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HomeMy WebLinkAboutBP25-023PERMIT #—C DATE: SECTION a�i �� BLOCK op M=Q LOT t. TYPE OF WORK % O / �Q ®/)S XiS e7 7`� P �1ai k % 3 �d�loa�c /� JOB LOCATION e PS / Vel? L/C � 1/ OWNER %�U�i- r�o OLc)!JE/,�C 8( j(�`S�G�je'S %fie LLC C/y)�.05 /'70c) CONTRACTOR i✓7P �Y /7 - ` I Z�j C /y� a�'S `�v o ` T. COST-� (�� 00 FEE TCO # FEE DATE DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION L Pl7fV#BfN6--�_ RGH PLUMBING GAS D / SPRINKLER ✓� $,dui-s ELECTRIC � � , LOW -VOLT ALARM _L V AS BUILT FINAL 6640 - ©3H R"Zadi Of 1 c "7/(f 0 � J � l,(ia is h � �► C- C OTHER APPROVALS BOT P8 ZBA OTHER -cc, LealeX 151as VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-085 Catificate of ®ccupaucp This is to certify that ToO—EOO Ouv-?er L of, RigP-)Ynn'k' N , having duly filed an application on 201. 5 requesting a Certificate of Occupancy for the premises known as, S00 S 0k2fn1)e Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: / Block: J Lot: 49 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No J , issued '?/ 20 c�5, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: &t3l,nas� y(.�(J�" J Construction: for the following purposes: ��� Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be e, and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the buil ' g be moved from one location to another until a permit to accomplish such change has a obtain the din spector. Building Inspector,Village of Rye Brook: Date: JUL 15 TM Qy� BR << i . 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.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 15,2025 760-800 Owner LLC PO Box 349 White Plains,New York 10605 Re: 800 Westchester Avenue,Rye Brook,New York 10573 Parcel ID#: 135.82-1-2 Mechanical Permit#25-014 issued on 2/7/2025 for Fire Sprinkler System Modifications This certifies that the fire sprinkler heads,installed under the above captioned permit,have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BRA 4' F.co c+P j v�u . 19 i l7 Cc��t,uvy 4 JJ,c,c,vW v `C 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.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 15,2025 760-800 Owner LLC PO Box 349 White Plains,New York 10605 Re: 800 Westchester Avenue, Rye Brook,New York 10573 Parcel ID#: 135.82-1-2 This document certifies that the work done under Mechanical Permit #25-037 issued on 3/21/2025 for the installation of new ductwork and diffusers have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to RECENE �p}R���>`` BUILDINd'WR YR MENT For office Use on1- MAY - 8 2025 VILLAGE OF RYE BROOK PERMIT# 3 ISSUED: ;2 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: VILLAGE OF RYE BROOK (9149068), 32- 6 FEE: DING DEPARTMENT PAID BUIL ww-w.r},g�ilropkt3y.g-ov r , 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 stssssss►rrts+ss+srsssr+++ssssassrsrrs+sss+sarrstssssssssrsrsssss++sssrrssrsss+sasssssss+ssrsrssrs+ssssssrssrs+•+ss+srsrsrrss Address: 8OO yV fSfCVy-Sfcr 8VC,(]ue- Occupancy/Use: Qffl Cf, Parcel ID#: &;i S(I e-�S L NUP 13 -1 13 S. a-1-a Zone: Q '.). Owner: UUibI'CkStei' PVe- LAC. Address: P.U. 66A NQ' Whl to & �,p y/D(aQS- P.E./R.A. or Contractor: SO e;oe- fit. Core. Address:C 0, &Z 3 yq /eft(15� y 1 b k 0S" Person in responsible charge: 1�t L01 Q T11 C Address:P�, &)X 3 yG]f LA-fil j I 191011)s. U y /Qb 6j' 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: Q( m Q(1(1 GQI I being duly swom,deposes and says that he/she resides at O, g( 3 l ,fJht (Print Name of Applicant)a (No.and Street) in White_ euinS intheCountyof in the State of NY that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ 1 00, 0 o 0 for the construction or alteration of: 00(z S f N e Q n .3 rC w r — 9 town rtlW n 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 Kati Sworn to before me this � t day of , 2025 day of /"1geQ , 20 y, Signature of roperty Owner Signature of Applicant Mc,r-bc, W�dnoa Mar-i-hp Wo Print Name of Property Owner �— Print Name of A t I�t^w•a� � 92��w,.9t�. Notary Public Notary Public Mohw msd Rahman Mohammad Rahmen 6/1/2024 Commission#OIRA0032973 CommissiW OtkA0032973 Notary Public State of New York Nosy Public State of New York My Commission Expiration:01/17/2029 My Commission Expiration:01/17/2029 QyE BRQ), cu � 1982 BUILDING DEPARTMENT J3 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 : 1�\\ DATE: PERMIT# , ` i ISSUED: —�' SECT: BLOCK: LOT: LOCATION: 0C < ` f � l��T � 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 0 FINAL ❑ OTHER QyC BRcb, • 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.or� - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - -- -- - - - - - - - ADDRESS : DATE: i—2-'-(,\-2g!:) PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: y' ❑ 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 QyE BRC�j�• O�` tim �• 1932 � BUILDING DEPARTMENT ❑BUILDING INSPECTOR L�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 :_,,;_ Co ) J DATE: PERMIT# Q1 �� oZ'� ISSUED: 7' Z SECT: �L BLOCK: LOT: LOCATION: St��..2 �� 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 3,4 L e. ` L ❑ OTHER vt r old w o _° a O o c eq N N n m a� n N ° N q44 14 0. v, a� � z a . Cl� o a p � $ x - y 4 Q W t� N z W , O C!) CN c� H O cli u ram, a d o 'a O n doot,, � a -0 Lin r. LO 0,04 oo AO O0-4 i abi a W w Q W p 0 Ln 1� A C7 cn 1-� co U o � O V Ucy a ram\ Fez++ u wd ° � � t'' ' " -0 zOz� .ti � '° 10 ~ a o a° E.-o q L = H W Z O W. o,,.M a d H p z � ,�d 0 �4 V U V 2 W I © a >+ a rn > a c O Z A W cw) d := 00 q W z d C � '� o � .. 0O W W a a c, a. a_ 5 Bum D�N MENT D ECEFY-E VIL E OF R OOK JAN 14 2025 938 KING ET RYE BR NY 10573 VILLAGE OF RYE BROOK W e ov BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: !� Approval Date:--RB 9 4 207s Permit#: ��` Application Fee: Approval Signature: Permit Fees: Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance ofa Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. L Job Address: WO W6 (!� tzr A VC°nuC SBL: IJS_ a II f Zone: 062, 2. Proposed Improvement.(Describe in detail): Minor M o d i f 1C(i tl o n S -[) c,K i S-d n q Of 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic f e suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(i fam.,2 fam.,comm.,etc...)Prior to Construction: C, M(YlULJaAfter Construction: CC)( 1Wr-C 0 1 6. MY State Construction Classification: N.Y.State Use Classification: 7. Property Owner: %DQ VVA the( et- AVe,., LL(. Address: PQ 6OX 3qq. A)hl,te el(slns, 0? IL)b@S Phone# Cell# email: N I(I(,Lc0 rr w Q roa.f O() 8. Applicant: 5-0 Pine' St. Corp. Address:�'Q R ox �99 Tli it' FL)S, Phone# q 1 W- W `1 -1 O0 Cell# email: 11'l m d d►-;g� C���_a P 9. Architect: st-efao u corelo'r (l I Address: 34 n6ll W6()d W, Li fP_ 0,3, Vi1111If QI(a 46,N1' A Phone# q J q - y3.7-%Tq Cell# email: Me 000 CQ(CQ(P,I11-- es+gn.con) Iowa 10. Engineer: 1I/A Address: Phone# Cell# email: 11. General Contractor: O Not t S - c G r c. Address: P 0 90A 3 99. 141 hi le, f 10i 0S. d b(- Phone# I ll-D E-)7 0 0 Cell# email: J 1-1 I0k" roue .CUm 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: /�'1 n� Finish: J I f (1) 6/l/2024 BUILD MENT D [E C IE ��E VIL E OF RY OOK ,�QIV 14 Z0ZrJ 938 KING ET RYE BRO NY 10573 d. S �ok VILLAGE OF RYE BROOK kn 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 YORK,COUNTY OF WESTCHESTER ) as: I, n Car I'OCa m rI d n G a l ,residing at, PC) R OX 3W q, WO; he_ P IO I PO, N E 1 U 60S (Print name) (Address where you 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; DO V\J-61Lr fS± I' (AyenVt ,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. 711 (Signature of Property, er(s)) (Print Name of Property Owner(s)) Sworn to before me this I day of 20 2- k, (N blic) JANET A HERTEN '.OTARY PUBLIC-STATE OF NEW YORK No.01 HE6085824 (2) Qualified in Westchester County vl�;�-ommission Expires 01-06-2027 6/t/2024 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: M(1� 'Y1-(:1 can ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as tKc 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 _a) P NY S1, Ca 0 , 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 n , 20 day of Za n�c: , 20 Signature of perry Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Q I V taty Public tary blic jANET A HERTEN �IOTARY PUBI.iC-STATE aF NEW PORK JANET A HERTEN No,O1 HE84BS624 NOTARY PUBLIC-STATE OF NEW YORK Qualified in Westc Coun" 7 No.01 H E6085824 YComissionExpies 0106202 Qualified in Westchester County h -,,AV Commission Expires o1-06-2027 (4) 6/1/2024 i1 a t � _ M , N N N N N a/ p q OL Ux ~ ' W • p n rn 0-4 00 tc 4-4 00 �n o z w en o w 3 ter' C7 v M00 WZ r C\CN " r•a M W pA � '� `" � � � C7 A �- z U � w w a � � M z o F Fr W o00 n a z � ? c 8 C. o i 601). aCn q O �- ' 00 z w z e ca �I as al z as X. _ a BUILDING DEPARTMENT � E C E� V C� VILLAGE OF RYE BROOK JAN 31 2025 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK \v\vu.ryebrookny.�v_ BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: J EP#: v Q� s Approval Date: 5 Permit Fee: $ 4R,��o^ Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1 1.Address: D O \VJ� �`� � `t�C^UC_ Sll'BL: 43�i O Q 4-1 C Zone: 2.Property Owner: Z Q o (;vc v J!-J Address:n n&,$) Wo f�±(,\KJY^ Phone#: Cell#: 1 of email: 3.Master Electrician/Licensed Installer: Address: Lic.#: 15 3 o Phone#: q y 3 F,"Cell#: email: P4 bG e 1C-L'}Y'\CA Company Name: bG ct SO, E C o Address: 3 =LL_ l�lGfiOv J,��5 n �J 4.Proposed Electrical Work/Fixture Count: 11A &k,9\ e-U/ L t of �� --14--J`( o u 11 G� e L ^\ I f`CE 5.31 Party Electrical Inspection Agency: STATE OF NEW YO COUNTYjK�,�n OF WESTCHESTER ) as: I (i��A N_f —+ �f'��',1' �g duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signin s tthe applic4nt) , state that(s)he is the l� �-Ir C 1 O w for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn t9-before me this '9 \ day of ,20 day of 20 Signature of Property Owner Signature f Applicant Print Name of Property Owner in ame oVf\lA�p�pJli^can�tx\ Notary Public Notar�d >sElite of New York No,01ME6160063 6/l/2024 Quallfled In Westchester County-?, Commisslon Expires l�nry 29,2 STATEWIDE • Service With Integrity 1:1 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOBAPPLICATION tel845.202.7224 • • 1•2 SWISNY.com SWISTraining.com Office Use Elect.Permit# � � � Date` Bldg Permit# ��— ��� Utility ID# Final Certificate# City/Village Zip Township County r Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number Y ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information 1ECEME DD - JAN 31 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by WAS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional Items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,owner or authodzed agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services C-0k]) 1080 Main Street F21, 12524 02REMcAYE- -8 2025DD 845 202-722424 Phone 914-219-1062 Fax STATF WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com Service With Integrity BUILDING DEPARTMENT Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Rabadi Electric Corp. 760-800 Owner LLC/800 Westchester Avenue LLC Khalil Al Rabadi 800 Westchester Avenue 368 Illington Road Rye Brook, NY 10573 Ossining, NY 10562 Located at: 800 Westchester Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-034 135.82 F-1 j 12 Certificate Number: 2025-3157 Building Permit Number: BP25-023 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 800 Westchester Avenue, Rye Brook, NY 10573 Suite 301 Brown & Brown was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 7th day of May 2025. Name Quantity Rating Circuit Type LED Luminaires 14 Light Switches 06 Power Receptacles 14 Smoke Detectors 08 Horn Strobes 02 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. i + + i + i i + V 00 ` OI N N s � + PLO �p rT, N N G + i M M x � CA � rr W � y✓� � i. '.7. _y O I+q Lr) z00 a f u � $ - d , VTdF = N (� 14 pNp V tryLn 'IT O N W O�, CA ' Ro co O �F� W 00 `i' z W r O J R" ' V Z .i Z O cn U z z iz 00 CN 94 ell04 ¢ 9 N f�G fs1 G ' rT, p C , F1 o ° o i z 0-4 z A. �. A W V) Uw CIA Q ¢ 0 � _ D C E,�V% BUILDING DEPARTMENT �I VILLAGE OF RYE BROOK MAR 2 5 2025 _j 938 KING STREET RYE BitocK.NY 10573 --- —� (914)939-0668 Fc(9t4)939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT «-WN .rV64iovk- r ELECTRICAL PERMIT APPLICATION Westchester County:Master EIectricians License Required FOR OFFICE USE ONLY BP#: o LP ;;: �•s— d �y Approval Date: Permit Fee: $ //�" c Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 3 s hereby made to the Building inspector of the Village of Rye Brook NY. for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures ,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed,,ill be in conformance with all applicable Federal, State,County and Local/Codes. 1.Address: SBL:/,55r SA— — a Zone:0 2.Property Owner: � Address: Phone T: / 7y0 Cell i': email: 3.Nlaster Electrician: Address: Lic.0: Phone 9: Cell a:9/, • 7&1 _7,W—email: Company Name: _ 4.Proposed Electrical Work Fixture Count: j;-§++;§:f+y.'..;i.;ry.�:yc:+:7rn-t:c+:t.:§�i:9rWWW4:WAY W9rWWWW kYt ie�C ir:YWWirW*Wir**fir Wyk aY i:l:WWW WWiX:iic%ic ictWWkic is i.'i it itx x9:9:WW kWaiWxW WxW:§WWit ict:§ic ';'I-ATE F VE ORY,,COUNTY OF TER ) as: 7 being duly sworn,deposes and states that he.'she is the applicant above d.and does further (print name of individual Ti ing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)hc is the for the legal owner and is duly authorized to make and file this application. (indicate arclut ,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his her knowledge and belief.and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&:building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this worn to before m this day of ,20 day of. 20� Signature of Property Owner Si pp t Print Name of Property Owner Pr" am o it Notary Public KIMBERLY JA KSON NOTARY PUBLIC,STATE OF NEW YORK Registration No.01JA6324279 Qualified in Bronx County Commissior Expires Ju 11,2027 ;,1� a STATE WIDE INSPECTION SERVICES, INC. 080 • • SWIS JOB • 062 1 SWISNYcoml SWISTRAINING.COM Othr.-us,, Elect. Permit ��� Date) Bldg Permit # BP 25-023 Sq Ft Plumbing Permit Final Certificate x City/Village RYE BROOK Zip 10573 Building Dept. County Address 800 WESTCHESTER AVE Cross Street Section Block Lot Owner Name/Address(°different than above) RPW GROUP Contact Number 0 Basement ❑1st FI. ❑2nd FI. ✓❑3rd Fl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 13P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# [:]Con Ed ❑NYSEG ❑Central Hudson ❑Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect )unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑Safety Inspection ❑Consultation Scope of Work 51 VOICE/DATA COMMUNICATIONS POINTS - BROWN & BROWN 3RD FLOOR p ���I� 1 r LARm 2 5 2025 t VILLAGE OF RYE BROOK BUILDING rPPARTMENT This application is valid for one i 1)year from the date received by SMS Thu application is intended to cover the above listed items to be inspected.it at any time of insneclioo additional item•,have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected The applicant dertares that there is no open applications for the above address with any other,nspe"asin romtsany The applicant.owner a authoitzed agent agrees to all the above terms and c.-mditrons as set for th for the appirral'oo Email Address KJACKSON@TELWORX.COM Name KI J K --- License# N/A-LOW VOLTAGE Date 3/25/20 Signat Z Address 800 WESTCHESTER AVE City/State RYE BROOK, NY WOO 10573 Company TELWORX COMMUNICATIONS Phone# 914-761-7600 DFCIcL StDate Wide Inspection Services CADD 1080 Main Street JUN 2 6 2025 Fishkill, NY 12524 Tb U S — 845 4-219 1 Phone VILLAGE OF RYE BROOK 914e(&swi ny. Fax STATE WIDE INSPECTION SERVICES Email: officeCa>swisny.com BUILDING DEPARTMENT Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Telworx Communications 760-800 Owner LLC Kimberly Jackson 800 Westchester Avenue 800 Westchester Avenue N-347 Rye Brook, NY 10573 Rye Brook, NY 10573 Located at:800 Westchester Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-084 135.82 1 2 Certificate Number: 2025-4334 Building Permit Number: BP25-023 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 800 Westchester Avenue, Rye Brook, NY 10573 The Third Floor Other : Individual offices,conference rooms, receptionist,desk,chemicals, IT room were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 25th day of June 2025. Name Quantity Rating Circuit Type Voice/ Data Locations 51 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. a L O NC W y _ � - L U L x °- x F- Coll o _ o 00 Ln en C 0 co l v W hl v' 7 ,r 0 � w Q V O 00 CN -84 a r b a o _ z \ 3 F� =I 11 r W PLO r , 06O O � y U en 7 it d`v C R u z o w u a Z) • BUILDING DEPARTMENT D C IM V VILLAGE OF RYtPROOK JD MAR 18 2025 938 KING STET RYE BROOK',NY 10573 : J (914) 9-0668 VILLAGE OF RYE BROOK w-*yw.ry r'0o"y.gov _BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: c�).S— O 3 7 1 Approval Date: MA � 20 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) *,t****,r******,r*,t****+r******ww,r*****,r,r,r*,t,r,r,r,r,r*,r***,r*www**,r**,r****,►*************,r****,t,r*,r**,rwntrr**,r*,t*ww* DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL= $150.00/unit • COMMERCIAL =$450.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice required) 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. Application dated,3111i7_5 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. 1. Address: Up k.Je t3kaltw AW • Zt4,%0( SSBL: y35,n A Zone: 2. Property Owner:040•&p Ck.►Aal t , r /ft0%J& , Pw_ dress: fl2&r IM („ K'q Q1pO.W Phone#:( 6kl?, -�'�aa Cell#: email: 3. Contractor: OAg _mai wa % Address:Qb J6yr 76M%f;sc&;%%m, Phone#(WW 1 R{,Gy Cell#:CZD5)'A_S%o3 email: 4. Scope of Work:New Installation(W)•Replacement( )•Removal( )•Other `~- 5. List Equipment: V-kw&xU y _ p& Xgamd In acLo* c impdwk L';slje - 6. Location of Equipment: r�OOt �f..'�.f1A U�etrs.� ;%<m 7. Method of Installation/Removal(list all equipment needed to perform job): LGA� oQ& k!t6 kim &C, Inn f w &X JL C Co ski and ftm &&WK 1 6/1/2024 STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: t+dsep 7� �e� being duly sworn,deposes and states that he/shris the applicant above named, (print name of individual signing as the applicant) and further states that(s)hc is the Heating, Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of hi0sep knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code, the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. Sworn to before me this I K Sworn to before me this I� r day of 20 day of V1l,&R1IlPA 20 'IS _ siq&M ohsapem Owner SigUature of Applicant Print Name of Property Owner Print Na of A I' t C C�a �` QNERtt��� i ( t lr✓ `gip •... �� ?Notary Public �`��, .'No T?i�ta folic JANET A HERTEN PORK �Z;'NO.O1CU6367294 Z= STATE OF I�E�1� =C): QUALIFIED IN :O— NOTARY PUBIC _ :DUTCHESS COUNTY; No 01 HE6085824 County — COMM. Exc r �/Jestchester ��, tt-13-2025 Oual ifled in n Expires 01-06-2027 P MY�ommissio UgLtG.• OtF tN Er`I t\y��`�`• Ihi, application must be properly completed in its entirety .,In.l 111011 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 nol properly completed in its entirety and%ot not properly signed shall be deemed null and void and will be returned to the applicant 2 61trmu O N a � N N N \ - x \ N rA ' r.4 W w A W vi u rA pp o p v� a; N W 0 old O ( - 4a^ � f• 3 u bACD tn 00 , u o � W � U fs, oo V a =4 ,� t u1 � 4 FBI V) fl 1^u � �/ �y W M.I O CN W Y Y Q r r� O / E u W .. U 2 H w N - F Cc zgv U 3 v = a V O C ''" A z a ' A a z E x ° � t BUILD MENT R Q DD VI E OF RY OOK 938 Knvc ET RYE BR plc,NY 10573 JAN 2 8 2025 (914)9" 9l4)939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION /FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: -��� Approval Date: FEB 0 tug �� mpft: C 6— d-Application Fee:$ Approval Signature: Permit Fees:$ lJ Disapproved: RZ Other: Application dated: 1/28/2025 is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: 800 Westchester Avenue, Rye Brook, NY 35st 2. Parcel I.D.: / f Q 4 / — cam- Zone: 0,6 C 3. Proposed Work(Describe system in detail including suppression agent): Modify Existing Sprinkler System for office interior alterations(Sprinkler Head Relocation) 4. Number&Types of Fire Sprinkler Heads: 19/ Reliable G5-56 Concealed Sprinklers 5. N.Y State Construction Classification: N.Y. State Use Classification: 6. Estimated Value of Job: 5,000.00 (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may be donated gratis.) 7. Property Owner: RPW Group Address: 800 Westchester Ave.Rye Brook Phone# (914)285-1700 Cetl# email: nilli@rpwgroup.com Applicant: Hang Fire Sprinkler Co. LLC Address: 106 Dakota Drive, Hopewell Jct., NY, 12533 Phone# (845)475-2390 Cell# (845)475-2390 email: jeff.anjos@hangfire.cc Architect/En&eer: Fire Protection Design Address: 14 Denver Road New City NY Phone# (845)721-9835 email: mikena,fuUrotectiondesign.net General Contractor: Address: Phone# Cell# email: l 1/30/2020 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Jefferson Anjos ,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. Sworn to before me this Sworn to before me this day of , 20 day of cl , 20 Signature of Property Owner Si ppti Print Name of Property Owner Print Name of Applicant 42 Notary Public Notary We GREGORY M.RIVERA Notary Public,State of New York No.09 Ri6441398 Qualified in Westchester County commission Expires September 26,2Q� 1/30/2020 B din9 Permit Check List&Zoning�� - Anal sis Address: e5 SBL2— Zone: Use: Const.Type: V0> Other. Submittal Date: Revisions Submittf Dates: Applicant: N Nature of Work Cq y-E, ca Reviews:ZBA. JAN 2 1 2025 PB: BOT: Other. r�✓�OK 2GJD ( ff FEES:Filing-. C/O: Flood Plane: Legalization: O ( �} APP: Dated.___,,A3otarized: 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. ( ) ( ) SURVEY:Dated Current Archival Sealed. Unacceptable: PLANS:Date Stamped. Sealed: Copies: Electronic. Other. c.kc.,(cv' gnrlsy t� ( ) License Workers Comp: Liability Comp.Waiver. Other. CODE 7S3#: 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. O O 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. ( )ARB mtg. date: approval• notes: ( )ZBA mtg. date: approval: notes: ( )PB mtg. date: approval: notes: REQUIRED EXISTING PROPOSED NOTES PROVED Area: Dam- FFoT9n9r Circle: Fronta¢e: Front: Front Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFk Tot Imp: Ft Imp: P� Height/Stories: notes: -4 t'Q- cAcoc cw-1 MCA S k 4 -:2 CARES,WA-01 MGIORDANO '4�oRo CERTIFICATE OF LIABILITY INSURANCE FDAT 9/5/2 D/YYYY) 9/5/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michelle Giordano NAME Assured Partners New England,Inc. PHONE FAX 100 Beard Saw Mill Road ac,No,E_:(860)426-6163 Alc,No;(860)426-6163 Shelton,CT 06484 """I Michelle.Giordano�ssuredPartners.com INSURERS AFFORDING COVERAGE NAIC 0 _ INSURERA:Selective Insurance Company of NY 13730 INSURED - __ - _ INSURER B:MS Transverse Specialty Insurance Company 41807 Carey&Walsh,Inc. INSURER C:AmTrust tnsurance Company-- 45954 - P.O.Box 2529 INSURER D:Hartford Life&Accident Ins.Co. 70815 Briarcliff Manor,NY 10510-1511 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 ADDLISUBR POLICY NUMBER POLICY EFF POLICY EXPL. LIMITS A X COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE [_X] OCCUR X X S 2509239 9/1/2024 9/1/2025 DAMAGE TO RENTEDEMISES occurrence) $ 500,000 MED EXP(Any oneperson) 15,000 PERSONAL&ADV INJURY 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY❑X JE� LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT dnll $ 1,000,000 X ANYAUTO X X S2509239 9/1/2024 9/1/2025 BODILY INJURY Per arson $ OWNED SCHEDULED BODILY INJURY Per accident $ _ AUTOS ONLY AUTOS p AUTOS ONLY AUTOS ONLY Pe�aEccAent AMAGE $ P 1 1 $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X X TSCEEX000344-00 9/1/2024 9/1/2025 AGGREGATE $ 5,000,000 DIED RETENTION$ C WORKERS COMPENSATION X PER OTH- IANDEMPLOYERS'LIABILITY YIN N X IOWC1010426 4/1/2024 4/1/2025 11000,000 i ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER a EXCLUDED? a NIA 1,000,000 E.L.DISEASE-EA EMPLOYE If yes,describe under 1'000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ p NY Disability LNY612715 4/1/2024 4/1/2025 Statutory i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Coverage: Pollution Liability Insured: Berkley Insurance Company(NAIC 32603) Policy#FEI-ECC-27778-04 Effective Date:9/1/2024 Expiration Date:9/1/2025 Liability Limit per Occurrence$1,000,000 Aggregate$2,000,000 SEE ATTACHED ACORD 101 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 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) v ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workers' sO E Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured Carey&Walsh, Inc. (914)762-9600 P.O.Box 2529 1c. NYS Unemployment Insurance Employer Registration Number of Insured 529 N. State Road Briarcliff Manor, NY 10510-1511 1d. Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 13-2591740 2.Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) mTrust Insurance Company Village of Rye Brook 3b. Policy Number of Entity Listed in Box 1a" 938 King Street OWC1010426 Rye Brook, NY 10573 3c. Policy effective period 11/2024 to 4/1/2025 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"3"insures the business referenced above in box"la"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 after 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: (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) (Date) Title: SVP, Risk Advisor Telephone Number of authorized representative or licensed agent of insurance carrier: (860)426-6163 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. / 1 DAT ACORO® CERTIFICATE OF LIABILITY INSURANCE E(MMlDDIYYYY) 5/24/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Cynthia Schmidt Allied Insurance Managers Inc. FIC No Ext (248)853-0930 FAX, (AIC No: t24e>e53-1512 1055 South Blvd. East E-MAIL ADDRESS: Suite #110 INSURERS AFFORDING COVERAGE NAIC# Rochester Hills MI 48307 INSURER A:Certain Underwriters at Lloyd's 100% 085202 INSURED INSURER B:Selective Insurance Co of NY 13730 Hang Fire Sprinkler Co., LLC INSURER C 106 Dakota Drive INSURER D INSURER E Hopewell Junction NY 12533 INSURERF: COVERAGES CERTIFICATE NUMBER:24/25 GL,Auto & Umb REVISION NUMBER:0001 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR POLICY NUMBER tMWDDIYYYYI IMWDDPfYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ X Blanket AI,PNC,WOS SP2240076 5/22/2024 5/22/2025 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN-L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY a JECTPRO- a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ]OTHER: mars&Orn—noa $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED S 2491771 5/22/2024 5/22/2025 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident)$ X BLKTAI wIPNC X BLKT WOS $ X UMBRELLA UAB N OCCUR EACH OCCURRENCE 5 5,000,000 ARDED XCESS LIAB CLAIMS-MADE SP2X240076 5/22/2024 5/22/2025 AGGREGATE S 5,000,000 RETENTION$ Follows Fom $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICFR/MFMBFR FXCI UDFD7 N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Il y— describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 A Pollution Liability SP2240076 5/22/2024 5/22/2025 Linit.- $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Jaysor. Bass/CMS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025(zalaol) NYSIF New York State Insurance Fund PO Box 66699,Albany.NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE F no ^^^^^^ 833132921 f� HANG FIRE SPRINKLER CO LLC a,,r 106 DAKOTA DRIVE � t} HOPEWELL JUNCTION NY 12533 F ' SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER HANG FIRE SPRINKLER CO LLC VILLAGE OF RYE BROOK 106 DAKOTA DRIVE 938 KING STREET HOPEWELL JUNCTION NY 12533 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2474 285-0 678094 05/23/2024 TO 05/23/2025 1/27/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2474 285-0, 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.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STATE S7NCE FUND / DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 459658918 U-26 3 ® DATE(MMIDDIYYYY) ACCMO CERTIFICATE OF LIABILITY INSURANCE 12/13/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Certificate Department NAME: AX Brown&Brown Insurance Services,Inc. p/CONNo Ext: (914)337-1833 FA C,No): 1133 Westchester Avenue E-MAIL 524.certificates@BBrown.com ADDRESS: Suite N-136 INSURER(S)AFFORDING COVERAGE NAIC# White Plains NY 10604 INSURER A: The Cincinnati Insurance Company 10677 INSURED INSURER B: The Travelers Indemnity Company 25658 50 Pine St.Corp INSURER C: The Cincinnati Indemnity Company 23280 PO Box 349 INSURER D: Federal Insurance Company 20281 INSURER E: White Plains NY 10605 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 IN SR AIJULIbUtSK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 F;Z71 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 A Y EPP 0589382 09/10/2024 09/10/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE s 2,000,000 POLICY ❑JECT PRO- ❑X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) s A OWNED SCHEDULED EBA0665174 09/10/2024 09/10/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident H $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE s 10,000,000 B EXCESS LIAB CLAIMS-MADE CUP-7S429260-24-NF 09/10/2024 09/10/2025 AGGREGATE $ 10,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X1 PER STATUTE EORH AND EMPLOYERS'LIABILITY YIN 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA EWC 0598194 03 12/10/2023 12/10/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory 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 $ Each Occurrence $15,000,000 $15M Excess x$1 OM Umbrella D 78194782 09/10/2024 09/10/2025 Aggregate $15,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as an additional insured for Commercial General Liability as respects issuance of permits to the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 938 King Street Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) � 0 A A A A A A 133772722 THE FLANDERS GROUP 300 LINDEN OAKS SUITE 210-1ST FLOOR ROCHESTER NY 14625 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 50 PINE STREET CORP VILLAGE OF RYE BROOK P 0 BOX 349 BUILDING DEPARTMENT WHITE PLAINS NY 10605 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2106 567-7 553898 01/01/2025 TO 01/01/2026 1/13/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2106 567-7, 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. 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.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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. 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