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HomeMy WebLinkAboutBP25-044PERMIT # /J/ 5'- 7 DATE: SECTION a� % 3 � BLOCK LOT- TYPE OF WORK JOB LOCATI N OWNER CONTRACTOR,1 fST. COST C CO # TCO # �CClYI i� a.� zoso� i�do�S //ems / 9v7- 9 /r, ir 4LC - /Q?} (Jiy)a7/- 407'15 7 a FEE PATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC C7 LOW -VOLT CO ALARM O AS BUILT FINAL OTH w-R APPROVALS ARB BOT P8 ZBA OTHER 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 28,2025 Steven Fleisher&Jamie Allen 9 BelleFair Boulevard Rye Brook,New York 10573 Re: 9 BelleFair Boulevard, Rye Brook,New York 10573 Parcel ID#: 124.73-2-14 Building Permit#25-044 issued on 3/24/2025 for Replacement Windows This certifies that the four new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to L.1 E C E ME For office use only: !_A BUILDING DEPARTMENT PERMIT# -O u AUG2 O 2025 VILLAGE OF RYE BROOK ISSUED: _ .' � `938 ING STREE1f;RYE BROOK,NEW YORK 10573 DATE: S VILLAGE OF RYE BROOK (914)939-0668 X-('914)939-5801 FEE: �,rj PAID UILDING DEPARTMENT "'un roak.or 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 iii#fififii#iittt#i4i4########tf##i#iit#ii44i}iii#f}4##4i4i44t4#4t4i4i4}t}4t44i44#44#4i4#4}4it4}t}f##t#iti4tiit4f444ii}it4iii Address: 9 BelleFair Boulevard Occupancy/Use:1 Family Residential parcel ID#: 124.73-2-14 Zone: R-3 Owner: Steven Fleisher & Jamie Allen Address: 9 BelleFair Boulevard P.E./R.A.or Contractor: Franzoso Contracting, IIC Address: 33 Croton Point Avenue Croton on Hudson NY 10520 Person in responsible charge: Peter Klatt Address: 33 Croton Point Avenue Croton on Hudson NY 10520 Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of 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: Peter Klatt being duly sworn,deposes and says that he/she resides at 33 Croton Point Avenue (Print Name of Applicant) (No.and Street) in Croton on Hudson in the County of Westchester in the State of NY that (Cityrrown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost ofthe 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:$ 6,380.00 for the construction or alteration of: 4 replacement windows 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 ofany 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 §250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this a C Sworn to before me this day of c , 20 day of , 20 a S Signa re of Property Owner </ Signature of Applicant � I°VQylV— ame of Property Owner Print Name of Applicant Notary Public SHARI MEULLO Notary Public Notary Public,State of New York Michael Babft No.OIME6160063 NoWy Public1 State of New York 3/21/19 Qualified In Westchester County � No.01BAf3331102 Commission Expires January 29,204i Oud led In Westchester County Commission Expires September 28,2027 QyE 4R�� O� 2m 04 cu � 1982 BUILDING DEPARTMENT ❑BUBU LDING 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 : � � I, ,,(�Li w _ DATE:-8 —2,(O - 2-d2,r PERMIT= 25r ' 0 � 1 ISSUEp 3'2�LrSECT:f 27.7,3 BLOCK:_LOT: LOCATION: GO.J T LJ� 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 �, C ❑ NATURAL GAS 0 J 0--.J ❑ L.P. GAS Sec-o-j o 2 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING lti Le J / ❑ CROSS CONNECTION ,FINAL v ` OTHER u �1 rJtia�S , CA a, w z rnor y ad' 73 -aho W C lr Q W V a W+ O v O W v0 "� C7 n A F o o - v U a V zLM v v a c cn O rj o MCI A W a' Zoc .c , ency E w Q1 W z W © O az00 b F 11 (•, U) V -00 C7 O A Z O 0 z w H ° c ;� � C+1 A W z d op 'S 0 BUILD PO', TMENT i D DD VIL OF R ooK ' MAR 2 1 2025 938 KING ET RYE BR NY 10573 14)939-06 VILLAGE OF RYE BROOK ov , BUILDING DEPARTMENT ' 1982 ' ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT RE RE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE O 2 APPROVAL DATE: ERMI`T#: APPLICATION FEE: /)4 oc)r APPROVAL SIGNATURE.: `� PERMIT FEES: &^/" H.O.A.APPROVAL: _Dmo, L)-e DISAPPROVED: OTHER: Application dated: II �u�!� 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. Job Address:9 Belle Fair Boulevard Rye Brook, NY 10573 2. Parcel ID#: 124.73-2-14 Zone: AW6 3. Proposed Improvement(Describe in detail): FOUR (4) single double hung windows removal/replacement in kind, insert replacements no structural or sizing changes 4. Property owner: Steven Fleisher Address:9 Belle Fair Boulevard Rye Brook, NY 10573 Phone# Cell# 914-907-5942 e-mail. jsfleisherl@gmail.com List All Other Properties Owned in Rye Brook: Applicant:Peter Klatt @ Franzoso Contracting, LLC Address:33 Croton Point Avenue Croton on Hudson NY 10520 Phone# 914-271-4572 cell# nla e-mail sales@franzoso.com Architect: NIA Address: Phone# Cell# e-mail Engineer:NIA Address: Phone# Cell 4 e-mail General Contractor: Franzoso Contracting LLC Address:33 Croton Point Avenue Croton on Hudson NY 10520 Phone# 914-271-4572 Cell# N/A e-mail sales@franzoso.com (t} 6/1/2024 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1-Fam Post-construction: '-Fam 6. Area of lot: Square feet:no changes Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: no change rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: Belle Fair Blvd 9. Area of proposed building in square feet: Basement:no chnangl st fl: 2°d fl: 31d fl: 10. Total Square Footage of the proposed new construction: n0 change 11. For additions,total square footage added: Basement: 1"fl: 2"d fl: 31 fl: 12. Total Square Footage of the proposed renovation to the existing structure: no change 13. N.Y.State Construction Classification: 1A N.Y.State Use Classification: R-3 14. Construction Type&Location: O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];(}Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories:2 Overall Height: Median Height: 16. Basement to be full,or partial:no change finished or unfinished: 17. What material is the exterior finish:no change 18. Roof style:peaked,hip,mansard,shed,etc: n/a Roofing material: 19. What system of heating:n/a 20, If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing autom tic 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) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more o impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: Area: 23. Will the proposed projec require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: V (if yes,applicant must submit a Site Plan Application, &provide detailed drawings) 24. 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) 25. 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) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (If yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) / 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: `✓ Indicate:TIER 1: TIER I1: TIER III: (ifyes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: S 6,380.00 Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion:June 2025 (2) 6/1/2024 BUILD G.Di RTMENT IECIEMED VILUA QF RYE`14�OOK 938 KING STREET RYE BR06k,NY 10573 MAR 21 2025 W401�&"1-01%' VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §21 to • STORM SEWERS AND SANITARY SEWERS C, —R �1 ,ZR SUPINITTED -1 . "'NY :BUILDING OR PLM-MING PERMIT 'ITT A, 'BE RZTTlI ZD TO THE APPLICANT . STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I,Steven Fleisher ,residing at, 9 Belle Fair Boulevard Rye Brook, NY 10573 )Print namo ).VIdre";S«i,- sic2) 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; 9 Belle Fair Boulevard Rye Brook, NY 10573 , Rye Brook,NY. iJuh 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. ls�lcvtn � )Sher (Print Name of PropLrt) Ohs ner(a)) Sworn to before me this 1} day (Ve ,20 Z S ubia All i nhr i EMLY PIERRE Notary Pubk—State o Now York (3) No.02PI6356539 Qualitled in KInp OD tiny 6/1f2024 This a F.pli lir.- t r•4i�- .t� tc`tUatG proper Architect or N.Y. StAk Lic:c:l;�_:c, f l ' [ I:� r .. � ► - :ti indicated. It rrtust also inc;lucic. Mr, 11: '_ _ , , C' :" <•�_' :' "Ot properly 1, and ,Ill be t�1' STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Peter Klatt ,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 contractor 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 further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Swam to before me this 11 c1 It Sworn to before me this 1 day of I6'6fUA k Z`l ,200-5 day of ftbvT,h , 20 4 9�� ' C� WAAr Signature of Property Owner Signature of Applicant �54wrv7 Flr- )tic Print Name of Property Owner Print Name of Applicant Nol P iblic Notary Public Michael Babft Notary Public,State of Now York No.01 BA6331102 OualMed in Westchester County XVMLV PIER" Commission Expires September 28,2027 Notary Pubk—Sts'a of New York No.02PI6356539 AIV�iC* County (4) 6/l/2024 Work Scope JOB: PRJ #60871:Fleisher, Steven: Window(s) Replacement ADDRESS: 9 Belle Fair Boulevard, Rye Brook, NY 10573 CONTACT: Mr. Steven Fleisher, 9 Belle Fair Boulevard, Rye Brook, NY 10573 USA PHONE WS: (914)907-5942 Window Replacement : • Insert Replacement: Remove existing molding, sashes, tracks and storm windows leaving existing window frame. • Inspect, remove and replace any rotten wood where necessary(Owner to be advised prior). • Supply and install the following windows: Vinyl. • Window Manufacture: MI. Window Series: Vanguard. • Style, Oty&Configuration: • FOUR (4) *DOUBLE HUNG: Single. • Window Color Interior: White. Window Color Exterior: White. • Glass Energy Package: Dual Pane Low-E Glass with Argon Gas. Tempered Glass: NO. • Glass Type: Ultra-U-Plus with Thermal-U-Plus Glass Package. STG Class (Sound Transmitting Glass) • Screens Material: Opti-View Screen Mesh. • Screens: Full. • Grids Style: Internal Flat Grids. • Grids Pattern: 1 H/2V 6 pane over 6 pane. Grids Location: Top + Bottom Sash. • Caulk and seal interior side of stop molding using a 3-point caulking system with high grade interior latex. • Install new interior stop molding. • Spray Foam Insulate & Seal around perimeter using slow expanding polyurethane foam to ensure an airtight seal. • Caulk exterior with Solar Seal 900 premium grade weather resistant sealer. • Frames and glass of windows to be cleaned by installer. • OTHERS responsible for finish paint/stain work. {as applicable). • Complete job site restoration and disposal of all job-related debris. Printed 02/06/2025 Franzoso Contracting, Inc. 33 Croton Point Ave Croton On Hudson, NY 10520 Phone: (914) 271-4572FRANZOSO Fax: (914) 271-8644 8644 www.franzoso.com 1 J ' and D00 s ACKNOWLEDGEMENT ORDER #2176751 ORDER DATE Warehouse: 116 - Temperance, MI 02/10/25 PAGE NO 1 of 1 ACCOUNT NO 410101-001 S MARK FRANZOSO S O F.C.I.TOTAL HOMES INC. H FRANZOSO CONTRACTING INC. L 33 CROTON POINT AVE. 1 3188 ALBANY POST RD D CROTON ON HUDSON NY 10520 p BUCHANAN NY 10511 914-271-4572 _ 914-271-4572 T T 0 O CSG/UID LOAD DATE CUSTOMER PO NUMBER QUOTE NO REQUEST DATE 6 ALEPORE P#60871 / FLEISHER - MANNY 5330966 02/28/25 ORDER TYPE SHIP VIA TERMS TAXABLE SALES REPRESENTATIVE Paradigm OUR TRUCK E1 NET 30 DAYS TAXABLE 1811 Tim Wilcox Line Item Number/Description O t y Oty Qty Unit Ext Ord Ship BO Price Price 001 V-1850 V-1850 VANGUARD DH 4 1 as entered:31 3/4 X 631/2 id:31 3/4 X 631/2 W/FBR MTG RUSTILES,W/2 LKS,EX WDW,WSI,EXT FUL L,FOAM EN,OPTI VIEW,WH,FINLESS,NTLCKS,WH-,5/8 FLAT,6/6-3Wx2H/3Wx2H,INS,DSB LOE366-3/16 LOE18 9,3f16,ARGON,HEAD EXP,SIL ADP U-F(.24)SHGC(.25)VLT(.46) DP(+20.05/-20.05)Water Rating(3.13)STC(32.00) Total Qtys 4 All ratings are for individual windows and doors only. Contact youi sales representative for information regarding mulled or stacked units. Review this Order Acknowledgement to confirm correct order information; changes must be made within 24 hours of receipt or buyer is responsible for any inaccuracies. This sale is subject to MI's Terms and Conditions of Sale and Limi ed Lifetime Product Warranty.Click the links below,visit wmv miwindows.com,or call(717) 365-2500 to obtain copies of the documents.I hese doc ments govern, exclusively control,and are incorporated into all sales of MI products. Goods Total: Sales Tax: Order Total: Terms and Conditions of Sale Limited Lifetime Product Warranty www.miwindows.com 02/10/25 07:33AM •j':z. Vanguard" Series SUNRISE COLLECTION'" OurVanguard Series V4550 vinyl double-hung windowcombines the elegant look of traditional wood windows with '1 the . . - -. . Illllltllll ;�high-quality /-- its multi-chamber is I hill ', fully enhanced with UltraCore polyurethane-the same type of insulation used in high-end coolers-for desirable strength and performance.Add striking curb appeal and interior comfort to your home with the bountiful design options of the ENEPGY What you can expect MAXIMUM VIEWS Due to the window's narrow profiles,the V4550 double hung provides greater viewing space on the glass without sacrificing performance. Whether your home looks out onto an amazing natural landscape or a beautiful downtown scene,this greater glass space delivers tremendous views to the outside The window's added glass space ushers more natural light into your home's interior CONVENIENCE AND STYLE Narrow profiles allow for more glass space,resulting in a viewing area that's 27 larger Both sashes tilt in for easy cleaning and maintenance Interior-woodgrain options include cherry,walnut, and maple Triple weather-stripping seals for top efficiency performance Warm-edge spacer system improves energy efficiency — - - FiberCore"fiberglass-reinforced meeting rail helps provide added strength and efficiency Cam lock provides added security By MITER Brands VANGUARD' SERIES / V4550 Engineered to perform Create a customized look Welded,multi-chamber frame and sash Enhance your home's spaces with a variety Available frame styles:nail fin,finless finish options and grid configurations. Optional OptiView-Clarity mesh screen allows fresh air in while providing particle protection FINISH OPTIONS Product has passed rigorous testing for water penetration, EXTERIOR INTERIOR air leakage,structural integrity,and forced entry Painter's white Painter's white Min and max sizing Antique Brown Balanced Black PAINT L—INATE MIN MAX Royal Oak _2 9G• Brown Mystic Gray Provincial•: PAINT Energy efficient glass vintage Linen Able to meet ENERGY STAR- requirements in all four climate zones.Optional technologically-advanced SolarClean'-self-cleaning glass helps keep your Colonial Cherry glass naturally clean using ultraviolet sun rays to break down dirt and debris. LAMINATE ENERGY Earthtone English Walnut Ultra Max 45c 0.28 0.28 Sandstone Ultra Max with Thermal U Plus 45G 0.24 0.28 Nc Extreme Ultra Max Triple-Pane 4sG 0.22 0.22 N.Nc.sc.s CAPSTOCK Extreme Ultra Max Triple-Pane with 45G 0.20 0.21 N.NC,SG 5 SS Thermal U Plus' F Omega Max 4sc 0.28 0.21 SC,s Custom Color Omega Max with Thermal U Plus Ise 0.24 0.21 Nc.Se.s Passive Max Black Endur 0.29 0.49 Passive Max with Thermal U Plus Black Endur 0.25 0.48 N GRID TYPE S Extreme Passive Max Triple-Pane with Black Endur 0.23 0.42 N I Thermal U Plus All jai u.•s ar.e rm':d-ms.dotcd glass without ynds �) E.rnr,•4•.•LAMA St-tra.—I A,'leakay,.Gate of.1-0 03 1 •Qwlifles for ENERGY STAR•Most Efficient tax credit. Gritls-Between-the-Glass Simulated Simulated Flat Sculptured Divided Lite Meeting Rail rl Most Efficient 0 o +;'�o veeeo Ro�.aa-wuMx 2024 * Scc addrt,anai Product and leer I� MUe191 -f�:i�i warranty tnformaUon online Build boldly by choosing a range of MI window and door styles '. with expansive views,contemporary framing and hardware. miwindows.com/windows/V4SSOidouble-hung ••�w. 11j11111,i i1!�11�� ,111x1i;},' i1� 11111.11�1 111 11 / '� NILJ�/I o ; a st i1111�r�2 lf fillth 3Y Ii111�1 �1i1 0>� .• - +yz, E ` N a`. > o K N �=Z °c y .= y • ti R 'C U 4r tn U H .�•J /I ( L '...a,�.(O► O) '' _ CN = =~~y r \I ^ C� W W fast �. z % Y Q z o R '�N :• ' F-- F— O Z n o V O O O O c, a w v 4- A, O O zo ch O j O x ? z U c cas ' s ! LL U In Y ; _ -C _ J c6 ,t 00 c? I K u cr u U •r tj lu 00 •+r.r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s`¢ • T; j 1� ?s"'a"-"-','j'" ";"'S"'�i ==.�_...,_� ._',i it :^li i��:i,=-%-•- --r-•-•1��� --i"--r--•-r:�1.1. -,-;-z� <(o)►�' ,1j1111, a,S111/�1, i,lllll�i ,IIIII,i _T ; 1 111, SIIIII�S: . ♦♦ �!P^�'i ♦♦ N ��PA�t1 t�� �SPA`s�� III `�PA t� J�II,�,.ry1}} ��{�PA�l�: 1 �IiP^ 1 iil(��A 6�S -. '.%' ' 1 DATE(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 03/11/2025 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 Certificates Team NAME: ROBERT T.KIRKWOOD.INC. PHONE (914)769-9070 FAX (914)769-4706 A/C No Ezt: AIC,No 91 Washington AvenueE-MAIL certificates@kirkwoodinsurance com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC A Pleasantville NY 10570 INSURERA: Selective Way Insurance Company 26301 INSURED INSURER B: Selective Insurance Company Of America 12572 Franzoso Contracting.LLC INSURER c: Sutton Specialty Insurance Company 16848 33 Croton Point Ave INSURER D: INSURER E: Croton-On-Hudson NY 10520 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMLDD/YYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A S2671254 02/13/2025 02/13/2026 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY FX PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S2671254 02/13/2025 02/13/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acc�tlent UMBRELLA LIAR I S"01 OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS LIAR rl CLAIMS-MADE ISCEX0300002437-00 02/13/2025 02/13/2026 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 1,000,000 a B OFFICER/MEMBER EXCLUDED? NIA WC 9128357 02/13/2025 02/13/2026 E.L EACH ACCIDENT $ (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 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Village of Rye Brook is additional insurance under general liability per blanket endorsement as respects work performed by the insured at 9 Belle Fair Blvd Rye Brook,NY 10573 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. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 /? /-Aw,/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD oRlc Workers' CERTIFICATE OF Board —� STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE �. 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) (914)271-4572 Franzoso Contracting LLC 1c.NYS Unemployment Insurance Employer Registration Number of 3 Croton Point Avenue Insured Croton on Hudson,NY 10520 1d.Federal Employer Identification Number of Insured or Social Security Number 33-3015054 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company of America Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1a" 938 King Street WC9128357 Rye Brook, NY 10573 3c.Policy effective period 02/13/2025 to 02/13/2026 3d.The Proprietor,Partners or Executive Officers are S 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"I a"for worlers' 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 a 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 poky expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rghts 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 conbined 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 referencd above and that the named insured has the coverage as depicted on this form. Approved by: Robert Kirkwood (Print name of authorized representative or licensed agent of insurance carrier) Approved by: A� � 3/11/2025 (Signature) (Date) Title: Principal Telephone Number of authorized representative or licensed agent of insurance carrier: 914-769-9070 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