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HomeMy WebLinkAboutBP24-131PERMIT # SECTION TYPE OF WORK JOB LOCATI N _ OWNER/ A o /, EST. COST \/CO #_ CC', % DATE: Q/ �L/ ;L6,6S _w s B CK � / T /IS 74a/I 00 aQ� Ue �S�a&�oo�'e �(03/�3 5�� OoC)J TCO # FEE DATE CZVIN FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT Q ALARM A5 QUILT 0 FINAL INSP _ / 3 3/4bely �S /oil jc"" aides OTHER APPROVALS 04 ARB /�-lave / ao BOT PB - ZBA t QyE BR � O` �4.s tIJVJ�1 Y tuLeo�J 4 LL�Gc,�vuYi 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www.ryebtookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE September 16,2024 Kamlesh Dungersingh Kothari&Charul Kothari 6 Heritage Court Rye Brook,New York 10573 Re: 6 Heritage Court,Rye Brook,New York 10573 Parcel ID#: 124.65-1-20 Building Permit#24-131 issued on 6/26/2024 for a Rooftop Solar Array This certifies that the rooftop solar array,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D Fn)- BUILDING llEPARTMENT PERMIT# use on1 � VILLAGE OF RYE BROOK` ISSUED: AUG 2 d 2024 .938 KING STREET,'RYE BROOK,NEW YORK 10573 DATE: �914 9 -0668 FEE: r�— PAID It VILLAGE O RYE BROOK BUILDINf — „ 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 ##►rtrtt#t4ifrt###f►#####rti►►f4tfftrtrt####►#tttt}rt}rt##44►##}4}}}ffrt##►ittf►tf#i4t►►►4►►i###i►i►i4###►►###ti####►###►#►#►i#ttt►4#rt Address: 6 Heritage Court, Rye Brook, NY 10573 Occupancy/Use: M Parcel ID#: 135.65-1-15 Zone: al) Owner: Kamlesh Kothari Address: 6 Heritage Court, Rye Brook, NY 10573 P.E./R.A. or Contractor: Michael Miele, P.E. Address: 33 Quaker Ave., P.O. Box 350, Cornwall, NY 12518 Person in responsible charge: Sue Estabrooke Address: 15 Little Brook Lane, Suite C, Newburgh, NY 12550 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: Sue Estabrooke being duly swom,deposes and says that he/she resides at 15 Little Brook Lane,Suite C,Newburgh,NY 12550 (Print Name of Applicant) (No.and Street) in Newburgh in the County of Orange in the State of NY ,that (Cityfrown/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:$ 23,903.00 for the construction or alteration of: Roof Top Solar Panels 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 be ore /me this Sworn to before me this day of •1 , 20 �`� y of �' , 20 il"I * � Signature of Property Owner` ANGELINA LLOYDNOTARY PUBLIC,STATE OF NEW YORK Signature of Applicant Kamlesh Kothari Registration No.01LL0003053 Sue Estabrooke Qualified In Westchester County County Print Na e of Property Owner Print Name f Applicant Commission Expires March 20,20 �.- eZ7 Notary P lic Notary Pu A GELINA LLOYD NOTARY PUBLIC,STATE OF NEW YORK R1 1, ,u,1 Registration No.01 LL0003053 Qualified in Westchester County County Commission Expires March 20,20 2-1 �yE BRC�� cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR /QASSISTANT 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 :- w F [n ice. DATE: J Y PERMIT#��� Ll - 13 1 ISSUED: SECT: BLOCK: LOT: )J LOCATION: 17 _� V 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 N F L ❑ L.P. GAS ❑ FUEL TANK L L. Wl O�(� �P ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ = M N a ti N N 7 �: .o .�+ o E,y � cOaca" p O W ►r W v A ., 0-.4 a w o GIN O �. 0 cd v� a v � a. �' � 0 • '� x ✓ o \ V � a � q p p pw O Cl) PQ p O w 3 o N v .. 0 ,4 4 M o O o s ... M . g - o - w w a � c B 1 'v 0. 'o. O W 1 z A a 00 A o '00 � v v a F-1 PTO O a (J M W w -5 7; z F+A1 A w @ ,t o � N Q a M--a� o w -_a s00 v W v v � H M O �r © z Z u Ova, v v � p 1.0 V 0 0 Po U o ? a? F+ I w O q v �i CA w py O a v � U u z O M � . _ Hc� 4o � y � 1I��w•� V � V � z � c� � � o � .. °. e A W Z .. ,� 0 W W 7 Q v ate°' mo o BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING' TTREET RYE BROOK,NY 10573 (914)939-0668 SAY ' 2 2�24 w ww. _ oo `or VILLAGE OF RYE BROOK _BUILDING DEPARTMENT FOR OFFICE USE ONLY: AQ 11 `` Approval Date: Permit — Application# -io C-3 t--1` Approval Signature: : ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: 1,, c Application Fee:A 1 U Permit Fees: APPLIC11ATION TO INSTALL PHOTOVOLTAIC SOLAR ARRAY Application dated: dT is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation of a Photovoltaic Solar Array as per detailed statement described below. 1. rob Address: 6 Heritage Court, Rye Brook, NY 10573 SBL: 124.65-1-20 Zone�Ud 2 Type,kW&Location of Array,(use additional sheets if necessary): Proposed (22) panel roof mounted array; (9.020) kW System. Inverters: (22) Enphase IQ Series Modules: (22) HANWHA QCELL Q.PEAK DUO G10 41OW 463.76 Sq. Ft. 3. Property Owner: Kamlesh Kothari Address: 6 Heritage Court Rye Brook NY 10573 Phone#(914)434-5759 Cell# e-mail kamlesh _kothari@yahoo.corr 4.Applicant: Sue Estabrooke Address: 15 Little Brook Lane,Ste C,Newburgh,NY 12550 Phone#631-348-0001 Ext. 102 Cell# e-mail Permits@GoPowerSolutions.com 5. Design Engineer: Michael Miele, P.E. Address: 33 Quaker Ave., P.O. Box 350 Cornwall, NY 12518 Phone#845-629-9693 Cell# e-mail nypsengineer@gmail.com Long Island Power Solutions-DBA New York Power Solutio�Sdress: 2060 Ocean Ave, Ronkonkoma, NY 11779 6. Solar Contractor:and Sue Estabrooke Anent Oka dress: # 631-348-0001 Ext. 102 Cell# e-mail Permits@GoPowerSolutions.com 7. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1-Fam Post-construction: 8. If building is located on a corner lot,which street does it front on: N/A 9. N.Y. State Construction Classification: N.Y.State Use Classification: 10. Construction Type&Location: ()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss [TT]; ()Pre-engineered wood[PW];Located;O Floor Framing(F];O Roof Framing[R];O Floor& Roof Framing[FR]; Other: roof mounted solar array. 11. Number of stories: 2 Roof Style:(hip,shed,mansard,etc...) 12. Will a New Roof Be Installed: No 19 Yes ❑ (a separate roofing permit is required to re-roof an existing building) 13. Roofing Material&Number of Layers: t 8f 12/2021 14. Will the proposed project disturb 400 sq. ft. or more of land,or create 400 sq,._,tt.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? No: 1[1 Yes: ❑ Area: 15. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? No: ❑ Yes: ❑ (If yes,applicant must submit a Site Plan Application,&provide detailed drawings) 16. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?No: 'L�J Yes: ❑ (If yes,applicant must submit a Tree Removal Permit Application) 17. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? No: ❑Yes: ❑ Indicate:TIER 1:TIER 11:TIER III:_ (if yes.a Home Occupation Permit Application is required) 18. What is the total estimated cost of construction: s23,903.00 (Note:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO). 19. Start Date: Completion Date: This application must bear the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I, Sue Estabrooke ,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, Agent/Contractor for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to/before�me this C�,-� day of pry l ,20 day of .20 �1� Notary PLIC Notary Publ' Sigilrature of Property Owner c Signature of Applicant Kamlesh Kothari Sue Estabrooke Print Name of Property Owner Print Name of Applicant ANGELINA LLOYD GEj jt4A LLO YJ YORK NOTARY PUBLIC,STATE OF NEW YORK 2 YBIC,SLATE°��� 03053 Registration No.01LL0003053 WOSAR istr0t►on No.fltiLL©� Co.1 Qualified In Westchester County County Reg d in westct+68t G etch 20,20 Al Commission Expires March 20,20 QC� is6o,expire��-r- 8/12/2021 r t a M , M �o `� . N x v ►� a W c Ln W c4 i� ti I C N A W ao N+r z a v v 04 ►� M W � $ Boa F 10PA N H A N (W+ 8 0 ` M+�I 4 cn an R+ . W w � z M H O W O o V ` O c� wo Z o oA � Uz WCA z ,R z W �, Z a z Eo v A Oc 11 a V z CQ r 1 MCIN cy W � O °� ] • H N a � o z w N .Wa o O oLn , z a z 'V z w z � BUIL G DE MENT �� VIL OF RYE OK R U N - 6 2024 938 KIN , ' ET RYE B ,NY 10573 VILLAGE OF RYE BROOK org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required l 2 FOR OFFICE USE ON L BP#: —� / EP#: ,:Dy Approval Date: l`J Permit Fee: $ Approval Signature: Other: ************************************************************************************************** Application dated, 6- 4p— 7 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 6 Heritage Court, Rye Brook, NY 10573 SBL: 124.65-1-20 ZoneA-- 2.Property owner: Kamlesh Kothari Address: 6 Heritage Court, Rye Brook, NY 10573 Phone#: (914)434-5759 Cell#: email: kamlesh kothari&ahoo.com 3.Master Electrician/Licensed Installer: Michael Catizone Address: 2060 Ocean Ave,Ronkonkoma,NY 11779 Lic.#: 1628 Phone#: 631-348-0001 Ext 105 Cell#: email: Permits@GoPowerSolutions.com Long Island Power o utions Company Name: DBA New York Power Solutions Address: 2060 Ocean Ave, Ronkonkoma, NY 11779 4.Proposed Electrical Work/Fixture Count: Proposed (22) panel roof mounted solar array. 9.02OkW System. Inverters: (22 ) Enphase IQ Series Modules: ( 22 ) HANWHA Q.CELL Q.PEAK DUO G10 41OW 5.31 Party Electrical Inspection Agency: SWIS STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Michael Catizone ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the Master Electrician for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to efore me this z Sworn b fore me this day of I 20 r-j ° day of ,20 c CtN� - 3 C < r Sign tore of Property Owner 3 Z c Z Si o pp scant Kamlesh Kothari N - . O °° rn a Michael Catizone . p n N Print Name f Prop rty O-jLjwner rrn r'„ � rn r- Name of A icant a,�. -- , 'V G 1 AAA� AD Nota ubllC ca o w m m y '� o o D No u is ANGELINA LLOYD 0 � v NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 LL0003053 0 c� Qualified in Westchester County County a -M N 3/3/2023 Commission Expires March 20,20 0'2 pw STATE WIDE INSPECTION SERVICES, INC. Service With Integirit-y 0•0 • • SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# Date ; 1 Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ Ist Fl. ❑2nd A. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels IP 3P it Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation E C IE �V1PID � J U N - 6 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SW IS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# Date `4 Signature Address City/State Zip Code Company Phone# DR [EC EC WFE C—A� State Wide Inspection Services R1080 Main Street JUL 16 2024 Fishkill, NY 12524 Sw U S 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: officeCcbswisny.com -' Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Catizone Electrical Kamlesh &Charul Kothari 2060 Ocean Avenue 6 Heritage Court Ronkonkoma, NY 11779 Rye Brook, NY 10573 Located at: 6 Heritage Court, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-133 124.65 1 20 Certificate Number: 2024-4510 Building Permit Number: BP 24-131 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 6 Heritage Court, Rye Brook, NY 10573 The Photovoltaic System was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 16Ih day of July 2024. Name Quantity Rating Circuit Type PV Modules 22 Micro Inverters 22 AC Disconnect 01 40AMP Meters 01 Combiner Box 01 Junction Box 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Michael E. Miele PE RF-- ---- , Licensed Professional Engineer ° AUG 2 6 2�7� Licensed In New York, New Jersey, Connecticut & California New York License#079676 New Jersey License#44042 VILLAGE OF RYE BROOK Connecticut License#23158 BUILDING DEPARTMENT California License#31508 July 25, 2024 Village of Rye Brook Building Department The Office of the Building Inspector 938 King Street Rye Brook, NY 10573 Re: Kamlesh Kothari —6 Heritage Court, Rye, NY 10573 Single Family Residence Solar Panel Installation Certification Village of Rye Brook County of Westchester, State of New York Dear Building Department, I have reviewed the solar energy system installation at the subject address. The system has been installed in accordance with the manufacturer's installation instructions and the approved construction drawing. I have determined that the installation meets all building code requirements and is certified as for all code and approved plans for the Village of Rye Brook. I can hereby certify that the installation complies with the 2020 New York Stare Residential Building Code and all applicable codes and design loads as referenced on the approved plans, including ASCE 7-16 (Minimum Design Loads and Associated Criteria for Buildings and Other Structures). If you have any questions, please feel free to call me at any time. Thanks, in advance. OF NEII/ Sincerely Yours, �P P�►- E 0 w Michael E. Miele, PE OFESSICNP�, 33 Quaker Ave. PO Box 530,Cornwall, NY 12518 ♦ Phone 845.629.9693 ♦ NYPSengineer@gmail.com Building Permit Check List&Zoning Analysis OB & C ONLY Address: ` 0\c 0 CL SBL: Zone: ��. 1 .� Use: Const Type: Other. Submittal Date: lZ �—� Revisions Submittal Dates: Applicant: , n, _ Nature of Work: —QA,,J l s Q (— C S� S Reviews:2JAY 0 P : BP: Other. NEED OK ( ( DES:Filing. /O Legalization: ( ) ( 5.-�P.: Date Stamped:✓Properly Signed:— SBL Verified: — dross Connection: F.O.G.: ( ) ( ) 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: ( ) ) LANS:Date Stamped: Sealed: Copies: Electronic: Other. ( %L tense: Workers Comp: Liability Comp.Waiver. Other. O Dated: N/A: (a� ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other: ( ) ( ) PLUMBING:Plans: Permit: Nat Gas: LP Gas: Grease Trap: Other. ( ) ( ) FIRE SUPPRESSION.Plans: Permit: N/A Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other. ( ) ( ) FUEL TANK: Plans: Permit FUEL TYPE: Other. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER C/O DENIAL LETTER: Other. _ ( ) ( ) Other: (1JARB mtg.date: I approval:- I' / '2 notes: ( ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval:- notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Area: Data. u n V 1 n24 Circle: FronraQe: _ Front: Front: Sides: Rear. F.A.R.: en Space Haeht: Stories: notes: BUILDp4d DEPARTMENT r—_-___ I VIL . OF RYE BROOK MAY - 2 2024 938 KING ET RYE BROOK,NY 10573 ` (] �49 VILLAGE OF RYE BROOK r gy BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address:6 Heritage Court, Rye Brook, NY 10573 Date of Submission: Parcel ID#: 124.65-1-20 Zone: — Proposed Improvement(Describe in detail): Proposed(22) panel roof mounted array; (9.020) kW System. APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT Inverters: (22) Enphase IQ Series The following items must be submitted to the Building Modules: (22) HANWHA QCELL Q.PEAK DUO G10 41 OW Department by the applicant- no exceptions. Property Owner: Kamlesh Kothari 1. Completed Application 2. Two(2)sets of sealed plans. (one full size (maximum Address: 6 Heritage Court, Rye Brook, NY 10573 allowable plan size=36"x 42") and one 11"x17") 3. Two(2) copies of the property survey. Phone#(914)434-5759 4. Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. One electronic/disc copy of the complete Long Island Power Solutions/DBA NY Power Solutions application materials. 6. Filing Fee. Address:2060 Ocean Ave, Ronkonkoma, NY 11779 7. Any supporting documentation. Phone# 631-348-0001 Ext. 102 8. ( ) HOA approval letter. (if applicable) 9. (\/Photographs. Architect/Engineer: Michael Miele, P.E. 10.( ) Samples of finishes/color chart. (a sample board or Phone# 845-629-9693 model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to heart any application not meeting the requirements contained herein. Sworn to before me ) this ��'1 Sworn to before me this day of ! 1 20� day of Art] 20 Sign ture of Property Owner Signature of Applicant Kamlesh Kothari Sue Estabrooke Print Na of Property Owner Print Name of Applicant z4x� Notary PiMic Notary Pu ANGELINA LLOYD ANGELINA LLOYD NOTARY PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK Registration No. 01 LL0003053 Registration No.01 LL0003053 Qualified in Westchester County County Qualified in Westchester County County Comm_ ission Expires March 20,20 a Commission Expires March 20,20 1 all 7 D A'�.•...,.�..,�.�o..b. MAY — 3 2024 Bold o/Pv.rfer. 0 BiD,F• BAd.R-R—X N.Y.I0573 February27, 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT BelleFair ARB 24 Bellefair Blvd Rye Brook, New York 10573 Kamlesh Kothari 6 Heritage Court Rye Brook, New York 10573 Re: Installation of Solar Panels on Roof Dear Kamlesh, We write in response to your request to the ARB for approval of the installation of solar panels on the roof of your house situated at 6 Heritage Court, Rye Brook, New York. We are pleased to inform you that based upon the details of your application, your application has been approved. Once this installation is complete contact our FirstService representatives, Rafael Reyes or Michael Napolitano so that a final inspection may take place. Please be advised that our approval will be expressly conditioned upon your continued compliance with Schedule D of the Declaration. Accordingly, if the aforementioned fails at any time to comply with the Regulations, the ARB reserves the right to direct modification or the removal of the improvements at your sole expense to ensure compliance. Please note that approvals are valid for one year as of the date of this letter. As a reminder, certain alterations will require the approval of the Village of Rye Brook's Building Inspector or Engineer. You shall be responsible for obtaining all required approvals and permits. The Village of Rye Brook will consider applications after BelleFair ARB approval is given. The Village of Rye Brook approval does not preclude the need for ARB approval, nor does ARB approval relieve you from any responsibility of obtaining Village of Rye Brook approval. If you have any questions, please do not hesitate to contact us. Very truly yours, The BelleFair Architectural Review Board yF, DR(ly� Village of Rye Brook ML MR O� yAgenda FB SE Architectural Review Board Meeting AC AD Wednesday,May 15,2024 at 7:30 PM j Village Hall,938 King Street JM WOO SF 1. ITEMS: 1.1. ARB24-043 (Consent Agenda) Jordan Webber,Keith Webber,Nancy Webber&Nicole Webber 21 Westview Avenue Rooftop solar array. 1.2. ARB24-044(Consent Agenda) 786 King Street Sanford Pallotta&Kimberly Pallotta 4'high white PVC picket fence. 1.3. ARB24-045 (Consent Agenda) Zachary Morris&Kathryn Linsky 42 Rock Ridge Drive 4'high black aluminum fence&4'high black welded wire fence. 1.4. ARB24-046 (Consent Agenda) Andrew Levinson&Stephanie Lerman 14 Elm Hill Drive 3.5'high white vinyl picket fence. 1.5. ARB24-047 (Consent Agenda) Paul Snisky&Kelly Snisky 41 Meadowlark Road 6'high driftwood style vinyl fence. 1.6. ARB24-048 (Consent Agenda) Dustin Harris&Rachel Boyman 71 Winding Wood Road 6'high white vinyl fence. 1.7. ARB24-049 (Consent Agenda) Fernando Rosales&Leslie Rosales 68 Tamarack Road 6'high white vinyl fence. 1.8. ARB24-050 (Consent Agenda) Matan Dvir& Ilana Dvir 1 Dorchester Drive 6'high white vinyl fence. Page 1of4 ti r n Architectural Review Board May 15,2024 1.9. ARB24-051 (Consent Agenda) Jeffrey Coombs&Kathryn Rightmyer Coombs 10 Carlton Lane Rear bluestone patio 1.10. ARB24-052(Consent Agenda) Andrew Gitkind&Amanda Gitkind 6 Birch Lane Rear Patio and front walkway. 1.11. ARB24-053 (Consent Agenda) Kamlesh Kothari&Charul Kothari 6 Heritage Court Rooftop solar array. 1.12. ARB24-054(Consent Agenda) RMSC Properties LLC 74 Woodland Avenue Above-ground inflatable swimming pool,4'high white vinyl fence&4'high chain link gate. Consent Agenda Approvals:/ Motion �/� Second Abstention Aye; '` Nay; Adjournment; Notes 1.13. ARB24-020 556 Westchester Ave LLC c/o Anthony Guastella 556 Westchester Avenue New rear windows. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.14. ARB24-055 Douglas Conrad&Judith Fried Conrad 42 Talcott Road Demolish one story bump out,construct new screen porch,renovate existing deck and remove skylights. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2of4 Architectural Review Board May 15,2024 1.15. ARB24-056 7 Bishop LLC 7 Bishop Drive South Single family dwelling. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.16. ARB24-057 Henry Parkin&Lauren Geller 3 Old Oak Road Window and door elevation changes. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.17. ARB24-058 Maria Sotire 9 Jean Lane 2nd floor addition over existing den/garage and a new rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.18. ARB24-059 John Capistrano&Maricar Capistrano 300 South Ridge Street Replace decking and railings. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 3 of 4 z • Architectural Review Board May 15,2024 1.19. ARB24-060 Jonathan Steiner&Viktorya Steiner 15 Loch Lane Legalize flagstone garden area,walkway and planter boxes. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.20. ARB24-061 William Delynn&Donna Delynn 6 Carlton Lane Replace decking and railings. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: June 18,2024 Page 4 of 4 CC� ��IC NEW YORK F14 DivittorioPV Solar Panel Agreement ' [ F A r7)OWE , MAY - 2 2024 �_____ I New York Power Solutions SOLUTIOII LAGE OF RYE BROW ain St. Ste 1000 White Plains,NY 10606 BUILDING DEPARTMENT 914 719-7786 Name: Kamlesh Kothari Date: April 13, 2024 Address: 6 Heritage Court Phone: (914)434-5759 Rye Brook, NY 10573 Phone: Utility Account#: 54-4837-4156-1804-8 Price: $23,903.00 Municipality:Rye Brook Existing contract with other company. No (specify if village) RepresentativetSystem Size Panels #of Panels Inverter(s) Drew Divittorio20 Q-Cell 410 22 Enphase Generator Backup Financing N/A Hybrid GS Additional Information: NYPS will provide: 25-Year roof penetration warranty (contingent on-site survey results) 25 -Year workmanship warranty on the equipment- parts and labor 25-Year Production Monitoring &Consumption (where available) Free Critter Guards Your Solar system is designed based on your current electrical usage. Tax credit is based on tax liability. 1 have checked with your tax adviser to see how much 1 qualify for. Special Instructions: Deposit: $6,900.00 (PAID) Customer agrees to service and terms: NYSERDA REBATE: $ 1,804.00.00 Apr 16 2024 Da e Final Payment: $15,199.00 (Due from /ll GREENSKY: Bridge loan-deferred interest and / ti payments for 18 months.) Customer has three(3)days from the date of this agreement to terminate this agreement and receive a full refund. Int.T The scope of work includes all obligations provided for in the Agreement,including the following,Site survey;Design of the System;Electrical,structural plans and specification sheets;Inverter and panel installation;Interconnection to Electric Utility and Start-up.System Design and Installation. N.Y.P.S shall provide all of the services in accordance with the DID LONG ISLAND ? ! ; MAY - 2 2024 2060 Ocean Ave Ronkonkoma, NY 11779 OW E R 63 1348-0001 SOLUTIONS ; �---- VILLAGE OF RYE BROOK www.longislandpowersolutions.com BUILDING DEPARTMENT VILLAGE OF RYE BROOK—Building Division 938 King Street Rye Brook,NY 10573 Dear Building Dept: As per your Building Department,enclosed please find the building permit application, submitted on behalf of our client/property owner: Property Owner: Kamlesh Kothari - (914)434-5759/kamlesh_kothari@yahoo.com Project/Property Address: 6 Heritage Court, Rye Brook,NY 10573 Section/Block/Lot: 124.65-1-20 Electrician/36178-ME: Michael Catizone—2060 Ocean Ave., Ronkonkoma,NY 11779—(631)348-0001 Contractor/53562-H: LI Power Solutions-2060 Ocean Ave., Ronkonkoma,NY 11779—(631)348-0001 Architecture& Planning: Michael E. Miele, PE—705 Orrs Mills Rd,New Windsor,NY 12553 —845-629-9693 Contact Information: Sue Estabrooke,Authorized Agent for LUNY Power Solutions 15 Little Brook Lane, Suite C,Newburgh,NY 12550 Permitsna,GoPowerSolutions.com/631-348-0001 Ext. 102 Enclosed Please find: • Permit Fee • Permit Application • (2) Engineering Drawings& Specs • Insurance Certs Should you have any questions or require anything further please call the office. Si erely, Sue sta roo e Permit Manager NY/LI Power Solutions 15 Little Brook Lane Suite C Newburgh,NY 12550 Ph-631-348-0001 Ext. 102 Fx-631-348-0018 Permits@GOPowerSolutlons.coin Go Green Save Green 4 i 1101 1 \1a,. y : �,• ` ', ill ,, 1 � �••� ,�l� � ::-f. IMP AVW AV J Se <�+ ,,� �• ' ,.,,�� d �� ° w � .�.:_+..vim.... (yam vim ; Ail WAE A' r. 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Mt go • D E CFE-_ `/ LE Michael E. Miele, PE MAY - 2 2024 Licensed Professional Engineer VILLAGEL___OF RYE BROOK Licensed In New York, New Jersey, Connecticut &California BUILDING DEPARTMENT New York License#079676 New Jersey License#44042 Connecticut License#23158 California License#31508 April 26, 2024 Village of Rye Brook Building Department Office of The Building Inspector 938 King Street Rye Brook, NY 10573 Re: Kamlesh Kothari —6 Heritage Court, Rye Brook, NY 10573 Single Family Residence, Solar Panel Loading Certification Village of Rye Brook, County of Westchester, State of New York Dear Building Department am the engineer of record for the above referenced project. I have prepared the attached plans dated April 17, 2024 that consists of the installation of(22) Q.PEAK DUO BLK ML-G10+410W solar panels at the above referenced location. I can hereby certify that the existing roof structure combined with the additional weight of the solar panels meets the requirements of The 2020 Residential Code of New York State, Publication Date, November 2019. The design loads were as follows, Roof Design Load: 30psf Wind Design Load: 115mph No additional structural members were required. The roof is currently framed with 2x4 wood truss framing @ 24" O.C. The roof structural members are in compliance with ASCE 7-16 for deflection and acceptable bending stress. If you have any questions, please feel free to call me at any time. Thanks in advance. Sincerely Yours, �OF NEW P P�v o w',' y0 C' 9� n W Michael E. Miele, PE mks S FO 079676 �e p9OFESSIONA 705 Orrs Mills Rd., New Windsor NY 12553 ♦ Phone: 845.629.9693 ♦ mmielepe@yahoo.com ,A lk-A1/����1 11 LO e � Co cc • MA = R O C ,o aj 0 CA ra O °p ? o ' CL �. w Q u . oAw UJ :;� :�••� p„ Cl cfl p Gv etc, .. •= O Z ° f C� Z aXi o r� Q U Ln 00 v1 = N V v y \ •-- -- - .__ _. - Via•- �, .. .. Q.: ,. .. �. .'. .. / , DATE(MMIDDlriVY) ACORO@ CERTIFICATE OF LIABILITY INSURANCEF02/25/2024 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christopher Curran Edwards and Company PHONE (631)472-8400 FAX 631 472-8486 140 Greene Avenue E-M Igo Ezt' ac,No: ( ) ADDRESS: CertS@edwafdsandCO.net INSURER(S)AFFORDING COVERAGE NAIC# Sayville NY 11782 INSURER A: James River Insurance Company 12203 INSURED INSURER B: Long Island Power Solutions,Inc dba New INSURER C: York Power Solutions;Michael Catizone INSURER D: 2060 Ocean Avenue INSURER E: Ronkonkoma NY 11779 INSURER F COVERAGES CERTIFICATE NUMBER: 24/25 Master 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MWDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 50,000 X Contractual Liability MED EXP(Any one person) $ Excluded A P0000000486 02,128/2024 02/28/2025 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability Each Claim $2,000,000 A P0000000486 02/28/2024 02/28/2025 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS, 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW j Workers' YORK CERTIFICATE OF INSURANCE COVERAGE STATE I Compensation —� Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured LONG ISLAND POWER SOLUTIONS INC 2060 OCEAN AVE 631-348-0001 RONKONKOMA, NY 11779 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e., Wrap-Up Policy) or Social Security Number 27-1175107 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York Village of Rye Brook 938 King Street 3b. Policy Number of Entity Listed in Box 1a Rye Brook, NY 10573 R97411-000 3c.Policy Effective Period 1/1/2015 to 6/4/2024 4. Policy provides the following benefits: © A.Both disability and Paid Family Leave benefits. B.Disability benefits only. C.Paid Family Leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employer's employees: 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 NYS disability and/or Paid Family Leave benefits insurance coverage as descr' d above. Date Signed 6/6/2023 By (Signature of insurance carrier's authori d representative or NYS licensed insurance agent ofthat insurance carrier) Telephone Number (646) 509-2100 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B, 4C or 5B is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers' Compensation Board (only if Box 48,4C or 58 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers' Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and Paid Family Leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form D13-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) �IIII'DNIININIIIIII1llllllll2l-ll1lll�l� N Y S I F PO Box 66699,Albany,NY 12206 New York state Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A 271175107 m � LOVELL SAFETY MGMT CO.,LLC 22 CORTLANDT STREET 33RD FLR NEW YORK NY 10007 7 0 _ SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POWER SOLUTIONS INC VILLAGE OF RYE BROOK 2060 OCEAN AVENUE 938 KING STREET RONKONKOMA NY 11779 RYE BROOK NY 10573 [:!Z�2�467 MBER �CE"RTIFICATE NUMBER �041011/2024 POLICY PERIOD DATE 8-8 2581 TO 04/01/2025 03/18/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2467 078-8, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT MICHAEL CATIZONE VICE PRESIDENT JOSEPH MILILLO TWO OF TWO OFFICERS LONG ISLAND POWER SOLUTIONS INC THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS' COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. 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