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HomeMy WebLinkAboutRP24-029PERMIT # R r SECTION TYPE OF WORK JOB LOCATION i. CO4 TCO FEE DATE �NSPEOTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING ❑ RGH PLUMBING GAS ❑ SPRINKLER ELECTRIC ❑ LOW -VOLT ❑ ALARM ❑ AS BUILT ❑ FINAL Sky/y)Ys G3 9-oyoo OTHER APPROVALS ARB BOT PB zBA OTHER DR 19 t.L4C(yV jJJ V 1�V4 yv1 j VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www.ryebrookny.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 Charles Goldsmith&Lois Goldsmith 54 Talcott Road Rye Brook,New York 10573 Re: 54 Talcott Road,Rye Brook, New York 10573 Parcel ID#: 135.50-1-17 Roof Permit#24-029 issued on 6/5/2024 to Re-Roof Existing Building & Install Skylights This certifies that the new roof and skylights,installed under the above captioned permit have been satisfactorily completed. Sincerely, Nvub mil, v t Freddy DiVitto Assistant Building&Fire Inspector /to D Ell, FForfice use pniv:JUN 12 2024 BVILDING DEPARTMENTTLAGE OF RYE BROOK : a VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEW PORK 10573 DATE:6—/1—� BUILDING DEPARTMENT_ (914)9 -0668 FEE:-V PAID19 www.ry ro knv. ov 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 *xs*xssxxs*xs*ssssssssssxsss xs*ssxssx*ssx*ss*sx*sssxsxssssss**sxssx*ssxs*xssxxsxxsxsss*s*xxssxss*sssxsssxsxxx*sxxsxxssxssxssx Address: \1-5-"I `Ll'��� Occupancy/Use: ' r 4arcel ID#: \Y3, U - l - Zone: Owner: LWAZ k LbS td&M4) Address: 15 T P.E./R.A. or Contractor: �Q((. I � e>n>u , t L Address: Person in responsible charge t'Q_* M,1A i Address: (2 VtEj�V J k ((V1 I l 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: ^ being duly sworn,deposes and says that he/she resides at AJ)P�rin4ta-m—R'/� f Applicant) (No.and Street) in 1{"�l l,4lS(City/Town/ �( ag in the County of (�jt 0 jA p in the State of that (City/Town/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:S t 5 1M)�' for the construction or alteration of: i(um 611 S v 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 Z �tjIl�ix�pl'ts rn to before me this day f ( 20 <•�` 'i``� A • `<< �� STATE d2t� �% , 20 2 ti tOPNEWYO � = j 't�►XrIRwPLRju Lf S a e Prop ��i 4 vs+�w.v W zz (.\ 01PA6.1i750Z t at�re. plicant STATE > r \ / o OF NEW YORI`% ','t?i�� � .� oa �. 1 _ 1 � i P'nt ame of r rty Owner _ 1 l IC ! ( �/1//111110 k t me of Ap li ant S � �((hwlifv.!ir.�c.cl�ver Cain j N �/ ` UIPA6347502 f b a Public u lic �yE BRC�k. uJ � Fb 1932• BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : _'5 q --t"'A 1 " J�l DATE: 1 I LV L V PERMIT# \ Zq - o Z ISSUED: SECT: / BLOCK: / LOT:�� LOCATION: �V��t OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION (� 1 ° r ❑ NATURAL GAS 1` ECAJ ❑ L.P. GAS S L IJ ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION [� FINAL ❑ OTHER s a c a ■ H y a CN ►FS .� s N z � N u .. C+.72 7 , ° N ►ncn 0-4 En 00 V) bA - _ CA) Lq Mai o a ao o n _ r^. Lr)en - Z V.L9 H U o o 7� O Q D 3 0 _ � a o � ovob ram{' � 010 n G� W OC Q v •� Q a lLn :. 0 3 en O n � � � n oo [- 00 ab tam �O Eom Ocs V m OW F--=1 C H p O b w O V .. W W v, d v. e Z ' U x N °o o a a H n re) W Q45o Cl� R•i U ` z v w � a NE �, � ' � 9 o ° � V V/-� 4 V D U �' � R x ' a ' Z A z y � �' v O 0 o F t� �y H, d .. p ' _ a d04 W W 0 un � b = BUILD MENT VI E OF RY \ oK MAY - 9 2024 938 KING ET RYE BR NY 10573 -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: ,��`` Approval Date: MAY 3 1 2 Permit# d 04C1 Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: Permit Fees: ROOF PERMIT APPLICATION Application dated:.- -L4 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statementdescribed below. A �f y 1, Job Address: � i!�N�,� es- 'U�f SBL: i � one: Property D neer: OM Address: W Phone#."f Cell#: email: Ovwr /� ,,• 2. Applicant: Address: S q"t.e�S�n�'y� Phone#: Cell#: ��email: ti► Q -rDAQj� - fT7`+ta•l 3. Roofing C ntractor:x S Address: a rtYk S�f✓t V Phone#: Cell#: email: �T4r(j VU/ZiU 4. Job Description,list all Methods&Materials:DIV*4_ �-, •y I-p,14-i mA!m�5 Ad k 7ki tW4-T �76t"J_48.1 I b-pt'FTiw,"th'�sh�•-�3. 5. Estimated Cost of Job: $ l"] t 100 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: 8. Number of stories:�4 �M Height: 9, Is garage being re-roofed:No:( )•Yes: Attached No:( )•Yes:lb Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: �� 11. Estimated date of completion: � �0 10/30/2023 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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,t e Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this `` p ��� Swom to before me this day© ,day ,20 STATE Z I�OF NEW YORE{% S a e gn wner j t -F�* YPUC r of Applicant a t �� elr�srtzsar i � ri t me of troperty Owner ',111'rON E:CVVW%,.111 Pkiame of Applicant ` �t Public bLATE o b c �rQF NEW YokjC\ ' i,4a` I MOW' -2- 1013012023 Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info@perryverroneroofing.com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 Y .y' Charley Goldsmith Prepared by Perry 54 Talcott Rd 5/2/24 Rye Brook,NY 10573 REVISED 5/3/24 914-589-0010 charley.goldsmith@gmail.com PROPOSAL ROOF REMOVAL AND REPLACEMENT • All existing asphalt roofing removed and carted from job site • All rotted plywood replaced at$90.00 per sheet • GAF Weather Watch Ice and Snow barrier installed on all gutter edges,valleys and around skylights (6 feet up) • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof(SHINGLE COLOR: ) • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • Aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges • Copper chimney flashing fabricated and installed • Rye Brook building permit for an additional cost TBD • GAF Lifetime Material Warranty included • Perry's Roofing"10 Year Workmanship Warranty" included The price for the aforementioned work,which includes labor and material (excluding any additional plywood), totals to the sum of: $15,900.00 PRICE EXPIRES 90 DAYSAFTER ESTIMATE DATE Page 1 of 5 Initial & Date: �. ADDITIONAL WORK OPTIONS Please check appropriate box for desired extra work ❑ Carpentry/handyman work calculated on a time and material basis, said work performed at$120.00 per man hour plus material ❑ Fixed skylight installed for an additional $700.00 per unit ❑ Aluminum Seamless Gutters and Leaders fabricated and installed ❑ Perry's Roofing is a GAF Master Elite Installer which allows us to offer you top of the line warranties directly from GAF for a minor additional cost, please contact our office for details and pricing Payment schedule is as follows: 50% 3 Days Prior to Start 50% Due the day of substantial completion 5% Retention may be held for resolution of unresolved issues Payment is accepted via personal checks and certified bank checks (made payable to Perry Verrone LLC or Perry's Roofing), MasterCard, Visa,American Express,and Discover credit and debit cards.All card transactions over$2,000.00 are subject to a 3% service fee. Payments of$4,000.00 or more are accepted via ACH/wire transfer upon request. Any monies not paid as specified above will be subject to accrue interest at a rate of 1.5% monthly, and 18% per annum. All material is guaranteed to be as specified above. All work to be completed in a workmanlike manner according to the standard practices.Any alteration or deviation from the above specification involving extra costs will be executed upon a written change order and will become an extra charge over and above the proposal.All agreements are contingent upon strikes, accidents, or delays beyond our control. Roof Replacement Instructions for Homeowner INSIDE THE HOME: 1. Any precious items in the attic can be either moved to a secure place within the attic or covered and secured to protect from the vibration of the roof removal process. 2. Dust and/or sawdust may be generated in the attic due to the roof removal process, securely covering belongings is advised. Clean- up of debris in the attic is outside the purview of this contract. 3. If your home has high hat lights located in the cathedral ceiling,you may want to tape the fixture to the ceiling (construction activity on the roof may cause these to come loose). Page 2 of 5 Initial & Date: - Premium Report - e ag l e v i e w _M 5/1/2024 _ 54 Talcott •• Rye Brook, • • i • i•• TABLE OF CONTENTS Images .....................................................................1 LengthDiagram.........................................................4 PitchDiagram............................................................5 Area Diagram ............................................................6 NotesDiagram...........................................................7 Report Summary........................................................8 MEASUREMENTS Total Roof Area =2,866 sq ft Total Roof Facets =4 Predominant Pitch =5/12 Number of Stories<=1 Total Ridges/Hips =55 ft Total Valleys =0 ft Total Rakes =134 ft Total Eaves =171 ft In this 31)model,facets appear as semi-transparent to reveal overhangs. PREPARED FOR Contact: Perry Verrone Company: Perry's Roofing, LLC Address: 12 Center Street Pleasantville, NY 10570 Phone: 917-578-8242 Measurements provided by www.eagleview.com Certified Accurate www.eagleview.com/Guarantee.asox ©2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.-All Rights Reserved-Protected try European Patent Application No.10162199.3-Covered try one or more of U.S.Patent Nos.8,078,436;8,145,578; 8,170,840;8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. Premium Report - e a I e v I e w 5/1�2024 _ g IMAGES The following aerial images show different angles of this structure for your reference. Top View qk t r e � � _ y F 1 I F _ gle)(i eW C) 2021 f 241N24 ,s 2008-2024 Eagle view Technologies,Inc.and Pictometry International Corp.-All Rights Reserved-Protected try European Patent Application No.10162199.3-Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8'818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 1 Premium Report — e a levie w M 5/1/2024 _ g • • • Rye Brook, • '•• i • 4•• IMAGES North Side iv rQ 't eagleview South Side �i ©2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.—All Rights Reserved—Protected by European Patent Application No.10162199.3—Covered try one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 2 ea leview - 5/1/2024 Premium Report g � 54 Talcott • • Rye Brook, • '•• i • 4•• IMAGES East Side 4 _ t, ; West Side k ©2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.-All Rights Reserved-Protected try European Patent Application No.10162199.3-Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 3 —� Premium Report a g — e I e v i e w rM 5/1/2024 _ 54 Talcott •• Rye Brook, • '•• i • 4•• LENGTH DIAGRAM Total Line Lengths: Valleys = 0 ft Flashing = 13 ft Ridges= 55 ft Rakes = 134 ft Step flashing = 12 ft Hips = 0 ft Eaves = 171 ft Parapets = 0 ft 19 + 22 00 N N N N +6 22 r w w 23 +6 -4 r to 00 N +9 r A 14 00 23 E �5 N w Note: This diagram contains segment lengths (rounded to the nearest whole number)over 5.0 Feet. In some cases, segment labels have been removed for readability. Plus signs preface some numbers to avoid confusion when rotated (e.g. +6 and +9). C,2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.-All Rights Reserved-Protected try European Patent Application No.10162199.3-Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 4 e ag I e v i e w M Premium Report 5/1/2024 � 54 Talcott • • Rye Brook, 1 • -p• • ' •. PITCH DIAGRAM Pitch values are shown in inches per foot,and arrows indicate slope direction.The predominant pitch on this roof is 5/12 5- 5 -► -5 5- E �5 N w Note: This diagram contains labeled pitches for facet areas larger than 20.0 square feet In some cases pitch labels have been removed for readability. Blue shading indicates a pitch of 3/12 and greater. ©2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.-All Rght5 Reserved-Protected try European Patent Application No.10162199.3-Covered try one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 5 —� Premium Report — e a l e v e w .M54 5/1/2024 _ g Talcott •d Rye Brook, • '•• i • 4•• AREA DIAGRAM Total Area = 2,866 sq ft,with 4 facets. 483 75 1713 595 E �s N w Note:This diagram shows the square feet of each roof facet(rounded to the nearest Foot).The total area in square feet, at the top of this page is based on the non-rounded values of each roof facet(rounded to the nearest square foot after being totaled). Q 2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.-All Rights Reserved-Protected by European Patent Application No.10162199.3-Covered by one or mare of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,980;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 6 Premium Report — e a l e v i e w .M 5�1�2024 _ g NOTES DIAGRAM Roof facets are labeled from smallest to largest(A to Z)for easy reference. B A D C E �S N W c,2008-2024 Eagle View Technologies,Inc.and Pktometry International Corp.-All Rights Reserved-Protected by European Patent Application No.10162199.3-Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 7 Premium Report -- e a l e v e w ,M 5/1/2024 _ g Talcott •• Rye Brook, • '•• i • i •• REPORT SUMMARY All Structures Areas per Pitch Roof Pitches 5/12 Area(sq ft) 2866.0 of Roof -L�L 100% The table above lists each pitch on this roof and the total area and percent(both rounded)of the roof with that pitch. ComplexityStructure Simple Normal Complex below.Waste Calculation NOTE:This waste calculation table is for asphalt shingle roofing applications.All values in table below only include roof areas of 3/12 pitch or greater. For total measurements of all pitches,please refer to the Lengths,Areas,and Pitches section Waste% 00/0 1% 4% 6% 8% 11% 16% 21% 26% Area (Sq ft) 2866 2895 2981 3038 3096 3182 3325 3468 3612 Squares* 28.66 29.00 30.00 30.66 31.00 32.00 33.33 35.00 36.33 Measured Suggested *Squares are rounded up to the 1/3 of a square Additional materials needed for ridge, hip, and starter lengths are not included in the above table.The provided suggested waste factor is intended to serve as a guide—actual waste percentages may differ based upon several variables that EagleView does not control.These waste factor variables include, but are not limited to, individual installation techniques, crew experiences, asphalt shingle material subtleties,and potential salvage from the site. Individual results may vary from the suggested waste factor that EagleView has provided.The suggested waste is not to replace or substitute for experience or judgment as to any given replacement or repair work. All Structures Totals Lengths,Areas and Pitches Property Location Ridges = 55 ft(2 Ridges) Longitude = -73.6877730 Hips = 0 ft(0 Hips). Latitude = 41.0163770 Valleys = 0 ft(0 Valleys) Notes Rakes' = 134 ft(8 Rakes) This was ordered as a residential Eaves/Starter# = 171 ft(9 Eaves) property. There were no changes to Drip Edge(Eaves+ Rakes) = 305 ft(17 Lengths) the structure in the past four years. Parapet Walls= 0(0 Lengths). Flashing = 13 ft(1 Lengths) k Step flashing = 12 ft(2 Lengths) Predominant Pitch = 5/12 Total Roof Facets = 4 Total Area (All Pitches) = 2,866 sq ft t Rakes are defined as roof edges that are sloped(not level). * Eaves are defined as roof edges that are not sloped and level. p 2008-2024 Eagle View Technologies,Inc.and Pkrometry International Corp.—All Rights Reserved—Protected by European Patent Application No.10162199.3—Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 8 Premium Report '/ eagleview -- 5/1/2024 Online Maps Online map of property http://maps.google.com/maps?f=q&source=s q&hl=en&geocode=&g=54+Talcott+Rd,Rye+Brook,NY,10573 Directions from Perry's Roofing, LLC to this property http://maps.google.com/maps?f=d&source=s d&sadd r=12+Center+Street,Plea santvi Ile,NY,10570&daddr=54+Talcott+Rd,Rye+Brook, NY,10573 ©2008-2024 Eagle View Technologies,Inc.and PKtometry International Corp.-All Rights Reserved-Protected by European Patent Application No.10162199.3-Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840; 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. PAGE 9 — Legal al Notice and Disclaimer — eaaIeview - 5/1/2024 54 Talcott Rd Rye Brook, Report: i • ♦ •• IMPORTANT LEGAL NOTICE AND DISCLAIMER Notice and Disclaimer No Warranty:The Copyrighted Materials are provided to you"as is,"and you agree to use it at your own risk. EagleView Technologies makes noguarantees,representations orwarrantiesofanykind,express orimplied,arising by laworotherwise,including but not limited to,content,quality,accuracy,completeness,effectiveness,reliability,fitnessfora particular purpose,usefulness,use or resultsto be obtained from the Copyrighted Materials. Contractors agree to always conduct a preliminary site surveyto verify Roof Report ordered.In the event of an error in a Report,your sole remedy will be a refund of the fees paid by you to obtain this Report. ©2008-2024 Eagle View Technologies,Inc.and Pictometry International Corp.—All Rights Reserved—Covered by one or more of U.S.Patent Nos.8,078,436;8,145,578;8,170,840;8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568; 8,818,770;8,542,880;9,244,589;9,329,749;9,599,466.Other Patents Pending. 0 Timberline"HM" High Definition`Shingles • 0 X - i qr,+` America's #1 -selling shingle just got better! 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Helps protect the beauty of your • Exposure:5 5/1,'(143 mm) ■ Bundles/Square:3 ■ Up to 99.9%nailing accuracy— roof against unsightly blue-green Pieces/Square:64 The StrikeZone' nailing area is so algae discoloration.' ■ StainGuarcl'Algae Protection' easy to hit that a roofer placed 999 ■ Hip/Ridge:TimberTex`:TimberCrest"; ■ High Performance—Designed Seal-A-Ridge`:ZRidge;Ridglass' with Advanced Protection` Shingle out of 1,000 nails correctly in our test. ■ Starter:Pro-Start":QuickStartl: WeatherBlocker'" ■ WindProven" Limited Wind Technology. Applicable Standards&Protocols: Warranty—When installed with ■ Seamless compatibility—The new • UL Listed to ANSI/UL 790 Class A the required combination of GAF ■ State of Florida approved Accessories,Timberline'HDZ' Timberline HDZ ' Shingles are com- ■ Classified by UL in accordance with Shingles are eligible for an industry patible with traditional Timberline HD' ICC-ES Ac438 g g y Shingles for the same look and feel ■ Meets ASTM D7158.Class H first:a wind warranty with no • Meets ASTM D3161,Class F maximum wind speed limitation.2 homeowners and contractors rely ■ Meets ASTM D3018,Type 1 on for beauty and endurance. • Meets ASTM D34625 ■ Our legendary Dura Grip' sealant • ICC-ES Evaluation Reports ■ Perfect Finishing Touch—For the ESR-1475 and ESR-3267 pairs with the smooth microgranule best look, use TimberTex' Premium • Meets Texas Department of Insurance surface of the StrikeZone" nailing Requirements area for fast tack.Then,an asphalt-to Ridge Cap Shingles or TimberCresY • ENERGY STAR'Certified(White Only) Premium SBS-Modified Ridge (U.S.Only);Rated by the CRRC:Can asphalt monolithic bond cures for Cap Shingles. be used to comply with Title 24 cool roof requirements Colors & Availability: Results based on study conducted by Home Innovation Research Labs, on independent research lab.comparing installation of Timberline HD' Shingles fo Timbedine°HDZ"Shingles on a 16-square roof deck using standard 4-nail nailing pattern under controlled laboratory conditions. Actual results may vary. '15-year WindProven"limited wind warranty on Timbedine"HDZ" Shingles requires the use of GAF starter strips,roof deck protection, ridge cap shingles,and leak barrier or attic ventilation.See GAF Rooting Biscayne Blue System Limited Warranty for complete coverage and restrictions.Visit gof.com/LRS for qualifying GAF products. StainGuard'algae protection is available only on shingles sold in c packages bearing theovered by a"logo.Products with Stamy against algae protection are covered by a 10-year limited warranty against j - - blue-green algae discoloration.See GAF Shingle&Accessory Limited �— - Warranty for complete coverage and restrictions. 'To be mixed on one root,Timberline'HDZ"Shingles and Timberline HD- 11 ax Hollow - -r Hunter Green Shingles must hove matching 6-digit codes found on the and of the bundle. • �""'"■r■■ When mixed,always use Timberline HD"installation instructions. 'Periodically tested by independent and internal labs to ensure _ compliance with ASTM D3462 at time of manufacture. 'Lifetime refers to the length of warranty coverage provided and means as long as the original individual owner(s)of a single-family detached residence[or eligible second owner(s)]owns the property where the qualifying GAF products are installed.For other owners/structures,Lifetime Mission Brown Oyster Gray Patriot Red Shakewood coverage is not applicable.Lifetime coverage on shingles requires use of GAF Lifetime shingles only.See GAF Shingle&Accessory limited Warranty o for complete coverage and restrictions.Lifetime coverage on shingles and I accessories requires use of any GAF Lifetime Shingle and any 3 qualifying o6t - GAF accessories.See GAF Roofing System Limited Warranty for complete coverage and restrictions.Visit gof.comARS for qualifying GAF products.Note:It is difficult to reproduce the color clarity and actual color blends • - -• - - of these products.Before selecting your color,please ask to see several full-size shingles. AMEWCAN r,vm A We protect what matters most q �1 i { f _ i 1; � sEspifSi, !° )! }i .,, !,s!�`tNili • it i r f V • .\ ii iEd i+ i�I� 1 � i tar is a1 a!i E all PitchedFS Fixed Skylight RooFS technical performance Cork Mark is It vd cenfiihratwn uhesle gamed by the 1� Cmrmonweallh of Au,Austtralia that provides legally binNig evdmce o1 mmphance to the Natmnal C—t-0.Code euor.s,ec• gl Auslralla.One renifkale ret0.xes dams of tmhnkal lepers. • in features VELUX Skylights are tested and approved to Smooth profile the appropriate Australian Standards. grey aluminium AS4285 SKYLIGHT capping i Cyclonic and Non-Cyclonic Tests't 1111 Pressure Rating -2.4kPa NEAT TM AS1288 OVERHEAD GLAZING coating on Laminated Inner pane outer pane AS3959 BUSHFIRE Attack Level 40^ 11 sizes NCC BOUNDARY SEPARATION Class 1 and Class 10 buildinas: available Within 900mm of a boundary wall Class 2 to Class 9 buildinas: 3 metres from a boundary wall^^ VELUX Skylights are deemed non-combustible by CSIRO and thereby comply with NCC boundary separation requirements. BASIX Sefection Gulife Interior,white Laminated double Timber,Low-E,Double glazed Argon filled painted pine glazing as standard f CSIRO assessment report available on request VELUX _ rttanmerds cmnunatan with relevant authority before wmk ter__" corrunerces. ^ Rao1 gtch 16'-75'.Skylight only.Custan•nede flashing regwred. Construction _ Skylight ad o amrot be chaser than u adjoining the boundary is ad nnq a mr Public place.Carsuk NCC for further details i Not certlflM to M DTCM. Quality frame made from Ponderosa Hailstone Test pine.Factory treated with a base preservative to reduce mould and VELUX Simulated Tests"ASTM E822-2009. mildew.Further treated with a coat ,of aa�caie�c�standard gtxv tiwue r��balls of white paint for clean interior finish. Energy rating The FS Skylight provides a cost effective solution for creating FS Skylights have been energy rated in 9 accordance with the Skylight Energy Rating light-filled rooms where adequate Scheme(WERS). ventilation already exists.Energy efficient glazing and the use of blinds ensures heat transference r 5 out of 5 stars for Winter Rating. Is minimised. 5 out of 5 stars for Cool Daylight in Summer. Technical Values Outer-3mm toughened Low-El Complete skylight 2.60 coated Cardinal glass. Glass only 193 Radiant heat block:Complete window approx 75% Cavity-9mm sealed Glass only approx 70% Heat Gain Co-efficient Argon gas space. UV Harmful rays block approx 99% •WERS rating 5 stars Complete skylight 0.24 Inner-536mm clear laminated .Double layer of Low-Ea coating. Glass only 0.28 Cardinal glass(0.76 PVB inter 10 year warrant on insulated lass seal. layer). y 9 Visible Light Transmittance •Reduced cleaning frequency. NEAT-Coating on outer pane Complete skylight 055 reduces cleaning frequency. - Luminous- CdCy a .� Warm edge technology increases energy efficiency. Laminated glass(standard with FS)must be used for Complete skylight 2.29 skylights installed 3m or more above floor level. TM NEAT Photocatalytic Coating nce Complete skylight 32dB# Silicone Dioxide/Titanium Dioxide coating reacts The coating also makes the glass surface smoother, Figures generated by AFRO accredited simulators.Figures based with the sun's UV rays to decompose surface organic so water disperses evenly,sheets off,and complete Aylgnt rwrniw son,naanm w)x U80r nt(H). x ea ed on Rw crake estee fo ysmel dirt before rinsing away with the next shower of evaporates quickly;thereby minimising rain,thereby reducing cleaning frequency. water spotting on the pane. IF •For roofs below 15•pitch.skylights need to be raised to 15•and custom flashed.VELUX can assist with tectnical advice and drawings (Ne:buildup not recamnerded in BrnMke areas). (V-AUS 0922) 3.04 FS Fixed Skylight W Pitched EDW flashing is used for skylights 3 .o .. installed into tiled ® :•,._ roofs and low bfinds of I profiled metal roofs(such as corrugated iron and spandek—not suitable for metal profiles such as Klip-Lok,Trimdek). EDL flashing is used for skylights installed into slate or shingle r e roofs—typically 4-8mm thick. • Adds a decorative effect. Colour:White on internal side.Silver V shaped sections are provided that • Colour:White on both sides. coating on external side. • Materials:Double layered pleats Materials:Light-tight polyester with act soaker pieces on either side (polyester)form a'honeycomb' heat resistant coating. of thhee skylight. structure.Inner faces of honeycomb White powder-coated aluminium EKW combination structure have aluminium coating. side channels and top cover. flashing White powder-coated aluminium Provides near total light reduction. side channels and top cover. Reduce heat by approx 40%.1 Designed for • Provides near total light reduction. Easy to install. installing multiple • Reduce heat by approx 70%1 skylights • Easy to install. side-by-side or Solar Solar above-below. Skylights must be • Built-in solar panel charges concealed Built-in solar panel charges concealed spaced 100mm apart.EKW suitable battery pack. battery pack. for same roofs as EDW flashing. • Operated by wireless wall-mounted Operated by wireless wall-mounted keypad(provided). keypad(provided). N13:For roofs below 15°pitch,skylights need to be raised MI a f 1 LIa I to 15°and custom flashed.VELUX can assist with technical advice and drawings.(NB:build-up not recommended in • Requires rod control(ZXT 200)for Bushfire areas.) out-of-reach situations. Blinds and control rods sold separately. NB:VELUX blinds and flashings do not fit older VELUX products.Contact VELUX to check availability of suitable blinds and flashings. 1 glazingdimensions Profile height above batten 100mm Product/size code► col C04 C06 C08 C12 M02 M04 M06 M08 Sol S06 Overall frame size wxh-mm 550x700 550080 550xll80 550xl4OO 550xl8OO 78Ox780 780x980 78Oxll80 78Oxl400 ll40x7OO ll4Oxll80 Internal glass size wxh-mm 462x6ll 462x891 462xl091 462xl3ll 462x1713 692x691 692x891 692x1091 692xL3ll 1052x6ll 1052x1091 Daylight area(MI) 0.28 0.41 0.50 0.61 0.79 0.48 0.62 0.75 0.91 0.64 L15 Weight in kg t 14.9 18.9 22.1 25.3 37.3 21.5 24.8 29.1 33.3 26.7 39.4 Skylights ran only be installed as per onentabon depicted above. t Weight Includes flashing. i Based on VELUX internal testing with 3076 model Roof window (v-AUs 0922) 3.04 �• o, ai - :r 3, a - .� I O ew C - 7-1 i .. _ _� .� w o Z L. " - � x a. o d ^ CD W � - 41 � 3 Ono f r.yui MJ W _ O v m TQ to E Onoz c W .Y Ono ! = c :i o V • li r rrr I N GOf y I =- w Y H U z ..O go ZZ MOAN E 0 i J o F- w woo w I C I v i� I Ih- r l` i' i t�i• '�N1 All ' lill`4da � 1'- if n 4; 1 - U ` �.., ,fir ,1.• ••� r i�«.Vs - .% . �. l......... +^"�.� - ,�y/ Y�,f{�tyF l'r 4�1�? (i' YAY. •� 1 _ _ — 1—� 1- r _ ` � A Y � 9 t 1 rt ; �l 4r{�:"r��J �Y Y \1 �; �� �. � i �i r'��Y� f' F., ��, �---- .w-- �� 1 _ 'tea- - _ - `y �� j,. -:,`: %i "- ' L' - _ �ir�--r -A r _ -' ` , f+fir _ _ •S✓ Z ._ � ,:� -H � ��. _.._ri !� .r�` � ! ! �_ `^�v � 1 r } .. .. .' _Y_ .:.. v yV'�: .�- ii�- ' - � - .;. i 'L�_ t -� -_/l \ �J �,'�� ' '�_ � � i ` y -� i ,� i_ +,�� .� J '� iJ �i i' � �� '- - i i �- � - - , 1 .�'1-=' i � � , . _ _- �� - �, �. � _ - ,ice i - � ��i �_� �,. i _- _�= --� � __ _- _- .- ,,- - -- ,�' R � •may e� / _- f L•�� .'f .:�.Y� mBuildinermit Check List&Zoning Anal is` Address: 5 CA000SBI. / �� • �/ —/ Zone: \2.. Use: Z 1 �� {_Cone.Type: v Submittal Data �`cl\'Ly 2-�Revisions Submittal Dates Applicant: GoOS Nature of Work ` L Revs 22A;MAY 2 1 2024 P& BOT. Other. pA NEED OK� `bRd� �� �W•c7D FEE-.Filing: �� BP- C/O: Flood Plane: Legalization: ?S ( ) ( VAPP: Dated:�GNotarized:---,,-SBL• / Truss I.D. Cross Connection: H O.A.: b ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review- Street Opening. ( ) ( ) ENVIRO:Long Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other- SURVEY:Dated: Current: Archival Sealed Unacceptable: (� ( ) PLANS Date Stamped Sealed Copies: Electronic Other 4--ticensa Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL-Plans: PermiC N/A: Other ( ) ( ) LOW-VOLTAGE ELECTRICAL Plans: Permit N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS Plans: Permit. I-W.I.C.:_Battery _Other ( ) ( ) PLUMBING:Plans: Permit Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans Peanin N/A Other: ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER C/O DENIAL LE ITER. Other. ( ) ( ) Other. ( )ARB mtg.date approval;- notes: ( )ZBA mtg_date: approval:- notes: ( )PB mtg.dun approval;- notes: REQUIRED EXLSnNG PROPOSED NOTES Area: Circle: F Front; Front Sides: Rear. Main Cow Aca v: FL H Sb: Sd.H Sb: GFA. Tom: Ft.jmR: Height/Storiex notes: a C' kk IN S i �' Residential Building Permit Fee Work Sheet Peanit#: Date Issued: SBL: Zone Address: Property Owner&Contact Info: Job Description: For all new dwellings and for additions measuring 800 sq. ft. or more made to existing dwellings, the following fee schedule shall apply:(plus any alteration fees) Total Sq. Ft. (excluding basements) x $300.00 x $I8.00/$1,000.00 Basement Sq. Ft. x $6S.00 x $18.(X)/$1,000.00 New Consavction Sq.Ft • New Construction Cost • Building Permit Fee Basement = sq. ft. x$6S.00 = $ x$I8.00/$I,000.00= $ Attached Garage = sq. ft.x $300.00= $ x$I8.00/$1,000.00 = $ I" Fl. = sq. ft.x$300.00= $ x$I8.00/$I,000.00= $ 2"1 Fl. = sq. ft. x $300.00= $ x $18.00/$1,000.00= $ P Fl. = sq. ft.x $300.00= $ x$18.00/$I,000.00= $ 4,1 H. = sq. ft. x$300.00= $ x$18.00/$1.000.00= $ Total Sq.Ft. = sq. ft. Total Cost = $ Taal B.P.Fee= $ Taal Amount Paid = $ Taal Amount Due = $ Date: Signed: � ���� i0r ✓ •asry ��/ 9txsy �`/ �esx.,���i -cam �/�- ��'i��% �M53 �tis�tt.r teats '7k� --�, 'S�+ A.-. \ '7 F v�/� . ��;1'►'i'I �i �b'h+'J{� 1 '`y'�'i t� � ;+�►�+i t� ;�,1��'iti'i' 1 .'►'�4'i'� � :�'�•� %; !!I '3 .ir':\'11/11'.._c ;:.�'11,1�1',izi. ��11 11' '��•i':�: hl 1 � .S.IN 111'_.t.d �;_ .:'1 11'�= is:11 ( I,�,�(i!)>t < Lf) A ,�- •; u "p to CN t yLO �•• E @ C O in O <(ss)1 l e v 3 p O Q ` ' b� ' r' .iM O N "J• If".I v r1 U F— O o 0 > W t C ;..^ W u Z v 4 Q�o�ection it ,• • J = J Yvi tz W \ ..1 W 0 �— > } Z a n �i•>�ri>' O y fY W Q 3 w •-o V C Rr w o w w N • ~ Y U r w z Ei 03 rJ U i. � M•• I,. cz C UCA lu rA CN �ft`)�n,�..�z3 s'E., '=s=�=1 1'-s:' _ �`11 1 . .s:.,r..�1 1 _ 1 1 5. _ �`rlllll'�::.. . .,.*ar 111 1 ::t*i,,•. '�(se ''i 'r'1` "l 1'r1111'Ih g $3 'rlltih +Ilrhl 1►Ir y {r Irhl ' • •' } 1!i•/1+ t�' ]�``s. 1+/+ � I+llli / jE{7ss{ y AI/^., ♦♦ � {\ ♦• A1�. •• >�A2 t •1 t A •• A • cl DATE(MM/DD/YYYY) ,aco�zo CERTIFICATE OF LIABILITY INSURANCE ��. 7/19/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Catherine Dolce Levitt Fuirst Associates, Ltd. PHONE FAX 520 White Plains Road :914-457-4200 A/c No:914 457 4220 Tarrytown NY 10591 ADO.Ess: info@levittfuirst.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Admiral Insurance Company 24856 INSURED PERRVER-01 INSURER B:Accident Fund Insurance Com an 10166 Perry Verrone LLC 12 Center Street INSURER c:ShelterPoint 81434 Pleasantville NY 10570 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1704074886 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUER POLICY NUMBER MWDD� MM1IDD� LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CA000045827-02 7/1/2023 7/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE FX_1 OCCUR PREMISES EaE occurrence) $300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ]PET LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLA LAB X OCCUR GXL000147002 7/1/2023 7/1/2024 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C DBL358637 5/10/2022 5/10/2024 Statutory Limit DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder and/or the entities listed below would be covered as an additional insured per attached endorsement,to the extent provided therein if required by written contract,on a primary non contributory basis on the general liability.Waiver of Subrogation applies.Additional insured,primary and non contributory basis and waiver of subrogation on the Auto.Additional insured,primary and non contributory basis and waiver of subrogation on the Umbrella Certificate Holder is included as additional insured when required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD KR Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured 914-867-1747 Perry Verrone LLC DBA Perry's Roofing 1c.NYS Unemployment Insurance Employer Registration Number of 12 Center Street Insured Pleasantville,NY 10570 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 26-2754386 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street 46-8841910120 Rye Brook,NY 10573 3c.Policy effective period 03/01/2024 to 03/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑ Included.(Only check box if all partners/officers included) �x 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, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Steven Diamond(President) (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �t¢�i� ��!i.Z1Zd 02/26/2024 (Signature) (Date) Title: Licensed Insurance Broker Telephone Number of authorized representative or licensed agent of insurance carrier: 516-488-3040 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