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Home My WebLink AboutBP25-040PERMIT # P jfltrgr TYPE OF WORKs,f�J JOB LOCATION OWNER; CONTRACTOR �o T. COST A%m Qad'J© DATE. 3 / 3 :),T LOCK LOT/- l/®l ce S�Q Qu)n 1JCc oo PS %W LLQ �9/y) �-/7�0 o -- FE 0 aso .� FEE DATE Q� TCO # FEE DATE COR INSPECTION RE IFOOTING DATE INSP FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER R.7 ELECTRIC LOW -VOLT ALARM AS BUILT C7 FINAL vv M�� p 3 s l�/e.�e Co LL � `7�)?c 7�/ C � Co r%Q C�aS- O /�elulaTX Cd��n G��i Ga�o�S PS OTHER APPROVALS ARB BOT ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-064 Certificate of ®ccup ucp This is to certify that —7 Lo QL(, r—er L c G of, P &-Oc-) k / V `/ , having duly filed an application on mQ 20 (:;1?5 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 13 5 0 Block: / Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. "0 , issued 20 a 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: guslcw,7s qyb1io " ,6 Construction: 153 , for the following purposes: y��-�r/o r �7 L r� A�)'?,$) -to e I tin r,4Yr rcj �'/00 r 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 ade,and no enlargement, whether by extending on any side or by increasing in he' t Shall be made,nor a the ' g be moved from one location to another until a permit to accomplish such change has ee in fro th B mg Inspector. MAY 19 2025 Building Inspector,Village of Rye Brook: Date: (�yE BRCS k C t�toYuv�� VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.iyebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E.Fews David M. Heiser Donald T. Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE May 19,2025 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 #25-034 issued on 3/14/2025 for the installation of new ductwork,diffusers and exhaust fan has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE BRnv� .11 4 �J,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.Qov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 19,2025 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#25-035 issued on 3/18/2025 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 D E C E I V E �—� For office use only: BUILDIN � TMENT PERMIT MP19 Q tiAY - 8 2025 VILLAGE OF RYE BROOK ISSUED: 3-/3-t2,5 9 8 ICING STREET,RYE BROOK,NEw YORK 10573 DATE:�g�� VILLAGE OF RYE BROOK (91�4�9 -0668 FEE:�V PAID BUILDING DEPARTMENT www,r k 1D ov 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 +tsasst+ssrtsr++s+tssrrssrsrtrstt►sttsrrss++++ssrss+++rtrrttrttttrtttstt+rtrt++■rsssrrssrrsrtrsrsr+++rsssrssrsrr++rsas►rsrrssr►s Address: mod.) W VStCht steer Ave,nLe Occupancy/Use: Off'Xt Parcel ID#: BL)1506 S (;n2U(? 9 135, �a-1'� Zone:_ Owner: V00 yi e'stue-sitr &e,, LLL Address: P.(}, 136X 3!/, tvh117_D P.E./R.A. or Contractor: $Tt (oro, Address: P(� B 0 W131 fe (jaiQS' W Locc- Person in responsible charge: O l r O l a Tot Address: P,p , G U , U 9, 14)6;rL O Q495.N,�1 1 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: 0i(ThG GCS O qCj I being duly swom,deposes and says that he/she resides at d. [�(y( 3 I lik I()bG5 (Print Name of Applicant) (No.an-8 Street) in Vu elf ff PICAitls in the County of {S tCh�S t�_f 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 woo, ()DO for the construction or alteration of: Q{(1 Le �PC9 e th 3 r' A Dor Pw 0 We 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 Sworn to before me this day of ma , 20 day of , 20� Signature of Property Owne Signature of Applicant Mar 'I Oil ( 1 n r f:h n del a da'.q / Print Name of Proper ram` _ Print Name of Applicant Notary Public Notary Public Mobrmmad Rahman Commission#OIRA0032973 6/i/2024 Notary Public State of New York Mohammad Rahman My Commission Expiration:01/17/2029 Commission#OIRA0032973 Notary Public State of New York My rnii r +sginn Fxniratinn:01/17/2029 �yE BRC��. .F o 1932 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.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - �V �- ` \ `�''ADDRESS DATE: PERMIT# � SSUED• I SECT: BLOCK: LOT: LOCATION: !- v OCCUPANCY: A( ❑ VIOLATION NOTED THE WORK IS-,,p ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION n\\ 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 ❑ GROSS CONNECTION q- FINAL ❑ OTHER �yE BRC�k. Zm cu � QJ,/� .��O•c ' 1932 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.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: 7 — / 7 PERMIT# ISSUED: SECT: BLOCK: LOT: 2-- 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 /J ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E BRC��, cu � 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ETASSISTANT 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: ? >� PERMIT# ISSUED: SECT: .S �Z BLOCK: LOT: , LOCATION: N 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 ❑ OTHE#t14o✓e �r �� , �r ? �� w4r i�,v C- - d tiu o cu � '9a2 BUILDING DEPARTMENT ❑ ,pLDING INSPECTOR 9ASSISTANT 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 : `3Cv V V ( DATE: �/' / �7 - —,)o-' S PERMIT# /t! ISSUED: SECT: z BLOCK: LOT: 2- CA LOCATION• U i +yJ-L ^)' 3 J 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 ❑ FUELTANK FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION AL ,(l ❑ FINAL ❑ OTHER II � � v t" '�D lL4r✓ C �, O � � W J Yx 1 :r. w �yE BRC�� 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.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 o � - a v d a :, Ra m Cn O A p 0 3 G4 CQ = O U x n v R fij bA - (,� W W o b °� o 00 "" o y o o Ln 010 M a W r o rn FBI � O � `� N x � � Nc •� � � A � p H J y W N z � z O �'ZO v o 0 p V U - CV�1 f� 00 ^ C/� w A 1.� O 'd v aoi U a O � � V �n W A w °' CD Lj) F W C a v � W o � O H z z cv � v � o VI �jr © O N U y W z7 [�] F �j «7 O l y r�ylj ^ 0? �i �)C�yy, F04 u U Q � Cc! O C qn � O Q - z p o o .5 o y u V V U z v o - c� >1 A z C, z x g b .. W W a? am : BUILD MENT VIL ` E OF R OOK 938 KING ET RYE BR NY 10573 ��B 0 2025 4 -0 ov VILLAGE OF RYE BROOK 13tIILDiNG DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Q�C) C� Approval Date: AR 1 L 202 Permit#: jet S -Q !� Application Fee:$ Approval Signature: QOA i Permit Fees:$ Disapproved: Other: Application dated: Q—10i--�' 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. 1. Job Address: $C�C3 �y'�Q,StCI 1 C St{'ir Pa/PXl SBL: 13S,E D, l�a Zone:S 2. Proposed Improvement.(Describe in detail): r }t fit on i ( Ii- �00 / Al O 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 fire suppression system(Fire Sprinkler,ANSI,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;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: COM t-6 IQ, After Construction:ro M rYlcaL la l 6. NX State Construction Classification: N.Y.State Use Classification: 7. Property Owner:90D WP5fCh _S tcr Ave_., LUL Address: PC ROA 3qq. white etGInS, IV IobUS- Phone# 9I+ ' eal 'I' rQrbQp-corn 8. Applicant: S(Q P I St, C0 I"0 Address: PO 6OX ( I /'' / 1 b DT Phone# 91+ a�,S'17D0 _Cell# email: fYl(Yl{'C1 6 qQ) P WO NO CUM 9. Architect: svfano (boamiliAddress: 2071 C(IUHWBOCI ecliwitc -)ba Wnj C �Mlns"\'y Phone# 0114-IID-as s4 Cell# emai1: 5 to frA n _0- M t OU Pe i I I -NPS i-r)ern 10. Engineer: N/P� Address: Phone# Cell# email: 11. General Contractor: P I Sfi, Ci)a. Address: PO P VA 3 L O W h UL 001 S, 1V 1/ /06Qs Phone# 9IL4-A� ` I7Dd Cell# email: l'}'1fY)QC1r1GQ! �plw .(cvr) 12. Estimated cost of construction $ OD (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated grans.) 1 13. Job Timetable: Start: I j �1�a U Finish: (t) 6/1)2024 BUILD MENT VIL E OF R OOK E C E ll 00 938 KING ET RYE BR NY 10573 +� o , �` FEB 0 2025 .ten`• iy L_ i .1 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, lnI -�f n ma (i n GQ ` ,residing at,2U 90K 3UG , WIC I re C1G 10, 1J Y /D(06L�; (Print name) (Address where you live) being duly sworn,deposes and states that(s)he is the applicant above named,and finther states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; f t j?_n u e_ ,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. (Signature of Property Ow (s)) �1k, C' (Print Name of Property Owner(s)) Sworn to before me this f 0 day of TOnvVaryk�, 20 2� (N ry ublic) JANET A HERTEN NOTARY PUBLIC-STATE OF NEW YORK No.01 HE6085824 (2) Qualified in Westchester County My Commission Expires 01-06-2027 6/1/2024 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: MAC-V^a (A () Q M ,being duly sworn,deposes and states that he/she is the applicant above named, �(printname ofindividual signing as 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 S��t�)S I- . C 06 . 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 fiuther 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 to I+\ oI" Sworn to before me this f U day of , 20= day of �� I� tJ , 20 �— Signature of P erty caner Signature of Applicant Print Name of Property Owner Print Name of Applicant .... 0� No Public o Public JA.NET A HERTEN PORK NOTARY PUSLIC-STATE OF NEW NEW Ji,NET A HERTEN estchester County IISLIC-STATE OF NEW PORK Qualified in W ires 01-0 p 6-2027 1OTAR'� °hy Commission Exp No.01 HE6085824 {i��eiitied in Westchester County Commission Expires 01 06 2027 (4) 6/1/2024 E ' � V M M u •' � r---i W � W a o W 0 F• ` W ul "t L R. W5 u. s ICI v LL+ ply ~� • O 4 1- .. A s, V O "" OG v ■ 00 N V O ` 4 cV W W >1 oo u U 000 Cn z W � Ln a a a a CA u ,,whhy� f M W 00 < U 0. G Ln � o H a vn . < oo A y z U Q Q U. �I w a a z R � BUILDING DEPARTMENT CC� ��II� VILLAGE OF RYE BROOK MAR 12 2025 938 KING STREET RYE Bgo ,NY 1057 (914)9 -0 VILLAGE OF RYE BROOK www.ryebrookny.gov BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: L/�J EP#: 06- o( o 7 Approval Date: MAR 1 8 0 Permit Fee: $ Approval Signature: Other: ************************************* *********************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE T TAL 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``. Q 1.Address: �9C� N C r'Y a Lz— SBL: ISJ, /-17- - Zone: 2.Property Owner: (9,r O � Address: P)9 Phone#: q(y -j Z q I �O Cell#: email: 3.Master Electrician/Licensed Installer: Address: r� Lic.#: f 5�QPhone#: (� ISM-VIkCell#: email: Company Name: :k,:, k ck!cu 94 E! C:tlf I C Cmfpdresss: f 4.Proposed Electrical Work/Fixture Count: c�1� 'Y� 1o��iL�� \Q-c 5.3rd Party Electrical Inspection Agency: YI STAT OF N YO C,C( [J�ITY OF WESTCHESTER ) as: eing duly swom,deposes and states that he/she is the applicant above named,and does further (p int name of individual signing s the applicant " state that(s)he is the G g2 C \V V� for the legal owner and is duly authorized to make and file this application. (Masterg iciad/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 to efore me this day of 20 0 Signature of Property Owner Signature of Ap licant 1< h f � Print Name of Property Owner Pri ame of Applicant Notary Public NoJ RY M.RIVERA Netary Public,State of New York 6/l/2024 No.01 RI6441398 Qualified In Westchester County/ Commission Expires September 26,2 J� STATE WIDE INSPECTION SERVICES, INC. CAO Service VVil/i Ittlegii,i/Y 0:0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit# /�/9 --)';�— Scl Ft Plumbing Permit# Final Certificate# City/Village y C Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑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 3P # 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 Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation elk. VIE MAR 12 2025 I VILLAGE OF BR0 K_ RR r ;-� ItP�� This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any ti of h7SbtlltrMal'it�ms haVe� r11f>'stal�,lyou ar 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 compa�'n`y.TFi'e aTfCe'Rf; owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# O Date Signature Address City/State Zip Code Company Phone# Dv State Wide Inspection Services 1080 Main Street MAY - $ 2025 Fishkill, NY 12524 a� 845 202-7224 Phone 4(amp WVILLAGE OF RYE BROOK 914-219-1062 Fax STATF WIDE INSPFCTICIN SFRVICES Email: office@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: 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, 3'd Floor,Suite N-301, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 25-067 135.82 11 1 1 2 Certificate Number:2025-2553 Building Permit Number: BP 25-040 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, 3`d Floor,Suite N-301, Rye Brook, NY 10573 The Third Floor Suite( RPW) 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 Fixtures 94 LED Dimmer Switches 1 VAV Boxes 03 Power Receptacles 53 Light Switches 08 Floor Box 01 Exit Sign 05 Emergency Light 05 Name Quantity Rating Circuit Type Fire Alarm System Smoke Detectors 24 Horn Strobes 07 Pull Stations 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. Page 2 s = O Ln s I .•r ..i � W M = M M Zj W y W �. � W � 00 00 O s M O M N W !n t � CY, �' oG r't V ^ � _ �j ■ N iIn O ■ " r' 1 ►—� ; o H z W n O ■ W � � h V oc IN v z r. 1-4 Q w z WW Q ` H g H a cr, p z w H z Q . < Q Z w Q oG v<i �3 fiot(7ifio4;A;U�644 44C;C4�464444 44444 tit 4 t��I��I�l��r��l��i��li� D FCC ` �V BUILDING DEPARTMENT MAR 21 2025 VILLAGE OF RYE BROOK _ 938 Kr\GSTREET RYF BRooK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668_F:�Y(914)939-5801 BUILDING DEPARTMENT ��•��.rvehruuic.or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: �� 0 EP#: Approval Date: 202 Permit Fee: $ 1-75 C Approval Signature: Other: Disapproved: (fees are non-refundable) 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. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: s�dj SBL: f S"5-, 00(=\* —1— ZoncO& 2.PropertyOwner: Address: Phone#A V 0/D i 41Q email: 3.Master Electrician: Address: Lie.#: Phone#: Cell 4: email: Company Name: �-P�1 t' � jL1Il I C'pA>��ddress: Y I 1� 4.Proposed Flectrical Work/Fixture Count: N `5 C *r******,r,r�r**:��r*:t*x***x*�*x*tr**xw*xxa**�e*,trr lttirlr yt7FRlt:Cir**Yr*Yr it t:l•7t:t F7rkttW&7k,e ir>r.k:t:e y;e f.%•iir it i it 3:k:txrr:txrr xi is itr.it kiY it is:F*A 5TAT F NEW YYO_RK.COUNTY OF ../1"'� V,� T�R ) as: �b 1 ` being duly sworn,deposes and states that he..she is the applicant above named.and does further sprint name of individual signing 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. V • _ for the legal owncr and is duly authorized to snake and file this application. (indicate architect.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 Sw to before me thi �� _ day of 20 Signature of Property Owner cant (o 4 Prnt Name of Property Owner Print Na o Notary Public KI RLY J CKSON NOTARY PUBLIC,BTAT!OF NEW YORK Registration No.01JA6324279 Qualified in Bronx County Commission Expires July 11, 2027 STATE WIDE INSPECTION SERVICES, INC. CA0 Service VVith lWegiilY 0•0 • • SWIS JOB APPLICATION •. • Office Use Elect. Permit# t ^ ; Date �, A Bldg Permit# 's—�� Sq Ft Plumbing Permit# Final Certificate# City/Village �. . //jar/, Zip Building Dept. County Address � f t ` Cross Street Section Block Lot Owner Name/Address(If different than above) j! ;' Contact Number ❑Basement ❑ 1st FI. ❑2nd Fl. FI FI. ❑More Than 3 . ❑Garage ❑Attic ❑Outside —]Residential [:]commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # 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 IECEW[EDI MAR 21 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.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 authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address ( %�� / Name License# AlY Date Signature Address ,,/ City/ / /C `'7 Zlp 7 Company (%j jt/j)(i/�'+n� 7� Phone ��j� I I State Wide Inspection Services MAY 14 2025 1080 Main Street Fishkill, NY 12524 a 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTIONSERVIIE` 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: Telworx Communications 760-800 Owner LLC/800 Westchester Ave LLC 800 Westchester Avenue N-347 800 Westchester Avenue Rye Brook, NY 10573 Rye Brook, NY 10573 Located at: 800 Westchester Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-075 135.82 J Certificate Number: 2025-1966 Building Permit Number:25-040 A visual inspection of the electrical system was conducted at the Commercial 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: Office 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 8th Day of March 2025. Name Quantity Rating Circuit Type Low Voltage Voice/ Data Locations 53 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. ■ `n c c a N N PLO M M o NCA F.W., ' a m n~ ■ F. Q lz a •Mr) Ln In w r � rl I-1 LCL L 0011, 00. • r ~ ZO -� o w � H O z � Z v 04 y O � � `n �,� O z Uu z � % � M■■I �i F-� . Lla c04 r F ._ iihhhlll V � � � M v ►-� Czl � a � � � G4 ^ Cid m ►-+ H fJ. � La F r O r C .J 04 C v $ ► i `n x � o � F w z A o � ■, ao ■ yEdRCv� D [ECIEV V BUIL DE MENT VIL E OF RYE B OK MAR 2 5 2025 938 KIN ET RYE Bw)O ,NY 1057 _ 6R VILLAGE OF RYE BROOK n ov BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: Q,5,—Qel, O PP#: Q Approval Date: MAR Permit Fee: $ Approval Signature: Disapproved: (fees are nun-refundable) 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, S— IS— Z '�- 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 Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address:8 � /4 SBL: /3 Z.. `Z Zonel/,[r 2.Proposed Work: Lam(/ 3.Property Owner: F w Address: qsjelia i Phone#: Cell#: email: / rptv.,rotio 4.Master Plumber: C��.. � j Address: .3 y / Lic.#:�L,S Phone#: C1� l� q^sell#: email: �' !'I.ww.W ,C�v Company Name:cs / 1 Address: S INDICATE FIXTURES&LINES TO BE STALLED AS PER THE F LLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 31d Floor L / 41h Floor ` 5`h Floor Exterior 5.* List Other Equipment(Provide Details: (Notarized Signatures Required Next 2 Pages) -I- 6/l/2024 STATMOF NFW YQRK,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 Master Plumber 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 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 2 4(4 Sworn to before me this Z day of IMU� 20 '--� day of P��'-I" 201A v gnature of Property Owner Signature o Ap i ant An& -�e e')ls2 S141 I Print Name of Property Owner Print Name of A plicant *Nary Pubjp;. A HERTEN ry Publ'5ANET A HERTEN NOTARY PUBLIC-STATE OF NEW YORK OTARY PUBLIC-STATE OF NEW YORK No.01HE6085824 No.01 HE6085824 Qualified in Westchester County Qualified in Westchester County ion Expires 01-06-2027 mmissign Expires 01-06-2027 TW�PJA Ron must be properly completed in its entirety and must inclu�� l°ie notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/1/2024 . BUILD MENT [E C IE� v VIL OF RY OOK MAR 2 5 2025 938 KING REST RYE BR ,NY 10573 _ (914 - VILLAGE OF RYE BROOK "IVW ry 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 COLLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: \ r 3, N\&-Q-W S•W Q t S residing at, gc'�- ?Qr44-N)P (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; - (goo Rye Brook,NY. (ob: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. (Signature of Propert, kn�C W S l�U SZ (Print Name of Property Owner(s)) Sworn to before me this 2 day of 20 Z1;- (No blic) JANET A HERTEN VOTARY PUBLIC-STATE OF NEW PORK _3_ No.01HE6085824 county n,181ified in Westchester ��commissionExpires0 �Ii2o2a M E N " z G k N z O O w A z N N C4 ..r it w a x wmm) ' ►� "� 0 ` [ N g -� i c o cr _ o z _ - . OD 13 1; Ca a ►ten O QTe � ; ' � } 00w F a 110 rA rn-� z w w U I a z v� ��' � w i u Ca 1O 0.0 w 2 E tip O O M C G. W F ZO 00 a M, a BUILDING DEPARTMENT D F J E VILLA'OE OF RYE.,,AROOK FEB �� 938 KING SltkEET RYE BROox,NY 10573 1 1 1) 970668 VILLAGE OF RYE BROOK ww BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: a�-��C) PERMIT#: Approval Date: ' Z Permit Fee: $ -�/1//� "r D�CJ Approval Signature: �AA Other: Disapproved: (fees are non-refundable) *****,r*,r**,r****w****w**,r,t,r**w*****tr,t,t,t,r,t***w***,r*,r,►*ww,►r*,rtrr*wtr*,r*,r,r**,r**ww**,►*w,t,r**,r*w****,r******,r**,r,r 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#C 105.2 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, 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: 800 IJtSLGSnt,S�e( 3 �1exi( SBL: Las.S7--l-Z Zone: 2. Property Owner: '*DO- (L,dt I1 -1&0 SSse dress: QO 6 ox Sy 9 w%:lc, 916-.q1. T1� Phone#: gtLk - ?SS- 1100 Cell#: email: 3. Contractor: COgt . &A LO"s1�, Address: QO %O-A ,JW Phone#: qA 1Io1-`L 66 Cell#:US wait-5ms email: 0C��6COA 4. Scope of Work:New Installation(Y)•Replacement( )• Removal( )•Other( ): 5. List Equipment: 14Qyj A jck,ak " 4YAr a k Awak Q:6 A fit e " RPw PiVixes.a V1,Skag (A kNkek l&N rrr.[ AtA J b�►coc� 6. Location of Equipment: 3C6 1p o r 1; 4 CtA , �Cly 13 7. Method of Installation/Removal(list all equipment needed to perform job): bRra icon A ,Aaa t 6/112024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ({ (6 be tI., ,being duly swom,deposes and states that he/she is the applicant above named, (print narnAof individual signing as the applicant) and further states that(*)he 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 hisPow 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 Z(c,th Sworn to before me this_ZG 7-)4 day of `r—C��p3'y t; '� ,�6 2Q Ls day of t lrv'�w- C� 20 k5_ 417, Signature of Property Ov/nerv~ SioaW of Applicant Maclipisi Print Name of Property Own Print N e of Applicant FE (Notary Public Q� R A Public JANET A HERTEN �0.• 'pTARy •. NOTARY PUBLIC-STATE OF NEW YORK _Q ;N� 0i0U6367294''•1i No.01 HE6085824 =X i ��)nuFt�o tN O C: ;pUTCHI yS COXP Qualified in Westchester County co MN _ ,. _ t 1.13-2025 r'? My Commission Expires 01 06 2027 Pu8�1G 1 1,;frOl7 t N U",w\\\� This application musl 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 andlor not properly signed shall he deemed null and void and will be returned to the applicant 2 6/taou Ln N N a ° Go v � M a a Thy v. I.n a, a t.. w W C N 3 = Q O Not L; a a y 1 - LLl Ob T cc _ (71 � �•I t � Q i � u � J ti Z a G C 'C 2 f Z O v c ON - .� a _ E- vLn a :, C C� CAr- Trtrj @ < a W 1 .n � w � � � E � ..a 00 Cc O (� 00 �" cA Q Ln t; TTo w f Fri 00 �j r-4 rl w f. atre) N t 1J y � 8 U u -4-+ Q OO z O A� C7 z O G c .o' v" BUILDING DEPARTMENT RAR " `W IE VILLAGE OF RYE BROOK �1I 13 2025 jD1 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK w��w.r�elfrot►l:n�.bow BUILMNO DFPAR T MENT APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Q Approval Date 2025 2025 P4: MP#: c S6 ©35Application Fee: $ �5 ) '—/ b Approval Signature: Permit Fees: $ — Disapproved: Other: Application dated: 3/13/2025 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: RPW Group Suite 301 cam 800\\Westchester Ave.,Ryebrook, NY 2. Parcel I.D.: /36> �a —1—' - Zone: 06— oZ 3. Proposed Work(Describe system in detail including suppression agent): Modify existing sprinkler system for new tenant alterations.Fire sprinkler head relocation. 4. Number&Types of Fire Sprinkler Heads: Qty.58/Reliable G5-56 Concealed pendents RA3415 5. N.Y State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job: $ $6,000.00 (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.,Ryebrook, NY Phone# 914-285-1700 Cell# email: nilie@rpwgroup.eom 8. Architect/Engineer: Fire Protection Design Address: 14 Denver Drive,New City, NY Phone# 845-634-2133 Cell# email: mike@frreprotectiondesign.net 9. Sprinkler Contractor: HANG FIRE SPRINKLER CO.LLC Address: 106 Dakota Drive, Hopewell junction, NY Phone# 845-475-2390 Cell# email: jeff.anjos@hangfire.cc 1 6/1'2024 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: ,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 Sprinkler 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 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 Swom to before me this /3 day of , 20 day of M a('G)r� , 20 ("'Y Z Signature of Property Owner Signatuur�� f licant �Je a 5c*') 14".-1 CJ Print Name of Property Owner ame of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.MME6160063 Qualified in Westchester County commission Expires 1anUary 29,20� 2 6/1/2024 Buil&g Permit Check List &Zoning Analysis OB & C ONLY Address: ROC:) W c STc_9ES TER A V,r. SBL: 13S . R 2 - ! - 2. Zone: O B-2 Use:A-2. t 43 Const.Type: Z A Other. Submittal Date: Z-10- Z S Revisions Submittal Dates: Applicant 000 W F S TG N E S 7,R A✓E. JL z!0o r) I N E .37-. C O&P• Nature of Work: Z/V T F J2 10 r2 A L 7,6 2 A 4)d/v s TO Fx/ ' T//1 6 OPPI LE SPACE . -- -�,�:�d ,�/Uy�' --��`�-r��e A'-301 Reviews:ZBA: FER 14 2025 PB: BP: Other. NEED OK (✓I ( ) FEES:Filing. z6-0Pei BP: 10,1000 Fct C/O: Legalization: ( ) (✓f APP.: Date Stamped: ,/ Properly Signed: L SBL Verified: ✓ Cross Connection: ✓ F.O.G.: ( ) ( ) 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: ✓ Seale4i V Copies: Z Electronic: Other. ( ) (JJ License: Workers Comp: ,/ Liability: ✓ Comp.Waiver. Other. ( ) ( ) Code 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. (✓S ( ) LOW-VOLTAGE ELECTRICAL:Plans: Perini N/A Other. (►j ( ) FIRE ALARM l SMOKEXTECTORS:Plans: ✓ Permit H.W.I.C.:_Battery:_Other. (✓) ( ) PLUMBING Plans: Permit Nat.Gas: LP Gas: Grease Trap: 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 Area: 6 Circle: Fmnta � A �L'�P1P11 Front: � D _ ��E Front Date.. use Sides: Rear. F.A.R.: en Space: Height Stories: notes: Filer- e Q r G To 2 P ^J. _ rl2Celveg /1 V. 6.c . L,AN :- -Q<'2 e a� V-%ME, SUPieCQ10A.) L re ery 6iN4- —/ i� I .)s A� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ O 12/13/2024 Y) 024 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: Brown&Brown Insurance Services,Inc. A/CONNo Ext: (914)337-1833 qC,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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCEAUULJbUtJK POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurtence $ 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 $ 2,000,000 POLICY J PRO- POLICY FX] LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ 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 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 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 PER/� STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICERIMEMBER EXCLUDED? N/A EWC 0598194 03 12/10/2023 12/10/2024 (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 $ $15M Excess x$10M Umbrella Each Occurrence $15,000,000 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 yif/f ©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 ^^^^^^ 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:/fWWW.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. NEW YORK STAT SUR NCE FUND T �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 524630855 U-26.3 Client#: 1362961 TELWOCOM ACORD„, CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 3/20/2025 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Donna Volz USI Insurance Services LLC PHONE g08-732-5554 FAx 732-349-0186 A/ N Eli: A/C No 1433 Hooper Avenue,Suite 110 E-MAIL donna.volz@usi.com INSURERS AFFORDING COVERAGE NAIC# Toms River, NJ 08753 INSURER A:Travelers Indemnity Company A18674 INSURED TelINSURER B:Charter Oak Fire Insurance Company 25615 800 Westchester Avenue x Communications LLC INSURER C:New Jersey Manufacturers Insurance Co. 12122 00 W Rye Brook, NY 10573 INSURER D: 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. LTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MM/U/VVYY Y EFF MM DD/YYVY LIMITS A X COMMERCIAL GENERAL LIABILITY ZPP16P8146024 4/01/2024 04/01/2025 EACH OCCURRENCE $1 000 000 CLAIMS-MADE u OCCUR DAMA E T RENTED $1 OOO OOO MED EXP(Any oneperson) $1 O 000 PERSONAL&ADV INJURY $1 OOO 000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 PRO- POLICY OX,J JECT D LOC PRODUCTS-COMP/OP AGG s2,000,000 POTHER: $ (; AUTOMOBILE LIABILITY 1107694622 9/08/2024 09/08/2025 COMBINED SINGLE LIMIT 11,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS ONLY AUTOSULED BODILY INJURY(Per accident) $ HIRED NON-OWNED X AUTOS ONLY X AUTOS ONLY PROfprPERTY DAMAGE $ A X UMBRELLA LIAB X OCCUR EXII Y81520524 4/01/2024 04/01/2025 EACH OCCURRENCE s5,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE s5.00O.00O DED I X RETENTION$10,000 B WORKERS COMPENSATION UB2Y4260742415G 9/09/2024 09/09/2025 X PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1 OOO OOO OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) **Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: Michael Franklin, Ot Michael Franklin,Ot CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED R(E,.PR�E}SSEENTTATIVE v`n.`'`. 'ACA 'C- ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S48562085/M46139500 NZUZP YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 914 761-7600 Telworx Communications LLC 800 Westchester Avenue 1 c.NYS Unemployment Insurance Employer Registration Number of Rye Brook,NY 10573 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e., a Wrap-Up Policy) Number 26-1768133 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) The Charter Oak Fire Insurance Company Village of Rye Brook 3b. Policy Number of Entity Listed in Box"l a" 938 King Street Rye Brook,NY 10573 UB2Y4260742415G 3c.Policy effective period 9/9/24 to 9/9/25 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"T'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 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: Donna Volz (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �o-nna. Yoi 3/20/25 (Signature) (Date) Title: Commercial Line Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 732-908-5554 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 / 1 75/24/2024 E(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 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 NAME: Cynthia Schmidt Allied Insurance Managers Inc. Ai NE t (248)853-0930 C No: (248)853-1512 1055 South Blvd. East EJMAIL 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 INSURERD: INSURER E: Hopewell Junction NY 12533 INSURER F: COVERAGES CERTIFICATE NUMBER:24/25 GL,Auto 6 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 ADDLTYPE OF INSURANCE INSD WVDSURR POLICY NUMBER MM/DDY LTR /YYYY MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGES (RENTED 100,000 PREMISES Ea occurrence $ X Blanket AI,PNC,WOS SP2240076 5/22/2024 5/22/2025 MED EXP(Any one person) S 5,000 PERSONAL &ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO POLICY a ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Errors&Omissions $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS S 2491771 5/22/2024 5/22/2025 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS rxx AUTOS Per accident 5 X BLKT AI w/PNC BLKT WOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000 000 A EXCESS LIAB CLAIMS-MADE SP2X240076 5/22/2024 5/22/2025 AGGREGATE $ 5,000,000 DED I I RETENTION$ Follows Form $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUnVE E.L.EACH ACCIDENT $ OFFICFR/MFMBFR FXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability SP2240076 5/22/2024 5/22/2025 Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 AUTHORIZED REPRESENTATIVE Jayson Bass/CMS — - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 17-091k*\1 NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^A^^^^ 833132921 tY - • key HANG FIRE SPRINKLER CO LLC #i i ' Fk_ } 106 DAKOTA DRIVE HOPEWELL JUNCTION NY 12533 ♦'' i 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 3/12/2025 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 • CARE&WA-01 MGIORDANO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/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). CONTACT Michelle Giordano PRODUCER NAME: AssuredPartners New England,Inc. PnHO No,Ext,(860)426-6163 ac,No):(860)426-6163 100 Beard Saw Mill Road Shelton,CT 06484 E-MAIL .Michelle.Giordano aU�4ssuredPartners.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of NY 13730 INSURED INSURERS;MIS Transverse Specialty Insurance Company 41807 INSURER c:-kmfirust Insurance Company 15954 - - -- 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 ADD L SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR X X S 2509239 9/1/2024 9/1/2025 DAMAGE TO RENTED 500,000 MED EXP(Any oneperson) 15,000 PERSONAL&ADV INJURY $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000 POLICY F11 I PROT- LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: JEC $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO X X IS 2509239 9/1/2024 9/1/2025 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS p BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ IS X UMBRELLA LIAR 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- AND EMPLovERs•LIABILITY STATUTE FIR — JOWC1010426 4/1/2024 4/1/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ X E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' N N/A (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 $ p NY Disability LNY612715 4/1/2024 4/1/2025 Statutory i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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:9/112025 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 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) u ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Yo K Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.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 WC1010426 Rye Brook, NY 10573 3c. Policy effective period /1/2024 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 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: (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. < � --n -< = m OO z cn D :;a (n M cn z r t�T � (n to O --< S N O T < m o W N m r NNOD��nc O �oC�co�o=m m —I (0 z m z m 0 m ni D zoZz�o o —Zj rr-- v � � r m -� Lo O r m c m D m M � N m m z (n o G7 Cn -O (n = m -< -D - y ZcnmDN m —i c� D ;;o m C/) z D�NG7� r- Z N C -0 O .. z mm x _ M — D ;:u . 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