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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 29,2025
Stephanie Madonia
226 Tree Top Crescent
Rye Brook,New York 10573
Re: 226 Tree Top Crescent, Rye Brook,New York 10573
Parcel ID#: 129.76-1-56
Demolition Permit#25-002 issued on 1/31/2025 to Demolish Finished Attic
This certifies that the finished attic demolished and returned to unfinished storage space under the above
captioned permit has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
ECENE
BUILD MENT For office use onl
PER #
MAY - 8 2025 VIL ? OK ISSUED:
9 8 KING STRE 3- YORK 10573 DATE:
VILLAGE OF RYE BROOK ...
BUILDING DEPARTMENT . ov FEE: PAID
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
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Address: �(
Occupancy/Use: V`s Parcel ID#: 70 Zone:
Owner: S O(VA i( ,k e /�Q�t�[;(\�Address: D&C jre'9-P-t7)0 r re�(e I1�
�r
P.E./R.A. or Contractor: 'Pere2 Ft ) V'zNt in dYe dress:
Person in responsible charge: fNCWt pe<C Z Address:
Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a
Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance
with law:
STATE OF NEW YORK, COUNTY OF WESTCHESTER as:
S}>P �l►1�c— ti being duly sworn,deposes and says that he/she resides at r eS
(Print Name of Applicant) (No.and Street)
in in the County of W 2 SAC!ASK►' in the State of 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:S
for the construction or alteration of, p H 30c) Z), 9-n o f y c (- Ohl n Soo f&r
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 Swom to before me this
day of -V , 20,P day of 520
Signature of operty Owner Signature of Applicant
7 t Na I of Property Owner:D�'
Print Name of Applicant
Notary PubliSHARI MEULLU Notary Public
Notary Public,State of New York
No.o1ME6160063
Qualified In Westchester County 6/l/2024
Commission Expires Jandary 29.20L-7
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BUILDING DEPARTMENT
❑BUILDING INSPECTOR
;KSSISIA.NT BMWING INSPIRC3TOR VILLAG.1. Oli RYE .BROOK
❑CODE ENNORCI{MEW OI1I+ICUlt 938 Kin};Str[xt•Rye Biti)ok,NY 10573
(91.4)939-0668 FAx.(914)939-5801
www_r���liruolcor�
- -- - - - - - -. - - - - - -- - - - - INSPECTION REPORT - - - - - - - - - ._ - - - - - - - - - -
ADDRESS:_-2 z V—.7Tr2 70p _.`^" __.._ DATE: 7- Z?- oZ a•J
PERrsrr# -c'�I__���OoZ- ---.I.ti;c�l,�►:_/_ /-- SEC'r: 7G BLoCK:. Lar:�
OCCUI'A]YCY:
❑ Violation Noted 'I1IE WORK IS... R'PASSED ❑ FAILED /REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DReINAGE
❑ FOUNDATION
❑ UNDERGIt.OUND PLUMBING NO'r.17,S ON INSPECTION:
❑ ROUGII PLUMBING'
❑ ROUGH FRAMING
❑ INSULATION •
❑ i,.P.Gas
❑ FUEL TANK - --
❑ FIRE SPRINKLER � ���� ��'LQ S�-1/! c� � ��� � �U✓Q�
❑ FINAL PLUMBING
❑ CROSS CONNECTION
.9--.(;`INAE.
13 OTHER
two c� _
QyE BR(�j�.
O�` tim
BUILDING DEPARTMENT
❑BUILDING INSPECTOR
Q4ASSISTANT 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 : '2 � (.,o DATE: ' �'� U
rN
PERMIT# 'x Q.5- coc1 L- ISSUED: SECT: BLOCK: � LOT:
LOCATION: A A C OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ell-REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS p
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION LA
❑ FINAL i L /L)> ��J✓�"� /' >>C-�/1
❑ OTHER
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~ BUILDING DEPARTMENT DM
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 .IAN 2 7 2025 1 a
(914)939-0668 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
DEMOLITION PERMIT APPLICATION
%ppi o 'd Dj i;. .BAN 3 0 2025 �/��S`1Z c� Application Fee:
Permit Fees:$ ac) ` P
Other: QOW 1 Z
Application dated: I I a1^I 12.S is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below. I /
1. Job Address: a oll� y rCe'1 OQ Creujr t SBL:���►71p�/ cp Zone: ,"
2. Proposed Demolition.(Ucscnbc in dcuul is re.rr,-0Yt W CULL .t L&c.f r i Lt g _
Cl c rG t rt F l o
3. Property Owner: h%cx ii i Address: .1 Z s i Y GP f-)P UCS ceri I
Phone# Cell# 41 N S7 S a cl t I email:_ S h-N 0 3 8'ct ® cZn I. cc 4/1
Applicant: S VC Df,( h(e CU)f\.VG1 Address: (p P.E%W 12 C
Phone# Cell# qP`If 1575 9W( email: is rh `(Zb cp-n 1- 0 fn
ele.t��,�Ct�u� r: Ati be(r) Tot fc- AcJL, CU0f(Arddress: Li 1J7-1 1 f GC Q� Li(7f1
Phone# Cell# 9)L4- Ll tt(p-QW email:
General Contractor: dr i un P C Ye Z Address: 15 PGIYK- ! Q nr4 S<C l '
Phone#_ t I 3 I Cell# email: nPft° Y-C rYNONCtr4r' IC®
c3m0.11
4. Estimated cost of construction $ 31,Soo — c0"\
5. Type of construction:(wood frame,masonry,steel,etc...) f ysJ d tl St'Per york.. e Us-T y ��-
6. Method(s)of Demolition:
7. Number&Location of Fuel Oil Tanks to be Removed: 1P%OC\
8. Number of Stories: Height to Highest Ridge: N I P To Highest Chimney: t.i i
9. Estimated date of completion:
I
6/1f2Q24
app --ation moat be properly complet I :rF its ::.-itirety ar
1ur- y of the legal owner(s) of the sui ec^ �3Tci-arty, and e.
Tided. Any application not propt ly in its
led shalS be deemed null and vc J and v:1�1 be returr.ert
''-'!ease note that applica Sri . re non-re:.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,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
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 Codeof the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this t Sworn to before me this
day of C n nrl� , 20 day of :: 3Q Ak-kAC 20 2 S
Signature of Prope Owner Si a e of Applicant
3"] SHARP MEULL0
Notary Public,State of New Yack J !
Name of Property Owner No.01MEU60063 e o Applicant
Qualified In Westchester County7
Commission Expires lnnuwy 29,2
Notary Public Notary Public
2
6/1/2024
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BUILDING DEPARTMENT -----�
VILLAGE OF RYE BROOK R1. R 10 2025 DDI
938 KING STREET RYE BROOK,NY 10573
(914) -0648
VILLAGE OF RYE BROOK
wWW. A9(kookny.gov BUILDING_ DE_PA__R_ TMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ON�Y ..UP-4- �� p)S-U�� EP#:
Approval Date: J `k 4-L_2
Permit Fee: $
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,-3'—/0—a� 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. / J / }�
1.Address: L Z 1l t2�C t (i P C Qom- L I SBL:/C7 /i 7t, _` _S C PaU
Zone
hn�Jt �A IP, � Z ,c �F �� 1"� CQPsCei �
2.Property Owner:
� `'T. n � Address:
Phone#: Cell#: email:
3.Master Electrician/Licensed Installer: LJ,' i'N,.;;' II c;L1-Z Address: b Y WWLigle I!Rb
Lic.#:Phone#: 793-1%M Cell#: Y 7 L,Sx'/� email: 4,r--Pa 1 rL e
Company Name: ZNC. Address: 6% N� /RK tf0/�/� N_ io
4.Proposed Electrical Work/Fixture Count:
L 167-1Ts / .1
DNS fr�� Py th
L N L
5.3,d Party Electrical Inspection Agency:
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
.being duly sworn,deposes and states that he/she is the applicant above named,and does further
(print name of individual signing as the applicant)
state that(s)he is the 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,�thee Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulatic,n.;.,
Sworn to before me this 70- ' Sworn to before the this
dayof /Ya4 tJ1 20 day of _-
3,� LISA DEEDEE SLAKE Y i_
NOTARY PUBLIC-STATE OF NEW YORK
Signature of Property Owner No.01 B L6313040 Signature of Applicant
Qualified in Bronx CountyhAy _
Commission Expires 10-14-2026 printN a pplicant
Print Na e o erty er
a r otary blic
6/l/2024
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• • 0801 SIMS
• •
State Wide Inspection Services
APR - 1 2025 1080 Main Street
Fishkill, NY 12524
VILLAGE OF RYE BROOK 845 202-7224 Phone
914-219-1062 Fax
STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com
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:
Faigle Elec Contractors Inc. Stephanie Madonia
64 Newkirk Road 226 Tree Top Crescent
Yonkers, NY 10710 Rye Brook, NY 10573
Located at: 226 Tree Top Crescent, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 25-065
129.76 1 56
Certificate Number: 2025-1933 Building Permit Number: DP 25-002
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: 226 Tree Top Crescent, Rye Brook, NY 10573
The Attic 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 315t Day of March 2025.
Name Quantity Rating Circuit Type
Pull Chain Light Fixture 01
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.
rr .Building Permit Check List&Zoning Analysis
Address. ��
Zone se: Cont.Type: Other.
Submittal Date: 2 Revision Submittal Dates:
Applicant: '` o., �_ \
Nature of Work 3P CL1 �� C_
l s �e�o L� Oc\L p v�i �nve�r� •g
Reviews:ZBA N 3 0 202 PB: BOT: Other: 1 fit✓"1 Y
NEED OK p
(yam( FEEs:Filing. BP: `�U C/O: Flood Plane: Legalization: r, D
( ) (t -APP: Dated:✓ 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.
( ) ( ) SURVEY:Dated Current: Archival• Sealed: Unacceptable:
( ) ) LANS:Date Stamped: Sealed Copies: Electronic Other. Pt
License: Workers Comp: Liability: Comp.Waiver. Other.
CODE 7S3#: Dated: N/A:
( ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other.
( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other.
( ) ( ) PLUMBING Plan: 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 Plan: 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 Date: JAN 3 0 2025
Area:
Circle:
F%tag
Front:
Front:
Sides:
Rear.
Main Cov:
Accs.Cov:
Ft-H Sb:
Sd.H Sb:
GFA:
Tot.Imp:
FL Imp:
pg&�.
Height/Stories:
notes:
Laura Petersen
From: Stephanie Madonia <sm0389@aol.com>
Sent: Friday, March 7, 2025 11:52 AM
To: Laura Petersen
Subject: Re: Demo Permit Application for 226 Tree Top Crescent
Hi,
The general contractor removed the duct. So I'm just waiting on the electrician.
Thanks
Sent from my Phone
On Mar 7, 2025, at 11:46 AM, Laura Petersen <LPetersen@ryebrookny.gov>wrote:
Hi Stephanie,
Not a pest at all. I have not received anything yet. We are still waiting on the
electrician to file and the HVAC contractor needs to file for the ductwork.
Thank you!
Laura
Laura Petersen
Office Assistant
Village of Rye Brook
938 King Street
Rye Brook, NY 10573
(914)939-0668
From: Stephanie Madonia<sm0389@aol.com>
Sent: Friday, March 7, 2025 11:25 AM
To: Laura Petersen<LPetersen@ryebrookny.gov>
Subject: Re: Demo Permit Application for 226 Tree Top Crescent
Hi Laura,
Sorry to be a pest. Did the electrician file this week?
Thank you,
Stephanie
Sent from my iPhone
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BR(�v� VILLAGE OF RYE BROOK
2 Building &Code Enforcement Department
Q 938 King St Rye Brook,NY 10573
Phone:(914)939-0668
1982'�
12124/2024
Madonia Stephanie
226 Tree Top Cres Rye Brook NY 10573
Notice of Violation - 226 TREE TOP CRES - 129.76-1-
56
RE: RB-2024-020 Construction to Finish the 3rd Flor Attic space without permits
Dear Stephanie Madonia,
The following violations of the Code of the Village of Rye Brook, and/or the New York State Uniform Fire
Prevention &Building Code (NYSUFP&BC)were found to exist at the property above.
DESCRIPTION
In that on or about December 23rd, 2024 an inspection at the premises 3rd floor attic area, found
that construction work was done to re-create a finished Attic without a building permit or approval.
Construction work is including but not limited to: electrical installations, without permit, HVAC/duct
installations for the attic without approvals or permit.All this in violation of Village codes. In that on
about 4/27/2015 a building permit was issued to remove the finishes and installations that created
the finished attic. In that on or about 6/29/2015 an inspection was performed by a Village Inspector
(SF) to confirm that all finishes were removed and the space was returned to an unfinished attic
space..
You are hereby directed to contact the Building Department, obtain all necessary permits and commence to
correct the above-captioned violation(s) immediately. Violations of the NSYFP&BC must completely be remedied
by January 20,2025, which is (20) days after the date of this notice and are returnable at the rate of
$1,000.00/day for each day of the continued violation, or imprisonment not exceeding one year, or both.
A RE-INSPECTION OF THE PREMISES IS REQUIRED BY LAW TO CONFORM COMPLIANCE WITH THIS
NOTICE &ALL APPLICABLE CODES.
FAILURE TO COMPLY WITH HIS NOTICE IS A CRIME PUNISHABLE BY FINE, IMPRISONMENT OR
B
Thank y
Steven E. Fews 2�J(� ,1 0 A
Code Enforcement Officer
VILLAGE OF RYE BROOK
938 King Street Rye Brook, NY 10573
www.ryebrook.org
° � VILLAGE OF RYE BROOK
Building & Code Enforcement Department
-� 938 King St Rye Brook,NY 10573
Phone (914)939-0668
02'
12124/2024
Madonia Stephanie
226 Tree Top Cres Rye Brook NY 10573
Notice of Violation - 226 TREE TOP CRES - 129.76-1-
56
RE: RB-2024-020 Construction to Finish the 3rd Flor Attic space without permits
Dear Stephanie Madonia,
The following violations of the Code of the Village of Rye Brook, and/or the New York State Uniform Fire
Prevention& Building Code (NYSUFP&BC)were found to exist at the property above.
DESCRIPTION
In that on or about December 23rd, 2024 an inspection at the premises 3rd floor attic area, found
that construction work was done to re-create a finished Attic without a building permit or approval.
Construction work is including but not limited to: electrical installations, without permit, HVAC/duct
installations for the attic without approvals or permit. All this in violation of Village codes. In that on
about 4/27/2015 a building permit was issued to remove the finishes and installations that created
the finished attic. In that on or about 6/29/2015 an inspection was performed by a Village Inspector
(SF) to confirm that all finishes were removed and the space was returned to an unfinished attic
space..
You are hereby directed to contact the Building Department, obtain all necessary permits and commence to
correct the above-captioned violation(s) immediately. Violations of the NSYFP&BC must completely be remedied
by January 20, 2025, which is (20) days after the date of this notice and are returnable at the rate of
$1,000.00/day for each day of the continued violation, or imprisonment not exceeding one year, or both.
A RE-INSPECTION OF THE PREMISES IS REQUIRED BY LAW TO CONFORM COMPLIANCE WITH THIS
NOTICE &ALL APPLICABLE CODES.
FAILURE TO COMPLY WIT HIS NOTICE IS A CRIME PUNISHABLE BY FINE, IMPRISONMENT OR
B
Thank you�� 1
Steven E. Fews Z� A
0 . 0
Code Enforcement Officer
VILLAGE OF RYE BROOK
938 King Street Rye Brook, NY 10573
www,ryebrook.org
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DATE(MMIDDIYYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE
6. �' 1 01/31/2025
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
NAME:
BIBERK p"CNE . 844-472-0967 �n"/c N,: 203-654-3613
P.O. Box 113247 E-MAIL
Stamford, CT 06911 ADDRESS: customerservice@biBERK.com
INSURER(S)AFFORDING COVERAGE NAIC 0
INSURERA: Berkshire Hathaway Direct Insurance Company 10391
INSURED
INSURER B
PEREZ M &W HOME IMPROVEMENT LLC
INSURER C:
1215 Park Street INSURER D:
Peekskill, NY 10566 INSURERE:
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 LTR 'ADDL SUER POLICY NUMBER MMIDDM(YY POLICY
EXP LIMITS
TYPE OF INSURANCE
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
TED
CLAIMS-MADE �OCCUR DAMAGET EN
PREMISES Ea occurrence $ 1,000,000
A N9BP490039 09/29/2024 09/29/2025 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ - Included
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
POLICY PECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000
X OTHER: $
AUTOMOBILE LIABILITY C.OMBINEDSINGLELIMIT $
Ea axident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESSLIAB Id CLAIMS-MADE AGGREGATE $
DED 1 1 RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED? ❑ NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE'.$
If es,describe under — --
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Professional Liability (Errors & Per Occurrence/
Omissions): Claims-Made Aggregate
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
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 r�
AUTHORIZED REPRESENTATIVE
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
� 0
^^^^^^ 853120492
PEREZ M&W HOME IMPROVEMENT LLC
1215 PARK ST
PEEKSKILL NY 10566
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
PEREZ M &W HOME IMPROVEMENT LLC VILLAGE OF RYE BROOK
1215 PARK ST 938 KING STREET
PEEKSKILL NY 10566 RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2591 806-1 690835 06/06/2024 TO 06/06/2025 1/31/2025
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2591806-1, 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 STAT SUR NCE FUND
TT �/
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 875062899
U-26.3
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