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HomeMy WebLinkAboutBP23-153PERMIT40 4% DATE: � a3 w(P: SECTION O BLOC LQT TYPE OF WORK JOB LOCAT ON owNE Qe a .� S s ree �,Uc�,a /� �o�°i°`'z �C��y)y� S�7 yas CONTRACTOR F e6lDrQ 0/1 LLB i/i/ / G!�`1C1�S�/y �P EST. COST �,Noo 000 f FEE` ✓CO # • FEE4 S� DATE TOO 0 FEE DATE 1 NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 02( RGH PLUMBING - GAS ED SPRINKLER ELECTRIC �Q LOW -VOLT CJ ALARM C� AS BUILT C7 0QlZti//P3"I .h 4f 1yn5 OTHER APPROVALS ARB BOT PS ZBA OTHER -O�� z� Y� �1��, G;� �-%�,� --cam re- ��l i a/ �P�y y y VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-158 Certif irate of (occupancy I n This is to certify that F- V KaraChOIMYO PCO a of, RMe F7)r CC�, JN y having duly filed an application on �mh�r l3, 20 rc Y requesting a Certificate of Occupancy for the premises known as, �W �/ /(�f J �• )qV(9d , Rye Brook,NY, located in a R—)o Zoning District and shown on the most current Tax Map as Section: ) Block: Lot: ,159 and having fully complied with the requirements of of the Building Code and the Zoning Ordinance under Building � q /Permit No. '�� , issued 20 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: 9-,3 on` " �� Construction: , for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement, whether by extending on any side or by increasing in hei ht shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change h ben ob d fr^the Building Inspector. DEC 1 2 2024 Building Inspector,Village of Rye Brook: Y& 7)1Date: G c�G4.°u owe t l.`V�b w,Yi DR VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.iyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E.Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 12,2024 Ankeet Bajaj&Shailashree Ramachandra Koppal 16 Bonwit Road Rye Brook,New York 10573 Re: 16 Bonwit Road,Rye Brook,New York 10573 Parcel ID#: 135.50-1-59 This document certifies that the work done under Mechanical Permit#24-019 issued on 2/21/2024 for the relocation of two HVAC outlets have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to p CCENE SEP 13 2024 DD BUILD _,MENT For office use nl o PERMIT# —/S 3 VILLAGE OF RYE BROOK V14 OF RYE OK ISSUED: BUILDING DEPARTMENT J38 KING SIRE ;j YE BROOK, YORK 10573 DATE: 9-/3-av 9 -06 OY FEE: /�aS— PAIDJW . OV 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 RtRt►♦tttiittti►•iitt♦tt►tti♦tiiittitR►Rlttt►ttiiittttiti••t►►►►t►►•itiii♦iit♦t►►►•i•tiiii►i►►►►t►t►itit►►ti►ti►iiti►ti►♦►i►i Address: I (� ►//�Dfti �l l-T �'�D C�� o�� !�y 1 V'—7 3 Occupancy/Use: / -� 411-( Parcel ID#: Zone: -/ Owner: Address: 1 b )7{rJ ;,J'T k O P.E./R.A.or Contractor: G 2yC- S-��"G 2es1o��!r��oN ' Address: Person in responsible charge: i LL P V w-11 A S,r v-t y Address: 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: being duly sworn,deposes and says that he/she resides at 1 b) (Print Name of Applicant) (No.and Street) in P yE '.ZO D k in the County of W in the State of N y 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:$ 2-81,D�,U for the construction or alteration of. [e\fi e,.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-IO.A.of e Code of the Village of Rye Brook. Sworn to)befor a this 5-f Sworn to before me this day of ��{{ll7lll 20 5 ` day of , 20 ,,Si�qfpirty�owner S kI A(LA-St l 121;c Signature of Applicant ,pN v iEC,7 &A1A) k0P[9AL Print Name of Property A y Print Name of Applicant /V�Fki D I Votary Public VNotary Public y Guidi,,; C 01000027366 1 ,u14 1%WY F*Iirb 81Mt of New York *OOMEMoo Expires:07/3 V10n �yE BRC��_ cu � • �9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Ef 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 : In e:)Z+J sl l K rJ .�� DATE: -1 - G j L`t PERMIT# �� 2 ISSUED: -1" ��I 2j SECT: 13.'. 0 BLOCK: LOT: LOCATION: T_ ;, 1 �� J i �, ) OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS i A ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER / ❑ FINAL PLUMBING ❑ CROSS CONNECTION Q FINAL ❑ OTHER �yE BR(��• 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 : DATE: PERMIT# \P Z 3 ' JZ ISSUED: SECT: BLOCK: LOT: Gi LOCATION: '� \ SCE OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ^. 1 ❑ NATURAL GAS 'r ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER �] FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��, w � 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 - - - - - - - - - - - - - - - - - - - - ADDRESS : ` �� �� DATE: (I L o l y PERMIT# L\- D ISSUED: SECT: 13 BLOCK: LOT: _ LOCATION: - AAA b CP�O�a i `� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... LJ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION l ❑ NATURAL GAS -� J E� �, a- ❑ L.P. GAS Q 4 1(b N eoo M AvOL " ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER N t A L QyE BRCZjk O�` y BUILDING DEPARTMENT 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 : G�c-A I I ~v DATE: PERMIT# 1 ti/� ISSUED. _SECT: ! BLOCK: —'' LOT: LOCATION: , SJ -C�S 4 C's /t1"f' OCCUPANCY: ' ' ❑ Violation Noted THE WORK IS... . PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION J� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ROUGH FRAMING 1 /0 INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL [[3-10THER c ■ S[ _ M ` M O" • w 5 = F�1 CJ1 ." 04 O cn En iCs 00 n 00 V LnON r ui en _O 44Ln w Co � � o fT1 ■ p Z z R. � W � � �o � •� � ,� w Q In Et v a-.�` _ Ln Ln 0. co O O a - s = O V W z O A AVM a�i aCiV U a , a Z Uzi a of a W � �-+ G, �{ I-•-� �''� 'x O � W �Wfj � V' p 'a bn yaj" �y �\� {,� z r h 1"'� U' C'1+ rx'■� � �+ � �j � �iy � � Q y o � oq•�. � x O aC�1 W °v O Iw'i `n a v 3 C u � ■ oz 00 L p u b o Fes+ � Gam+ W _ O C x ■ ~ y U o C R b v W a O Ei ', CH) ZO O V , % C4 v 'zL ° y , ' u 15, z W O pd Y 'r, a .o .. A. W BUILDING DEPARTMENT HAUG VILLAGE OF RYEB• ROOK 18 2023 JD 938 KING STREET RYE BRO61k,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryrook:org BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:Approval Datv. AU ' it#: 3—/f 5,3 Application Fee: S Approval Signature: Permit Fees: S /ter Disapproved: Other: ***��rsf**��*•re**�e::**w****tar•r*�*•�:,rrrf;****w«*��e****#***�*+�*�*t��*:*:arfr*�+��•*sew*.s:*ss*�e�*a***«**s**** Application dated w 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 a4 exi ring building,or for a change in use,as per detailed statement described below. p 1. Job Address: 4v 1 SBL: � � '-��/ Zone: —t�- 2. Proposed Improvement. (Describe in detail): t-iii n-, eMid 1IM021 F=it L4.e,J-0,X d>0 - 4-tA k �� Tub 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,ANSI, System,FM-200 System,Type I Hood,etc...) : No: ✓ Yes: (lf.ms. Pleas;.ubmit a separate Automatic Fire `tippre,sion~.stein Permit application & ? -x;ts(,I'detailed cngincr.i k%J 111,mS j 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 1�� 6. MY State Construction Classification: N.Y. State Use Classification: 7. Property Owner. 00ge-el 4} , c. f� Address: Nrc,�K N� Phone C13111 -�9G p&f 3 __ Cell# email: Anke-4e-4- ou cxll—l-CO►'- 8. Applicant: k.c, 41 �1�rklnclS1(„ce Address: ` Z3 Sam Nn.\t 9#2l0 �rdsL.s 4J�R Phone# 4t14 -JfY7-L425 Cell# email: KP�u;rif'��14. ItZ atw�.J_�cwc 9. Architect: lk 4e-L Address: 93-D l U SWD 1 i 2 o2- ,,Jg 'PY Phone# I Z-3 2-2 - ,26!? Cell# email: M �iP z1A",e ri!3,nea e,,., 10. Engineer: Ye_ Zlnella Address: 4�p Dl _&61 tAX0 -it 2-02- ,,r„de- WX Phone# Cell# email: 11. General.Contractor: '�-Y4Aok51 A Address: 923 (-iJf-r ?,L 4�, 2 20 Phone# 6N, - 6q 7- 6V 75 Cell# email: l�r,�t 'Pao:A'A�� 12. Estimated cost of construction $ 000 (NOTF: Ilic c,timatcd oust,hall includc all labor,material.sc all'oltiing.lied o uipment.pmtessioilal tees,and matrrud:uid lah,w %khidl ma, h�64 lutcd gnttis.) 13. Job Timetable: Start: PC-4 Finish: (1) 6/1/2023 BUILD MENT [E C [E �V E V,L E OF RY+ ID , OOx 938 KING ET RYE BR ,NY 10573 AUG 8 2023 4 "Q VILLAGE OF RYc BROOD BUILDING DEPART-MENT is r.ik k:F d'irk]F3:*'k iC it is xx*:kxkk:tF:4**:kir*:k nF ie*:Fa':*:F*.FF]Fk:F%kk;F eFk*dkk:k'k�k]ter]Flt*'*xd':F]t1F'kknl'i:ki:SF:F.F![�f 4C]t**sF al'*F'IC it:k a":�l"k iCx it*a:c i;.?:`7:'G ' 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, fi{I f �j "�t3� , residing at, (ram �V AUJ _ 7A {Print name (Address where you live) 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, 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 j;i c nature of perty✓✓✓✓Owner(s)) (�f� H l'� R/4m PCH A N 1X A �[k�E F T 6AJA I k0OPAC (Print Name of Property Owner(s)) Sworn to before me this t.fJ-747-7 VENESSA VITIELLO NOTARY PUBLIC-STATE OF NEW YORK day of r"i " u 20 2- 3 No.01 V16412798 Qualified in Westchester County My Commission Expires 01-11-2025 (Notary Public (2) 8/12/2021 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: _ to Ic'U� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individua signing as the a licant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the 1C1<� �1 , ti►`al6�E for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,a ,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 520 -)_3 day of , 20 �prt,Own MR(CA ,H KG c Signature of Applicant Print Name of Property gTer Print Name of Applicant Notary Public Notary Public VENESSA VITIELLO NOTARY PUBLIC-STATE OF NEW YORK No.01 VIS412798 Qualified in Westchester County My Commission Expires 01-11-2025 (4) 8/12/2021 / a i t z 1 OFAM x ►n �? Ln o v a w W 60M tn z A W i1 Z 01, M ° ch L f-"4 P u C im z o a �, z a O W ~ � Z z H 000 Q A t • C f�;,,,1 z ��'i V w '�i zcz co � s w ' Ln 00 W g O n - �z W w U W a Z z z`� M a z � x W w c x o ° S < O z x w z G4 as Ln z t ~" w o w z a � ° • c7 '" A o c7 q p jy z w p z � � �� a a ? as w = y • ` R DR IEIE F yt✓ nv� .....�.�� DD BUIL � MENT SEP - 7 2023 VIL E, »BYE;- OK 938 KING I RYA y NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT W orr ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ` �y FOR OFFICE USE ONLY BP M EP#: Approval Date: SEP 1 2 Permit Fee: Approval Signature: Other: Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/ol ren ove 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: l _ SBL:��Jf SV"���J Zone /d� 2.Property Owner: �e�f S'�I'Q � Address: V, �r Phone#: }Cell#: email l� �y �,,,�,� 3.Master Electrician/Licensed Installer: 1 Qt 1 CM Address: 35 k I ) , ��P • `(W e Lie.#: 1775 Phone#:9/y 5 7, Cell#:q,T(o 5Z'+52-1 email: ( � ( Company Name: '�q u1 , ) T�' . Address: 13 i0J 7 4.Pro osed Electrical Work/Fixture Ce Couunt: pl el f l e 'Ceof-ScAMd w u ew W«k 'S 5.3`d Party Electrical Inspection Agency: S ST�A�TE O NEW YORK,COUNTY OF WESTCHESTER ) as: i 117ZO ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of Individual sionii� s the applica`�� state that(s)he is the ffiai l,a Y�`t Vl lJ for the legal owner and is duly authorized to make and file this application. (Master Electricia /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 to this �7� Sworn to before me this 74� day of 20 Z' day of Signs re o roperty Owner Si�y�ure of Applicant . /�r'i'EEl &A3A1 s ht Ai HaGr: VLAN RC.I-+ANbv A rWaPH t� I �1 t I k Cro Print Name Pr e Owner Pri ame o Itc t Notary Publi ROBEK L CIMMINO VENESSA VITIELLO NOTARY PUBLIC-STATE OF NEW YOfiK NOTARY PUBLIC-STATE OF NEW YORK No.01 C16360697 3/3/2023 No. 01 V16412798 Qualified in Westchester County Qualified in Westchester County My Commission Expires 06-26-2025 My i:ornmission Expires 01-11-2025 • STATEWIDE INSPECTION Service With Integrity 181 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOBAPPLICATION tel845.202.7224 • • 1•2 I SWISNY.com I SWISTraining.com Office Use Elect.Permit# � �/ � � Date r,• � �� Bldg Permit#AA)3 -5 3 Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block FLot Owner Name/Address(if different than above) ;. I Contact Number ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑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 IE]Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information a y ckc I VJ �lJ. I' vtc_, c +f O\_I� C�Dot CID l J I SEP - 7 2023 VILLAGE OF RYE BROOK ff BUILDING DEPARTMENT i 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 aWksnt,owner or authorized agent agrees to all the above temp and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date � ' J Signature Address % City/State Zip Code License# 1i - , "� Phone# D: i State Wide Inspection Services JAN 17 2024 1080 Main Street C i Fishkill, NY 12524 Q -I 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES 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: Totally Wired Inc. Ankeet Bajaj Anthony Piliero 16 Bonwit Road 135 Columbus Avenue Rye Brook, NY 10573 Tuckahoe, NY 10707 Located at: 16 Bonwit Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-199 135.50 1 59 Certificate Number: 2024-0083 Building Permit Number: BP 23-153 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 16 Bonwit Road, Rye Brook, NY 10573 The First Floor,Second Floor&Garage were 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 8t' Day of January 2024. Name Quantity Rating Circuit Type Luminaires 26 Switches 06 GFCI 04 Exhaust Fan 02 Service 01 200 Amp Meter 01 Panel 01 Grounding and Bonding of Service to Current Code. 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%vork performed on the date of inspection only. N i'00 xx y w w oo a oo c 1� u M �^ F" "" a. v �a W C Z010 � rn >dF a a w2 u z V O cn O w c Ey R� .-. Z C/o M H en kn a `A T••4 to � � a V et r.a a a 0. 4 0 W tn M v F8 o �- � �I 0.41 a w = � DID BUIL -P�MENT _� _1EME VIL E OF RYE OK 938KIN , ' T'RYB NY to LEP2 5 2023 , i r/ or VILLAGE OF RYE BROOK PLUMBING PERMIT APPLICAT N BUILDING DEPARTMENT FOR OFFICE USE ONLY BP#: 3 PP#: Q 3_/0 SEP 2 6 2023 Approval Date: Permit Fee: $ v Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, a3 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: t(o SBL: 9 Zone:�/c�- 2.Proposed Work: l(p (!o On w%i i..__..1 A 5 u vine 3.Property owner:A4-)Kdar(3.Oti4) — )AN?jpCjj Address:_Lb Q OTC W%�- R� , ?V 4- J�VQ M, 0(i Phone#: Cell#: email: 4.Master Plumber: X&6 VHf O Zh 1 n a1 Y t Address: 71a VQft tS 614 e- Ud`�\A+ AV 10 Sq S Lic.#:l V O Phone#0jA4-8Q6-Sb 11 Cell#:QI�'-8AC-n-)I Company Name:Z V AY[i-1p4JU\ 1a%+3;1 X;me ai-%: c Address:'aa glQrt-S P(ae a 11cth*%"g1\z10 NY I oSq INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1stFloor 2nd Floor ` t 31 Floor 4m Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: 1R'QP1 C(C& ngu-) 121 U t"b t r,u TI X N r e S t h �'k2 / eo ttu a( f- -}W 6/S hpt-V l f f a stavt d s k or�ve,tz H q'c es f k4';"h fo o cti. (Notarized Signatures Required Next 2 Pages) -1- 3/3/2023 r C�f�NE BUILD PARITMENT SEP 2 5 2023 VIL OF:RYA OOK _ 938 KnvG LT �RL ,NY 10573 VILLAGE GF 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: 31"WtkEcr Basal xsHAkASNV-e F 'CAL residing at, 6 ?>OY)%L-� 'Ka, (Print name) (Address where you live) 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; l fo bo'nW'%k Rd , 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. ature of Propeffy Owner(s)) ANV_C[J min 'I ; HAT LASuV-GE KO(DPAL_ (Print Name of Property Owner(s)) Sworn to before me this 12 day of , 20 23 (Notary Public) sCaTT W.CRAIQ Nowt'Ptillik:of MrW York REG NO. WMPA30W _g_ COMMIssION EXPOES 04M&2W 8/12/2021 STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: J PC i�r z, 20 1 N C(r?—.' ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this ( 1 Sworn to before me this 2 day of ,20 3 day of Se P 20 a - Signatur Property Owner SignaJure of Applicant SHA Print Name of Property Owner Print Name of Applicant Notary Public 14kary Public p6TER).CH OF NgV4 Y�RK �rw.t� RY PUg1-1C,Gh7163Cg-166RGQUr4 N�pubftofOWYork So NO. O�Eg-1GHg5TULY 28+ZC� REG NO. MRe3�1 tEp 1N 1Rg5 3 COMMISSION EXPIRES 04tivio t QUp1 1F M1551GN 6XP This application must be properly completed in its entirety and must inQ11&o le notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 3/3/2023 M 0 � wyy v v H N N Cnj Cd C w 00 00 F : Ln IZ a oo C: r M fT1 'tt v y ` Z o M�'1 v a OQo � � � Q o z F+ L r� �wz ° 99 " " MM U A w ouay ... A �! '�' w m w O w$ � ° � W oo s V w H o o b a H a o�j Uz Z W , v q a z W � � � � . o °gAu Q , a � x w � x � � � � o a M .� ►Tl W N pq v .o E• x 0 F 5 � P .v ° � d O O cn cn a'< o � v a ` p SO � x a a Z.z H aV! r U z N p (y w U O a z C7 av� yavo 0-4 z W `n 0-4Z oe B os' 04 u y �I U H . � .� BUILDING DEPARTMENT D 0 VILLAGE OF RYE BROOK FEB 2 0 2024 JD 938 KING STUET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.Kyebrook.org BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING E UIPMENT FOR OFFICE USE ONLY 13 PERMIT#: QC) Approval Date: Permit Fee: $ /0Q Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit• COMMERCIAL=$350.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice required 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. ************************************************************************************************* Application dated, c) is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. , 1. Address: I b c�0 ty yj.4 Kp�D SBL:/315-, 5-0-/-S Zone: -/�- 2. Property Owner: \yC,QQ!)- Stjzl�vaN Address: Phone#: 3I7-y 96 Q&S,? Cell#: email: 3. Contractor: INgFg QL) L" we, 7, Address: `7oZ t3�Qv��S P�Z(t� VU (/1t( a1}PL/ Phone#: d y -13 a 6 -•&&-111 Cell#: email:�1�pb 0 q r a j`, cptM 4. Scope of Work:New Installation( )•Replacement` -Removal( )•Other( ): 5. List Equipment: RQ�OiCGI�Q 2 "M Ae. 0U11.(2iS O t, !u r� "©M VW&, 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): t 10/30/2023 S l \I E Ol'NF.\\ 1'(312I�.C'ul IN l:1'OF\\'IiS1 C'111;S11iR ) as: 2�'t'�121 being duly sworn.depo%cs and slate%that hdshe is the applicant abme named. tpnnt name of ind,tdual stpntng a%the applicant) and Itirther states that(s)hc is the I leafing,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorised to make and file this application. 1 hat all statements contained herein are true to the best of his/her know ledge and belief.and that any work performa or use conducted at the atxv.a captioned pmperiv will he in conformance with the details as suit forth and contained in this application and in an. accompanying approved plans and specifications,as well as in accordance with the New York State I'niform Fire Prceention R Building Code,the Code of the Village of Rye Brook and all other applicable laws.ordinances and regulations. Sworn to before me this / h Sworn to before me this 4 _ day of l C 'ICG 41t .20 Z day of 20 eC 'Signature o roperty Owner Sig lure of Applicant 5i-fA A islC�t� r5A3A3 ,tfC[;PPL1L ����tyy'\o 2`�t M��a` Print Nam of Prrt%pgOwwner Print Name of, ant71/in'�'Y Nolan'Public Nolan Pu to SCOTT GOWE NOTARY PUBLIC OF NEW YORK I.D.#01G06357188 ELIJAH DEMOND WARE MY COMMISSION EXPIRES�1�7/7�'�� Notary Public-State of New York NO.01WA0018286 Qualified in Bronx County My Commission Expires Dec 9,2027 This application must be properly completed in its entirety and must tnc u e-t 1e notarize stetnaturetsl c" the legal owner(s)of the subject property,and the applicant of record in the spaces provided. An% 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. z 10 3u 2023 .Building Permit Check List&Zoning Analysis Address: SBL: Zone: /%_)­\A1— Use: Const.Types �_ 1 Other. Submittal Date: \� � evisions Submittal Dates: Applicant: Nature of Work awo Reviews:ZBAPU G 2 6 2023 BOT• Other. �FBP OK ' (,'(FEES:Filing. BP: U `. C/O: Flood Plane: Legalization; ( ) ( ) APP: Dated. Notarized. SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening: ( ) ( ) ENVIRO: Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY.Dated: Current: Archival: Sealed: Unacceptable: ( ) ( LANS:Date Stamped:__6,�ealed: ' Copies:A electronic: Other. (� (Pf 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. ( ) 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: 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: REQUIRED EXISTING PROPOSED NOTES APPROVED Circle: Datw•Aw Z �n•,., Fie Front Front. Si Re r. Main Cov Accs.Cov Ft.H Sb• S .H Sb: QE& Tot.Imp &Imp P ku' Hight/Stories: ` notes: 2vcp ,�tp ,e a dtaS n • +!r'W4 `< '4'• -I' .a� ��- �Y�•1��t�� 'AN •1(�'��.`g& 'T�i�`!i(� 91i1�a 'U�7 ��: h4�h�'�l ea}� ., �11���� t r3^��1• �-:, id3' �. / Ln O V � y O 4 Oki O O O b t uCJ o m ection o o cr p �T Z o C t lo) W u a LL wa O O 3t � r �e ++ � 1- O y ! C ~ Q X ,o z 3 c i 'J dv �� x L tVal 1 v u M � ! + :! d �;�fas), _• :r 4`, r �_ 7"i�ra°"'� .t"..�,:,' �t!,� n``''-"�. r h a�-.�sr"-�y-:��� 4loU) - ,A,� DATE(MMIDD/YYYY) �-- CERTIFICATE OF LIABILITY INSURANCE 081 07i2023 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 SUBROGATIONIS 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: INSURANCE ASSOC OF AMERICA LLC PHONE (262)789_8500 FAx 83412066 17500 WEST LIBERTY LANE (AIC,No,Exig (AfC,No): NEW BERLIN WI53146 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Underwriters Insurance Company 30104 INSURED INSURER B: GRYF STONE RESTORATION LLC INSURER C: 77 DONALD DR HASTINGS ON HUDSON NY 10706-3623 INSURER D: INSURER E 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE Fx IOCCUR DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) X General Liability MED EXP(Any one person) $10,000 A X 83 SBA AW3Z70 03/09/2023 03/09/2024 PERSONAL&ADV INJURY $1,0001000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY PRO- ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) A AUTO S ALL OWNED AUTOS SCHEDULED 83 SBA AW3Z70 03/09/2023 03/09/2024 BODILY INJURY(Per ardent) HIRED NON-OWNED PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) UMBRELLA LIAB I OCCUR EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS- A MADE 83 SBA AW`3Z70 03/09/2023 03/09/2024 AGGREGATE $5,000,000 ED RETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ATLITE ER T ANY YIN PROPRIETOWPARTNER/EXECUTIVE E L.EACH ACCIDENT . OFFICERIMEMBER EXCLUDED? N/A E L.DISEASE-EA EMPLOYEE (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTIONTI N CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Village of rye brook IN ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St. AUTHORIZED REPRESENTATIVE Rye Brook,NY 10573 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 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^ 830546565 GRYF STONE RESTORATION LLC fts, 77 DONALD DRIVE HASTINGS ON HUDSON NY 10706 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GRYF STONE RESTORATION LLC VILLAGE OF RYE BROOK 77 DONALD DRIVE 938 KING ST HASTINGS ON HUDSON NY 10706 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2500 065-4 552154 01/31/2023 TO 01/31/2024 8/9/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2500 065-4, 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:/fWWW.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. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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. 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