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HomeMy WebLinkAboutBP25-090PERMIT # /Jy SECTION TYPE OF WORK JOB LOCATION _ OWNER1� CONTRACTOR /EST. COST � �J' �/ CO # C2 TCO # �� o DATE; ,3n �; 30 c)6 if 6 BLOCK LOT_ `% �O > � �cla ,Orayer4Q.� LLC - crciQnv �e���v�v C9/4Y)3�'y 3�/S D� DATE FEE DATE ' INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION �( PLUMBING 5 L' RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT O ALARM CJ AS BUILT 0 FINAL SD u7 �/r � S / l L1✓L1 � w �/ T�/�Y7✓l� OTHER APPROVALS ARB BOT PS IZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 25-076 Certificate of Occupacucp This is to certify that_,try/e / Gil �a F-tO * ' —0-1ba of, RUC &bnk, having duly filed an application on (?-4 20_a,:5 requesting a Certificate of Occupancy for the premises known as, 57 R60cl Rye Brook,NY, located in a /2— / Zoning District and shown on the most current Tax Map as Section: :5. Block: 0 Lot: 1 -7 and having fully complied withthe requirements of the Building Code and the Zoning Ordinance under Building Permit No _ )Q , issuedql,�_20_4;2j, 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: 9— Construction: for the following purposes: 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,nor shall thedmil ing be moved from one location to another until a permit to accomplish such change has a obiom the spector. Building Inspector,Village of Rye Brook: Date: JUN 2 3 2021 D E C E N E For office use onI ID BUILDING DEPARTMENT PERMIT# JUN - 9 2025 VILLAGE OF RYE BROOK ISSUED: 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: &p-9— — VILLAGE OF RYE BROOK (914)939-0668 FEE:,&(::)- ,7): �K — PAIDIX BUILDING DEPARTMENT www.nebrookuy.gov 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 ssrssssrrrrrrrstsrtrrsrrrrsrrrrssrtrasssssssrrsrssrrrrsssssrstrrtrtrsrrrsstrsststtstssststtssrrrstsrrtsttatsrsrstsstattrrrrrt Address: " I R R (A- RD Occupancy/Use: Parcel ID#: Zone: P-7 Owner: 69'/0 Address: I rA /`^ARA CQl , 2() P.E./R.A. or Contractor: FF f 4 tj oU HQ.A-F r-j Address: Z L/I TT-i f T, P-)f w r Person in responsible charge: 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: f I(LP V)0 being duly sworn,deposes and says that he/she resides at 5-1— T<;;tm q qC1c f—v Q d. (Print N e of Applicant) ` f e� (No.and Street) in v(, �'0 in the County of WePin the State of ,that (Citylfown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S Z�R 000. 0,0 for the construction or alteration of: mlorvr � sp. Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this 2.,n,� Sworn to before me this 211� day,of �ryv.� , 20� day of 12)/A uf"o ldl6d' gnature of Property Owner Si nature of Applicant R It cl-6t W1 k'6 &In(3 [�4;C�g h A 0) o Print Name of Property Owner Print Name of Applicant \ 'V\y���� ���v��Jeti� Notary Public Notary Public \ Mohammad Rahman Commission#OIRA0032973 Mohammad Rahman 6/1/2024 Notary Pubho State of New York Commission#OIRA0032973 My Commission Expiration:01/17/2029 Notary Public State of New York My Commission Expiration:01/17/2029 QyE BRC�uk BUILDING DEPARTMENT ��❑BBUILDING INSPECTOR VASSISTANT 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 : 6 7 a, rvi a r a-Oc gnA.A DATE: (a I & • Z oLS PERMIT#W 2S'-O S C7 ISSUED: 40-ZPSECT: —; . 40 BLOCK:_LOT: / 7 LOCATION: r l �C." OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION L ❑ NATURAL GAS / to � �7 /^' I NIG ❑ L.P. GAS ❑ FUEL TANK / ❑ IRE SPRINKLER //�,S �IQ d Ap 'e -Q/j's VFINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER v O N y 0 LW ■ y w WWI yW�. Qi p •� �1r � � ~7 � W F—+ cn � •: o v 1-4 � � ai m •� O ,� H7 , 0 4 -0 ■ L n zLn O a oo -8t A 00 Yam,-,�^ �"' z ✓ Q M - w -_ u M U O z -° Q om = o A w O W z -, 7 -1 a (� W co �i U M A H a �' ° c� ■ o V O I-N -el z U z p C cn z M..,r oo ON a Cf) = o z z w a ] v ro- 1~ w � © a, Z U A W z ° v o ti .. v 0 a - I-� O U '4 BUILDING DEPARTMENTDD i VILIGE OF RYE'4 ;OOK I tt 1 4 2Q25 j R 938 KING S'r1a�EEm Rvl�BttoOK,NY 10573 RAPR (914)939-0668 - VILLAGE OF I=tYeE BROOK 4 %-%vwx ebrn--ol����,Qov t BUILDING DEPARTMENT 3'7T INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: AP ��5 'ern IJo Application Fee:$ 16 /00 Approval Signature: Permit Fees:Sync) at: : - Disapproved: Other: Application dated:! !0 is hereby made to the Building Inspector ofthe 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. r7 1. Job Address:_; ' fi� M R M- SBL: 13516Q— one: 2. Proposed Improvement. (Describe in detail): &,Jwz MAL► L" '-Qf � �•,� 3. Does t e proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No:—Y,,--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: M—A, After Construction: l FAIN. 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: Dpwia I f u j Cis 04aN O Address: 1Af� E �a:�A- Phone# 0O)) )& - ' 6A 3 Cell# Wd 3da - )3 5 f email: &PA/JO 3 S3 92 L4AIc, C y-, 8. Applicant: pi✓o ffl-t p►,09 Address: JJ VI tr,"Jt- CANA-- ,C 1012JO Phone 1303) 1)6 Q 3 00 Cell#C Vq1 3P-1 f 1 S email: � 1 LGLtA,✓�® ���`At L_ C o,^4 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: L 0 44 A d.0 pf•I Address: 31 I/I Cr: CT, Phone#6 43' a)o-�lo.o Cell# J ��-J,e 1 T email:61L VC(A Atom +% -Ale_ LA, 12. Estimated cost of construction $ '50, 60-0 (NOTE.The esumated cost shall include all labor,material,walMding.17.rcd eyuipmcnL prulcssiunal Jees,and material and labor Khidh niay be dunated gratis.) 13. Job Timetable: Start: [' —J 5 Finish: 7 1 (I) 6rtno24 BUILD Xp DEPARTMENT ® [E- � " E VEL ) E OF RYE BR©OK I APR 14 2025 938 KINGET RYE BRODK,NY 10573 (914 � VILLAGE OF RYE BROOK rr wry or BUILDING DEPARTMENT *k*******k**+F***************************:4*t:*:t'k*k F*-k xt rk k.F k is******k*****:F*9F i;***F*kR kk k k**kk****kk**k*•lc y:tx 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, (Print name) (Address�rbcrr wu 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; )CJ ,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. L&��LiA (Signature of Property Owner(s)) ktici6( n (liana (Print Namc of'Property Owner(s)) Sworn to before me this r y Of �J 2� SCOTT GOWE day /l , NOTARY PUBLIC OF NEW YORK I.D #01 GO6357188, MY COMMISSION EXPIRES (Notary Public) f'_i 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 NE YORK,COUNTY OF WESTCHESTER ) as: GO_R_UCk &*'o _ ,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. Swom to before me this r Sworn to bef re rnq this day of Z , 20 �� day of � , 20 75� 1&q ftao� 4��( Signature of Property Owner Signature of Applicant [�1U J�� 1�U;� Print Name ofProqv4 Own Print Name of A licant S�IA ..&. '_ Notary Public Notary Frublic SCOTT GOWE SCOTT GOWE NOTARY PUBLIC OF NEW YORK NOTARY PUBLIC OF NEW YORK f I.D.#Q1GO635718 MY COMMISSION EOXP 663671 RES��l 7�7 MY COMMISSION EXPIRES f /! (4) 6/112024 r s N N Q+ 11 = _ s _ O zLr) _ z z z w of :n A w W FJ w a Q ° z 00 � Q0.4 s O N V r z ►�- r-, � C CA 00 a3 w GQ w cy • 1 M � � � r��' L z w H �' �' H Ln 5 o Z zz w V Fs J -4 � ° x z r A " a oon � F, .1 om �' BULLENT SUN 13 2025 VIL OK 938 KiN NY 10573 VILLAGE OF RYE BROOK ID BUILDING DEPARTMENT wwov PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: '�� /`/ PP#: —J Approval Date: JUN 16 ZQ25 Permit Fee: $ Z � 0LO �J r— 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, CO'�3 aS 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: M.0 SBL: 13.E/&0—/—/ 7 Zone: Z 2.Proposed Work: 3.Property Owner: Ari F<< CIq r".9 Address: I 'DtPhone#: 3-a c-3G'�3 Cell#: email: L QA�O 3 T 3 IG 6Jl^ 1�4 C 4.Master Plumber: 16-t I eS� Address: 4W V/'i /psw Lic.#: ga G Ph�9e#:'i'{ 29(? 1 27, Cell#: email: Company Name: r aQ4 ��6l� „� —Address.]`7 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 Ist Floor �,l 2nd Floor W 3'Floor 4'Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) I- 6/l/2024 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 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 is day of ,20 day of \J��e ,20 � Signature of Property Owner Signature of Applic Print Name of Property Owner Jintme of Ap licanJL p�h}Notary Public P ANAEULL0 Notary Public,State of New York No.O1ME6160063 Qualified In Westchester County Commission Expires Jandary 29,20Z3 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- 6nno2a STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: r�VC t C, 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 2M Sworn to before me this '&,A day of '�UVW- ,20 day of 730v%I ,20 ignature of Property Owner Signature of Applicant RI �+� Aagtlo /v ;q �)/� 0 Print Name of Property Owner Print Name of Applicant Notary Public Mohammad iman Notary Public CopunissionO O1RA0032973 Mohammad Rahman Notary Publio Stebe of New York C0m0issi0n*0IRA0032973 My Commission Expiration:01/17/2029 Notary Publio State Of New York MY Commission Expiration 17 029 This application must be properly completed in its entirety and must include the notarized signatures)ot� 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 BUILDV4 TMENT D [E C E N IE VIJET F RYtj�AOOK JD 938 KINGRYE BR ,NY 10573 J U N 1 3 2025VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I �t y (U4 N( 4nr� , residing at, � Tarn4f�C,(C (Print name) (Address where you live) being duly sworn,deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Tu�au� Pxcj 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)) _ Te'l1 C4a nMno (Print Name of Property Owner(s)) Sworn to before me this ?_116 day of 20 2 S (Notary Public) ;Mohammad Rahman Commission#OIRA0032973 -'- Notary Public State of New York My Commission Expiration:01/17/2029 6/l/2024 Building Permit Check List&Zoning Analysis Address: (J SBL: � �. R -► 1 \` Zone: / U e ��_ Cost.Type: Other. Submittal Date: �����z Revisions Submittal Dates: Applicant: Nature of Work: (L _e Reviews:ZBA. APR 2 PB: BOT: Other. NEED OK �FEES:Filing: BP: C. 0. Flood Plane: Legalization: ( ) ( )_,APP: Dated: --Notarized.— SBL: Truss I.D. Cross Connection: H O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO: Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival: Sealed. Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed: Copies: Electronic: Other. (� ( ) License: Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other. (� ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery._Other. (� ( ) PLUMBING Plans: Permit: Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER. C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg. date: approval: notes: ( )ZBA mtg. date: approval notes: ( )PB mtg. date: approval:- notes: REQUIRED EXM ING PROPOSED NOTES APPROVED Area: Gate: ADD 2 4 3p2G Circle: Fie Front Front Sides: Rear. Main Cov Accs.Cow. Ft.H Sb: Sd.H Sb: a&. Tot Imp. Ft Imp: Paz Height/Stories: notes: M a yN K NLLJ t• 1. n E o a a ° r f U ._ L O lu u a� C 4.0 J v c J C n \\ CD w Qy ^� w IT U b v: / �• >1 00 L > w C ocr ✓gyp O a ►- Z � < Zt o r l < ILI - V L, Q > N O � O N fl z ,L y a , v N a v N 00 M "a ° I v - . 1 M ..'Y ., L =lu OD 'O + L d ' LOAM r S d V ,a►co/ty® CERTIFICATE OF LIABILITY INSURANCE °"03122s20 sY 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 NAME CT AJC Insurance Agency PHONE ---- --- - --- -"FAX LAIC,No.Exl) (860)721-0922 (AIC No):(860)529-2162 1650 Silas Deane Hway a-MAIL ADDRESS: PRODUCER - -- CUSTOMER IO e: Rocky Hill CT 06067 —'-- INSUREII(S)AFFORDING COVERAGE NAIL• INSURED INSURER A:UTICA FIRST INSURANCE COMPANY _ 5326 PERINOTO HANO OME IMPROVEMENT LLC LUCITO INsummIII:HARTFORD UNDERWRITERS INS.CO 104 OT _ - INSURER C: 20 MAPLE RIDGE ROAD TRUMBULL CT 06611 INSURER-D: RNSURER E: INSU 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. IN8q TYPE OF NNWRANCE 'BU�R MY POLICY EFF POLICY!XP LIMITS- ---- —- GENERAL LIABILITY _ _ 1,000.000 A � � 11/07/2024 11-07-20 1 EACH OCCURRENCE f T-1 MERCIAL GENERAL LIABILITY DAMA(1FTo�NTEU- IEa occurronaLAIMS-MADE XJ OCCUR , MEDEXP(A_nyorwpwaon) f _ 5,0_O ART 5046626 06 1 000,000 �PERSONAL&ADV INJURY f r NERAL AGGREGATE f __2 OW,WO GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO f __z X POLICY 71 PRO- f -. AUTOMOBILE LIABILITY COMBINED SINGLE LIMI7 1--�� (Ea accWent) f ANY AUTO 1 BODILY M Jl F- 1RY(PerALL OWNED AUTOS BODILY INJURY(POracadeM) f -_-_-_ SCHEDULED AUTOS i PR)—PE DAMAGE- -- HIREDAUTOS (per acciftrN) f NON-OWNED AUTOS f f X UMBRELLA LIAB OCCUR 5048M 08 EACH OCCURRENCE f 1 000.000 TEXCESS LIAS CLAWAS44ADE AGGREGATE f DEDUC11Bt E f RETENTION f f B WORKERS COMPENSATION 09J30112024 08I3Qf2026 I WC STATU- AND EMPLOYERS'LU1BILnY NY A PROPRIETORPARTNERIFXECUTIVE YIN, 6S60UB-4N64529-8-19 E.L.EACH ACCIDENT f OFFICER/MEMBER EXCLUDED? NIA r ,000,000- (Mandatory in NH) E.L.DISEASE-EA EMPLOYE f flfl yes,dascgbe under _ _1,000,000 qPFCIAI r r E.L.DISEASE-POLICY LIMIT f 500,000 1 i,l I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,0 more space is requhed) 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(2009/09) The ACORD name and logo are registered marks of ACORD Cloar All NYSIF New York State insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � � O ^^^^^^ 471282340 PERINOTO HOME IMPROVEMENT LLC (CT LLC) f 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 061540 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2569 700-4 973594 05/13/2024 TO 05/13/2025 3/27/2025 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:I/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 ANDiOR 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 SU NCE FUND T DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:25989895 U-26.3