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HomeMy WebLinkAboutRP24-094PERMIT # � _ '�7� 0 /? DATE; g 3 � ®(P• SECTION � BLOCK LOT TYPE OF WORK 2 D /S %1 Lf/ //J JOB LOCATION ✓ / rCe s C ell OWNER O rnNTRn(`TnQ L..LL' R/Aq)?# % EST. COST ©" FEE aQ- ✓C• # GC FEE/0 5'0 /ob DATE TCO # FEE DATE INSPECTION RECORp I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS C7 SPRINKLER ELECTRIC O LOW -VOLT 0 ALARM L AS BUILT O FINAL Ij $ - 2ot�l IF F1s>Q OTHER APPROVALS ARB BOT PS ZBA �yE aR C. � J 4.p* V V . 19 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 September 10,2024 Robin Terzi 204 Ivy Hill Crescent Rye Brook,New York 10573 Re: 204 Ivy Hill Crescent,Rye Brook,New York 10573 Parcel ID#: 129.76-1-9 Roof Permit#24-094 issued on 8/13/2024 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D My S BUILD R MENT For office use only: '/ PERMIT# -O 9 VIL OF IRYE ' OK ISSUED: AUG 3 0 2024 938 KING STRE E$Roox YORK 10573 DATE: -30-ay R . • Oc FEE: 15O' PAID p VILLAGE OF RYE BROOK w ov BUILDING DEPARTMEb}T« 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 r***rwwww*r**r*+r*+t+*r*►r►**■*+*trr►+*rrr*rr++*r*www+r*rr*rrrrwrwrww*w**w*w*ww**r*rrw*rrrw**w***sr►***t*+►str*rt+rrrsrstrsrt Address:204 Ivy Hill Crescent Occupancy/Use: Residential parcel ID#: 129.76-1-9 Zone: Owner: Robin Terzi Address: 204 Ivy Hill Crescent P.E./R.A. or Contractor: Perry Verrone, LLC Address:12 Center St, Pleasantville Person in responsible charge: Perry Verrone Address:12 Center St, Pleasantville 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: Perry Verrone being duly sworn,deposes and says that he/she resides at 12 Center Street (Print Name of Applicant) (No.and Street) in Pleasantville ,in the county of Westchester in the State of NY 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 5,750.00 for the construction or alteration of: Roof removal and replacement 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 Sworn to fore me this n ay 1 t20 day f , 20 C LI—tu4reofPperty0wifer / t I I I t t l t i nattue of A Ile t OF NrW � P ,,� S PP Robin Terzi = 1 NOTAR PY PIJB IL f i ��`��'}�:' —''�; �')?erry Verrone t - -_` o = ► /� STATE ri Name roperty(`w OIPA6347502 / OF NEW YOR 'nt o pplic t NOTARY PUBLI 1�.wesn�e> v4 of ry Publi �i t I t I I I I t�� n� otr�a347soz /* Public i� ''����%N E-00\0\\ 6/l/2024 �yE BRCi' Fo 1932 . 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 : l L L - DATE: / -S- `G J L� PERMIT# t\ Z y' 9 ISSUED: �' '/S Z 1SECT: 12 5, 7 BLOCK:_LOT: LOCATION: 1`Q7 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... D ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS �I1 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER C ■ a ■ N N w ■ 0 O N CLT T h N � y ono w v w = QI oo o H ■ Cl) ■ a W �j v v u ■ w cn W U mo o°". � `� Q LL v ya rr (� O ++ W z w ,.., - c W cw N H a h.j p Do: 0 v y A ■ W _ a W ° o = _ � � > O 00 A @ a SO o c 0 .� C) C> r�i u " o ° v ►� a let in b R: v V o N z `n r' I- � 4 a W00 A O A V ev u " V ICI = ZFBI W I « C/) a 1"1 M �+:{ Ili '� C� LLt d N W e^ 0 A o . : �--� z � o W w p., � u V z o o U = _ G1 © Z A M 0.! El 0 O zA i � � = Q� 1.4 M a C z Z ` o u Ln Ln x N c O rx Ln r~ E-+ z o IS a. v v VCR ?o E �� v W w p H U 4 z �; N A W z oq 9 G GIR am' .. w 5c.A oa _ �I GC R.� � W � x udi � � �, •v BUILD MENT A VI E OF RY OK AUG2 ZQ24 938 KING ET RYE BR NY 10573 VILLAGE OF RYE BROOK -0 � BUILDING DEPARTMENT ov FOR OFFICE USE O Y: ; Approval Date: 7 : Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# : Secretary: ZBA Approval Date: Case# Other: 7, Application Fee: 00-A d Permit Fees: ROOF PERMIT APPLICATION Application dated: 8/12/24 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 statement described below. 1. Job Address: 204 Ivy Hill Crescent SBL:f�1i'an.—/— 9 Zone: Property Owner: Robin Terzi Address: 204 Ivy HIII Crescent, Rye Brook Phone#: Cell#: 203-940-1550 email: robinterzi@gmail.com 2. Applicant: Perry Verrone Address: 12 Center St, Pleasantville Phone#: 914-747-7663 Cell#: email: maria@perryverroneroofing.com 3. Roofing contractor: Perry Verrone, LLC Address: 12 Center St, Pleasantville, NY Phone#: 914-747-7663 Cell#: email:.maria@perryverroneroofing.com 4. Job Description,list all Methods&Materials: Roof removal and replacement- 10 sq 5. Estimated Cost of Job: $ 5,750.00 (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 comer property,indicate street frontage: 7. Construction Type: NYS Construction Class: 8. Number of stories: Height: 9. is garage being re-roofed:No:O•Yes:( )Attached No:00•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: peaked 11. Estimated date of completion: Mid August t1tnoz4 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: Perry Verrone ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the contractor for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Swom to before me this rr Sworn to before me this d ST ,20 day of NWA , 20 Si Zo rop Owner Signature of Applicant u r rr a of PropAy Owner Ntauf pplicant �Y �3r \551t1IIrrl� STATE STATE �'OF NE W YORK\\ `, ��OF NEW YORK\ NOTAR PUBLIC i NOTARY PUBLIC + �,\ 01PA6347502 /1 j _ \ 0IPA&U75M ti 5 � 5 �rr!lllll55\1\\ '//lllflllll\ '2' 611/2024 Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info@perryverroneroofin. .com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 Robin Terzi Prepared by John 204 Ivy Hill Crescent 8/5/24 Rye Brook,NY REVISED 8/7/24 203-940-1550 robinterzi@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: Per HOA Guidelines ) • 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 • Brown aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges • 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. $5,750.00 PRICE EXPIRES 90 DAYS AFTER ESTIMATE DATE Page 1 of 5 Initial & Date: - Premium Report e ag - _ 8/9/2024 203 Ivy Hill Cres, Rye Brook, NY 10573 • ... : • TABLE OF CONTENTS Images .....................................................................1 Length Diagram.........................................................4 PitchDiagram............................................................5 Area Diagram ............................................................6 Notes Diagram...........................................................7 Report Summary........................................................8 MEASUREMENTS Total Roof Area =926 sq ft Total Roof Facets =3 Predominant Pitch =8/12 Number of Stories >1 Total Ridges/Hips =20 ft Total Valleys =2 ft Total Rakes =77 ft Total Eaves =47 ft In this 3D 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 10 Certified Accurate www.eagleview.com/Guarantee.asl)x ?.2000-2024 Eagle View Technologies,Inc.and Pctometry Internatonal Corp.-All Rights Reserved-Protected by European Patent Application No.10162199.3-Covered try one or rnore 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. —�10111111111111111 Premium Report 8i9/2021 203 Ivy Hill Cres, Rye Brook, NY 10573 Report: 60805839 IMAGES The following aerial images show different angles of this structure for your reference. Top View ;• d r Its, i �. T, '�D 2008-2024 Eagle View Technologies,Inc.and Pictornetry International Corp.-All Rights Reserved-Protected try European Patent Application No.10162199:3-Covered by one or more o/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 i— e a l e v i e w 8/9/2024 _ g Rye Brook, 60805839 IMAGES North Side A. 14 South Side f f, ` 1 ,4�`` 1 J PKtornetry➢m: r.,nal Ca. 10162199.3-Covered by one or more of U.S.Patent Nos.8,0 - 8,209,152;8,515,i2S;8,825,45 bean Sl•:,J,Btb _.,,o. •..'-ia,S89;9,329,749;9.599,466.Other Patents Pending. PAGE 2 ea I e v I e W Premium Report g - 8/9/202 203 Ivy Hill Cries, Rye Brook, NY 10573 Report: 60805839 IMAGES East Side West Side '4 Eagle Vp Techno"g , .ntanatlatel Corp.-All Rights Reserve,. .. _ _ ,,:.101621U ...,.me or more of u.: sent Nos.8,078r"' i,145,578;8,170,840: 152;8,515,125;8,825,454;9,135,737;8,670,961,9,5:4,566,8,816,710;8,542880,9,24 4 589;9,329,749,9.5994b.Other Patents Penomg. PAGE 3 Premium Report e agleview203 Ivy Hill Cres, Rye Brook, NY 10573 Report: 60805839 8/9/2024 LENGTH DIAGRAM Total Line Lengths: Valleys = 2 ft Flashing = 10 ft Ridges = 20 ft Rakes = 77 ft Step Flashing = 33 ft Hips = 0 ft Eaves = 47 ft Parapets = 0 ft 22 m - 22 w N J S E 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). 5 2008-2024 Eagle View Technologies,Inc.and P¢tometry Intematronal Corp.-All Rights Reserved- Protected by European Patent Applicatron No.10162199.3-Covered by one or snore or 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 aaI e v� e w y Premium Report . �.J 8/9/2024 203 Ivy Hill Cres, Rye Brook, NY 10573 Report: 60805839 PITCH DIAGRAM Pitch values are shown in inches per foot, and arrows indicate slope direction. The predominant pitch on this roof is 8/12 F8 8 8 w N S E 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. .t,2008-2024 Eagle Yiew Technologies,Inc,and Pictornetry 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,"0; 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 Penning. PAGE 5 Premium Report e agleview203 Ivy Hill Cres, Rye Brook, NY 10573 Report: 60805839 8/9/2024 AREA DIAGRAM Total Area = 926 sq ft, with 3 facets. 414 422 +90 w N x A S E 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). ?00B-2024 Eagle View Technologies,Inc.and Pictornetry International Corp.-All Rights Reserved-Protected by European Pe.- ntan No.10162199.3- i—of U.S.Pat"' 8,209,152;8,515,125;8,825,454;9,135,737;8,670,961;9,514,568;8,818,770;8,5-12,880;9,244,589;9,329,749;9,5919,406 Other Patents Pending. PAGE 6 - Premium Report - e ag l e v i e w 8/9/2024 _ 203 Ivy Hill Cres, Rye Brook, NY 10573 Report: 60805839 NOTES DIAGRAM Roof facets are labeled from smallest to largest(A to Z) for easy reference. B C A w N S E Note: This diagram also appears in the Property Owner Report. 5 2000-2024 Eagle view Technologies,Inc.and Pmome"International Corp.-All Rights Reserved-Protected by European Patent Application No.10162199.3-Covered W one or mare of U.S.Patent Nos.8,078,436;8,145,578;8,17QM; 8,209,152;8,515,125;8,825A54;9,135,737;8,670,961;9,514,568;8,818,770;8,S42,880;9,244,589;9,329,749;9,599,466.Other Patents Pending, PAGE 7 Premium Report — e a l e v i e w203 Ivy Hill Cres, Rye Brook, NY 10573 Report: 60805839 8�9�2024 _ g REPORT SUMMARY All Structures i Areas per Pitch Roof Pitches 8/12 Area(sq ft) 925.4 of Roof 99.9% The table above lists each pitch on this roof and the total area and percent(both rounded)of the roof with that pitch. Structure Complexity Simple Normal Complex NOTE:Waste Calculation . .le roofing applications.All values in table below only includeo total Waste % 0% 3% 6% 80/o 10% 13% 18% 23% 28% Area (Sq ft) 926 954 982 1001 1019 1047 1093 1139 1186 Squares* 9.33 9.66 10.00 10.33 10.33 10.66 11.00 11.66 12.00 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 = 20 ft(1 Ridges) Longitude = -73.6767714 Hips = 0 ft(0 Hips). Latitude = 41.0315213 Valleys = 2 ft(2 Valleys) Notes Rakes' = 77 ft(6 Rakes) This was ordered as a residential Eaves/Starter' = 47 ft(3 Eaves) property. There were no changes to Drip Edge(Eaves+ Rakes) = 124 ft(9 Lengths) the structure in the past four years. Parapet Walls = 0 (0 Lengths). Flashing = 10 ft(1 Lengths) x Step flashing = 33 ft(4 Lengths) Predominant Pitch = 8/12 Total Roof Facets = 3 Total Area (All Pitches) = 926 sq ft t Rakes are defined as roof edges that are sloped(not level). t Eaves are defined as roof edges that are not sloped and level. c 2008-2024 Eagle view 7echnoicgles,W.and Pktometry Internatonal Corp.-AN Rights Reserved-Protected by European Patent Appl2abon No.10162199.3-Covered by one or more of U.S.Patent Nos.8,078,436:8,145,S78;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 >: ��� ,li1f111� i}►s �If !: 6�flf/f �IS - : �- % N > 4 X. N O G ^ O L LO �'' ♦ � O LO F. CL r� cr E N o LLJ CA �• x W c Cl. yr �i Z LL �-- Z U `- cL Q r L" y W W j r �ffifl) w z «O)> ate' 49fL4 o a W o : ale aQ 0-4 a o O JW 0 �+ x -a (u �r • QI 3 r. 0) •`iabc;. .�."�• a 7 7 a� rZ 4- C14 �icss)> �• � o � s � 4ffii) I �• � O � y v U_ >V -�• i1 ' .. 10 ;•`.' 's: - . .;1 '#.;111 41':}?xa _ rss::..11 1 - r s:1111� -ems g=_ 111}`II II tr_ • "'111,1} t.,.. s(0)> 0 '�. A A •♦ A A .1, s PERRVER-01 CDOLCE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(M/2 DIYYYY) 6127024 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 Kevin Kelley NAME Levitt-Fuirst Associates,LTD PHONE FAX 520 White Plains Road (A)C.No,Extq:(914)457-4200 laC,No):(914)457-4200 2nd Floor E-MAILADDRE .info@levittfuirst.com Tarrytown,NY 10591 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED INSURER B:Accident Fund Insurance Company of America 10166 Perry Verrone LLC INSURER C:ShelterPoint 81434 12 Center Street INSURER D Pleasantville,NY 10570 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP TR IN SD WVD MM/DD/YYYY) (MM/DDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE FX]OCCUR CA000045827-03 7/1/2024 7/1/2025 DAMAGE TO RENT ante S 300,000 PREMISES�Ea MED EXP(Any oneperson) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000'000 POLICY�X PEef LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a acci S ANY AUTO BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON�WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S S B UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 X EXCESS LIAB CLAIMS-MADE GXL000147003 7/1/2024 7/1/2025 AGGREGATE $ 5,000,000 DED I X I RETENTIONS 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NLITE ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMB R EXCLUDED? ❑ N I A (Mandatory In NE I E.L.DISEASE-EA EMPLOYEE S If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C NYS Disability DBL358637 5/10/2022 5/10/2025 Limit-Statutory DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required( Village of Rye Brook-is included as Additional Insured for covered operations of the named insured 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 ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Rye Brook, NY 10573 AUTHORIZED REPRESENTAT401 IVE X-4 * 'M ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation 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 1 d.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 1 a" 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) Qx 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: �tQ�Q ��!1�1 drLG� 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