Loading...
HomeMy WebLinkAboutBP25-032AMMIT #i MMON TYPE OF WORK Joe LOCATIO OWNER /c7 e//vj/ —03cDATE. aoc>jc)sm � % BLOC LOT= �Qo�7 e QCelne,-�? f )oyoca/ C rPPlgS l�%Ve qS e co // _(9/y) 09037 5a/� CONTRACTUh f- 14C/es7�e� C'us fog, �,:., o ws PLC — i�►clsoy Zos of d3) a `;fV i (Y�Y& EST. COST FEE 4 c>) S V/CO # FEWSV")b DATEUl TCO FEE DATE FOO'iING FOUNDATION FRAMING RGH FRAMING INSULATION PLUM ING O RGVPLUMBING GAS C7 SPRINKLER ELECTRIC CO Low4OLT ALARM AS BUILT [7 FINAL OTHER APPROVALS ARB 80T PS zBA OTHER v ti C �V Vv`iV 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 28,2025 Bernice Coll 17 Doral Greens Drive East Rye Brook,New York 10573 Re: 17 Doral Greens Drive East, Rye Brook,New York 10573 Parcel ID#: 129.27-1-4 Building Permit#25-032 issued on 2/28/2025 for Replacement Patio Door This certifies that the new patio door,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �~ BUILDING DEPARTMENT For office use only: APR 16 2025 VILLAGE OF RYE BROOK PERMIT# 3 -25-0a ISSUCD: 02- Z8-2D25 938 KING STREET,RYF.BROOK N1ew YORK 10573 DATE: VILLAGE OF RYE BROO': ' (914)939-0668 FEE: C SCE PAID BUILDING DEPARTNIEN?" X, -----�---------- www.ry irnoknv.00N 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 asra araarssessssssstsrsrrrrttttaasrsrsssssssssssr♦♦sraarasrsssessssssssaasrasssssssrartaaaaaasar••tsrrrsrrrrrra rsrassrarrsss Address: ),)OP-AL 62ZG)3S ))Q-A01E Elks Occupancy/Use: 1 - FQrm Parcel ID 4 Zone: R- 3 Owner: ��R�'l C E CO LL- Address: P.E./R.A. or Contractor: Renewal by Andersen Westchester Address: 421 West Avenue, Stamford CT 06902 Person in responsible charge: Franklin Barahona Address: 421 West Avenue, Stamford CT 06902 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: Franklin Barahona being duly swom,deposes and says that he/she resides at 421 West Avenue (Print Name of Applicant) (Na.and Street) in Stamford in the County of Fairfield in the State of CT ,that (t.jt\�Fo%Ni Vilinge i 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:$ tpt SC-) I for the construction or alteration of ,�� �( >LAgi7 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 eretrtedicompleted 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 crcated,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 Q Sworn to before me this q17 day of 202-6 day of fQ�T , 20 �o_. Signature of Property er' Signature pli Franklin Barahona Print Name of Property Owner Print Name of Applicant Notary Public Notary Public BRIA MACDONALD BRIAN MACDON A D NNN AcDON NOTARYPUBL/C arARYPURUC4 state of conn"Wcut M S Y ON EXPIRES Od.312= MY COMMISSION EXPIRES OcL 312= QyE BRC�� 1932 BUILDING DEPARTMENT ❑puILDING INSPECTOR [QAssiSTANT 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 : l..U� ✓�,1\T� DATE: <` 2 O Z S PERMIT# ISSUED: . SECTJZ5 '-�Z) 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 C 'L ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER _ _ M N0\0 � 114 N N • � d � a -71 = N C- Q o aA N 00 r.a GT v o © C) f' lz C C 0 O b w :I ww q � w O N z I rrTT R w A � z . � W 00 Cc, A w ;; g o 40 40 Tt cn 00 G� �/ aJ �l ON w cn r Y H cc� F+y w 1-1 r y y� ✓ O 5i .,cc C :: A d ° � � ° N w F o z M o v 0 U v Vy� N w °� A w Z tea' 4 0 � o .. a �i Ui 0 a _ BUILD �TMENT — v><Lt o � 1xooK I FEB 2 4 2025 938 KING,S� T R5'E BRfQ 1,NY 10573 (914)939-061�)Ov VILLAGE OF RYE BROOK www'Xiebrookn BUILDING DEPARTMENT ADMINISTRATNE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE US T 1 25 APPROVAL DATE: PERMIT#; � 7 iPPLICATION FEE—: APPROVAL SIGNATURE: _PERMIT FEES: 4 /.�C) i�)y �P__ H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: 02/11/2025 is hereby made to the Building Inspectorofthe Village of Rye Brook,NY,Far the issuance ofa Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 17 Doral Greens Drive East, ,,�,f� k NY 10573 I. Job Address: , 2. Parcel1D#: 129.27-1-4 Zone; loa6 3. Proposed Improvement(Describe in detail): Installation of ( 1 ) replacement Andersen 200 Series Perma-Shield 2-Panels , Exterior & Interior WHITE, no grilles Into existing openings with no structural alterations in the Livingroom. 4. Property owner: Raymond Coll ET/1/c e ;- / Address; 17 Doral Greens Drive East,eye, , NY 10573 Phone# (914)403-5216 Cell# (914)403-5216 e-mai[ raymond_coll@hotmail.com List All Other Properties Owned in Rye Brook: Applicant: Lindsay Loson Address: 17 Doral Greens Drive East, y(? ,/'(,,V NY 10573 Phone# (914)403-5216 Cell# e-mail lindsay@permitflow.com Architect: N/A Address: N/A Phone# N/A Cell# N/A e-mail N/A Engineer: N/A Address: Phone# N/A Cell# N/A/ / e-mail N/A General Contractor: Address: N/A Phone# Cell# N A e-mail N/A (1) 6/112024 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: N/A Post-construction: N/A 6. Area of lot: Square feet: N/A Acres: NIA 7. Dimensions from proposed building or structure to lot lines: front yard: N/A rear yard: N/A right side yard: N/A left side yard: N/A other: NIA NIA 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: N/A 11 fl: N/A 2"d fl: N/A 3rd fl: N/A 10. Total Square Footage of the proposed new construction: N/A 11. For additions,total square footage added:Basement: NIA I'fl: N/A 2nd fl: Yd fl: N/A 12. Total Square Footage of the proposed renovation to the existing structure: N/A 13. N.Y.State Construction Classification: NIA N.Y.State Use Classification: N/A 14. Construction Type&Location:O Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; (}Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: N/A 15. Number of stories: N/A Overall Height: N/A Median Height: N/A 16. Basement to be full,or partial: N/A finished or unfinished: NIA 17. What material is the exterior finish: NIA 18. Roof style:peaked,hip,mansard,shed,etc: N/A Roofing material: N/A 19. What system of heating: N/A 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21, Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No:_ N/A (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft_or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: Arew IIVV 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) N/A 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes; No: N/A (f yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25, Is the lot located within 100 ft,of a Wetland as per§245 of Village Code? Yes: No: N/A (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: N/A (if yes, the area and elevations of the,flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: NIA (if yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: N/A Indicate:TIER l: TIER I1: TIER III: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ 6,591 Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: N/A (2) 6/1/2024 BUILD _ ;'�MENT VILL E OF RY1 �R,OOK FEB 2 W �� 938 KING ET RYE BRO�b ,NY 10573 25 ' 14)9 ��-��Y VILLAGE OF RYE BROOK 'ov BUILDING DEPARTMENT i 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 RAYMOND COLL ,residing at,17 Doral Greens Drive East, �yQT , NY 10573 (Print name) (Address where N.011 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; 17 Doral Greens Drive East,404boK , NY 10573 , Rye Brook,NY. (.lob Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps,or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. ,::: C (: ignaLulvof Prollerth (h�uer(s)) RAYMOND COLL (Print Name of Prupert} 0%Nneris)) Sworn to before me this 17¢� day of R)37?VL)r►/ 20 L',j BRIAN MACDONALD NOTARY P(MIJC State of Connecdcut my COMMISSION ExpaFs Ott 31 2WM (Nolan Publicl (3) b1112024 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as: LINDSAY LOSON ,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 Agent for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agcnt,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 stonnwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this W-h Sworn to before me this 18th day of*—"—, 20 Z L day of February ' 20 25 11':�K 4AAa* J_04� Signature of Property Owner Signature of Applicant RAYMOND COLL LINDSAY LOSON Print Name of Property Owner Print Name of Applicant Notary Public Notary Public Chesi> ld N BRIAN MACDOALD NOTARY PUBLIC Suite of Connecticut >\n \�,,4µTM oR64rjl Jermelsha Cur la Justlnlano My COMMISSION EXPIRES Oct.31 n9 u • N REGISTRATION NUMBER ery �_` 78881d5 Nov COMMISSION EXPIRES ` W114IIVN�O\�\ June 30.2028 Notarized remotely online using communication technology via Proof. (4) 6nr2oz4 (b) DESIGNATION OF AGENT(S): I, BERNICE COLL 17 Doral Greens Avenue Rye Brook,NY 10573 hereby appoint: My spouse. RAYMOND COLL 17 Doral Greens Avenue Rye Brook. NY 10573 as my agent. If you designate more than one agent above and you do not initial the statement below. they must act together. ( ) My agents may act SEPARATELY. (c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL) If any agent designated above is unable or un%011ing to sene. 1 appoint as my successor agents: My son EYTAN COLL 49 Fieldstone Terrace Stamford. CT 06902 and My son GIDON COLL 31 Jane Street, x3G New York.NY 10014 If you do not initial the statement below, successor agents designated above must act together. ( ) My successor agents may act SEPARATELY. You may provide for specific succession rules in this section. Insert specific succession provisions here: (d) This POWER OF ATTORNEY shall not he affected by my subsequent incapacity unless I have stated otherwise below, under "'Modifications." (e) This POWER OF ATTORNEY DOES NOT REVOKE any Powers of Attorney previously executed by me unless I have stated otherwise below,under"Modifications. Home Improvement Agreement and Payment Terms DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Raymond Coll Legal Name:Fairchester Custom Windows LLC 17 Dorsal Greens Dr E RENEWAL CT HIC#.0667292,WC-35743-1-122.Putnam#51220 Portchester,NY 10573 byA MHWN .RSENMWLOW 421 West Ave.Building 11 Stamford,CT 06902 H:(914)403-5216 Phone:203-406-0545 l Fax:203-406-0828 1 sales@rbawestchester.com Raymond Coll 01/28/25 BUYER(S)NAME CONTRACT DATE 17 Dorsal Greens Dr E ,Portchester , NY 10573 (914)403-5216 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER raymond_coll@hotmail.com PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Fairchester Custom Windows LLC d/b/a Renewal By Andersen of Westchester and Fairfield County("Contractor"),in accordance with the terms and conditions described in this Home Improvement Agreement and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Home Improvement Agreement,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL CONTRACT PRICE: $6,591 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DOWN PAYMENT: $1,318 BALANCE DUE: $5,273 We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at AMOUNT FINANCED: $0 this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. METHOD OF PAYMENT: Credit Card NOTES: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 01/31/2025 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SIGNATURE OF SALES PERSON: SIGNATURE OF CUSTOMER 1: SIGNATURE OF CUSTOMER 2: Ed Coll Raymond Coll PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 01/28/25 Page 2/ 26 VEW _ Order Summary � dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD Raymond Coll COUNTY 17 Dorsal Greens Dr E R E A L Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292. Portchester,NY 10573 by A N D E R S E N WC-35743-H22, Putnam#51220 H (914)403-5216 421 West Ave,Building 1 1 Stamford,CT 06902 Phone:203-406-0545 1 Fax:203-406-0828 1 tech®rbawestchester.com ROOM SIZE DpTail's JOB 101 Living 70-1/2" 79-1/2" 2 Panel, Stationary/ Active, 70_1/2" 79_1/2" Aluminum Sill, Performance Calculator: PG Rating: 25 1 DP Rating: + 25/ 25 Glass: All Sash: Tempered High Perf. Hardware: Albany, White, Auxiliary Foot Lock Color Matched Screen: Gliding, Full Screen Misc: Miscellaneous, Footlock upgrade Construction: None Material: None PRODUCTS: 1 WINDOWS: 0 PATIO DOORS: 1 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 Updated 1128125 Lei:10 Lei Estimated Duration: JOBPHOTOS 01/28/25 Page 2 / 6 Order Summary dba:RENEWAL BYANDERSEN OF WESTCHESTER AND FAIRFIELD Raymond Coll COUNTY 17 Dorsal Greens Dr E RENEWAL Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Portchester,NY 10573 bYANDERSEN WC-35743-H22,Putnam#51220 H (914)403-5216 421 West Ave,Building 1 1 Stamford,CT 06902 Phone:203-406-0545 1 Fax:203-406-0828 1 tech@rbawestchester.com •• FLOOR UNIT NOTES Applicable to any job less than or equal to 3 units. i i ------- 101 ----- . i FRONT I i rRnJYT Original: 01/29/25 1 Updated: 01/29/25 2:21 PM Page 3 / 11 an;leiuosaLaaa sales uas;apuy to joleap LnclA loeluoo aseeld uoileuuolul aruewicaped liun o!pads Lod ary; afiel»Pluwm°P'+rlOt S1r.g°»:roroulu„n,vntO 591oo►•m-d lkk3l321ac suoildo pue azis pun Aq sauen aouewjo}Lad Aluo aomajal col sl uogewjolul Slyl 12 ON z'0> K t►'0 ct'0 9C'l ►Z'0 1000-StS10-CI'N'ONtl laelea4fu.owW¢:elln01.,14e4•wj ON Z'0> tl it 1 9Vo GS"l IZ"0 10o00-6ZSlo-Cl,N-0NV nn P°Pln'O llnj �, £ Ran' lj'1151ON t'o> 6L LC'0 9l'0 9t'l IZ'0 COOOo-[ZS l0 Cl ttONtl °Igcnow.N roualul Pallcisul to opl P°P'n'O pPKlnw15 s i JH Z'0> 92 ita 9 C 9C't 1Z'0 LOO"ESlo-CI'NONV Isselbeyru.awyaq•so11!r0).04011—A :T 2 12IIMH 7: Z"0> iL 110 SZ'0 I CS'l IZ0 IOOOo-1Z9lOT l'N-ONY apl pa P'n'O ilnj E I2 ON. LY0 SL'0 90't /Z"0 C000D-ZZS&0"MN-ONV .1q-...y rou.Wl p,ra-1 lo.,,I WP-o p.lrinmg i l7 - Z'0> LC C9'0 wo 57'1 GZ 10 t0000'SLCL"l-N'0Ntl Issel&a4tuaarnio¢s°IW01,,.74011w1j 17 L'0> SZ 900 LVO 9L-1 It"0 t0OCO-C9C10•C1-N'UNV Pun P°Plnlf111n3 n E l: z'0> !i "0 L1'0 57"l CL'0 CDOOtrt 9twt L.N.ONY Plgenewoy reuoiul p.lmmul+o stll pap-o poi.lnw'S m S ON z'0> 9L 1Yo 6l'0 45"l W'0 L0000'9Lflo-t L-N-ONY Isselb.yluwny>¢so4'r0),.iy0q.u'j 3 nsl ON z'o> CI 9L'0 LI'0 S9'l SVO LO00tr99C10-tl-N-ONV °PI P•P-C)llnj o — � m JN I'0> SI 1f'0 tV0 ( 95'L 9Z'0 C0000-KCI0-9I'N-ONV alq--klr.—M F•Imlful:o.pl P•PNIO MKInw,S 1 I .�ON Z'0> 11 LZ0 9I'D S9'L 6I'0 1000D-LLCIO-S I-WONV Isss10-ay}uaa>nlPS sa4u8)„1404wij ON Z-0> 2l CZ-0 9l"0 OL-1 OC"0 10000S7CL"l'N•0NV aul P.Plw'O llnj f OS JN z'0> f l Cz'0 Sl'0 S9't 6Z'0 COOOOtSClo-tlN'ONtl °Igenoway roualul FallCisul ro apl p°P!n'O poKlnw'S m 12 JN Z'0> IZ "D IZ'0 j 65"1 12-0 10000'7LCIo-CL-N-ONYI Isscle-ey>uauv.ya¢s°IluBl�,:y0i;.u'j sl J>f Z'0> Ll 110 51'0 101'1 0 1 '0 10000'99C10-Cl'H'ONV •pl P•Pln'O llnj f Z'0> CL i1'- SZ'O LS'1 -0 MOO-ZSCltrtI W0NV algI-11lou.1u1 P•Ilelsul ro opl P•P!n'0 P°K1n1wS m lolvoiD to.j soillio Im•sselo Polodwol t'C 17� Z'o> tf 590 Cl"0 Z>'t SLO {0000'OCSL7Cl'M-OHtl Issel6ay>u..wny¢sollu0l,,,iy0';wrj 12 Z-0> 92 IS'0 C1'0 I S9"l 620 LDOOtr125to-f t-N'ONY apl P•Pln'O r v LTTIE Z'0> LC Z9'O w. Z/'l SO ZOOOtr1Z5ltrCl•N'OHV algcngw°N roualul Wlleisul ro opl PPP!n'0 paKlnw'S R ? LZ 12t3N 20> 9[ 09'0 P►'0 Zt'1 Si'0 t0000-12510'C IN'ONtl s°IIuO ON 1 j Z 0> lZ CTO eC0 9t a 1Z 0 t0000-ZE510-EL-WONY (ssg6+yr u..MP¢sollu0i..:404wy JOO(]o!ied BuIP110 WPl-lL1S-etwod Cj L'0> 91 it'0 6l'0 fist 9Z'0 10ot10-92510-ft-N'ONV °pl P.Pln'O 11nj v e 5eue$DOL u m IjL'0> lZ C/'0 Cl0 9f't OOOOT2510-i 1•ItONtl algcnewed lou°WIP.Ilclsul ro ol!I PaP!n'O p.Klnw'SQ Voa ZZ 61,0 iz0 19C'l K0 ()GWCZStOTI-N-CNV s•lluO oN 1-11 ON L"0> 9L it 0 art 9t'l 1z D loCOtrltSlo-Cl•N'ONtlI 1ssglD-ayruo+M1°¢sgl'r0) 1404w1j 17 - ON L'D> L2 it'0 920 6S'l 12'0 1000o-SZSl0•L l•N-ONtl •allF P'n'O llnj n c 12 ON 1'01 92 it'0 Iz'0 9t'l 11-D :00 ZZSitr[t'N-ONY o!q.—H r°u°WI P•Imisul ro.q! l WPN!O p.Klnw15 R IZ ON L"0> 9Z Wo ZC'0 19t'l K'D t00o0-ZZ9to-tl•N-ONY — -- - s-IWD ON 1 12 I'0> LC CSO L'0 5Tl 6Z'0 1OOOo-67110-11•N-ONV Issry0-ay>uaw.>a¢salpr0)�Ly0lpuy 17 Z'0> IZ CS'0 LYO IL I1"0 110000•LSCLO•Cl•N-ONY .i'I P•P'n'O ilnj C o n F IZ Z'0 a LC t5'o L9'0 59'l 6Z'0 ZOOOo-tSf IOT LNOMV °Igcnowea ro'roWl P•Imisul ro syl P•P!n!O pe Klnw.S L.Z 17 Z"0> K 19.0 C9'0 59'L CI'0 10000-15[to-[l-N'ONY —11"t)°N LZ ON 2'0> 9l »0 GL"O 6S"l It LOo002LC10•Cl•N-ONYI (ssg6ay►uww.yq srylu0)�,yy04aulj ON Z'0> CL tt'0 i1'0 OL'L 01'0 t000110911111-N'ON11 °111 P°P-a imi a . o G F tj ON z'0> 91 1V0 6l'0 65't IZO Z0000-T$C to-Cl•H'ONY •Igenouroy-P•1ul Pallclsul ro 411I POP!n!O poiel—s Lj ON Z'0> LL 09"0 it 69'l 9L'0 LOOOtrKCItrCI'N'0NV 5-11.0 oN 1 ZN z'0> 11 LZ0 1Via S9'l 6S'o 10000,lLCLOTt-N-ONY IssryO-.y;w✓n1o¢so11u0).,240'Iw'j L'0> Ll LZ'O IVO 9L'1 t['0 1000o-65C lOT t-N OIfY al!1 P°P!nlO lln-4 N o JN Z'0> tl (Z'0 Il'0 571 I CZ'C 20000•tStIPCI•N'ONYI Plgentwroy lowWl Wlmisul ro.yl P•p!nlO P.Klnw'S m ON z"0> SL IL'D DZ'0 59t 62'C 10000"t5flo-tl"N'0NY -11.0 N ON Z'0> L2 1f0 IL'0 CS'l IZ-0 10000'0[Llo-[L-N'OHY Isse10-•4>uo...Vq.sryWe)•,•lye4owj ' :IN L'0> it 99'0 IL'0 OL'L of 10000-95L 10-Cl-N-ONV •1!1 POPIn!O 11nj c E 2 JN i"0> tZ 4Y0 IZ"0 65.1 1Z'0 LOOO-1-1l-N-ONY alq.—H—ju?P.Imnul ro.a,Wp-Cl pa.In—S m ON L'0> C2 SSO IC'0 i5'1 IL0 t0000-ZSCItrLL-N-ONtl s•1140°N _t ueyl ss.n sollpo Pue solipf)ON 1N1-sselE)Pu.dwel t-C N Z > > s .g, s _ ➢ n . raGwnN AloLaarro 00j, sdAl LOnpad L y O ^n n slonOwd GdAl s11NtJ aselo 4 ourl tonPoid t'►n D 9 n s fn t? P.11WOO Oki jN ussDapuY .uaa[apuv 21Y1S UVIS F AsliGN3 AOw3N3 apeus9 s n I I • 3a •1. •oi• � - �1• •1••• � 1111• r J I. fr r r � r - :L e K yF _ t,m w OF f "i� �`--ter �` �. � �5;"'.` ,, '"•'�j;'�'� Y� it i v 'y `1 r i a T "' ``'��.: �: �, � ;� � _. _,.. ._ . .- ","�a '',� �!�'�' - "�'�, i �: .... ,4 .,i�, .� �} �t, v.»•. r � Rr ��,} � � - _ _ �t`° _�. 1F,�' �. L ti - � - � ._ �� +. ��. � , _ _I � � ■ e .. a �, � .�. �•• I ��� fit:•.; at+. is ��+�tii TE. � .. i7:T l �,, ., �9 � _ � �,, ��� � _` . x- T- x+r i I I f' %vestc tc ster I George Latimer ( + James Maisano Westchester County Executive `�OUn"Y Director,Consumer Protection t 1 Department of Consumer Protection Home Improvement License 1 J / I FAIRCHESTER CUSTOM WINDOWS, LLC 421 WEST AVENUE- BUILDING 1 t i QTR.h4FORD,CT-06902 This license is issued in accordance with Article XY;of the Westchester County Consumer Protection Code and is valid only upon i presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. 1 NOT FOR FEDERAL PURPOSES `ok Consun,Pl- f Leo 0 o ,. License Number ,� Date of Expiration WC-35743-1-122 � s�� � 09/20/2026 i. a/assfa� s�0hester CO" FAIRCUS-01 PSMITH ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Y/VY) 8/7/2024 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). NTACT Theresa Brandon PRODUCER CO E MBI Company Group LLC. PHONE 280 State Street (A/C,No,Ext): (203)288-3401 ('A,C,No):(203)281-0414 North Haven,CT 06473 E-MAIL .theresa.brandon@mbi-ins.com INSURERS AFFORDING COVERAGE NAIL k INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba: Renewal by Andersen INSURERC: Fairchester 421 West Avenue, Building 1 INSURER D: Stamford,CT 06902 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYY MM/DDfYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR X S 2516791 8/12/2024 8/12/2025 DDARMAGE TO RENTED $ 500,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY�X PE X� LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER. $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea acodent)ANY AUTO S 2516791 8/12/2024 8/12/2025 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ X Comp Ded$500 X Collision Ded$500 A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE X S 2516791 8/12/2024 8/12/2025 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 $ A WORKERS COMPENSATION SER AND EMPLOYERS'LIABILITY X PTAT T X ORTH- Y/N WC 9099063 8112/2024 8/12/2025 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE a N/A E.L.EACH ACCIDENT $ PFFICER/MEMBER EXCLUDED? 500,000 Mandatory in tJFiI E.L.DISEASE-EA EMPLOYE $ If yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Village of Rye Brook is Additional Insured as required by written contract per the endorsements included with this certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ,� / ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Fairchester Custom Windows LLC. 203-406-0545 dba:Renewal by Andersen Fairchester 421 West Avenue. Building 1 1c.NYS Unemployment Insurance Employer Registration Number of Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.. a Wrap-Up Policy) Number 88-2855660 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street Rye Brook, NY 10573 WC9099063 3c. Policy effective period 08/12/2024 to 08/12/2025 3d.The Proprietor, Partners or Executive Officers are ❑X 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 1a"for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c", whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed. nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Patricia Smith (Print name of authorized representative or licensed agent of insurance carrier) Approved by P � 1�7mZ6� 8-9-2024 (Signature) (Date; Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 203-288-3401 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. C-105.2 (9-17) www.wcb.ny.gov