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HomeMy WebLinkAboutBP25-160SECTION TYPE OF JOB LOCA EST. 0 OATE r& J5 WP. l& D6 Ala 4l MK / LOT TCf1 � FEE DATE �c�F�T1ON RECB>y I DATE INSP i` FOOTING FOUNDATION FRAMING %/ 7� 7,0; AS RGH FRAMING _ / , La tf I INSULATION �/ ZZ�Zat ,- cl PLUMBING �J RGH PLUMBING GAS L7 �— SPRINKLER f; ELECTRIC r LOW -VOLT [©� ALARM AS BUILT 0 Z� 2aL M 1 FINAL 12 �i V/ OTHER APPROVALS ARB BOT PB SBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 26-008 Certificate of ®ccupancp This is to certify that of, having duly filed an application on kezl&ahPr_r 20_,--2 requesting a Certificate of Occupancy for the premises known as, Vs/ I /I U/ldl) 6ep,S'C�h , Rye Brook,NY, located in a RID Zoning District and shown on the most current Tax Map as Section: 2 ' Block: � o Lot: � 2 7 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. �� , issued 20 , such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: �— Construction: for the following purposes: 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 ' ht shall be m e,n shall the building be moved from one location to another until a permit to accomplish such change as en ined om the Building Inspe tor. 't Building Inspector,Village of Rye Brook: Date: JAN 16 2026 BUILDING ilY ENT For office use only: V 1 L LA E OF hp RYE OK PERMIT# DEC 17 2075 ISSUED: 7 1<P ' Z� 938 KING STREETS YE BROOK,,, YORK 10573 DATN: Z. i ) •l,� (9 9 -06 0 FEE. 2� PAID wW 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 rssarrsssssssrtssrssrrtssssssssrswrss,,tsttssrssssrwssttssssssssswrtrrssssrtwsswttwtwtwwtwwttttsswsstststwtwwsssswwttttttrststtttt Address: J ffel aA h10/1fW eoe4e of Occupancy/Use: Parcel ID 7&--`-- jp27 Zone: ptfD Owner: 4 a&/ /'W W G Address:/3-? xr"4 P.E./R.A. or Contractor: '�t,d#0 effzlyo Address: 2 YV J'rN' A4A#r,. V& �.,AV 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: Lor k m ek c e. being duly swom,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in �x e E"C=r,y_ ,in the County of in the State of IV I' ,that I (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:$ 9,0e•0.e 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 of the Village of Rye Brook. Sworn to before me this � Sworn to before me this l�l day of 20 day of f 20 J _LAI �- Signature of P perry Owner Signature oVApplicant n (M k I j 01 Lt 0-i' Print Name of Pro O er Print Name of Applicant _ No is lic Joni Lamaj Commission#O1LA0025681 Joni Lamaj 6/I/2024 Notary Public,State of New York C0m1nission#0ILA0025681 My Commission Expires:June 07,2029 Notary Public,Sto ofm w yo& My cemmbsion Egjm:)40 py.= w � '9a2 BUILDING DEPARTMENT UILDING 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.r,.yebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:- -;.3 �� U S� (1 LLD(J W • DATE: PERMIT# >? ISSUED:-Z--/,6'2TSECT:1Z9. 70�-BLOCK: LOT: /27 LOCATION: IC t K�'✓� t 1/�p� _ `� IOJ� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 9"*ACCEPTED ❑ REJECTED/ REINSVECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION 1 n/ ❑ NATURAL GAS ,-X t ✓- , ❑ L.P. GAS L, V� 4ti0 GG.p .� ❑ FUEL TANK ❑ FIRE SPRINKLER c�a mo-y ❑ FINAL PLUMBING [35ROSS CONNECTION FINAL ❑ OTHER QyE BkCZ�� O`` 2 cu � a��7. .'i�O`c '9°� 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 :_I_%-I Vf U►S^ Wo" 7 Ciui DATE: I L' ZZ— ZdZT PERMIT# { _ ISSUED:7- I i-ZTSECT: /19.7Go BLOCK:_L LOT: 1Z7 LOCATION: 4- it 130-L Q�'t�1A�04 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... DACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION Ll ❑ NATURAL GAS Iti J I C q ❑ L.P. Gas tA El TANK 0� M re O.7 El IRE SPRINKLER J!j ,INAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRO ,, w � 1982 BUILDING DEPARTMENT ""I DING INSPECTOR 1�As3IsTANT BUILDING;INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street. Rye Brook,NY 10573 (914)939-0GC8 FAx (914)939-5801 www.rygbrook.org - - - - - -- - - - - - - - - -- - - - - INSPECTION REPORT - - - - - - - - - ADDltlstiti : D 33 ar���1OLL00 lam- DATE:_ `-AY"Za Z � PERMIT#_-_ �T .Z�� I Ce O ISSUED: SECT: Z/ I. 7lo BLOCK:_ LOCATION: _ 1�l ��+�. OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING N011 S ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING R'INSULATION _❑ Natural Gas t'�.► S / --Ic A95 r ,vA (n1\ ❑ L.P.Gas 1 ❑ FUEL TANK ❑ FIRF SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O INSPEC'.1-olt VUX.A.G.14. OF '.RYE BROOK 938.h.ING SIAMIT-lava?BROOK,NY .10573 (914) 939-0668FAx (91.4) 939-5801 - - - - - - -- - - - - -- - - - - -- INSPEC'UON REPORT -- - - - - - - - - - - - - - - - - - -- Ao L L o cJ 62 Lar: 1?, 7 OCCUPANCY:__ 0 VIOLATION NOTED 'i'vii wolup'- is... ,��ACCEPTMY) ❑ REjECTED/RLaNSPECTION 11 SPY)?JN-SPECTION RL.-QUIRED 11 Foo-rim; 0 J."00TING DRAINACM, 'tWommi'mum)llixomilm, 'NO'll"N(YK TN'SPECTION': 0 Rol-14-4-1-1 PTATMOING jalIG"14-11 VRAWN(4 D 1NNUTTATION 0 N)vnixA.T.Us'As 1-01 13 1 A (J'AN Fulu"Y&Mm p 1"ll"i-SPIONRIMA 0 VINAII)TATt 0 Clams Comi.licTim EJ VINAL 13 O'n-nut BuiLDINGDEtbARI MEN T 11 WRAPING INSPI(C-Mit 0ASSINIANt J;1J11J)j,N#4 INSITW-VOR VILLAGE 01.4 R.Yji BxtooK ()jipj4:j.tjt 938 KINA -1-ty-li 111100K,.NY 10573 (91-4) 9.39-0668):"Ax (914) 939-5801 g - - - - -- - -- - - - -- - - - - - - -- INSPECTION REPORT - - - - - - - - - - - - - -- - - - - 13 3 -)— 1 —7 Z, S— DATE:-- -- 0 Z Svc.l -IA?q,2L-BLOCK:--/ LOT.-/,?e7 LMINVION: 0 VIOLATION No-ni-A) woxt.T.-�-is... W-Ak(-CEP11,10) ❑ RE'll."ICTEM/RmNSPECTION RL.-Quilma) L] U001'ING 17 VIATM.-RING N0'-FJ,,',S ON INS141,C1.11O.N': 13 R0114,11 URAIWING 0 .114-SITTATIPT-4 LA CAS ...... I ri citoss comium lox 1:1 FINAL ■ ■ = O _ Ln N W y _ C T y � iai y ■ DWI L vi W &R Aow Cy W s acn w 0 z l ■ .a c W bA MWr1 ■ I--- V � O W O O (� CG C °a g o ^� ■ o o a �, r-1 ■ 40 aC n Z � CS A u z °' Z 1 SN A Lzr c rx� W o z z vw U. U zZo a � a �yj y W O O a Q U _ FBI C W H p z x = : 0 t V V U z Put R - o M C7 >* A z o O Y .v a " o = z q W z ] o guo .ti �i l =1 Il W .a BUILDING DEPARTMENT R 1 VILLAGE OF RYE BROOK JUL 1:1 :2:02]5 938 KING�TREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK is w.rvebrooknN.<(_,ov BUILDING DEPARTMENT INTERIOR BUILDING PERNUT APPLICATION FOR OFFICE USE ONLY4��-,�,�e'rillitho;=,�—)6oApplication ApprovalDate: � Fee:$ D Approval Signature: ' Permit Fees:$ Disapproved: Other: **�+.��*#*,►�**«#�*]******,r*,�******************�*�*�*******�****�**+,*�***��**,►,t��***r*at*�r**�*ram****�*******«*,r4« Application dated:_ / is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. I. Job Address: /33 A3k1,d 14110P dr-eff SBL:Za 91 ? -zone: 2. Proposed Improvement.(Describe in detail): C/ d PA A'kevv4 ,cl l�MIV Yvt 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: *,I ' 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: %?" Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy; 1 f 2 fain.,comm.,etc...)Prior to Construction: After Construction: 6. NX State Construction Classification: N.Y.State Use Classification: 7. Property Owner: loci i91A*ei4?,4 Address: /33 4Gf'Z"r'+ 1-1o1%1(i NWJf Phone# Cell# Gyp .?W- h'/y-? email: 16t/4,4/.4Je,4� 4 m 9�.�•L 8. Applicant: Address: Phone#_ _ Cell# email: 9. Architect: Ar. A�WIAi 'PA14,V Address: .2Yy .s '1/- NaG �/✓ .�/,/! Phone# Cell# 6 y4 - 0026011-4WO email: Kle-v Ian&C6-A1- 4 AAedr.d&M ,K10- Engineer: Re C �,B f..'61 Address: Phone#— tv/V— y ram'?/s C # �ernail: 11. General Contractor: JCO�i+Aofwer 9'41AtVMiI1WAddress: 7+/y�_ .oG4v�f,iC�A� T& Phone# Cell# q/y — 7D7" Z�/__email: 12. Estimated cost of construction $ zl OOo 406 (NOTE.The estimated cost shall include all labor,material,scaltttlding,fixed equipment,professional fees,and material and labor which may be donated gratis.) s1loe i 13. Job Timetable: Start: Finish: G 2 dI) 6/U4024 BUILDING DE MENT VILLAGE OF ROOK 938 KING$TRE T RYE BRo'oX,NY 10573 JUL1 ZQ25 (914)939-066.$�` VILLAGE OF RYE BROOK Ni ehvio �' 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 OFf NEW YORK, COUNTY OF WESTCHESTER ) as: L ,� O I, b V 1' A ! rn I d v� ,residing at, b 3 6-1- S h C f e S h P 6 is (Print name) (Address where you live) Py 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 3 3 6 r�k S N M 0 W C iQS I C yl P 66 01L 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. X t4kbl 14 r11�- (Signature of Property Owner(s)) tAv) +( YvA (Print Name of Property Owner(s)) Sworn to before me this �`+\ i day o 20 Joni Lamm Comfniss im#01 LA00250, Nosy Public,State ofNew york M (Notary PFi i y Commission Expires June 07,2028 (2) 6/1/2©24 This form must be properly completed&notarized by the Design Professional of record and the Property Owner. Failure to provide this complete permit application will delay the permitting proce u C/ ********* ******************* ****** JUL 11 2025 ID Notice of Utilization of Truss Type,Pre-Engineered WWGE OF RYE BROOK or Timber Frame Construction. (Title 19Part 1264& 1265 LDiNG DEPARTMENT To:The Building Inspector of the Village of Rye Brook. From: AWd . 4 41 r' AlAe,4& Subject Property: /3 3 43"'"-f1' f,�/�O& dr-cto'_ SBL: Zone: Please take notice that the subject;❑One or Two Family; ❑ Commercial, ❑New Structure ❑ Addition to an Existing Structure N(Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction(TT) ❑ Pre-Engineered Wood Construction(PW) ❑Timber Construction(TC) in the following location(s); ❑ Floor Framing,including Girders&Beams(F) ❑ Roof Framing(R) ❑ Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYC RR§1265 for One&Two Family Dwellings. Sworn to before me this � Sworn to before me this day of ,20 day of 20_­�Q �1r',Pi A� . = Signature of Prope Owner Signature of Design Professional � 6ay. Print N o Pro O Print Name of Design Professional AL — tary lic Notary Joni Lamy ANA M SALAZAR Commissim*011LA0025681 "NOTARY P141Llc,STATE OF NEW YORK Notary Public,statt oftJew York Rr84trafion No.01 SA6365173 My Commission Expires:June 07,2028 Qualified in Wesichesier Counly (3� Commission 6xPires 10-02.2025 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 1 o 12 f A I gi e 4 g ,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 lP Y/11 Sworn to before me this k day of fY��1 ,20 0(°S day of 20 a 5 r L 66 Signature of Property Owner Signature of Applicant Lo r-i A i m E ( [A) rl( A fal e 9 d at Print Name of Property Owner Print Name of Applicant Notary Pu rc ary Public Joni Lamaj Commission#91LA0025681Omm&ODWILA0025681 Notary Public,State ofNew York Notary Public,State ofNew York My Commission Expires:June 07,2028 My Commission Fxnires:June—ln,s 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- 6/1/2024 • 00 � N N w ■ LA N N = w L ■ r a u �k w o w E" Gj W V'ON ■ C1r .. � � '"� � y "" aS O ■ 1�/i N r �,` H _ w z C a o w g < 0 O _ 00 _ w v z U F" 00 H Z \ ° v R, = WCsCIS x OC ONO V r04 04 m < i� V 0w a 0 oLA Ey N , p z 3 U � W x o _ ►ter Q < �' pq T z 8 0 c ° CA o o x � � s H V W z a � , ■ yE BRnv D E C ICE IJ�V I BUIL E MENTD�) VIL E OF RYE OK JUL 1 1 2025 938 KIN , ET RYE B ,NY 10573 VILLAGE OF RYE BROOK n _-BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master /Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Approval Date: r-A Permit Fee: $ Approval Signature: VN Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, j6!L L124 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 /, 1.Address: 133 ,fit-wA A(GAw �t.V# SBL��7rt76—/% _)_7 Zone/)U4 2.Property Owner: oWC. 4 0 r-I A1.4 r_/4*d(A Address: /JJ jll s- r k /-6/6 0 &7praAr Phone#: Cell#:6+' ,241J-7/fU email: 3.Master Electrician/Licensed Installer: &)t it Z Ln l� --d Address: �� � �"�� 727 Lic.#:/ (� Phone#: 1" F Y (7' � Cell#: email:V ktck.4 tObta„'•a �.• �. 1� r �.4% 1• Cn✓L Company Name: I�fI11 4��-: Address: l� G �.f � � 4.Proposed Electrical Work/Fixture Count:AG_der- s �— �' { e* 5.3'Party Electrical Inspection Agency: SW S STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: t,tt cc"",", f'-69-0 ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individu si ip4as the�pglic�gtJ k Jj]� state that(s)he is the � L<eU4 TQ((� lJ 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 Lori A Almeida Sworn to bef a me this 3 e day of d ,20�MOTARY PUBLIC STATE OF NEW YORK day-of �M5 20 N0.01AL6035432 ature o_ operty O r alifieo in Westchester County y Commission Expires 05-02-2026 i ature of Applicant l� l r Zip P • Name of Property Owner Print Name of Applicant JOHN DIONISIO N�rv�ublic Notary blic Notary Public State of New York Qualified - Westchester County 6nr2024 # OIDI4804045 Exp. 9130126 STATE WIDE INSPECTION SERVICES, INC-1 0•0 • SWIS JOB APPLICATION0. • Office Use Elect. Permit# s--- $ Date // \ Bldg Permit# I ��� Scl Ft J Plumbing Permit# Final Certificate# .� City/Village K �(op� zip �� Building Dept.( yF ��k County Address r� �[a/�b� ( + Cross Street i� Section Block Lot Owner Name/Address(t(BArenT*than a4e),�\ f l t Cow ymber fez /� 7/ G/ ❑Basement tQ'lst FI. ❑2nd A. 3rd FI. ❑More Than 3 FI. ❑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 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 JUL 11 2025 _ j VILLAGE OF RYE BROOK ! BUILDING DEPARTMENT This application is valid for one(t)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time 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 rICC PUCu 1, is (41, LL Name r! •� �61 License# / ;L57 Date)— I/� Signature; Address 6 City/State'A y (�� Zip Code � a�y Company l C C V_C, tt, �' [� Phone# 7 l c S C �p State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 DEC Q 8 2025 845 202-7224 Phone 914-2194-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@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: Viking Power and Light LLC Lori Almeida 180 East Prospect Avenue STE 227 133 Brush Hollow Crescent Mamaroneck, NY 10543 Rye Brook, NY 10573 Located at: 133 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-180 129.76 1 127 Certificate Number: 2025-8586 Building Permit Number: BP25-160 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: 133 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 11`h day of September 2025. Name Quantity Rating Circuit Type GFCI 01 AFCI 05 Range 01 Dishwasher 01 Refrigerator 01 Microwave 01 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. i + Y' +I i' r l a a O Ln V /� O W r ' H 8 H zbc w 00 1. U Z ' W ICI f C H W M A � M O v x w � O ►� ram_', ��.� oZj � d N �ell 0 CA a w w z o Ln o a a Q4 x = i' Y' BUIL NG DEPA1 yT.IDD VIL E OF RYE OK J U L 11 2025 938 KIN ET RYE B ,NY 10573 �. VILLR IAGE OF RYE BROOK Wtiv �tQn}�ny.g BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: �. (��i PP#: Approval Date: JUL � �Z Permit Fee: $ —�/ A Approval Signature: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSI ED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 1`2%% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 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. ).Address: /33 ^Rtu-54 {101how ��s�N SBL: /C7Y, 2f; 75�--/-)7 Zone: 2.Proposed Work /���cha� ��/.K'� S�a� '��wrs�.r� ��>* XG n�.�ri s')0r1j'A 3.Property Owner: NK Lor' Aln�e%�/.�, Address: /33 a&x,4 Phone#: 6f6• R',2y-65o3 Cell# o!(S'6-;)Y/- ?1e13 email: 4.Master Plumber: Mte-4Acl- S Seq/`e,(L0 Address: 5!!�P / F f44 Aug. . /e./AArN NY-100'0 3 Lic.#:IV- Phone 0 y,5ryo-yy K Cell#: 9` y email:`L! s P/ L C. Company Name:/'�� 1'luw+SiaJ4 aJ),Aa-l�.-t-5sN1Ne Address:V1� /!�'F ���a� t l to 03 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 ' 2nd Floor / ^ 31 Floor p� 41 Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 1- 6/l/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 1h'(144Z :1 —'�gr6 f440 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing-Is 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 `Q day of 1403 1E ,20_ day of ,20 k..) bu�PLL it�' — S gnature of Property Owner Signature of Applicant - �Jt Print ame of Pro rty O er 'nt Name of Applicant 1YZ � - Notary Public Lori A Aimeida Notary Public NOTARY PUBLIC STATE OF NEW YORK KLARITA LIKRAMA No.01LI6312785 No.01 AL6035432 Notary Public.State of New York Qualified in Westchester County Qualified in Bronx County My Commission Expires 05-02-2026 My Commission Expires 10/06/Z_ 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- 6/1/2024 BUILDING, MENT VIL E OF RYE OOK rREJUL1 1 2025 938 KING ET RYE BRO ,NY 10573 4 -066j� ! VILLAGE OF RYE BROOK w ov BUILDING DEPARTMENI AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 31, -.4r' /}1MC idA ,residing at, 32 4?5-4j� drxca..x0;' (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; /,33ra-rti /�o 'moo �✓raJ>�v� ,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. VV � (Signature of Property Oxrner(s)) Logy 4lmf1d �. (Print Name of Property Owner(s)) Sworn to before me this Joni Lamaj day of 120 Commission#01LA0025681 Notary Public,State ofNew Yotk My Commission Expires:June 07,2029 otary Pu 1: - -3- 6/1/2024 Building ernit Check List&Zonin Anal sis^c Address: C SBL• Zone: Use: Const.Type: Other. Submittal Date: r��� Revisi Submittal Dates: Applicant Nature of Work '« Reviews:ZBA: J U L 1 5 2025 PB: BOT: Other. NEER'OK / � �C� (=)�ES:Filing. �� BP: C/O: 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. Shorr. 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 7S3#: Dated N/A: (/� ( HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other. ( ) ( ) 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. 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 EXLSnNG PROPOSED NOTES APPROVED Area: Circle Fron e: Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: QFA: Tot in: Ft.Irv: PA&n Height/Stories notes: QyE BR(�j�. cu � 'o 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: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED © REJECTED/ 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 t Ay- S-*VQ Laura Petersen �1 ' ��P S�pTc '7L1�7�I i�l Lls7�/0�y From: Lori Almeida <loriaalmeida@gmail.com> Sent: Friday, January 10, 2025 9:30 PM To: Steven Fews Cc: Laura Petersen; Alfredo DiVitto; Tara Orlando; Arbors Property Manager Subject: Re: 133 Brush Hollow Crescent - Interior Building Permit Application I used Total Restoration with Sotange. My neighbors the left had a floor while away then I had a pipe burst. All three of us used the same company be we were in a panic with all of the water damage and trying to find and stop the leak. The week was terrible with the cold and trying to find alternate housing. I feel like things have been a blur since then. I wilt read through the documents this weekend and get back to you. /'�/'?/ / 3 �� /33 /3L/ On Fri, Jan 10, 2025 at 3:29 PM Steven Fews <sfewsCa)ryebrookny. oo >wrote: Good Afternoon Ms. Almeida, For your information, there are normally two types of application fines that are imposed on work done or started prior to obtaining a Building Permit(s). The first is a Stop Work Order. This a red placard notice affixed to your front door that directs all work to stop and no further work to continue until the necessary permits are obtained. This can included the building permit, electrical permit, the plumbing permit and HVAC permit etc... Each of those permits where applicable carry a $500.00 Stop Work fine/fee. Secondly,there can be a legalization fee which is assessed at 12%of the total construction cost, at a minimum of $750.00 So far your home was not posted with any Stop Work orders, though I would have been in my official rights to do so. This because no one called to advise that major demo work was taking place, or needed to take place. If not for a question from a concerned party, I would not even have been notified at the time that I was. -0'&- /3 3 h 74&//otv Cj.e3 e_a,7 -f— I understand that this was a situation that you did not foresee or preplan, still my office should have been called to advise about the demo you, as well as the neighbors had to do. It shouldn't be an after thought when you find that kitchens need to be gutted, walls & ceilings need to be taken down as well as major appliances removed. Each of those attached homes are required to maintain a Fire wall/Fire Rating between them that is code compliant. The electrical as well as plumbing work must be preformed by a qualified licensed individual. So it is concerning to me that a restoration clean up company can come in and do this major work without as much as an email or call from anyone to the Building Dept. Be advised, that I have already spoke to a manager named Solange of one of the restoration companies. She has taken responsibility and agreed to come in Monday to pay the legalization fee for two of the units she did work in. Please advised me of the name of the restoration co, you used so that we can confirm if they want to take responsibility for the work done in your unit. Also, if your unit has had the interior demising Fire Wall removed, we will need an Architect stamped plan with your interior application for the construction of how that wall and/or any other walls are to be put back. Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 2 From: Laura Petersen<LPetersen@ryebrookny.gov> Sent: Friday,January 10, 2025 2:40 PM To:Lori Almeida<loriaalmeida@gmail.com> Cc:Steven Fews<sfews@ryebrookny.gov> Subject: RE: 133 Brush Hollow Crescent- Interior Building Permit Application Good afternoon Ms. Almeida and thank you for the email. I have copied the Building Inspector Mr. Steven Fews for response. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, NY 10573 (914)939-0668 From: Lori Almeida <loriaalmeida@email.com> Sent: Friday,January 10, 2025 1:35 PM To: Laura Petersen<LPetersen@rvebrookny.gov> Subject: Re: 133 Brush Hollow Crescent- Interior Building Permit Application Thank you. I haven't found a contractor yet. I need to get 3 quotes for insurance. I've been in a jam finding a hotel and a temporary home. I'm trying to do one step at a time and my children's safety and home was first. 3 How much is the fine?And what is it for? I had a leak. I fully expect to rebuild and get permits as soon as I know the next steps. I've never been through this with a leak so I'm figuring it out as I go.To be fined for a situation when children and the cold weather are happeningjust seems wrong. Lori Almeida On Fri,Jan 10, 2025 at 9:52 AM Laura Petersen <LPetersen@ryebrookny.gov>wrote: Good morning, Please see the attached interior building permit application and please let me know if you have any questions. I marked off which lines you need to fill out. Please note 2 pages require your notarized signature. We have notaries here in the Village Hall in Administration if that helps. The information I will need from your contractor are as follows: 1. General contractor's contact name (first and last) & phone number. 2. Copy of general contractor's valid Westchester County Home Improvement License. 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 5. Estimated cost of construction to determine the building permit fee ($18.00 per $1,000.00) (due once permit is issued and ready for pick-up) There is a $100.00 application fee due when you bring in the application. Again, please let me know if you have any questions and I will help you with whatever you need. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 4 auk 100 e".'•,$��__ r may.j, r r $:•5 r^ GRI �• ��fi =1�A� ..ti�A - \AOm Al ,���bf�s4 tl v! yl,` ..♦ v •.• • ♦♦ • /•1• , 11/1+)17 l�j� 1+111 +11�i 1- 111 ••::hlNl+: _:w'::._:h1N�,.— ��hNIPs.,= s•� •�4 •-=.w hl 11 . - ��,.1 HI --- _ K �,PSter James Maisano a _ George Latimer > ounty Director,Consumer Protection _— I Westchester County Executive 44E Department of Consumer Protection Home Improvement License ate :. HAMMER GENERATION LLC icao» 53 ALEXANDER STREET-#3 GREENWICH,CT-06830 t 1 i 4 Consumer Protection C This license is issued in accordance with Article XVI of the Westchester County ode and is valid only upon presence of the official department seal.Proof of citizenship or immigration status is not required for is of this license. NOT FOR FEDERAL PURPOSES `ot Constrr�e� K ? 0 Date of Expiration License Number 4n ro ' 10/08/2026 K` a I, WC-38255-H24 ester Co SIR. .......4.. 111�Il++,l.,iltlff v a. _ :. +//1,t/llh��i4�}��J`I`�Il/i/l/ll, ��w�i�� `11�/i�1/11 1 1�A �1 11+,1- ;i�` 111•1/1 �A�i� 1/•1.11 aa: . toys! ' ^• +5�1/1 ^ .` ��.� o, `�!\\�a� y,Q�: tft���^,\\"'� �0\ t{�" >h. �0� f ���n ^.q��I� �"a'�� V Z 'w..V� l O Y O .{ �.• O J 1I1 '\1!• fi \I tK x„Nd\ � - �yp � LITHO- MUSA O GbES J4G1 G\lL.r.:•... , 03I3�I2o�' a 2'1 I Zu2"' •> rK1C,OG53G�3 0�1 _ 'YID.- - S,caico - DATE(MM/DDIYYYY) ACOREP CERTIFICATE OF LIABILITY INSURANCE L� 07/03/2025 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 SharpInsurance Services Inc CONTACT Moises Rosales NAME: 120 N Main St, 2nd Floor PHONE 2032479524 FA(AICX, No):2036638200 Port Chester NY 10573 AIL ADDRESS:mrosales@sharpsvcs.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sutton Specialty Insurance Company 16848 INSURED HAMMER GENERATION LLC INSURER B: 53 ALEXANDER ST INSURERC: APT 3 INSURER D GREENWICH CT 06830 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. 1CY EXP LTR TYPE OF INSURANCE ADDL SWVD UER POLICY NUMBER MAi POLICY D/YYYY MM EFF M//DD/YYYY LIMITS J/ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE �✓ OCCUR PREMISES Ea occurrence) $60,000 MED EXP(Any one person) $5,000 A ISCPCO4000060049 07/06/2025 07/06/2026 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY PRO- ❑ LOC JECT PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED 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 accident $ UMBRELLA LIAB OCCUR Li EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ LJ F7F-J E] DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BUILDING DEPARTMENT VILLAGE OF RYE BROOK Certificate Holder included as additional Insured CERTIFICATE HOLDER CANCELLATION BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING ST RYE BROOK NY 10573 AUTHORIZED REPRESENTATIVE Moises Rosales PRODUCER ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD /vm!�N NYSI F New York state Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 471905377 *% A SHARP INSURANCE SERVICES,INC 120 N.MAIN ST-2ND FL PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER HAMMER GENERATION LLC(A CT LLC) BUILDING DEPARTMENT 53 ALEXANDER ST APT 3 VILLAGE OF RYE BROOK GREENWICH CT 06830 938 KING ST RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2481118-4 580206 08/10/2024 TO 08/10/2025 7/3/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2481118-4, 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:/IWWW.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 SUR NCE FUND TJ / DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 263707753 U-26.3