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HomeMy WebLinkAboutBP24-071PERMIT # / ,) / 0 7/ DATE; SECTION I Jam. 3 BLOCK TYPE OF WORK CQ /ne7; J/ JOB LOCATION OWNER 4 AJ CONTRACTOR6 T/ . COSTS& co # C C L'a 1, 000 7 o 9�y o� gsa I -CA s 1ef-z 003) y1ol 3 7/ e /') _ Aps TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING rl RGH PLUMBING GAS CI SPRINKLER ELECTRIC 0 LOW -VOLT CJ ALARM O AS BUILT C� FINAL I NSP OTHER APPROVALS ARB BOT PB ZBA OTHER `�yE BRCS . 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury w w.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 16, 2025 Alfred Short& Elvira Short 63 Winding Wood Road Rye Brook,New York 10573 Re: 63 Winding Wood Road, Rye Brook,New York 10573 Parcel ID#: 135.34-1-41 Building Permit#24-071 issued on 4/29/2024 for Replacement Windows This certifies that the eight new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILD R ENT For office use only: PERT# VII. OF RYE K - � ISSUED: 712- 8KINGSIRE YE BROOK, YoRK 10573 DATE:AN 9 FEE: I S�� PAIDV,a - ->r `�, , 0V APPLICATIONF(WtERTIFICATE 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*tts*ttt*+*t***+*+s*ssssssssss*sss**ts***tttttts*t+t+ttt***ts**ttsttssssss*ts**ssss*s*ss*********tt*s*****t**ss*ttstst*ttttt Address: 6,3 CJ•-- e- S Occupancy/Use: ° AA 10 � Parcel ID#: 12-3 / 13 5,�.1 - ( -`A ( Zone: Owner: la«ieA k C�ly.tA Sw- -� Address: b' lti;; .� w,•>,1-�I;d S P.E./R.A.or Contractor: &rs:> e,, eaY-- � Address: ii1:7 1_,o,1�e Dr . jAkyrV'0CAC ►�x - T Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCBESTER as: IQ 1 -�-A S-t6� being duly sworn,deposes and says that he/she resides at to'-3 (Print Name of Applicant) (No.and Street) in � 'g-r ers� ,in the County of t �' Sl�-r in the State of rJ �( ,that (01NITown/Villaee) 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:$ 1 D,0- , for the construction or alteration of. J1 fir- WL^� Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this �A Sworn to before me this 2 VI day of ,orvvu , 20 ?Q- day of Prv.�titP�!- , 20 ZS I Signature of Pr a er Signature A li v-e 7 r Name of Property Owner SHARI MELILLO ', me of Applicant Notary Public,State of New York , No.O1ME6160063 blic Qualified in Westchester County Notary Public Commission Expires J�01L.^-y 29,20?7 W 1 -1024 �WyE BRCS'. 1982 1;iV BUILDING DEPARTMENT ❑BUILDING INSPECTOR eASSISTANT 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 : 103 1 'J �a7C 1��.`� DATE: PERMIT# L 2-i n:2 1 ISSUED: -Z7'2"iSECT: OJ,3 Z BLOCK: LOT: LOCATION: `T�J i"I' . } OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... - ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION NATURAL GAS c k1S ❑ L.P. GAS �� D ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL Q OTHER s z \ O o v N Ncu N a� 0 ~ ■ 0"'4 E, X F/�. F' r. Q En W O U ro a. � W Fl. ° w x V o w �' �1 � $ O o a o c cn PQ A ooj cn o z W o � •q c O 00 r/ - �--� .>--� o rqMd W � ovovc Hz 0 O N w �1 w LLB © Fu a O O V W W O 0 U C p ^� ai U C)1Z o U \ x z vaCf)w ccr am, 1-4 h� 00 00" w I-� CN � A u - !�I 14 o z � 0 ; wrn ' av c LA A w z cY � O '� � •� o .n = BUILD TMENT V1L OF R OOK [A PR 2 6 262.4 938 KING ET RYE BR NY 10573 14)939-06 -— VILLAGE OF RYE BROOK BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: q q �J APPROVAL DATE: APR 2 9 2024 ERMIT#: � ��� / / APPLICATION FEE: APPROVAL SIGNATURE: PLRMIT FEES: H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. Job Address: 7J W- d e S 9�tg Pry k• M Y t 015-7 3 2. Parcel ID#: -r �— 1— I Zone: 4e—/S 3. Proposed Improvement(Describe in detail): l,p c w� U ��. �iio-0� W• +�A c�+✓S 4. Property Owner: A l rre d Ski' Address: (0-2,2 wl.":r_E3,1.— i� V c Phone#_q l Lt—_7vK-a5 Z1 Cell# G I —?V� 5 2� e-mail �S k ' �'`^P;�• G-c?m List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: b t D C^-v- p f,t,4 ^ Se,-- W�- A rf $ -e Address: 1(r 6 -6l le_ Me�� pA-r_ -4 C�5q Phone# �2-6 L11 D l 3-7 1 � Cell# e-mail (1) W 112023 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Fwww Post-construction: 6. Area of lot: Square feet: Acres: .3 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: W "�•^'S 9. Area of proposed building in square feet: Basement: I'fl: 2°1 fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 1 g'fl: 2°d fl: 311 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:p Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; ()Pre-engineered wood[PW];Located;()Floor Framing[F];()Roof Framing[R];()Floor&Roof Framing[FR];Other: 15. Number of stories: 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: 'V-- (rf yes,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:`-C Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No:_DZ-!� (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: �,L (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: 'JL (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: Z (if yes,the area and elevations of the f lood plane must be properly depicted on the survey&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-Occupa . as per-§250-38 of Village Code? Yes: No: k Indicate:TIER I: TIER II: TIER III: (f yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of constructio $ 1 0, G-VV / _Note:estimated cost shall include all site improvements, labor,material,scaffolding, ed equipment,profeagionalfees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated c�stT�aa anal fee will be required prior to issuance of the CIO. 30. Estimated date of completion: LAft k LH (2) 6/1/2023 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: _ 14 t (—,,.__S 5"X-a` ,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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this 2(c day of��"t( , 20�_ day of .-. , 20 i Signature of Propel O ner Signature o App1ica Print Name of Property Owner Print Name of Applicant Notary P rc GREGORY N.RIVERA GREGORY M.RIVERA Notary Public,State of New York Nitro Public,State of New York No.01RI6441398 No.01 R1644139a Quallfled In Westchester County Quallfled In Westchester County Commission Expires September 26,20� Commission Expires September 26,2f�i (4) 6/1/2023 O O N OLO N w O Q O O O z a COz W .� o w o Z m 3 w w U W Q Q � O as QC O z 0 o � Z > z � Wcu � A O 0Z O o a o 0 C CQ Lo (n F � CL w ' W a aa. `� � a o •S � � Q I U i O a z 1 M ° O �_ = z ELL 00 a x cl �_ y m m W 3 W (� `° � W F - c J pq z o LL W O W U) J w _o Lj ` Lj C7 w Q ACL L Q la m N - '^ V V) 1 00 W — r, 0 Z c 3 W 1 r ' IDCN ►� O J w NCO 1 J _ .1Z O T� ' J > I-- 2 W /C//^) _ O W cn w _ W , N E m M6 0 0 O -0 O oa _ H Q = mow 1 W M `� _ D � w Co 0 J 1 O � a> L A >- W `� > O Q W W W -a ` U- B & D Carpentry Services Invoice !' 167 Lake Drive Mahopac, NY 10541 1564 203-410-3718 CT Lic#HIC.0661203 Date 2/1/2024 WC Lic#33701-1-121 Fred/Elly Short , • 63 Windingwood Rd South Rye Brook,NY Windows Basement Description Windows delivered Monday $10,667.42 0.00%on$0.00 $0.00 $10,667.42 Customer Quote New Beginnings Window&Door 42 Pleasant Ridge Dr Pella Corporation pella.com POUGHKEEPSIE, NY 12603-5425 (845)2983667 Distributed by: DHD Windows and Doors LLC Customer Name Deliver To Address Order Information 62 MCKINLEY ST Estimated Delivery Date: 11/30/2023 Order Number: 050CB3156 62 MCKINLEY ST WAPPINGERS FALLS, NY 12590 Quote Number: 16844372 WAPPINGERS FALLS, NY 12590 Final Wall Depth: Primary Phone: (845)2983667 Customer PO: Outside View Line# Qty Description 10 3 Lifestyle, Casement Left, 35 X 55, Without HGP,White 1: Non-Standard Size Left Casement Unit Type: No Program General Information: No Package.Without Hinged Glass Panel.Clad, Pine,5", 3 11/16" Location: Exterior Color/Finish:Standard Enduraclad,White Interior Color/Finish: Prefinished White Paint Interior Rough Opening: 35.75"X 55.75" Glass: Insulated low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options:Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device. No Limited Opening Hardware. No Integrated Sensor Screen: Full Screen,White, InViewT"^ Performance Information: U-Factor 0.28, SHGC 0.27,VLT0.51, CPD PEL-N-14-00685-00001, Performance Class LC, PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 25.25,Clear Opening Height 50.875, Clear Opening Area 8.92079, Egress Meets Typical 5 7 sgft(E)(United States Only) Grille:No Grille. Wrapping Information: Foldout Fins, Factory Applied. No Exterior Trim,4 9/16",5 7/8", Standard Four Sided Jamb Extension,Factory Applied, Pella Recommended Clearance, Perimeter Length= 180". Outside View Line# Qty Description 15 3 Lifestyle, Casement Right, 35 X 55, Without HGP, White 1: Non-Standard Size Right Casement - Unit Type: No Program General Information:No Package,Without Hinged Glass Panel,Clad, Pine,5",3 11/16" Location: Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Prefinished White Paint Interior Rough Opening: 35.75"X 55.75" Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options:Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device, No Limited Opening Hardware, No Integrated Sensor Screen: Full Screen,White, InVieWTM Performance Information:U-Factor 0.28,SHGC 0.27,VLT 0.51,CPD PEL-N-14-00685-00001, Performance Class LC, PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 25.25,Clear Opening Height 50.875, Clear Opening Area 8.92079, Egress Meets Typical 5.7 sgft(E)(United States Only) Grille:No Grille, Wrapping Information: Foldout Fins, Factory Applied,No Exterior Trim,4 9/16",5 7/8", Standard Four Sided Jamb Extension. Factory Applied, Pella Recommended Clearance,Perimeter Length=180". For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 11/3/2023 Proposal Page 1 of 3 Customer: Project Name:63 Windingwood Rd S Quote Number: 16844372 Outside View Line# Qty Description 20 1 Lifestyle, 2-Wide Casement, 70 X 55,Without HGP, White 47 4) 1_MO. _ 1: Non-Standard Size Left Casement Unit Type:No Program General Information:No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16" Location: Exterior Color/Finish:Standard Enduraclad,White Interior Color/Finish:Prefinished White Paint Interior Rough Opening: 70.75"X 55.75" Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options:Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device, No Limited Opening Hardware,No Integrated Sensor Screen:Full Screen,White, InViewTm Performance Information:U-Factor 0.28,SHGC 0.27,VLT 0.51,CPD PEL-N-14-00685-00001, Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Egress Meets Typical 5.7 sgft(E)(United States Only) Grille:No Grille, 2:Non-Standard Size Right Casement Unit Type:No Program General Information:No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16" Exterior Color/Finish:Standard Enduraclad,White Interior Color/Finish:Prefinished White Paint Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options:Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware,No Integrated Sensor Screen:Full Screen,White,InViewTm Performance Information:U-Factor 0.28,SHGC 0.27,VLT 0.51,CPD PEL-N-14-00685-00001, Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Egress Meets Typical 5.7 sgft(E)(United States Only) Grille:No Grille, Vertical Mull 1:FactoryMull,Standard Joining Mullion,Mull Design Pressure-20,Overall Thru Direction- Vertical Wrapping Information: Foldout Fins, Factory Applied,No Exterior Trim,4 9/16",5 7/8",Standard Four Sided Jamb Extension,Factory Applied,Pella Recommended Clearance,Perimeter Length=250". Outside View Line# Qty Description 30 1 Lifestyle, Casement Right, 32 X 41,Without HGP, White a I1:Non-Standard Size Right Casement Unit Type:No Program General Information:No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16" Location: Exterior Color/Finish:Standard Enduraclad,White Interior Color/Finish:Prefinished White Paint Interior Rough Opening: 32.75"X 41.75" Glass: Insulated Tempered Obscure Low-E Obscure Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options:Side Pivot Hardware,Fold-Away Crank,White,No Window Opening Control Device, No Limited Opening Hardware,No Integrated Sensor Screen:Full Screen,White,InViewTm Performance Information:U-Factor 0.28,SHGC 0.27,VLT 0.51,CPD PEL-N-14-00685-00001, Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08111,Clear Opening Width 27.625,Clear Opening Height 36.875,Clear Opening Area 7.07411, Egress Meets Typical 5.7 sgft(E)(United States Only) Grille:No Grille, Wrapping Information:Foldout Fins,Factory Applied,No Exterior Trim,4 9/16",5 7/8",Standard Four Sided Jamb Extension,Factory Applied,Pella Recommended Clearance,Perimeter Length=146". For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 11/3/2023 Proposal Page 2 of 3 Custome(' Project Name:63 Windingwood Rd S Quote Number: 16844372 Thank You For Your Interest In Pella@) Products PELLA WARRANTY: Pella®products are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details, taking special note of the two important notice sections regarding installation of Pella®products and proper management of moisture within the wall system. Neither Pella Corporation nor the branch will be bound by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening (egress) information does not take into consideration the addition of a Rolscreen®(or any other accessory]to the product. You should consult your local building code to ensure your Pella®products meet local egress requirements. Order Totals Customer Signature Pella Contractor Signature Taxable Subtotal $9,877.24 Sales Tax $790.18 Non-taxable Subtotal $0.00 Date Date Total $10,667.42 For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 11/3/2023 Proposal Page 3 of 3 r O o � � � U CV LJ (V O r �00 ima •_=� U) J r^ W V I Mti I� •.� U o w U � � LO LLI n rn W Q _ a Lt] U En CD Fri 06 X o z � co AN co as U A L0. y d d ' � ' (,���++ll. �� �� �:. /•'•,' it ^ l' � v Mob �c J 704/26/24 TE(MM/DO/YYYY) AIR" CERTIFICATE OF LIABILITY INSURANCE 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: PETER J BOCCAROSSA&ASSOCIATES LLC PHONE 203 847-3757 AX No): 203 847-8296 95 Main St E-MAIL ADDRESS: boccol@optionline.net Norwalk,CT 06851 INSURERS AFFORDING COVERAGE NAIL 0 INSURER A: ATLANTIC CASUALTY 42846 INSURED INSURER B: CHRIS DIETZ INSURER C: DBA B&D CAPRENTRY SERVICES INSURERD: 167 LAKE DR INSURER E: MAHOPAC NY 10541 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. ILTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MM DDPOLICY/YYYY MM DDfYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE U OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Anyone person) $ 5,000 A X L261004692-3 02/22/24 02/22/25 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JE C LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY❑ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR Ll CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is requlred) 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 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED EPRESENTATIV /A ©1988-2 15 A ORb-CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0. '" .0 R , ^AAAAA 011642162 BOCCAROSA INSURANCE 95 MAIN ST f;- NORWALK CT 06851 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER CHRISTOPHER DIETZ DBA CITY OF RYE BROOK B&D CARPENTRY SERVICES 938 KING ST 167 LAKE DRIVE RYE BROOK NY 10573 MAHOPAC NY 10541 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2545 100-6 725478 04/17/2024 TO 04/17/2025 4/26/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2545100-6, 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. 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