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HomeMy WebLinkAboutRP23-032PERMIT#k&J t)*3 A E: �® oi� 6�(p• JQ SECTION BLOCK j T TYPE OF WORAK /s � JOB LOCATIONQ. QWNER ///CONTRACTOR EST. COSTFEE �C0 FEE DA U o� TCO # FEE DATE �NSPECTfON RECORD FOOTING FOUNDATION FRAMING ""-- RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT Cl ALARM AS BUILT FINAL OTHER APPROVALS ARB BOT F'8 ZBA OTHER J CcctiCwo' J� G VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE September 21,2023 Lana Kang 496 Franklin Street Rye Brook,New York 10573 Re: 496 Franklin Street,Rye Brook,New York 10573 Parcel ID#: 141.27-1-43 Roof Permit#23-032 issued on 7/10/2023 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D BUILD W& MENT For office use only: PERMIT# -v3 d. BVIL OF RYE OK ISSUED: '7-/O—ol3 JUL 2 5 2023 938 KING STRE YE BROOK, YORK 10573 DATE: 9 *1Q6 0 FEE: d //O-- PAIDJX VILLAGE OF RYE BROOK BUILDING DEPARTMENT 21EPPLYCATFONTOk 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 t►iitrttiikiittii�rkiii;i;iiii;►#;tiittktiiitiii#titii itiikktitikk#44i4#i Rrttrtrt4kk#iitii####44##i#i►#ki►►k4#itti►tiiR4►ii►tit►iR Address: 4q�eIF-r o.n STY L+ . /D is-6 Occupancy/User Parcel ID#: / a 3 Zone:/( )F Owner: 4 a. La LILM Address: P.E./R.A. or Contractor: �,-' Address: / �J' �// Person in responsible charge: /T. S (ivY};� �� / Y .LL4olyl5k ,Pogo o�c/o 1cR It 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 YOR�KpCOUNTY OF WESTCHESTER as: Ly l.i'L9� � , --\ being duly swom,deposes and says that he/she resides at �'�0.n (Print Name of Applicant) (No.and Street) in �roK ,in the County of��Q��- S- >�' 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 a uipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ o_ d for the construction or alteration of: 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 D_ 3 Sworn to before me this day of I .2 J , 20 j day of , 20 Signatur ropertooyA�Owwner Signature of Applicant Ze4"' Print Name of Property Owner Print Name of Applicant i Notary P Notary Public ( f111� l � (J 1 E BR(v�• 1982 BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - -- -- -- - ADDRESS : (0 V'C(7Xn " '` � '�"�DATE: PERMIT#�._�[� �L`� ISSUED: 1( ` SECT: ( BLbCK: LOT: LOCATION: (C ( 1, ])n.j!Jz OCCUPANCY: ❑ violation Noted THE WORK IS... C]'PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �E BR(�k, - cu � FO BUILDING DEPARTMENT Q'iUILDING INSPECTOR /b ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - -- - - - - - - - - - - -- - - - ADDRESS : '" DATE: Z' PERMIT# 1 ` �/�-'- ISSUED: I� SECT: BLOCK: LOT: LC LOCATION: ��\ c U(� 1d OCCUPAN Y: ❑ YAolation Noted THE WORK IS... ❑ PASSED ❑ FAI D /REINSPECTION SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION C. ❑ Natural Gas `"J `t~� �C�b� :� C c� �•C �� (� ❑ L.P. Gas w e 1f 0" (I ❑ FUEL TANK � U � �PC� Ca� ��-� �C UCJn ❑ FIRE SPRINKLER ❑ FINAL PLUMBING 1 ❑ CROSS CONNECTION ❑ FINAL t M f l-0-` �3� t �lC uC 0 < CA � ❑ OTHER ( JOtl� � tC-"� U �� \ -� � � k SURE' Cc�.CkS 7 7� V v o �E DR(b, o`` tim cu � 19812 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 - - - - - - - - - - - - - - - - - - - - INSPECTJON REPORT - - - - - - -- - - - - - - - - -- -- A van ADDRESS : DATE: �-� PERMIT # � ISSUED: J( (]izCT: BLOCK: LOT: A7 LOCATION: �( � ` C_� v OCCUPArICY: - ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ ;FA#E/pp REINSPECTION ,SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE f ❑ FOUNDATION ❑ UNDERGROUND PLUMBING J NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P.Gas ❑ FUEL TANK �l + ❑ FIRE SPRINKLER ❑ FINAL PLUMBING r, e ❑ CROSS CONNECTION ` `� C ❑ FINAL ❑ OTHER C yw C) � o W v � vro cry a y o. „ i..i ro P.W a v1.0 h , o w w L a rx y y w o W CA oolq v V > 0> v `O a o w° c cn GQ 00 F+ o o -r • p ON y F. co o v w rJ s W z Q q V ca I ~ ` Z o w P. z M x � � c _ x w Ez x w V � v �4 lu t M 0 O V PC y Fri a z o gW, > acn � w „ c . O W W 0 � H a.� o ] _D2ECF2V/F I BUILDING DMA,TMENT DD V1>, E OF RY 'ffkOOK JUL - 7 2023 938 KING �, ET RYE BROOK,NY 10573 -0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: e tit#` Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: ry Application Feecgla)�b Permit Fees: �7 ROOF PERMIT APPLICATION Application dated: 7 /"a 3 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 Building,as per detailed statement described below. l/ ,/ 1. Job Address: I� l Ya h 1� 11 � SBL: ��7I r 7~ T 3 Zone: Property Owner: Address: fU Phone#: �� ��� �f 9 fl Cell#: `�1 1f email: �, 2. Applicant: t�P� oY Yn[i`2f�1[1-vmd ate/ Address: 1,8 G Od 1/i 9�t ! , 1344kd(Y4 e'a rr Phone#: 1 q Cell#: q/y 3/0 G/pZ email: 3. Roofing Contractor: OYLS Y�/CiAddress �� P f Phone#: 1*/6Y Cell �/_O email ion G o GO9r�l �� `'v,, qq_� L fl�Ary 4. Job Description, list all Methods& Materials: /mot u e ad C> } .'S hq - ��t ul� 5A "a/f G� -u'��i S7,/ 5. Estimated Cost of Job: $ 9, Rd OJ (No I E: I'he estimated r«'t ,hall include i ll tiite impro�cnients. I�ihor. matcruiL �.,illi7Etlinc. li�cd e<lui�mrru_ prul�s+iunal 1�cs.at d material and lahur��hi�h mas he donated ratis.l 6. If corner property,indicate street frontage:_ �l�C(K 7. Construction Type: r NYS Construction Class: 8. Number of stories: Height: - r /7� �2. Y 9. Is garage being re-roofed:No:( • Yes: ( )Attached No: ( )• Yes: ( )Number of Cars: rc a 10. Is roof peaked,hip, mansard,flat, etc: (�' • 11. Estimated date of completion: -t- 6/1/2023 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. 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. 7�+ Swom to before me this / Sworn to before me this {Q day of ) v , 20 ) day of 7E , 20 Signature of Prope er Sig fure of Applicant Opp Print Name o ctpe Owner Print Name of Applicant Notary P lic Notary Public EL17 BEl-H D,t,2 As a Commis er of DeedS For the City of yonkers 1VY Westchester�punb, C e�mPerton Eantrr,Q-`� 611/2023 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. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this / Sworn to before me this day of �u , 20 e�_3 day of , 20 Signature o4P-pe Owner T Signature of Applicant Print Name of Property Owner Print Name of Applicant /""?, T�)- e, Notary Py is Notary Public 1 (4) 3/21/19 Steven Fews From: Steven Fews Sent: Wednesday, August 16, 2023 10:40 AM To: Jinny K; Anthony M Cc: Laura Petersen Subject: RE: C/O Application for 496 Franklin Street Attachments: 496 Franklin St Site Inpection report.pdf Expires: Thursday, December 14, 2023 12:00 AM Good Morning, I am sending this email as a follow up to my site Inspection with the Roof Contractor on Monday 81/14/23. Please see the attached report. As you are aware, I had the contractor set up a ladder so that I could physically go up on the roof to inspect. I wanted to see the work around the chimney to see if anything the contractor did was an obvious sign of creating a condition to allow leakage inside the home. I could not determine that. I did note however, that the chimney is missing a cover cap, which then allows for rain water to flow through the opening and down through the chimney all the to the basement floor. Water was found only around the base of the chimney. Furthermore, the chimney bricks are also loose and cracked in areas. This may also be a cause of water entry. You must have the chimney pointing done as well. Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 From:Jinny K<jinnyk1224@gmail.com> Sent: Wednesday, July 19, 2023 11:30 AM To: Steven Fews<SteveFews@ryebrook.org> Cc: Laura Petersen <LPetersen@ryebrook.org> Subject: Re: C/O Application for 496 Franklin Street Good morning, I wanted to reach out and request an update for 496 Franklin Street, Rye Brook. I haven't heard back from the contractor and I wasn't sure what the next steps were. By any chance, did they reach out to your department? I gave instructions for the contractor to reach out and I wanted to know if they did. The roof is continuing to leak and the exhaust for the kitchen fan is disconnected and I am just worried and frustrated translating for my parents because they would like an update from the contractor. He hasn't reached out to us or demanded payment ever since I reached out to your office for assistance. Thankyou 1 Warmly, Jinny On Fri,Jul 14, 2023 at 11:25 AM Jinny K<iinnyk1224@gmail.com>wrote: Thank you so much for your email. I appreciate your time to respond so quickly. I will give the contractors a call to reach out to you. Thank you again On Fri,Jul 14, 2023, 11:06 AM Steven Fews<SteveFews@ryebrook.org>wrote: Good Morning, the work has to be done satisfactory.To your families satisfaction as well as the Building Inspector's satisfaction. If you are reporting to me that the home is still experiencing water leaks despite the work that they did, it will not pass inspection.We always try to advised homeowners to withhold some portion of the payment until they receive the certificate of occupancy/compliance from our office. If you finish the payments,you have no leverage to have them fix whatever is not right. If he is reputable,the contractor should be wanting to make things right for your family. Feel free to have the contractor call me to discuss the job. Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 From: Laura Petersen <LPetersen@rvebrook.org> Sent: Friday,July 14, 2023 10:09 AM To:Jinny K<iinnyk1224@gmail.com> Cc:Steven Fews<SteveFews@rvebrook.org> Subject: RE: C/O Application for 496 Franklin Street 2 Good morning and thank you for the email. I have copied the Building Inspector for response and help. Thank you Laura Laura (Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 loetersen(a rvebrook.org From:linny K<jinnyk1224@Rmail.com> Sent: Friday,July 14, 2023 10:02 AM To: Laura Petersen<LPetersen@ryebrook.ors> Subject: Re: C/O Application for 496 Franklin Street Good morning, I wanted to attach photos for the roof repair that was completed on 07.09.2023 at 496 Franklin Street, Rye Brook NY 10573.The contractor is demanding payment and I explained that there's a leak after the repair and they mentioned that the inspector will come out to inspect? I just want directions/confirmation as to what the next steps are for my family's situation. He is coming to my home at 6 in the morning for payment and the conversation is going in circles as to my family wanting the leak fixed and them wanting payment for the project and pushing the leak to your department instead. Can you and your department please assist us with what the process is? Do we pay for the inspection to take place? I apologize I am the daughter and translating for my parents and I don't know what to do. 3 Thank you so much, hope to hear from you soon. Warmly, The Kang family On Mon,Jul 10, 2023, 9:10 AM Laura Petersen <LPetersen@ryebrook.ore>wrote: Good morning, I have also attached the C/O application required for completion before scheduling the final roof inspection to close out permit. Please note the roof permit fee due is $180.00 and the C/O fee is $110.00 (check made payable to the Village of Rye Brook). Could you also please provide the property owners phone number? Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Ioetersena-rvebrook.org 4 Q�E BRC��. Q 1 ��O•c • 1932 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 - - - - - - - - - - - - - - - - - - - - I� t l 2C� ADDRESS : ` `l DATE: e)l E> PERMIT#R V�c.I ISSUED: 16CT: BLOCK: LOT: Inc P OZA y cNI oC- L�Ik corms r r� LOCATION: 1(Jd �zj CCUPAN Y: DL,.v4olation Noted THE WORK IS... ❑ PASSED ❑ FA D / REINSPECTION SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION c ❑ Natural Gas \ \ Od LO C.zxn Q-kzlv a`-Q-�< ❑ L.P. Gas W Q C�CO �LOdC ka) av'�Q' ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING C \e-v �" c�LSS C� CQ [I CROSS CONNECTION 1�, ❑ FINAL l C --AN �CI C�`X Orv-- 1Aa t+QAk C� + ❑ OTHER Q \ a� \ -, T1 ?Vrg-NQ crc'c-�-S c- xes) c- P-,(--4z� s a C�oc (1k (e v k44 S w C ems, 00 J, �J 2 9 lu, Ll u � i 1S LuJviah Rd Bardo nia.\Y. 109 (914) 310-6102 (914) 609-6168 (718) 775-1136 anthon%ronstruction a lhe.com Lic.= NBC-26768-HI^-::,Yo:-.:,... 3-S'.NYC =-2001926-DCA,Rocl:land=H-12179-A6-00-01 ATT: WCOntra �t . � SCOPE OF WORK: ROOFING Roof to be stripped down to sheathing. Ro .;: i:�_.:surements are approximatel� I�4b sgft: y - • Install �/8 CDX pl�-wood wherever is necessary approx. pieces: • Install aluminum drip edge: • Install Ice R Water shield6-ft from the gutters up in the �alley. chimney i boots: - p Pe l • Install s-,-nthetic underla,,-ment on roof; • Install GAT architectural Timberline Lifetime over the entire roof area: The color being 1c • Install pipe boots: • Install new rich vent on rich cap on peal- of the roof. • Lifetime manufacturer warranty on material: Cr • 5 nears contract's warrantv on'labor- 0 Debris Removal: Complete clean up and remo%al of all job-related debris off this site: .225 c) _ kian JVIA �-- mv _ `1 Ics Grand Total (labor and material): S PAY`TIENT PLAN: Down Pa}-mint 0io50 ..� Upon Completion %50 �y�ry �lZ sus Product Properties SPECIFICATION'S a AWARDS&REC0GtiiT;0;,l D167ENS!O!IS(SP) .„ [J x 3 3 .. STAINGUARD=' J""•u'_[„ ='_:i ALGAS STAIN PROTECTION 5•SSSS - DURA9iL!TY 3TOUGH':ESS EXPOSURE EXTREME WEATHER Is+PA:,T r.ATED _ NRE RATING _ WIND V,ARPANTt WIND RATING SHINGLE STYLE SHINGLE TYPE APPROX.NAILS!SQ �v; R. 9 VOAA ............ ........... -Aw A4 E; CN....... ...... kli ..... ..... z1g% C\j C') z C"z C "w N.S� *Am U +FAO ............ 0 Ln CY) ction 0 7 uD 0 Q 0 CO 0 co 0 daQ < 4t. 7- z 00 T- Sv:r� CD An ............. ��9 DATE(MWDD,YYYY) A C CERTIFICATE OF LIABILITY INSURANCE ,o 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: l rl>tma Ite\e� Multi I ine Ill,tlr WC A",`nc\ PHONE (91 )061-M,h( AX A/C.No.Ext: (AIC,No)'. SI11)Yonkers \%c ADDRESS: (.n>lina-d nnilulinein;.cunl INSURER(S)AFFORDING COVERAGE NAIC# Yonkers \l I0-111 INSURER A: PRLFERRLDCO\IRAC`IORS INS(O 1_141)- INSURED INSURER 8: M A\l I IONY'S CONS FRU i ION INC \I ANTI IUAY'S(t)A1;TRI lilt 1\I A( INSURER C: I;LI D%'I(,I I RD INSURER D: INSURER E li.\RD"\I\ \l l u`i<1 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DO/YYYY) LIMITS r COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000.00) CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5.000 IX-4-1;9`) 02 23 20_23 02 23 2024 PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000 X P ❑PRO- POLICY ❑ JECT LOC PRODUCTS-COMP/OP AGG S I,01111,11110 OTHER S AUTOMOBILE LIABILITY (Ea accident) S ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED T1Z0PrR77TTAM7ES AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATION - AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTIVE FFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ IIIESCRIPTION andatory in NH) E.L.DISEASE-EA EMPLOYEE S yes.describe under OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached if more space Is required) VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BL ILDI\(i DF"PAfZI\If.\l \'ILL:>GL )I Rl I- BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 9±S K1\(,\IRFI F, RI I- BROOK AUTHORIZED REPRESENTATIVE Sa.w�w.at- A 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New'fork Stab:Ir 5urance Fwid PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE [Mail. ^ ^ ^^ 462380653 r j BERMUDEZ INSURANCE AGENCY INC * �, 75 GRAMATAN AVE � t1� MOUNT VERNON NY 10550 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER b1 ANTHONYS CONTRUCTION INC VILLAGE OF RYE BROOK 18 LUGVIGH RD 938 KING ST BARDONIA NY 10954 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2383 014-4 475903 05110r2023 TO 05110l2024 F7/6/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2383 014-4, 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 LEANDDRO MIZHIRUMBAY GOMEZZ M ANTHONYS CONSTRUCTION INC 1/1 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 /�f� �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:368689274 U-26 3