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HomeMy WebLinkAboutBP24-196PERMIT # SECTION ,,Z.�2 TYPE OF WORK JOB LOC ION . OWNER CbNTRACTORA EST. COST c vCs # GC', TCO # 9/ DATE: 9 / 3 0cP: 9 /3 QL C LOT �i'n � nr o.� In n.ox. a ri' Ida r C- FEE FEE P� DATE Lf- FEE DATE INSPECTION REC013II DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS C3 SPRINKLER ELECTRIC C7 -- LOW-VOLT [� ALARM 0 - AS GUILT C� FINAL #(g/)y9y g83y k�1112 Qd l/a �o,?(: )oj)2'w19- I9ye J OTHER APPROVALS ARB BOT Pe ZBA OTHER Qy� QR . 190 C tCG4'o J�v 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.g_ov TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 22,2025 Daniel Savitt&Shari Markowitz Savitt 104 Country Ridge Drive Rye Brook,New York 10573 Re: 104 Country Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 129.67-1-8 Building Permit#24-196 issued on 9/13/2024 for Replacement Patio Doors This certifies that the three new patio doors,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to p �`�� i APR 15 2025jD R� For office use onI BUILDING E 'ARTMENT PERMIT# L9� VILLAGE OF RYE BROOK ISSUED:!—/3—tom VILLAGE OF RYE BROOK 938 KING STREET,WE BROOK,NEH'YORK 10573 DATE: BUILDING DEPARTMENT I (914)934-0668 FEE: yg as,5-- PAID W www,r�e�rouknv.�ov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION •titik;fii}}i}ififRii9 ifiiiiiilikl►ftf;rtlrtrt rtki�}krt+♦irtirtrti•i�k}k}ai�sRlif+iiliktRi kiRRii YitkYt;iiktii Riiik Rtirtk R}irt<}ti})sill Address: 104 Country Ridge Dr Occupancy/Use: 1-Fam Res Parcel ID#:1.29.6/-1-8 Zone: R Owner: Dan Savitt Address: 104 Country Ridge Dr P.E./R.A.or Contractor: Renewal by Andersen Westchester Address: 421 West Avenue, Stamford CT 06902 Person in responsible charge: Franklin Barahona Address: 421 West Avenue, Stamford CT 06902 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 WESTCHE,STER as: Franklin Barahona being duly swum,deposes and says that heishe resides at 421 West Avenue (Print Namc ol'Applicant) INo and Street) in Stamford in the County of Fairfield in the State of CT that (CIINJovn. 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:$ S2A00MDCD for the construction or alteration of: Installation of(. 3 ) replacement Andersen 200 Series Narroline Patio Doors 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 bu ilding 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. iSfh Sworn to before me this Sworn to before me this ,, day of fiFl-,( h ?0 Z'� day of 1`t 2006/ L- Signature of Property Owner Signature of AfKtcaiff- '-w Oa,n 4-)C►V► Franklin Barahona Print Name of Propem 0%%tiJ'ne- Print Name of App�l iccaant Note Public Notan Public BRIAN MACDONALD NOTARYPUB!!C BRIAN MACDONALD State o/connecdcut NOTARYPUBUC MY COMMISSION D(P1RES Oct 312025 state of Connecdcut - MY COMMISSION DIPIRES OCL 31121121 QyE BRC��_ 1982 BUILDING DEPARTMENT ❑BuILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �I J 12)c I DATE: ? S PERMIT# /" ! ISSUED: X/j_Z'/SFCT: Mq-d 7 BLOCK: , LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 9 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK / ❑ FIRE SPRINKLER ❑ FINAL PLUMBING / ❑ CROSS CONNECTION FINAL ❑ OTHER n1 ` a • N y H w ow _ W �'- Fi V :: p •� w I1 ,� aid cia aw z et W ' @z o a, p E. N 7 6J s P4 z v `p x a •= U wCA 00 O z z M Ga O A p o aCi U F ° �° 2 � � o UZ ti a P4 �--+ 1-4 ' ' 11, A cn x p W .o as o cry 04 zzb o u H � u V o o C) u U V U z W � o z ° a v o r+ A w z Q or g 1-4 016 � v BUILDING DEPARTMENT SEP 12 20 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT Ni iN+i xvebrookny.Ilov ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORT: Wmcii DOFs N07' REQUIRE VILLAGE ARCIIITFC lTR,%L REN']E,,% B()ARI)APPRON Al. FOR OFFICE USE ON L Y: ! SEP APPROVAL DATE: � I _ }L f/ APPLC�TIO# aCJ N r� FEE: Al /0�L/ APPROVAL SIGNATURE: PERMIT FEES: H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: �+ ttt#tt##t#tt#i#t##i##tilt#t#iiii##t#iii##i#i#iiiiiii#t#####itt######t#t##t####�#####tt#t•##dirt######t#####• Application dated: September 12, 24 is hereby made to the Building Inspectorof the Village of Rye Brook,NY,for the issuance of Permit forthe construction of buildings.structures.additions,alterations or for a change in use,as per detailed statement described below. 1. Job Address: 104 Country Ridge Dr, Rye Brook, NY 10573 2. ParcellD#: 129.67-1-8 Zone: 3. Proposed Improvement(Describe in detail): EXTERIOR COLOR IS : WHITE Installation of( 3 ) replacement Andersen 200 Series Narroline Gliding Patio Door no grilles, into existing openings with no strucutural alterations. 4. Property Owner: Dan Savitt Address: 104 Country Ridge Dr, Rye Brook, NY 10573 Phone# Cell# e-mail List All Other Properties Owned in Rye Brook: x Applicant:Franklin Barahona / Fairchester Custom Windows dba Renewal by Andersen Westchester Address: 421 West Avenue . Stamford CT 06902 Phone# 203.249.1986 Cell # 203.249.1986 a-mail Permits@RBAWestchester com Architect: x Address: Phone# Cell /t e-mail Engineer: x Address: Phone# Cell# e-mail General Contractor: Franklin Barahona/ Fairchester Custom Windows dba Renewal by Andersen Westchester Address: 421 West Avenue , Stamford CT 06902 Phone# 203.249.1986 Cell # 203.249.1986 e-mail Permits@RBAWestchester com (I) 6/l/2024 Residential Residential 5. Occupancy;(1-Fam.,2-Fam..Commercial.,etc...)Pre-construction: 1-2 Families post-construction: 1-2 Families 6. Area of lot: Square feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: S. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I"fl: 2°d fl: 311 fl: 10. Total Square Footage of the proposed new construction: IL For additions,total square footage added:Basement: 11 fl: 2id fl: 311 fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: N.Y.State Use Classification: 14, Construction Type&Location:()Typical Western Lumber Frame;()Timber Frame[TC],()Wood Truss[TT]; ()Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];()Floor&Roof Framing[FR];Other: 15. Number of stories: 2 Overall Height: Median Height: 16, Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style:peaked,hip,mansard,shed,etc: Roofing material: 19, What system of heating: 20, If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21, Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type 1 Hood,etc...)Yes:_No: X (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22, Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:x Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: x of yes,applicant must submit a Site Plan.application,&provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: X (jves,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: X (ifyes,the area ofwedand and the wetland buffer-one must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: X (if yes,the area and elevations of theflood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: X (ifyes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X Indicate:TIER L TIER II: TIER ill: (if)es,a Honie Occupation Permit Applicatlott is required) 29. What is the total estimated cost of construction: S 26,000 A'ote:estimated cost shall include all site improvements,labor,material,scaffolding,foxed equipment,professional fees,including ant,material and labor which may be donated gratis.If the final cost exceeds the estimated cost,air additional fee will be required prior to issuance of the CO. 30. Estimated date of completion: September 2024 (2) 6/112024 BUILDING DEPARTMENT �"R VILLAGE OF RYE BROOK SEP 12 2024 938 KING STREET Ri,E BROOK,NY 10573 (914)939-066$ VILLAGE OF RYE BROOK www.rvebrookn�•.goi BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE 216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I, Dan Savitt , residing at, 104 Country Ridge Dr 11'r llll II:1m,1 . % I'.I. 1 being duly sworn,deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 104 Country Ridge Dr , Rye Brook,NY. l 1,1, vidi,. Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. L.1 I C f ' (Signallll'C of l'ruI1Cr1� I lt���;rl,ll Dan Savitt ll'rmi Namw of I'r.gi�rn Ihrllrn. Sworn to before me this I207 RIAN day of 5ePkMW ,20 ?J � NQircau'C►'-° scarce ofQnneclicut k1Y COMMISSIOM"PM pCL 312M (3) 6/1/2024 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: FRANKLIN BARAHONA ,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. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. , Sworn to before me this 1Z Ih Sworn to before nze this Hy day of Wkm bu ,20 7,q day.of %e f`�'. e,,gbr ,20 Zy Signature of Property Owner Signature of Applicant Dan Savitt FRANKLIN BARAHONA Print Name of Prupert Oti%ne BRtAN MAcDol ALor NOZ4WPUVLJC Print Name of-Applicant State ofCOMW14cut W C011M15810M EXPIRES Oct.31�926 Notary Public Notarl Public BRIAN MACDONALD ,NaTARY PfJBLlC stye ofConneCdCUt BRIAN MY COMMISSION pUMM Oct 312025 �'�T "t_l� my jCant) NEFlE (4) 611/2024 DocuSign Envelope ID:D5390473-CACE-464F-8284-4E6347189462 W, Agreement Document and Payment Terms AdIDBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Dan Savitt Legal Name:Fairchester Custom Windows LLC 104 Country Ridge Dr RENEWAL CT HIC#.0667292,WC-35743-H22.Putnam 051220 Rye Brook,NY 10573 byANDERSEN 421 West Ave.Building1 Stamford,CT 06902 ..vnq.enwv e.,Yrr H:(917)494-4834 Phone:203-406-0545 1 Fax:203-406.0828 sales@rbawestchester.com C:(914)939-0455 Dan Savitt 06/06/24 BUYER(S)NAME CONTRACT DATE 104 Country Ridge Dr, Rye Brook, NY 10573 (917)494-4834 (914)939-0455 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER savidanc@gmail.com PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Fairchester Custom Windows LLC d/b/a Renewal By Andersen of Westchester and Fairfield County("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms, any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL JOB AMOUNT: $26,063 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DEPOSIT RECEIVED: $5,212 BALANCE DUE: $20,851 We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at AMOUNT FINANCED: $0 this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. METHOD OF PAYMENT: Credit Card NOTES: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 06/10/2024 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 9&-Z-- DocuSignea by ' ( L� F6E9DF9F5E5640C SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Amy Stein Dan Savitt PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 06/06/24 Page 2 / 18 Order Summary dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD Dan Savitt COUNTY 104 Country Ridge or RENEWAL Legal Name Fairchester Custom Windows LLC 1 License 0 CT HICK 0667292, Rye Brook,NY 10573 MANDERSEN WC-35743-1-122.Putnam#51220 H (917)494.4834 421 West Ave.Building I I Stamford,CT 06902 Phone 203.406-0545 I Fax 203-406-0828 I techorbawestchesteccom C (914)939-0455 IDLI ROOMS1?F DETAILS JOB 0 0'• Misc: Misc, Miscellaneous Job Items. Lead Safe Work Practices. Quantity 1. EPA requires contractors that disturb painted surfaces in homes. built before 1978 to be certified and follow specific work practices. Construction: None Material: None 101 Living Room 95-i/4 79-1/2" Patio Door: Gliding, 200 Series Narroline. 2 Panel, Stationary ; Active. 95-1/4" 79-1/2" Aluminum Sill. Exterior White, Interim White Performance Calculator: PG Rating: 25 1 DP Rating: + 25 / - 25 Glass: All Sash: Tempered High Perf. SmartSun with Heatlock Glass Hardware: Albany. Stone Screen: Gliding. Full Screen Grille Style: No Grille Misc: None Construction: None Material: None 102 Living Room 95-1/4 79-1/2 Patio Door: Gliding. 200 Series Narroline. 2 Panel. Stationary Active. 95-1/4" 79-1/2" Aluminum Sill, Exterior White. Interior White Performance Calculator: PG Rating: 25 1 DP Rating: + 25 ' -25 Glass: All Sash: Tempered High Perf. SmartSun with Heatlock Glass Hardware: Albany. Stone Screen: Gliding, Full Screen Grille Style: No Grille Misc: None Construction: None Material: None 0" 0' Misc: Misc. Permit Fees. Town of Rye Brook- Estimated Permit Fees. Quantity 1. Renewal by Andersen will facilitate the application of the building permit to the Town of Rye Brook. Homeowner is responsible for any outstanding permit applications or code violations that may prevent Renewal by Andersen from procuring permit. Renewal b} Andersen is not responsible for any historical or architectural review applications and approvals that may be required as pre-requisite for a building permit. Construction: None Material: None 103 Basement 95-1/4 79-1/2' Patio Door: Gliding. 200 Series Narroline, 2 Panel. Stationary Active. 95-1/4" 79-1/2" Aluminum Sill. Exterior White. Interior White Performance Calculator: PG Rating: 25 1 DP Rating: t 25 / - 25 Glass: All Sash: Tempered High Pert. SmartSun with Heatlock Glass Hardware: Albany. Stone Screen: Gliding. Full Screen Grille Style: No Grille Misc: None Construction: Nnne Material: None PRODUCTS: 5 WINDOWS: 0 PATIO DOORS: 3 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 2 Updated 6/6124 06/06/24 Page 2 / 12 Tax Parcel Maps Address: 104 Country Ridge Dr Print Key: 129.67-1-8 SBL: 12906700010080000000 Rye Brook oil- ski !� E111%- i Ryet 6�raok .e Disclaimer: This tax parcel map is provided as a public service to Westchester County residents for general informalion and planning purposes only.and should not be reload upon as a sole informational source.The County of Westchester hereby disclaims any liability from the use of this GIS mapping system by any person or entity.Tax parcel boundanes represent approximate property has locat on and should NOT be interpreted as or used in lieu of a survey or property boundary descnplion.Property descriptions must be obtained from surveys or deeds.For more Information please contact the assessors offico of the municipality =�� RENEWAL byANDERSEN Technical Data RIEI•SERVICE WHOM&DOOR MACEMENT SPECIFICATION AND TECHNICAL MANUAL �t Fairchester Custom Windows is not using an Engineer / Architect due to installation of replacement windows and doors into EXISTING openings with NO structural y alterations . >- "`. ..:. - �► a +�=-+��,�.��F; .�. �«-�" -'�'�`'�'•�, -,lec:rrsla(:Uy lc-olaaU tnol, ^eluc: aSeaid U011P Motu.SOU[u110Lo 1•un 9ygatk 10_ SS NA d -.a rS tu0ld0 `I; ,C.sow�:p•.>s,.tr,25,+a+a:a_plr:.a_•:s•a•.7 eCe I• 1 N, _?21'_';::1!'AG S'c:lE!.BotleWtt)}taa{ - � I v u u e,u W W ra b>ge.aytwwltfalP,Dl.-ud;aaj `� Ii t'o+ :c ts'o [rD Frl f:o Iatco-:fiMlrMauY 1+caeaytu+ew,r,wl"el..+va1.r!j } of li I w se. t: sra tro Gsl t:D IDLM:xco-u MaNtl °+'I PaP!1'D and eN eN >N rN eN eN I+se!O+ql-u•awyq•s°!luE),,,IyW!auy � 3_ l2 X1:;4 All. 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I- Hal-.1 :Z K'e 2[0 ft'I 40 IOECtri:t:o-l}µCr:T s,pup otl .1 urgl a,l 9aI1V9 Put igINO ON.•^-ctelp Pardw.1 t C N 4 2� "' J :7_ - a• :6 i +apwnrr Mol:>nc :cA! a.lA!,mpwd I t n 09. o i 1 q:= Pold edAI>1UD ::CID Y-Ull—1-Id trots dYlf _ A � e 1 l Pam>0�tlaV 1:aL aPUY u...,aPUY ).nu:: 3 nDU3t13 > mru•� L n Order Summary dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD Dan Savi" COUNTY 104 Country Ridge Dr R E N*EW L A Legal Name:Fairchester Custom Windows LLC I License 0 CT HICII.0667292, Rye Brook,NY 10573 br A N D E R S E N WC-35743-H22,Putnam#51220 H.(917)494 4834 421 West Ave,Building 1 1 Stamford,CT 06902 C:(914)939-0455 Phone:203-406-0545 1 Fax:203-406-0828 1 tech*rbawestchester.com .: NOTES Install new interior casing to specification Install new exterior casing to specification Caulk between siding and exterior trim with color matched caulking Caulk interior trim with ALEX interior painter's caulking Estimated Duration:3 days .. UNIT NOTES 103 06/21/24 Page 4 / 18 pp Order Summary dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD Dan Savitt COUNTY 104 Country Ridge Dr RENEWAL Legal Name:Fairchester Custom Windows LLC I license#CT HIC#.0667292, Rye Brook,NY 10573 byANDERSEN WC-35743-H22,Putnam#51220 . ���"""`r•' 421 West Ave,Budding 1 I Stamford,CT 06902 H (917)494.4834 Phone 203-406-0545 I Fax.203-406-0828 I techarbawestchester.com C.(914)939-0455 •• ••• UNIT NOTES EPA requires contractors that disturb painted 102 tni surfaces in homes,built before 1978 to be certified and follow specific work practices. Renewal by Andersen will facilitate the application of the budding permit to the Town of Rye Brook. Homeowner is 10 1 Existing unit dimensions 95 1/4 x 79 3/4 JOB PHOTOS 06/21/24 Page 5 / 18 4 . . 0--o o� 0 .�J L C X G c N 0 W L7� z J Z l••{ 0 = W 0 p 0 0 a 4 . . (D--O cc oz M O O � � O x W N O Q W J Z o ' cc 13 -_ , r tf. lilt M- - - :inn:.: - ��-•a.,.�.�. ar M I a.. 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Y"''•ti••:�� •`•r�ivr,• `r'':�!� ri.�,•:���`•.y.••���•. v.- �• v .�� 4>ti �S.xN J v?K!��'••.aw.'6�r'��i �fi¢o: �....r.•. •xL�' �w. �a�.i.•.- I' ,;. a .��,rh,,�c;��` s'»n,:<" "`�cum-. 'O7_� �ta:c a:>w:. n•,as:ti.•J% ` i��r./!:' h•.t•+.;-«� V�;.:v.,r"�* FAIRCUS-01 PSMITH ACORN CERTIFICATE OF LIABILITY INSURANCE DATEUrn2712 DIYYYY) 024 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: H 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 Geu of such endomemen s. PRODUCER C CT Theresa Brandon MBI Company Group LLC. PHONE., ;(203)288-0401 FA",Ne:(203 281-0414 280 State Street North Haven,CT06473 kepAglkss.theresa.brandon mb14ns.com INSURE S AFFORDING COVFRAGE INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba:Renewal by Andersen INSURER C: Falrchester 421 West Avenue,Building 1 INSURER D: Stamford,CT 06902 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 DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTRI LIMITS A X COMN.ERCIAL GENERAL uAsiLRY EACH OCCURRENCE S 1,000,000 CWMS�fADE �X OCCUR X 2516791 8H2I2024 8112I2025 DAMAGE TORENTEn s 500,000 MED EXP one $ 15,000 PERSONAL 6 ADV INJURY 1,000,000 ENt AGGREGATE LIMIT AP ES PER. NERAL AGGREGATE S 3,000,000 POLICY a%eT I_I LOC PRODUCT -COMPIOPA 3,000,000 OTHER: S A AUTOMOBILE L416I1-ITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 2516791 8/12/2024 8/12/2025 BODILY INJURY Per person) AUTOSDONLY M AIJ�TOSLEDBODILY INJURY Per accideNX AUTOS ONE A 0 Y�O of Y AMAGE $ P Dad $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 4,000,000 Excess LAB CLAIMS-MADE X 2516791 8/12/2024 8112/2025 AGGREGATE s 4,000,000 DED I X I RETENTIONS A AND E PPLOOYERS'LIABILITY X P R X OTH- ANY PROPRIETORIPARTNERIEXECUTIVE I N C 9099063 8/12/2024 8112/2025 E.L.EACH ACCIDENT 500,000 OFFICERMEMg�R EXCLUDED? N N I A {Mandatory to NH) E.L.DISEASE-EA EMPLOYEE 3 500,000 If yyaass deaDr'*under DESCRIPTIONOFOPERATIONSbet E.L.DISEASE-POLICY LIMIT S 600,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addttlonal Remarks Schedule,may be attached If more epa ce k required) Village of Rye Brook is Additional Insured as required by written contract per the endorsements Included with this certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Village of Rye Brook ACCORDANCE EXPIRATION WITH THE POLICY PROVISIO SCE WILL BE DELIVERED IN 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEW Workers' CERTIFICATE OF STATE Com Boardpensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured Fairchester Custom Windows LLC. 203-4D6-0545 Renewal Andersen Falrchester 421 West Avenue,Building 1 1c.NYS Unemployment Insurance Employer Registration Number of 421 Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain l)cadons In New York State,i.e.,a Wrap-Up Policy) Number 88-2855660 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"I a" 938 King Street Rye Brook, NY 10573 WC9a99D63 3a Policy effective period 08/122024 to 08/12/2025 3d.The Proprietor,Partners or Executive Officers are X❑ 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"3"insures the business referenced above in box"1 a'for workers' compensation under the New York State Workers'Compensation Law.(To use this form, New York(NY)must be listed under Item 3 A 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: Patricia Smith (Print name of authorized representative or licensed agent of insurance carrier) Approved by: Pa&4u� S{yy� 8-9-2024 (Signature) (Date) Title:Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 203-288-3401 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