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HomeMy WebLinkAboutBP25-060PERMIT # /`-,z=)L� — c_ 6 O DATE: 4//k3 QfP: y SECTION f.3S-1 BLOCK / /LOT TYPE OF WORK / d/ P� O ✓Q7_l'0/�?S JOB LOCATION S , 00 q OWNER CtL� aQ. kI a cz CONTRACTOR. V lIS uC7�7U• _! C-�-r7�iiQilil ��9 7)�5/8-/7aG EST. COST cm Oa FEE v/cO # �FEE41600 Pb DATE TCO # FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING dGl -l3" 2OL,S 9 RGH PLUMBING GAS 4uC SPRINKLER ELECTRIC LOW -VOLT M rrALARM 0 ' /3' 2OZ57 twseefJ AS BUILT M FINAL OTHEf2 APPROVALS ARB BL�OT rO ZBA VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK -� NO. 25-105 Certificate of ®ccup ucp ��- This is to certify that of, te 0c)Jk NY A6r Oz , having duly filed an application on (� ae 20 5 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a �r/� Zoning District and shown on the most current Tax Map as Section: J 5. Block: / Lot: 2- , and having fully complied with the requirements /o/f the Building Code and the Zoning Ordinance under Building Permit No.o25 91&V , issued 20 4-4 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: Construction: , for the following purposes: I� / /�� /2010740 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 be made,and no enlargement, whether by extending on any side or by increasing in height shall be made, she building be moved from one location to another until a permit to accomplish such change has bee obtained fro th uB ilding Inspector. Building Inspector,Village of Rye Brook: Date: AUG 14 2025 For office use onl : D BUILry F1,:f 0 , iTMENT PERMIT VILBROOK ISSUED: JUL 2 5 2025 938 KING STRE ,NEw YORK 10573 DATE:8 _y FEE: Sk,, :570-=PMD,X VILLAGE OF RYE BROOK I*W.ii&oI ov BUILDING DEPARTMENT 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 ++■r+ta+++s+++t+++++rss++++rst++sssrsssassrt+rtQs++t++sr+s+tsst++++s+st++ss++++++ss++ssssttt+s?+++++***+t+s+++s*t+************* Address: 2 es II yA '\ e. om N I 0 J Occupancy/Use: ` Parcel ID#: L3 y3 -'' — c-�Q•l I Zone:: n I Owner: 1VaY1q Ltu . 7 i ��'^ Address: Z IxWIeS "y, kgeD,.,4. , Yrov?3 P.E./R.A. or Contractor: DUE Ccnsiu, r l IviC Address: � Person in responsible charge:. h C�aKnAnAddress: r— 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: ( L c l U a n j Ll tA being duly sworn,deposes and says that he/she resides at Z S ►'QSl S"� 't 0 Z (PrirltNameWAp lica ) (No.and Street) in ,in the County of t �1 e.1� in the State of C 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:$ I O 0 0 O 0 for the construction or alteration of: i 'A f 2 Y,ov if SLY,a Vq 5 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-IO.A.ooff the Code of the Village of Rye Brook. Sworn to before me this 0 Sworn to before me this day of ��� , 20 C*Z__> day of v`�� , 20Q1- Sigrff ure Of rop ty Owner Sign re of plica SHARI MEULLO y 11 I va hq �--I (A Notary Public,State of New York Y"VOLKI Lt H in e o o wner No.01ME6160063 Pr t e of Applica& Qualified In Westchester ,202 29 Commission Expires January 29 20 Notary Public Notary Public 6/l/2024 QyE BRC�uk. O� Zm �7 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:— ^� j W r DATE: V z PERMIT# L ' ISSUED: y (' SECT: - BLOCK: LOT: Z Z_ LOCATION: - OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED 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��. ��O•c • 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 : �� InJ A �� DATE: P LS- J -2 3 - ? -1. i PERMIT# PP Z S 0 C1 z> ISSUED: SECT: - BLOCK: LOT: LOCATION• !',/'\ t�, 4, o —, S ¢ k I ) il, OCCUPANCY: ❑ Violation Noted THE WORK IS... [3"'PASSED ❑ FAILED 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 13 FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 0 W Q ,,/�' E9F32•��O BUILDING DEPARTMENT ❑]tUiI,DIN(;INSPECTOR .PfAssls�eN'I'1tIrII,I�rtvc INSPI,(:'1'OIt VILLAGE OF RYE BROOK ❑CODE ENIlOItCEMIiN1'OI+I:ICr•,It 938 King Street:. Ryc Brook,.NY 10573 (914) 939-0668 I Al: (91.4) 939-5801 wwwxytkook.org - - - - - - - - - - - - - - INSPECTION REPORT ADDRESS '4— f Gu 4 -- _DATE: 8-3 1- Z aZ 7g PERMIT# Q LS! d�1.3 ISSU1',D:_ _ - _ SECT43 .!Y-? BLOCK: I LOT: ZL � LOCATION: ,,.�// t A- --._--lr� 1 1 t'IZ. _-- +t.NQt1 )•� OCCUPANCY: ❑ Violation Noted THE wolu:is... I)Ass1 v El ❑ SITE INSPECTION (� FAILED /REINSPECTION ❑ FOOTING 1,Q AR.4 t�i REQUIRED ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UND.ERGRO(TND PLUMBING NOTES ON E1 jN'QD' ON: ❑ 1tooG PLUMBING ❑ JtOUGIE FRAMING ❑ INSULATION ❑ Natural Gas ❑ FUEL TANK ga ro o ❑ FIRE SPRINKLER �FINAI,PLUMBING ❑ CROSS CONNECTION Aiti4a$ p� ❑ FINAL I(.. ❑ OTII131t -------------------- e D C' o re �yu It Ro - �yE BRC�k. O� 2m cu � BUILDING DEPARTMENT ❑BUILDING INSPI:(:TOR B�ssIS'rAN'r.'IiUII.IIING INS)INCTOR VILLAGE OF RYE BROOK ❑CODE El-WORCEMENT OPItICER 938 Kiiig Street.Rye Brook,NY 10573 (914) 939-0668 FAX (914)939-5801 www ryebrook.ort; - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: DATE: l'1" 7 ' Z0 PERMIT#_ CO �_-�O 0_ IssUL'D:_/_q-t? SEc'C: I3 y3 BLOCK:_LOT: ZZ• / LOCATION: �Tyl�'\,_ �+_Ov !flJ _ OCCUPANCY: ❑ Violation Noted 'fIIE WORK Is... PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION f AeAj Gj• REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas —:ro,.s ItA ,"o v ► ❑ L.P. Gas ?*-A •� 1 ❑ FUEL TANK: eta ❑ FIRi?SPRINKLER ❑ FINAL PLUMBING 'e 1 � S �rpQ 6_ �.I� Lu ❑ CROSS CONNECTION •i•p ,(� IV (gyp a FINAL ❑ O'rIIER : E 0 ILn N w CD eq E ` rA cl) y U w 10, .w ►�I Lei y cn CN : a �f oo 22 a u. 00 o = a 1-4 op u u v aw 1.0 � a )MEMOV} c~n W z a di Q rx � S] M 4 „y. Q7 W z w H $ W Vi 4 p O6. C7 A z N A w z .. ,.� Q u � � O F' •' :.as . =S BUILD/ING DEPARTMENT3D VIL AnUE OF RYE OOK MAR 1 938 KING 1REET RYE BROOK,NY 10573 3 20�5 (914) _-OGd$x VILLAGE OF RYE BROOK �tiv.�v o ov BUILDING DEPARTMENT INTERIOR BUILDING/PE RMIT APPLICATION FOR OFFICE USE ONLY: AZZ Approval Date: APR — ;t Application Fee:$ _ Approval Signature: Permit Fees:$_3(00- �•(-93'U SM Disapproved: Other: -91, � lbn ii�f yc�0 — ���R��������Kx��x,�xx���x�,��,��x����,x��xxxxx�xx���x��x����x�*****�*�����x��xx���R���x�xxx����**� Application dated:3 I c)S 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. ? Job Address: f Jow%Q�S 14" . Aq a Brook. NY. /a5 7 3 SBL:l J�� /�3 �!—�,I Zone: Proposed Improvement.(Describe in detail): C4;AA s 6¢p(a.4zi,A6o%A ri. iiE. k4x&A— _t", sscoo� 169wr fo�([�is reolo oe.�•w.7f , JjWtu.L ndc�i A ra. 01 sta•'rt / oZ0. Q,�:C r/ 5 eP,:L r, k;'�r/- � r Q I1 rii+. _/re b! /K ..//Je �?IPC_�! CRC ,D�lt�4 //� 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 1: 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,ANSL System,FM-200 System,Type 1 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 fain.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: Property Owner: l�faQ�?� J l U Address: .2Tc. w s Q ��f a Areek, A/�'_ l o,i 7? -- Phone#&D iQ —3'/ 5s83Cell# ZI 8 — 9 74 —(,ZSS email: fo n la 11 10 4.�+e•+`l. Cd,,,,� 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General cContractor: Phone# ll 7�1'4-% ell# 'It 7 51R, 1�mail: V7 012,)Estimated cost of construction $ (MOTE.The estimated cost shall include all labor,matenal,scatfolding,fixed equipment,professional fees,and material and labor which map lx donated gratis.) 13. Job Timetable: Start: Finish: (1} 6/I/2024 BUILD EPARTMENT Q [EC FL, �W LEz VIL OF RYE BkOOK MAR 13 2025 938 KING ET RYE BROOK,NY 10573 939-0668 / VILLAGE OF RYE BR001< wvVehrt�n#:m.��tt� '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: residing at, 2 Ja a U A.rl / f �Tv , N l, /�S ;.2 (Print name) (Address where A 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; Z ,,�a,,.•�s GJ 'M , �y e , rook_, N to 1 '73 , 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. 7,a-- & (Signature of Property Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this day of �"1ct�c-� _ , 20 a� 14u�_ S� Lo� (Notary Public) SHARI MEULLO Notary Public,State of New York No,01ME61B0063 Qualifled In Westchester County (2) Commission Expires Jentlary 29,20 2--7 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 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 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. Sworn to before me this 0 Sworn to before me this day of In6LCC, h , 20_a� day of , 20 7,,--- 7A.1- Signature of Property Owner Signature of Applicant t Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MEULLO otary Public,State of New York No.01ME6160063 Qualified In Westchester County, �7 :,mmission Expires January 29,20 / (4) 6/1/2024 a w =_ i � N N a3e N \ \ w _ W \ CS y� :J 1F 0 > C- ON w en w CS W U O O z a = ° 0-4 " Ln � O \ Q r Uz a w ►-+ '-' M � tA t O x CN U � ►� Il-1 Q W a V aWo a Z c � U v U. o w � w N it. i BUILDING DEPARTMENT EC EWE VILLAGE OF RYE BROOK R APR 14 2025 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK \vwvy.ryebrooklw. oy BUILDING nEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required G� FOR OFFICE USE ONLY BP#: _ OCR EP#: Approval Date: APR 1 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 ''T//OTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 7—�7—+�s 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: km e ►3ro€, le , Aly, 1 os 73 SBL:Z,' JS, �/3 Zone: —10 2.Property Owner: 1,C"' 70'e` Address: Z JA,6n�S t-JAW , /4e-- -k-' Al)l Phone#: 7 f - �f) L� — 6 L3 S Cell#: 719 71f� S�email: 3.Master Electrician/Licensed Installer: 1 W U"CG ry Address: S9'Mt f -PC4,/tl 4Ve Lic.#:Phone#:�14-46Q L l?U Cell#: emaid i cA S eur Compan�y Name:/1KA R J r?cz,( Address: 5i% 0))'Ge gktOW eJ 4vG 4.Proposed Electrical Work/Fixture Count: 7 GFcx CjtA-le-45 C tJ ujYk1' tori f lrf5 5.3`d Party Electrical Inspection Agency: 13e&i, fir,me. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Lt/a ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of indivi ual sign as the applic nt) in state that(s)he is the �11f&I L(yti for the legal owner and is duly authorized to make and file this application. (Master Electrician/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�11fore me this + I Sworn to be ore meAthis mA day of 20 day of 20 Signature of Property Owner Sig ature of p licant Pri Name of Property ner P ' t Name o licant Notary RY M.RNERA N i , ate of NewY Notary Public,State of New York No.01 DE4988573 6/1/2024 No.01R16441398 Qualified in Westchester County Qualified In Westchester County Commission Expires November 12,20 Commission Expires September 26, 5 Buckout Road BETTER HOMES /Qfm\o West Harrison, 90 10444 Phone:914-906-0443 ELECTRICAL INSPECTION SERVICES INC. Email:betterhomes252@gmail.com NAME: DATE: ELECT.PERMIT NO. T'G AN U I w(POZ lf�P—) CITYNILLAGE ZIPCODE BLDG PERMIT NO. c ;'45 ,-) 5- 0&0 ADDRESS_ BUILDING�PT4rook /AJ PHONE# SECTION BLOCK LOT UTILITY -C-(-M - �v EMAIL ADDRESS: r( Residential ❑ Commercial I .nG „T� ❑ OWNER'S NAME AND ADDRESS n "r o.A rA.A/ / 02 ;c..Mrs cA)&C) f`U3C aro0 S WORK LOCATION: eA Outside ❑Basement []Garage []Attic ❑Porch Floor: E3'1st floor ❑2nd floor ❑3rd floor ❑4th floor ❑Other floor F-IReinspection ❑Renovation ❑Generator ❑New home ❑Other Comments: APR 14 2025 1JU VILLAGE OF RYE BROOK I BUILDING DEPARTMENT SERVICE AMPS CASE NO. SERVICE ENTERS BUILDING: Overhead ❑ Underground ❑ CON EDISON COMPANY NAME: DATE OF APPLICATION: LICENSE#WHEN APPLICABLE: t I1/T S STREET ADDRESS: CITY: STATE: ZIPCODE: -- "�' - 1/4 ( • t «C I 1 10&l TELEPHONE: CELL PHONE: EMAIL: ,q1y—et 90 C4 1 T SIGNATURE OF 116f APPLICANT: X The application is intended to cover the above listed items to be inspected.If at any time of inspection additional items have been installed,we are authorized to make the inspection and adjust the fee for the additional items inspected as provided by the applicant.The applicant declares that there are no open applications for the above with any other inspection company.Application only good one year after filing date. D EO��� JUL 2 8 2025 + BY THIS CERTIFICATE OF COMPLIANCt VILLAGE OF RYE BROOK Better Homes Electrical Inspection Serviz-wf EAR MENT 5 Buckout Road, West Harrison, NY 10604 914-906-0443 CERTIFIES THAT Upon the application of: Upon premises owned by: Alfa Electrical Tian Tan & Yiyang Liu 58 Mayflower Ave 2 James Way New Rochelle, NY 10801 Ryebrook, NY 10573 Certificate Number: 4422 Certificate Date: 7/14/25 Located at: 2 James Way Occupancy Type: Residential Ryebrook, NY 10573 Permit Number: EP-25-099 Section: 135.43 Building Permit Number: BP-25-060 Block: 1 Lot: 22.1 A visual inspection of the electrical system at this premise described above, wherein the premises electrical system consisting of electrical devices and wiring, described herein. All inspections are in accordance with the National Electrical Code and the details of the installation, as set forth below, was found to be in compliance therewith on the date of the inspection. Name Quantity Rating Circuit Type Refrigerator 1 120v 20a Appliance Dishwasher 1 120v 20a Appliance Microwave 1 120v 20a Appliance Stove 1 120v 20a Appliance Hood vent 1 120v 20a Kitchen fan GFCI receptacle 6 120v 20a GFCI duplex outlet AFCI circuit 2 120v 20a AFCI breaker AFCl/GFCI circuit 3 120v 20a AFCl/GFCI breaker This certificate may not be altered in any way. ..l�;�e�>k;; o - SEAL This certificate is valid for work performed ', 2022 before the date of inspection only. Licensed Inspector 11\sa\\\,,,, t' a z a , S d0 'n N O N N uj r � W s' N a m � cn °� x FBI Z OAG LLB oA �..I '� ►n 0-4o , O Z o W f o ° A V 14 W 00 U x ] w w Z o V ,' O ^ U O a 00 CN cn C\ �` ►-a w � � Ey � F' '� Q ✓ we a o zZ U o IN x Ln 6s W e Z Q O r i N A w z Q Q oA O U zj a BUILOdbEPAR,.MENT APR 15 2025 VIL E OF RYE BR OK 938 Kitt ' ET RYE BRO ,NY 10573 VILLAGE OF RYE BROOK -0668 BUILDING DEPARTMENT wwiv ny.gov PLUMBING PERMIT APPLICATION �— FOR OFFICE USE ONLY BP#: 0 PP#: 0J — er)29 Approval Date: MA tA,20M�� Permit Fee: $ l �� —16 6 Approval Signature: Disapproved: (fees are non-refundable) 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 TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 7 Application dated, '���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: 2 �r 3 tjc m , 4 r- a�o9/L, /VY, /os SBL:/3,5,� Zone: 2.Proposed Work: 144c� f'-b 3.Property Owner: 7-_ Tam Address: Z ,ja^-cs IQ 2" k.4 e- df-Do, , tiY, /oT Phone#: Cell#: email: f„ a . f- 4.Master Plumber: as 0_;fr;C/- Address: �c)-7 ko 4.e- SZ (2- Lic.#: S47 Phone#: Cell#: �5 1-�S� email:lgfj j i,P ASS 014 n 1 t Company Name: a s uv/ Address: INDICATE FIXTURES&LINES TO BE NSTALLED AS PER THE FOLLOWING 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 1st Floor 2nd Floor 31d Floor 4d'Floor 5d'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6i1n024 STAT OF NEW YORK,COUNTY OF WESTCHESTER ) as: t ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the plicant) 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 Sworn to before me this �b day of `G ,20� day of 1�p� t ,20 a Signature of Property Owner Signature o p rc Print Name of Property Owner Print Name of Applicant Notary PubligHARI MEULLO Notary Pub RESA A GRISTINA Notary Public,State of New York NOTARY PUBLIC-STATE OF NEW YORK No.01ME6160063 No.01GR6438779 Qualifled in Westchester County Qualified in Putnam County Commission Expires January 29,20�i This application must be properly completed in its entirety and must incluWrH4fd9fP " t5ai��s� 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 BUILDING DEPAR MENT D E GC D VIL AGE OF RYE OOK APR 15 2025 938 KING ET RYE BRO NY 10573 14)99-066$� VILLAGE OF RYE BROOK Poly 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, T'c:.. ,residing at, > ,f�.�.�-.S w""" . '�-q r (Print name) (Address here yo 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; /'j 24 1 e at'0L k. /1l y 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 Owner(s)) (Print Name of Property Ovvner(s)) Sworn to before me this of rG h , 20 (Notary Public) SHARI MEULLO Notary Public,State of New York No.OI.ME6160063 Qualified in Westchester County CO MMiSSion Expires January 29,20 Z -3- 6/1/2024 E rl F A a ~" ... x C- °o .4 8 > C , OZo wH � � E A . O o Q ` z °° �4 .. , s U ■ H a O �o p _ w _ rw v zeq .c w d ,;00 Z 14 00 _ T `.J Q o� U a W 0 ►`7. oZ tin w H a fN r : 0: $ U W W c ZLei C Z � _. a w � U og s U a w � � ° r N o w z a oa a � W W W a j R [ECENIE BUILOV,%G DEPARTMENT J U N 11 2025 VILLAGE OF RYE BOOK 938 KING STREET RYE BROGlk,NY 10573 VILLAGE OF RYE BROOK (91,4) 939_0668 ' BUILDING DEPARTMENT yvyv%�.rvehi-ookily.goy PLUMBING.PERMIT APPLICATION � ,FOR OFFICE USE ONLY BP#:_ —�0 PP#: Q 5__ 0913 Approval Date: JUIN ZQZ� Permit Fee: $ �� /�� /_ h Approval Signature: Disapproved: (fees are nun-refundable) DO NOT START WORK or ( i)NS`ROC IION fJNTll..N PF.RNIIT W'6 BEEN ISSI. [ 1) BY THE BUILDING INSPECTOR. THE ADtii1NItiTRATIVE FETE FOR A,GORk PROGRESSED OR COMPLETED WITHOUT .% PERMIT IS 12%OF THE: 1 ti 1'AL COST OF C 0.NS1'Rl.1:("I'I0N WITH A NIININlE N9 FEE OF$750.00 Application dated, ( 13) 2<' 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 w+th all applicable Federal,State,County and Local Codes.l.Address: 0- 1:SAPQ_1& 1"tC 00� SBI_: Zone: Ye—I(D 2.ProposedWork: l�k��1�t� 3 IoAirrbo�ns �ac� l�asl�2o s.�l� NUdS -t7g-o .41:) be- blLaa�s� r — o) �IF�NQS k.4 3.Property Owner: \I !/'IN I�nl �E/,,t� L,!� Address: _- Phone (P to- J !W 3 Cell#: _email: 4.Master Plumber: PA i YZ\C.1/ SS�i�.1 Address: CA t Q L til/ ICE`S 1 Z Lic.#: Phone#:kq j��,5 (4c�-Cell#:(e�(c- C (o email: Y3 LR r� C_ISS,0,,a Lu.(,�C C.C, Company Name: PC L-4 Address: 22-- OM.,�1 /0 S 12- INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tabs Tuns Service Service Sewer LP Gas Basement I st Floor '_'nd Floor i 31d Floor 4"Floor I 5"Floor Exterior 5.*List Other Equipment/Provide Details: C` -INIz-r CS C_­�Jk N.UGI S C- S kit q:[- VQkk . (Notarized Signatures Required Next 2 Pages) 6/I/2024 STATE OF NEW Y)ORK,COUNTY OF WESTCHESTER ) as: $-S , _,being duly sworn,deposes and states that he/she is the applicant above named, prod nameindividual of signing as th applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of �- 20 Z. day of�� n� ,20 --.__ Sign o Pro Owner Si plicant y L I'LA Print Name otProperty Owner Print Name of Applicant Notary Public N tary Pu TERESA A GRISTINA THOMAS ROBERT LEBEL NOTARY PUBLIC-STATE OF NEW YORK Notary Public Connecticut N o.01 G R6438779 Tl S"�a i��i V'Mnb Fly n completed in its entirety and must i rY ali`rn ;f � Putnam peg -' b ) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6tl/2024 BUILD pAATMENT IvyD `— C� " ID `—' VILLAGE OF RYE-BAOOK J U N 1 1 2025 938 KING$,TREET RYE BRoQK,NY 10573 � 14)939-066.$ a VILLAGE OF RYE BROOK wie# loolziraov 1 BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED ZE D SIGNATURE OF THE LEGAL PROPERTY OT,^lS7E R ATE BE SUBMITTED ALONG T11 T H AVY BUILDING OR PL,QfBINGt PERMIT APPLICATION. A Y BtTILDiNG OR PLT3M-RING PERMIT APPLICATION SUBMIT'.T.'ED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO TIM APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: g t � 3, I U n ► f/l residing a , 2`� f OJ�S�- Sf /T - J -_ -- --- —- — - - —`f (Address i1 hcrc '%on l I�C i 0(J 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; e S y �� --- _ 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. (Sig iV re i''opc tv ncr(,•)) Sworn to before me this A day of 20-'Z s (�Otilrl )ti(�tCT TMOMM ROBERT LEBEL Notary Public Connecticut My Commission Expires Feb 28, 2030 -3- 6/l/2024 WI I F i o 0 0 z m z W a 3 w w v W 1 Z ~ O Ua � Facr > m .�., z [mo t 3 .sz > v O z c E •• z W 1 O � 1 Q N o z i ~ > ` s 2 c f) Frj z CL 1 O 4 1 W ai a> a 1 a o c -> d i a> i' z (/) O4r L Cr,C N W i o E LL LLJ LL � � o C� z lJJ a R m Q Q; W Yo UJ Q w � 2 Cl) e , 0 N a. r� V) 0, � LU CL) W r E o U � W • -_ a Q x o Q u (n U) W . a) J � � O oN (� N Z f [� `�� w cr- o VJ O V� LJLJ W 1 N O -- �— O N a w W } ( oW o WJ Q 1 °rv' E m F'" 54 W 0 � a) O tnJm o Lu � a0 v a> oa _ F- ' Q � oW p W '" ALL D (n w �- R =) O a o J O Q (A m 4 o Q cn � •� 0 0 Z m a i 47 c-' O LC) = k7 I w z O Q O O O 0 W W i Z d W J 7_ N 3 = Z > U O , O % _ E W z Z O J 0 CD A o O W y i OSE . to W Q Z; Z .� w 1 R 1 u 0 ma m ,. w poL W = coW F W w z O t t W a Z o Z a oa) W LL Lee A Q v LU� oQ zo C/) Q w boo W J 3 NW � N M Z A •� W V cr , r i 0 Q ~ O J � 2Z _ O cn 3 W I+ o - = a w O W (/) J m > W CO W LJ.I Q O O { r r � (Q •L I� O ; Q WW z M C/) W . o A a 1 i , j c CD a "o � z � 1 m z p i Z LLJ m 3 � w v W Q Q R c Fil 1 ' ♦ co cy 4 E-i i Vt 3 .s Z > C7 o 0 V o W � z o 0 0 c ,� ; �-- •� V) F �l. 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Sob —� NEED OK P ( �U S.lam• U (` E. i_ � FEES:Filing \CPI BP: C/O: Flood Plane: Legalization:, tq 0_ O ( �—APP: Dated:---_Notarized.--- SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. J _ ( ) ( ) ENVIRO:Long. Short: Fees: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed. Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic Other. (� ( ) License: Workers Comp: Liability: Comp.Waiver. Other. LODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL.Plans: Permit N/A Other. (� ( ) LOW-VOLTAGE ELECTRICAL-Plans: Permit: N/A Other. (� ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery: (�( ) 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. 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: APPROVEU REQUIRED EXISTING PROPOSED NOTES Date: APR 3 2025 Area: Circle: Fie Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot : Ft.ImD: Height/Stories: notes: Y , Laura Petersen From: Steven Fews Sent: Friday, March 28, 2025 9:22 AM To: Laura Petersen;Yiyang Liu Cc: T T;Alfredo DiVitto Subject: RE: 2 James Way - Building Permit Application for Kitchen and Bathroom Renovations Expires: Saturday, July 26, 2025 12:00 AM Good Morning Yiyang, The problem is as you stared,you have several contractors. When I arrived at you home a day after the Stop Work orders were posted, one of your Queen's contractors let me in to see the extent of what was being done. I saw all the bathrooms being renovated,the bedroom door modifications,the flooring,the kitchen work etc...This work should have never been started without contacting the Building Department first to see what would be required. Now, in addition to being stopped,you are facing fines and legalization penalties The first thing required is that you file a permit application,wherein you are required to have a Westchester County Licensed Contractor(GC). The gentlemen you had working from Queens NY don't have a license to do home renovation in Westchester County. Matt,the cabinet installer, has advised us that that he only does cabinet installation,therefore we cannot process your permit until you have a County Licensed contractor to take over all this work. I will not allow Matt to be the GC,there is too many other factors involved in this Job. You need to hire a Westchester Country Contractor. Thank You. Steven E. Fews 3 a d J Building Inspector& Fire Inspector U 0 p i P n J Office (914)939-0668 / From: Laura Petersen<LPetersen@ryebrookny.gov> Q / Sent: Friday, March 28, 2025 8:50 AM To:Yiyang Liu <hflyy1986@yahoo.com>; Steven Fews<sfews@ rye broo kny.gov> Cc:T T<tina.tan2011@gmail.com> Subject: RE: 2 James Way-Building Permit Application for Kitchen and Bathroom Renovations Good morning and thank you for the email. I have copied the Building Inspector, Mr. Steven Fews for response. Thank you Laura Laura(Petersen Office Assistant 1 f Village of Rye Brook r938 King Street Rye Brook, NY 10573 (914) 939-0668 From: Yiyang Liu <hflyy1986@yahoo.com> Sent:Thursday, March 27, 2025 4:46 PM To: Laura Petersen <LPetersen@ryebrookny.gov> Cc:T T<tina.tan2011@gmaiI.com> Subject: Fwd: 2 James Way- Building Permit Application for Kitchen and Bathroom Renovations Hi Laura, Attached please find Matt's liability insurance and workers compensation waiver. Could you please review them and let us know if they are acceptable? I have a question about the building permit application. Matt told me there was an issue of him being listed as a general contractor in the application. However, when Tian filled out the application form, she was instructed by you to list Matt as the contractor on the form since we have several contractors. We are aware that Matt's responsibility is cabinet installation, and that we need to apply for electrician and plumber permits separately. Is there still an issue with our building permit application? Feel free to call me at 626-340-5583 if you need further clarification. Thanks, Yiyang 2 ;a a c s o a L ca > G N :u i v CN to C 'n � cG SYYY' E i C 40 � O V v = z0 W J co .R c Q�o�ection U U Q r> a U L o o j 3 ^ � orG �G •� O �2, w u d�Ta&daa �e (as)k c y j X cztj eS N E � — C O 00 % R t U V1 v � � ' DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 04/01/2025 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 Daniel Barros NAM StateFarm Daniel Barros-State Farm Agent HO No.Exec No): 941-9076 (a/c.Nol: •= 430 Hamilton Blvd,Ste 1 W E-MAIL daniel@barrosinsurance.com S Plainfield,NJ 07080 INSURERS)AFFORDING COVERAGE NAIC N INSURER A; State Farm Fire and Casualty Company 25143 INSURED INSURER B: State Farm County Mutual Insurance Company of Texas 26816 DVE Construction Inc INSURER C: 13507 63rd Ave INSURER D: Flushing,NY 11367-1010 INSURER E: 0 INSURER F: 0 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 ADD --POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A X X 92-EE-F177-6 04/12/2024 04/12/2025 PERSONAL&ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 10,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED UAMAUF AUTOS ONLY AUTOS ONLY Per accident $ $ X UMBRELLA LU1B X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE X X 92-EC-V503-3 10/20/2024 10/20/2025 AGGREGATE $ 5,000,000 DED RETENTION j $ WORKERS COMPENSATION SPTERTUT OTH- AND EMPLOYERS'LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT y OFFICER/MEMBER EXCLUDED? ❑ N/A (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) 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 ST AUTHORIZED REPRESENTATIVE RYE BROOK,NY 10573 Completed by an authorized State Farm representative. If signature is required,please contact a State Farm agent. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.14 04-13-2022 NYSIF New York State Insurance Funs PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 � A A A A A A 471897920 PCF INSURANCE SERVICES OF THE WEST LLC 28 VILLAGE RD N STE 3R ' BROOKLYN NY 11223 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DVE CONSTRUCTION INC. VILLAGE OF RYE BROOK 135-07 63RD AVENUE 938 KING ST FLUSHING NY 11367 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Q2389 999-0 264787 05/19/2025 TO 05/19/2026 4/02/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2389 999-0, 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRES 1/1 EN CHANN YANG DVE CONSTRUCTION INC. 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER. THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND �/4 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 829364925 U-26.3