Loading...
HomeMy WebLinkAboutBP24-040PERMIT # SECTION. TYPE OF JOB LOCA /EST. COST W� N CO# r TCO # FEE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC 0 LOW -VOLT O ALARM O AS BUILT 0 FINAL LOT / \ kJS cCeine�{'Eni✓y UCK1/ 1�4Aolx', @o3)ay9-) 9A06 OTHER APPROVALS ARB BOT PB ZBA OTHER QyE BA C r . 1q VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.iyebrookM.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E.Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE June 17,2024 Peter Dellipaoli&Amy Dellipaoli 103 North Ridge Street Rye Brook,New York 10573 Re: 103 North Ridge Street,Rye Brook,New York 10573 Parcel ID#: 135.67-2-7 Building Permit#24-040 issued on 3/12/2024 for Replacement Windows& Door This certifies that the ten new windows and one new entry door,installed under the above captioned permit has been satisfactorily completed. Sincerely, Freddy DiVitto Assistant Building&Fire Inspector /to BUILDING DEPARTMENT For office use nlv: PERMIT# -DyO J U N 10 2024 LL, VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NE11'YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: — PAIDR, BUILDING DEPARTMcNT_ www.rvebrook.org 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 ............................................................................................................................. Address: 103 N Ridge St , Port Chester New York 10573 Occupancy/Use: Residential Parcel ID#: 135.67-2-7 Zone: 11C—7 Owner: Peter DelliPaoli &Amy DeIlPaoli Address: 103 N Ridge St , Port Chester New York 10573 P.E./R.A. or Contractor: Renewal by Andersen Westchester Address: 421 West Avenue, Stamford CT 06902 Person in responsible charge: Franklin Barahona Address: 421 West Avenue, 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: Franklin Barahona being duly Swom,deposes and says that he/she resides at 421 West Avenue (Print Name of Applicant) (No and Street) in Stamford in the County of Fairfield in the State of C T ,that (Ciryfrown/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: $ 30, C?di for the construction or alteration of: �/O Installation of replacement Windows and/or Doors.(/) Deponent further states that he/she has examined the approved plans of the structurehvork 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§250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this �q H7 Swom to before me this I fh day of ' 20 day of_C�t�T'; 20 2 Signature of Property Owner BRtglr MACDONALD Signatur t j p ican NOTARY Pv,uuc S7itW ofConnecucut Franklin Barahona Peter DelliPaoli &Amy DeIlPaoli MYCOrr,sswwexPIRESoct.3,10« Print Name of Property Owner Print Name of Applicant Notary Public Notary Public QyE BRC�k, cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR CIASSISTANT 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 : ST DATE: f0 - H- G 04- PERMIT# 7 (/ ISSUED: _i-12-z SECT: BLOCK: Z LOT: !�0�� LOCATION: �V 1 ��(�✓ � 4" �cJ OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... aAcCEPTED ❑ 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 OTHERYEA( O = N Cq C W v C N a cr o. z W p nn � Ln c Wcn U v � w 00 OCC, Eno o x Q FN M � 1 I 11 N r O ¢ w 40 a V z � A � C'n ►--� r W Ole • 00 w 99 u �7 W o O o W ICI -''� W O U Z o G 1 v rir fi' ZL Q o W v D [ C IE W IE BUILDING DEPARTMENT MAR -6 2024 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT wNvw.ryebroo'Lora ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAi,REVIEW BOARD APPROVAL FOR OFFICE USEONLY: APPROVAL DATE: tl IT# YOAPPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: I H.O.A.APPROVAL: DATE: DISAPPROVED: DISAPPROVED: OTHER: **w++•rw*w*r++**aww*wwww+t**wtt+w**wwt�**+ww+w+w+t+*aarttt++rr♦trr*rrrrrrrarrr+tr+irtrrw++*rrrt+rtr++*+rtrr Application dated:February 21, 2024 is hereby made to the Building Inspectoroftlie Village of Rye Brook,NY,for the issuance ofa Permit forthe construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. lob Address:_ 103 N Ridge St&fflWbok New York 10573 2. Parcel ID#: 135.67-2-7 Zone: k 7 3. Proposed Improvement(Describe in detail): Removal and Installation of( 10 )replacement windows & ( 1 ) replacement Entry Door into existing opening with no structural alterations. 4. Property Owner: Peter DelliPaoli &Amy DellPaoli Address: 103 N Ridge St ,k'yE, ewe New York 10573 Phone# (914) 588-6227 Cell# (914) 305-1500 e-mail petedee2307@gmail.com List All Other Properties Owned in Rye Brook: Applicant: Franklin Barahona Address: 421 West Avenue, Stamford CT 06902 Phone# 203.406,0545 Cell# 203.249.1986 e-mail Permits@RBAWestchester.com Architect: Address: Phone# Cell# e-111atl Engineer: Address: Phone# Cell# e-mail General Contractor: Fairchester Custom Windows dba Renewal by Andersen Westchester Address: 421 West Avenue, Stamford CT 06902 Phone# 203.406,0545 Cell# 203,249.1986 e-mail Pcrmits@RBAWestchestcr.com RBAWestchestec.com fl) 6n no23 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1-2 Fam Post-construction: 1-2 Fam 6. Area of lot: Square feet: Acres: 7. 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: 11 fl: 2nd fl: 3'd fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I'fl: 2id fl: 3`d 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. Construction Type&Location:()Typical Western Lumber Frame;O Timber Frame[TC];()Wood Truss[TT]; ()Pre-engineered wood[PW];Located;()Floor Framing[F];()Roof Framing[R];()Floor&Roof Framing[FR];Other: 15. Number of stories: 3 Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18, Roof style:peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type i Hood,etc...)Yes: No: X (ifyes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. 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: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: X (ifyes,applicant must submit a Site Plan Application,&provide detailed drawings) 24. 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) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: X (ifyes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: X (ifyes,the area and elevations of the flood plane must be properly depicted on the survey&sire plan) 27. 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) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X Indicate:TIER I: TIER II: TIER iiI: (ifyes,a Nome Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ 30,991 Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: TBD (2) 6/1/2023 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 www.rvchrook.org 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 Peter DelliPaoli & Amy DeIlPaoli , residing at, 103 N Ridge St „QyFgkx..,e New York 10573 tl'rint n.nnrt 0-L• "ll,i':"'r In"1 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; 103 N Ridge St , eyC-7,B,e4z)L- New York 10573 Rye Brook,NY. A, 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. r �• Peter DelliPaoli & Amy DeIlPaoli Sworn to before me this 1 day of kbwa)- / _, 20 13RIAN MAcDONALP !VOTARY PUiB1JC State ofConnecticut my EXPI(IESOct.]t 7t (3) 6/Ir2023 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. #**#********k**k*k*****k*#***kkk*k**k**kkk*k******kk****k***kk*k*kk**k**k*k*********#******#*#**##*******# STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as: Franklin Barahona , 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 Contractor 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 n1e this Sworn to before me this 2 r day of 1' r16rt/ad ,20 f/ day of T t , 20 7/J Signature of Property Owner Signature of pplicant Peter DelliPaoli & Amy DellPaoli Franklin Barahona Print Name of Property Opener Print Name of Applicant Notary Public Notary Public BRIAN MACDoNAL.D NOTARY PURIJC BRIAN MACDONALD State ojConnectfcut NOURY PUBLIC Wry COMMISSION ExptR E S Oct.31 J. 21 srtaw of C--ec'-' BAY COMMISSION EXPIRES Od.31 Z-7t (4) 6/112023 ���l Agreement Document and Payment Terms ` DBA=RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Pater DelliPaoli 8 Amy DallPooli RENEWAL Legal Name:Fairchester Custom Windows LLC 103 North Ridge St. CT HIC#.0667292,WC-35743-1-122,Putnam#51220 Port Chester,NY 10573 byANDERSEN' 421 West Ave,Building1 Stamford,CT 06902 uam.cm qua mumm H:(914)305.1500 Phone:203-406-0545 1 Fax:203-406-0828(sales®rbawestchester.com C:(914)58"227 Peter DelliPaoli&Amy DellPaoli 02/18/24 BUYER(S)NAME CONTRACT DATE 103 North Ridge St.,Port Chester,NY 10573 (914)305-1500 (914)588-6227 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER amcinerneyl@yahoo.com PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyers)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: $30,991 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: $6,198 BALANCE DUE: $24,793 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: 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 02/21/2024 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. 0�4 SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Leonard Pesce Peter DelliPaoli Amy DellPaoli PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 02/18/24 Page 2/ 30 Itemized Order Receipt u�p DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Peter DelliPaoli 3 Amy D•llPooli Legal Name:Fanchester Custom Windows LLC 103 North Ridge St. RENEWAL CT HIM 0667292.WC-35743-H22,Putnam#51220 Port Chester,NY 10573 byANDERSEN 421 West Ave.Building 11 Stamford,CT 06902 H:1914)305.1500 ii vrn.nwr�en+e.v Phone:203-406-0545 1 Fax:203.406-0828 1 sales0ibawestchester.com C:(914)588-6227 ROOM: SIZE: DETAILS: PRICE: 0 W Misc Misc. Miscellaneous Job Items. Lead Safe Work 0 H Prachces. Quantity 1, EPA requires contractors that disturb painted surfaces in homes. built before 1976 to be certified and follow specific ..ork practices. 0 W Misc Misc, Miscellaneous Job Items, Miscellaneous, Quantity 0 H 1, Ternpured glass creclit 101. Living 87 W Window AcclaimT'•' Gliding Triple 1:2:1 Base Frame, Exterior 41 H White, Interior White, Performance Calculator PG Rating: 30 1 DP Rating: � 30/ - 30 Glass, .All Sash: High Performance SmartSun Glass, No Pattern. Hardware, White. Standard Color Hand Pull. Screen, Fiberglass. Full Screen. Grille Style, No Grille, Misc, None , 102 Living 36 W Window AcclaimT"' Double-Hung(DG) 1:1 Flat Sill, Insert 41 H Franre. Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 1 DP Rating: + 40 - 40 Glass, All Sash: High Performance SmartSun Glass No Pattcrn, Hardware, ',Vhite. Standard Color Recessed Hand Lift. Screen. Fiberglass. Full Screen, Grille Style, Grilles Between Glass (GGG), Grille Pattern, Sash 1: Colonial 3w x 2h. Sash 2: No Grille, Misc, ,Vnne , 1.03 Dining 36 W Window Acclaimi" Double-Hung (DGi 1:1 Flat Sill, Insert 41 H Franre, Traditional Checkrail, Exterior White. Interior White, Performance Calculator PG Rating: 40 I DP Rating: + 40; - 40 Glass, All Sash: High Performance 5martSun Glass, No Pattern, Hardware,White, Standard Color Recessed Hand Lift. Screen, Fiberglass. Full Screen, Grille Style, Grilles Between Glass iGEG), Grille Pattern, Sash 1: Colonial 3w x 2h. Sash 2: No Grille. Misc, Nn•te 104 Dining 36 W Window Acclaim"' Double-Hung (DG) 1'1. &a1 Sill, Insert 41 H Frame. Traditional Checktail. Exterior White. Interior White. 02/18/24 Performance Calculator Page 3/ 30 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Peter DelliPaoli i Amy DellPooli Legal Name:Fauchester Custom windows LLC 103 North Ridge St. RENEWAL CT HIC#.0667292.WC-35743-1-122,Putnam#51220 Port Chester,NY 10573 byANDERSEN 421 West Ave.Building 11 Stamford,CT 06902 H:(914)305.1500 Phone:203.406 0545 1 Fax:203-406.0828 1 sale sprbaweslchester.com C:(914)588.6227 rROOM: PG Rating: 40 ! DP Rating: + 40 / - 40 Glass. All Sash: High Performance SnrartSun Glass, No Pattern. Hardware, White. Standard Color Recessed Hand Lift. Screen, Fiberglass. Full Screen, Grille Style, Grilles Between Glass (GBG), Grille Pattern. Sash 1: Colonial 3w x 2h. Sash 2: No Grille, Misc. None , 105 Bedroom 36 W Window Acclaim"-' Double-Hung(DG) 1:1 Flat Sill. Insert 41 H Frame. Traditional Checkrail. Exterior White. Interior White. Performance Calculator PG Rating: 40 ! DP Rating: + 40 / - 40 Glass,All Sash: High Performance SmartSun Glass, No Pattern. Hardware,White. Standard Color Rccessed Hand Lift. Screen, Fiberglass. Full Screen. Grille Style, Grilles Between Glass (GBG). Grille Pattern Sash 1 Colonial 2w v 2h, Sash 2: No Grille. Misc, None . 106 Bedroom 36 W Window Acclaim'" Double-Hung(DG) 1:1 Flat Sill, Insert 41 H Franie.Traditional Checkrail. Exterior White, Interior White. Performance Calculator PG Rating: 40 ! DP Rating: + 40 / - 40 Glass, All Sash: High Performance SnrartSun Glass. No Pattern. Hardware, White. Standard Color Recessed Hand Lift. Screen, Fiberglass, Full Screen. Grille Style, Grilles BetY.ecn Glass (GBG), Grille Pattern. Sash 1. Colonial 3w x 2h, Sash 2: No Grille. Misc, None . 1.07 Bedroom 2 36 W Window Acclaiin'" Double-Hung(DG) 1:1 Flat Sill. Insert 41 H Framc,Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 ! DP Rating: + 40 ! - 40 Glass, All Sash: High Performance SnrartSun Glass. No Pattern. Hardware, While. Standard Color Recessed Hand Lift, Screen, Fiberglass, Full Screen. Grille Style. Grilles Between Glass (GBG), Grille Pattern, Sash 1: Colonial 3w x 2h, Sash 2. No Gril,r:. Misc, Nwo� . 108 Bedroom 2 36 W Window —--- - 41 H - -- 02/18/24 Page 4/30 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Petor DolliPooli i Amy Deliftali Legal Name:Fairchester Custom m Windows LLC 103 North Ridge St. b CT HIC#.0667292.WC-35743-H22,Putna #51220 Port Chester,NY 10573 N ERSEN 421 West Ave.Building 11 Stamford.CT 06902 H:(914)305-1500 Phone:203.406.0545 1 Fax:203.406.0828 1 sale sOrbawestchester.com C:(914)588-6227 r • DETAILS: Acclaiml" Double-Hung (DG) 1:1 Flat Sill, Insert Frame, Traditional Checkroil. Exterior White. Interior White. Performance Calculator PG Rating: 40 1 DP Rating: + 40/ - 40 Glass, All Sash: High Performance SmartSUn Glass. No Pattern. Hardware, '.,Vhite, Standard Co or Hncrssed Hanc Lift. Screen. Fiberglass. Full Screen. Grille Style, Grilles Between Glass (GBG), Grille Pattern, Sash 1: Colonial 3w x 2h. Sash 2: No Grille, Misc, None 109 Bathroom 28 W Window Acclaim''' Double-Hung (DG) 1:1 Flat Sill, Insert --------------------- 41 H Frame, Traditional Checkiail. Exterior White. Interior White. Performance Calculator PG Rating: 40 1 DP Rating: + 40 ; - 40 Glass,All Sash: High Performance SmartSun Glass- No Pattern. Tempered Glass, Hardware, White. Standard Color Recessed Hand Lift. Screen, Fiberglass, Full Screen. Grille Style, Grilles Betv.een Glass (GBG). Grille Pattern, Sash 1: Colonlat.3.-Uttaah Sash 2: No Grille, Misc, None . 110 Kitchen 36 W Window Acclaini"-' Double-Hung (DG) 1:1 Flat Sill, Insert 41 H Frame,Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 1 DP Rating: + 40/ - 40 Glass, All Sush: High Performance SmartSun Glass. No Pattern, Hardware, White. Standard Color Recessed Hand Lift. Screen. Fiberglass. Full Screen, Grille Style, Grilles Bettis-er Glass (GBG!, Grille Pattern. Sash 1: Colonial 3w x 2h. Sash 2: No Grille, Misc, None , 111 Enrty 0 W Misc Misc. Miscellaneous Jub Items. Pro-Via Door, Quantity i � / 0 H 1. Details of ProVia door specifications to be provided on ( supplemental agroernent. WINDOWS: 10 PATIO DOORS:0 ENTRY DOORS:0 SPECIALTY:0 MISC:3 TOTAL $30,991 Renewal Gv Andersen is committer)to our customers'sofety l.y complying with the rules and lend-soli•work practices specifier/l y the Elsil. 02/18/24 Page 5/ 30 L 00 m y -E E n i o s o E a > O m O N > O C l! r y 7 LL V v O 01 ago H E O ,n Y E v, R 2 O LL C m LL L C Z E o m t E w a :Ei o o p m o f L m o a t v m c E Y c 75 N ro c E a E c ¢ -o v m m yyj C _'1 V N C .�� L V C V O N pLn N C '1 C rp Q •�• C s Z o4 E ° t 3 c o L E o �` o c % L � o C o o nai 6 W • J `' aa, E a v v+ 3 C 7 N V L O a rj O F- E m x v 3 3 uo E 3 S 4 v 'D u Z J V 0 x Q l7 {L 0 Ji 2 N 'a Z U ° o � " o O ry - !1 M 3 s M 5 j 00 s O w 0 = N a�i I Z O O r II — V O E � � o n Q K of r wvi O v o = a .0 V/ O W N .— - LL v s O 3-1 E s a K. o o fi • a 0 L 1 � 3 �� ` RENEWAL byANDERSEN Technical Data 7 FUEE•SERVI[E MNDOW&DOOR REPEAGMENF MI_ SPECIFICATION AND TECHNICAL MAN UAL AA i RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance Renewallby Solar Heat Gain Coefficient(SHGC)1 Andersen"Product Without Grilles 0.42 0.41 0.51 0.51 .82 Clear Full Divided Light Grilles 0.43 0.41 0.46 0.46 Without Grilles 0.31 0.28 0.28 0.27 .72 Low-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-E4ISun Casement Full Divided Light Grilles 0.33 0.30 0.16 0.15 WithoutGrillcs 0.31 0.28 0.19 0.18 .65 Fixed Low-E41 SmartSunl" Full Divided Light Grilles 0.32 0.29 0.17 0.17 >v, Low-E4"SmartSun Without Grilles 0.26 0.24 0.18 0.18 .63 with HeatLock' Full Divided Light Grilles 0.26 0.24 0.17 0.16 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.25 .42 Enhanced Triple pane with Without Grilles n/a 0.19 n/a 0.17 .37 SmartSun' Clear Without Grilles 0.43 0.41 0.51 0.51 .82 Full Divided Light Grilles 0.43 0.41 0.46 0.46 Low-E4' Without Grilles 0.31 0.28 0.28 0.27 .72 Full Divided Light Grilles 0.32 0.29 0.25 0.25 Low-E41Sun Without Grilles 0.32 0.29 0.17 0.17 .40 Full Divided Light Grilles 0.33 0.30 0.16 0.15 Low•E4"'SmartSunn" Without Grilles 0.31 0.28 0.19 0.18 .65 Full Divided light Grilles 0.32 0.29 0.17 0.17 Low-E4`SmartSun Without Grilles 0.27 0.25 0.18 0.18 .63 with HeatLock" Full Divided Light Grilles 0.27 0.25 0.17 0.16 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.25 .42 Enhanced Triple pane with SmartSun'"' Without Grilles n/a 0.20 n/a 0.17 .37 Clear Without Grilles 0.46 - 0.58 - .82 Full Divided Light Grilles 0.46 0.52 - Low-E4 Without Grilles 0.33 0.30 0.31 .72 Full Divided Light Grilles 0.34 0.31 0.28 0.28 Low-E4m Sun Without Grilles 0.33 0.30 0.20 0.19 .40 Full Divided Light Grilles 0.35 0.31 0.18 0.17 r sr n Without Grilles 0.32 0.29 0.21 0.21 .65 (All Frames) Low-E4'SmartSun'm Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4 h'SmartSun WdhoutGrilles 0.27 0.25 0.20 0.20 .63 with HeatLock' 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 Enhanced Triple pane Without Grilles n/a 0.20 n/a 0.19 .43 with SmartSun"I Low rt$un"•.'low E4 ,low Wit,Sit a' Hcatlock.9 are Andersen vademarks 1p-Low{"glass . I)lFPactor defines the amount of heal loss mrough the total un tin lln ll r/f12.-F.The lower he value,the less heal,s lost through the entire product.window values represent had tempere7 glass.Use of tempered glass can increase U-ractor ratings,see anaetsenwindows.com/nhc for spec Rc performance values. 2)solar Heat Gam co ffi dent(SHGc)defines the fraction of solar radiation admitted through the glass both o needy tronsmitted and absorbed and subsequently released inward.The lower the value.the less hea:is Vansmnted through(he product. 3)wsible Tmnsmdlance(VT)measures how much light comes through a product(glass and frame).The Ngner the value,from O to 1,the more daylight the product lets In over the product's total unit area wslble Light Transmittance is measured duet the ago to 760 nanometer portion of the solar spectrum. •NFRC ratings are based on modeling by a thud party agency as validated by an ndepmdent test lab m compliance wnh NFRC pioglan and procedural Iequdemen:s •This data is accurale a$of April 2021.Due to ongoing product changes.updated test results,or new industry standards o'requirements,this data may change over time.Ratings are for sizes speared by NFRC for leshng and certification.Ratings mayvarydepend ri use of tempered glass.different grille options,glass wan capillary breather woes for high attitudes.etc.-Low-E4,i)'Low-E4W. smarlSunr•-am*Low-E400 Sun' 09-9 COMPANY CONFIDENTIAL- REVISION AA-01 RENEWAL BY ANDERSEN SPECIFICATION& TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS a AND TEST DATA NFRC Total Unit Performance (continued) Renewal by Andersen' I.I.Factor IBM/(hr ft2 oF))' Solar Nest r. r GlassType Product Air Ar Gas Blend Without Grilles 0.46 0.44 0.57 0.57 .82 Gear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E41 Full Divided Light Grilles 0.34 0.31 0.28 0.28 Low•E40Sun Without Grilles 0.33 0.30 0.19 0.19 .40 Full Divided Light Grilles 0.35 0.31 0.18 0.17 a•Double (Full F""nel Without Grilles 0.33 0.29 0.21 0.21 .65 low-E41SmartSunTM Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4'SmartSun Without Grilles 0.28 0.25 0.20 0.20 .63 with HeatLock' Full Divided Light Grilles 0.28 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with SmartSun" Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4' Full Divided Light Grilles 0.35 0.31 0.28 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 a• Double-Hung Low-E41Sun Full Divided Light Grilles 0.35 0.31 0.18 0.18 Without Grilles 0.33 0.29 0.21 0.21 .65 (Inwrt Frame) Low-E4'SmartSun"' Full Divided Light Grilles 0.34 3 { 0.19 0.19 low-E4^SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLock' Full Divided Light Grilles 0.27 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Trple pane with SinartSunnr Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.47 0.45 0.59 0.59 .82 Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 Without Grilles 0.34 0.30 0.31 0.31 .72 Low-E4' Full Divided Light Grilles 0.35 0.32 0.29 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4'Sun Full Divided Light Grilles 0.35 0.32 0.18 0.18 =vdd rilles 7Enhanced rtSun"' 0.33 0.29 , 0.21 0.21 .65 Fulght Grilles 0.34 0.31 0.19 0.19 artSun Without Grilles 0.27 0.25 0.20 0.20 .63 ck' Full Divided Light Grilles 0.27 0.27 0.18 0.18 le Pane Without Grilles n/a 0.20 n/a 0.28 .47 panewithWithout Grilles n/a 0.19 n/a 0.18 .43 ' low E417 SmarlSun-'tow E4M.'Lo t E01 Sun'and Hcatloek1)are Andersen trademarks for'Lew E'glass 1)u-Factor dernes the amount of near loss through the total unit BTU/tu/112.OF.The lower the value.the less heal is lost through the entire producl.window values repiesern non-tempered glass.Use of lempe'ed glass Can Increase U-Factor ratings.See ancersenwindows.com/nfri:for spec fic performance values. 2)Solar Heat Gain Coeff cient(SKC)de5nes the fraction of solar radiaton aumined through the jtass Lain meetly t'ansmdted and absofbed and subsequently feleased inward.The love•the value.the less hea:is transmntea through the product. 3)VINbk Tiansmdtance fVT)measuicstaw muchlight Oomesthfough a pfoducl(gia5sand frame)The higher lhevalue.from 0 to 1.the mored3rkgh:the product lets in oefthe product'siotal unn area Vmble Light hansmn:ance is measured Olen the 3so to 760 nanometet portion of the solar Spectrum •NFRC ratings arc based on odefing br a thud patty agency as.akdaced b)an independent test tab in cUrrplwnce wdh NFRC program and procedural requirements •Th s data is a zurate as Million,!2021.Due to ongoing product changes.upcatec test resAts.or new industry standafds o•mqu cements uss data may mange overwrite.Raluigs afe fa by NFRC far test,ng ara crbbcation.Racags may vary depera ng on use of temaered glass.ddfeenl gni a opuons.giass wdn capillary weather tuces for h-gh amivaes.etc.'low.E4',,'Low E4T SmartSun-and'Low{4 T Sun' 09-10 COMPANY CONFIDENTIAL- REVISION AA-01 RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance (continued) Renewal bry Anderson"' High Performance Glass Type Product r r e Without Grilles 0.44 0.42 0.61 0.61 .82 Clear Full Divided Light Grilles 0.45 0.43 0.55 0.55 Without Grilles 0.31 0.27 0.33 0.32 .72 Low-[40 Full Divided Light Grilles 0.32 0.28 0.29 0.29 Low-EQ'Sun Without Grilles 0.31 0.27 0.20 0.20 .40 Picture Full Divided Light Grilles 0.33 0.29 0.18 0.18 (Full Frame) Without Grilles 0.30 0.26 0.22 0.22 .65 Low-E4'SmartSun' Full Divided Light Grilles 0.32 0.28 0.20 0.20 Low-E4`SmartSun Without Grilles 0.25 0.22 0.22 0.21 .63 with HeatLock' Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced TnplePane Without Grilles n/a n/a n/a n/a n/a Enhanced Tnple pane with SmanSun'" Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.45 0.43 0.64 0.64 .82 Clear Full Divided Light Grilles 0.46 0.44 0.57 0.57 Without Grilles 0.31 0.27 0.34 0.34 .72 Low-E4" Full Divided Light Grilles 0.33 0.29 0.31 0.31 Without Grilles 0.31 0.28 0.21 0.2 .40 Low-Ell'Sun Picture Full Divided Light Grilles 0.33 0.29 0.19 0.19 (Insert Frame) Low-E4'SmartSun' Without Grilles 0.30 0.27 0.23 0.23 .65 Full Divided Light Grilles 0.32 0.28 0.21 0.21 Low-E4`SmartSun Without Grilles 0.25 0.22 0.22 0.22 .63 with HeatLock' Full Divided Light Grilles 0.25 0.22 0.20 0.20 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with SmartSpn" Without Grilles n/a n/a n/a n/a n/a Clear Without Grilles 0.44 0.42 0.61 0.61 0.82 Full Divided Light Grilles 0.45 0.43 0.55 0.55 Low-E4' Without Grilles 0.31 0.27 0.33 0.32 0.72 Full Divided Light Grilles 0.32 0.28 0.29 0.29 Low-E4`Sun IVithoutGrilles 0.31 0.27 0.20 0.20 0.40 Picture Full Divided Light Grilles 0.33 0.29 0.18 0.18 (Universal Frame) Low-EQ''SmartSun'" Without Grilles 0.30 0.26 0.22 0.22 0.65 ' Full Divided Light Grilles 0.32 0.28 0.20 0.20 Low-E4`SmartSun Without Grilles 0.25 0.22 0.22 0.21 0.63 with HeatLock' Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced Triple Pane Without Grilles n/a 0.16 n/a 0.30 .50 Enhanced Triple pane with Without Grilles n/a 0.16 n/a 0.20 .45 SmartSun' 'Low E44D SmartSun'",'lor E41D,'Low E40 Sun'and Heatlock:S are Andersen trademarks for'low E'glass 11 Ulaclo dehMs the amour or neat bis UrouCn Vie total tin t n elu/hqu.•1.]he bane the value,the less heat Is lost through the enure product.w ndo-.values represent non-;empe•eo glass.use of tempe•ed Cass can increase U-Factor ratings. See a^ders",ndows.comtare for specific prfwmance vales. 2)Solar Heat Can Coe^vent(SHa defines the traction of sclar radiation acm(?;ed through the pass Lyon.areedy ra^smelted and acso•Ded and suoseduendy released r-ward.The lower the value,the less heat is transmitted through the product. 3)vosiule Transmittance(vl)measures now much light comes mmugh a product(Klass and flame)Thehrgherthevalue.fwm0to I.the more da,hght the product lets of over the product's total unit area YwWe lrpr;Lanvmt:ana•rs meawrcd wee tnc 380 to 160 nanometcf pouon of the solar spttoum •NFRC ratings are uaxd on model gq a tsoN party agency as validated by,in independent test tan in emcphance with NI HC pmgra n and procetlural n vlwmmrnts •nos Bala s accurate as of April 2021.Due to ongoing product changes,updated test results.or new mdusl'y standards or redorements.this data may change over time.Ratings ate for sues specified oy NFRC for resting and certification.Ratings may vary depending on use of tempe,ed pass different gr Ile options.pass with candidly Wainer TAGS for high attitudes.etc.-1 ow-E4[9•,'Low E4R SmartSunr.-and'Low-E4T Sun- 09-11 COMPANY CONFIDENTIAL-REVISION AA-01 *�-- Order Summary dba:RENEWAL BY ANDERSEN OI:WESTCHESTER AND FAIRFIELD Peter DelliPaoli&Amy DellPaoli COUNTY 103 North Ridge St. RENEWAL Legal Name:Fairchester Custom Windows LLC I License a CT HICM.0667292, Port Chester,NY 10573 by A N D E R S E N WC-35743-H22,Putnam k51220 H:(914>305-1500 421 West Ave,Building 1 I Stamford.CT 06902 C:(914905-6227 Phone.203-406-0545 1 Fax:203-406-0828 1 tech@rbawesichester.com •OFLOOR UNIT NOTES EPA requires contractors that disturb painted 1 ur; surfaces in homes,built before 1978 to be .105 certified and follow specific work practices. Tempered glass credit +1mi 1u•1 1 1 1 Details of ProVia door specifications to be 10.1 provided on supplemental agreement. 110 1111 ll l 101 JOSPHOTOS 02/27/24 Page 7 / 28 1 1 ; 1 r Y a - - s tr f l. .y �- i rr .+ � { lV °'A� �� --_-- rt�� -- yy{{��� _ _ 4 .. �r� �1.. �. t l � •��'`..mp� �- -► `- �1 ,.,. _+ M� i 1 _ -3+r � .. e ",.,. _. 1 .q� 1 ..K,::j.y� -� f, l �.�, � �' �» �� y " II��II'�i'iIJ'�li I'lll'lllllllll 9111111Pdllllll IIIIIIIIIIIIIII �ii@',iry,IPdh� lillill'il'dllll '� II�II�IIVI I .. sc i �•.r i � � J 1' - 103 � a 1 , M �` t ' I rr 'r :;.; � 1 � t � !-. � �� ,•}� �l 1� � i t � � j i � � ' ,�.�.; ;� - '' �-� ��y ,� ,��. ���` <<,: '� � � ��� �� . �,- _ .�; s _� ' .- _ ���� .. - - 108 Bedroom 2 Acclaim"I Double-Hung(DG).36.00W x 41.00H CHANGE ORDER- • s • ExrEaroR <360* inrEwoa n�T 0, 108 Bedroom 2 Acclaim"' Double-Hung(DG)-36.00W x 41.00H CHANGE ORDER- • • a EXTERFOR 36 IKTERtOR ,o�„ 101 Uving Acclaim"' Gliding-Triple-87.00W x 41.0011 -CHANGE ORDER- • 3600 • 101 Uv(ng AcclaimT^' Gliding-Triple-87.00W x 41.00H CHANGEORDER- • • 109 Bathroom �^ Acclaim"" Double-Hung(DG)-28.00W 41.00H CHANGEORDER- ti • 0 EXTERIOR 36 IPRERIOR ro roa�iT.r 109 Bathroom Acclaim"' Double-Hung(DG)-28.00W x 41.00H CHANGE ORDER- EXTERIOR �360* INTERIOR TOE, Fairchester is not using an Engineer / Architect due to installation of replacement windows and doors into EXISTING openings with NO structural alterations . Tax Parcel Maps Address: 103 N Ridge St Print Key: 135.67-2-7 SBL: 13506700020070000000 I 1 1 I l 1 I 1 OvRon M"- : za.. go 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 properly boundary description.Property descriptions must be obtained from surveys or deeds.For more information please contact the assessor's office of the municipality. vo Me MR, votIAMT � ' Ali 04 44 za co kection Zr 0 o U) 07— LL ct OWN CN IWO FAIRCUS-01 CERTIFICATE OF LIABILITY INSURANCE DAT29/20/YYY1) 9/29/2023 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER JRAJACT Theresa Brandon MBI Company Group LLC. FAlCNN,Eat): 203)288-3401 FArc No; 203 281-0414 280 State Street North Haven,CT 06473 Xabss,theresa.brandon@mb14ns.com INSURERS AFFORDING COVFRAGF NAIC 0 INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba:Renewal by Andersen INSURER C: 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 LTRTYPE OF INSURANCE ADD SUB POLICY NUMBER POLICY FFF POLICY D(P LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f 1,000,000 CLAIMS-MADE a OCCUR X 2516791 8/12/2023 8/12/2024 DAMAGE TISE,O RENTED 500,000 MED EXP oneperson) 15,000 PERSONAL 6 ADV INJURY 1,000,000 GENL AGGREGATE LIMIT AP S PER GENERAL AGGREGATE f 3,000,000 POLICY a jra L_J LOC PRODUCT -COMPIOP AGG S 3,000,000 OTHER f A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f 1,000,000 (Ea aondentiANY AUTO S 2516791 8/12/2023 8112/2024 BODILY INJURY Per f OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per E a ccdent A XANO Oae1AMAM��S ONLY Pmd fX Camp Ded S500 X Co0lsion Ded$500 f A X UMBRELLA LU18 X OCCUR EACH OCCURRENCE f 4,000.000 EXCESS LIAB CLAIMS-MADE X S 2516791 8/12/2023 8112/2024 AGGREGATE 41000,000 DED I X I RETENTIONS 0 f A WORKERS COMPENSATION X PERTUTF I X I OTH• AND EMPLOYERS'LIABILITYSTA ANY PROPREIETgOERIPARTNERIEXECUrIVE Y/N C 9099063 8/12/2023 8/12/2024 500,000 gU,I dERIMry nNHj EXCLUDED? ❑N NIA EACH ACCIDENT SOO,000 (rvu I NH E.L.DISEASE-EA EMPLOYE If yes,descnDe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddIdonal Remarks Schedule,may be attached If more aP�co is required) Village of Rye Brook Is Additional Insured as required by written contract per the endorsemonts included with this certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPTION DATE THEREOF, Village of Rye Brook ACCORDANCE WITH THE POLICY P O S ONSCE WILL 8E DELIVERED IN 938 King Street Rye Brook,NY 10573 AUTHORIZED� REPRESENTATIVE j 6--I " 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 Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.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 1c_NYS Unemployment Insurance Employer Re Registration Number of 2041 West Main Street9 Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number certain locations in New York State,i.e.,a Wrap-Up Policy) on umer o Insured or Social Security 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"I a" 938 King Street Rye Brook,NY 10573 WC9099063 3c.Policy effective period 08/12f2023 to 0 8/1 22 02 4 3d.The Proprietor,Partners or Executive Officers are ❑X included.(Only check box if all partnors/officors Included) ail excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"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,1 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: —IZUZ4-a, 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 jM authorized to Issue it. C-105.2(9-17) www.wcb.ny.gov