HomeMy WebLinkAboutBP23-147PERMIT # &�)/
SECTION
TYPE OF WORK
10B LOCATION
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EST. COST
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FOOTING
FOUNDATION
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LOW -VOLT 0
ALARM 0
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
www.ryebrookny.g_ov
TRUSTEES BUILDING & FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
August 21,2024
David Fink&Emily Fink
14 Birch Lane
Rye Brook,New York 10573
Re: 14 Birch Lane, Rye Brook,New York 10573
Parcel ID#: 135.43-1-5.29
Building Permit#23-147 issued on 9/6/2023 to Change Front Door from Double to Single
This certifies that the new single door,installed under the above captioned permit has been satisfactorily
completed.
Sincerely,
Steven E. Fews
Building& Fire Inspector
/to
BUILD -R ENT For office use only
n1j) PERMIT# --/41 7
VIL OF RYE OK ISSUED: — 3
AUG 13 2024 38 KING STRE YE BROOK,` YORK 10573 DATE: — 3--a
� FEE: — PAID f 3
VILLAGE OF RYIE BROOK ov
BUILDIN'7 7`DARTMEh1T
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
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Address: 4i v, L r% &upv h
Occupancy/Use: NS Parcel ID#: Zone: ►`—3
Owner: fool i) Fhk Address: ��' (►-�I�
P.E./R.A. or Contractor: 1 i������ Ifa, Phl��,�h Address: (� but Av�
t 1 � y/
Person in responsible charge: W 111 itnn L tA)b Address: 6 1kni A1,C, P&,rd oIr6Y
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 YORK, COUNTY OF WESTCHESTER as:
Doi►) F-"A being duly sworn,deposes and says that he/she resides at
(Print Name of Applicant) (No.and Street)
in %!e. t-4`H)V( ,in the County of \tj e)\},� N in the State of that
(City/Town/Village)
he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements,
labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may
have been donated gratis was:$
for the construction or alteration of: h Inext Lir �k �0
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-IO.A.of the Code of the Village of Rye Brook.
Sworn to before me this 3 Sworn to before me this 3
day of 20,')'l day of IJ�.S , 20 "A
L"U I I
Signature of Property Owner Signature of Ap scant
NgUl(1 Fi\IV Aw�
Fin/n Name of Property Owner Pame of Applicant
AkAt:�� "
J-JL
Notary Public SHARI MELILLO No Public
Notary Public,state of New York SHARI MELILLO
No.01ME6160063 Notary Public,State of New York
Qualified In Westchester county No.01ME6160063 6iti2o2a
Comn)lssion Expires January 29,20,� Q-alified in Westchester County Corr;rr,ission Expires January 29,20 Z�
�E BR(��,
cu �
BUILDING DEPARTMENT
�❑,,BILDING 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 : I L4 lCrC� 1r DATE: A 4 Z�
PERMIT# �/\ �� / ISSUED: ' (o" SECT: _ BLOCK:_LOT: 5 -Z
LOCATION: �Rn�� L? k v'A 1p OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... Vl--A/CCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS J
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
a'FINAL
Q OTHER
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BuIL C DE1;X,41 MENT L�
VIL [ OF RYi, [i�z0Ox JUL 31 2023
938 KING Lr'r itvh;Blzo,p NY 10573
l->l)939-U(i �
VILLAGE OF RYE BROOK
--t r°�lv' r� BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
AUG 1 8 2Q?3 _ :� : � �
Approval Date: Per Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
Or
ZBA Approval Date: Case#
Other: p�t
Application Feet Permit Fees: / d ��U�
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: oCJ is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the
construction of build ngs,s ructuu�res,additions,alterations or for a`change in use,Jas per detailed statement described below,
1, JobAddress: ��' —ON Lh L till✓uT�✓Y IU J� 7 7 p
2. Parcel ID#: S� 3 - I -� a Zone:
3. Proposed Improvement(Describe in detail):_min h tun �gur ian A.Wt J.or
4. Property Owner: ay+d I
Address: - �;,_uJl�/�,V -
Phone# ls 7600 Cell# 51 (� _(�S� (� tt� _- c-maid"GVIq , U �iM1�►rQl' �tM��� c�ih
List All Other Properties Owned in Rye Brook:
Applicant: t _i 4
Address: l-
Phone# hoo Cell# e-mail joylJ.64I'kpl 5mocu"%
J
Architect:
Address:
Phone# Cell# e-mail
Engineer: jy/A
Address:
Phone# ;y. Cell# e-mail
General Contractor: Pcotl C V`6
Address:_ ti 1& <- vt Vo rr °j y2v- >V y toy 71
Phone#___�_()o 6 S , 0 Cell# Y TAT UNI-e-mail
(1)
6/11ZU2;
5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: I-FGty Post-construction: I Ft"t,
6, Area of lot: Square feet: A 01 U'�I Acres: (),q6
7. Dimensions from proposed building or structure to lot lines: front yard: r;/f- A rear yard: 111A
right side yard: A left side yard:�lv�14 other: ff T
8. If building is located on a corner lot,which street does it front on: P I N
9. Area of proposed building in square feet: Basement: 11,fl: 2"d fl: KN 3rd fl: �
10. Total Square Footage of the proposed new construction:
11. For additions,total square footage added: Basement:_ I`fl: 2"d fl: 0 3rd fl:_
12. Total Square Footage of the proposed renovation to the existing structure: IV/^R
13, N.Y. State Construction Classification: & N.Y.State Use Classification:Nffi
14. Number of stories: Overall Height: At Median Height: NIA
15. Basement to be full,or partial: finished or unfinished: JV�P
16. What material is the exterior finish: Br J
17, Roof style; peaked,hip,mansard,shed,etc: AILA Roofing material: JJ��
18. What system of heating: (rk)
19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this
application.
20. 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...) Yes: No:
(ifves,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
21, Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a
Stormwater Management Control Permit as per§217 of Village Code? Yes: No: X Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: � (if yes,applicant must submit a Site Plan Application, &provide detailed drawings)
23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: X
(if yes,you must submit a Site Plan Application, &provide a detailed topographical survey)
24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: X
(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan)
25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: �.
(tf yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan)
26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: X
(if yes,applicant must submit a Tree Removal Permit application)
27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No:
Indicate: TIER I: TIER IT: TIER III: (ifyes,a Home Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
29, What is the total estimated cost of construction: S 11)%0 . 1 4 Note:The estimated cost
shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees, including any material and labor which
may be donated gratis.ff the final cost exceeds the estimated cost, an additional fee will be required prior to issuance of the C/O.
30, Estimated date of completion: ne(%6te lr aU l3
(2)
6/112023
BUILD&DEPf1i MENT b� ��U E �1 � E
VIL E OF R1�r OOK JUL 3 1 2023 DD
938 KING irH,'r Rl'E Bizo. ,NY 10573
� 4)939-06613� VILLAGE OF RYE BROOK
wwwr rO 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:
NV'jc Fink , residing at, �- 4irw Ln _TIV�
(Print naive)
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;
Dtl-i-I LA A4 11Z ki All , Rye Brook,NY.
(Job 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.
/�'/ —A,
(Signatu ot'Property Owner(s))
(Print Name of Property Owner(s))
Sworn to before me this 3 I � t--
day of L t , 201
4
(Notary Public)
JEAN E. HUGN
NOTARY PUBLIC
State of New York, #497161B
Qualified in Westchester County
Commission Expires Septembe (6)r 10, ('
8/12noz1
This application must be properly completed in its entirety by a N.Y. State Registered
Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where
indicated. It must also 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:
0&V1) 5;Ne ,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,*#Ir\eg- 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, sutnp 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 thisr Sworn to before me this <_J l u
day of V t , 20 day of v r> l f , 201
, 4_4 L ,1')e"1 TJ
Signature of PropeRy Owner Signature of d pplieant
Dc'VI) i/ tAk bc,Viy F-OL*
Print Name of Property Owner Print Name of Applicant
Notary Publ' Notary blic
Y
JEAN E.HUGHES
NOTARY PUBLIC JEAN E. HUGHES
State of New York,#4971618 NOTARY PUBLIC
Qualiiied in Westchester County 3�ti1 State o1 j`4.-�v York, #1971618
Commission Expires September 10, Qualiiied in VJe tchester County U"L
Commission Expires September 10,
(8)
8/12/2021
Building `Permit Check List&Zoning Analysis
Address: 1 \f c Y ` `_n SBL A'�) ^ 1 1
Zone: " ` Use: C Const.Type: V Other.
Submittal Date: 20 Revisions Submittal Dates:
Applicant: > N
Nature of Work 6—z�,n O �-(�_ cu�
Reviews:zBA: AUG 0 7 2023 PB. BOT: Other.
n v°
ICED ( FEES:Filing. — BP: \ � C/O: Flood Plane: Legalization:
( ) ( APP: Dated: —Notarized. SBL 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 S�Ped. Sealed: Copies: Electronic Other.
( (. License: ✓ Workers Comp: ty ✓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.
( ) ( ) PLUMBING Plans: Permit: Nat.Gas: 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.
( ) ( ) 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.
(J� mtg.date: \L 2't, approval VG notes: '09/
( )ZBA mtg. date: approval: notes:
( )PB mtg.date: approval:- notes: w
REQUIRED EXISTING PROPOSED NOTES �1�' �
Circle:
Fronm
Front
Front:
Sides:
fir.
Main C�v
Accs.Cov
F HS :
S .HS •
QFA:
Tot.!=:
EL-IMP:
Perking.
Hight/Stories:
notes:
BUILDING.DIEPARTMENT �� E C i=N E
VIL 'A,(,E OF RYE\BROOK
938 KING �f ,`,ET RY'E 3R O ,NY 10573 JUL 3 1 2023
VILLAGE OF RYE BROOK
_.._
BUILDING DEPARTMENT
ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS
This form must be completed and signed by the applicant of record and a copy shall be
submitted to the Building Department prior to attending the ARB meeting. Applicants
failing to submit a copy of this check list will be removed from the ARB agenda.
Job Address: 6IYo) L n �br,a iv i ,V 'Y Date of Submission:
Parcel ID#: 1 , 4 —L�Zone: 5 I �
Proposed Improvement(Describe in detail):
Ch(" r,,nv dour uM IU( APPLICANT CHECK LIST:
I� MUST BE COMPLETED BY THE APPLICANT
wr i) SI C lwr The following items must be submitted to the Building
Department by the applicant-no exceptions.
Property Owner: e 1. (4Completed Application
p rty I�1GV rl IFth� �A� : �:lYir\�( 2. ( )Two(2)sets of sealed plans. (one full size (maximum
Address: I If 6 jr� Lh My allowable plan size=36"x 42") and one 1 I"x17")
3. ( )Two(2)copies of the property survey.
Phone# 8 I S 400 4. ( )Two(2)copies of the proposed site plan.
Applicant appearing before the Board: 5. ( One electronic/disc copy of the complete
application materials.
6. (,A Filing Fee.
Address: I`�- )�;rV, Ln Pre "Iy, All IuT/ / 7• ( )Any supporting documentation.
Phone# r16
8. (�HOA approval letter. (if applicable)
1 2t,U� 9. ( Photographs.
Architect/Engineer: 61A 10.( )Samples of finishes/color chart. (a sample board or
model may be presented the night of the meeting)
Phone#
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Sworn to before me this '�1 s t Sworn to before me this
day of 1; i 1.� , 20Z day of v 201-�--
Signature of Propdty Owner Sig re of A licam
r)c,VIj r-,.,.Ik be,,ia F,Ak
Print Name of Property Owner Print Name of Applicant
_ V
Nar�rPublic Notary blic
JEAN E. HUGH S JE E.
ot HUGHES
NOTARY PUBLIC III Iv0 i,RY PUBLIC
State of New York, #4971618 State of York.#4971618
Qualified in Westchester County Qualified in ir:'e�tchester County
Commission Expires September 10, p'1-1 Commission Expires September 10,
8n 2i2o21
� LjC DRnV� Village of Rye Brook
Agcnda
ti Architectural Review Board Meeting
Wednesday,August 16,2023 at 7:30 PM
Q
Village Hall,938 Sing Street
�j
1. ITEMS:
1.1. ARB23-085 (Consent Agenda)
Fasih Ahsan&Talha Rathore
320 Betsy Brown Road
4'high silver chain link fence.
1.2. ARB23-086 (Consent Agenda)
Eric Hammer&Barrie Hammer
25 Old Orchard Road
6'high clay PVC fence and gates.
1.3. ARB23-087 (Consent Agenda)
Benjamin Alper&Dilrukshi Ekanayake-Alper
60 Windsor Road
Rooftop solar array.
1.4. ARB23-088(Consent Agenda)
Michael Ryan
24 Tamarack Road
Rooftop solar array.
1.5. ARB23-089 (Consent Agenda)
Eric Newman&Cindy Newman
39 Tamarack Road
6'high white vinyl fence and gates.
1.6. ARB23-090 (Consent Agenda)
Volkert Braren&Maureen Braren
262 North Ridge Street
Rooftop solar array.
Consent Agenda
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.7. ARB23-091
David Fink&Emily Fink
14 Birch Lane
Change front door from double single.
Approvals: Motion C- Second �'A
(L Abstention
Aye; Nay;�� Adjournment;
Notes
1
Architectural Review Board
August 16,2023
1.8. ARB23-092
Sound Federal Savings&Loan
121-125 South Ridge Street aka 115 South Ridge Street
Two illuminated monument signs and one non-illuminated wall sign"M&T Bank"
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.9. ARB23-093
BelleFair Homeowners Association
38 BelleFair Boulevard
One non-illuminated wall sign"Childtime Learning Centers"
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.10. ARB23-094
Bryan Wolkind&Jodi Wolkind
30 BelleFair Road
Rear deck.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.11. ARB23-095
Steven Miller&Fran Miller
10 Country Ridge Drive
Renovate existing deck,new windows,remove chimney and new exterior door from
garage.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 2 of 3
Architectural Review Board
August 16,2023
1.12. ARB23-096
Aamani Property Holdings LLC
221 Betsy Brown Road
Front entry landing,repair walkway and driveway.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.13. ARB23-097
Lindsay St.Lawrence
1 Churchill Road
Repair and replace retaining walls and add stone facade to driveway wall.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.14. ARB23-098
Brett Goodman&Stephanie Goodman
11 Edgewood Drive
Rear 2nd story addition over existing family room.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.15. ARB23-099
Michael Chu&Dianne Chu
2 Winthrop Drive
Rear deck,patio,reconfigure windows,interior and exterior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
NEXT MEETING:
September 20, 2023
I ag, 3 3
Laura Petersen
From: Laura Petersen
Sent: Thursday, August 24, 2023 1:16 PM
To: david.b.fink@gmail.com
Subject: Building Permit Application - 14 Birch Lane
Good afternoon,
The building permit application has been approved by the Building Inspector. Before I can issue
the
building permit the following items must be submitted to our office,
General contractor's contact name (first and last)
� Copy of general contractor's valid Westchester County Home Improvement License.
3. General contractor's valid liability insurance (the Village Of Rye Brook must be the
certificate holder)
A. General contractor's valid workers compensation on a NY State Board form (C105-2 or
U26.3)
5. Building permit fee $198.00 (due once permit is issued and ready for pick-up)
Thank you
Laura
Laura Petersen
Office Assistant
Village of Rye Brook
938 King Street
Rye Brook, New York 10573
Phone(914)939-0668 1 Ipetersen aaryebrook.org
1
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r� CERTIFICATE OF LIABILITY INSURANCE F08/29/2023
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(les) 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 endorsemant(s).
PRODUCER NAME cT CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE:P.O.BOX 328 1AH CNNu,E:q:888 333 4949 Fn c,Nol:507 446-4664
OWATONNA,MN 55060 anGRlESs:CLIENTCONTACTCENTER FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 379-939-2 INSURER B:
PALETTE PRO PAINTING&RENOVATION INC INSURER C:
13 BENT AVE
PORT CHESTER,NY 10573-4454 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:163 REVISION NUMBER:4
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 SARJ POLICY NUMBER IZNWrff EFT PO lM
Y XPYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS MADE17XOCCUR AMAOE TO ENTED PREMISES $100,000
ME EXP(Any one pence) EXCLUDED
A Y N D941594 11/12/2022 11/12/2023 PERSONAL&ADV INJURY $1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL T
X POLICY �CTT LOC PRODUCTS&COMP/OP ADD S2,000,000
OTHER:
AUTOMOBILE LIABILITY E MBBI'E�44D SINGLE LIMIT $1,000,000
JANYAUTO BODILY INJURY(Per Person)
AOWNEDAUTO60NLY Hr��S� U.ED N N 0941594 11l12/2022 11/12/2023 BODILY INJURY Per Pcciden9
HIRED AUTOS ONLY qO ONL OPERTY D R AMAGE
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000
A EXCrSSLLAB CLAIMS.MADE N N 6056072 11/12/2022 11/12/2023 AGGREGATE S1,000,000
DED 7
X RETENTION f1 D,000
WORKERS COMPENSATION PER STATUTE DTHER
AND EMPLOYERS'LIABILITY YRy
ANY PROPRIETORIPARTNER/EXECUTIVE E.I.EACH ACCIDENT
OFFICERIMEMBER EXCLUDED? N/A
(Mandatary In NMI E.L DISEASE EA EMPLOYEE
It yes,describe Inds
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT
i
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.AddiOonal Remarks Schedule,may be aNached i1 more space is required)
ADDITIONAL INSURED ALSO INCLUDES DAVID FINK, 14 BIRCH LN, RYE BROOK, NY 10573.
CERTIFICATE HOLDER CANCELLATION
1534
VILLAGE
OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
VILLA
938 KING ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
RYE BROOK,NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE AOU
®1986,2015 ACORD CORPORATION.AN rights reserved.
ACORD 25(201Sf03) The ACORD name and logo are registered marks of ACORD
NYSIF
New York State Insurance Fund PO Box 66699,Albany,NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
A A A A^A 472709745
PALETTE PRO PAINTING&
RENOVATION INC
13 BENT AVE
PORT CHESTER NY 10573 SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
PALETTE PRO PAINTING& THE VILLAGE OF RYE BROOK
RENOVATION INC 938 KING STREET
13 BENT AVE RYE BROOK NY 10573
PORT CHESTER NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2559 777-4 613457 11/12/2022 TO 11/12/2023 8/29/2023
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2559 777-4, 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
RODRIGO VASCONCELLOS
VICE PRESIDENT
RAFAEL VENTURA
PALETTE PRO PAINTING&
RENOVATION INC(2 OF 2)
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
T 4/
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 966133149
U-26.3
CERTIFIED DOOR QUOTE
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Brockway Smith Company-Wilmington
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Bethel,CT Branford,CT Darien,CT Lewisboro,NY
(203)797-1212 (203)488.3551 (203)655-2525 (914)533-2517
:8: Wc5t Avenue (NO)797-6511 (866)758-3551 (800)390-1000 (688)533-2517
DAR:EN C^_ 06820
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(203) 655-2525 (860)439-0155 (860)355-5566 (860)739-5441 (203)761-1000
F: (203) 656-7557
(866)439-0155 (888)350-8966 (800)303-6526 (866)842-7883
TRANSACTION
TYPE STORE
81,andacd Y'uoCe THANK YOU FOR SHOPPING RING'S END Par'en, —
BILL TO: 1 SHIP TO:
PALETTE PRO P^_G S RENOV.
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:3 BEN: AVE
POR- CHESTER NY :0573 RYE NY10.580
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CUSTOMER TRANSACTION CUSTOMER
CODE DATE NUMBER TIME 1 _-- PURCHASE ORDER NUMBER SALESPERSON
1)FA1. P8 'n6/30!Lri23. 37194 ! • 0 RO - -
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SOFiGOR i 1/:0X3/1X:/_0X6/8 RH I -.000 7536.000/EACH 7536.00
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either expressed or implied,that this quotation may be taken as a statement of all required material. Additional respons'rbilites of the owner
(or owner's agent)Include,but are not limited to,verifying sizes,specifications,code requirements and all quantities prior to placing orders. If
allowances have been included in this quotation they represent only a recognition that these products may be necessary,but are not meant to be
taken as specification of actual product or final pncing for same.
MiSC 1 1 SALES REMAINING INVOICE
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77220 NANTUCKET
DOOR SPECIFICATIONS (AS SHOWN):
Wood Species: Fir
- Profile: Ovolo Sticking
Panel Type: 3/4" FP
Rough opening needs to be 2" wider and 21/2" taller than your door.
STANDARD OPTIONS
Quantity 1 Change Quantity
Change Door Shape
No Face-Pin Option? O Yes OO No
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view more
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Feet Inches Fraction
Original Slab Width
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77705 NANTUCKET SIDELIGHT
DOOR SPECIFICATIONS (AS SHOWN):
Wood Species: Fir
Glass: Clear
Profile: Ovolo Sticking
Rough opening needs to be 2" wider and 21/2" taller than your door.
STANDARD OPTIONS
Quantity 1 Change Quantity
Change Door Shape
No Face-Pin Option? O Yes * No,
view more
Stain or Paint? OO Stain O Paint
view more
Wood Species Fir
Feet Inches Fraction
Original Slab Width
view more
CERTIFIED DOOR QUOTE
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Door Company INSPIRATION
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Brockway Smith Company-Wilmington
CERTIFIED DOOR QUOTE SUMMARY
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100-2 77705 Nantucket Sidelight Paint Grade 1-10"x 6-8 1/2"x 1 Quantity: 1
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100-3 77220 Nantucket Paint Grade 3-4"x 6-8"x 1 3/4" Quantity: 1
Approved
Date
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