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HomeMy WebLinkAboutRP25-032PERMIT # /` J' S-0 3C4 DATE: 30 5kxP: � 3 SECTION J S 5'1 BLOCK 1,0T 1DI TYPE OF WORK e/S /9U/� �77 JOB LOCATION 9f OiJk PaiQ OWNER 110J/SSo /�l'PbS zt �C��Cr�J ei�P 7s TRACTOR 4 2 �LC� C k FEE lI D �Z� DATE TCO N FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS CJ SPRINKLER ELECTRIC LOW -VOLT O ALARM CJ AS BUILT CO FINAL OTHER APPROVALS ARB BOT , P8 ZBA OTHER �yE BRn yCC w°J J�V C C GG VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury -.vww.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 11,2025 Michael Krebs&Marissa Krebs 85 Valley Terrace Rye Brook,New York 10573 Re: 85 Valley Terrace, Rye Brook,New York 10573 Parcel ID#: 135.51-1-61 Roof Permit#25-032 issued on 5/30/2025 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to ED [VIL " F For office use onlBUILD MENT PERMIT#JUEOF 2025 VIL4YE E OK ISSUED: �"S 30--c�"S- 938 KING SIREOK, YORK 1OS73 DATE:LAGE RYE BROOK 0 FEE: / PAID BUILDING DEPARTMENT ov 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 rtrttrt*trtrwrrw+++*++sts++s+s+srt+rts+►rw+rww+s++++sssrrtrsssrrrrr+*+wtsr+++rs+sss+t+ss►ttrtts►s►rwwrtt►wrrrrrr►wwrtw►wrwrrsrwrwrrw+ Address: 85 Valley Terrace Occupancy/Use: Parcel ID#: ),3 j iJ�� —�—cP Zone: Owner: Michael Krebs Address: 85 Valley Terrace P.E./R.A. or Contractor: Perry's Roofing Address: 12 Center Street, Pleasantville Person in responsible charge: Perry Verrone Address: 12 Center Street, Pleasantville 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: Perry Verrone being duly sworn,deposes and says that he/she resides at 12 Center Street (Print Name of Applicant) (No.and Street) in Pleasantville ,intheCounryof Westchester in the State of NY ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S $10,355.00 for the construction or alteration of. Roof removal and replacement Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-IO.A.of the de of the Village of Rye Brook. �ih Sworn to before me this q Sworn to before me this day of , 20 2 S day of , 20 \\�tttttlrrrr//i \\tttllrrr,/ n Signature of Property er STATE \Y ,% �� Sj \ �Signature of Applicant %OF NEW Michael Krebs - N07ARY PLIBLIC =Perry Verrone Print Name of Property(finer I)V* 1C/��rjnt Name of Applic t A63�7302 2 cOM v S J \ Notary blic 1111111t� F)MMESt` Notary Public 0 1 2024 k;yE aRG��k Q � 99£i2' BUILDING DEPARTMENT ❑BUILDING INSPECTOR CJ AssISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENUORCEMENT ONFICUR 938 KING STR.LE-T • RYE, BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www. ebro rk or. - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - _ _ _ - _ - - _ _ .A.DDRESS S V,iA L U J DATE' �j- fO`Z.OZ5— PERMI'.r# Q:3z- 1 __Itisurn:S' 'C'�' 7SECT:/. X- / BLOCK: LOT' LOCA'.E'ION: _ Qopf OCCUPANCY: ❑ VIOVATION No'rl;l) TIII,WORK Is... i;? ACCEPTED ❑ It1:IEc:'rtiD/ RIilIYshF;c:'t'ION ❑ SITE INSPECTION 1ZLl2U I R1 1) ❑ FOOTING ❑ FOOTING .DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ~ ❑ NA'rmut,GAS ❑ L.P. GAS � � r ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL O'l.'III,R i n -o W a T^, lfj M N 1 a W w W 04 a C.. 0"4 a L9O Lin o p H a ° a �noa W O W w � c H w ILn 4-4 Z h1 W 00ogEa' O = W O a W O dQc ° oaa' _ 06 vo- W n z z o 24 2 a o 00 ii W � u 0-4 40 Q O .� aQv �• c z 'Le) Wy U - K z En W p v v c v W o � av �U —1 EA w o °3 o z U w o H x = V O V V _ p,•-- r 0-d n � tu -a i i = i D C LE �W E BUILDING DEPARTMENT VI E OF RYE OK c MAY 2 7 2025 938 KING ET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK 939-0668�; BUILDING DEPARTMENT www.ryW"Wk 4Lgov -- FOR OFFICE USE ONLY: ? Approval Date: MAY 3 O 29 Per it ! —D3 Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: Permit Fees:' /J ROOF PERMIT APPLICATION Application dated: 5/27/2025 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. JJ 1. Job Address: 85 Valley Terrace SBL: Zone: Property Owner: Michael Krebs Address: 85 Valley Terrace Phone* (914) 522-2615 Cell#: email: mike@mkrebs.net 2. Applicant: Perry Verrone Address: 12 Center St, Pleasantville Phone#: 914-747-7663 Cell#: email: maria@perryverroneroofing.com 3. Roofing Contractor: Perry Verrone, LLC Address: 12 Center St, Pleasantville Phone#: 914-747-7663 Cell#: email: maria@perryverroneroofing.com 4. Job Description,list all Methods&Materials: Roof removal and replacement- 18 sq 5. Estimated Cost of Job:$ 10,655.00 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: Residential NYS Construction Class: 8. Number of stories: 1 Height: 9. Is garage being re-roofed:No:bO•Yes:( )Attached No:O•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: Hip 11. Estimated date of completion: 5/30/25 -t- 012024 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Perry Verrone ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the Contractor for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this .Z V Sworn to before me this day of , 20 day of , 20 �x/', �p1ttll lfl///// tttllllll// Signature of Property Owner ,�+' STATE �` ,Y'i"STATE a�ure of Applicant /OF NEW YORK, _ !OF NEq, e YO Michael Krebs = ; NOTARY PUBLIC 1 , :5117, '� t/NOT_A, K'P qly V rrone r_ . ca••r c; C I'W d"i.w e a Appl' nt Print Name of Prope Owner','� VIPA04T502 / olr Notary Public //''OZ1rs otary Public _2_ 611/2024 QuickMeasure 85 Valley Terrace, Rye Brook, NY 10573 (1) March 26, 2025 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N a Contents Measurements Overview 1 Roof Area 1,818 sq ft Top View 2 Roof Facets 17 Side Views 3 Predominant Pitch 12 / 12 Lengths 4 Ridges/Hips 94 ft Pitches 5 Valleys 80 ft Areas 6 Rakes 208 ft Summary 7 Eaves 103 ft Materials 8 Bends 18 ft QuickMeasure Top View Roof Reports in Under an Hour Ve- a � • • • �� 71 Ar • r IS Prepared For: Perry's Roofing © 85 Valley Terrace, Rye Brook, NY 10573 (1) QuickMeasure Side Views Roof Reports in Under an Hour A -� � Y .a u� y J Prepared For: Perry's Roofing © 85 Valley Terrace, Rye Brook, NY 10573 (1) QuickMeasure Lengths Roof Reports in Under an Hour A Flash Step Drip N 9 1 1 8 1 1 1 I 1 1 ■ Bend ■ Eave ■ Rake ■ Ridge ■ Valley 18 103 206 Ya do Lengths in feet Prepared For: Perry's Roofing U 85 Valley Terrace, Rye Brook, NY 10573 (1) QuickMeasure Pitches Roof Reports in Under an Hour A N 12 12 9 5 9 8 9 5 9 8 9 5 9 12 4 El 9 Pitches in inches per foot Prepared For: Perry's Roofing © 85 Valley Terrace, Rye Brook, NV 10573 (1) QuickMeasure Areas Roof Reports in Under an Hour A N 113 384 26 124 26 26 27 176 27 26 26 72 26 185 482 36 a 36 Areas in square feet Prepared For: Perry's Roofing 85 Valley Terrace, Rye Brook, NY 10573 (1) QuickMeasure Summary Roof Reports in Under an Hour " Pitch 4 5 8 9 12 Area 482 372 51 231 682 Percent 27% 20% 3% 13% 38% Suggested Waste 0% 6% 9% 11% 13% 16% 21% Area 1,818 1,927 1,982 2,018 2,055 2,109 2,200 Squares 19 20 20 21 21 22 23 Roof Area 1,818 sq ft A Roof Facets 17 N Pitch 12 / 12 Bends 18 ff Eaves 103 ff Rakes 208 ft Ridges 94 ff Valleys 80 ff Flash 17 ff Step 88 ft Drip Edge 312 ft Leak Barrier 514 ff Ridge Cap 94 ff Starter 312 ft ❑ Penetrations 1 Pen. Area 4 sq ff Pen. Perimeter 8 ff Notes:1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped roof edges.3)Eaves are defined as level roof edges.4)Flashing pertains to level roof edges and excludes valleys.5)Step flashing pertains to sloped roof edges and excludes areas around penetrations.6)Drip edge=eaves.rakes.7)Waste table excludes additional materials needed for ridges.hips,valleys,etc.8)Suggested waste factor is based on the roof complexity and is provided for guidance purposes only. You should confirm the appropriate waste factor prior to ordering. Prepared For: Perry's Roofing 85 Valley Terrace, Rye Brook, NY 10573 (1) QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 6% 11% 16% Shingle Products Timberline: HDZ, UHDZ, NS, ASIL HDZ RS bundle 56 59 62 65 Royal Sovereign Low-Slope Roofing System Liberty Base/Ply Sheet roll 0 0 0 0 Liberty Cap Sheet roll 0 0 0 0 Liberty Asphalt Primer gallon 0 0 0 0 Liberty Flashing Cement gallon 0 0 0 0 Starter WeatherBlocker bundle 4 4 4 4 Pro-Start bundle 3 3 3 4 Quick-Start roll 10 11 11 11 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 2 2 3 3 Shingle-Mate roll 5 5 6 6 VersaShield roll 6 6 6 7 Leak Barrier StormGuard, WeatherWatch 2 sq roll 8 9 9 9 WeatherWatch 1.5 sq roll 11 11 12 12 Ridge Cap Seal-A-Ridge, Seal-A-Ridge AS bundle 4 5 5 5 TimberTex bundle 5 6 6 6 Z-Ridge bundle 3 4 4 4 TimberCrest box 5 6 6 6 Nails Cap Nails box 1 1 2 2 Coil Nails 1.25 in box 1 1 2 2 Step Flashing Step Flashing 10 ft piece 9 10 10 11 Step Flashing 8 ft piece 11 12 13 13 Drip Edge Drip Edge 10 ft piece 32 34 35 37 Drip Edge 8 ft piece 39 42 44 46 Notes:1)These approximate quantities are based on estimated measurements and are for guidance purposes only. You should always confirm quantities prior to ordering and ensure you are following local building code requirements.2)For Timberline.3 bundles=0.984 squares.3)Starter=eaves+rakes.4)Leak barrier=bends+eaves+flashing+hips+rakes+step+valleys. 5)Ridge cap=hips+ridges.6)Low-slope products applied to 1/12 pitch areas.7)Timberline products applied to 2/12 pitch areas and above.8)Installed coverage will be less and depend on quantity and width of side and end laps.9)Liberty low slope rooting system should be installed as a system.For more information,see gof.com/liberty. Prepared For: Perry's Roofing U 85 Valley Terrace, Rye Brook, NY 10573 (1) QuickMeasure Attic Vents Roof Reports in Under an Hour Static Quantity Units Cobra@ Rigid Vent 3TM, SnowCountry8 & SnowCountryG Advanced 25 ff Cobra@ Exhaust Vent Roll-Nail Gunnable 31 ff Cobra@ Exhaust Vent Roll-Hand Nailable 26 ff Cobra@ RidgeRunnerCRO 35 ff Cobra@ Hip Vent 49 ff Master Flow@ SSB960 Metal Super Slant-Back Roof Vents 8 vent Master Flow@ RV50/R50 Square-Top Roof Vents 9 vent Master Flow@ IR65 Plastic Slant-Back Roof Vents 7 vent Master Flow@ High-Capacity Dome Vents 4 vent Master Flow@ 10' Aluminum Ridge Vent 21 ff Cobra IntakePro@ Rooftop Intake Vent 49 ff Master Flow@ Undereave Intake Vents- 16" x 8" 9 vent Powered - Roof Mount Exhaust Cobra Master Flow 16x8 (vent) IntakePro (tt) Intake (vent) Master Flow@ ERV4 Power Attic Vents 2 107 20 Master Flow@ ERV5 Power& Wi-Fi Attic Vents 1 67 12 Master Flow@ ERV6 Power Attic Vents 1 80 15 Master Flow EZ Coollm Plug-in Power Attic Vents 1 56 11 Master Flow@ GreenMachinelm Solar/Dual-Powered Vents 3 84 16 Master Flow@ GreenMachineTm High-Power Solar/Dual-Powered Vents 2 80 15 Master Flow@ 12"Wind Turbines 3 79 15 Master Flow@ 14" Wind Turbines 2 75 14 Note:The estimated quantity of attic ventilation products in this report is based solely on the total exterior square footage of all roof planes and is meant for estimating purposes only. It is the responsibility of the installer to verity the correct quantity and type of attic ventilation products prior to commencement of work. Installer must always review Job-specific attic ventilation needs such as local code requirements,attic floor square footage,roof design,and conditioned spaces under the roof. GAr recommends a minimum of 1 square foot of attic ventilation(evenly split between intake and exhaust)for every 300 square feet of attic floor space.The amount of exhaust ventilation at or near the ridge must never exceed the amount of intake ventilation at or near the soffit. See gaf.com/ventcalculator for details. Prepared For: Perry's Roofing 85 Valley Terrace, Rye Brook, NY 10573 (1) GAF � • 2023-03-21 2020-02-24 f. y _ r 1 .j 1 2017-04-08 '; 2014-09-23 I r Al -.. -. - .. 10 .. to Timberline®HDZTM Shingles Benefits: Product details: ■ LayerLock"Technology—Proprietary durability, strength, and exceptional Product/System Specifics technology mechanically fuses the wind uplift performance. ■ Fiberglass asphalt construction • Dimensions(approx.):13 i/V x 39'/e" common bond between overlapping ■ StainGuardQ°Algae Protection— ( ) 337 x 1,000 arm shingle layers. Helps protect the beauty of your Exposure:5%*(143 mm) Bundles/Square:3 ■ Up to 99.9%nailing accuracy— roof against unsightly blue-green ■ Pieces/Square:64 The StrikeZone" nailing area is so algae discoloration' ■ StainGuard�Algae Protection' ■ Hip/Ridge:TimberTex TimberCrest'": easy to hit that a roofer placed 999 ■ High Performance—Designed Seal-A-Ridge'°;ZeRidge:Ridglasse out of 1,000 nails correctly in our test. with Advanced Protection` Shingle • Starter Pro-Start"°;Quickstart'; WeatherBlocker' ■ WindProven" Limited Wind Technology. Applicable Standards&Protocols: Warranty—When installed with ■ Seamless compatibility—The new ■ UL Listed to ANSI/UL 790 Class A the required combination of GAF ■ State of Florida approved Timberline HDZ Shingles are com- ■ Classified by UL in accordance with Accessories.Timberline HDZ'" patible with traditional Timberline HD" ICC-Es AC438 Shingles are eligible for an industry Shingles for the same look and feel • Meets ASTM D7158,Class H first:a wind warranty with no • Meets ASTM D3161.Class F ' M homeowners and contractors rely Meets AST D3018.Type 1 maximum wind speed limitation. on for beauty and endurance.'' ■ Meets ASTM D3462' ■ Our legendary Dura Grip'"sealant ■ ICC-ES Evaluation Reports ■ Perfect Finishing Touch—For the ESP-1475 and ESP-3267 pairs with the smooth microgranule best look, use TimberTex Premium ■ Meets Texas Department of Insurance ' surface of the StrikeZone'" nailing Ridge Ca Shingles or TimberCrest" Requirements area for fast tack.Then,an asphalt-to g p g ■ ENERGY STAR"Certified(White Only) Premium SBS-Modified Ridge (U.S.Only);Rated by the CRRC.Can asphalt monolithic bond cures for Cap Shingles. be used to comply with Title 24 cool roof requirements Colors & Availability: Results based on study conducted by Home Innovation Research Labs. an independent research lab.comparing installation of Timberline HD' Shingles to Timberline'HDZ"Shingles on a 16-square roof deck using standard 4-nail nailing pattern under controlled laboratory conditions. Actual results may vary. '-15-year WindProven`limited wind warranty on Timberline'HDZ" Shingles requires the use of GAF stoner strips.roof deck protection, ridge cap shingles and leak borner or attic ventilation.See GAF Roofing Copper System Limited Warranty for complete coverage and restrictions.Visit gatcom/LRS for qualifying GAF products. ._. 'StoinGuarW algae protection is available only on shingles sold in packages bearing the SfomGuord"logo.Products with StainGuard" algae protection are covered by a 10-year limited waaany against blue-green algae discoloration.See GAF Shingle&Accessary limited i Warmnryfor complete coverage and restrictions. 'To be mixed on one roof.Timberline`HDZ`Shingles and Timberline HD' DI Hickory Shingles must have matching 6-digit codes found on the end of the bundle. When mixed.always use Timberline HD"installation instructions. Periodically tested by,ndependent and Intemol labs to ensure compliance with ASTM D3462 at time of manufacture. `Lifetime refers to the length of warranty coverage provided and means . ,. as long as the original individual owner(s)of a single-family detached residence for eligible second owner(s)j owns the property where the Wit, -,L_ quolitymg GAF products are installed.For other owners/shuctures.Lifetime 7 .Ar� ; Mission Brown Oiiiiffiiir -dPete'l�G-rciry Shakew,00d coverage is not applicable.Lifetime coveroge on shingles requires use of GAF Lifetime shingles only.See GAF Shingle&Accessory LimitedWonanfy ') for complete coverage and restrictions.Lifetime coverage on shingles and accessories requires use of any GAF Lifetime Shingle and any 3 qualifying GAF accessories.See GAF Roofing System Limited Warranty for complete s coverage and restrictions.Visit got.com/LRS for qualifying GAF products. - ■ Note:It is difficult to reproduce the color clarity and actual color blends Weatheredlate Sunset Brick S Wood ® Williamsburg Slat of these products.Before selecting your color,please ask to see several lull-size shingles. © P AMERICAN ssrr.a..r n,n i sr., i R We protect what matters most Timberline HD High Definition'Shingles \ 1 • ly 4 }� Ttr r"'{,..rr ter' 'y -!t s7�i• -✓w`3- -• i' _ �� f �� /sue ..✓ �..r � as :!_' �.i, � '�'LIG�► i'.` j..1�.. 7. r.- VA America's #1 -selling shingle just got better! 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I+R(0)►�"`r(" a -:_'1,j1 = i 11 1� •--. „a�, 1111`- E>'gz'q;' 1 11ii;..-�„".`'1 1 ts$ z=?_,`oa:? 1 1 rE��se;::: 1 r <( lli'Illi'� f1i/1�1ti111 11'II�IIi1Z'� _ -�1;11O11I1 1�111�11�4 r /,'1114h "° _ p = ". lip /11 a t` �1/11 g 111111` �j 4� �111.1}�� 9 ,A, y�yL✓ t l; +t{>` ^ E S� �� i�l �A Sy�Q.��:q<i fit m •• � A`/� ��/♦ *1 A F i /,✓ )'{�Ai��7 &lYw }n, rl �JN� tgt4 ^ � " ¢1 h+w al Sr tiq' xr �i, ° Qr +.�{tip O �,, PERRVER-01 CDOL E ACORO CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DDIYYYY) �� 6/27/2024 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). NTACT Kevin Kelley PRODUCER CO Levitt-Fuirst Associates,LTD n/Co,NN, 520 White Plains Road Ext:(914)457-4200 ac,No): 914)457-4200 end Floor E MaL .info@levittfuirst.com Tarrytown,NY 10591 INSURER S AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED INSURER B:Accident Fund Insurance Company of America 10166 Pent'Verrone LLC INSURER C:ShelterPoint 81434 12 Center Street INSURER D: Pleasantville,NY 10570 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE F_X]OCCUR CA000045827-03 7/1/2024 7/1/2025 DAMAGE TO RENTED 300,000 MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY Fx_1 JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a ANY AUTO BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS Ep BODILY INJURY Per accident AUTOS ONLY AUOTOS ONLY Pe�acatlentDAMAGE B UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5,000,000 X EXCESS LIAB CLAIMS-MADE GXL000147003 7/1/2024 7/1/2025 AGGREGATE 51000,000 DED I X I RETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT FndtnNH)EXCLUDED? NIAMaa i E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT C NYS Disability DBL358637 5/10/2022 5/10/2025 Limit-Statutory DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Village of Rye Brook-is included as Additional Insured for covered operations of the named insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE X.J4 49 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK ' Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name S Address of Insured(use street address only) 1b. Business Telephone Number of Insured 914-867-1747 Perry Verrone LLC Center S enter Street Roofing 12 1c.NYS Unemployment Insurance Employer Registration Number of 12 C Pleasantville,NY 10570 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 26-2754386 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Village of Rye Brook 3b. Policy Number of Entity Listed in Box"la" 938 King Street 46-884191-0122 Rye Brook, NY 10573 3c.Policy effective period 03/01/2025 to 03/01/2026 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) XD all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Steven Diamond(President) (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �7tQ.(i 02/28/2025 _ (Signature) (Date) Title: Licensed Insurance Broker Telephone Number of authorized representative or licensed agent of insurance carrier: 516-488-3040 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov