 0. p Q, N �►�, O v 00 03 Z 6J •S"'•• f �3x �_•= � �V�yyI W LLI C) a �+ O�ecti0!} Q OD Ln U smk "� 1� Q z W 72 Co U � G Ca « .. ,. / � O t o)>� O CA '�'.•� "� V 4) LO Lam•• < a OD y O GM y O U •pay ! F • g'��,_>d1114 _ I- I/lq y_ ;:Ill�lyi��_-ss� :,►1�//1,"s.}=.,� ;� '`'t►I+�IIy`'`'`9€�.��. Mra;NE 11- i1111/1�1►I i � .I2ellj/�1�112 ~3�>�$, f..r:...'IIIj/111�1< 'w 1� 21�111112 A -'1�1<111�►• A �,.2'�Ii1�111•::`�>._i�%e'gg,..': - �?�. A'1� ,..r./r ♦!. •..x^c:.'-{i ,,yr��1 t a^ +� g �i.''�$A4 "{yy �l $1'. -tr 1 1 jyu.„,}, ,3�3 4 ��•,t A. .v�flS/t l4�'�"���d i ��'l'� 7l wt sv�ti�0 r�. "2 ./3Yy+,�ytii��2•itie�.-. ^ �Et��ri'?��5��\�:Y .^ � A ^ ..•brM w '''�' �t <tyv,,� '• ;:,vex s�, ��� 3' .� .X f.. �>,�*,., '+ �''f�-- a;•: yrJ:�- v ::�. �f? c �"o DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 03/20/2023 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 NAME: ANA C EUGENIO Albert Palancia Agency, Inc. a/c°No • (914)698-1373 FAX No:(914)698-0125 116 Mamaroneck Avenue p'Ess: ana@palanclainsurance.com Mamaroneck, NY 10543 INSURERS AFFORDING COVERAGE NAICA INSURERA: QUAKER SPECIAL RISK INSURED INSURERB: Progressive Northern Ins. Co. 38628 FIGARO INC. INSURERC: 121 WAPPANOCCA AVE INSURERD: RYE, NY 10580 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000055-1486414 REVISION NUMBER: 50 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLTYPE OF INSURANCE J=SUER POLICY NUMBER MM/DDPOLICY EFF MOM/LDDPIC EXP LIMITS LTR WVD A X COMMERCIAL GENERAL LIABILITY Y APP61906103 10/22/2022 10/22/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREM SES EaEocc.IT.. $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000,000 �( POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2000,000 OTHER: _ B AUTOMOBILE LIABILITY 04053736-7 10/13/2022 10/13/2023 Ee ac identsINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ 1,000,000 OWNED AUTOS ONLY X AUTOEDULED BODILY INJURY(Per accident) $ 1.000.000 HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Pe�aaiden DAMAGE = 1 OOO OOO S UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED 1 1 RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDE( (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The Village of Rye Brook is included as Additional Insured. 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 Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street RYE BROOK, NY 10573 AUTHORIZED REPRESENTATIVE ��JJ ` oo ACE ©1988 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by ACE on 03/20/2023 at 03:43PM NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE T ^^^^^^ 133790018 ALBERT PALANCIA AGENCY INC 116 MAMARONECK AVE Or.i MAMARONECK NY 10543 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FIGARO, INC. VILLAGE OF RYE BROOK 121 WAPPANOCCA AVE BUILDING DEPARTMENT RYE NY 10580 938 KING STREET RYE BROOK NY 10580 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2463 213-5 165 01/28/2023 TO 01/28/2024 3/20/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2463 213-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT STANLEY KOTYZA VICE-PRESIDENT MARTA KOTYZA FIGARO, INC. 2OF2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY, NEW YORK STAT SU NCE FUND 7 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 278540728 U-26.3 3aoD ONia-ina SAN MAR 21 2023 Had se aminb3L Sa0103130 3NOWS VILLAGE OF RYE BROOK BUILDING DEPARTMENT n � m O 0 c C� 0 �" z fA 17' r I I gwm a r*4 1 o T