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HomeMy WebLinkAboutBP23-084PERMIT # q&2L SECTION _._L._ TYPE OF WORK JOB LOCATION OWNER CONTRALTO � ��E$T. COST VCO # 4 09 DATE: B CK / LOT AQ�ij s2vallo re h ,Lad �d i 1 c^ 4/Ul m 04 FEE ZO10 -Pb DATE TCO # FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION RGH PLUMBING GAS o SPRINKLER ELECTRIC AS BUILT FINAL DATE iNSP 0 0 / ver�oLs �AIy1751 y ���5a�/��c C'v.•� OTHER APPROVALS ARB BOT - Ps ZBA --- OTHER VILLAGE OF RYE BROOK WESTCHESTEI2 COUNTY, NEW YORK NO. 23-132 Certificate of ®ccupaucp This is to certify that I L V of. ..,P3 k i /V Y , having duly filed an application on I T JU IV / 20 C>10 requesting a Certificate of Occupancy for the premises known as, 3 6 PI CJL.GOAL , Rye Brook,NY, located in a I P Zoning District and shown on the most current Tax Map as Section: 1!3LJ . vL 7 Block: Lot: and having fully compliedwith the requirements of the Building Code and the Zoning Ordinance under Building Permit No.Oul^>J-0a , issued 20 c23, 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 Classification: &13//?eJ2t-T ,?-coup 8 Construction Classification: , Maximum Occupancy: I I Arsol)s for the following purposes: )r 4eri o r- repo yQ-Al oiQ S Lab Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: I JS occr, pa ey nuhie-4 -to 4ziennial fiy'e )nspeahons as reGai red by V� l)aqe rode G N�h/ Yovy- S�a4e C_'Ode 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 h fight shal shall be made,n .the building be moved from one location to another until a permit to accomplish such change n from a wilding Inspector. AUG 1 5 2023 Building Inspector,Village of Rye Brook: Date: BUILD R ENT For office us >Ilv: ID PERMIT# --,)3_aq JUL 19 2023 VIL OF RYE. K ISSUED:15-llv-a3 938 KING STRE BR0()X' YoRK 10573 DATE: 17—/2—J3 VILLAGE OF RYE BROOK 9 -06 FEE: Ar eo 1p — PAID$BUILDING DEPARTMENT 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###i##f#ift###fftfittiftfftti#iitii#tti########ti#t#fttftttfitt##t►tft#i#itft#s*****sss######sst#st####i###sistiiss###* Address: 13 FIG., p��b66 f p ug:e'A Occupancy /Use: ."Al Parcel ID#: / Y/, a 7- /-co Zone: Owner: wLN �a-)bs k 'Cm Ixe Address: l lc P.E./R.A. or Contractor: k J U Co►v I t'14-c f L 6— Address: Person in responsible charge: / All- �'r\tt/ Address: Q14n Ati" 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 II OF NEW YORK,COUNTY OF WESTCHESTER as: 1/ F4oV\0r being duly sworn,deposes and says that he/she resides at 27 L11 nwR �u (Print Name of Applicant) (No.and Street) ,/ in 0�OT5 H—// ,in the County of �v`eAr 6i /' 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:$ U,utI) for the construction or alteration of: 8 1 auk 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 Z2.N� Sworn to before me this day of -�+ `/ , 20 23 day of , 2025 %AgnatUdof Prop rty Owrmv Signature of Applicant ISft x �.�. KF(12,✓ Print Name of Property q" Print Name of Applic Notary Public Kr:LIY SANG!-ER Notary b. c_. . jintary f UbliC, '=.t, c,; Niew York No. 0' C:. !n %A/estchcster County 9i12i2021 �:crnr. fission F_rp r,3s March 9, 20' QyE BRX O`` tim Q 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 - - - - - - ---- - - - - - - - - - - c2f 2� r� ADDRESS:— DATE: PERMIT# }� ISSUED: ECT: BLOCK: LOT: LOCATION: N ` Lc.6> OCCUPANCY: ❑ Violation Noted THE WORK IS... 0 PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION ,� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION - O ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER QyE DRcb - BUILDING DEPARTMENT [J UILDING 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 :— 1 DATE. PERMIT# � c 0 ISSUED: SECT: �, Z !BLOCK: LOT: LOCATION: `�' OCCUPANCY: o ❑ 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 _ l ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION + C fJINAL '© OTHER tJ �' ��'�--p-r,�-.vim -2 _�.. � c�(7 e c, c �.`�� �� � �►�,�� d' a dd' cn a. MCI aj a 0 QZ Lr) Q O O a.•' 'r �j O W Cn W ° _ ° 0 A H o ri) vI � zo � � o � O W � o o U� A Q () q V Uzb o � , © w w p .� z w Ena Ca a V ' z no 00 WC,4 > ogi 5 - p, • ► W w V zz � 3 y 0 ;Z) 'd y V u �ay14 U If �" W O H a O 'b y v y c� o � v � V O z w � oo ,op � �a x w w O7 •� z oq x a .� BUILDING DEPARTMENT FJUN - VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 _ www.n,ebrook.org VILLAGE OF RYE BnOOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: y� Approval Date: Permit#: (/� Application Fee: $ Approval Signature: i Permit Fees: $ .� Disapproved: Other: Application dated: 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. Job Address: ��1� SBL:1 d1I I �i7—f —(! 7 Zone:+ 2. Proposed Improvement.(Describe in detail): OUCIV S'f'f�C4A^ o�-r�..a , &I A i .-y 1`1 (-c T JaO! 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes, indicate: TIER I: TIER II: TIER III: 4. Will the proposed project 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...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: �w.,llN l 1. C Address: Z� F e FI� Phone# q[� � y I "4tt);7 Cell# � ' `�email: �' ✓\ 8. Applicant: -�) 10Loss: °y c e r t e— IL YJ 'e '�4 Phone# / ?( Cell# ,�i�� email: 9. Architect: i!'-,j r t 5 - 5 tf e U Address: 1 3 a ""� 11 0J Phone# 4 r Cell # email: 10. Engineer: Sv V wed V ►Y W Address: Phone# Cell# email: 11. General Contractor:KJ Y rt144-�W 14 (Address: _ ejZ PY Jam( t' O fie, Phone# � ( k Cell# email: �?:46YLch'Al?' 19[ 12. Estimated cost of construction $ a 0 b 0 - 00 (NOTE:The estimated cost shall include all labor,mat rial,scaflbtding,fixed equipment,professional fees.and material and labor,chicb may be donated gratis.) 13. Job Timetable: Start: 4/S Finish: {I) 6/v2o2a BUILDING DEPARTMENT DIECIEWIED VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK, NY 10573 JUN - 5 2023 (914)939-0668 Nvw«.ryebrook.or VILLAGE OF RYE BROOK 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: I, DAVID F_ItJdquSi+ , residing at, Id 9YE 21Df e eiAZA. . RW_ gg r3 MM (Print name) C\ddre,.NNhere.\ou Ii\el 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; R1 D6E RAZA, , 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. 7 I'rnhLrt� v I Lru S 1 (Print\Jme of Property 4wmr"n Sworn to before me this 5 � day of 20 Z INo are UNICl Kr-I_IY p1\10r)l FR Nntar y Fi.i:.f, t�� n' �!ew York No. C' 0,.Plifi�'d in `P'= r,,,<;.r Gounty (2) cornrrissiort Expues Maiuh S, 2J 8/t 2/2021 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: ?/4 V V 4=r 11-e efA::�5 , 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 _ COO 1 p- 6C= _ 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. Swom to before me this Sworn to before me this day of J V IJi , 20 Z 3 day of , 20� S gnat of Propero Owner /�{Z n t 7 5 gn re of I bR1J 'Vim �V fin^ a III p� l e�C Print Flame of Property Owner �pT� r Print a of Ap licant I c tan' ublic KELLY SAMDLER Notary Public, c+ate of New York Q talifi din 'n. Y®s Mlarch 9U20�r_ Commission Exp oc.�� � 4�1�LIt~,6TAT�OF NEW YO1tK l tltill�#t No,02CO6357170 t11� ttt Wrstehest� �o ty �(11�`Cd'%WjjWft tVires: (4) S/12/2021 ri c c w h+lONz � u ' �'k ^ z CA G W O .� n °' Qll M x 3 O o 0-4 O �f� �w O W a N 4 v V w H w O o ►-� Z Gn +� p H a O ONE x � �' p � z a � , x , o0-4 � o FBI W y. O cn o w x r � o r W v ,� V 00 c.L A cn Z U z � cn M ..� U V O - � < O •, 0.4 00 � z < H i � re) Vj 5 r t x z A a A cz Gz it A F F x , cnz ►.y .. •- o z o CA , Q Ln U Fg w (0", 0 /3 P EVILLAGE aRC�BUIL E ENTVIL E OF RYE K �938 KIN ET RYE B NY i0573 N 2 9 -023] 01 or OF RYE BROOK ELECTRICAL PERMIT APPLICATIONG DEPARTMENT Westchester CountyMaster Electricians License Required FOR OFFICE USE ONLY BP#: Q3_ O SZ4 EP #: Approval Date: SUN 3 0 2023 Permit Fee: $ l S-0--/LIr6 Approval Signature: Other: Application dated, 06/2201112 is hereby ma a to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 13 )Zti6 ZrQ6, &-M 1ShhlPPV6 CZWMA SBL: /`/I.Z) - I -41 p Zone: 2.Property Owner: �.T/� RT0(6 �C II tl L L L Address: 24 gVe PX01 4 /!�A'w .s#,e ccv-n L Q Phone#: -111 -201 - If Dom Cell#: email: 3.Master Electrician/Licensed Installer: CoSTO-,VZ Address: a Rocn1 Go Ny i Lic.#: VL-LU Phone#: 0104 -3O-(01 60 Cell#: q S� uti2l1 -got -oZ email: �EOSTi46�1ZZ2 6M/�2C.Co,.� Company Name: 12610 Col?P Address: Z OIL /4o-- 6ivo(es /W /v 2.v 4.Proposed Electrical Work/Fixture Count: De-/-0 cr- C -RJT32y6 of c..S IZTA)6 0,._r_ W4 Lk_ f 26M t]VAC. 5.3"d Party Electrical Inspection Agency S WAS STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: S'My'&V Ga&T19A/Z a ,being duly sw•om,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) �1JC� 00 S^rANl.o state that(s)he is the tZt4 SS/w CLaC for the legal owner and is duly authorized to make and file this application. (Master Electrician'Licensed Installer) The undersigned further states 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 q 1, day of ,20 day of UI , 20 Signature of Property Owner Si ure of Ap tcant ST£C--f ru S).q✓V" Print Name of Property Owner P 'nt e of Applicant Notary Public otat� Pt lic eq una B.FErtNar�e 2? '^� Notary Public,State of New York 14o.01FE0005034 OuaBfled in Westchester County Commission Expires 04/04/2027 STATEWIDE • Service Willi liilegri�y 1080 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOBAPPLICATION tel845.202.7224 I fax9l4.219.1062 I SWISNY.com SWISTraining.com Office Use Elect.Permit# l Date Cif - _S Z 1i Bldg Permit# I utility ID# Final Certificate# City/Village Zip Township 1c - County , Address 7 ? t t,?o6c /�, m S Cross Street Sections!/ Z 7 Block Lot Owner Name/Address(If different than above) / (7 � Contact Numberq j 7 ❑Basement ❑1 st Fl. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential 'Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information r or JUN 2 9 20231] DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name tc 60 /�_ ZZi Date j z Z Signature Address AL City/State � ) Zip Code License# -2/�-[t- Phone# 1 ..-3/� __� 7 DState Wide Inspection Services R 1080 Main Street coJUL 2 7 2023 Fishkill, NY 12524 sv"wri U s 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com Website: www,swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Red Star Electric Corp. Win Ridge Realty LLC 2 Hedge Row 13 Rye Ridge Plaza Congers, NY 10920 Rye Brook, NY 10573 Located at: 13 Rye Ridge Plaza, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-144 141.27 Certificate Number: 2023-5347 Building Permit Number: BP23-084 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 13 Rye Ridge Plaza, Rye Brook, NY 10573 The First Floor was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 24`h day of July 2023. Name Quantity Rating Circuit Type *Demo and Rerouting of Existing Wiring Only. Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Buildina Permit Check List&Zoning Analysis Address: V3 1 SBL Zone.s_ UseA-L Const. e: V Other. Submittal Date: Z evisi\o^ns Submittal Dates: Applicant: � C' Y 1— Nature of Work: � N oc- C Reviews:ZBA J UN 1 5 2023 PB: BOT: Other. l O ( ) FEES:Filing. BP:&5&0-)�UcC/O: Flood Plane: Legalization: r) APP: Dated Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: 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.'N-\ ' ( ) ( ) PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. 1- ( ) ( ) 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: REOMED EXISTING PROPOSED NOTFS APPROVED & Cir • •`�+^��• Fr n e Frorrt: Front: Sides 13s�� Main Cov Accs.Cov Ft.H S Sd,H S QFa Tot,imp: Et-Imp: P rlun Height/Stories: notes: ncvK� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �i 06/02/2023 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 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: NORTHEAST BROKERAGE PHONE FAX 1325 FRANKLIN AVENUE SUITE 1375 E-MAIL 914 762-4400 ac No: 914 762-4461 GARDEN CITY NY 11530 ADDRESS: mza as is inc.net INSURE S AFFORDING COVERAGE NAIL 0 INSURER A:Utica First Insurance Company INSURED INSURER B: KJV CONSTRUCTION LLC 39 CEDAR LANE#2 INSURERC: OSSINING NY 10562 INSURERD: INSURER E: Westchester 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 UBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMIDD MMMO X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR AMA E To RENTED PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A X Y ART3000593120 11/02/202211/02/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT : Ea acadant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION E $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE E ERR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 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) Carpentry, Landscaping& Masonry Certificate Insured and Additional Insured are the sante:Village of RNe Brook CERTIFICATE HOLDER CANCELLATION Villa(e of Rs e Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 Kin St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook Nl' 10573 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD USE) NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 364986606 MAGDALY ZAYAS/INFINITY AGENCYry 95 CROTON AVENUE OSSINING NY 10562 ❑C< ��J� SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KJV CONSTRUCTION LLC VILLAGE OF RYE BROOK 39 CEDAR LANE 2 938 KING ST OSSINING NY 10562 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2577 748-3 388050 09/14/2022 TO 09/14/2023 6/3/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2577 748-3, 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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STAT SU NCE FUND T4 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 817909186 U-26.3