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Home My WebLink AboutMP12-076 yE 4 . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 8,2023 Marvin Mirel Lazar& Carol Pastan Lazar 4 Westerleigh Court Purchase,New York 10577 Re: 4 Westerleigh Court,Rye Brook,New York 10573 (4 Westerleigh Court,Purchase,NY 10577) Parcel ID#: 135.41-1-2 This document certifies that the work done under Mechanical Permit #12-076 issued on 9/17/2012 for the installation of a new air conditioning unit has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building&Fire Inspector /to • 9812� BUILDING DEPARTMENT UILDING 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: H J DATE: PERMIT# \� ISSUED: \-I g7SECT: BLOCK: LOT: LOCATION: 1 " 1"T \ �C C��1 OCCUPANCY: ❑ Violation Noted HE WORK IS... PASSED ❑ FAILED 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 09/14/2012 09:20 845-628-2054 SULLIVAN INSURANCE HAUL Ul/U-' DATE IMMIDOm'YY) o CERTIFICATE OF LIABILITY INSURANCE 0911412012 RTIF ATE AC LY AMEND, EXTEND OR ALTER THE COVERAGE AFFLDER- THIS ORDED ( THE POLICIES THIS CERTIFICATE IS ISSUED AS A MAT-TER OF IN NErAT TION ONLY AND CONFERS NO RI E�gTN�SSU NGN THE ENSURER S)�AUT>'�IZED CERTIFICATE DOES NOT AFFIRMAT WELY ORBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B act!o VE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: IF trig val"llicHt@ r OI�fIan taDD IpIFAL�equIre an enoO4,3emarTt. A Statemeon on tlhis carltfcate does not IconDTer rigMs)to the the terms and conditions of Policy- car5ficate holder in lieu of ouch endorseTT><Ant Sullivan Financial Group incorporated NAME: qR B45 62B•2054 PRODUCER is (g45)628.9804 (NyNO)'� LOVU110 Assodate9,Inc. ro ■U`. 6450 Transit Road ADi2t, N41C A Dapew,NY 14043 INBURf'RLS]AFrORpfNOCOVERAOE Z7987 IMSURERA.NORTHFIELD INSURANCE COMPANY M9URED Jonathan P.Omer Heating&Air Conditioning Inc INSURER 6 303 East Lake Blvd INSURER C' Mahopac,NY 10541 INsuRW 0 INSURER E INSURE F REVISION NUMBER: RIOD COVERAGES CERTIFICATE NUMBER= THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO WH LICY PE INDICATED NOTW 6ESTANDI OR MAY auiREMNE E NSURANCo AFFORD 0 B T11E PULICIE DESCNDIT10�1 OF ANY CIOWAACTR EDOHEREIN la 8 BJECLIMENT WITH TED ALL THEIC TERMS, ER EXCLUSIONS AND CON0111ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN RED'UCI:D BY PAID CLAIMS. uMnS TY PE AF INSURANCE PO T NV ER M 1 DDD 000 09I13/2D12 09M 312013 EACH OCCURRENCE i A pENERALLIAOILMY CP5874d0 ;IRElMSE5-tcn`am1r. � S 100A00 X I CCMMERCIAL GENERA'..LIABTLXY MED EIIP(MI one?—a.l S S,D00 CLAIMS-MADE �OCCUR PERSONAL d ADV INJURY S 1 OOO,U00 GENERAL AGGREGATE L 2000,000 �1 PRODLY'TS.CDIdIP/0?AGG S 2 D00 000 GEN1 Ar,*AEGATE LIMIT APPLIES PER 9 X POLICY' PRO- F7 LDC Es ago onISINGLF I! IT S AUTQMMILE LWIUTY $ODILY INjjAY(Pe.PRW^) s ANY AUTO AODILY IN NRY(Pe,erddonq S ALLOWNED 9CHfEDULED F' YU E i AUTOS AU T03 �Pw actkenl NON-OWNED S MIRED AUTOS AUTOS ;ACWOGCJRRENGE $ UMBRELLA UAB OCCUR AGGREGATE i MMES9 LIAR r,LAIMS-MADE i DED RETENITONS .9TA7U. CTH. WO Ejr cOMPEKSATION E.L.EACH ACCIDENT S AND FVFt.9'tERS'LIAeILr'y Y 111 ANY PROPR ETORJPARTNER/Er ECUTIVE❑ N r A ''.L D'15EASF-EA EMPLOYE S OF7 Aaalory In U EXCLUDErY' ASE-POLICY lIM1T S E.L DI9E 1I S.O9.11im UM6r NS hMTM p 'RioTIOV I UaCRI NPTIO OF oPERATIONS I LOCATIONS,VFNICLPS 1Atmeh ACORD td1,AApNoncl R�rrn�6a1+eMAe. t rtgr0 AP�cv 1�ropuYe01 Job location:4 Westerlaigh Coul1 CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 111E EXPoAT10N DATE TMEREOF, NdTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISICINS- gUTuORRETI R_PR :::Ze? VILLAGE OF RYE BR�K938 KING STREETll rights 04erved. ACORO 25(2010105) The ACORD rams and logo are registamd marks of ACORD Certificate of Attestation of Exemption From New York State Workers' Compensation and/or Disability Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers' compensation and/or disability benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit JONATHAN P.ORSER HEATING AND AIR CONDITIONING From:VILLAGE OF RYE BROOK,NY INC. 303 EAST LAKE BLVD MAHOPAC,NY 10541 The location of where work will be performed is PHONE:845-628-8010 FEIN:XXXXX9883 4 WESTERLEIGH COURT,RYE BROOK,NY 10573. Estimated dates necessary to complete work associated with the building permit are from September 13,2012 to September 30,2012. The estimated dollar amount of project is s0-s10,000 Workers' Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS' COMPENSATION INSURANCE COVERAGE for the following reason: The business is a one person owned corporation,with that individual owning all of the stock and holding all offices of the corporation. Other than the corporate owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,other stockholders,unpaid volunteers(including family members)or subcontractors. Disability Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC, LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability Benefits Law.) I,JONATHAN P.ORSER,am the President with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true, that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. 1 further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN ISignature: Date: HERE-]--- Exemption; Y ficate Number f _ >,Received 20 ;-0 37 Septe n jbe��r__"�1,3, 2012 NYS Workeis; tudpnsation Board CE-200 12/2008