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HomeMy WebLinkAboutDP23-007PERMIT # 3 -M7 DATE. I 3v �3 L(P: SECTION BLOCK LOT TYPE OF WORK / ©,17Vf; JOB LOCATION //P jeldqe OWNER 007 / - (yS5y CONTRACTOR 2 OBIS U o*#? � - t2 /EST. COST � FEE � O V CO # FEES � 6 DATE .221i; 2 &f off TCO # FEE DATE — INSPECTION RECORD i DATE INSP �'OOTI NG FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING MBING 1WYe D4 /� RGH PLU GAS El SPRINKLER �7177 ��3—ay5�,�jeCCa ��Qc7�C ©� y� ELECTRIC - LOW -VOLT CJ ALARM C� AS BUILT FINAL o"N.—A erg) — OTHER APPROVALS ARB BOT P$ ZBA VILLAGE OF RYE BROOK WESTCAESTER COUNTY, NEW YORK y� o NO: 23-199 �9t32 Certift'rate of ®ccupoucp This is to certify that 14a// l e lel of, 3Y-00 k having duly filed an application on ,T�Cemr7 20 requesting a Certificate of Occupancy for the premises known as, R" & Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 5 -4/ Block: Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Demolition Permit No. 3~ /, issued 20 a3, such authority and permission is hereby granted to the property owner to lawfully occupy orr�use said premises or building or part thereof listed under the following New York State Classifications,Use: -v - �L Construction: , for the following purposes: �L Y C o y Ve y- C� �U 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 height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change a ed fro e B g nspector. DEC 1 2 2023 Building Inspector,Village of Rye Brook: Date: �Rfl>� For office use only: RF DEC — 7 BUILDI T r ' T,, PERMIT# (� VIL / OF RYE OK ISSUED:/3o VILLAGE OF RYE BROOK 938 KING STRE YE BROOK, IE V PORK 10573 DATE: —a3 BUILDING DEPARTMENT 4 9 -06 O'.� FEE: ct$` //p� Pato�f 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 I14SPECTION .......................................................................................................I..................... Address: 4 Pine Ridge Road, Rye Brook, NY Occupancy/Use: Residence Parcel ID#: 135.al-l-le Zone: R-12 Owner: Harriet Klein Address: 23 Ramapo Trail, Harrison NY 10528 Double R A Construction Corp 9 Jean Lane, Rye Brook NY P.E./R.A.or Contractor: mecca Electric - Rye, inc. Address: 109 maple Ave, Rye NY Person in responsible charge: Harriet Klein Address: 23 Ramapo Trail, Harrison NY 10528 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: Harriet Klein being duly sworn,deposes and says that he/site resides at 23 Ramapo Trail (Print Name of Applicant) (No.and Street) in Harrison ,in the County of Westchester in the State of NY ,that (cityrrown/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 ofany materials and labor which may have been donated gratis was:S $4100.00 for the construction or alteration of. Attic Demolition to remove built-ins and electrical work converting the space into an uninhabitable room. 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-I O.A.of the Code of the Village of Rye Brook. Sworn to before me this 7th Sworn to before me this day of December , 20 23 day of , 20 Signature of Property Owner Signature of Applicant Harriet Klein P nt Name of I'r� �erty Owner FLAURAANNKLEINPUBLIC.STATE OF NEW YORK Print Name of Applicant tratior, No OlKL6312735ec in"est':hester CountyNotary Public ssion Expres Oct. 6 2026 Notary Public �yE BRC�uk o`` tim UILDING INSPECTOR BUILDING DEPARTMENT 916l❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: , 1 DATE: 12 1 1I c!? Y� Z� PERMIT# --^-�� ISSUED: ' , SECT: LOCK: LOT: LOCATION: QCCUPANCY: ❑ Violation Noted THE WORK IS... �/PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL OTHER _ c z ryya °' v QI i—�i W Cw 00 � w � z v _ = H L \ O w o o O v - t A E+ u a. ~ 72 44 w O z >-+ x en W f° caa. O Q .� w W ' oo - a � t-, v o ti c 'o w v "ov9 - cn A Q " r ,1-0 o N a o Q V 00 Vr 1 v z O O W O u O IUD e F� Ci in 4v Q94 w F+I 'IN M op L�,' 9 H z A {oj GQ W O ° cs G1 ''"'' W E- x •-•� o (� w o ad4orba r� cn x w a � V = - r Q ] o 0O -d v,.0 u _ ■ rw� o 14 A v _ U IR H o A z o a �� P� w w a ov d' A w z x � o � '� „ „ 00 p W r = BUILDING: MENT VILLAGE of R'Y� OOK NOV 2 9 2023 938 KING$Tlzrff RYE BR6 ,NY 10573 _ (914)939-066$`` � VILLAGE OF RYE BROOK rtiebrootc,a2. BUILDING DEPARTMENT DEMOLITION PERMIT APPLICATION FOR OFFICE USE ONLY:��� Ion—16ci Approval Date: �� r #: ,Ir� OV Application Fee:$ Approval Signature: Permit Fees: $ /©C� Disapproved: Other: Application dated: / —C}!` is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: 4 Pine Ridge Road SBL: 135 41-1-18 zone: R-12 2. Proposed Demolition.(Describe in detail): Remove built-in bed platforms, lighting fixtures, closets in a finished attic to make it an unhabitable space. Cut cords to existing A/C wall unit and cover. Remove baseboard heating. 3. Property Owner: Harriet Klein Address: 23 Ramapo Trail Harrison, NY 10528 Phone#914-835-0333 Cell#914-772-8554 email: mklein@mlklein.com Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: General contractor: Double R. A. Construction Corp. Address: 9 Jean Lane, Rye Brook, NY 10573 Phone# 914-223-7222 Cell # 914-939-7710 email: doubleraconst@aol.com aol.com 4. Estimated cost of construction $ 1300.00 (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 5. Type of construction:(wood frame,masonry,steel,etc..,) wood frame 6. Method(s)of Demolition: sledge hammers, crow bars, manual labor 7. Number&Location of Fuel Oil Tanks to be Removed: 0 8. Number of Stories: 2 Height to Highest Ridge To Highest Chimney: 9. Estimated date of completion: 2 days from the date of permit i 6/1/2023 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .,&I e 4' V ir f n ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications, as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this 1-1 irk Sworn to before me this day of 20 day of , 20 signature of Property Owner Signature of Applicant 1 OL�V'1 C � vie 1 �1 t�au��h�ri►x�rtsv Pr`nt Name of Property Owner Notary i-11tA r. �++3tC U�Aa �, Print Name of Applicant QU&Ied in Ir/�utr.�u AftC �1 r8, <AJltnty My Cornrnirs pn U,virea 1 N ry Public ( '?9!A Notary Public �Icrr z�r LAURAAMN KI.r_tr4 Notary 01113k Of lkirV YOrk Llualriea is county Ma O I KLW Ol 35 My Comtrizmon U prea IQAq4A 1v/4 ZoZ4 z 6/l/2oz1 s Ln N • c w M N N c � O = o OP z H E-{ 1-4 O x a �Q 00 °: a oA �+ ►zi mot; o � w M p a Z o N w � Cl) Q00 o Q • � � � cn H � aco O Ln o �� u o � � zuz cn d- � � � Z a z z z o a MM cM U , w p 5 gypp' 'rl► C ) Zu OD N w w p z °z° W a cn z Ln V � g x Z v w z 0 (09. W , w 00 Q) a a � BUILDING DEPARTMENT VILLAGE OF RYE BROOK NOV 21 2023 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 www.ryebrook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electriciia�ns License Required FOR OFFICE USE ONLY B� d 00 / dJ� — C �EP#: Approval Date: ```�\ Permit Fee: $ � PL Approval Signature: Other: ************************************************************************************************** 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 Application dated, 1 ( i'll 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 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. I.Address: SBL: 13 5 - 1 �6 Zone: 2.Property Owner: C i,P-\- kjke.n Address: �-? RZcLmgcyo -TV cr i':X10 1�1 Phone#: 91 - 35- 0'2;3?D Cell#: 9 19 email: KY-J't-�n Q �k�KIP n l 0Yn 3.Master Electrician/Licensed Installer: (\`J hl`fi5�rt,3 Address: ItA 'icAtTI2, PM. Lic.#:_Phone#: tiH-Q(a7- �961Cell#: email: �f_aw Company Name: C -\-t' Address: 109 9 e4& eub_ �_U15S-t) 4.Proposed Electrical Work/Fixture Count: 4G. — —�C,l - CkAl 5.3'Party Electrical Inspection Agency: ********************************************************************************************************* STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the (41 ACCI&1 war il) for the legal owner and is duly authorized to make and file this application. (Master Elec cian/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this (14h Sworn to before me this day ofOUIIMbf✓ ,202-2-> gda (¢e ,203 St ature of Property Owner FELICITY FULLER Applicant U P j— GI Notary Public-State of New York 4 C� l No.01FUS425939 . 'f'Print Name f Property Owner Qualified in Westchester CountysApplicant My Commission Expires II/ d _ Notary Public Notary Public 10/30/2023 STATE WIDE INSPECTION SERVICES, INC. 0•• • • SWIS JOB APPLICATION •2.7224 1 fax 914.219.1062 1 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# �� Date Bldg Permit#- a / Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County t� Address L Cross Street Section ' `C c I Block Lot I Owner Name/Address(If different than;above) `t ( � y _ 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 C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven (s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation VILLAGE ' -)OiC J This application is valid for one(t)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address 2,P - �I ( ; �(1 Name License# Date J '�3 Signature Address 10 ( M IC � City/State :� N / Com Zip Code �p pany i„r(�(✓� P P ACC Phone# C/ `� � C� State Wide Inspection Services DEC — 8 2023 3D1080 Main Street Fishkill, NY 12524 TOM"U 5 VILLAGE OF RYE BROOK 845 202-7224 Phone BUILDING DEPARTMENT 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: Mecca Electric of Rye, Inc. Harriet Klein Anthony Nostro 4 Pine Ridge Road 109 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 4 Pine Ridge Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-245 135.41 1 18 Certificate Number: 2023-8824 Building Permit Number: DP 23-007 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: 4 Pine Ridge Road, Rye Brook, NY 10573 The Attic was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 8`h day of December 2023. Name Quantity Rating Circuit Type Receptacle 01 Switch 01 Smoke Detector 01 *Removal of Existing Receptacles and Electric Baseboard Heat A Visual Inspection of existing conditions was performed on December 8`h, 2023, of the Attic and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. 1 � Officer: frank 1. Farina - This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. �;. IR6 �� /i Y Y f1'. .. 4, Sm ' i '` _✓ ,�.-i �. ____ .� �. ., =. - -- - --' � �-- ----- � -� _� y �r �� I� 1 '' 1 ., Permit Check List&Zoning Anal sis Address: ` l sBL: Zone: C. 21 Const.Type: Other. Submittal Date: \IS 26Z_Lisions Submittal Dates: Applicant: l 1' Nature of Work: `2'l�'�U Come r Reviews:ZBA: PB: BOT: Other. (liJ ( FS:Filing._ ` BP: \ /O: Flood Plane: Le alization APP: Dated ✓Notarized: SBL g ( ) ( -��'russ 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: ( ) k ) PLANS:Date ed Sealed. Copies: Electronic: Other. ( (v 'License: Workers Comp: �I,iability Tmp.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.: Plaza: 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. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: REOUMED EXISTING PROPOSED NOTES Area Cir : Frontage Front Front Sides: Main Cov Accs.Cov Ft.H Sb: Sd.H S a&. T I : ELknp P ku' Height/Stories: notes: r`S`wI 41 �Fw�h W nAJ. . 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A �'+i:il:..11l�ll'•l.+•:. o '��� •�.�, >7" y ram• J Al } ) W = CV �( S° •9� e L O Ofx •� 4 E s= C C U O a; = a, \j, 'Q► G� �► U J W c okectionWiwi C/) a� « LLJ CO3 •� r..l W W ci W o )) a U O :y ' 1, y co o�'renn C N O C LO LO •vim L' y � N N U _ �• ,L:. •� y y V > 1 .(")' 1 N i�i 4 111 tYri k.YWlpip agr�r.:III,IQ Illilllil+' q�U��A9Jt 1��\�!'• -,���^ ♦�• �1€Yw 1' �� , '�' 1 ����1'� d' d ?� ix M r t ti ,ai r i r• 17ij 1 i \ �If1zl�jY ilx \t+Uur O 4u;.�•llt�w.it o �11f.( ki�,j,'7���Ajlr o; iri,pQ0�ly1;!.,�1 0:�'�� ;'O L'. `O •r��': •+ Iva! �\ OP �- A� ro DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/29/2023 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: George DOurdmanis Dur-America Brokerage Inc PHONE No . (212)302-2672 F,"� No;(718)956-9731 214 W 39th Street, Suite 205A AIL ADDRESS: cortificates@duramerica.com New York, NY 10018 INSURERS AFFORDING COVERAGE NAIC• INSURERA: ATLANTIC CASUALTY INSURANCE CO42846 INSURED INSURER B: Double R A Construction Corp INSURERC: 9 Jean Lane INSURER0: Rye Brook, NY 10573 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00003019-2138729 REVISION NUMBER: 186 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 ADDLSU D POLICY NUMBER /Y MM —POLICY E LTR IDDYYY MIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y L302002290-0 10/15/2023 10/15/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE I—XI OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 X POLICY❑JE O- LOC PRODUCTS-COMP/OP AGG $ 1 000 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) E AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB i CLAIMS-MADE AGGREGATE $ DIED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHOR12E REPRESENTATIVE F_P ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are r istered marks of ACORD Printed by FP on 11/29/2023 at 04:53PM NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 .0 ^^^A^^ 061605879 DURAMERICA BROKERAGE INC 214 W 39TH ST STE 205A NEW YORK NY 10018 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOUBLE RA CONSTRUCTION CORP VILLAGE OF RYE BROOK 9 JEAN LANE BUILDING DEPARTMENT RYE BROOK NY 10573 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2336 816-0 10519 06/13/2023 TO 06/13/2024 11/29/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2336 816-0, 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 ANTHONY SOTIRE VICE PRESIDENT MARIA SOTIRE DOUBLE RA CONSTRUCTION CORP 2OF2 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 S7NCE FUND V DIRECTORJNSURANCE FUND UNDERWRITING VALIDATION NUMBER: 925479374 U-26.3