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HomeMy WebLinkAboutRP23-024PERMIT # /C f SECTION [. .e TYPE OF WORK 10B LOCATION _ /EST. C V CO # TCO # �D3 lsY7n4 rvai K�/eLl (y/ 7d,c4cj-j3<s AL r W ;61% 78 944 14 u 1 �� DX FEE A 4/O —�4owl DATE CDI I5 a� �3 FEE DATE INSPECTION RECORD I DATE INSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS (� SPRINKLER ELECTRIC E3 LOW -VOLT 0 ALARM m AS BUILT 0 FINAL OTHER APPROVALS IARB BOT PB zBA OTHER C 4,�a,aJJ V 19 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 June 15,2023 Jason Riley&Naomi Riley 10 Woodland Drive Rye Brook,New York 10573 Re: 10 Woodland Drive, Rye Brook,New York 10573 Parcel ID#: 135.36-1-29 Roof Permit#23-024 issued on 5/15/2023 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 Building&Fire Inspector /to For office use only: R DD BUILDN646,ATMENT PERMIT#",)3-£,a VILLAGE OF RYE BROOK ISSUED:.,57-/5-a3 MAY 17 2023 938 KING STREET,RYE BRooK,NEw YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: A //0-- PA MA BUILDING DEPARTMENT y:M2,r ` rkrgQk,orQ 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 ♦►►►►s►ssssJJs►►ss**Iss.s//s*s*rs*sss*srss**rsr►rrsrsrssrs►ssrssrsrsrsrrs►rrsrsrsrr►sssr►s/►sssssr►ssssss**ssssrssrssrssssssssrrrsrr Address: ( U Wi7o� �oi�� br1Ve_ Irk/ e �,'�o�� A % / D S ? 3 Occupancy/Use: / Fury Parcel ID#: 13 5,3 - 1-a Zone: Owner: "Iti 5 h 1� (e�� Address: /O W o z;114 M a pe RV P 6jZdG N 1 /U) 3, P.E./R.A. or Contractor: Perrti VP//'c"e Address: 'A' 66nter 51 (Je'tiSGh�v�(�P�it/� Person in responsible charge: ' n,r t, �/e✓/'�n -e- Address: ! y:(1t A ,/0 f 7-o 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 YOM COUNTY OF WESTCHESTER as: 4 f oA being duly sworn,deposes and says that he/she resides at /U i.✓ 0 0 K r �e (Print Name of Applicant I / (No.and Street) Y in R ti Q 0 r" � ,in the County of "� o tC�e�lr lll in the State of to// ,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 i /(r rl O 0 for the construction or alteration of: {l o C. 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 Ct \Z Sworn to before me this day of , 20 a day of , 20 Signature 6fProperty Owner Signature of Applicant /�' u5tL,'N � - (ek- tarne'of Property Owner Print Name of Applicant Notary Public SHARI MEULLO Notary Public 14otary Public,State of New York No.01ME6160063 Qualified In Westchester County 8/12/2021 ^ommission Expires January 29,20z.:7 �E BRC��•: Q� ��O•c 19�2 BUILDING DEPARTMENT Q 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 :— �A DATE. J PERMIT# < ISSUED: J CT: ' BLOCK: / LOT: LOCATION: >,y l `� U` OCCUPANCY• ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION ft�1 �U, REQUIRED ❑ FOOTING ` L ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ .UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑-' ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑/r-ROSS CONNECTION FINAL OTHER b i e A N N w C s ■ A O 41 J ^d \ \ o ■ ui s O � ■ _ � z4.485OC ✓� h � A v A O Q zx E o # W e : a"i v tc �U ww a O P-4 14 0 O w �vWji W oA y �� e 4141+14414;49449464;09690Q41444149419 9 44141441444444444a BUILDJN(�-DOARTMENT D fl VILE , 1 OF RY OK 11 ED 938 KING ET RYE BR NY 1057 MAY 12 2023 �41 -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: Pe 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: r ermit Fees: ROOF PERMIT APPLICATION Application dated: n 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 Bihidirig,as per detailed statement described below. 1 + -I n 1. Job Address: 1O W()Ucll0rnd �I( �Qe �rbj) . SBL: J — 1' N Zone: L� Property Owner: Ik 1 EQ ( Address: ioI 2. Phone# q 0 17 _4 A� Cell#: email: I ckwn � 2. Applicant:-PC II Address: A /' l Phone#: 1`11 Cell#: email: I 3. Roofing ontraetor: t� Address: 1 l/l' eI' e Phone#. 1 t Cell#: `1 Z email: V 4. Job Description,. list all Methods&Materials:�(�( I(()IMUIIQ � -}- ( o&o j y\e-h� tU -�C-u0c -4 K(X e r 1Ql S Ct{tG1C bl? d 5. Estimated Cost of Job: $ �� ���� }, (NOTE:The estimated cost shall include all site improvements,labor,material.scat of d ng,fixed equipment,pro essi Z WIC fees,and r rmaterial and labor which may be donated gratis.) 6. If comer property,indicate street frontage: 'I�/O �GCYI Ar +M r (urcke 7. Construction Type: rUO` NYS Construction Class: 8. Number of stories: Height: 9. Is garage being re-roofed:No:IV -Yes: ( )Attach� 'ld No: (X4•Yes: ( )Number of Cars: �-- 10. Is roof peaked,hip,mansard,flat,etc: DC C LQ C-1 It. Estimated date of completion: Q_QV- Cr er r{'VI mo.� -t- W 212021 Please note that this application must include the notarized signature(s) of the lee'al uwner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: i'e,,rri U*,r r0111­L ,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 !,u-A 6(,\J -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. Sworn to before me this Sworn to before me this day of 20 1� of , 20--L—D e-of Property Owner Signature of Applicant Verr✓'uVk Print Name Property Own Moa of A icant 01J o ry lic �,wItit�i Ic gA PAt, ;%, STATE�`� �� \`IIIIIIrrrr7i l�OF NEW Y0 E ``,0\yLA P.qt,!�,,�� t STATE; elPA63447502 /pp� VOWS /,�� DW 1'm�}u{`� + NOTARY PUBLIC (j\, 0IPA6347502 -2- 8112/2021 Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info@perrwerroneroofing.com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 Jason Riley 5.9.23 10 Woodland Drive Rye Brook, NY 10573 (917) 822-338S lasonriley7l@)gmail.com Prepared by Perry PROPOSAL ROOF REMOVAL AND REPLACEMENT Designated sections excluded(see diagram pg. 2) • Special attention to protecting solarium glass roof • All existing asphalt roofing removed and carted from job site • All rotted plywood replaced at$95.00 per sheet • GAF Weather Watch Ice and Snow barrier installed on all gutter edges, valleys and around skylights (6 feet up) • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ Williamsburg Slate 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 • White aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges • Rye Brook Building Permit for an additional cost TBD GAF Golden Pledge Warranty (Full roof to be registered) Page 1 of 6 Initial& Date: The price for the aforementioned work,which includes labor and material (excluding any plywood),totals to the sum of. $11,900.00 PRICE EXPIRES 90 DAYSAFTER ESTIMATE DATE ADDITIONAL WORK OPTIONS Please check appropriate box for desired extra work Carpent ndyman work c on a time and material basis, said work performed at$ er man hour plus material Front entran of re-roofed (see diagram below additional $700.00 o GAF Liberty base cap sheets ' ed on entire field of front entrance roof o Alumin ravel stop fabricated an lled over front entrance DIAGRAM AM = Sections excluded N from proposal F-1 = Front entrance roof Page 2 of 6 Initial&Date: Timberline'HM" High .- GnF LAYERLOCK` Americ TECHNOLOGY 8 1 • • shinglegot • The same shingle you know and love, now with LayerLock" - • •• which powers • widestnailing are• z 0 Timberline HDr Shingles Benefits: Product details: ■ LayerLock'Technology—Proprietary durability, strength, and exceptional Product/system specifics technology mechanically fuses the wind uplift performance. ■ Fiberglass asphalt construction common bond between overlapping ■ Dimensions(approx.):13'/n'x 39'h' ■ StainGuard•Algae Protection— (337 x 1,000 mm) shingle layers. Helps protect the beauty of your ■ Exposure:5 5h'(143 mm) ■ Bundles/Square:3 ■ Up to 99.9%nailing accuracy— roof against unsightly blue-green ■ Pieces/Square:64 The StrikeZone'"nailing area is so algae discoloration' • StoinGuardr Algae Protection • Hip/Ridge:TimberTex$;TimberCrest-; easy to hit that a roofer placed 999 ■ High Performance—Designed Seal-A-Ridge';Z°Ridge;Ridglass" out of 1,000 nails Correctly in our test.' with Advanced Protection'Shingle ■ Starter:Pro-Start'r;QuickStarr; WeotherBlocker" ■ WindProven' limited Wind Technology. Warranty—When installed with Applicable Standards&Protocols: ■ 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 com- . Classified by UL in accordance with Shingles are eligible for an industry patible with traditional Timberline HDr" ICC-ES AC438 g g y Shingles for the same look and feel Meets ASTM D7158,Class H first: a wind warranty with no homeowners and contractors rely ■ Meets ASTM D3161,Class F maximum wind speed limitation.2 4 Meets ASTM D3018,SType 1 on for beauty and endurance. Meets ASTM D3462 ■ Our legendary Dural Gdp' sealant ■ ICC-ES Evaluation Reports ■ Perfect Finishing Touch—For the ESR-1475 and ESR-3267 pairs with the smooth microgranule best look, use TimberTex',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) Premium SBS-Modified Ridge (U.S.Only);Rated by the CRRC;Can asphalt monolithic bond cures for Cap Shingles. be used to comply with Title 24 cool roof requirements Colors & Availability: Results based on study conducted by Home Innowhan Research Labs, an independent research lab,comparing installation of Timberline HD" • .. - Shingles to Timberline"HDZ`Shingles on a 16-squore rod deck using standard 4-nail railing pattern under controlled laboratory conditions. �_. Actual results may wry. '15-yeor WindProven"limited wind warranty on Timberline°HDr Shingles requires the use of GAF starter strips,roof deck protection, ridge cap shingles,and kak barrier or ark venfibtion.See GAF fMofirg Bfr• •• _ System limited Wmanly for complete coverage and restrictions.Visit itq!jwood Biscayne Bluegot conM for qualifying GAF products. Barkwoodanyon I - 'StoinGuord°algae protection is awiloble only on sMgles sold m Packages bearing the SlomGuord•logo.Pradu;h Wit 9abGwrd° algae protection are covered by a lQyea limited womanly,against blue-green algae discdori ion.See GAF Shungle&Accessary binded Warmnryfor complete coverage and reshichons. T` 'To be mired on one roof.Timberline*FDZ-Shingles and T•nbertme HV . - - Hunter -- Shingles must have matching 6-d gd codes found on the end of the bundle When mixed.always use Timberline HD'installation lalnatans. 'Penodicalh tested by irdepertderd and eland labs to van compliance with ASTM D3462 at tine at mmuloclure 'Lifetime rents to the too of warmly coverage provided and means . - as lag as the original milividtal owners)at a si giedmmiy debated residence[a etigide second ovmer(s)]owns the proWly,where the qualit"GAF products are installed.For otter ow ers/slrudues.lifetime • - _ - Shakewood coveroge is not applicable.lifeline coverage on strop nequiii use al GAF Lifetime shingles a*See GAF Shingle&Aobessoy 1n*d Mhrtarly to compete towrope and restrictions Lifetime comW an sfrgles and y accessories requires use of any GAF Lifetime SLwtgle and arty 3 qutifyig GAF accessories.See GAF Rodiirg System limtifed Kbtariry for complete t� oomoge and restrictions Visit gafcom/M fa q j*"GAF products. 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Iq ii,t 1' ; r'j i !i Fli!Li1-Rti!11►i(ir 1`" iii i•;+ 'ti 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure May 5, 2023 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N Contents Measurements Overview 1 Roof Area 3,204 sq ft Top View 2 Roof Facets 12 Side Views 3 Predominant Pitch 5 / 12 Lengths 4 Ridges/Hips 199 ft Pitches 5 Valleys 47 ft Areas 6 Rakes 33 ff Summary 7 Eaves 269 ft Materials 8 Bends 7 ft QuickMeasure Top Viiem Roof Reports in Under an Hour ... v . yam,M ,lr. �h•' • l ,� � ��f, 1 , 1 i • r!� • ` `VV li � J • � R 1 J r _ I , y • e r� ti Prepared For: Perry's Roofing © 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Side Views Roof Reports in Under an Hour North e 1 "lll A I M r. �- Prepared For: Perry's Roofing © 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Len fhs Roof Reports in Under an Hour AFlash Step Drip N 20 a 19 -2 1 20 i ■ Bend ■ Eave ■ Hip ■ Rake ■ Ridge ■ Valley 7 269 122 33 76 47 Lengths in feet Prepared For: Perry's Roofing U 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Pitches Roof Reports in Under an Hour A N 5 0 5 5 5 5 5 Pitches in inches per foot Prepared For: Perry's Roofing © 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Areas Roof Reports in Under an Hour A N 420 462 29 377 694 189 160 382 253 Areas in square feet Prepared For: Perry's Roofing 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Summary Roof Reports in Under an Hour Pitch 0 5 Area 29 3,175 Percent 1% 99% Suggested Waste 0% 7% 10% 12% 14% 17% 22% Area 3,204 3,428 3,524 3,588 3,652 3,748 3,909 Squares 33 35 36 36 37 38 40 Roof Area 3,204 sq ft ARoof Facets 12 N Pitch 5 / 12 Bends 7 ft Eaves 269 ft Hips 122 ft Rakes 33 ft Ridges 76 ft Valleys 47 ft Flash 16 ft Step 30 ft Drip Edge 302 ft Leak Barrier 510 ft Ridge Cap 199 ft Starter 291 ft Notes 1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped roof edges.3)Eaves are defined as level roof edges.4)Hashing pertains to level roof edges and excludes valleys.5)Step Clashing performto sloped roof edges and excludes areas around penetrations.b)Drip edge=eaves+rakes.7)Waste table excludes additional materials needed for ridges,tips,valleys,etc.8)Suggested waste factor is based on the roof complexity and is provided far guidance purposes only. You shald confirm the appropnote waste factor prior to ordering. Prepared For: Perry's Roofing 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 7% 12% 17% Shingle Products HDZ, UHDZ, Natural Shadow, ASII, bundle 97 104 109 114 Reflector, Royal Sovereign, 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 9 10 10 11 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 4 4 4 4 Shingle-Mate roll 8 9 9 10 VersaShield roll 10 10 11 11 Leak Barrier * StormGuard, WeatherWatch 2 sq roll 8 9 9 9 WeatherWatch 1.5 sq roll 11 11 12 12 Ridge Cap Seal-A-Ridge, Seal-A-Ridge AS bundle 8 9 9 10 TimberTex bundle 10 11 12 12 Z-Ridge bundle 7 7 7 8 TimberCrest box 10 11 12 12 Nails Cap Nails box 2 2 2 2 Coil Nails 1.25 in box 2 2 2 2 Step Flashing Step Flashing 10 ft piece 4 4 4 4 Step Flashing 8 ft piece 4 5 5 5 Drip Edge Drip Edge 10 ft piece 31 33 34 36 Drip Edge 8 ft piece 38 41 43 45 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)f8dge cap=hips+ridges.6)Low-slope products applied to 1/12 pitch areas.7)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 10 Woodland Dr, Rye Brook, NY 10573 (1) QuickMeasure Attic Vents Roof Reports in Under an Hour Static Quantity Units CobraC Rigid Vent 31m, SnowCountry,a, & SnowCountry',A Advanced 43 ft Cobra®Exhaust Vent Roll- Nail Gunnable 55 ft Cobra®Exhaust Vent Roll-Hand Nailable 46 ft Cobra®RidgeRunnerF' 61 ft Cobra® Hip Vent 85 ft Master Flow®SSB960 Metal Super Slant-Back Roof Vents 13 vent Master FlowC RV50/R50 Square-Top Roof Vents 16 vent Master FlowC IP65 Plastic Slant-Back Roof Vents 12 vent Master FlowCw High-Capacity Dome Vents 6 vent Master FlowC 10' Aluminum Ridge Vent 36 ft Cobra IntakePro,�_R) Rooftop Intake Vent 85 ft Master Flow:u Undereave Intake Vents- 16" x 8" 16 vent Powered - Roof Mount Exhaust Cobra Master Flow 16x8 (vent) IntakePro (ft) Intake (vent) Master Flow@ ERV4 Power Attic Vents 2 107 20 Master Flow® ERV5 Power& Wi-Fi Attic Vents 2 134 24 Master Flow@ ERV6 Power Attic Vents 2 160 29 Master Flow EZ Coollm Plug-in Power Attic Vents 2 112 21 Master Flow®GreenMachineTM Solar/Dual-Powered Vents 4 112 21 Master Flow®GreenMachineTm High-Power Solar/Dual-Powered Vents 3 120 22 Master FlowC 12" Wind Turbines 5 132 24 Master FlowC 14" Wind Turbines 4 150 27 Note:The estimated quantity of attic ventilation products in this report is based solely on the total exterior square footage of all roof planes and is meant for estimating purposes only. It is the responsibility of the installer to verity the correct quantify and type of attic ventilation products prior to commencement of work. Installer must olways review job-specific attic ventilation needs such as local code requirements,attic floor square footage,roof design,and conditioned spaces under the roof. GAF recommends a minimum of 1 square toot of attic ventilation(evenly split between intake and exhaust)for every 300 square feet of attic floor space.The amount of exhaust ventilation at or near the ridge must never exceed the amount of intake ventilation at or near the soffit. See gaf.corn/ventcalculator for delaih. Prepared For: Perry's Roofing 10 Woodland Dr, Rye Brook, NY 10573 (1) � .11.1., �9 Q, r 1�<cssi> "' ,-'.-_,'► 1'i' __ . *:� NI►� :.ems ;.+i: NII► �s�s .. 4 p,�ato)s LO o j y C. N b U c0 LO Aw " r _ � tl�.'!��M� L: •b to ca a.. rn O O U U s. r� L O •� � : tom_ 1`;. Vl u p •'= �„n o c En •• a F- o w U a Q�otie�tio W G� p 0O fn L1J mow; • W N Q Y N :_J p w a Lu 4., � ale ad X F. s au rz �itss)s 1 d cc U z7 l r �• C U E o �.Iy: 1 1�'.ja i/ 1 1\- ,•. . .f'.,_,, 4 ems• F,, , _�-.s. . . .;+. . ..� 3�-�-- •.s.' - ='".a ►1►►, ','Z w-. nv" ox. ot.eWOv ��-per � - .. - - ,. - -.�• . ACORO( DATE(MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 8/1/2022 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 A/C No Ertl•914-457-4200 No)•914 457 4220 Tarrytown NY 10591 aooAss: info levittfuirst.com INSUREIIII AFFORDING COVERAGE NAIC A INSURER A:Admiral Insurance Company 24856 INSURED PERRVER41 Perry Verrone LLC INSURERS:Accident Fund Insurance Com an 10166 12 Center Street INSURERC: Pleasantville NY 10570 INSURER0: 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. ow INS TYPE OF INSURANCE ADDL SUBR POLICY NUMBER �', IMAOAIUDCY EFF POLICY EXP MMlDD/YYYY ITS A X COMMERCIAL GENERAL LIABILITY 937258902375890 7/1/2022 7/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS�AADE X OCCUR DAMAGE To RENTED L X PREMISES(Ea occurrence) i 300,000 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY S 1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY 7 71 LOC PRODUCTS-COMP/OP AGG $2 000 000 OTHER - S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)S ANY AUTO BODILY INJURY(Per person) i OWNED - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accdent i e UMBRELLA LIAB X OCCUR 9073490723490 7/1/2022 7/1/2023 EACH OCCURRENCE $5,OW,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DIED X RETENTION$lnS WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 5rATUiE ER ANYPROPRIETOR/PARTNERiEXECUTIVE F E.L.EACH ACCIDENT = OFF ICERMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EAEMPLO S If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 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 AUTHOR17FORF.PRFSFNTATIVE Rye Brook, NY 10573 C f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name 8 Address of Insured(use street address only) 1b.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"1a" 938 King Street 46-884191-18 Rye Brook.NY 10573 3c.Policy effective period 03/01/2023 to 03/01/2024 3d.The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/officers included) X❑ 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 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 aqent of insurance carrier) Approved by: � � T�GG.lNd 03/28/2023 (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