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HomeMy WebLinkAboutBP25-078PERMIT # e! off -� �C1 DA 4 SECTION TYPE OF WORK JOB LOCATION Ij �j '�` /�J rUsu OWNER_ / CYLl�'VI kZwtrzp42 %' CONTRACTOR.r'rnGIu,Me o'e ose cj to1444 i �QQ9-C. o /.c_) C_ f e CF'o z vem e,�7 -- Zr c ieF o�t�. � i n c C y)) _3 Zl old'/S b - � FEE TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING Mr r &ZQal' IrA&Wq RGH PLUMBING GAS Cl SPRINKLER ,e ,—/ r T� /,QC'o�YJC ELECTRIC L�T �S ram//� co of LOW -VOLT O ALARM CJ AS BUILT C3 FINAL o ;;5=g/7a OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 25-108 Certificate of Orrupaucp This is to certify that a&' �Iwvzer LI-26A7 of pue 6P-6)0It-- v having duly filed an application on U 20 requesting a Certificate of Occupancy for the premises known as, / )JeZ3h Rye Brook,NY, located in a l�/�Zoning District and shown on the most current Tax Map as Section: . / Block: / Lot: /o? , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit NOO75"-4! .) , issued q L,,-)3 20 25, 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: 1404X - /� Construction: , for the following purposes: � a e 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 pre building in a safe and lawful condition. No changes or rearrangement in the structural parts of uilding or in exit facilit► shall be made,and no enlargement, whether by extending on any side or by increasing in eight hall be de, r shall_the ilding be moved from one location to another until a permit to accomplish such change h be from t i ' g Inspector. Building Inspector,Village of Rye Brook: Date: AUG22M D BUIL120, NT For office use only: 3D PERMIT# c3�--U 7y AUG 18 2025 VILK ISSUED: -y—a 3— ls'- 938 KING STREYORK 10573 DATE: '—/ VILLAGE OF RYE BROOK FEE: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 Qtittiti#iittt##i####tirt####i#iirtrtirt##firtrtiifiifiiiirtii irtrttrt#rtiiirtii#if#ifft#if iffrtfiff#t####ili##iirtrtitfff Address: i >� ')ry S N N0((_'9G✓ C F� r Occupancy/Use: LL Parcel ID#: ! J)9, 76 Zone: Owner: M1�r Address: 3 ��-() ! pl Ho((o w ��C Fr P.E./R.A. or Contractor:rC ((✓a�-Q n£ ' Address: rr- jr fjFw CF/I/Alk - C-I- Person in responsible charge: L✓c-(p ,,, rif � 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 YORK,COUNTY OF WESTCHESTER as: CV< (P,/0 �`�✓ CL9 being duly swom,deposes and says that he/she resides at (/ (Print Name of Applicant) (No.and Street) in U- C/-`1�PP/ ,in the County of in the State of Cr— ,that (Cityrl'own/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:$ O for the construction or alteration of 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 Code of the Village of Rye Brook. Sworn to before me this _ I i'/" Sworn to before me this 1 day of ku�L S4- , 2013 day of S , 20 Signature of Property Owner Signature of Applicant i Name of Property Owner in m ae of Applicant t., �A' L Public SHARI MEULLO Notary Pub'4HARI MEULLO Notary Public,State of New York Notary Public,State of New York No.OIME6160063 No.01ME6160063 Qualified in Westchester County Qualified In Westchester County 6/l/2o2a Commission Expires January 29,20Z� Commission Expires January 29,20� QyE BRC��. cu � 1. '9b2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q 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/ /�lc.l S ►` l' iD L.G aj DATE: PERMIT# �` 7�" �� �' ISSUED: SECT: BLOCK: / LOT: LOCATION: ' '� OCCUPANCY: ❑ Violation Noted THE WORK IS... D'IPASSED ❑ 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��. 1982 BUILDING DEPARTMENT VBILDING INSPECTOR ISTANT 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 - - - - - - - - - - - - - - - - - - - - 2, L I 1 L J�.� C^uJ� . DATE: ) U I c J�J ADDRESS: - �.1 PERMIT# O� ISSUED:q- 21-1-' SECT: /Z i BLOCK: LOT:/2 LOCATION: "� �-Cn 9 ` « �� �J J OCCUPANCY: ❑ Violation Noted THE WORK IS... Er PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas t` ..�� ��t:_ 1 r �� -tv 2 /ti ram, .c ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION INAL ❑ OTHER /vFC,�, o.i BUILDING D PPARTMENT ❑BUILDING INSPECTOR 0'XSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : z raj s`►. F Liou') e4pus.. DATE: L ` I to- a ods- PERMIT# Ei '15 'c O S ISSUED: SECT: d •Ao BLOCK:LOT: 422, � LOCATION: r�jam`+' LOB b- {.�( F-� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 2 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING e-TNSULATION ❑ NATURAL GAS lfl L� ❑ L.P. GAS �/00 ❑ FUEL TANK ' ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL Floelo ✓rl ❑ OTHER QyE BRCV�. cu � F0 • 1982• BUILDING DEPARTMENT ©"BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: i PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: E'1 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 1 a s h o Ln f� "m _ F y A O Oa. 1.0 QJ W ° U x W blf3 ^! ON a u ; _ z a y C y s go o b A 00 - � m u s � b y ►-� s s I1 Fr1Tri �i ---i dCJ x y C C _ z o E V M A Q � � ° � O cc) 0 © Z 0 40 W qt UZ � oaa c!a ( I 4j wt] W � Plo � o "� o w 4 .4 = a °M° CA w o 0 0 1-4 n �i G.i cG z -cs ►� cz og A W = A z x � b BUILD MENT D `" VIL E OF RYE ID i JUN _ 29ZrJ 938 KING ET RYE BRO ,NY 10573 �{ 4)939-0668_ + VILLAGE OF RYE BROOK wH'1�'.1°�rhr 'ov BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I, k V f-z e V-- ,residing at, (Print name) (Address where yuu Ii�C) 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; �'ou ., P��SCe�'r , 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. a&__/e_z'__�� (Signature of Property Owner(s)) (Prin(Name of Property Owner(s)) Sworn to before me this dav of 20 � (N()ary PuI,Gc) SHARI MEULLQ Notary Public.State of New York No.03 ME6160063 Quawted In Westchester County Commission Expires January 29.202_7 (2) 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 andlor 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 Is Sworn to before me this day of L�2 , 20-s:- day of:_ ,20Q Signature of Property Owner Sign re of Applicant e afProperty Owner Pri e of Applicant Notary Public Notary Pu he Sk1ARt MEULLO Notary Public,State of New York SHARI MELILLO No.01ME6J.60063 —3 N(,tary Public,State of New York Qualified in Westchester 29 20 t No.0-IME6160063 Commission Expires JentlarY Qualified In Westchester County commission Expires January 29,20_Z77 (4) 6/1/2024 a a DD A _ a N ❑� s 914 I-i-1 a a 94 OW {lam' U q o W N 1-4 O0 VJ F7 V L C C O 7 � •� H w O 0-4 e� Veq F-+ ,n, o z b a A ;� � WOc C A O O 0 ^0 a�vi di U �=1 U z v ¢ C%J w rr H V7 o 00 w F� w H �' r v U .� z z oo r- ag � z ° � a c� L z 0 C A ¢ U 0 OS -0 0.m R' V O Gp 0J w H Q W 0 1�1 N z 4 U C7 A Z .. a w w a °' �I PLO a w x _ 464646916��46- A AU 16- 4-0444-4440444414-0.0a446494a4;46464m a D C-C IE 'C D1 BUILD MENT MAR 2 6 2025 Vn. oFRY oox VILLAGE OF RYE BROOK 938 KING � t F.'r RYE RR ,NY 10573 BUILDING DEPARTMENT 0 % r ov INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: 7 V Approval Date: APR 2 2 2 e Application Fee:$ CX:2y� Approval Signature: Permit Fees:$ ;eo 1 Disapproved: Other: '4 7S0 L e S 4 h Zsc-r o n-UV''2 Application dated: 3-7 caw c3!�7 is hereby made to the Building Inspector of the Village of Rye Brook:,NY,for the issuance ofa Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described bellow. 1. Job Address 134 Sro5W Uo{.a.oW(-(e5tg-rt+ SBL: AA, 76 -I-/,)& Zone: a6 2. Proposed Improvement.(Describe in detail): Wkre l - pA►tl A A E VF4 VJ4L-L4 ' LQvfWrst, k kTLA4-r� CAbtn& R Gee. oL,+Jets t —kitn 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 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existin automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: r FA#0Uq After Construction: A 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:SHAt * IJIcoL- UIE4t-6-F Address: 134 0�,uslJl 4LLO J Clue.sten' 1ZyIE'$Rpec& Al 10,573 Phone#— Cell# S UP • 5 zfs - 8 2 45 email: 8 WE A LE tztIO MA;1. Caen S. Applicant: Address: 12.5- 14944911ALE P-b JucKA?1yE tJ 074'7 1. Phone# 114y 5� -7 dZ Cell# 4t&► 76p• 3 39 email:��+ n�A GvnsoAtde'S!Jh C,&el ��0A Com 9. Architect: 1`I Address: Phone# Cell# email: 10. Engineer: !y Address: '— Phone# �}. Cell# email: 11. General Contractor:VIOCAFt NCV GIG Address: /ZSd- Al(b)t i e. E, T oKdkze- Illy {0-70-7 Phone# 11h► is71- 57i7Z Cell# 16D- 3315 email: tt7rL/t�t�l�yllsu/��GSK',�Go►y5lru�c .Gi�, 12. Estimated cost of construction $ '31 Opp. `» (NOTE:The estimated cost shall include all labor,material,scatfolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: ASAP- Finish: b W99k-5 (1) 6/1/2024 1 BUIL MENt { Ok �rtMe k�t>Pra;a�r,4*pry g.�,�y.^k�a x*trr�#x�e�+�,e x�t vest�t 3 xx x n t;�try x,�A ae at x xx,��tx r+e 4#xr�r�rtA x x�x rrsa t*xk bt:rxtef�•t�r�t,r,��#�y��rk#x�r�#[ AFFIDAVIT OF COMPLIANCE WnAR I aT Or T v MOM J 7lL�3nc � "P IM �T VPL1C,XT'T . my am=m S APPL TON VMCTTBD 1�I Z NMARIZW rw W.EL. S R8 o 'STATE of NEW'� ) �far, E TCHEST R � 9 y..........�. �residing FSt� 1. V� & ✓ 4 4Td iV l! 5 bcft�W ..,m..o.....m. dt. Sl ' deposes.and stags (s)he is the applicant a "ve zed,and der' l ,oWner f the property to hick ibis Affidavit of Compliance ".s fit; - {.tom, nth hem�true,and that to the best afSher knowled ;�i , Are'to ifle gross o ctionsconcerning eitherthe stanza sewer or sanitary sewer,and tom , p, f drai ,su p p f car der prohibited storm atbs or groundwater r i or .. bfiow(w" o a ofaroiy iuto the sm tuy sewer from the subject property C � S a""" { L Y- } M F A n � pp k r e19e►swt w of ft 1"A twer(s) of the subj*d Wty. a t d the appi of reewd in spaces prod. n-not r �p�d" � e or not �'app�'�o � Y � #rr sad shelf be dosawd nuH and void and will be raitum to the apO Pfe t noti.thit appka*m s are a on'-ref nda*., bT being duly swam,d+epose&and seas that hoshe is the SPOCA tt ve U and fmdw sWW t ($)he is the ICIW O*Mer of thr propeny to which the application permim or tl s (sft'is the for to tc O�Vnet and is duh,sudwrized to m&kt tW file Ibis apple ' at sits hat�m i rt,um to dwo best of his`hislw know =4 behtf,and that an wwk Tlaf Or v at the sbme , U be in cam`- w!M t Otails as set fad and con iu this applkadon p4mynkg g9med plam and specifications, *v l as in amor4ancewith the Ntw Yo&State Vidom Fut pmvemfim&BW1ft CO&-'tho C k of tbit V9UP of Rye Brwk and&U a "'ble laws and ae Ufi*tic' i .� '. this, t ren,the lmpwy owrAr fimber d Ism that 's his iaspeatd thetutou pmpetty,aunt&A to, " *e b&A raft kwWWW t art to t oef ci ,r► ststs arothmi "�ar groa�st t � or s�umoi of r�ftsda t o the sanit per s the vAjovt pr4exty. . to brit me this _ b4=me-etc OWN or . 'Oka tl)L��t? � O1 - t Vate"4 New Yo* �E���asnrtrss rsr " i { n � 1 v �hv k PM1 " �'��'�+�,.fit• x xm �'� T h 00 N N u _ NN CD p�G W \ \ _ A w c H v z B L ` FBI W y y ^ O _ cr. aj W L r x _ V a - O O o v U z z _ W ~' wLn0 ' cn = ■ r N _ ■ ovG f� a U "', w c cn wcd w w v z °z V A W z C � O % 0-4 0 Z 00 w N 0 0 a. H G � 5) u Zw � z = wz � 0r _ o rr� M•■� r C V x x U x < V Z Li. w o a co o pq CS u ad = F-+ a4 O < N�] < ce w e u Z z H O o _ W F ! iri Z Z W U > g a -' oo U4 !!1 W r W F pp 0 i••i z x ` a U W Z a v� ■ w z a o � en �. z p w a rr BUILDING DEPARTMENT RJ 17 2025 ID VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)99-0668 BUILDING DEPARTMENT yv ti N ryebrooknv.,gijv ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: Y EP Approval Date: Permit Fee: S Approval Signature: Other: **********************************************V-MIT DO NOT START WORK or CONSTRUCTION UNTILAHAS BEEN ISSUED BV THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE T TAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, t7 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/ r re ove 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. -7/ / j� 1.Address: 13`T V Koh /40 LL01� `RES&4r SBL: /c99. /4 / �-'/a6Zone:. pub 2.Property Owner: DAM Address: 5A^115 Phone#: 1Y Cell#: email: 3.Master Electrician/Licensed Installer: Address: Lic.#: 13?6 Phone#^^�+ 97 - g Cell#: einaii1: ATAQQArl-EC,rgI/C.10 bP-ro JL 6. Ak/ T Company Name: AT) 6�CTML Address: IA,2 iIJRA€ fCD 4.Proposed Electrical Work/Fixture Count: wi,acf Nt vV STov'Lc R ePCACEMENT 5.3`d Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: t1i�A& —'T'koY ,being duly sworn•deposes and states that he/she is the applicant above named,and does further (print name of individual i ning as the applicant state that(s)he is thei�S7C/l C C/b4JAA✓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 before me this Sworn to be a�e this day of 120 day of u 1 20 Signature of Property Owner Signature of Applicant CAN AEL 2OY Print Name of Property Owner nt ame of Applicant Notary Public NO"PUbW,State of New York No.01ME6160063 6/t/2024 Qualified In Westchester County Commission Expires January 29,20z- STATE WIDE INSPECTION SERVICES, INC. Service With Integri/Y 0•0 • • SWIS JOB APPLICATION •. • Office Use Elect. Permit# 1 Date f /7 13f Bldg Permit# Q Sci Ft Plumbing Permit# Final Certificate# City/Village C RGOKf Zip TBuilding Dept. r,9 Q County �Cs7• Address)Aj O W �'-! � Cross Street Section., 7� Block Lot iz Owner Name/Address(If different that,above) Contact Number ❑Basement ast Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside 0 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 I SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation nJc V%) 57o ve p OM C DD r J U L 17 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at 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 A-"A J�Lt CTR/L & d PT0 Ll/J,C lVtl I Name f—11,GN,q ' /1404/ License# ) 30(.0 Date -7 /,-IS- Address Signatu "7 / t A ti (Z A 6 R D City/State S-TAM �� /-r Zip Code 0680 Company I "T A EL Ec-fKIL Phone# C�/�c/ S7 d/ - 9 GI( g—/ I `1 State Wide Inspection Services 3D 1080 Main Street Fishkill, NY 12524 AUG 18 2025 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES 7 VILLAGE OF RYE BROOK Email: officeCa)swisny.com service with Integrity BUILDING DEPARTMENT Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: ATA Electric, LLC Adam &Heather Kurzer 79 Briar Brae Road 134 Brush Hollow Crescent Stamford,CT 06903 Rye Brook, NY 10573 Located at: 134 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-185 129.76 1 126 Certificate Number: 2025-5515 Building Permit Number: BP25-078 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: 134 Brush Hollow Crescent, Rye Brook, NY 10573 The First Floor Kitchen was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 15"' Day of August 2025. Name Quantity Rating Circuit Type Cooktop 01 30 Amp Oven 01 30 Amp 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. MI O N O N r_, Ck z cn w N O a z � , PooLrl CA co 4 0° V H z a v� H O w Z � z z cr o Z a N Uz z w � V �� . � w c O ,c CN rA 5 � 00 ac 0000 - F z z H8 y H , BUILDING DEPARTMENT D D VILLAGE OF RYE BROOK R JUN 2 4 2025 938 KING SmE'i,T RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.1yebrookny.gov L BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP #: �C' �9 PP#: ` r Approval Date: JUH 3 0 Permit Fee: S 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 WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, L- IQ— 15 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: I / L I1 v J N NOL t E,k F,-< SBL: 1)l i 76 ZoneAb(b 2.Proposed Work: I rJ j 'TA Lt k j rC Hfr' l itik pwk gAtµ S J�h 0,1 TO/LIF'r 3.Property Owner: A QP�A .V Address: �'( vf1i kaaal— f Phone#: Cell#: email: 4.Master Plumber: Fp„ os �V i,� , Address: / ` 4�►'1, ids �-E Sh.�,�► C,R /g,� Lic. #: 1?J-4 Phone#`1'/V 2fQ j s Cell#: email-1-1120 Company Name: ?oC_gy Address: t7 /I.IL 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 Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 5' 2nd Floor 3`d Floor 4`h Floor 5'Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this .L \ day of �k►2 120 Z S day of 20�� Signature of Property Owner Si ature of Applic l erg'✓l\ 1 6-"t= t L Print Name of Property Owner Print Name of Applicant Notary I*A N� !dot try Public,State of New York No ay u ,State of New York No.OIME6160063 No.01ME6160063 Qualified in Westchester County7: Qualified in Westchester County Commission Expires January 29,20 Commission Expires January 29,20Z 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 ti BUILDING DEPARTMENT D VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 JUN 2 4 2025 (914)939-0668 Nv ww.rvebrookny.Izov VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGI? 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 OFNEW YORK, COUNTY OF WESTCHESTER ) as: It- , residing at, )3� BrK� 4ataa # Ccelc�Jy 1 g; ��r (Print name) I.A�I�h��.��Il rc "w tip,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; �r�s� �{�(u✓� C�ejcv`'r �r �jd�t�. N� /Qf 77 , 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. JA tSienature of Property Owner(s)) (fruit Name of Property O�Nner(s)) Sworn to before me this ice" day of :yv^-t , 20 ZS SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County 3 commission Expires January 29,26AD 6/1/2024 Certificate INV-032025 Date: 06/14/2025 Bill to: The following spray foam product(s) has/have been installed in the areas of the project Job address: 134 Brush Hollow Cres Rye Brook,NY 10573 • Apply spray foam closed cell high density 3" Rv21 • High-Performance Closed-Cell Spray Foam • Insulation that Delivers Exceptional R-Value, • Great Energy Savings, Water and Air Barriers, • and Added Strength Against High Wind Events Rodrigo Rodriguez President D CC� COM� J U N 17 2025 DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT Certificate: NATURAL Any doubts or questions you can call the office POLYMERS number.# 203-522-2207-475-2109327 N YS I F NCF'I Email r.rsprayfoom207@gmaii.com https://ryrinsulation.com —1.1^•°-°"1—d RO�WOOL Facebook:R&R Spray Insulation Certified Applicator (� � :J LX�!�� r,:.`��L�.l:��.1 ice_ ii ••x f J i ro A ro � Cn g; c°o O ,' of N � Z � � I f �.?,• 04 ^' \ PTI o � ro rm C 1 ,1 µ CD ° z -1 �c f•. `°s to O � �' rz et E 't ro O v r , �+ r 1 N w o �• l ) � ro � � I � �" f • c r , 3r AC�® DATE(MM/DDrMY) `� CERTIFICATE OF LIABILITY INSURANCE 3/25/2025 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 YQSenla Maggio JMG Insurance Corp rHOMIE+e FAX P.O. Box 700 •203-838-5554 taC,No);203-857-7848 IL Norwalk CT 06852 ADDARE S: certs@jmg.com INSURE S AFFORDING COVERAGE NAIC 0 INSURER A:Travelers Property Casualty Insurance Company 36161 INSURED CDCLLCO-01 INSURER B:Accelerant Specialty Insurance Company 16890 CDC LLC, Vincent Franco Consult Design Construct LLC INSURERC: 125 A Marbledale Road INSURERD: Tuckahoe NY 10707 1 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:89051391 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 SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MWDDM(YY B X COMMERCIAL GENERAL LIABILITY Y SG1_183R0008500 5/31/2024 5/31/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PRERENTED- MISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X J POLICY❑ PR LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acc dent _ a B X UMBRELLA LIABI X OCCUR SXS183R0008600 5/31/2024 5/31/2025 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED 1 1 RETENTIONS $ A WORKERS COMPENSATION 6JUB-A387437-9-25 2/20/2025 12l7/2025 X STATUTE ERH CT AND EMPLOYERS'LIABILITY Y/N -- ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook 938 King Street Rye Brook,NY 10573 is included as an additional insured under the General Liability Policy,if required by written contract executed prior to a loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany.NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) DAf f ^^^A^^ 264356825 ! VINCENT FRANCO CONSULT DESIGN �I CONSTRUCT LLC *: 125A MARBLEDALE RD W r`aL TUCKAHOE NY 10707 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VINCENT FRANCO CONSULT DESIGN VILLAGE OF RYE BROOK CONSTRUCT LLC 938 KING STREET 125A MARBLEDALE RD RYE BROOK NY 10573 TUCKAHOE NY 10707 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2109 451-1 243476 08/04/2024 TO 08/04/2025 3/26/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2109 451-1, 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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. 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 STAT S7NCE FUND V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 724070151 U-26.3 Laura Petersen From: Adam Kurzer <kurzeradam@gmail.com> Sent: Thursday, June 5, 2025 1:21 PM To: Laura Petersen Subject: 134 Brush Hollow Cresc - Permit Change Hi Laura, My name is Adam Kurzer and I recently purchased the property at 134 Brush Hollow crescent, rye brook. Please update the open permit to have my name on it with the updated contractor: New contractor: Perinoto Home Imporvement Luciano Perinoto Thank you, Adam Kurzer APPROVEi.? Date: (J FILE COPY ,,/G,C j� pe cv�Il Sew vS"/7 M �oUS12 Bargain and Sale Deed,with Covenant against Grantor's Acts--Individual or Corporation(Single Sheet) CONSULT YOUR LAV,YER BEFORE SIGNING THIS INSTRUMENT--THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY -let THIS INDENTURE, made the day of June, in the year 2025 BETWEEN Bryan Wexler and Nicole Wexler, residing at 134 Brush Hollow Crescent,Rye Brook,New York 10573 party of the first part, and Adam Kurzer and Heather Kurzer, i}S Hu 51'-f-od Rrd W t F�- residing at 300 West 55"'Street,Apt. 19D,New York,New York 10019 party of the second part, WITNESSETH,that the party of the first part, in consideration of Ten and other dollars paid by the party of the second part,does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the State of New York,County of Westchester,more particulary described as follows: see Schedule "A"Attached Said Premises being known as 134 Brush Hollow Crescent,Rye Brook,New York 10573 Being and intended to be the same premises conveyed to the Grantor herein by Deed dated June 1,2023 recorded June 6, 2023 in the Westchester County Clerk's Office as Control No.: 631433153. This unit intended for residential purposes TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law,covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: Bryan Wexle Nicole Wexler / Y � l�tco�i", o o CD 00. L y N Ln C ed ' Y U .�'• is .^r o• . - G� o u zLU moo; L oo p • CD w I— o r o +section f O d Z 2E `� j o U) Q ayi cli Lij �.r ❑ F Z cd ui lt tj v co x _ :j N •_ = co - I cY)Ln _ r� pM � •6J y •,�j U + L = V L t i` \ to --- - o rat �Inl A�ORO� CERTIFICATE OF LIABILITY INSURANCE °A0325/20°25 Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT CT AJC Insurance Agency -NAME SHONE — (A/C,No.E.O:(660)721-0922 Ho):(880)529-2182 1850 Silas Deane Hway E-MAIL ADDRE$8:__ PRODUCER Rocky Hill CT 06067 CIl8741lt1E81Dr _- _- - _____—_ NAIC_s_ INSURED INSURER A:UTICA FIRST INSURANCE COMPANY _ __ 32326 ___ LUCIANO PERINOTO muRme:HARTFORD UNDERWRITERS INS.CO. 0104 PERINOTO HOME IMPROVEMENT LLC — -- — - wuRER c 20 MAPLE RIDGE ROAD -------------- -- -- - TRUMBULL CT 06611 INRD' INSURER E: INSURER IF 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. - 'BlI BRI - - -- --- - -�� - TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY yy l' A GENERAL LIABILMY 11/07/2024 11-07-20 EACH OCCURRENCE 1 ____ 1,400,000 X COMMERCIALGENERAL LIABILITYr—� PRA�Ii�SD�ENT $ —w.000- CL AIMS-MADE X 1 OCCUR r J( f MED EXP(My ores Pwfon)ART 5046626 06 5 OHO ---- --- t I PERSONAL S ADV INJURY S 1 000 UQO ---— GENERAL AGGREGATE 5 2 000�000 GEPfL AGGREGATEPRODUCTS-COMPADP AGG f X POLICY!f � PRO LOC LIMIT APPLIES PER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMB : ANY AJTO r i lEa acaaenei------ --- - I BODILY INJURY(Per parson) _- ALL OWNED AUTOS SCHFOULED AUTOS 80DILY INJURY(PeraoddwW S 9C HIRED AUTOS I PROPERTY DAMAGE f NON-OWNED AUTOS - X UMBRELLA LIAR X OCCUR 06 EACH OCCURRENCE = 1,000 000 EXCESS LIAR_..__ CLAIMS AADE I ----— - .._. AGGREGATE _ f DEDUCIBLE RETENTION S S - B WORKERS COMPENSATION 09/30/2024 i 09/30/2025 1 WC STATU- I AND EMPLOYERS'LLABILtTY i 1 IT ANY PROPRIETORPARTNERrEXECUTNE YIN 6S60UB-4N64529-8-19 E.L.EACH ACCIDENT = OFPCFR,MEMBER EXCLJLFD7 r NIA _.._-.. 11100,000 (Mandatory in NH) IT yes.describe(Inner E.L.DISEASE-EA EMPLOYE f _1 040,000 E.L.09WAN-POLICY LIMIT f 00,000 I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks schedule.N more space Is required) PAINTING CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE Village Of Rye Brook POLICY PROVISIONS 938 KingStreet AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 Paul Siqueira ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD C1e r All NYSIF New York State Insurance Find PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) � 0 A A A A A A 471282340 PERINOTO HOME IMPROVEMENT LLC (CT LLC) ❑■ #i r 22 VITTI ST NEW CANAAN CT 06840 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PERINOTO HOME IMPROVEMENT LLC VILLAGE OF RYE BROOK (CT LLC) 938 KING STREET 22 VITTI ST RYE BROOK NY 10573 NEW CANAAN CT 06840 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2569 700-4 255401 05/13/2025 TO 05/13/2026 6/8/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2569 700-4, 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:/M/WW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S7NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 740369637 U-26.3