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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
www.ryebrook.org
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
June 7, 2024
Dziugas Reneckis& Cristina Pires
9 Maple Court
Rye Brook,New York 10573
Re: 9 Maple Court, Rye Brook,New York 10573
Parcel ID#: 135.66-1-78
Building Permit#24-037 issued on 3/11/2024 for Replacement Window
This certifies that the one new window,installed under the above captioned permit has been satisfactorily
completed.
Sincerely,
Steven E. Fews
Building& Fire Inspector
/to
R D E C Ez �W[E
BUILDING DEPARTMENT For office use only:
MAY — 9 2024 PERMIT#
VILLAGE OF RYE BROOK —037
ISSUED: //—aq
VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 5-9—aZ1
BUILDING DEPARTMENT (914)939-0668 FEE: ( / lep— 2AID I5K
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
............t.............................................................................__.................................
Address: 9 Maple Ct., Rye Brook, NY 10573
Occupancy/Use: Residential Parcel ID#: 135.66-1-78 Zone: ' !O
Owner: Cristina Pires & Dziugas Reneckis Address: 9 Maple Ct., Rye Brook, NY 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
(Cnvrrown/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: $ 0_7�_` 7/
for the construction or alteration of. Installation of replacement Window:
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 f-h Sworn to before me this /S T h
day of ►4�t�1 , 20 ZL� day of 4?ri 20
signature of Property Owner Signature of p',can
Cristina Pires & Dziugas Reneckis BRIAN MACDONALD Franklin Barahona
Print Name of Property Owner NOTARYPUBUC Print Name of Applicant
State of Connecticut
MY COMMISSION EXPIRES Oct 312026
Notary Public Notary Public
QyE BRC�uk
1982 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
El 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 : (� /� Lo �,F Lv L„ DATE: I J zc)z/
PERMIT# &( 2 7 ? ISSUED: SECT: BLOCK: LOT:
LOCATION: ?1 J OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... El ACCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION p
❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
(�}`FINAL
❑ OTHER
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BUILDING DEPARTMENT FEB 2 9 2024
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 BUILDING DEPARTMENT
wivwxyebrook.ore
ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION
FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL
FOR OFFICE USE ONLY:
APPROVAL DATE: R O PERMIT# S/ QS7,tQ,PPLICATION FEE: J!t V/0 /AA
APPROVAL SIGNATURE: PERMIT FEES:�C�<J`"jQU
H.O.A.APPROVAL: DATE.
DISAPPROVED: OTHER:
s+******t+rs+ssrtrrtrt*»rtrtsts+**s*srr*tss*s*ssssst*tsrtrsr»»rrt+rts»+rtr*t**»*»sr*+»tits++***rrt+s*srs**++*s*srt*
Application dated,February 21, 2024 is hereby made to the Building Inspector of the Village of Rye Brook.NY,for the issuance of Permit for the
construction of buildings.structures,additions,alterations or for a change in use,as per detailed statement described below.
1. Job Address: 9 Maple Ct., Rye Brook, NY 10573
2. Parcel ID#: 135.66-1-78 Zone: —10
3. Proposed Improvement(Describe in detail): Removal and Installation of( 1 )replacement window
into existing opening with no structural alterations.
4. Property Owner: Cristina Pires&Dziugas Reneckis
Address: 9 Maple Ct., Rye Brook, NY 10573
Phone# (929) 245-5769 Cell# (203) 209-8245 e-mail pires.eristina.m@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# 203.249.1996 e-mail Permits@RBAWesichester.com
Architect:
Address:
Phone# Cell# e-mail
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 Permits@RBAWestchester.com
(I)
6/I/2023
5. Occupancy;(I-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: 1 v fl: 2nd fl: 31d fl:
10. Total Square Footage of the proposed new construction:
11. For additions,total square footage added:Basement: 1°fl: 2"d fl: Yd 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;()Timber Frame[TC];()Wood Truss[TT];
O Pre-engineered wood[PW];Located;()Floor Framing[F];O Roof Framing[R];()Floor&Roof Framing[FRI;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,ANSI,System,FM-200 System,Type I Hood,etc...)Yes: No: X
(fyes,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
Stormwatcr 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 (if yes,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
(if yes,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
(if yes, 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
(i(yes,the area and elevations of the flood plane must be properly depicted on the survey i&site plan)
27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: X
(if yes,applicant must submit a Tree Removal Permit Application)
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: (if yes,a Home Occupation Permit Application is required)
29. What is the total estimated cost of construction: $ 2,971 Note.estimated cost shall include
all site improvements,labor,material,scaffolding,fixed equipment,professional fees, including any material and labor which may be
donatedgratis.lfthe final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O.
30. Estimated date of completion: TBD
(2)
61 t/2023
BUILDING DEPARTMENT FEB 2 0 2024
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 BUILDING DEPARTMENT
www.ryebrook.orl!
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE U 16 • 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,Cristina Pires & Dziugas Reneckis ,residing at, 9 Maple Ct., Rye Brook, NY 10573
Wfilu ItaillL.) I
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;
9 Maple Ct., Rye Brook, NY 10573 ,Rye Brook,NY.
{Juh �
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.
Cristina Pires & Dziugas Reneckis
Sworn to before me this 7
day of T 20 Zy
(\wjn g1uhrri
BRIAN MAC1)01IAL1:
NOTARY PUBIJC
State:Of Connecticut
MCWHIMONFAPWSCct.1120t (3)
611 t2023
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:
Franklin Baraliona ,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,ettomev,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 2 ,�h Sworn to before me this --h
day of 11" rt•YtEy , 20 day of 6;bM" r. . 20 2,V
Signature of Property Owner Signature of pplicant
Cristina Pires & Dziugas Reneckis Franklin Barahona
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
BR m��J u Stare of Connecticut
DIY COMMISSION EXPIRES OCL 31702f Mukm IdACDO�c
NOTARY PUEMC
state ojconnecttcut
AIYCoMMLc 1tNi EXPIRES Oct.31,Cr
(4)
6/1/2023
VNE`WAL
Agreement Document and Payment Terms
DBA3 RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Crisfino Pires&Dziugas Reneckis
Legal Name:Fairchester Custom Windows LLC 9 Maple Ct
R CT HIC».0667292.WC-35743-1-122,Putnam#51220 Rye Brook,NY 10573
a'ANDERSEN 421 west Ave,Building 1 i Stamford,CT 06902 H:(929)245-5769
uivm.ow>n nnn.m
Phone:203.406.0545 i Fax:203-40"828 i sales@rbawestchesler.com C:(203)209-8245
Cristina Plres& Dziugas Reneckis 02/20/24
BUYER(S)NAME CONTRACT DATE
9 Maple Ct,Rye Brook,NY 10573 (929)245-5769 (203)209-8245
BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER
pires.cristina.m@gmail.com dreneckis@gmail.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: $2,971 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: $594
BALANCE DUE: $2,377 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 Buyers)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 02/23/2024 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.
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Richard Creiner Cristina Fires Dziugas Reneckis
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
02/20/24
Page 2/ 30
Itemized Order Receipt
`!�✓ DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Crisfina Pires 8 Dxiugas Reneckis
EE W�A L Legal Name:Fauchester Custom Windows LLC 9 Maple Ct
RENEWAL NWA L EN E CT HICtr.0667292,WC-35743-H22,Putnam 051220 Rye Brook,NY 10573
., 421 West Ave.Building 11 Stamford,CT 06902 H:(929)245.5769
Phone:203-406.0545 1 Fax:203-406.0828 1 sale s@tbawestchester.com C:(203)209-8245
sROOM:
ow Misc Misc. Permit Fees,Town of Rye Brook- Estimated Permit
0 H Fees. Quantity 1. Renewal by Andersen will facilitate 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.
101 Bathroom 53 W Window Acclaiin"� Awning Base Frame. Exterior White,
26 H Interior While. Performance Calculator PG Rating: 40 1 DP
Rating: + 40/ - 40 Glass,All Sash: High Performance
SmartSun Glass. No Pattern, Tempered Glass, Hardware,
White, Screen, Fiherplass. Full Screen. Grille Style, No Grille,
Misc, None ,
WINDOWS: 1 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 1 TOTAL $2,971
Reneimil by Andersen is committed to otcr rustwneri'snfety by
complying teith the rules and lead-safe teork practices specified by the EI'A.
02/20/24 Page 3/30
RENEWAL Technical Data
byANDERSEN
�. FULLSERVIEE Vi IDOW x DOOR REPLACIMFUT
SPECIFICATION
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TECHNICAL
MANUAL
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RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION
PERFORMANCE RATINGS AND . a
Without Grilles 0.42 0.41 0.51 0.51 .82
Clear
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-E4'Sun 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'SmartSun"' 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 0.26 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-EQ' WidtoutGrilles 0.31 0.28 0.28 0.27 .72
Full Divided Light Grilles 0.32 0.29 0.25 0.25
Without Grilles 0.32 0.29 0.17 0.17 .40
ELLow-E41SunFull D' s 0.33 0.16 0.15
Without Grilles 0.31 0.28 0.19 0.18 .65
artSun1°
Full Divided Light Grilles 0.32 0.17 0.17
martSun 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 Without Grilles n/a 0.20 n/a 0.17 .37
SmartSun'"
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-E4°Sun Without Grilles 0.33 0.30 0.20 0.19 .40
Full Divided Light Grilles 0.35 0.31 0.18 0.17
Low-E43 SmartSun1q Without Grilles 0.32 0.29 0.21 0.21 .65
Full Divided Light Grilles 0.34 0.30 0.19 0.19
Low-E411 SmartSun Without Grilles 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 SmartSunl"
Im"1144b SmarlSun"','low•C419,'Iow E4,V Sun'and Ileatlock4D are Andersen trademarks fm'Luw.E'glass.
I I U-FaClor d6nes Die amount of heat loss through the total unit in BIWIti/112.'r.Moreover the value,the less heat is lost through ire entire product.W.ndow values represent non-tempored glass.Use of tempered pass can increase U4am
ratings.See ancerse-naows.com/nhc for spec tic perho'manee values.
21 solar Heat GanCoe"centfSHGQdecres the tractionof solar radiation attmittedthroughtiropassbot"directly orsmdled and absorbed and subsequentlyreleasedin•ard.The lower ire value.thelessneatIsbansmltted through the product
3)Visible hansmdtance fVlf measures how much licht comes through a product tgLass and ham).the hfgherthe value.from 0 to 1.the more daybed the product lets in over the product's fecal unit area.Visible light transnruttmrce is measured over
the 360 to 760 naoometer portion of the solar spectrum.
•NFRC ratings are based on modeling by a Ihrd party agency as validated by an independent test tab in compliance with NFRC program and procedural niqurremen9.
•this data n accurate as of Apnd 2021.Due to bngong product changes.updated test results,or new industry standards or requ rements.this Bata may change over time.Ratings are for yes specified by NFRC for testingane Certification.Ratings
may vary oewnding on use of tempered pass.different finite billions,pass with wpAlarybrealheen tubes for hip altitudes.etc.'lox-Ift.'Lew-L4c0 Smar•Surv-and'Low-E44o Sun'
09-9 COMPANY CONFIDENTIAL- REVISION AA-01
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: 9 Maple Ct
Print Key: 135.66-1-78 SBL: 13506600010780000000
• 4
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.
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FAIRCUS-01 TBRAN
ACORO' CERTIFICATE OF LIABILITY INSURANCE DAT 9 29120231 Y)
29/2
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.
II SUBROGATION IS WAIVED, subject to the terns and conditions of the policy,certain policies may require an endorsement A statement on
this certificate does not confer rights to the cortificato holder In lieu of such endorsements.
PRODUCER C ACT Theresa Brandon
MBI Company Group LLC. PHONE FAX
280 State Strout A/C No,Ent: 203)288-3401 FAX,No: 203 281-0414
North Haven,CT 06473 XMSS,theresa.brandon mbi-Ins.com
__ INSU __S AFFORDING COVERAGE NAIC 0
INSURER A:Selecilive Insurance Company of America 12572
INSURED INSURER 8:
Felrchosler Custom Windows LLC dba:Renewal by Anderson INSURER c_
Fairchostor --
2041 West Main Street INSURER 0:
Stamford,CT 06902 INSURER E
INSURER F:
OVERAGES 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 A S POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A X COMMERCIAL GENERAL UABILM EACH OCCURRENCE $ 1,000,000
CWMS-MADE OCCUR X 2516791 8/12/2023 8112/2024 "AMA aESO(ERE�ren 500,000
MFD EXP one non 15,000
PERWNAL&ADV INJURY 11 1,000,0
G_EML AGGREGATE LIMIT APPLIES PER. N RAL AGGREGATE 3,000,000
U LOC PRODUCTS•COMPIOPA 3,000,000 POLICY D jp&-
OTHER S
A AUTOMOBILE LIABILITY COMBINEDSINGL LIMIT $ 1.000,000
ANY AUTO S 2616791 8/12/2023 8M2/2024 BODILY INJURY(Ps,
AAU�TOS ONLY X NpN�pyyU�LE�D -BODILY INJURY Per atUOenl
X AUTOS ONLY X AUTOS ONIe Pa R $
X cam OW$500 X CdbWn Dod 55M
A X UMBALIABXOCCUR EACH RRENCE $ 4,000,000
EXC
CLAIMS•MADE X S 2516791 8/12/2023 8/12/2024 AGQREGATF $ 4,000,000
DED X RETENTION$ 0
S
A WORKERS COMPENSATION X PER rTATUTF—FX 0TH-
AND EMPLOYERS'LIABILITY
ANY PROPREIETgOER/PARTNER/EXECUTNE N C 9099063 8l12/20T3 8/12/2024 ID W 500,000
FICE ory 4,MNN�EXCLUDE07 N I A
E. — EMPLOYE 500,000
II ye0 detafDe under
DESCRIPTION OF OPERATIONS below .L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD t01,AddIII—1 Romrk•Schedule,n Y b—tLcMd If more•w m 1s requlmd)
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) 01988-2015 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
Ia.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured
Fairchester Custom Windows LLC. 203406-0545
204
West Main Street
Renewal by Andersen Fairchesler
2041 1c.NYS Unemployment Insurance Employer Registration Number of
Stamford,CT 06902 Insured
Work Location of Insured(Only required if coverage is specifically limited to Id.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 o1 Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder)
Selective Insurance Company
Village38King Street of Rye Brook 3b.Policy Number of Entity Listed in Box"1 a"
938 King
Rye Brook,NY 10573 WC9099063
3c.Policy effective period
08/12/2023 to 08/12/2024
3d.The Proprietor,Partners or Executive Officers are
QX Included.(Only check box if uJ partners/of;cers included)
all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box'3"insures the business referenced above in box"1a"for workers'
compensation under the New York State Workers'Compensation Law.(To use this form,Now York(NY)must be listed under Item 3
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 tamer must nobty 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: � �� � � 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