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HomeMy WebLinkAboutBP25-117wEr�+tT � �/��-/� 7,_,_ �►�: 5 a3 � pip; S 3 MCP SECTiaN —, 3 �� � � RI nru / � n* /:� e � EST. V � #i ��/Ovu 4�5�/ylF.'77` df/Gi7/ p, �� (� ��In � C7 ��I�1 -� ® FEE FEES � �� i'� TCO � FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUME3ING RGH PLUMB{NG GAS a SPRINKLER ELECTRIC LOW -VOLT 0 ALARM O AS BUILT C� FINAL • h�: � DATE IMSP �i' /o �Z02� G3JP !�� �7�7/S-��/9 Ps ,-tee// i� �38- �a� �_ OTHER APPROVALS ARB BOT PB - i ZBA VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-091 Certificate of ®ccupa.ucp Ehis is to certify that h a / StA/7"IPM as Jr -d of. ' Jac- having duly filed an application on/ V 20jg;2,5 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: / (47 Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. , issued ,—;)3 20 ,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: k— �6,kqe- Construction: , r 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 theIK ng or in th it facilities shall be made,and no enlargement, whether by extending on any side or by increasing in heig be m e,no shall the building be moved from one location to another until a permit to accomplish such change has bbe om. a Building Inspector. Building Inspector,Village of Rye Brook: Date: JUL 2 1 2025 +- For office use only: L BUILDING 66ARTMENT PERMIT 7 JUL 16 2025 UU VILLAGE OF RYE BROOK ISSUED:�'S a3-� 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE:--/ VILLAGE OF RYE BROOK (914)939-0668 FEE: &tS]0— PAIDAL BUILDING DEPARTMENT ww,%.ry4 Ookuv.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 sssta►srssttta*tt*♦srtrrs►rrsss► s►►srrrrrr** ** *t*s*ttt*t*ts*tt*trstrsrsrssrsrsss►srssass►rtrrrs►►e**srrt**s*tss***sttrrrr Address: / 1 - t +A,) Occupancy/Use: l ✓L1 Parcel ID #: 133 1 3 Zone: Owner: ST OF 14IUS ( ddress: f �i �-G (.L 0+i) P.E./R.A. or Contractor: ress: Person in responsible charge: 1,/�t 1/�� ddress: 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, COUNT OF E TE S c �r-t I D � ���� 5.rf:t � �&Ae,�SA- being duly swom,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in ,in the County of +V in the State of ,that (Ci /Town/Vill he) he/she has pervised 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 '3 0 for the onstru tion or alter ' n of: e) 6✓ G/ S e /— l'i N /i► �e sIr 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✓offthe Code of the Village of Rye Brook. Sworn to before me this J �' Sworn to before me this �V of , 20 ?, day f l 20 2S^ lluA gnatureof ropertyOwner/, C(/ Signature ofApplicant n V/PrNCSSA-- SC.N-a�t t� V q'titiSS/� JI��J'1 I Print Name of Prope Owner/ 1( � I I Print Name pplica Notary PhbKc Notary Public CHRISTOPHER J.BRADBURY CHRISTOPHER J.BRADBURY Notary Public,State of New York Notary Public,State of New York No.01 BR6159985 �n/2oza No.01 BR6159985 Qualified in Westchester County Qualified in Westchester County� Commission Expires January 29,20 Commission Expires January 29,2022. ��E f5R(�vk• O �m w � 19(832 BUILDING DEPARTMENT ❑(WILDING INSPECTOR PrASSISTANT IRUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914)939-0068 FAx (914) 939-5801 www Uebrook.org - - - - - -- - - - - - - - - - - - - - INSPECTION REPORT - - - - -- - - ADDRESS: 19 R -- --.------ --DATE: 9" a aod s- PERMIT# y 2 S- I.�7 -ISSUED: 't SECT: /ZS'4?6 BLOCK:_/LOT: /3 LOCATION: A�E �aG.�� 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❑ N:tund Gas ~,j_/ &Z 110 A;j C0l--+.0 ❑ L.P.Gas CW • ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ,Q'FINAL ❑ OTIIER ■ s ■ � N N '� y ■ � N N P� v x y a �'o O I� of W ■ V• V wcn ray w •€ ch Lei j1-4.� a cn PQ L _ IdA Cl. ■ �� p H Q O cr A p H ? o Cf) v _ _ � b va CS 0 w �U .ems Z z o v �° V = Woo V -4 w Uzi °Oe 00 ON r�y z i o v vw Q Lei 0 �/ p = Q x u � � ~ O C ►+y `o = V V � x � � s BUILD G DEl MENT D VIL E OF RY OOK MAY 12 2025 938 KING ET RYE BRQ, ,NY 10573 -0 VILLAGE OF RYE BROOK w ov BUILDING DEPARTMENT f INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:Approval Date: MAY 1 9 925 , a iiit # X/ems �]- / Application Fee:$ Approval Signature: Permit Fees:$ Disapproved: Other: _ Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. l 7 1. Job Address:�f ,�Ua vtL� SBL:/3-i c) (C �—/J Zone: 2. Proposed Improvement.(Describe in detail): �r`t +t 1 tit � 7T�PC 4 IP,44*l 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 I1: 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;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7.1 Property Owner:VA,N 6 k l D 6 6C✓9AAess: I GHV l-Uf IL,L R-o*-0 Phone# Cell 9212 -1/T--!5�1 email: 84Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone#— Cell# email: 10. Engineer: — __-" -—Address: Phone# Cell# email: 11. General Contractor: A-010 Address: 66 OrAv4grnell P Phone# D y-� -70D4 Cell# / grO © email: OF-Conk & E1tr1*t t,�avA 12. Estimated cost of construction $ ©© (NOTE.The estimated cost shall include all labor,mattkial,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis i 13. Job Timetable: Start: Finish: (I) 6i1r2az4 BUILD MENT D IE C r � V L VIL E OF RY OOK MAY 12 2025 938 KING ET RYE BR ' ,NY 10573 VILLAGE OF RYE BROOK -Fm• BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE V16 • 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: ,, ,n I, jAnaws CAW 10 I�� ,residing,at, r! � �mf4it I LL (4 kb (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; PO4-0 , 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. 1 (Signature of Property U� er(s)) qprt�0�� A- -T— - 1;C I�v'\ ) � (I 't (Print Name of Property Owner(s)) Sworn to before me this f Opt\ 20 (Notar 1'11[)S•IARI MELILLO Notary Public,State of New York No,OIME6160063 Qualified In Westchester County. Commission Expires JnnJary 29,20� (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 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: �l00V6, S� Ski ! �_ ,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 _ _ F_'x�_ rVT-Pf-- _ 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 \D Swom to before me this r day of . 20 day of , 20 Oy Signature of Property Owner Signature of Applicant VP�NgSA- Sty )in a of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester county-� Commission Eltpires January 29,20_ (4) b/I/2024 a , s 0 a t' v W WCA N ON Fri M v H F. , M q U N cn 00 _ p m ICI 'I'^� •-� �, � > O V u CL O -� 0o sa ? U 7 V) W W I 1C- 1�1 to) CA MM M A U a a w o, 'e:Ln a ' x fq 07 cn a ✓� W �' w .� O Z a r+r W � < a F a, = < D ECEWE BUILDING DEPARTMENT MAY 2 8 2025 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT vv v�vv.•yebrookny.gov ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ? FOR OFFICE USE ONLY BP#: CDs—// / EP#: Approval Date: S " 2 41 ' 2 0 Permit Fee: $ Approval Signature: d Other: ************************************************************************************************** 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 Application dated, S_ ��'a� 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. / ? I.Address: I�H L22C A l t- - K LI SBL: / Sir c)& —�—� J Zone: S 2.Property Owner: K l.A��S C 1�/"1 L� Address: S A M t ' Phone#: Cell#: email: Fob 3.Master Electrician/Licensed Installer: N1U4Aft /Rc7`! Address:79 RRIA& AtaK RO cT veaq°3 Lic.03 VP Phone#:, jjt379- g` ,?7 Cell#: email:A-31 E,l-TRic-0 nprb ju..JE ,NET Company Name: 1q rk CL�TQtL Address:79 6f A4 A,'Ae- kO S-,AMrcf__0 CT 06�63 4.Proposed Electrical Work/Fixture Count: 1JS74LL. QcCES T. SC0 444AS 41\40 /O kewTeCLE 5.31 Party Electrical Inspection Agency: STATE OW�YORK,COUNTY OF WESTCHESTER ) as: NICAAA- &( // —being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant)state that(s)he is the /`1 S> CIA J 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. G Sworn to before me this Sworn to before me this �o day of ,20 day of 20 Signature of Property Owner Signa ure of Applicca t tGirAC-L //SOY Print Name of Property Owner ame of Applic 0 Notary Public NoAKIN P"t,Rate of New lorK o.01ME6160063 Qualified In Westchester Coun*JY224 Commission Expires January 29,20 STATE WIDE INSPECTION SERVICES, INC. Service With Init—ri1v i•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# �, �/ Date .b Q � S Bldg Permit# 9 S Ft O Plumbing Permit# Final Certificate# City/Village ` Zip ; - Building Dept.R v i p0 County Address 12 v Cross Street Section Block Lot Owner Name/Address(If different than above)KLACAS Contact Number 2: asement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch 8 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 vi i KGs &Asex1 &'VT g ool-1 MAY 2 8 2025 VILLAGE OF RYE BROOK BUILDIrJG 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 'TAEC6C /k�t:.C' y y ,fir Name T License# 8G Date S a8 Ids' Signature - Address city/State a LT iP Code U�o 5O 3 Ro ►>L., Company A.--rA . tLe-rRIC Phone# 91y 97j -FY8 State Wide Inspection Services 1080 Main Street Ri J� UN 2 3 2025 DD F2l, 2 12524 02- 4 TOM"US845 4-219 1 Phone VILLAGE OF RYE BROOK 914-219- 062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(c�swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: ATA Electric, LLC Klaus Schmid & Marie-Paule Schmid 79 Briar Brae Road 19 Churchill Road Stamford, CT 06903 Rye Brook, NY 10573 Located at: 19 Churchill Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-138 135.26 1 13 Certificate Number:2025-4231 Building Permit Number: BP25-117 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: 19 Churchill Road, Rye Brook, NY 10573 The Basement Family Room 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 20th day of June 2025. Name Quantity Rating Circuit Type Receptacles 10 Luminaries 08 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. L-�:)Building PermitChe nalysck List&Zoning Ais�--Address• C1ChV (- � \- 1 ( SBL: 1 , :) /X I� Zone 'k7s U Const.Type '_S6 Other. Submittal Date: l �� Revisions Submittal Dates: Applicant: Nature of Work \ Reviews:ZBA: PB: BOT: Other. �OK �� ( ) ( ) FEES:Filing. BP: c/o: Flood Plane: Legalization: ( ) ( ) APP: Dated: Notarized: SBL: Taus 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: Pemlit: 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: REQUIRED EXISTING PROPOSED NOTES M 2 5 Area Date: Circle: Fronts e Front: Front: Sides: Rear. Main Cov. Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot : Fes: Paring. Height/Stories notes: On the Date Written Below LETTERS are Granted by the Surrogate's Court, State of New York as follows: File #: 2024-2292 Name of Decedent: Klaus Schmid Date of Death: March 20, 2024 Domicile of Decedent: Rye Brook, New York Fiduciary Appointed: Vanessa I Schmid Mailing Address 227 W. 11th Street Apt 51 New York NY 10014 Letters Issued: LETTERS TESTAMENTARY Limitations: NONE THESE LETTERS, granted pursuant to a decree entered by the court, authorize and empower the above-named fiduciary or fiduciaries to perform all acts requisite to the proper administration and disposition of the estate/trust of the Decedent in accordance with the decree and the laws of New York State, subject to the limitations and restrictions, if any, as set forth above. Dated: March 24, 2025 IN TESTIMONY WHEREOF, the seal of the Westchester County Surrogate's Court has been -�� affixed. WITNESS, Hon Brandon R. Sall, Judge of the Westchester County Surrogate's Court. Eugene G. Yates, Chief Clerk These Letters are Not Valid Without the Raised Seal of the Westchester County Surrogate's Court Attorney: Michelle Berman The Ettinger Law Firm 140 Grand Street Suite 410 White Plains NY 10601 L . Y u J _ •4 LU (7� �a DATE(MM/DD/YYYY) AC ` C CERTIFICATE OF LIABILITY INSURANCE 5/15/2025 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 JMG Insurance Corp PHONE FAX P.O. Box 700 •203-838-5554 A/C No:203-857-7848 Norwalk CT 06852 ADDRESS: certs@jmg.com INSURERS AFFORDING COVERAGE NAIC 0 License#:P -904790 INSURER A:Southwest Marine&General Ins Company 12294 INSURED JNFCONT-01 INSURER B:New York State Ins.Fund 4029 J.N.F. Contracting Corp 66 Heatherdale Road INSURERC: Ardsley NY 10502 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:908916579 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 ADDL TYPE OF INSURANCE JUSa BR POLICY NUMBER Mb POLICY LTR D/YYYY MMMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y GL2025RLH00192 5/12/2025 5/12/2026 EACH OCCURRENCE $1,000.000 DAMAGE TO RENTED- CLAIMS-MADE FXI OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY C0 'INEDSINGLELIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) E AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident E A UMBRELLA LIAB X OCCUR EX2025RLH00021 5/12/2025 5/12/2026 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE b 3,000,000 DED X RETENTION$n $ B WORKERS COMPENSATION 13265293 7/20/2024 7/20/2025 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH► E.L.DISEASE-EA EMPLOYEE $100,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re:9 Dorchester Drive Rye Brook,NY 10573 Village of Rye Brook 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 Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE _ f�zGGiuQ ©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 Func: PO Box 66699,Albany.NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o E ^^^^^^ 223567582 JOHN M GLOVER INSURANCE AGENCY PO BOX 700 a NORWALK CT 06852 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER J N.F. CONTRACTING CORP VILLAGE OF RYE BROOK 66 HEATHERDELL ROAD 938 KING STREET ARDSLEY NY 10502 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1326 529-3 623929 07/20/2024 TO 07/20/2025 5/15/2125 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1326 529-3, 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:/fWWW.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. JAMES FARRELL-PRESIDENT FRANCES FARRELL-V.P. 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 SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER. 828509127 U-26.3 P 3 7 li a _... w�. 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