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HomeMy WebLinkAboutRP25-011PERMIT # OQS .DATE.. SECTION 1,3,Sl BLOCK LOT l TYPE OF WORK 2 - X20 0 X/NS r1 r7 j /.-7 JOB LOCATION OCR OWN ER.Z C/P-tlQo! esQ/ ehel;e7Qz ,sq�' 9/ 7 539- QOlo9 CONTRACTOk yS _ ��1e� LC - Qs l(c �Q�yi�lc�� (Y1a- d'8it0 EST. COST 000 � FEE �9 4 — /Q f w 744 /0 > V/CO# C,L_ LP FEE4c7 ��DATE 4 TCO # FEE DATE - INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT 0 ALARM m AS BUILT 0 FINAL INSP OTHER APPROVALS ARB BOT P8 ZBA OTHER — BR(� 4 JJa4C,VFW V K 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 April 10,2025 Purvand Desai&Mehernaz Desai 4 Red Roof Drive Rye Brook,New York 10573 Re: 4 Red Roof Drive, Rye Brook,New York 10573 Parcel ID#: 135.42-1-5.15 Roof Permit#25-011 issued on 2/11/2025 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to F�j BUILDJ$d' >6 �ART,MENT P oires= niv MAR 2 6 2025 PERMIT a 1 VILI,Afi�OF RYE BROOK VILLAGE OF RYE BROOK 938 KINGSTHELF�RVF BROOK,NIEM YoRK 10573 DATF 3 -aZo-ems" BUII_01N. ^F^1RTMENT— (914)_939t"6$ �r,w r I>rrttt�kb�� TIFICATF OF OCCUPANCY,CF.RTIPICATE OF COMPLIANIf F, APPLICATION FOR CFRNDCERTIFICATION OF FINAL COSTS PRIOR TO THF. FINAL INSPFC_ T?OR mn A! StrAMI2TSD ONLY UPON COMPLETION OF ALL FORK[ AND — — ............................................................................................................................. Address. 4 RgdRaOf QI fte Rrnr>,k N - 105Z3� — ------ - lone: Occuptl wt : Usc / �� Parcel ID N: 135.42-1-5.15 a Brook NY- 10573 Address: 4 Red Roof Dr. Rye Owner Pury n _Desai 180 E Prospeol Ave.STE 1o55 Mamaroneck NY 10543 P E./R A or Contractor: SolEnergy NY LLC -Address: Ave STE 1055 Mamaroneck NY 10543 Pasquale Maran i Address. tso E prospectPelson In respottctble charge. _� 9 —— 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 321 Fenimore Rd Mamaror►edt. NY 10543 Pasquale Marangi being duly sworn,deposes and says that he/she resides at_` ----- M8r118rAf18C — that iPn:.�amr 1MestOhesler ietlbe state of N in k m the Conttty of he/she has supervised the work at the location indicated above.and that the acts al total cost of the work.including all cite improvements. labor.matenols. cafolding fired equipment,professional fees.and including the monetary value of any materkaF aline/labor which may have been donated gratis%k ac for the construction or alteration of 25,000 Deponent further states that he/she has examined the approved plans of the Apr•,Uftrwork heroin referred to for which a Certificate f Occupancy Compliance is sought,and that to the best of his/her knowledge and bcaef.the structure/work has been erected completed :n accordance with the approved plans itnd any arntxidm cats 0wrc o CRi e A to so rw as variations therefore have been legally authorized,and to accordance d/complcted complies with the lawt:goveming building construction Deponent further understandsdW it shall be unlawful for an owner to use or pereeit the use of any building or premises or part thereof hcrcaflcr created.erected,changed,converted or enlarged,wholly of partly,m its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have be=duly issued by the Building inspector as per§250-10 A of the Code of the Village of Rye Brook Zi sworn to before me this Sworn to before me this day of 20 day of RGt z c� 20 � .ignature of Ap�lu nt S f Property Owner D fA S_'RLAg4,r ).ORA A]�-1 Print Name of Pro iris k Pant Name of Applicant Notary f N ui e LISME MEW JO'ON DIONISIO Notary Public,State of Connet-cif:tr Notary Public State of New York I My Commission Expires March 31,2f Qualified - Westchester County # 01DI4804045 Fx . 9/30/26 �yE BRC�� 1982 BUILDING DEPARTMENT �+0 BUILDING INSPECTOR u 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: 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 a ! i S i a 1-t yy+ ! lr� N Si N v v ' O N W v in r_i CA ' W N 0.' ' rn LL V J s � w = H w W U a �, W ! : � v� ] � � •o o � ►di G w > A OLr) h--I © O w o V u v n w d w Q a � o '� L an H z a, LW ga • .,� � ° � � a cls a H W W 00 Q W o ' O00 V d z U z gs s A D O C y U a en e �' A z c Woe ap jcy z O En p A4 O O U V zoab � c" �i d lot o ' o � W O v s [ ] O o O 11 C y 11 FF•+�MM `/ V 4 z a w w a s 04 n^� a I FBI PLO f'�"V W VS ;+ �d•p "O S i BUIL ENTDD FEB - 3 2025 V1 ' �OF y ©K 938 KING Ef RYE BR NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ov stttststsssttwstttssstssrrrstwwsssettstrstststt+start:stssttssst*+ssssrr+srrrr*++ssrss++srsrr*++++ssrsrr*rr FOR OFFICE USE ONLY: 2���J FEB 0 4 Application Approval Date: it# # Approval Signature:_ ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: -- - _ BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# - Other: Application Fee'4/00 r"" Permit Fees: srststr*rtrr*+ssssrssrttrsr**+sssrssrrr*s+r*+swrrrsrrtrst*+++st;s*s*rtrr**tsrssr*srrrr+++srrrssrrs*++ssrsss a ROOF PERMIT APPLICATION Application dated: "` is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. 15 42-1-5 Property 135. . Zone: 1. lob Address: 4 Red Roof Dr Rye Brook.NY- 10573 SBL: Owner: Pury ip Desai Address: 4 Red Roof Dr Rye Brook.NY- 10573 Phone#:917.539.2069,Cell#: 917.539.2069 email: urvan 5 hotmail.com 2. Applicant: Pasquale Maran i Address: 180 E Prospect Ave.STE 1055 Mamaroneck NY 10543 m Cell#: email: Pasquale. arangi®solenergyrly-com Phone#: - — 3. Roofing Contractor: SolEnergy NY LLC Address: 180 E Prospect Ave.STE 1055 Mamaroneck NY 10543 Phone#: 646-812-8840 Cell#: email: �"t°ak marangcl�solenergrny.com 4. Job Description,list all Methods&Materials: Roof shingles replace.Install new architectural single, install standing seem metal roof at 5 locations.Materials:asphalt sin les GAF timberline,Drip ed a 30 white aluminium top shield defender protector ice and water,Gaf timbertex charcoal class 3 felt RI 15# top shield starter strip plus 36 )rip edge white premium. S. Estimated Cost of Job:S 21,000 (NOTE:The estimated cost shall include all site improvements.labor, material,scaffolding.Fixed equipment.professional fees,and material and labor which may be donated gratis.) 6. If comer property,indicate street frontage: 7. Construction Type: Roof replacement NYS Construction Class: V B 8. Number of stories: 2 Height:30ft 9. Is garage being re-roofed:No:(X )•Yes:( )Attached No:( )•Yes: ( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc:Gable U. Estimated date of completion:_ Feb 20 2025 WA24 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. S�AOF�NE YORK,COUNTY OF WESTCHESTER ) as: — "� beingduly sworn,deposes and states that helshe is the applicant above named, ual si mg 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 Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this -70/`k Sworn to before me this day of_ya N u ch T , 20 'Z i day of , 20 signadK of Property Owner Signature of Applicant 14IVGVII Print Name of ropert a Print Name of Applicant Notary Public Notary Public KYLE CROVM NOlaly Pd t:,swcrowndcd W _2. U112024 coxs�Cc EMAR2 6 2025 76 North Meadowbrook Drive Scott E. Wyssling, PE Alpine, UT 84004 Coleman D. Larsen, SE, PE VILLAGE OF RYE BROOK office (201) 874-3483 Gregory T Elvestad, PE BUILDING DEPARTMf:t T ! swyssling@wysslingconsulting.com March 14, 2025 Green Tech Renewables 1299 Farnam Street Suite 300 Omaha, NE 68102 Re: Engineering Services Desai Residence 4 Red Roof, Rye Brook, NY 16.560 kW System To Whom It May Concern: We have received information regarding solar panel installation on the roof of the above referenced structure. Our evaluation of the structure is to verify the existing capacity of the roof system and its ability to support the additional loads imposed by the proposed solar system. A. Site Assessment Information 1. Site visit documentation identifying attic information including size and spacing of framing for the existing roof structure. 2. Design drawings of the proposed system including a site plan, roof plan and connection details for the solar panels. This information will be utilized for approval and construction of the proposed system. B. Description of Structure: Roof Framing: 2x8 dimensional lumber at 16" on center Roof Material: Composite Asphalt Shingles Roof Slope: 33, 36, 38 degrees Attic Access: Accessible Foundation: Permanent C. Loading Criteria Used • Dead Load Existing Roofing and framing = 8 psf o New Solar Panels and Racking = 3 psf .) TOTAL = 11 PSF • Live Load = 20 psf(reducible)—0 psf at locations of solar panels • Ground Snow Load = 30 psf • Wind Load based on ASCE 7-16 o Ultimate Wind Speed = 116 mph (based on Risk Category II) o Exposure Category C Analysis performed of the existing roof structure utilizing the above loading criteria is in accordance with the 2020 Residential Code of New York State (2018 IRC). This analysis indicates that the existing framing will support the additional panel loading without damage, if installed correctly. Page 2 of 2 D. Solar Panel Anchorage 1. The solar panels shall be mounted in accordance with the most recent Unirac installation manual. If during solar panel installation, the roof framing members appear unstable or deflect non- uniformly, our office should be notified before proceeding with the installation. 2. The maximum allowable withdrawal force for a 5/16" lag screw is 229 Ibs per inch of penetration as identified in the National Design Standards (NDS) of timber construction specifications. Based on a minimum penetration depth of 2'/2", the allowable capacity per connection is greater than the design withdrawal force (demand). Considering the variable factors for the existing roof framing and installation tolerances, the connection using one 5/16" diameter lag screw with a minimum of 2'/2" embedment will be adequate and will include a sufficient factor of safety. 3. Considering the wind speed, roof slopes, size and spacing of framing members, and condition of the roof, the panel supports shall be placed no greater than 48" on center. Based on the above evaluation, this office certifies that with the racking and mounting specified, the existing roof system will adequately support the additional loading imposed by the solar system. This evaluation is in conformance with the 2020 Residential Code of New York State(2018 IRC),current industry standards, and is based on information supplied to us at the time of this report. Should you have any questions regarding the above or if you require further information do not hesitate to contact me. V truly yours, �42 Scott E. Wyssling, NY PE License No. 92303 New York COA#022082 , . CO 7) LL Wyssling Consulting, PLLC 76 N. Meadowbrook Drive,Alpine UT New York COA#0022571 Signed 3/14/2025 Expires 7/31/2027 �CSSUNG 41 . - CONSULTING : 1 E Prospect Mamaroneck1 Iit H)1. 11Rt►Pt►ti,A 1 Date 01/15/2025 Customer Purvang and \Incel Desal Property -address 4 Red Roof Rye brooks NY Phone Umail ii;til olll_ Description Roofing Shingle Replacement I Removal of existing rooting shingles from the roof of the home 2. Install new rooting shingle(34 sq) surface along with specified accessories and features 3. Remove from the premises the removed roofing material and dispose of off premises New roof surface to be installed to replace the existing asphalt shingles of the Home. Includes the removal of the existing layer roofing shingles. Work to be done as follows: 1. Strip the existing one layer of asphalt roofing shingles from the shingle roof surface of the home Based on the age of the home, it is unlikely that there are two layers of existing shingles. If there are, then there will be a slight increase in price for the removal of the added layer and the additional disposal costs. 2. Inspect the wood framing and wood sheathing for rot or deterioration. If anv rafters, sheathing or other wood needs to be replaced, this can be done at added cost by way of change order. 1 3 Install aluminum drip edge. 4. Install the first line of paper will be install in ice and water as for the valis j 5 We will install GAF starter shingles under the first course across the entire 6. Install standing seem metal roof 9+4 front gables and flat area on top of the front door Cost of this proposed work Total- $ZgDesai Pu SOLENERGY NY LLC Pasquale Xtamgi • • • - • • sole nergyny. • - r i, olra'� s1p�g1lti �t'!'�I+", M` M (`, '!I► AP f r. �i-a^su,•,' .J,� r $ � lAm�a\L,aa�a ay.,.wr. La.1r Yr t•Umrr ,1 11���i\' .�� \\.at.hr•hr l nunH t ara rlt,r Ibrr.lur.1 unwawar Pndra lion F� . Department of Consumer Protection home I mpro%ement License SOLENERGY NY LLC e 180 EAST PROSPECT AVENUE-01055 ? MAMARONECK NY-10543 K. e'�T?, Ilea �,r,.a i,i..ur,1 m.•.a.ra .... t tr,.c \'. �.i ih, N..t.l,a-:1 t.�rr i.m•..-. hn.t,•.t n t 1.J;an4`...1 1 ,'., t�1>,•n '�9' h�.•.o. •I1 ll1".'i l ..j hI l �.. .,I�ip�t n.nnti�t,•i.tdda:.w,��yun�di li,,,u:� ■tv.) \Ill 111H H Di It 1111101141"t\ �. L 1 °nsu�'',o 1 n:n.r\urnhcr >;• w I late 1rl f \Pu.1u.,; . a �3 o OStOd 2lilti ...... WC-37708•H24 0 � aht Gam° `.rwr���.. _�� �, `j^�,� � k`a'I����, �i�X1y �.y �.1;�V �'�'4'�`,�'L��ItMI' `�.• Il,.�...:r Not Client#:293816 SOLENER DATE(UMMONYYYI ACORD., CERTIFICATE OF LIABILITY INSURANCE 1/29/2025 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 cerdflcats holder b an ADDITIONAL INSURED,the pol"lles)must haw 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 statenwdan this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME:CT Commercial Support - Edgewood Partners Ins.Center �H o,Ems:631_3N-9700 Not: 144 Gould Street,Suite 100E-MAIL ADDRss: NECertificates&picbrokers.Com Needham, MA 02494 Iwcs utetlREps)AFFOItosto oD+raeAaE-_-- 781 45"700 eauRER A.1111101"kaur—ComPGnY INSURED INSURER 8: -- SolEnergy NY LLC etsuRER c: --- 180 E Prospect Ave.,Ste 1055 INSURER D: Mamaroneck,NY 10543 I - - - 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 CONTRACTOR 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 ADDsuen 1 Y r FJ(P LIMITS LIP TYPE OF INSURANCE _ IN-R INIOM POLICY NIIpw — -- A X CON"ERCLU GENERAL UAaa1iY FEIECC3575M 11111293125 01IM020 EAACCHA�OECCTURRENCE S1y000 i00- - CWMS4dADE FX OCCUR BREMISEi e rm $50 000 'MED EXPj�g ane penan) S O0 _. _. _ - --- PER90NAL S ADV INJURY S 1 80on e00 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 52,000 000 ❑PIRO- LOC PRooucTS-CoMPIOP AGG 3 000 7x POLICYJECTS --- ---- ---- — COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY enl BODILY INJURY(Per person) S ANY AUTO - OWNED SCHEDULED BODILY INJURY(Peraoddent) S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED S AUTOS ONLY AUTOS ONLY -LL--- S UM13RELLAI" OCCUR EACH OCCURRENCE S EXCESS UAS CLAIMS-MADE AGGREGATE S DED RETENTIONS .. -- - -- - PER OTH- ERS COMPENSATION AND EMPLOYERS'UAa1LRY ANY PROPRIETORIPARTNER/EXECUTIVE Y I N E.L EACH SE ACCIDENT $ OFFICER/MEMBER EXCLUDDEED? ❑ NIA; (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 3 I es,describe under E.L.DISEASE-POLICY LIMB S DESCRIPTION OF OPERATIONS_below _ - ------------ _A —-- A Pollution Uab• FEIECC3575800 1/2412025 01/24/2026 51M Ea Occ/$2M Agg DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it Mors 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 BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING STREET Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S7253147/M7252016 SC003 " Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave 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 and paid family leave benefits insurance is not required. The applicant may NOT use this foam 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 SolEnergy NY LLC From:Village of Rye Brook 180 E Prospect Ave Ste 1055 Mamaroneck,NY 10543-3709 PHONE:646-812-9840 FEIN:XXXXX4333 The location of where work will be performed is 4 Red Roof,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from February 3,2025 to November 30,2025. The estimated dollar amount of project is $25,001-$50,000 Workers'Compensation Exemation 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 LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor, leased employees,borrowed employees,part-time employees, unpaid volunteers(including family members)or subcontractors. Partners/Members: Pasquale Marangi Disability and Paid Family Leave Benefits Exemation Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE 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 and paid family leave 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 and Paid Family Leave Benefits Law.) I,Pasquale Marangi,am the Member 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. I 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 and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately famish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN Date: Z/ 0/ 5 HERE Signature: © ( I ! O 2 Exemption Certifica Number Received 2025-007509 February 3, 2025 NYS Workers'Compensation Board CE-200 01/2018