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HomeMy WebLinkAboutSP24-004PERMIT # SECTION _L TYPE OF WORK JOB LOCATION CONTRACTUI E,ST. COSTS 40 # TCO # -eJ DATE: a o �cP: aS Z._ BLOCK LOT FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING :SAS O SPRINKLER ELECTRIC LSW-VOLT [] ALARM CJ AS BUILT 0 FINAL �' 21� ZOZy ASS FD OTHER APPROVALS ARB �7 0) oc BOT PB ZBA OTHER c DR t VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.iyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 23,2024 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 19A Rye Ridge Plaza,Rye Brook,New York 10573 Parcel ID#: 141.27-1-6 Sign Permit#24-004 issued on 7/22/2024 for a New Awning This certifies that the new awning,"Mendel Optical Insight",installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D E For office use otil " D AUG 2 0 2024 BUILD A�tTMENT PERMIT# ` - �� VIL OF Rtii$TOOK ISSUED: — � J VILLAGE OF RYE BROOK 938 KING STREI YE BROOK, EW YORK 10573 DATE: U —1 BUILDING DEPARTMENT 9 -0(�ji$, FEE: PAI 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 ................ .. ...D....................... .................................................0............................. 4 % tIt` . Address: /�/t �/j ,7,Z,_ Occupancy/Use: Parcel ID 4: h"�, �7 —/��' "Lone: Owner: C. Address:C�4 � G Iev, r,go C P.E./R.A. or Contractor: �i til /� la�^-1��•�td�iN Address: �Oh(Gt)�/,L V¢. rw7 (q�S�cr2�Aj zo. Person in responsible charge: h 1�n7� Address: o�{�),/1d7 kF t9ogj ei (KS73 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: --J C being duly swom,deposes and says that he/she resides at 16,6 Lld lGy Ave- t Na to gf Applicant) i / (No.and Street) J ! �'` / / o in �" 1>�'f'� ,in the County of (, .� _ try 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: 60•D D J for the construction or alteration of: �i y� 't QLe-� C ,lA 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 I',if Swom to before me this /,/)I— day of -ivSf , 20 day of 120621 D., e of Prope Owner (Signature of Applicant �AVC HPrn, N'et Property I Print Namc of Applicant Notary Public L V �7b�9 I E TO NOTARY PUBLIC, STATE OF NEW YORK AIENA MAKANJIN NO. 01 N14899825 WTMYPUBM,SUTEOFWWYORK QUALIFIED IN WESTCHESTER COUNTY Rtpiatration No OtHA0013645 COMMISSION EXPIRES DECEMBER 3, 2026 Qualified in Westchester County My Commission Expires 9119-7C- �yE BRC��. O�` tim • �9�2 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.or$ - - - - - - - - - - - - - -- - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I `` /� V' Z . DATE: PERMIT# S1 Z i W 7 ISSUED: - ZZ-Z SECT: //•l 7 BLOCK: >> LOT: ( le-1 LOCATION: 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 V F /'' {/►�N �? �Nc�e L f /Gc�.� NS i l• ❑ L.P. GAS M ��, zG 4.1 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL OTHER r 1wm i,.3\ _ v 0 � N O4 � •� s �7 Go v v a W � oW � aa A = ■ ^/ W O c v � h U � N w�z O to E � s W00 ^ ! 1 C O Q U is aA [ u U uz � CA r Cam, di �1 o -5pp V = 00 ON z � a � v 3 �I V J 11 z ZO � w o� A C7 W O ^ � z � � � � � ;� o o � o � F ■ U UU a � r � W 0 p o U �/ z V w o ,° 1. � ° V z W ° N .. A W Z d bal ate' 0 ■ �I G4 �'-+ � W � x � � � -o � O 6 , = m BUILD) 4(; DEPARTMENT VILLACM OF RYEAwOK � �f 1 2��1{ 938 KING ST'JMET RYE B116ox,NY 10573 !� ED i 9 _ _� 014) 2-0668 , I VILLA EG 4F RYI_ SR©OK BUILDING DEPARTMENT FOR OFFICE USE ONLY: -7 Approval Date: P # �- Application# /�+ )� �� Approval Signature: ___�_. ARCHITECTURAL CTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: _Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date:_ Case# Other: Application Fee U Permit Fees: !�_ 1,141 i!iti4#4##i##kitii#s####i###ik#*kk*######ki4####i#ii!###*kki#k#><##i##!!#ii#k#*kk######ik####ii#i#!!!kklii#• SIGN PERMIT APPLICATION Application dated. is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction/installatio�n}of a sign in accordance with Village Code§250-35 as per detailed statement described below. 1. Address:_94. ' SBL: I q I ,j:j —j-jeZone: 2. Property Use or Business Name: i 3. Proposed Sign(s)(Describe in detail including number of signs,types,sizes,exact location(s),and illumination method(s)if applicable.) {A separate Electrical Permit will be required for any associated electrical work.) 4. Height from grade to highest point of sign: 1 to lowest point of sign: 5. Property Owner: U)t ry t ` koA� _QQ�'T�1 LL(_' Address: G P Wk-,tj a57', Phone# - Cell# email:'.L f1 l�n rh',i n - 2h2i_��- b. Applicant:}`` °f y�C t'�1 ram, Address: 464 j,1 I_ tle Phone# A 17-6 Cell# T Architect/Fngineer: _- _—Address: Phone#_ Cell# _ ._ email:---n 8. Sign Contractor:�t�t;�, � �f�j -+-;(" tz)nt.fl Address: 4r111 l -1W �i¢ • fQ�� 1��te� '.1�`� 1L�7'S Phone# I - Cell# _ - email:` �� 14 t�tst4 ,Co,rr 4- 6/1/2024 9. Will the proposed tgn require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: Elf yes,you must submit a Site Plan Application,&provide detailed drawings) 10. Does the proposed sign involve a Home-Occupation as per§250-35 of Village Code? Yes:—No:—If yes,indicate: TIER 1: T1ER 11: TIER III:_ (if yes,a Home Occupation Permit Application is required) 11. If building is located on a corner lot,which street does it front on: 12. Property frontage: - 13. Property size: Sq. Ft.: Acres: 14. What is the total estimated cost of construction: S U ('Ilse estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 15, Estimated date of completion: _ tri,4ttt#tttttrrtltr#t#tkittittti#*ktlt#4*ittittt##irkt#t#irtkititit*i*ittt#t#t#t1r 1k*1tr�ttt4itiitittttt#;t#t#t This application must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. trrr#tttiitrtttt#k*kk####*kkik****tkiiiiiikkii*ii*it#itt#titttt#trttrrrrrtttk*t*rt*r##*#*#r#rtttttrrtittit SIAI.&OF NEW YORY,COUNTY OF WESTCHESTER ) as: f,C-g. being duly sworn, deposes and states that he/she is the applicant above named, (print name of Individual cigmng of the apptiea t) and,further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the _,c _ a— for the legal owner and is duly authorized to make and file this application. (indicate architect,conaaetnr,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 I________ Sworn to before me this � 1 2 day of �_, 0_ day of _ & 20 i re of Pro city finer l Signature o pplicant t e of P 1yownTirvivt Print Name ofApplicant Notary Public I I Notary Public ALENA HAKAPUIN tt TOY rueuc,PAR OF Namff L C)!S N 1 ETO p*q{•trattoe No.O1HA0 C a••Int►e In w.atc"st•r C NOTARY PUBLIC, STATE OF NEW Y©RK ctsmntb•ia+ � NO. O 1 N 14899825 QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES DECEMBER 3, 2026 -z. 6/l/2024 Bvtildin P c C leck Luc& Zorun2 Anal su Addrexs A ZSBL Zone C Use: Corot.Type: Other: Subrmttal Date.. Revuions.';t uttal Bates: Applicant C1 Nature of Work: C Ot C3C1 S Renews zmjjj n 2 2024 P& BOT: Other. NE W- �& � (V(VFEES: Fd.4r. � ' G\ c/O: Flood Plant Legall=on: ( ) ( ) APP: Duel Notarized: SBI: Truss I.D. Cross Connection: FLO.A.: ( ) ( ) Same Roads: Steep Slopes Wetlands: Storm Water Review Street Opening•. ( ) ( ) ENVIRO: Long Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W MgmL: Tree Plan Other. ( ) ( ) SURVEY:Deed Currenc Ard uvaL' Sealed: Unacceptable ( ` (WPLANS:Dace Stamped Sealed C,vpues: I:leetrornc Other: (� ( ) License Workers Comp: lrabdiry Comp.Waiver Other: ( O CODE 753#: Daud. N/A: ( ( ) HIGH-VOLTAGE ELECTRICAL Plans: Petmut N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL-Plans: Panic N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Pemut FLW.I.C.:_ n Battery_Other. ( ; ( ) PLUMBING:Plaru: Penrnt Nat.Gu: I-P Gas: N/A/ Other. FIRE SUPPRESSION:Plans. Permit N/A Other. ( ) ( ) I-VAC.: Plans: Pemut: N/A: r.Othe ( ( ) FUEL TANK Plans: Peanut Fuel Type. Other. ( ( ) 2020 NY State ECCC N/A: Other. ( ( ) Final Survey Final Topo: RAPE Sign-off Letter. As-Built Plans: Other. ( ( ) BP DENIAL IL-1-TER- C/O DENIAL.11-1 I"ITR: Other. ( ( ) Other. GARB rntg.due approval;- /7 notes: ( )ZBA mug.date: approval' notes: PB rmg.date: approvaL' notes: REQUIRED EXESIING PROPOSED JUL Arei Date: ?01e FF E=ror>t: Emm Rear. Ac4 Cor — — — - Ft.H/Sb: -- H -- QFA. Ft�[un : paw` -- - - HogEtt/Stones notes: Q BUILD � P_ARTMENT ` JUN 18 2024 VIL OF RYE'HOOK 938 KING 5 ET RYE BRc} ,NY 10573 VILLAGE OF RYE BROOK 4�9,39-0668i BUILDING D,L- TMENT j 14 wi ^O�.Pov tiff;;f4fitittii;i#t4ittt;#i;kii4rt###t4#t##kt#t;#iti#tt##ktlt4tttk;##4t;Ott#t#k#tif;kRtt#tttkf;;###l;t;kt4t 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: �q A L'. O_ K► e, 19112.e— Date of Sub ission: Parcel ID#: —� _ .Zone: _ 74.24 Proposed Improvement(Describe in detail): Pr° E'x(,5�trva AIJr\tna -15"N lad APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT ,CG4hiCg Qn.t'n4eZL ��,51�>t � 1�� The following items must be submitted to the Building ,rnl�Y\orv�lel C��1'tcQ.1 �nSiB l��__ DepartT1tent by the applicant-no exceptions. "T� n nezj:W Copleted Application Property Owner:lA),n C to Ic , 1 LL' m �,Op �// (� 2. (✓S Two(2)sets of sealed plans. (one full size {nwimum Address:�1� I I _ LI t�G,G P�liz�- 11G Brd' : allowable plan size=36"x 42"l and one l l"x17") T— 1w 75 3. ( )Two(2)copies of the property survey. Phone# 414 " 4. ( )Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. (L f One electronic/disc copy of the complete Y Sk. ,� , : �� t�� application materials. 1r}t1=II=Z�--�- 6. ( iling Fee. Address:41)4 L JL� _j., . Pa � (��� 7• ( )Any supporting documentation. Phone# u 1l�- � � �p 8• ( )BOA approval letter. (if applicable) 9. ( bf Photographs. Architect/Engineer: 10.(a Samples of finishes/color chart. (a sample board or model may be presented the night of the meeting) Phone# By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions A Procedures,and that their application Is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this Swom to before me this 7 day of F lV — , 20_Ztt day of -�Jai(/ 20 �7 tiguaidre of Pmperl owffer ture of App ne of Prop er Print Name o Applicant Notary Public — — — Notary Public LOIS NIETO NOTARY PUBLIC, STATE OF NEW YORK ALENA HAKANAN NO. O 1 N14899825 NOTARY PUBLIC,STATE OF NEW YORK QUALIFIED IN WESTCHESTER COUNTY Registration No.Westchester Count COMMISSION EXPIRES DECEMBER 3, 2026 Qualified in Westchester County My Commission Expires 9119/2027 6/t/2024 Architectural Review Board July 17,2024 1.6. ARB24-020 556 Westchester Ave LLC C/o Anthony Guastella 556 Westchester Avenue New rear windows. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB24-078 G&G Homebuilders Corp 18 Rock Ridge Drive Second story addition,deck and fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB24-083 Robert ONeill&Melissa ONeill 4 Loch Lane Garage door overhang. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.9. ARB24-087 Win Ridge Realty LLC 19A Rye Ridge Plaza New awning,"Mendel Optical Insight" Approvals: Motion .S ftl Second_ A r Abstention Aye;�� Nay;_ Adjournment; Notes Page 2of4 • Architectural Review Board July 17,2024 1.10. ARB24-088 Paul Cuzzupoli&Pamela Lustig 7 Lincoln Avenue Two-tier retaining wall and drainage. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB24-081 (Re-Appearance) Kenneth Gerchick&Amy Bernstein Gerchick 3 Mohegan Lane Second floor dormer addition. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB24-089 Emily Groglio Irrevocable Trust,Shari Melillo,Trustee 5 Paddock Road Enlarge rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB24-090 Christine Sciandra 47 Roanoke Avenue Window and door changes,rear paver patio,relocate mechanical equipment. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 3 of 4 Architectural Review Board July 17,2024 1.14. ARB24-091 Francesca Italian 31 Arrowwood Circle Extend existing deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.15. ARB24-092 Michael Oles&Kathleen Oles 33 Arrowwood Circle Extend existing deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: August 21,2024 Page 4 of 4 ` �yE DR(� Village of Rye Brook ML MR Ot� yAgend FB SE Architectural Review Board Meeting AC AD Vr Wednesday,July 17,2024 at 7:30 PM Q Village Hall,938 King Street I m SF 1. ITEMS: 1.1. ARB24-063 (Consent Agenda) (Amendment to Approved Plans) Eric Steinert&Caryn Steinert 24 Meadowlark Road Install two skylights on rear deck roof. 1.2. ARB24-069 (Consent Agenda) Eric Steinert&Caryn Steinert 24 Meadowlark Road 6'high white PVC fence and gate. 1.3. ARB24-084(Consent Agenda) Jeffrey Mensch&Hannah Mensch 10 Red Roof Drive Rooftop solar array. 1.4. ARB24-085 (Consent Agenda) Craig Bergman&Samantha Bergman 11 Jennifer Lane 6'high white vinyl rear yard fence. 1.5. ARB24-086 (Consent Agenda) Norman Wang&Esther Wang 180 Country Ridge Drive 6'high white vinyl rear yard fence&gates. Consent Agenda Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 1 of 4 ACO 9 DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/17/2024 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(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 Joanne Sinco NAME: Borrelli Partners Insurance Agency AICONNo Exit: (914)939-7900 AXc No): (914)407-5088 287 Bowman Avenue E-MAIL jsirico@borrellipartners.com ADDRESS: Suite 406 INSURER(S)AFFORDING COVERAGE NAIC 0 Purchase NY 10577 INSURER A: Travelers Casualty Ins Co of America 19046 INSURED INSURER B: Travelers Indemnity CO 25658 Lanza Corporation dba Sign Design&J C Awning INSURER C: 404 Willett Ave INSURER D: INSURER E: Port Chester NY 10573 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2451305722 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. INSA PE OF INSURANCE POLICY Y EFF POLICY LTR INSD WVD POLICY NUMBER MM/DDM'YY MMIDWYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 A 6805J175092 06/05/2024 06/05/2025 PERSONAL&ADV INJURY $ 1,006000 P 'LAGGREGATELIMITAPPLIESPER GENERAL AGGREGATE $ 2,000,000 POLICY [g PRO, LOC PRODUCTS-COMPIOPAGG $ 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 _ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B X EXCESS LIAB CLAIMS-MADE EX5J175240 06/05/2024 06/05/2025 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION A STATUTE ERH AND EMPLOYERS'LIABILITY YIN 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA UB5J175160 06/05/2024 06/05/2025 E.L.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BLANKET AI-OWNERS,LESSESS OR CONTRACTORS,AI-MANAGERS OR LESSORS OF PREMISES,AI-STATE OR POLITICAL SUBDIVISIONS PERMITS RELATING TO PREMISES,Al LESSOR OF LEASED EQUIPMENT.PRIMARY&NON-CONTRIBUTORY WORDING,WAIVER OF SUBROGATION-WC POLICY INCLUDES BLANKET WOS 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 PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Lanza Corporation 914-937-6360 DBA Sign Design and J C Awning 1c.NYS Unemployment Insurance Employer Registration Number of 404 Willett Avenue Insured Port Chester, NY 10573 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 13-3525268 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Travelers Indemnity Company Village of Rye Brook 3b. Policy Number of Entity Listed in Box"l a" 938 King Street UB5J175160 Rye Brook, NY 10573 3c.Policy effective period 06/05/2024 to 06/05/2025 3d.The Proprietor,Partners or Executive Officers are ® included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'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". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? AYES ®NO 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. Joanne SiriCo (Print name of authorized representative or licensed agent of insurance carrier) Approved by: � � � � 06/17/2024 (Date) Title: Sr ACCt Mgr Telephone Number of authorized representative or licensed agent of insurance carrier: 914-939-7900 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 (9-15) www.wcb.ny.gov InsightsMendelOptical t 24 Rye Ridge Plaza,Rye Brook NY 110573 Village of Rye Brook Architectural R evlew Board SIGN DESIGN fRtAlirt � 6+ rfl S}1VElaP11E111 Approval Date: Chairman: ' t'n Frame "�Recover Exis ig - _ 404 Willett Avenue With White Graphics Port Chester NY 10573 Phone:914-937-6360 - 4644 FAX: 7-0105SunbrellaCharcoal Greywww nYsi ndes 9n c om Email:signs@nysigndesign.com Co 4/ PERMIT# Project Contact W Drawn By: DATE Seth Komblau • • Date: E t Pro o ed , Job Clientx i n NSPECT0R, V I! 0¢7-eei 0 '�'.*�••�r•..�.r.�,...,,�„� s�rrs�s..r.�..r.�..� �a�rrrw�wry ar w�r�twr�w�i ■r ti■�r ��. s .�..N.,.....r...'� .��.■.�"ri�'i....Rw...r a■rlr�twrr��iis+�r �■■�w��iir.s��.�•r�r�w�i �i■� �- I�w awlt�ra 1M�rw�w��1+�■� .�.■■.r�••••.ww..�i.�..�r..�...� I Awwlals a 1 t•t•�I�wrr t, I . .. .....�..��.........�......�"..�... .a.�r. 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This custom design is the exclusive `f 9 LAG C3 ��r- property of SignDesign&J.0 Awning g All rights to its use and reproduction BUI �-_ •'- ") Pry RTM E N1`- are reserved Hi RRIN I ED t-0.-0 R R N D E R I N G lSt IN TEN-0E1') 0 GE I ;ER AF--PROXlIVA 1 E i;01 0 R H L)L--S ND DiST:IF)U i ICA BEST EFFORTS WVE BEENI CIr,DE T 0 Sit IL)L- 'l E'f HE AC(UAL I-�;J�1u�EVEI: E,.,;' T c_: ► O R,$)t:��l�OP�t�` E S .EIt�rl~`:h.l r!E� Et;; ;E}1 �.�l�UR SYt:IBPI.�GNP OR SAM- �E 1Graphics�Mendell Optical InsightlAwning WO Mende[ O Insights 24 Rye Ridge Plaza,Rye Brook NY 10573 SIGN DESIGN (I I A`,IF IVatA61 L{'#t.Of'Y NT Proposed Awn'ing R With 404 Willett Avenue Port Chester NY 10573 Phone:914-937-6360 FAX:914-937-0105 www.nysigndesign.com Email:signs@nysigndesign.com y, Project Contact- Drawn By: PM: Seth Komblau Date- Job!Client- Description NDEL OPTICAL INSIGHTS 95 60 r , 11 11 CLIENT ACCEPTANCE Print Name ' Sign Name- Approval Date: Revision Date: 91 11 Revision Date. Specifications: 5/31/24 ' 4644 •Fabric. Sunb rella WhiteG ra hiCS•. PaintedThis custom design is the exclusive property of SignDesign&J.0 Awning ' Roman Bold All rights to its use and reproduction • New Font. Timesare reserved i H!S PRiN T ECG t;a OR REKIDERIIUt�IS INJ T ENDED 10 BETTER APPKOVIVIATE IL"O_GR I-WES AND DISTRIBUTIUN. BEST Er F(.Pl S HAVE BEEN MADE i 0 SIMUUk T E THE AC11JAL CU_OR;S I�(W."EVER,E)KA:T u��zLrR;�;Cri,,\i ONLY BE SEEN FRO1 THE SPECIFIED C,)LOR ZSYS I Ert CHIP OR SAIAPLE 1GraphicslMendell Optical Insight\Awning W � Optical InsightsMendel 24 Rye Ridge Plaza,Rye Brook NY 10573 SIGN DESIGN F`a ik A r I rr 0 V 1 0 1 , 404 Willett Avenue Port Chester NY 10573 Phone:914-937-6360 �. FAX:914-937-0105 _.n - _ www.nysigndesign.com Email:signs@nysigndesign.com F � ` Project Contact 1 '` Drawn By A Pm Seth Komblau Date: !�omm aim nw i• a ■ri WW iM., r t) Job 1 Client k ( Y ti 1; Description IL CLIENT ACCEPTANCE 1 Print Name* Sign Name- Approval Date- Revision Date. Revision Date: ..�. r 5/31/24 61 This custom design is the exclusive property of SignDesign&J C Awning All rights to its use and reproduction are reserved. THIN Pl?IN i LD,COLOR RENDE.RI1eCy IS INTENDED. i)BETTER AP1='RO)".110ATI CO.',C R HUE AND DIS'TRJ*b!MON. E:E4'T�FFifRTS I-Ir;\iEI ft�A.D TO SllttlUTE THE i��U,�, GjL::R(S) — �_ r� r'r.G — N GAIN s 1 i lI- �.r s1,���S Y�;-r IL?��C.�ii� ti 1 GraphicsWendell Optical Insight\Awning W o-�uv���:-7VER '_XAGT�.','L R'S)G \IN ONLY BE SEEN PrR(IK4 THE SPEC, IEL ,� S. K p''t. Mendel. Optical Insights 24 Rye Ridge Plaza,Rye Brook NY 10573 Surrounding rea SIGN DESIGN C N A S i G►Y f M I b 1 404 Willett Avenue Port Chester NY 10573 Phone:914-937-6360 FAX:914-937-0105 www.nysigndesign.com Email:signs@nysigndesign.com a Project Contact - Drawn By Pm Seth Komblau Date 1�'• i .- Job I Client t Description 411k- 40 y CLIENT ACCEPTANCE Print Name- Sign Name: P SIN,I t Rye Ridge prarnia,!,ry Approval Date* Q Revision Date. PBs.d vtrs Fwd lover s h4afket • i..•M..ui. Revision Date: f�ta5® 5/31/24 This custom design is the exclusive property of SignDesign&J C Awning All rights to its use and reproduction are reserved. 1 Graphics\Mendell Optical Insight\Awning WO