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HomeMy WebLinkAboutBP25-036PERmrr # A)6 SECTION �, A g BLocK t oT, TYPE OF WORK roatil 4 Q room JOB LOCATIO I PPC' lcJO p�lPl/Q� OWN] iYIC�S CONTRACTORQ,6 %7 ZAi Zv ep? Iribni O'e>,�,/O 0 TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBINGmmlkluf 0 �►Cje 14t)d S/y // ytif rP/, c�� C9/y) 74 E// 7 CAS GAS CI ELECTRIC 3 as l LOW=VO AS BUILT O FINAL OTHER APPROVALS ARB �✓'G(Q�'L! / � aOa� BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-144 Certificate of ®ccupoucp Ellis is to certify that1 0/MS r4o of, Rue &0©k, /y Y , having duly filed an application on 20��requesting a Certificate of Occupancy for the premises known as, 161 ,[J�L (�f/�C/t �U/��� , Rye Brook,NY, located in a K 01-5 Zoning District and shown on the most current Tax Map as Section: 13 .Q Block: l Lot: 7 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.0 5- 3 , issued -3 20 r, 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 nn New York State Classifications, Use: K— Q/7 /� Construction: for the following purposes: rnQt,� l/l l'� 1 �Qr�dyJ�7 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 maybe 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 facilities shall be made,and no enlargement, whether by extending on any side or by increasing in hei shall be ma ,nor Aall the building be moved from one location to another until a permit to accomplish such change h bee b ' ed a Building Inspector. Building Inspector, Village of Rye Brook: Date: NOV 18 2025 E C E RV I' BUILD R NT For office use onl PERMIT# JUL 2 8 2025 DO, VIL OF RYE OK ISSUED: - s 38 KING STRE YE BROOK, YoRK 10573 DATE: VILLAGE OF RYE BROOK 9 :Q �� FEE:—QQ5 PAID 0101 BUILDING DEPARTMENT W 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 Address: 1(0 b .,j-kWbW > p'Wr'> Occupancy/Use: I T73 -. Parcel ID#: 3(o.2g " + 7 Zone: -25 Owner: bdUI&A 1169AIk6o l61709- Address: J(7 B4;jtWWMp N,11D. P.E./R.A. or Contractor: CPTI I,LUWI 2ULDIN& 6;9-P Address: j` t4 RD. VpW. a O6( 3 Person in responsible charge: ( kpa-,j am" Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YOM COUNTY OF WESTCHESTER as: T*Qb)AA06 ?6-17DED being duly swom,deposes and says that he/she resides at ((a --'s[,V D (Print Name of Applicant) (No.and Street) in �y i� ,in the County of in the State of 1s4 y ,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:$ Ao,o0 , for the construction or alteration of.. ©F Ing ff>w- em"-Oby'� /W—TOR-Wi-(�Dl-� 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- 2( day of ,20 Signa Frdpehy Owner Signature of Applicant Print Na Property Owner Print Name of Applicant r Notary Public _ Notary Public RO EMAR w York Notary ublic Stal 3476 0.01 Quay d in Westc ester County 6,i 20?4 Mymission Expires Feb 7,2026 om 4K(1v�• o tim 04 cu � 1982 BUILDING DEPARTMENT ❑BOLDING 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:"----Z-cap mj-o-o LJ� DATE: OLI- PERMIT# > 7,6_"_QZ�v_ ISSUED:3"(i'2J"SECT:__/-3(o.ZIBLOCK:_I LOT: LOCATION: fA AsleA IA V Agq"A 4- &c 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 n n � ❑ NATURAL GAS ❑ L.P. GAS 1� El FUEL TANK - ,JeM IQ nl� ' ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑FROSS CONNECTION ALL. VJO G f r M INAL tl' t C ❑ OTHER /-1 AQyE 4R(b, O�` tim Q�/� F o '982. 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 : �� <�U :i 'J C DATE: > i `/ - PERMIT# 9 Co ISSUED: y 6 — Z) SECT:/360• BLOCK: LOT: yam' LOCATION: /4 �� �' � 7 h �� �" �� 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 QyE BRC��• cu � 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR El 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: Z ^ PERMIT# ISSUED: SECT: /3(• 25 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 ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E BRCv�• 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 : (c Q�� �I ���� DATE: ! ? PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: t��/ l 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 M � N ��••vv `" �, s o z IS cn v V N p. o 4� CA H C ;'•w Q p L ■ o rill o y QC zb L. Ccq a " a 11 n W W ° �u a crn� A = .246- _ � - ■ �►/ �' W W � � ° w � w° O w O w O fl o o z ul) C/) Ln � � � � W W � - . a �•.0 �. TJ CIS (81 C7 A o v � c V C o �! Uoa ` v oo v v cn Q w W z uZo 4.4 � W � Q p � p � g � a •y � H - � ,� z � � W F. C d • '�,� a o •• � P-' BUIL ��-�`-1 �', MENT VIL ;E OF RYE': OK CIEWIF 938 KING ET.RYr. BRO' ,NY 10573 066 FEB - 5 2025 vvvv 4 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: Permit /0c)'�--OIA Application# AR/32(� Approval Signature:L ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: < `) BOT Approval Date: Case# Chainnan: PB Approval Date: Case# Secretary. ZBA Approval Date: Case# Other: Application Fee:Y ( '" �� Permit Fees: .t4 ?C)U� 1 EX`\TERIOR. BUILDING PERMIT APPLICATION Application dated:V—J{—r ' is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: ,r 2. Parcel ID#: L Y&, & /O / — 7 Zone: 3. Proposed Improvement(Describe in detail): ALIMR4722.w "rb U , 4. Property Owne``r:ww r----- F22TTS4Z Address: GC9 &EEL�4 P Phone# Cell# 7,2f e-mail List All Other Properties Owned in Rye Brook: Applicant: 5134— t9a-4"9-Z Address: Phone# Cell# e-mail Architect: � � �-�� d Address: re7 Phone# Cell-4 e-mailer Engineer: Address: Phone# Cell# e-mail General Contractor: - 91LV11.c1� Address: !47-a 25!4�J 20" �F29D , Phone# Cell 4-714 —691) e-mail (t) 611/2024 5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: NLIL'y Post-construction: 6. Area of lot: Square feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. if building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 1"fl: 2"`'fl: 3 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: l"`fl: 2r'd fl: 3"'fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: 7V77 N.Y. State Use Classification: 14. Number of stories: Overall Height: Median Height: 15. Basement to be full,or partial: finished or unfinished: 16. What material is the exterior finish: 17. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 18. What system of heating: 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must he submitted with this application. 20. 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: (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. 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: N)-l.' Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: 1>9� (if yes.applicant must submit a Site Plan Application,&provide detailed drawing.~) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (f yes,you must submit a Site Plan Application, &provide a detailed topographical survey) 24. Is the lot located within 100 ft. of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: 1� (f yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (ifyes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER I: TIER II: TIER III: (if'yes,a Home Occupation Pettit Application is required) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: $ (}_04)D . Note:The estimated cost shall include all site improvements, labor,material,sraffiolt�g,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: (2) 6/1/2024 BUILD - MENT a `� r� fl ' V E OF RY x 938 KING ET RYE BR NY 10573 FEB - 5 ���� d11 _0668 Y12oV VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, TVOW106 Pb-rrt�p ,residing at, 16 12� VJ60D 8WD Print name) (Address where you I i, 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; 1(o ?_7:PC--CJ4 W LV D. , 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. (Signs re lof Property Owner(s)) (Print Name di Propety(?umcrys)) Sworn to before me this , 20 at � l Notary Public) ROSEMARI J MOGAYERO Notary Public-State of Nei r'k NO. 0 05023476 Quaof'd in Westchester Cou y {� My Commission Expires Feb 7. 2026 ( ) 611l2024 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: T-4410MI962 P rum ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the 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 Sworn to before me this day �Ql , 2 day of , 20 Signature of Property Owner Signature of Applicant `TASM lam✓ Pa-rr6 Print Name of Property Owner Print Name of Applicant i / r Notary Pubh Notary Public ROSEMARIE J M GAVERO Notary Public-Stat of New York N0. 01M05 3476 QuaV� ed in Westchester County My Commission Expires Feb 7,2026 (8) 6/1/2024 _ • a a = ■ 00 OD Q Ln ■ : Lin c N a = =i N < ■ a f Il A pC r U (n ■ ■ W0-4 W z J LZi Q` ■ :43 rWr a. ■' N � a O x = M CA OeqLn a CY. c W oo ■ f 7 . A 1�' �y W W W �j V : W r,l .n fix " a r ■ M"� �-■I O 4 E" C7 Ca 'o n F a 3 H : V CW7 oc o < x w � w V W z O F W z n U Q oA = 0 a, Q C" x ■ �I a� a a z c� w = _ a'. a ME BUII.DING-DEPARTMENT E C E VILLAGE 4F RYE BROOKR MAR 31 2025 938 KING.S'IR.EETRYE BROOK,NY 10573 (914)93'9,- 66& Ax Q( 14)939-5801 VILLAGE OF RYE BROOK www rvel5rdok.orQ BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY T Approval Date: APR 0 2 Application Fee: S V Approval Signature: Permit Fee: $ Disapproved: Other: (fees are non-refundable) Application dated, <31 3 1 1 of 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 R e fi C q(w odd QLV p. SBL: ��g — •- 7 Zone:IR-3 2.Property Owner: Tkom s 4 G't4_" 1 oyek Address: & &ECFfwo,-V (fit-yd Phone#: Cell#: email: 3.Master Electrician: L k N CYe"LeCr`, Address: _St'w )sat Rj e A auct My jars Lic.#:0 5 3 9 Phone#:0/J N��93C1- ��/ Cell#:9_/y-cQ)9-$`rZC! email j_q.1 f'0_-o &-IQL. &M Company Name: w cc.-Tn y fta _ :�--f eyra iL Address:6 SU.0 Ol f en-D 4.Proposed Electrical Work/Fixture Count: LU i P A.FA_M ASIpt- Se4 a m j .as•Tk/la! 9 43 aea rs swdr--4, /a UTA.-uo9,4144 as_ 1-t kb, i A, V i 0"'e/9,44 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: To"k*J G1C l Ze-y being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C0► rr(L,4 c1foaL for the legal owner and is duly authorized to make and file this application. (indicate architect, ontrac ,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 Sworn to before me this day of 20 20 _ Signature of Property Owner S' a f Appl' t Print Name of Property Owner r Name of Applicant Notary Public Now' RTMEULLO Notary Public,State of New York No..01ME6160063 Qualified In Westchester County Commission Expires January 29,20,Z7 1/5/16 STATE WIDE INSPECTION SERVICES, INC. ••0 • • SWIS • : APPLICATION tel 845.202.7224 1 fax 914.219.10621 • Office Use Elect. Permit# Date Bldg Permit# Scl Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑1st Fl. ❑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 iP 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 p C�C� C�Od � MAR 31 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(t)year from the date received by SWIS.This application is intended to cover the above listed items to be Inspected,If at anytime 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 asset forth for the application. Email Address Name License# Date Signature Address City/State Zip Code Company Phone# DR CE C E M I State Wide Inspection Services CA� 1080 Main Street Fishkill, NY 12524 R TO U AJUL 3 0 2025 845 202 7224 Phone �/C1Ali 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com BUILDING DEPARTMENT Website: www.swisny.com Service With /ntegrly ___.._ _...... BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Westmore Electric Thomas & Ellen Potter 6 Sunset Road 16 Beechwood Boulevard Rye Brook, NY 10573 Rye Brook, NY 10573 Located at: 16 Beechwood Boulevard, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 25-088 136.29 1 1 7 Certificate Number: 2025-2531 Building Permit Number: BP 25-036 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: 16 Beechwood Boulevard, Rye Brook, NY 10573 The Second Floor : 1 Bedroom(s), Closet(s), Hallway(s), Master Bathroom were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 23rd day of July 2025. Name Quantity Rating Circuit Type Receptacles 12 GFCI 03 AFCI 04 Switches 15 Dimmers 02 7rze-4 -1.a 16 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. e N � N ■ N N N her C C ►r cS w x = F+ z = as _ A O rr11 e--i pp O � A w tz Z C w ~ N c C` N O Q V N 0-4 zz 1'' LJ W Q fs! z W fI� ■ O 00 O o w o a z � z `� p M - - � u 00 ce ►--� � � � ,� O a H � w � 5 Q � V x a z o , zz `n W � 3 d W n 44 z z BUILDING DEPARTMENT p VILLAGE OF RYE BROOK JUL - 9 2025 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK w��.ryebrookn\4_10N BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY B JLL% EP#: �` 762 ��- Approval Date: Permit Fee: $ Approval Signature: Other: ******************************************* **************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE —7 TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, /—c)J is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: I r0 66ECNwOM aL V D SBL:136 , Zone:R -3— 2.Property OwnerjVloMNS + Ee.t.-N PC-Vep. Address: 16 6(�6CNl,VOUGI BLUQ Phone#: Cell#: email: 3.Master Electrician/Licensed Installer: S'n hm &A- eco Address:6 SU/uSN o�r1 Lic.#: 6 5_19 Phone#:914-e1 3'(-2 qZ/Cell#:?/41-879 :SYa 9 email: rl e Gv if Ad L. COM Company Name:1A)e_STVYLU(iZ £I C,cl Etc- Address: 6 S U4601- 01Q 4f_(S Ir c9 /Us73 4.Proposed Electrical Work/Fixture Count: Trt_,K60_V '1 W) of -T 0 4 e aL BCa-6P/Lu e7 ,1 C'/ C yn D e_' e CAS cwt l De 4eK L oc��-ed1 ,� 1 d 5.3`d Parry Electrical Inspection Agency: Skj 1sS TA,30Ce Tiof--- f!5" STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: C)xlu 6r_Lc(-y being duly sworn,deposes and states that he/she is the applicant above named,and does further (Ilrint name of individual signing as the a l(icant) state that(s)he is the �) !mot. �I t CT2fC/ 4 N for the legal owner and is duly authorized to make and file this application. IMMSer FlectricFap Licensed Installer) The undersigned fu er s 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 be ore me this day of 20 day o 20�� Signature of Property Owner Si ure Applicant Print Name of Property Owner Pri me of Applicant Notary Public No *flabiic,State of New York No.01ME6160063 6/l/2024 Qualified In Westchester County Commission Expires January 29,20 Z7 STATE WIDE INSPECTION SERVICES, INC. 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# �� /' Date '7 Bldg Permit# G Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot i Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 Fl. ❑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 0 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 J UL - 9 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT I 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 anytime 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# Date Signature Address City/State Zip Code Company Phone# _ f = Lr) v' V , O O O OC 0-0 A- GQ w CA C Ln 00 co F-� �' O A V �" O (� r,l-- z • s Z n O Z \ �" o� Z W A M z ter. - _ o � a V � W ~ co") Z W A N W Z y • •i ; �. W zz N a o _ o o a F H2 � S W W u _' W a w � C7 � A C7 A � (AVr z a Z �. a , , , r, Y BR BUIL MENT CEPIVED VII. r E OF RYE OK MAR 31 2025 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK V.Rov BUILDING DEPARTMENT PLUMBING PERMI�T/APPLICATION FOR OFFICE USE ONLY BP#: � �3CfJ PP#: Approval Date: APR 02 Permit Fee: $ Approval Signature: Disapproved: (fees are non-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 V1'ITHOUT a PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750 00 Application dated, 3-3)-c) is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: 1(0 RAnx4awwo oy./ . SBL: 13,p,c19-1- 7 Zone: 2.Proposed Work: Q LoC Stj?M 4X56� 1-1 SA!S_mN la jW&gyp BA�nj I O s4r�. v AH.457 /e&t l / TO"T 12 .S1 N 11.54 PAVCF75/5700 W672 DQAttJ 3.Property Owner: `•r}�A"$qIAFN Q01RJ�_ Address: (p Q }f AAW 2[,fl/I>. Phone#: 0-14 a,24 11-Cell#: (94) 2&I "(72l email: 4.Master Plumber: Address:7�{ ,Fn D",tJ� l c/&I Gyt'1!/1 Lic.#: "-Phone#: Cell#: email: ` r.c:c'SC� N0+ Company Name: PW VA 17r '�401A✓ Address: _;2 A-$tC0r.q , d� �� f lam• �- Ca INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: F,C P CGN h0 G 0-- Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement I st Floor 2nd Floor A 3'd Floor 4'Floor 5'Floor Exterior 5.* List Other EquipmentfProvide Details: (Notarized Signatures Required Next 2 Pages) STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �"�(,O tAS7� ,being duly sworn,deposes and states th 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 C/ Sworn to before me this 1 day ofJ On L4QL- ,/20 day of�cxc-,\-N ,20 Signature of Property Owner i a p icant TA-0ua6! ?O_ Nc 1510W BAEZ Print Name of Property Owner Print Name of Applicant Notary blip SEMARIE J MOG Notary i(MEULLO Lary ublic-State of York 0. 0IM0502347 Notary Public,State of New York Q life. in Westchester ounty No.01ME61663 My Co00ssion Expires Feb 7. 2026 Qualified in Westchester County Commission Expires January 29.20ZJ 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. 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/l/2024 BUILDING DPPARTMENT IFEB `�C�EiD VILLAGE OF RYE-BROOK 938 KING STREET RYE BROOK, NY 10573 - 5 2025 (914)939-0668 www.ryebrookny.eov VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE $Z 16 • 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: 3J, T{10wUA-5 P6 ,residing at, 16 1a66:5f W660 BWD I'rni nanirj (Adhlntss where v(uilive) 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; I �` CC E3LV D , Rye Brook, NY. 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. X (tiiiu"he )] 'ngierly'I hwnrri,ll Wrini woe 41(('roliePly Owner(s)1 Sworn to before me this Zoe_ 4 � a.ny Poldic) ROSjl.'Ales' J MoAf VNEe RwO SNotary PtaO 05023476 QuadfiN chester irk Cow. y My Commission Expires Feb 7. 2026 (6) 6/l/2024 (^ .Building Permnit Check List&Zoning Analysis/ • Address: \y G-Qe6Aum-�A "J�4C2 SBL: Zone: a-25 Use: 2\ Const.Type: Other. Submittal Date: ZrJ Revisions Submittal Dates: Applicant: 2 11 Nature of Work: I- Reviews:ZBA:T_FJ W PB: BOT: Other. NEED OK �n� ^ n ( FEES:Filing. �E IP: \ l /C/O: Flood Plane: Legalization: O ( ` APP: Dated: Notarized. SBL: — Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening: ( ) ( ) ENVIRO: Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan. Other. Y.Dated: Current: Archival: Sealed. Unacceptable: v� PLANS:Date Stamped: Sealed Copies: Electronic: Other. ( ( ) License: Workers Comp: Liability Comp.Waiver. Other. CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ) LOW-VOLTAGE ELECTRICAL:Plans: Perot: N/A: Other. ( ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 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. (&.I.�mtg.date: 'Z. 'L- approval:- notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg. date: approval:- notes: REQUIRED EXISTING PROPOSED NOTES Area: A D�[�r�FEDIXWV Circle Fro�ge: Q 113 7MF Front: Front: Sides: Rear. Main Cov: Accs.Cow Ft.H Sb: Sd.H Sb: GFA: Tot.in: Ft.in: Paz�nQ: Height/Stories: notes: BUILDING DEPARTMENT D C IE U V VILLAGE OF RYE BROOK ID 938 KING STREET RYE BROOK,NY 10573 ` FEB -5 2025 (914)939-0668 -- wwwxvebtookny.2ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: Ko 22 ( Vk\ pop Vg,a D Date of Submission: Parcel ID#: i 16, c�9—/— 7 Zone: — Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: 1 T► MUST BE COMPLETED BY THE APPLICANT W 114DOW MMEtCATIoA/S!(gHT The following items must be submitted to the Building Department by the applicant-no exceptions. Property Owner: 4 -(}fawns Pb'j'r 1. ( -f- ompleted Application 2. (JfTwo (2) sets of sealed plans. (one full size Imaximum Address: allowable plan size=36"x 42"} and one I I"x 17") 3. (-' Two (2) copies of the property survey. Phone# 4. ( )Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. ( One electronic/disc copy of the complete S� nR `� AA 1 application materials. Y 6. (Filing Fee. Address: 6':jC$TT Cj PnCL)W,,, J>jAU-bj6k 7. (-'f Any supporting documentation. 8. ( ) HOA approval letter. (if applicable) Phone# �9/�a'$15 (�((�0 9. ( ) Photographs. Architect/Engineer:_ 5WG7 10.( ) Samples of fmishes/color chart. (a sample board or Phone# model maybe presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hearer a`n�y,,,application not meeting the requirements contained herein. Sworn to before me this "1 w J Sworn to before me this day of C , 2( day of , 20 r� x Signature Property Owner °Signature of Applicant Print Na we of Property Owner Print Name of Applicant i IR— 7 otary Public Notary Public III =Quao�ec 05023476 stchester County xpires Feb 7, 2026 6/l/2024 BRnv� Village of Rye Brook ML MR X y Agenda FB SE t v y Architectural Review Board Meeting AC AD c Wednesday,February 19,2025 at 7:30 PM JM SF Q ...+ Village Hall,938 Sing Street 1. ITEMS: 1.1. ARB25-005 (Consent Agenda) Pak Yun Chan&Jaclyn Chan 745 King Street 4'high split rail fence. 1.2. ARB25-006 (Consent Agenda) Maxwell Buckley&Whitney Buckley 31 Boxwood Place 6'high white vinyl fence and gates. 1.3. ARB25-007 (Consent Agenda) Purvang Desai&Mehernaz Desai 4 Red Roof Drive Rooftop solar array. Consent Agenda Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.4. ARB25-008 Donald Amell&Katlyn Amell 235 Irenhyl Avenue New front entry. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.5. ARB25-009 Bradley Scharf&June Scharf 8 Magnolia Drive New rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 1 of 3 Architectural Review Board February 19,2025 1.6. ARB25-010 Maxwell Buckley&Whitney Buckley 31 Boxwood Place New front portico,new deck,new windows and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB25-011 Thomas Potter&Ellen Potter 16 Beechwood Boulevard Window change and add skylight. Approvals: Motion M Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB25-012 (Amendment to Approved Plans) Matthew Wiener&Erica Wiener 18 Boxwood Place Eliminate pergola,add roof over deck,eliminate section of deck,enlarge outdoor kitchen and change railing to cable railing. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.9. ARB25-013 (Amendment to Approved Plans) Michael Frenklakh&Amy Frenklakh 177 Betsy Brown Road Remove stone veneer and change siding material. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2of3 • Architectural Review Board February 19,2025 1.10. ARB25-014 Joseph Bradford&Amanda Bradford 304 Betsy Brown Road In-ground swimming pool,patio,retaining wall and fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB24-133 (Re-Appearance from 11/20/2024) Pak Yun Chan&Jaclyn Chan 745 King Street Roof over existing patio. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: March 2025 Page 3 of 3 00 W. � ^ _ A . 9}���9 1 ���/i' ��'!�t \��} /•. 4� r �1���� V 1."�" O O''Y+�L�ULk O v�0� kv ►t.�!!1.1/11111 a TI.1�1 �� i �,•• !r ] •• �► u) liil V V ►)) •\Illf Illi ��`,�;s,::�lllllf�l/lll 4� �,�fi 11�1'/"Ij� +� •� lj�//loll ... � `�1••/•I����v�� 1••1•1 1 , � •• � • �• ,, •- �� �:=:; 1,1/ .�:.;s � � Nfll'�:-:r �•;t�tiil►j►gill �� �_�1�1►f111P1;t•I3 �. lil)41�� �3�, / .. t. In- o � <�.•.I D .. 04 •e3 t `G �O o a N U") a oAmw Q 1i• C •�1 O O 0 U tn rat, V/� �/ u c :U LL In � W •.�' .». �+� U w o •R o� Q`otection c ZC~f) Z CO Or qt �G7 YI v �:• "; p \ to1 >, d O co rii ~ d - Ar", "�+ `,' . . . .�. •-� .�^�f'"�'=1! /1-. 1 f 11 •t 1 j1 '•1�1 1; sta � i1i11' ., t�) 0)► .. >. f -it 11-nz' ti=lllf111-�2 Illii►1�1-, 11',111,11� (••��• m •/•►•• •�• Ise- Y• AC"R"® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3124/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT TONY CIRINO NAME: Anthony Cirino PHONE . (860)329-0105 ac No: (860)620-0504 276 North Main St. FL 2 E-MAIL ADDRESS: guy@aol.com ins u @aol.com Southington, CT 06489 INSURER(S)AFFORDING COVERAGE NAIC8 INSURERA: UNITED FARM FAMILY INS COMPANY 29963 INSURED INSURER B: FARM FAMILY CASUALTY INSURANCE 0408-13803 OPTIMUM BUILDING CORP INSURERC: 70 PROSPECT STREET INSURERD: PORT CHESTER, NY 10573 INSURERE: NY 10573 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 EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 DAMAGE TO RENTE15- CLAIMS-MADE X OCCUR PREMISES Ea occurrence E 100,000 MED EXP(Any one person E 5,000 B X Y 3101 L6417 2/1/2025 2/1/2026 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 XJET LOC PRODUCTS-COMP/OP AGG E 2,000,000 POLICY❑ OTHER: $ AUTOMOBLELIABLrrY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) E A OWNED LX SCHEDULED 3101C7984 2/1/2025 2/1/2026 BODILYINJURY(Peraccident) S AUTOS ONLY AUTOS XHIRED NON-OWNED PROPERDAMAGE E AUTOS ONLY AUTOS ONLY Per accdent E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE E DIED I I RETENTION E 10,000 E WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL INSURED ON GENERAL LIABILITY 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 1988-20' 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) R. R1 ^^^A^A 133887956 OPTIMUM BUILDING CORP N 429 DEN RD STAMFORD CT 069033811 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 128SOUNDVIEW OPTIMUM BUILDING CORP VILLAGE OF RYE BROOK 429 DEN RD 938 KING ST STAMFORD CT 069033811 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1478 260-1 659828 04/09/2024 TO 04/09/2025 4/4/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 1478 260-1. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION CHRISTOPHER SCELFO-PRESIDENT OPTIMUM BUILDING CORP ONE PERSON CORPORATION 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 S7NCE FUND V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 220418789 U-26.3 0 Z ILLn, -- ow w i� CL Q lJ LCO) I uj o 0 0 W Z LL. > co ate+ L N v- iA y ,re)� I z 1E d 0 � p M U c oLP _ ' -�-. 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