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HomeMy WebLinkAboutBP24-252PERM R # SECTION TYPE OF WORK JOB LOCATION CONTR EST. COST V CO #C BLOC LOT, x,s ),mayo�� nn o .tea �i-o lj)Cllob- 9995 `7rrc TCO # FEE DATE - INSPECTION f�ECORD I DATE 1 NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS O SPRINKLER ELECTRIC Cl LOW -VOLT O ALARM C� AS BUILT 0 FINAL OTHER APPROVALS A ARB o✓PRAA,/ 072,)o-1l BOT Ps zBa OTHER Qy� R �tCG4°taJJ J CCU.CG.. �. �90 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.Uebrookny.uov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 26,2025 Maryann Profeta&Donna Profeta 62 BelleFair Road Rye Brook,New York 10573 Re: 62 BelleFair Road, Rye Brook,New York 10573 Parcel ID#: 124.65-1-45 Building Permit#24-252 issued on 12/3/2024 This certifies that the new bluestone treads and stone veneer on existing front entry stairs,under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to Dt v For office u e onl : BUILDING DEPARTMENT MAR 14 2025 VILLAGE,OF RYE BROOK ISSUED: /,D-3-c71/ 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: �3 Ll c3S VILLAGE OF RYE BROOK (91�4)_9+�-0668 FEE: PAID o BUILDING DEPARTMENT www,ry tlrookny.eov 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 Address: Z Occupancy/ Use: Parcel ID #: Z�7i CO —�— D Zone:� Owner: �o/✓/1iA- ��o � 7 - Address: G 2 P.E./R.A. or Contractor: / uj Address: Person in responsible charge: 714y]12 Aaddress: � �(,�'Ck_ ,rT �'fj•� 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: /h l`/nyf M . Aw-all being duly sworn,deposes and says that he/she resides at (Prin Name o Applicant) (No.and Street) in A Y /0 !< in the County of in the State of /0 y ,that (Cityfrown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ o * - 0 for the construction or alteration of: a 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 P,� Sworn to before me this day of OL , 20_L� day of , 20 ignature of Property Owner a ure of App ant Print Name of Property Owner ?? Print Name of Applicant Not ry iblic Nota Public June Wagner I June Wagner ,, ,,,t„4 Notary Public, State of Connecticut Notary Public, State of Connecticut My Commission Expires Nov 30,20 My Commission Expires Nov 30,20� — �yE[3RC�k• O� 2m F o 1932 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 : DATE: 7c� I z� PERMIT# ISSUED: SECT: BLOCK: LOT: 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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER S o n - Lrl N w r� 4 c. = vi } [� Ln V CU L , W a Lo 72 A Qy o -s C O 11 O En W C H 00 4. � - M V en � 0 � w P-4 w t; t o - �r W op c, Q F p `� U P* 0 -< ti a z vz ; cn _ w o o 0 en d 00 cn ` , J U ►a � a w a � F O o ° �� � LU � � , H v v o $ ° � H 2 w I a 74 ° C7 A z O p 7v'+ -au a ° o 4 " �� o : BUILDING: DEPMENT VIL E OF RYE ROOK D v ' 938 KING ET RYE B119"i,NY 10573 OCT 2 2 2024 - VILLAGE OF RYE BROOK B1111_7-DING DEPARIWENT FOR OFFICE USE Nov ON 2 2 LV: 9 Approval Date: i P it# d � � Application Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary ZBA Approval Date: Case# Other: t1n /� Application Fee:t//00—/06 Permit Fees: EXTERIOR BUILDING PERMIT APPLICATION Application dated: 11# Z( 7,¢ is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildin s,stru tures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 1 i 2 IF U, C7 _4 2. Parcel lD#: c i C� —� Zone: u 3. Proposed Improvement(Describe in detail): (.L i r.j ' r"Z - �-o ��+� n.'r � n-G{-� �'17���1 �� ►2-1 ?� ni`T"G,1-t -�, 0 a nj 0 le Ll�+/ f'71y r. Y:F12~t- S y R-6--ck 4. Property Owner: 4L/J A TV,. 4? e7 Address: 612 It ua,- f-p 1 Phone Cell# � ,) Z(�a Q41'G1 e-mail r4 rA c4�j C!D V List All Other Properties Owned in Rye Brook; Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address; Phone# Cel / e-mail General Contractor: J I C o C — V%d �r Address: c�p Phone# Cell# l00 7 !I-033 e-mail M 6/1/2024 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 0=,4 A, 6. Area of lot: Square feet: -1 Z 1 '3 �S ial— Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: &14= rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: z`/& 9. Area of proposed building in square feet: Basement: I'M AIIALnd fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added: Basement: 1S,fl: / fl: 3`d fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: &14- N.Y.State Use Classification: 14. Number of stories: Overall Height: Median Height: 15. Basement to be full,or partial: finished or unfinished: 16. What material is the exterior finish: 4d__ 1 17. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 18. What system of heating: A_ 19. If private sewage disposal inecessary,approval by the Westchester County Health Department must be submitted with this application. l '. 20. Will the proposed project require the installation of a new,or an extension/modification to an existing automati fi suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: Ni ('dyes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. 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:��Area: 22. Will the proposed projec require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: ("dyes,applicant must submit a Site Plan Application,&provide detailed drawings) 23. 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) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. 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) 26. 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) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER 1: TIER III: TIER III: (ifyes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: S �� . ( �(, --� Note.The estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipm n�onal fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: (2) 6/1 n024 BUILDJNG D TMENTID VIL=EET 6 OF RY OK QCT 2 2 2 938 KING R}'E BR NY 10573 Q 0 . VILLAGE Or RYE BROOK ov 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 YO,�RaK, COUNTY O,FWESTCHESTER ) as: n Q� 3J, / /�/� /-1 h11 f fit ,residing at, /�/� 71 t� All i (Prin(name) (Address where Nou live) 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; Rye Brook, NY. (.lob 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. (Signature of Property Owner(s)) b---�NIVA M 1 A (Print Name of Property Owner(s)) Sworn to before me this day of 0(_4-0 --,/ , 20_1�_ (Notary Pu rr) .June Wagner Notary Public, State of Connecticut (6) My Commission Expires Nov 30,20 6IB12024 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,&At6FT), UN Y OF WESTCHESTER ) as: D a t-J t,,l n �. 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 rp operty to which this application pertains, or that (s)he is the 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 2,1 Sworn to before me this Z day of Oc, b g-2 , 20�— day of Ov'-�lrLV 2, 20 — 4)oz 6q4-= / Z_ Signature of Property Owner ature of Applicant PR o Print Name of Property Owner rint Name of Applicant �-. At Notary Pu Notary Pu June Wagner June Wagner Notary Public, State of Connecticut [N]otarY Public, State of Connecticut My Commission Expires Nov 30,201 mission Expires Nov 30,20 (8) 6/1/2024 9 Building Permit Check List&Zoning Analysis U Address: v - i CAR G SBL• Zone Use: Const Type: / Other. Submittal Date: U 12 ZI Z�( evisions Submittal Dates: Applicant �- 1 1 Nature of Work \ ` a C Ur + Reviews•zBA: OCT 3 1 2024 PB: BOT• Other. NEED OK i (` FEES:Filing: BP: � O Flood Plane: Legalization: ( ) (q APP: Dated: L Notarized: SBL: Truss I.D. Cross Connection: H O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review Street Opening: ( ) ( ) ENVIRO:Long Short: Fees: N/A.- SITE PLAN:Topo: Site Protection: S/W Mgmt: Tree Plan: Other. ( ) ( :YSURVEY:Dated: Current: - Archival Sealed: Unacceptable: ( ) ( )PLANS:Date Stamped: Sealed: Copies: Electronic Other. License Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other: ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other: ( ) ( ) FIRE ALARM/SMOKE DETECTORS-Plans: Permit: H.W.I.C.:_Battery_Other. ( ) ( ) PLUMBING:Plans: Permit: Nat Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other: ( ) ( ) H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other: ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER C/O DENIAL LETTER Other. ( ) ( ) Other. ( mtg.date: approval• !/- Z C- L Y notes: ZBA mtg.date: approvaL• notes: ( )PB mtg.date: approval• notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Area Cirde Fro�taee: Front Front: Sides: Rear. Main Cov: Accs.Cov. Ft H Sb: Sd.H Sb: GFA: Tot.imp: Ft Im : PNjjW. Height/Stories notes: BUILDING DEPARTMENT D IE C IM W �� ] 3 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 OCT 2 2 2�211 (914)939-0668 VILLAGE OF RYE BROOK ""W' DO '`rO`I BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: � 1� )Q(j/)0 Date of Submission: Parcel ID L1, taS '/S Zone: U I u 2 I ?4A— Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT S The following items must be submitted to the Building A-p 'P 6 -n (JAj Department by the applicant-no exceptions. Property Owner: w n 1. ( Completed Application 2. ( Two(2)sets of sealed plans. (one full size (maximum Address: (o L,f 1J rL- (✓V allowable plan size=36"x 42 and one I 1"x l7") 3. (�Two(2)copies of the property survey. Phone# �Ct t L{-� 2(�o Cl GI S 4. (;)Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. ( One electronic/disc copy of the complete �>64\ � �A � tt--17 application materials. 6. ( )Filing Fee. 4 k o(..) _ Address: 2-4G S tLt,j�jGUt-- S;T Mr' 7. ( )Any supporting documentation. Phone# �� Cl Ci o o �j 3 G'�— 8. (,-1 HOA approval letter. (ifapplicable) 9. ( Photographs. Architect/Engineer: 10.( )Samples of finishes/color chart. (a sample board or N/� model may be presented the night of the meeting) Phone# I By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit j Instructions&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 2- 1 Sworn to before me this 2 day of d!/jU h , 20��— day of ��- , 20_2G¢ signature of Property Owner gnature of A c nt Print Name of Property Owner Print Name of Applicant n Nota Public No Public June Wagner [II June Wagner \ Notary Public, State of Connecticut Notary Public, State of Connecticut \ My Commission Expires Nov 30,20 2 My Commission Expires Nov 30,20_ a r- IT i/v ,Srta N ve n T> 6 6/1/2024 r IDiL �`"4AWkFl A 0CT 2 2 2024 September 18, 2024 p VILLAGE OF RYE BROOK BUILDING DEPARTMENT BelleFair ARB " 24 Bellefair Blvd , Rye Brook, New York 10573 Donna Profeta 62 Bellefair Road Rye Brook, New York 10573 Re: Installation of Two - Inch Bluestone to Front Porch Treads and Concrete Porch and Steps Et Horizontal Surfaces; Application of Thin Stone to Front Porch and Vertical Surfaces; Et Replacement of Existing Concrete Caps With New Bluestone Caps At Wall Dear Donna, We write in response to your request to the ARB for approval of the installation of two-inch Bluestone to front porch treads and 4oncrete porch and steps and horizontal surfaces; application of thin stone to front porch and vertical surfaces; and replacement of existing concrete caps with new Bluestone caps at wall situsted at your home situated at 62 Bellefair Road, Rye Brook, New York. We are pleased to inform you that based upon the details of your application, your application has been approved. Once this installation is complete contact our FirstService representatives, Rafael Reyes or Michael Napolitano so that a final inspection may take place. Please be advised that our approval will be expressly conditioned upon your continued compliance with Schedule D of the Declaration. Accordingly, if the aforementioned fails at any time to comply with the Regulations, the ARB reserves the right to direct modification or the removal of the improvements at your sole expense to ensure compliance. Please note that approvals are valid for one year as of the date of this letter. As a reminder, certain alterations will require the approval of the Village of Rye Brook's Building Inspector or Engineer. You shall be responsible for obtaining all required approvals and permits. The Village of Rye Brook will consider applications after BelleFair ARB approval is given. The Village of Rye Brook approval does not preclude the need for ARB approval, nor does ARB approval relieve you from any responsibility of obtaining Village of Rye Brook approval. If you have any questions, please do not hesitate:to contact us. Very truly yours, The BeReFair Architectural Review Board y Village of Rye Brook ML MR Agenda FB SE Architectural Review Board Meeting AC AD W Wednesday,November 20,2024 at 7:30 PM Village Hall,938 King Street JM SF 1. ITEMS: 1.1. ARB24-128(Consent Agenda) Pei Wang&Yu Zhu 1 Brookside Way Rooftop solar array. 1.2. ARB24-129 (Consent Agenda) Donna Profeta&Maryann Profeta 62 BelleFair Road Bluestone treads and stone veneer on existing front entry stairs. Consent Agenda Approvals: Motion rVV1 Second lVk Abstention Aye; / Nay; Adjournment; Notes 1.3. ARB24-130 Christopher Ware&Anita Ware 3 Terrace Court Second story addition,three dormers and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.4. ARB24-131 Robert Gordon-Brown&Jennifer Parker 33 Woodland Drive Raised patio terrace with retaining walls,outdoor kitchen,and pergola. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 1 of 3 Architectural Review Board November 20,2024 1.5. ARB24-132 Adam Polay&Bari Polay 31 Mohegan Lane New front door,rear deck and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.6. ARB24-133 Pak Yun Chan&Jaclyn Chan 745 King Street Roof over existing patio. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB24-078 (Amendment to Approved Plans) G&G Homebuilders Corp 18 Rock Ridge Drive Exterior elevation changes. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB24-134 2 Elm Hill LLC 4 Elm Hill Drive In-ground swimming pool,patio and deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 3 Architectural Review Board November 20,2024 1.9. ARB24-135 2 Elm Hill LLC 345 Betsy Brown Road In-ground swimming pool,patio,deck and chain link fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: December 18, 2024 Page 3 of 3 �; � � S 11 �I G1 I e David Stafford From: David Stafford Sent: Friday, September 13, 2024 3:39 PM David Stafford Subject: Profeta - neighbor' front porches _ Y 1 ' r ;e *wd Dave Stafford Project Dibico Construction, • • 1 . 1 • www.dibicoinc.com J 4 w 11/A ' rr rF" ..• 1. rfLri.. IL i• • �� . ; , ~ 4 i�,r� � 1d ice+i+.- � Via! �i �_'t �• • +ice `T 1 ;r '" � y�� +� yam. = • ..�H�r ��Tr:�"•"'A' '� i'.AN-`n�• '\��~{ A'� '�� ��'�+} A�y, , : A •. 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'3 ► '#.. yk / t .y�� _ �; tt ..�'. ;f 1'y�' 'tt--3^,s-r.-1`�rf t-c ir••,y,�� •�1 !.<,r;• �•.. n,t.,�. •tilftlrltc �,j;./,i. #{�•;�. `�1 •t DIBICON-03 KSEARS ,acoRO CERTIFICATE OF LIABILITY INSURANCE P"12131'2024 DD/YYYY) 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 NQ TACT Acrisure New England Partners Insurance Services,LLC PHONE �,(203 699-4500 FAX 10 Research Parkway,Suite 400 ) (A/C,No): Wallingford,CT 06492 Ap AIL INSURERS AFFORDING COVERAGE NAIC S INSURER A:Selective Insurance Company of America 12572 INSURED INSURERB: DIBICO Inc. INSURER C: 803 Woods Brooke Dr INSURERD: Mahopac,NY 10541 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POUCY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx-1 OCCUR S 2510758 9/9/2024 9/9/2026 DAMAGE TO RENTED 500,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑jpa LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Per arson $ OWNED SCHEDULED AUTOS ONLY AUTOS SSyWy BODILY INJURY Per accident $ AUTOS ONLY AUOTOS ONEDY PROPERTY accident) GE $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE 1,000,000 EXCESS LIAB CLAIMS-MADE S 2510758 9/9/2024 9/9/2025 AGGREGATE $ 1,000,000 DED I RETENTION$ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITYSTATUTE EIR Y C 9097597 9/9/2024 9/9/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE r N/A WE.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? andatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured if required in written contract per form CG 73 00 06 22 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) o ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Dibico, Inc. (203)618-1232 803 Woods Brooke Dr Mahopac,NY 10541 1 c.NYS Unemployment Insurance Employer Registration Number of Insured 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 13-3818316 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 of America Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box"l a" Rye Brook,NY 10573 WC 9097597 3c.Policy effective period 9/9/2024 to 9/9/2025 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"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 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Gale Roman (Print name of authorized representative or licensed agent of insurance carrier) Approved by: C oa>` ���� 12/3/2024 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: (860)461-1441 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers area authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov T't I r, KI e, 071 __ _ %A i n n A e) ,, �a s f 02 ` 8ti L of Areo-- ( r ) •l YQx � i � V Y p ' , 1 f E • �� .. � �1"7P:`P � �weeaeaxlay.^meama..n.[aswle..".[4'fTe!>tcJu.Nbb:nwio.cT :w^S9'e:q OCT 22024 v� o �urf P}. 1 o/ 129p re P) a re d f o r- Vi'LLj-"-`k,GI,:'- 0F­'- RYE-- r p y �. __ �[:9AJl@4+T.Mpri:.V[!'1.:. R.G U4WA^.[{Y:[M:tC1Y:19T'.C">oLLxtiYC IILOOK � A L I B �» �� t N_ f ""w.... R cum, rH a� a w.V_. y 1n the Vol I I a g e of Nzy B ro o k Tc) w n o f FR y e Westchester County, �I.Yo ScaI 1" Sep-t-M 302 19-99 Foundolion SurveySurvey and eel -cation added ✓u/y /2, 2000. The ,oremllges being Lot 62 as shown on o mop entitled 'Revised Subdivision plop of t9e/%fair preoareo' for the Sel/efoir Horne & Land Compony " dated Dec. � Feb. P 1999 and f%d April 12 1999 as County Clerk Atop No. 26J.. 9 Certified to Firs/ American Tif/e Insurance Compony of New York Slafen !s/and Savings aonl- and Gi/ Rmolefi and I1/en Z. F/mol&A Nolte - U�'i/ify information shown hereon vs ,oar Coun y Clerk Mop No. 26190. 21noudhorized a/lero/ions or oodo'ilions to a survey rnao is a Yio/alion of seclion 7M9, subvision 2, _of The New York State Education 1 ow. "only cooies of The original survey marked with the /and surveyors inked or embossed , sea/ sho/I be considered a true and va/id copy " '�7erlifi'calions 1�7dicoted hereon SI, 2nify that Phis survey was prepared h7 accordance with the ' e,Visfing code of ,practice for L and Surveys oo'aoteo' by the New York State Association of Professional Land Surveyors Said certifications sho!/ run to The arson for whom . V p o the survey �s prepared only, and on his behalf to the Tit/e Compony, governmental agency and /ending �hstifulion /sled hereon, and to flee assignees of /he Ienodll�g insfi?ulion . CERT/f/CATIONS ARE NOT rR14NSfERABLE TO ADDIT/ON,4L /I�ST/TUT/ONS OR SUBSEOUFNT OMN' CRY . " 75 &pmaroneck Avenue Copyright l'cJ 1999--2000 Ward Carpenter Engineers, Inc. All Rights Reserved. �f/hif�' f�/pins, 1, Y. 10501 Job # 39881-41279-•41412-419.43 BELLE LOTS LOT62.DWG- M 157 tJ S l o n! S � 1. 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