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HomeMy WebLinkAboutBP23-189PERMIT # J 9_ DATE./ ,� SECTION / 01 TYPE OF WORK JOB LOCATION _ OWNER A4 CONTRACTOR/ EST. COST V/CO # TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT O ALARM O AS BUILT C� FINALYii- 39— 7 <Yff(4o ,BQ,1240/0CCZ03)a OTHER APPROVALS PB zBA OTHER BR, 90 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.Qov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morhno CERTIFICATE OF COMPLIANCE September 27,2024 Jim Fishbein&Jenelle Fishbein 4 Stone Falls Court Rye Brook,New York 10573 Re: 4 Stone Falls Court, Rye Brook,New York 10573 Parcel ID#: 135.67-1-37 Building Permit#23-189 issued on 11/14/2023 for Replacement Windows This certifies that the three new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to R For office n.e r_tnlN: FEB - 6 2024 3B UILDING.DEPARTMENT PERMIT# -/ems VILLAGE OF RYE BROOK ISSUED: /— j 938 KING STREET,RYE BROOK,,NEW YORK 10_573 DATE: — —c� i VILLAGE OF RYE BROOK (914)939-0668 FEE: 4 // O� PnIoI'Q I BUILDING DEPARTMENT www,ryebrook.or<c APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED OP:LY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL IN:SPECTIOti •••s•sssssssss•sss••••s•s•••♦sssssss•s•••••••••ss•••s•••s••rsss•••••••••s•••s•••as••••••ss•ssssp sss tsssss••................. Address: 4 STONE FALLS CT g'P a3 — ) 9 1 Occupancy/Use: Residential Parcel 1D#:135.67-1-37 Zone: R-3 Owner: JIM FISHBEIN Address: 4 STONE FALLS CT P.E./R.A. or Contractor: Renewal by Andersen Address: 2041 W Main St., Stamford CT 06902 Person in responsible charge: Franklin Barahona Address: 2041 W Main St., Stamford CT 06902 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: JIM FISHBEIN being duly sworn,deposes and says that he/she resides at4 STONE FALLS CT (Pnm Name of Applicant) (No.and Street) in Rye Brook ,in the County of Westchester in the State of Ncw York that (Cny/rownt Village) lie/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S 9,645 for the construction oraltcrationof. Installation of( 3) Replacement window into Exisiting Openings with no Structural Alterations. Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this I's- Sworn to before me this �th day of -e, 20 day of v10.J' , 20'�"hL C) I Z I� Sig" BRIAN MACDONALU of Property Owner NOTARYYUBUC Signal licant State ofConnecUcut JIM FISHBEIN ff000NWON EXPIRES Oct 312026 Franklin Barahona rint lantc of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20Z-1 �E BRC��. 1932 BUILDING DEPARTMENT ❑BYILDING 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 : n ),AJL1 DATE: z O Z PERMIT# ISSUED: //"/y-43 SECT: BLOCK: LOT: LOCATION: 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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION © FINAL ❑ OTHER WiNO��JS f k w cr' ae a 44 F+i '' A c j dj ti u F W yG Ic-i U U rd ONO © ~j O oP oA30 � v � lu O 00 O in 3�„ �� y O 41 C . i O �/ / \ b V i U LE ca 11 r 11dox V U N Q -lq co E-+ 00110 INC A � U r rA00 ■ _ '—' � � �' A z x w � z � � � � p • V la � (n � W c� � v °� W � cn a� v o "� b c.�► E-i U z ui ` ° .- � � H ~ ~i.. pC., p4 U a V) Z W 0d .� � ' a, q W z oU ab .. o W W A o, ,u a01 BULgET R MENT VILOF RYE OK 938 KING Ri'i BR (fNY 10573pCT 31 2023 -064" VILLAGE OF RYE BROOK —' BUILDING DEPARTMENT FOR OFFICE USE ONLY: If 9 2023 Per Approval Date: P rmit# ; Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: ase# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: C/o "col j(7 /`" Application Fee:IS/lO—AN Permit Fees:`# EXTERIOR BUILDING PERMIT APPLICATION Application dated: 10/15/2023 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings.structures.additions,alterations or for a change in use,as per detailed statement described below. I. 1obAddress:4 Stone Falls CT 2. Parcel ID#: 135.67-1-37 Zone: —�Q 3. Proposed Improvement(Describe in detail): Installation of(3 ) Replacement Windows into Existing Opening, No Structural Alteratio,ro 4. Property Owner: Jim Flshbeln Address: 4 Stone Falls CT Phone# (914)703-0157 Cell# (914)939-7886 e-mail jim.fishbeinl@verizon.net List All Other Properties Owned in Rye Brook: Applicant: Franklin Barahona / FairChester Custom Windows, LLC Address: 2041 West Main Street Stamford CT 06902 Phone# 203-406-0545 Cell# 203-249-1986 e-mail Permit,it RBAWestchester.coni Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: FairChester Custom Windows,LLC Address: 2041 West Main Street Stamford CT 06902 Phone# 203-406-0545 Cell# 203-249-1986 e-mail Permits@RBAWestchester.com (1) 8/12/2021 5. Occupancy;(1-Fam..2-Fam.,Commercial.,etc...)Pre-construction: I 1 2 I'amiI` Post-construction:same 6. Area of lot: Square feet:50 Acres: T Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I'fl: 2r,d fl: 3rd fl: 10, Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I'fl: 2nd fl: 3rd fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y. State Construction Classification: N.Y.State Use Classification: 14. Number of stories: Overall Height: Median Height: 15. Basement to be full,or partial: finished or unfinished: 16. What material is the exterior finish: IT Roof style;peaked,hip,mansard,shed,etc: Roofing material: 18. What system of heating: 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 extensionlmodification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: X (f yes,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: X (dyes.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 (ifyes,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 Torre 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: X (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 (ifyes,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: X Indicate: TIER 1: TIER II: TIER III: (fyes,a Horne 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 9,645 ( permit not included } Note:The estimated cost shall include all site improvements, labor,material,sca#blding,Jlred equipment.professional Dees,including any material and labor which may be donated gratis.If the.fnal cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: 2024 (2) 8/12/2021 BUILDING DEPARTMENT 1D . VILLAGE OF RYE BROOK OCT 3 1 2023 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.org 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; 3j, 7S—" 1:- 15�1 8E l,r✓ , residing at, Srvn �F�t-c--S" C T_ 7 l Or. Orillt 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; d 5�v+oe' �Ms- C T i ,Rye Brook,NY. (Job kddic5,) 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. (Si4 autr afPr.u,. . 77 Sworn to before me this 4 _ day of C �` , 20 1,7 (6) 8/1 212 02 1 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: -ICI,)k—ir r� , ;, ct h �` ,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 C.';� i-r C_ 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 j Sworn to before me this �r day of t7 j , 20_1=!:) day of , 20 E3 r r �-r Sign ture Vf Property Owner Signature 9f AWicant Ut r-7,34�-('A OL L tt#1 6? Print Name ofPr perty Owner Print Name of Appli ant l Npkay Kblic Notary Public i (8) 8/12/2021 *�Ar Order Summary �'. dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD Jim Fishbein COUNTY 4 Stone Falls Court R E NN E W_A L Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Rye Brook,NY 10573 br A N D E R S E N WC-35743-1-122, Putnam#51220 2041 West Main Street I Stamford,CT 06902 C:(914)939-7886 Phone: 203-406-0545 1 Fax:203-406-0828 1 tech@rbawestchester.com ID# ROOMDETAILS JOB 0 011 Misc: , Misc, Permit Fees, Town of Rye Brook- Estimated Permit Fees, Quantity 1, Renewal by Andersen will faciliate the application of the building permit to the Town of Rye Brook. , Homeowner is responsible for any outstanding permit applications or code violations that may prevent Renewal by Andersen from procuring permit. , Renewal by Andersen is not responsible for any historical or architectural review applications and approvals that may be required as pre-requisite for a building permit. Construction: , None Material: , None 0" 0" Misc: . Misc. Miscellaneous Job Items, Lead Safe Work Practices, Quantity 1, EPA requires contractors that disturb painted surfaces in homes, built before 1978 to be certified and follow specific work practices. Construction: , None Material: , None 0" 0" Misc: , Misc, Miscellaneous Job Items, Small Job Fee, Quantity 1, Applicable to any job less than or equal to 3 units. Construction: , None Material: , None 202 Room 1 30" 62" Window: , Casement, Single, Right, Base Frame, Exterior White, Interior 27-3/4" 61-3/4" White Performance Calculator: , PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: . All Sash: High Performance, No Pattern Hardware: , Stone Screen: , TruScene, Full Screen Grille Style: . No Grille Misc: , None Construction: , Exterior Installs (1). Interior Stops Only (1) Material: . Alex Plus Painter's Caulking (0.25), Off White Caulking (1), R-13 Fiberglass Insulation (1). 2" x 7/8" L-Trim Off-White (9167849) (2), Fibrex Stop White (9138973) (2) 203 Room 1 62" 62" Window: , Picture, Insert Frame, Exterior White, Interior White Performance 62" 61-3/4" Calculator: , PG Rating: 35 1 DP Rating: + 35 / - 35 Glass: . All Sash: High Performance, No Pattern Grille Style: , No Grille Misc: , None Construction: , Staging 10/10/23 Page 2 / 11 WAII Order Summary dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD Jim Fishbein COUNTY 4 Stone Falls Court R E*NE WA L Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Rye Brook,NY 10573 byANDERSEN WC-35743-H22,Putnam#51220 C:(914)939-7886 2041 West Main Street I Stamford,CT 06902 Phone:203-406-0545 1 Fax:203-406-0828 1 tech@rbawestchester.com D• ROOM SIZE DETAILS (extension ladders/ladder jacks) (1), Exterior Installs (1), Interior Stops Only (1) Material: . Alex Plus Painter's Caulking (0.25). Off White Caulking (1), R-13 Fiberglass Insulation (1), 2" x 7/8" L-Trim Off-White (9167849) (2), Fibrex Stop White (9138973) (2) 204 Room 1 30" 62" Window: , Casement, Single, Left, Base Frame. Exterior White, Interior 27-3/4" 61-3/4" White Performance Calculator: . PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: , All Sash: High Performance, No Pattern Hardware: . Stone Screen: , TruScene, Full Screen Grille Style: . No Grille Misc: . None Construction: . Exterior Installs (1), Interior Stops Only (1) Material: . Alex Plus Painter's Caulking (0.25), Off White Caulking (1), R-13 Fiberglass Insulation (1), 2" x 7/8" L-Trim Off-White (9167849) (2), Fibrex Stop White (9138973) (2) PRODUCTS: 6 WINDOWS: 3 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 3 Updated 10110123 •: NOTES 2nd floor Lswp not required 3 insert windows Remove sashes Install new cs , pw, cs L trim exterior Park in driveway Estimated Duration: 1 days 1 0/1 0/23 Page 3 / 11 +NE Agreement Document and Payment Terms DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Jim Fishbein Legal Name:Fairchester Custom Windows LLC 4 Stone Falls Court R E WA L CT HIC#.0667292,WC-35743-1-122,Putnam#51220 Rye Brook,NY 10573 bYANDERSEN 2041 West an Street Stamford,CT 06902 Main S � f C:(914)939-7886 Phone:203-406-0545 1 Fax:203-406-0828 sales@rbawestchester.com Jim Fishbein * 10/10/23 BUYER(S)NAME CONTRACT DATE 4 Stone Falls Court, Rye Brook, NY 10573 (914)939-7886 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER jim.fishbeinl@verizon.net PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Fairchester Custom Windows LLC d/b/a Renewal By Andersen of Westchester and Fairfield County("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms, any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL JOB AMOUNT: $9,455 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DEPOSIT RECEIVED: $1,891 BALANCE DUE: $7,564 We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at AMOUNT FINANCED: $0 this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. METHOD OF PAYMENT: Credit Card NOTES: Deposit by Credit Card; No Financing Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 10/13/2023 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Alan Steen Jim Fishbein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/10/23 Page 2/ 30 Zr1:. Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Jim Fishbein Legal Name:Fairchester Custom Windows LLC 4 Stone Falls Court RENEWAL CT HIC#.0667292,WC-35743-1122,Putnam#51220 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 C:(914)939-7886 ,•.n.n+n+�urw Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com ROOM: SIZE: DETAILS: PRICE: 0 W Misc Misc, Permit Fees, Town of Rye Brook- Estimated Permit 0 H Fees, Quantity 1, Renewal by Andersen will faciliate the application of the building permit to the Town of Rye Brook. Homeowner is responsible for any outstanding permit applications or code violations that may prevent Renewal by Andersen from procuring permit. Renewal by Andersen is not responsible for any historical or architectural review applications and approvals that may be required as pre- requisite for a building permit. 0 W Misc Misc, Miscellaneous Job Items, Lead Safe Work 0 H Practices, Quantity 1, EPA requires contractors that disturb painted surfaces in homes, built before 1978 to be certified and follow specific work practices. 0 W Misc Misc, Miscellaneous Job Items, Small Job Fee, Quantity 0 H 1, Applicable to any job less than or equal to 3 units. 201 Primary Bedroom 120 W Window Casement Triple 1:2:1 Left Vent/ Stat / Right Vent, 62 H Base Frame, Exterior White, Interior White, Performance Calculator PG Rating: 30 1 DP Rating: + 30 / - 30 Glass, All Sash: High Performance, No Pattern, Hardware, Stone, Screen, TruScene, Full Screen, Grille Style, No Grille, Misc, k Elevated Installation , Applicable to ANY unit insert or full- frame that is more than 12' from the ground to the bottom of the sill AND over 60" wide., WINDOWS: 1 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 3 TOTAL $9,455 Renewal by Andersen is committed to our customers'safety by SSA complying with the rules and lead-safe work practices specified by the EPA. 10/10/23 Page 3/ 30 �� Addendum Cost Responsibility ® dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY JIM FISHBEIN` Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292,WC-35743-H22,Putnam#51220 4 Stone Falls Court R E N E WA L 2041 West Main Street i Stamford,CT 06902 Rye Brook,NY 10573 by A N D E R S E N Phone:203406-0545 1 Fax:203-406-0828 1 tech@rbawestchesteccom C:(914)939-7886 HrWJaewraantimr• Measure Tech:Michael Quinn, Sales Rep:Alan Steen,(203)249-0304 Jim Fishbein * 10/11/23 BUYER(S)NAME ADDENDUM DATE 4 Stone Falls Court Rye Brook, Rye Brook 10573 BUYER(S)ADDRESS (914)939-7886 PRIMARY TELEPHONE NUMBER SECONDARY TELEPHONE NUMBER jim.fishbeinl@verizon.net PRIMARY EMAIL SECONDARY EMAIL LINE ITEMS CHANGED AFTER PURCHASE ROOM WIDTH HEIGHT DETAILS PRICE CHANGE -REM REMOVED- COST RESPONSIBILITY:HOME OWNER 201 Primary Bedroom 120" 62" -$8.661.35 Vent Base FFEIFAe Extef'eF White 'mtefieF White Perferpnenee P8 iein Hardware Stoic Serev_ Tr cvcene—Full r Screen GFIlle Style PIE) GFille Mlse! Elevated Installation ,App'iealg'e 202 Room 1 27-3/4" 61-3/4" Window: Cas2M_q Single, Right, Base Frame, Exterior White, $3,204.20 Interior White,Performance Calculator: PG Rating: 40 1 DP Rating: + 40/ -40,Glass:All Sash:High Pert - ^lo Pattern,Hardware: Stone,Screen:TruScene, Full Screen, Grille Style: No Grille, Misc: None 203 Room 1 62" 61-3/4" Window: Picture,Insert Frame, Exterior White,Interior White, $3,487.42 Performance Calculator: PG Rating: sting: +35/- 35,Glass: All Sash High Parfn, ni p�*+� r•ub Style: No Grille,Misc: None 10/11/23 Page 1/2 LINE ITEMS CHANGED AFTER PURCHASE ROOM WIDTH HEIGHT DETAILS PRICE CHANGE -ITEM ADDED- COST RESPONSIBILITY:HOME OWNER 204 F';ro' 27-3/4" 61-3/4" Window: Casement. Single, Left, Base Frame, Exterior White, $3.204.20 Interior White, Performance Calculator: PG Rating: 40 1 DP Rating: +40/-40,Glass:All Sash: High Performance, No Pattern,Hardware: Stone,Screen:TruScene, Full Screen, Grille Style: No Grille, Misc: None 10/11/23 Page 2/ 2 Order Summary dba:RENEWAL BYANDERSEN OF WESTCHESTER AND FAIRFIELD Jim Fishbein COUNTY 4 Stone Falls Court RENEWAL Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Rye Brook, NY 10573 brANDERSEN WC-35743-1-122, Putnam#51220 w uro:trsr'rmran:anxi.0 2041 West Main Street I Stamford,CT 06902 C:(914)939-7886 Phone:203-406-0545 1 Fax:203-406-0828 1 tech@rbawestchester.com •• • FLOOR UNIT NOTES 202. 1 ! 203 i 204 r nu^• JOBPHOTOS 10/10/23 Page 4 / 11 RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA PERFORMANCE NFRG Total Unit Performance(continued) NFRG Total Unit Performance(continued) Renewal by Andersen' Nacre, High Perhonnanno Glass Type 10-Factiar fBTU/(b,ft2oFl)- W.r'H.�IGAI Clear Without Grilles 0.46 0.44 0.57 0.57 .82 � Blind Fall Divided Light Grilles 0.46 0.44 0.51 0.51 Clear Without Grilles 0.44 0.42 0.61 0.61 .82 Without Grilles 0.33 0.30 0.31 0.31 .72 F1111 DNitletl Light Galles 0.45 0.43 0.55 0.55 Low-E4' Full Divided Light Grilles 0.34 0.31 0.28 0.28 low-E41 Without Grilles 0.31 0.27 0.33 0.32 .72 Without Grilles 0.33 0.30 0.19 0.19 An Full Divided Light Grilles 0.32 0.28 0.29 0.29 Low E4•Sun Without Grilles 0.31 0.27 0.20 0.20 .40 FUII Divided Light Grilles 0.35 0.31 0.18 0.17 Low-E4e'Sun Without Grilles 0.33 0.29 0.21 0.21 6, Full Divided Light Grilles 0.33 0.29 0.18 0.18 Law E4"SmertSunTM Full Divitled Light Grilles 0.34 0.30 0.19 0.19 LowE4w SmanSun'" Without Grilles 0.30 0.26 0.22 0.22 .65 Low-E4"SmanSun Without Grilles 0.29 0.25 0.20 0.20 .63 Full Divided Light Grilles 0.32 0.28 0.20 0.20 with HeatLock` Full DNitletl Lghi Grilles 0.28 0.25 0.18 0.18 LawE4`SmeilSun Without Grilles 0.25 0.22 0.22 0.21 .63 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a With HeatLock` FUII Divided Light Guiles 0.25 0.22 0.20 0.19 Enhanced Triple pane with Without Galles _ Enhanced Triple Pane Without Grilles n/a n/a n/a n/a V. SmanSun"' n/a Na n/a n/a n/a Enhanced Tnplepane with Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.46 0.44 0.57 0.57 .82 SmallSun"' Clear --� Without Grilles 0.45 0.43 0.64 0.64 .82 FUII Divided Light Grilles 0.46 0.44 0.51 0.51 dear Without Grilles 0.33 0.30 0.31 0.31 .72 Full Divided Light Grilles 0.46 0.44 0.57 0.57 low-E4" Withuut Grilles 0.31 0.27 0.34 0.34 .72 Full DNitletl Light Grilles 0.35 0.31 0.28 0.28 f��Fall Witheut Grilles 0.34 0.30 0.20 0.19 .40 rvidetl Light Grilles 0.33 0.29 0.31 0.31 Low-E4`Sun without Grilles 0.31 0.28 0.21 0.2 .40 Full Divided Light Grilles 0DII Double Hung , .35 0.31 0.18 0.16 Low-E4"Sun 1owE4`SmartSun'" Without Grilles D.33 0.29 0.21 0.21 .65 Fell DNitletl light Grilles 0.33 0.29 0.19 0.19 _ FUII Divided Light Grilles 0.34 0.30 0.19 0.19 Low E4'SmertSun`" Without Grities 0.30 0.27 0.23 0.23 .65 Urbi InarilSun Without Grilles 0.21 0.25 0.20 0.20 .63 Full Divided Light Grilles 0.32 0.28 0.21 0.21 with HeatLock` Full Divided Light Grilles 0.27 0.25 0.18 0.18 Low-E4^SmanSun Without Grilles 0.25 0.22 0.22 0.22 .63 Enhanced Triple Pane Without Grilles n/a o/a n/a a/a n/a with HeatLock" Full Divided Light Grilles 0.25 0.22 0.20 0.20 Enhanced Triple pane win Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a SmanSun'" Without Grilles n/a n/a n/a n/a n/a _ Enhanced Triple pace with Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.47 0.45 0.59 0.59 .82 SmallSun`" Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 Clear- Without Grilles 0.44 0.42 0.61 0.61 0.82 Without Grilles 0.34 0.30 0.31 0.31 .72 FUII Divided Light Grilles 0.45 0.43 0.55 0.55 Law-E4m Without Grilles 0.31 0.27 0.33 0.32 0.72 Full Divided Light Grilles 0.35 D.32 0.29 0.28 LowE4m Without Grilles 0.34 0.30 0.20 0.19 .40 Full Divided Light Grilles 0.32 0.28 0.29 0.29 Law E4"Sun Without Grilles 0.31 0.27 0.20 0.20 0.40 Full Divided Light Galles 0.35 0.32 0.18 0.18 LowE4e Sun Without Grilles 0.33 0.29 0.21 0.21 .65 Full Divided Light Grilles 0.33 0.29 0.18 0.18 Low Eat-SmartSun"' Without Grilles 0.30 0.26 0.22 0.22 0.65 FUII Divided Light Grilles 0.34 0.31 0.19 0.19 - Low-E4"SmartSun'" LOwE4"SmanSon Without Grilles 0.27 0.25 0.20 0.20 .63 Full Divided Light Grilles 0.32 0.28 0.20 0.20 with HeatLock` Full Divided Light Grilles 0.27 0.27 0.18 0.18 LowE4e SmanSun Without Grilles 0.25 0.22 0.22 0.21 0.63 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.28 .47 with HeatLock" Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced Triple pane with n/a 0.18 .43 Enhanced Triple Pane Without Grilles n/a 0.16 n/a 0.30 .50 SmanSun"' Without Grilles n/a 0.19 Enhanced Triple pane with Without Grilles n/a 0.16 n/a 0.20 .45 'tw cap,smmrs"rr^'E IC, 1-0ae Smanstrol. 1)ofien<r Nrrwz nw aw<um orn.arbumrouN um!nW vm!nvaru<,nnnr.n.wrt.rtn rtlue Nit Msrzmnms irv+Wnme.mne paeru:.wna.,.mlrr.a rrq.xmrrar.lempnaa(uzn.vwar!erra ea paaauninr.<x-. rw.[ir9 smenSvn^r lmr.FaW,'Eow.EaW wri era xe.xEuaa9nrt ArMmsennHemaxsror'lov E'glase. ra!rrw>aee I IU£umr MrmvlM arravn!MMm bu tMwan pw!cral wl!In 9i11/M�Re.'F.liw bn�mx vdrk,rMMa Mq mbm!tevup!meerwr<grdun.Wrraowvalw•revnemnonamrrpweapalke cl!ertaarwp"a car Izremn DFxlm raVWs. a19Pwr1Np Oar helhrkn!(SNOCra<mrer meme unln cmwNr raGa!bnMmm.d!MuveNvrxpnr Mrn er,mgrrvn ru rd+rmrrec!h rekaca vwara.'ne bwm Uw Wue.!MH3n.,e.synmmX:eelmmrVr;n. roenermba<Wcrnrry'wslm ziarnc urrmmmevWues. mibai mme lvllme raneam s!i uugnPpmrrc!Ipaae ena Nanwlt laarmr!rre v.uu<.Irani O!P lore mwe aaynpn!ney Pauc!re!z rn m<r!wprwunamW unnarna.vrsrde Lyntmrmm!ara:ersm<e...,. a)aabrH NOC)e.rimem. brraNwbngnrn!eamaui1- Thl.a era- .MrM rtW Wu.Mbsn..r nW UraWnvy weawl. rrfr rrpvpamez!mwan n pmun!pns me rmnml ine NBMr!newlue.nw!r O rp I.ee nrae.ryrrp<ne praanat Ia�w�ne y�uaburan'ze!w rme mea vivid`t,m!lremmn!wae rsnxewnea aertlre mingzm vnWNny yy nrW<rr ur<aren ]an'. nerepvdnrn n .21 o rrprnh A^fm«enn0.n urylntMpmu lnrlie! le<rintivwrreiardarMm purrnmena late NrluumrWRrm aorv`arm.No!rnyae rorahn iPnclnM o<NFN:.lur wen{:rMcenblcarnn.W!InRf NERCra!)nrgn me oneo aonnaNrry rryornnayanv aHenrymvwraxn LvnnngepenMrrttniraLnrcymgrnrrr:ew IAC prW�anrara prarxernnl rtarwernen!s. ry vaeraeyeraure<n uu<I!emperM peu err!u.n!Vtli<oPnprw yeu«m udYre b.nrWr!uMa br mVr MnWn.w.'rawEMa'low{e V arw!aun�'.ra'lw.£aa Sun' w dyrll aria l Dr..a on0.111a prr+axl<wnew,rrPruw.a rnra1.o1 rill i bua!rr u.rwreanr reornrem.nu nesbd mwclwEenwr imw bxmeawel<r wn srwrm.a av Wnc'.,u o,i,waceMewpn.array arn4 an in.<rlemmrw par ammm!a'rW rnmoro Vitae":Inraalimr PmeNw!rparnr bran de!yrn.nr"lorEa0.r"WwfeV Smwnun^'.rw'loe{an:irr 09-10 COMPANY CONFIDENTIAL-REVISION AA-01 09-11 COMPANY CONFIDENTIAL-REVISION AA-01 *1ARENEWALkIi NEVVAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION brANDERSEN Technical Data PERFORMANCE W t sie"Kl rieuora uoou pwletrr+lhl NFRG Total Unit Performance act GT1.l S,14r Host Gain Coefliciont GC)' ArG2,2111and Air Glass Type At, r'ehl ithout Grilles 0.42 0.41 0.51 0.51 .82 ar Full Drnded L ht Grilles 0.43 0.41 0.46 0.46 SPECIFICATION _ Without Galles 0.31 0.28 0.28 0.27 .72 E4" Full Dwitletl Light Grilles 0.32 0.25 0.25 "'hoot Galles 032 0.29 0.17 0.17 .40 AND "SunFull Dvided Light Grilles 0.33 0.30 0.16 0.15 Without Grilles 0.31 0.28 0.19 0.18 .65 martSuW- TECHNICAL Full Divided Light Grilles 0.32 0.29 0.17 0.17 martSun Without Grilles 0,26 0.24 0.18 0.18 .63 MANUAL Lock" Full Divided Light Grilles 0.26 0.24 0.17 0.16 riple Pane Without Galles n/a 0.20 n/a 0.25 .42 kpanewith Wdhoul Galles n/a 0.19 n/a 0.17 .37 on'" Without Grilles 0.43 0.41 0.51 0.51 .92 -� Clear Full Dwitletl Light Grilles 0.43 0.41 0.46 0.46 WhhoutGrilles 0.31 0.28 0.28 0.27 .72 LI3w-E4" Full Divided Light Grilles 0.32 0.29 0.25 0.25 -� Without Grilles 0.32 0.29 0.17 0.17 .40 Low E4"Sun j r Full Dwided Light Grilles 0.33 0.30 0.16 0.15 Without Grilles 0.31 0.28 0.19 0.18 .65 Lrvw141SmartSun'" WII Divitletl Light Grilles 0.32 0.29 0.17 0.17 Low E4`SmartSnn Without Grilles 0.27 0.25 0.18 0.18 .63 with Heatlock< Full Dwid1d Light Grilles 0.27 0.25 0.17 0.16 "t Enhanced Triple Pane Without Gilles n/a 0.20 n/a 0.25 .42 Enhanced Triple panewiN SmanSun'" Without Grilles n/e 0.20 n/a 0.17 .37 M Without Grilles 0.46 0.58 .82 6 Clear FUII Divided Light Grilles 0.46 - 0.52 Low-E4" Without Grilles 0.33 0.30 0.31 .. Full Divided Light Grilles 0.34 0.31 0.28 0.28 Low-E4°Sun Without Grilles 0.33 0.30 0.20 0.19 .40 FUII Divided Light Galles 0.35 0.31 0.18 0.17 Without Grilles 0.32 0.29 0.21 0.21 .65 Low-E44 SmartSue -es Full Divided Light Grilles 0.34 0.30 0.19 0.19 4 V. - Low-E4-SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 w - �4" ,alk with HeaLLock" Full Divided Light Grilles 0.30 0.27 0.18 0.18 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.29 .47 *e - Entranced Triple pane Without Grilles n/a 0.20 n/a 0.19 .43 w+��>..�.e.........,,r.._-....._ with$martSun"' • :4 Srr aM MaenussN wa.smenev nquamar<1lur'law f'9ea 1)Ulecrnr aM�m Memo or Aex4"a MrqugxtNb;wwNmaiU,nr'n..-r.'Mb.arl».au<m.Nae n<.x l,lrc,rlaougnm.«ur<par,c;.wmaa..Yir..r,pr.ram rmrt<mperrar�<u.urea urronsadeeaunrno.a,.urarrer . augya s«amera<rwrrwo.s.:.a,r,nr mrfo<amcp.rrermaM.w"aa. 3I bNr NrY:.ernCormsumtSNGLreNrnnmelremm�al soNr raeuri r prueuep ae,tteamrou;gr-isEamarrrclryrremmrlr artl ap.ore.ea+eswsepue^Ur.xaem raw<ra.irxtrwer rn.vNue.U.hv neN re rcenrmme"woupr me 31ViaiWelransnananrrrylrneeyresnpw mum Irgln macs mreugn a ess aria Irgmel.ne xRlrermevYuelrrxn ro 1.me mwe aaylrgM me proeunletz iir uer IM prrravas wulunn uea.vrade Lgnrkensnn;arNe rsnvewreu un ,n maU;o IlA rren msWnrun T• •xiXg'rntings.xapiasee anWnwNungby�einu Wrryagerrcy as vYraYm lwanrruepeM<grustiWgrcwnqranre wmr NfeC paynm ne prnaeurai iequrenrnr;s. brrl:Uli Uumongomg waepr.;<nmgn.upa YraW,f.or wurpa eranenesur r<qurrun<M..tnudxa mgrs+ny oru Umr.futingeu<rar WeeeprHtl gNIMC brlwurrgam cmMlcuUort Pabnfs � Imf sn u.<.II xM ea glee.Yr1<rere grrlb.Vriviu.wufvwrrxpipl4ur brsnrm ulum.lur lYm ewwa.n.ea.W.1ak.W«tre.Snarrsun"arb tuu-ficn>uri 09-9eaan COMPANY CONFIDENTIAL-REVISION AA-01 RenewalRenewal by Andersen of Westchester byAndersea, 2041 West Main St WINDOW REPLACEMENT an Andersen Company Stamford CT 06902 Date: 10/10/2023 Original Contract Date: 10/10/2023 Jim Fishbein Original Contract Price: $ 9,455.00 Name: 580.00 Additional Cost: Address: 4 Stone Falls Court Cost Reduction: $ 0.00 (negative amount) Current Adjustment: $ 580.00 Total Amended Contract Price: $ 1 0,035.00 :Cit Rye Brook y Total Deposits Received: � 1 ,891 .00 Phone Number: (914) 939-7886 Total Balance Outstanding: $ 85144.00 Payment Method: ❑Check Credit Card Finance CLARIFICATION OF CONTRACT CHANGE OF PAYMENT METHOD MORE WORK ® LESS WORK PRICE ADJUSTMENT SPECIFIC DETAILS & MEASUREMENTS Customer has agreed to havE(2 casement singles and 1 picture window (all inserts) installed instead of 1 casement triple since the maximum width is 120" and his window is 123" so as not to impact trim. This will add additional cost of $580 which the customer has agreed to supply too the tech measure on 10/11/2023 See email approval from customer j c)c.d � Clyn5ed Alan Steen Company Representative Owner(Or Representative of O v�r er) 10/10/2023 10/10/2023 Date Date Tax Parcel Maps Address: 4 Stonefalls Ct Print Key: 135.67-1-37 SBL: 13506700010370000000 Vf— r' i I r I Disclaimer: This tax parcel map is provided as a public service to Westchester County residents for general information and planning purposes only,and should not be relied upon as a sole informational source.The County of Westchester hereby disclaims any liability from the use of this GIS mapping system by any person or entity.Tax parcel boundaries represent approximate property line location and should NOT be interpreted as or used in lieu of a survey or property boundary description.Property descriptions must be obtained from surveys or deeds.For more information please contact the assessor's office of the municipality. ^� � r�' i '� ��`.• �<y.��lcl l �. ea.�' saw �_, � t s i '�i ..�� -versa.•' ,`'� , ROc�.�AtJ .-��att,� fi'.s;'T 1/•y9e�• �-��".#h. v -. A a. 2,w �,� .• �a� ��� A i �. ti ■ RIM a aim � t i t �'w t a, y �w1•1� �• 4 �'��Y n r. .�Y ij 54 l 1 r i z � yr k.Y .'� a r .�;� .. '� ;•,. �'�` r ,���- �. * ���_ � k L' �4 o-:. i, ` 1 5. _ i ii �� � �(� �, a �,� A i _.. - 1 .. -.. �;� ... �' _ � _ t y mum f/ 4v. r .._ ... •:....erns s...ri -. - - - - - + .,.� -. _ .. � - ' - Al ;�F _ A£k A '= � A 6'•,F r `'A ♦•A$z�' - 95 ,,1,E-, \O{ j .g,I "�S ,�t}y `� Fh \�}'r � F t '',� �j/.'• a � RIt?i .;1♦ 7Y , '1Sao� h�• \�A t' v9YN°,." �JB ,r �i7,. v °a;14r ♦ n. � yr � r♦♦ �•n�, �d >t ♦ f; �r v ,:�, ♦ r � •� r ',I: . +q+ � 4:U• •♦ �' � ♦ ,, • ;,�? , _; a ytltlrll;► $3 �z,r,t1/+1;, {1� 11Fi'f�44'1'I�r 49ar11 (( i tr�►t1� t , 14't r�l� s 11 ' i 1�•, - S 1� 1/ 1 f/ �_ � + r;_»'.Fj•Ir ' -. 1,/!{S1 - , 1 1 �1+111 ,l a�` ul 1 j :._+11 4 f._ .;r3& I i�1 �'•c..:._.__•�.:A�a'4L� ::.�`= 11�L'i.'Z. -s�.s+ �� rFa�::Ga►:�c}iY /1 a +-..,; 1.__r 11 IP � iry�• ' "+_''j._�I�i/1� a+�' •-1 .. •' I. 11 7. . •,, 'sec= K George Latimer James Maisano z' Westchester County Executive Director,Consumer Protection Department of Consumer Protection Home Improvement License FAIRCHESTER CUSTOM WINDOWS, LLC «,,,3 2041 WEST MAIN STREET STAMFORD,CT-06902 ._ This license is issued in accordance with Article XVI of the Westchester County Consumer Protection Code and is valid only upon - ..: 'A A n presence of the official department seal. Proof of citizenship or immigration status is not required for issuance of this license. NOT FOR FEDERAL PURPOSES '= License Number �� m Date of Expiration o r� WC-35743-1-122 09/20/2024 •_:. : Aster Co i , 1._. y1v.-r t, -�. 'zT'.'.S3•Z gym-•- �4! z ,. . . g F. . •.r . . . . . . <to1> ..::-h y - -'•�,► ►p r� ,r p :.,>:' »,.s :a ''•� `_�11{ 1 a s�r ��•� : +-7 c�� ��/ t'X' ) g >z +'4b�'�' ,t'{p @fit. �'ddi+bl �. /,y♦ 4 i, IAAi :,� �p♦♦+ :�`�l��t�i[ �,/•1, � A �N P :.^ '," � -A, -�� .41 •.... ,y�� ... W''J'� •¢y 'r}•�n•Y:,. •.;,..'•th, .``, ��v� �!�•v (yam` �v �' "! �_}µy'� � "5:�� I: FAIRCUS-01 TBRAND ACORO CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 9/29/22912023 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 Theresa Brandon NAME: MBI Company Group LLC. PHONE 280 State Street (A/C,No,EXt):(203)288 3401 (A/C,No):(203)281-0414 North Haven,CT 06473 ADMDARIEs :theresa.brandon@mbi-ins.com INSUREI AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Com an of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba: Renewal by Andersen INSURERC: Fairchester 2041 West Main Street INSURER D: Stamford,CT 06902 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 LTR IN D WVD MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2516791 8/12/2023 8/12/2024 DAMAGE TO RENTED 500,000 X PREMISES Ea occurrence) $ MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY❑X PRO- ❑X LOC PRODUCTS-COMP/OP AGG $ 39000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accdent $ ANY AUTO S 2516791 8/12/2023 8/12/2024 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ XT 1xx SOLD ctlenDAMAGEAUOSONLY NON-OWNED ONLY (Per c t $ xi Comp Ded$500 Collision Ded$500 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE X S 2516791 8/12/2023 8/12/2024 AGGREGATE $ 4,000,000 DED I X RETENTION$ 0 $ A WORKERS COMPENSATION X PTAT TE X ORTH- AND EMPLOYERS'LIABILITY Y/N WC 9099063 8/12/2023 8/12/2024 500,000 ANY PROPRIETORIPARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is Additional Insured as required by written contract per the endorsements included with this certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Fairchester Custom Windows LLC. 203-406-0545 dba:Renewal by Andersen Fairchester 1 c. NYS Unemployment Insurance Employer Registration Number of 2041 West Main Street Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 88-2855660 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1 a" 938 King Street Rye Brook,NY 10573 WC9099063 3c. Policy effective period 08/12/2023 to 08/12/2024 3d.The Proprietor,Partners or Executive Officers are X❑ included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"S'insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Theresa Brandon (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �� 54al�rL 09/29/2023 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 203-288-3401 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov