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HomeMy WebLinkAboutBP24-244PERMIT # Am SECTION TYPE OF WORK 10B LOCATION _ f1WNFR /";44 IT. COST CO #_� TCO # DATE: / 1 7 / a J/ .� o& C%Lo/k)es L�9007 U /'C. l Q Lt INSPECTION RECORD I DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC C] LOW -VOLT C7 ALARM C� CelreswL)oi:l�olow1 s 91=4 / 41) C ��o90c)"�lo6l �33q Pb OTHER APPROVALS ARB BOT PS ZBA OTHER tl�qua JJ V 4 �•(.0 � BR 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury �,%-ww.ryebrookny.g_ov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE November 19,2025 Greg Mann&Lauren Mann 57 Country Ridge Drive Rye Brook,New York 10573 Re: 57 Country Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 129.59-1-9 Building Permit#24-244 issued on 11/21/2024 for Replacement Windows This certifies that the fifteen new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILDING DEPARTMENT For office use only: PERMIT# f:�E — 2q4 VILLAGE OF RYE BROOK ISSUED: I ( 21 I Z 938 KING STREETS RYE BROOK,MEW, YORK 10573 DAT : I NOV 14 2025 (914)9 ,-0668 FEE• PAID wWw r - o kn ov `/U 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 *s*tssss+s***ttt*s+ssss*t*t*»*sttt»t»t**/*�*s�++t*****tst*ss+t»*+*sn*t+ssss»t**tt*ttytsttsststt++t+*sstrtrt*stt*stsssssttss*st+t++ Address: S) (CAM Occupancy/Use: Parcel ID #: 1 W-`19 w 00 Sq -Ud 1-M -0 00000//�� Zone: R IS Owner: L Awfm MAAA Address: ? [aftlfey 91q#k ow- At, P.E./R.A. or Contractor: Address: /-7& ,, CA, sq oae+,t�Y 1171 j Person in responsible charge: &ARIA Man a,Pt&f Address: 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: ,,- a vI g l& m a n n being duly sworn,deposes and says that he/she resides at ! &64h teo otd (Print Name of Applicant) (No.and Street) A /�'/ in 54 0 S ytj— ,in the County of N qj of V in the State of /V / 'that ( ty/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:$ a3 $00 qq , for the construction or alteration of: R2,/IAC1�V►-�-�— kA4 e7dL OV11J 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 D - , Sworn to before me this 1 day of M ueralzc , 20� d9Z3%z:� 2025 C> Signature of Property Owner tignature of App scant �-oa Vf Ot Mvl�tj n (Fvina Id M A n A Print Name of Property Owner Print Name of plicant Notary Publ' ota�r P is B. MANN ROSELYNNE D MIZNER Notary Public, State of New York Notary Public-State of New York NO.30-4757153 h 1 2021 No.01 M I5003432 Qualified in New York County Onalified in Nassau County My Commission Expires 0310712027 Comu-1 �wu r.:y�ues April 30�20 O - ❑I' �►I►9A I„► BUILDING DLPARTMEW XASSISI•ANP BUILDING INSPIA-Folt VILLAGE OF RYE BROOD ❑Cc►ul:linr�nc� r.an.�r t)rru;L•It 938 KING STRIXT- IlYu Bltoou, NY 10573 (914) 939-0668 FAx (914) 939-5801 w_% v_.r !Abm .or - - - --- - - - - - - - - - - - - - - INSPECTION REPORT --- - -- - - - - --- - - - - - - - Awmmss DATE: --5-7. co(A-171n.- pI:ItMIr» F3� o�� " Z�`{ Is:,t;en:f/_- �'L�ti1 �..I: -cj Iil.och: LoT:� LOCATION: � � N(��... W>N�00 ` 9, _0W_tl-&,T— OCCUPANCY: ❑ VIOLATION NO'1.1:1► •I•I11? Wolff is... (;C:IiP'l'IJ> ❑ ItEJECTL'D/ Rr:INsPk:c•r1oN ❑ SITI` INSPECTION ItEQU1RED ❑ FOOTING ❑ TOOTING 1)RAINAI;1.: ❑ FOUNDA-rION ❑ UNI)UIUMOUNU NLUMMM, NO'1'FS ON INSPECTION: ❑ ItOUGH PLUMBING ❑ Rour:H FRAMING ❑ INSULATION -� 1 ❑ NATURA 1.GAS `CQ��..6d.0 C�_-.__�►�(_,,__ r►V 09v� S av� ❑ PU L TANK ❑ I'Ulil.��ANIC ❑ Flim'S111UNKLI'.R ❑ FINAL PLUMBING -- - ❑ ROSS CONNISCTION -- FINAL a � P W 4a 1u=��� P P P P !� P P 1■� P P Pi�71=1�17N=�M7�.7r��P��� W�1� �u���i��l�P x . . i VLiny y x -b w v T-4 OV CA x 4 a .4 v r1 W a R O4-1 b (14 � y r C/] C O ro `� F. ` `� W [�] F, B u O w z Cl? w � vcac R w N F, o � r ° x ►� " •o y, � C, rj cif w � v w ono �l O w 00 ob v � vU � 0..4ro- ICI A A z WR 0 ° � � U n x �] cn [� 'n 0-4v� 3o C� w U c,/) V� R :� b 0 5 n qczze °' ~ A (.? o a p _ z a" °� O N U W OCR o � A z x b . BUILDING DEPARTMENT IE C IE U W VILLAGE OF RYE BROOK NOV 21 2024 938 KING STREET RYE BRQOK,NY 10573 (914)939-0668 . VILLAGE OF RYE BROOK www.ryebrookny.gov BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY:APPROVAL DATE: #: Z/— APPLICATTdQ*T vv *4/00— I'� APPROVAL SIGNATURE: PERMIT FEES: H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: 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 of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. Job Address: �C �/ o(/&"t y R l� P//?1 VE 14, a**- /VY 2. Parcel ID#: `!��7 �/ —V00 '^,�/Qd'����DrGone: /r r 3. Proposed Improvement(Describe in detail):A® wxboW &A&E&e W_ 4. Property O v f Address. e7e, cvU T blqlVC C 6R i1 O Phone# QZ Cell# ��7d ^�OZ� a-mail List All Other Properties--Owned in Rye Brook: Applicant: � I06_N • e�Mg � �1' � � Address: // ON Q ftS dss lU / Phone# �I?-?0?- 6/ Cell# 7 r�6�a©2i_ p e-mail R ,�/rrr/✓//����Jd l�( �t Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: O'k6CA/ JI& DCO P� iJ �� Rrd1t✓✓C iN 110A4 Address: �"1 I 0 d '5" 0 ;5;67 D / ./ Q, Phone# Cell# �17—90� �d 1 e-mail 0i"�l/ W1:0e tQV.400n {1) 6/1l2024 5. Occupant <(1-F 2-Fam.,Commeercial.,Oetc...)Pre-construction: Post-construction: 6. Area of lot: Square feet: d j -) 1'I Acres: 7. Dimensions from pro led building or structure to 1 tPries: front yard: rear yard: rt L right side yard: 100 left side yard: other: 8. 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'fl: 3`a fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I"fl: 2"d fl: 3'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:O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; ()Pre-engineered wood[PW];Located;()Floor Framing[F];()Roof Framing[R];()Floor&Roof Framing[FR];Other; 15. Number of stories: Y Overall Height: Median Height: 16, Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish:W49P , 18. Roof style:peaked,hip,mansard,shed,etc: 09 Roofing material: 19. What system of heating: I' Ole GCV *_( Ail - 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 I Hood,etc...)Yes: No (If yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detaile engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ff.or my pervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No:impervious 23. Will the proposed pf2pct require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: 4 (tf 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: (if yes,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 (f yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&siteVpan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood 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: (if yes,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: J' Indicate:TIER I: TIER II: TIER III: —(if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ / CT Note:estimated cost shall include all site improvements,labor,material,scaffolding,fiod equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimate4 cost,ag additional ee will be required prior to issuance of the C/O. 30. Estimated date of completion: (2) 6/1f2024 5EC F V E BUILDWG DEPARTMENT VILt,AGE OF RYE;BROOK NOV 2 1 2024 938 KING�TREE'r RYE BRA,NY 10573 (914)939-06638 I VILLAGE OF RYE BROOK www.rvebrookny.iov BUILDIf�!r DE1'AR E(WENT 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, La men Own en , residing at, J 1 C0_L1 li`1 A g1 e.c -N-1 Ve (Print name) (Addres here you e) 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; G`G-e �' I y 2 ,Rye Brook,NY. (Job Address) 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. �1N 0AILIf U (Signature of Property Owner(s)) Li Af ey) Moj)n (Print Name of Property Owner(s)) Sworn to before me this STEPHEN B. MANN day of 0� 20 Notary Public,State of Now York No.3 0-4757153 X1 G(iLZ Qualified inNassau County / (N taryPub1 ) - Commission Expires April30,20�!'. (3) 61112024 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 F NEWA(*K,COUNTY OF WESTCHESTER ) as; 4 4 0'fd n ,being duly sworn,deposes and states that he/Ke is the applicant above named, (print naihe of individual signing as the applicant) and further states that he is the legal owner of the property to which this application pertains, or that *he is the COftaQWK 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 Sworn to before me this day of /VeVy P1,1 6 e4'- , 201o_� day of 44 y eop e L ,20 Ty Signature of Property Owner Sign lure of Applicant Print Name of Property Owner Print Name of Applicant Nw.LZ(�— otary Pumic Notary blic I-LPHEN B. NANNt STEPBEN B. IWiANPJ Notary Public, State Notary Public, State of Newyork No.304757153 No.30-4757153 Qualified in Nassau County Qualified in Nassau County Commission Expires April 3 0,20 y� Commission Expires April 30,20 (4) 6/1/2024 BUILDING DEPARTMENT D L� v VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 JUN 10 2025 (914)939-0668 VILLAGE OF RYE BROOK wwwxyebrookny.2ov BUILDING DEPARTMENT FOR OFFICE USE ONLY: \ 1[� Approval Date:JUN 20 r ' # �—d / �/ Application # Approval Signature ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Cale# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Amendment Fee: Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. !1. Job Address: 7 �UIJ f t7'� ov!C Existing Permit#:R y 2. Parcel ID#: 74 1 7/1 I ` Zone:Z& Original Approval Date: 3. Proposed Amendment(Describe in detail): _ Q 4. Property Owner: v rGG' OL tA Of eA ` Address: 1 GOV A l Dc qR N& E 0 Phone# — —/ /O��L Cell# S —?� 91—-10 L� e-mail t.k0 V .a Applicant: &IA"I t5 C�PHIE•'1 URP — "IV MM✓/✓ Address: rW k0ft -S OS p / ' Phone#9 OZ-" �6 Cell# 516'- 1�L—a 1 e-mail�� Architect/Engineer: Address: Phone# Cell# e-mail 5. Occupancy;U-F ,2-Fam.,Comm.,etc...)Prior to construction: After construction: 6. Will the proposed amendment 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 I Hood,etc...)Yes: No 01 (if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineere plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or m re of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes: NoX Area: i 6/1/2024 8. Will the propose ndment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No:__V (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No:Ar(ifyes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: NoX— (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) `/ 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No:�(ifyes,you must submit a Tree Removal Permit Application) ` 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No:l' Ifyes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so,provide such additional footage here. No (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 6 06 (The estimated cost shall include all site improvements,labor,material,scaffolding,ffxed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y.State Construction Classification: / jll DEff`�«��N.Y. State Use Classification: 17. Estimated date of completion: 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. STA"j;E��yO/�F//�N�����NTY OF WESTCHESTER ) as: h/ ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and )he is the legal owner of the property to which this application pertains, or that (s)he is the �Q 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 Sworn to before me this day of 1 1 K c JA 20 v, day , 20 Signature of Property Owner Signature of Applicant "v��M� R���� Print Name of Property Owner Print Name of Applicant bil& ^'�VA Notary Pub'c tAy Pu rc 2 ROSELYNNE D MIZNER STEPHEN B. MANN NO Public,State of New York ►ter Public-state a New York Notary No.30-4757153 No.01 M►SO03432 Qualified in New York County Qualified In Nassau County My Commission Expires 03/07/2027 Commission Expires April 30,20 4 SPECIAL SERVICES CUSTOMER INVOICE-Continued Name:MANN Page 2 of 2 NO. H8466-251607 VENDOR DIRECT SHIP#1 (Continued) iSlOFREIGHT USTOMER S1019 1008-729-628 1.00 E1,3:400 Series Casement Unit 2:4/Unit 1,3:400 Series Y $1,331.61 $1,331.61' Unit 2:400 Series Picture Window-CW#4 S1020 0000-289-185 1.00 ESeries Twin Casement,Stationary(AII/400 Series Twin Y $795.74 $795.74' #5S10FR 0000-811-843 1.00 Y $99.00 99.00 VENDOR WILL SHIP MDSE TO: JMANN,STEPHEN ADDRESS: 57 Country Rid a dr CITY: Rye Brook STATE: NY ZIP: 10573 COUNTY: WESTCHESTER SALES TAX RATE: 8.38 "OUTNT ' $9 970.86 PHONE: 917 6894093 ALTERNATE PHONE: PAGER: END OF VENDOR DIRECT SHIP TOTAL CHARGES OF ALL MERCHANDISE & SERVICES .- - $s 970.86 Policy Id(PI): SALES TAX $835.06 TOTAL $10 805.92 BALANCE DUEI $0.00 'The Home Depot reserves the right to limit/deny returns.Please see the return policy sign in stores for details.' END OF ORDER No.H8466-251607 * Indicates item markdown Page 2 of 2 NO. H8466-251607 Customer Copy SPECIAL SERVICES CUSTOMER INVOICE Page 1 of NO. H8466-251607 ------------------------- -------------------------- Store 8466 SYOSSET Phone:(516)364-4677 111 JERICHO TURNPIKE Salesperson:WXROXCY SYOSSET,NY 11791 Reviewer: Name Hama Rt MANN STEPHEN REPRINT Add— 35 HEDGEROW LN W. P"°"' (917)6894093 G°mperry Name CRY JERICHO '°bDmaip` Awning-picture combo :2025-04-24 07:34 sob NY Z'° 11753 °oonty NASSAU VENDOR DIRECT SHIP #1 MERCHANDISE AND SERVICE SUMMARY We the oldrtocustomers9hl[o limit the quantities ofmerchandise TO: CUSTOMER S/O-MERCHANDISE TO BE SHIPPED: S/O ANDERSEN REF# S10 ESTIMATED ARRIVAL DATE: 05/16/202 LOGISTICS .#66501746 REF# SKU QTY UM DESCRIPTION PI TAX CH EXTENSION S1010 1008-729-628 4.00 EA NA/Unit 1:400 Series Awning Unit 2:400 Se/Unit 1:400 Series AwningUnit $974.76 $3,899.04` 2:400 Series Picture Window-AW#1 S1011 1008-729-628 2.00 EA NA/Unit 1:400 Series Awning Unit 2:400 Se/Unit 1:400 Series Awnin Un Y $1,024.26 $2,048.52' 2:400 Series Picture Window-AW#2 S1012 1008-729-628 2.00 EA NA/Hardware:PSA Contemporary Folding White/Unit 1:400 Y $15.50 $31.00* AwningUnit 2:400 Series Picture Window-AWAIT TO # S1013 1008-729-628 2.00 EA NA/Insect Screen 1:400 Series Awning,AR35/U it eries AwningUnit Y $89.49 $178.98* 2:400 Series Picture Window-AWATT TO #2 D S1014 1008-729-628 1.00 EA NA/Unit 1,3:400 Series Casement Un 1,3:400 Series Y $1,388.95 $1,388.95* CasementUnit 2:400 Series Pictur i W#3 S1015 1008-729-628 1.00 EA NA/Hardware:PSC Conte ding White/Unit 1,3:400 Series Y $12.90 $12.90* CasementUnit 2:400 Se' i e Window-CWATT TO #3 S1016 1008-729-628 1.00 EA NA/Insect Scre 00 eries Casement,CR/Unit 1,3:400 Series Y $86.11 $86.11* Casement eries Picture Window-CWATT TO #3 S1017 1008-729-628 1.00 EA NA/ ar r . SC Contemporary Folding White/Unit 1,3:400 Series Y $12.90 $12.90* en nit 2:400 Series Picture Window-CWATT TO #3 S1018 1008-729-628 1.0 nsect Screen 1:400 Series Casement,CR/Unit 1,3:400 Series Y $86.11 $86.11' CasementUnit 2:400 Series Picture Window-CWATT TO #3 CONTINUED ON NEXT PAGE �0 Check your current order status online at www.homedepot.com/orderatatus Indicates Page 1 of NO. H8466-251607 * CustoimerCmpydown The Home Depot Special Order Quote Customer Agreement#: H8466-240021 Printed Date:30/8/2024 Customer: STEPHEN MANN Store: 8466 Pre-Savings Total: $6,291.93 Address: 35 HEDGEROW LN Associate: WILBERT Total Savings: (Saoo) JERICHO,NY 11753 Address: 111 Jericho Turnpike Pre-Tax Price: $6,291.93 Phone: 917-689-4093 Syosset,NY 11791 Email: STEVEBM22@GMAIL.COM Phone: (516)364-4677 All prices are subject to change. Customer is responsible for verifying product selections. The Home Depot will not accept returns for the below products. ■ RO Size=381 8"x 36 7 8" ANDERSEN f / / Unit Size=37 5/8"x 36 7/8" NumberLine Room LocationNow Quantity 100-1 400 Series Double-Hung Equal Sash, $555.59 $555.59 2 $0.00 $1,111.18 AA,37.625 x 36.875,White w/White Sash/Frame:Pine White-Painted Panel:Pine White-Painted 100-2 Insect Screen 1:400 Series Double- $46.30 $46.30 2 $0.00 $92.60 Hung,TW30210 Full Screen Aluminum White PN:1610136 Version:08/05/2024 Unit 100 Total: $601.89 $601.89 $0.00 Begin Line 100 Descriptions ---Line 100-1---- 400 Series Double-Hung Jamb Liner Color=White Stool Option=None Overall Rough Opening=38 1/8"x 36 7/8" Glass Construction Type=Dual Pane Installation Material Options=No Overall Unit=37 5/8"x 36 7/8" Glass Option=Low-E4 Re-Order Item=No Installation Method=Nailing Flange High Altitude Breather Tubes=No Room Location= Installation Zip Code=11791 Glass Strength=Standard Unit U-Factor=0.3 U.S.ENERGY STAR•Climate Zone=North Central Specialty Glass=None Unit Solar Heat Gain Coefficient(SHGC)=0.31 Search by Unit Code=No Gas Fill=Argon Unit CPD Number=AND-N-24-07365-00001 Standard Width=TW30XX-RO:38 1/8" 1 UNIT: Glass/Grille Spacer Color=Stainless U.S.ENERGY STAR®Certified=No 37 5/8" None Clear Opening Width=33.875 Standard Height=XX210-RO:36 7/8" 1 UNIT:36 DP/PG Upgrade=No Clear Opening Height=13.75 7/8" Sash Lift Type=None Clear Opening Area=3.25 Frame Width=37 5/8 Lock Hardware Style=Traditional Unit Part Number=1600467 Frame Height=36 7/8 Number of Sash Locks=1 Insect Screen 1 Part Number=1610136 Unit Code=TW30210 Lock Hardware Color/Finish=White(Factory SKU=407679 Frame Option=Installation Flange Applied) Vendor Name=S/O ANDERSEN LOGISTICS Venting/Handing=AA Window Opening Control Device=No Vendor Number=60509030 Exterior Frame Color=White Insect Screen Type=Full Screen Customer Service=(888)888-7020 Exterior Sash/Panel Color=White Insect Screen Material=Aluminum Catalog Version Date=08/05/2024 Interior Frame Wood Species=Pine Insect Screen Color=White SKU Description=S/O 400S TILTWASH Interior Frame Finish Color=White-Painted Exterior Trim Style=None Interior Sash/Panel Wood Species=Pine Extension Jamb Type=None Interior Sash/Panel Finish Color=White- Page 1 of 5 Date Printed:30/8/2024 Painted ----Line 100-2 Description is the same as line 100-1---- End Line 100 Descriptions AERSEN RO Size=38 1/8"x 36 7/8" ■,"'"°°ND" °°°" Unit Size=37 5/8"x 36 7/8" cataiog Version 259 Line Number Item Summary Room Location Was Price Now Price Quantity Total Savings Total Price 20D-1 400 Series Double-Hung Equal Sash, No screens $555.59 $555.59 1 $0.00 $555.59 AA,37.625 x 36.875,White w/White Sash/Frame:Pine White-Painted Panel:Pine White-Painted Unit •0 Begin Line 200 Description ----line 200-1---- 400 Series Double-Hung Interior Sash/Panel Finish Color=White- Stool Option=None Overall Rough Opening=38 1/8"x 36 7/8" Painted Installation Material Options=No Overall Unit=37 5/8"x 36 7/8" Jamb Liner Color=White Re-Order Item=No Installation Method=Nailing Flange Glass Construction Type=Dual Pane Room Location=No screens Installation Zip Code=11791 Glass Option=Low-E4 Unit U-Factor=0.3 U.S.ENERGY STAR"Climate Zone=North Central High Altitude Breather Tubes=No Unit Solar Heat Gain Coefficient(SHGC)=0.31 Search by Unit Code=No Glass Strength=Standard Unit CPD Number=AND-N-24-07365-00001 Standard Width=TW30XX-RO:38 1/8" 1 UNIT: Specialty Glass=None U.S.ENERGY STAR®Certified=No 37 5/8" Gas Fill=Argon Clear Opening Width=33.875 Standard Height=XX210-RO:36 7/8" i UNIT:36 Glass/Grille Spacer Color=Stainless Clear Opening Height=13.75 7/8" None Clear Opening Area=3.25 Frame Width=37 5/8 DP/PG Upgrade=No Unit Part Number=1600467 Frame Height=36 7/8 Sash Lift Type=None SKU=407679 Unit Code=TW30210 Lock Hardware Style=Traditional Vendor Name=S/O ANDERSEN LOGISTICS Frame Option=Installation Flange Number of Sash Locks=1 Vendor Number=60509030 Venting/Handing=AA Lock Hardware Color/Finish=White(Factory Customer Service=(888)888-7020 Exterior Frame Color=White Applied) Catalog Version Date=08/05/2024 Exterior Sash/Panel Color=White Window Opening Control Device=No SKU Description=S/O 400S TILTWASH Interior Frame Wood Species=Pine Insect Screen Type=None Interior Frame Finish Color=White-Painted Exterior Trim Style=None Interior Sash/Panel Wood Species=Pine Extension Jamb Type=None End Line 200 Description AN DERSEN RO Size=38 1/8"x 52 7/8" ��" Unit Size=37 5/8"x 52 7/8" Line Number Item Summary Room Location Was Price Now Price Quantity Total Savings Total Price , �atai"g VC!510/I ZiU 30D-1 400 Series Double-Hung Equal Sash, $666.43 $666.43 2 $0.00 $1,332.86 AA,37.625 x 52.875,White w/White Sash/Frame:Pine White-Painted Panel:Pine White-Painted Page 2 of 5 Date Printed:10/8/2024 300-2 Insect Screen 1:400 Series Double- $56.26 $56.26 2 '$0.00 $112.52 Hung,TW3042 Full Screen Aluminum White PN:1610139 Version:08/05/2024 Unit 00 0i Begin Line 300 Descriptions ----Line 300-1---- 400 Series Double-Hung Jamb Liner Color=White Stool Option=None Overall Rough Opening=38 1/8"x 52 7/8" Glass Construction Type=Dual Pane Installation Material Options=No Overall Unit=37 5/8"x 52 7/8" Glass Option=Low-E4 Re-Order Item=No Installation Method=Nailing Flange High Altitude Breather Tubes=No Room Location= Installation Zip Code=11791 Glass Strength=Standard Unit U-Factor=0.3 U.S.ENERGY STARO Climate Zone=North Central Specialty Glass=None Unit Solar Heat Gain Coefficient(SHGC)=0.31 Search by Unit Code=No Gas Fill=Argon Unit CPD Number=AND-N-24-07365-00001 Standard Width=TW30XX-RO:38 1/8" 1 UNIT: Glass/Grille Spacer Color=Stainless U.S.ENERGY STAR®Certified=No 37 5/8" None Clear Opening Width=33.875 Standard Height=XX42-RO:52 7/8" 1 UNIT:52 DP/PG Upgrade=No Clear Opening Height=21.75 7/8" Sash Lift Type=None Clear Opening Area=5.13 Frame Width=37 5/8 Lock Hardware Style=Traditional Unit Part Number=1600470 Frame Height=52 7/8 Number of Sash Locks=1 Insect Screen 1 Part Number=1610139 Unit Code=TW3042 Lock Hardware Color/Finish=White(Factory SKU=407679 Frame Option=Installation Flange Applied) Vendor Name=5/0 ANDERSEN LOGISTICS Venting/Handing=AA Window Opening Control Device=No Vendor Number=60509030 Exterior Frame Color=White Insect Screen Type=Full Screen Customer Service=(888)888-7020 Exterior Sash/Panel Color=White Insect Screen Material=Aluminum Catalog Version Date=08/05/2024 Interior Frame Wood Species=Pine Insect Screen Color=White SKU Description=S/O 400S TILTWASH Interior Frame Finish Color=White-Painted Exterior Trim Style=None Interior Sash/Panel Wood Species=Pine Extension Jamb Type=None Interior Sash/Panel Finish Color=White- Painted ----Line 300-2 Description is the same as line 300-1---- End Line 300 Descriptions ANDERSEN RO Size=38 1/8"x 52 7/8" ' ' °°°" Unit Size=37 5/8" x 52 7/8" L atzic�g vemm�15-, NumberLine •• 400-1 400 Series Double-Hung Equal Sash, no screens $666.43 $666.43 2 $0.00 $1,332.86 AA,37.625 x 52.875,White w/White Sash/Frame:Pine White-Painted Panel:Pine White-Painted Unit 4 t •f: 00 Begin Line 400 Description --Line 400-1--- 400 Series Double-Hung Interior Sash/Panel Finish Color=White- Stool Option=None Overall Rough Opening=38 1/8"x 52 7/8" Painted Installation Material Options=No Overall Unit=37 5/8"x 52 7/8" Jamb Liner Color=White Re-Order Item=No Installation Method=Nailing Flange Glass Construction Type=Dual Pane Room Location=no screens Installation Zip Code=11791 Glass Option=Low-E4 Unit U-Factor=0.3 U.S.ENERGY STAR®Climate Zone=North Central High Altitude Breather Tubes=No Unit Solar Heat Gain Coefficient(SHGC)=0.31 Search by Unit Code=No Glass Strength=Standard Unit CPD Number=AND-N-24-07365-00001 Standard Width=TW30XX-RO:38 1/8" 1 UNIT: Specialty Glass=None U.S.ENERGY STAR®Certified=No 37 5/8" Gas Fill=Argon Clear Opening Width=33.875 Standard Height=XX42-RO:52 7/8" 1 UNIT:52 Glass/Grille Spacer Color=Stainless Clear Opening Height=21.75 Page 3 of 5 Date Printed:30/8/2024 7/8" None Clear Opening Area=5.13 Frame Width=37 5/8 DP/PG Upgrade=No Unit Part Number=1600470 Frame Height=52 7/8 Sash Lift Type=None SKU=407679 Unit Code=TW3042 Lock Hardware Style=Traditional Vendor Name=S/O ANDERSEN LOGISTICS Frame Option=Installation Flange Number of Sash Locks=1 Vendor Number=60509030 Venting/Handing=AA Lock Hardware Color/Finish=White(Factory Customer Service=(888)888-7020 Exterior Frame Color=White Applied) Catalog Version Date=08/05/2024 Exterior Sash/Panel Color=White Window Opening Control Device=No SKU Description=S/O 400S TILTWASH Interior Frame Wood Species=Pine Insect Screen Type=None Interior Frame Finish Color=White-Painted Exterior Trim Style=None Interior Sash/Panel Wood Species=Pine Extension Jamb Type=None End Line 400 Description ANDERSEN " RO Size=32 1/8"x 44 7/8" Unit Size=31 5/8"x 44 7/8" '._.taioF UcfSK)n 279 N_qmber Item Summary Room Location Was Price Now Price Quantity Total Saving s ---Total Price 500-1 400 Series Double-Hung Equal Sash, $568.92 $568.92 1 $0.00 $568.92 AA,31.625 x 44.875,White w/White Sash/Frame:Pine White-Painted Panel:Pine White-Painted 500-2 Insect Screen 1:400 Series Double- $47.56 $47.56 1 $0.00 $47.56 Hung,TW2636 Full Screen Aluminum White PN:1630171 Version:08/05/2024 Unit 00 $0.00 Begin Line 500 Descriptions ----Line 500-1---- 400 Series Double-Hung Jamb Liner Color=White Stool Option=None Overall Rough Opening=32 1/8"x 44 7/8" Glass Construction Type=Dual Pane Installation Material Options=No Overall Unit=31 5/8"x 44 7/8" Glass Option=Low-E4 Re-Order Item=No Installation Method=Nailing Flange High Altitude Breather Tubes=No Room Location= Installation Zip Code=11791 Glass Strength=Standard Unit U-Factor=0.3 U.S.ENERGY STAR°Climate Zone=North Central Specialty Glass=None Unit Solar Heat Gain Coefficient(SHGC)=0.31 Search by Unit Code=No Gas Fill=Argon Unit CPD Number=AND-N-24-07365-00001 Standard Width=TW26XX-RO:32 1/8" 1 UNIT: Glass/Grille Spacer Color=Stainless U.S.ENERGY STAR®Certified=No 31 5/8" None Clear Opening Width=27.875 Standard Height=XX36-RO:44 7/8" UNIT:44 DP/PG Upgrade=No Clear Opening Height=17.75 7/8" Sash Lift Type=None Clear Opening Area=3.45 Frame Width=31 5/8 Lock Hardware Style=Traditional Unit Part Number=1600368 Frame Height=44 7/8 Number of Sash Locks=1 Insect Screen 1 Part Number=1610171 Unit Code=TW2636 Lock Hardware Color/Finish=White(Factory SKU=407679 Frame Option=Installation Flange Applied) Vendor Name=S/O ANDERSEN LOGISTICS Venting/Handing=AA Window Opening Control Device=No Vendor Number=60509030 Exterior Frame Color=White Insect Screen Type=Full Screen Customer Service=(888)888-7020 Exterior Sash/Panel Color=White Insect Screen Material=Aluminum Catalog Version Date=08/05/2024 Interior Frame Wood Species=Pine Insect Screen Color=White SKU Description=S/O 400S TILTWASH Interior Frame Finish Color=White-Painted Exterior Trim Style=None Interior Sash/Panel Wood Species=Pine Extension Jamb Type=None Interior Sash/Panel Finish Color=White- Painted ----Line 500-2 Description is the same as line 500-1---- End Line 500 Descriptions Page 4 of 5 Date Printed:30/8/2024 ANDERSEN RO Size=32 1/8"x 44 7/8" "' Unit Size=315/8"x 44 7/8" ..a.a:og Vernon? 9 Line Number Item Summary Room Location Was Price Now Price Quantity Total Savings Total Price 600-1 400 Series Double-Hung Equal Sash, No screens $568.92 $S68.92 2 $0.00 $1,137.84 AA,31.625 x 44.875,White w/White Sash/Frame:Pine White-Painted Panel:Pine White-Painted Unit 600 • ,i Begin Line 600 Description ---Line 600-1--- 400 Series Double-Hung Interior Sash/Panel Finish Color=White- Stool Option=None Overall Rough Opening=32 1/8"x 44 7/8" Painted Installation Material Options=No Overall Unit=315/8"x 44 7/8" Jamb Liner Color=White Re-Order Item=No Installation Method=Nailing Flange Glass Construction Type=Dual Pane Room Location=No screens Installation Zip Code=11791 Glass Option=Low-E4 Unit U-Factor=0.3 U.S.ENERGY STAR•Climate Zone=North Central High Altitude Breather Tubes=No Unit Solar Heat Gain Coefficient(SHGC)=0.31 Search by Unit Code=No Glass Strength=Standard Unit CPD Number=AND-N-24-07365-00001 Standard Width=TW26XX-RO:32 1/8" 1 UNIT: Specialty Glass=None U.S.ENERGY STAR®Certified=No 315/8" Gas Fill=Argon Clear Opening Width=27.875 Standard Height=XX36-RO:44 7/8" 1 UNIT:44 Glass/Grille Spacer Color=Stainless Clear Opening Height=17.75 7/8" None Clear Opening Area=3.45 Frame Width=315/8 DP/PG Upgrade=No Unit Part Number=1600368 Frame Height=44 7/8 Sash Lift Type=None SKU=407679 Unit Code=TW2636 Lock Hardware Style=Traditional Vendor Name=S/O ANDERSEN LOGISTICS Frame Option=Installation Flange Number of Sash Locks=1 Vendor Number=60509030 Venting/Handing=AA Lock Hardware Color/Finish=White(Factory Customer Service=(888)888-7020 Exterior Frame Color=White Applied) Catalog Version Date=08/05/2024 Exterior Sash/Panel Color=White Window Opening Control Device=No SKU Description=S/O 400S TILTWASH Interior Frame Wood Species=Pine Insect Screen Type=None Interior Frame Finish Color=White-Painted Exterior Trim Style=None Interior Sash/Panel Wood Species=Pine Extension Jamb Type=None End Line 600 Description Page 5 of 5 Date Printed:10/8/2024 ho s�3�1•ilih,02 dry,IN.. a�. A1I��,�f�t=. 111111,��1 1 _ N C 't- r to C J Lu CC OA p ... O •grsl O i• � m E C C w • cc y . 6r pw o p , Aw Y y O V S N A�okiction R t` �'�'•� "CSC O Wt�. o In O F- (n aNi a w r a► � ` ' • o � � cn o � `` � as '� ,'` w Z W '� o a 1 a u o � � I•rr, ''� ACOROe CERTIFICATE OF LIABILITY INSURANCE °11/15/220'Y' 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an ondorsernent. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER State Farm Insurance NAMEA l 17 R PHONE ------.. ----. FAT( .-- - 75 Lake Rd (Arc,No.Eau;M-5 257 22900 (AIC.No):845267 2930�- im Congers. NY 10920 QnriES� --e -_-_-- uinness.com -- ------ --------- A - INSURER SJ AFFORDiNO COVERALiE-- - NAIC -- - INSURER A;State Farm Mutual Automobile Insurance ComDany26178 INSURED Green Star Development Corp INSURERS: 7 Eaton Rd INSURIERC: _ Syosset, NY 11791 INSUF"D: 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 - -- - -- -- . ..---- IM, IN R TYPE OF INSURANCE ,7I1Rfi SUB up POLICY NUMBER _ MM/DD/YYYY op EXP O A GENERAL LIABILITY Y 98 J3 9316 6 09M5=24 09/05/2025 i EACH OCCURRENCE S 1,000,000 X COMMFRCIAI CaENLRAL LIABILITY { L)AAMIDE TV RE NTEIT— _ CLAIMS MADE X�OCCUR MEO EXP(Any arie permn) $ 5,000- -' - _ .. PERSONAL 6 ADV INJURY S _ -GENERAL AGGREGATE S 2,000,000 GEWL AGGREGATE LIAR APPLIES PER PRODUCTS-COMPIOP AGG S 2.000.000 X POLICY PRO LOC = AUTONOINLE LIABILITY COMBINED SINGLE LIMIT (Es Iccidaril 3 ANY AUTO BODILY INJURY(Per person) _ ALL OWNED SCHEDULED BODILY INJURY Per accident s _ AUTOS AUTOS ( ) 4 MIRED AUTOS AUOTOSWNFD PIS LRTVDi\AAAGE _ s UMBRELLA LIAR ,OCCUR EACH OCCURRENC_F.___ EXCESS LIAR CLAIMS-MADE AGGREGATE S CIF RETENTIONS = WORKERS COMPENSATION STATU 0 - AND EMPLOYERS'LLABILITYER ANY NROPRIETOR/PARTNER&XECUTIVE YIN — Ol rICEAAEMBER EXCI U0FD7 N/A E.L.EACH ACCIDENT S (Mandatory In NH) E L DISEASE-E.A EMPLOYE S II yea dexcrtba undp EL.DISEASE-POLICY LIMIT. S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule.A more space N required) Home Improvement Contractor/Frafn{ng/Dormers/roofing/Siding/Kitchen/Bath/Basement 8 Masonary Sub-Contracting CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZ EPRES- TATIVE k ®1988- 10 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registbred m rks of ACORD 1001486 132849 7 03-01-2012 "; II \\ NYSIF New York State Insurance F.i PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE R1. • `AAAAA 113336150 GREEN STAR DEVELOPMENT CORP i 7 EATON ROAD ❑• SYOSSET NY 11791 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GREEN STAR DEVELOPMENT CORP VILLAGE OF RYE BROOK 7 EATON ROAD 938 KING STREET SYOSSET NY 11791 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2248 619-5 368847 12/07/2023 TO 12/07/2024 11/13/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2248 619-5, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:NWWW.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. RONALD MANN-PRES OF GREEN STAR DEVELOPMENT CORP-A ONE-PERSON CORP 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. NEW YORK STAT SU NCE FUND 4 1/ DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER 634775 NYSIF Now York State Insuran,c^ r--i PO Box 66699,Albany.NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0e�� 0 ^^^^^ 113336150 3 GREEN STAR DEVELOPMENT CORP 'ifr5s�', 7 EATON ROAD ❑� �3L ' SYOSSET NY 11791 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GREEN STAR DEVELOPMENT CORP VILLAGE OF RYE BROOK 7 EATON ROAD 938 KING STREET SYOSSET NY 11791 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2248 619-5 368848 12/07/2024 TO 12/07/2025 11/13/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2248 619-5, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. 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.COMICERT/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 RONALD MANN-PRES OF GREEN STAR DEVELOPMENT CORP-A ONE-PERSON CORP 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. NEW YORK STAT SU NCE FUND 7 41/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 219580373