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HomeMy WebLinkAboutBP25-161PERMIT # SECTION TYPE OF WORK J013 LOCATION ATE• J� � �,� /� a LOCK 3 � OCR i Tc�p,-s 1 � ` i 7777 /il )A Ci A ozo�JO/ r6 T. COST Q F VCR � �J � � FEE pA'I'E / C> TCO # FEE DATE FOOTING FOUNDATION _ FRAMING MGM FRAMING INSULATION PLUMBING .1�"+ RGH PLUMBING Gab C7 SPRINKLER ELECTRIC C7 LOw-vOLT C7 ALARM 9 AS BUILT Cj as FINAL �.-- III L'3i� � ovghol? i7 7y �S 96<3- C� 2/70 /` lvla)o cly) y c)flS OTHER APPROVALS ARB BOT PB iZBA OTHER VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK -Nc>• 25-147 Certificate of ®ccup ucp This is to certify that 9 oer of, /3W64 / V y having duly filed an application on 20 O�F requesting a Certificate of Occupancy for the premises known as, , Rye Brook,NY, located in a P,—)5 Zoning District and shown on the most current Tax Map as Section: Block: —)—Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. , issued 14oO 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: �" lone-A&wII&I Construction: _yam for the following purposes: ,/ "�Y�[/Y ?n� Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the build, moved from one location to another until a permit to accomplish such change ha o inedfr th mg Inspector. Building Inspector,Village of Rye Brook: Date: NOV 19 2025 • CYEBROOK, For office use onl : t BUILTMENT PERMIT# NOV 12 2025 VILROOK ISSUED: _11D-a5 938 KING STRENE YORK 10573 DATE: / /.� FEE: PAID EtVy.20V 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 *###►##ti*ttit}iiti tiii►}►►i►►##i►##i##**####*##it#ii►i}tit}ti##►i►i#ii#►**#######i#tti##}iii#}#i kii►i#it►t►#######*##it}}ii} Address: 01 (OU T l F C(A r l / 2 _ Occupancy/Use: �,S Parcel ID#: 1 a - 74 — 1 J 3 Zone: r�� Owner: DP t/It REQ EC Address: ) 9 'DL-r T f y gj' (, Cr�LL£ P.E./R.A.or Contractor: Q�FINoto 0,4 j-P Address: -)) v 1 rr,' J r ref w CA,,-AA- Cr Person in responsible charge: L U4(Aro ftt,4g0 Address: 2 2 v l rrl V r✓E w CRi/`iv- c ; 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: L(/G(A-,? (FA(A49(�2 being duly swom,deposes and says that he/she resides at 2 L (Print Name of Applicant) (No.and Street) in (1 f l/4►r ,in the County of k1 11% (_(h in the State of C f 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:$ DO,07�j , for the construction or alteration of: T N o 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 DS day of a`{ , 20 _ day of `�.t� , 2Q5- -�J _K? . .do Signature of Prope wner Sign of lxplicant I,"/-,_-, (y Name of Property Owner-) e o t Applicant Notary Public Notary PukHARI MEULLO SHARI MEULLO Notary Public,State of New York Notary Public,State of New York No.OIME6160063 6/t/2024 No.OIME6160063 Qualified In Westchester County Qualified In Westchester County Commission Expires January 29,20 Z� Commission Expires January 29,20Z _ ,AE R90) BUILDING DEPARTMENT ❑Pk;11.01 NG IN%I,I cl oit A%MS ANT BUII.I)IN(, INSPVC-1 14 VILLAGE OF RYE BROOK ❑COD1. I'.NI uucr.an.Nr Orru:r.R 938 1�ING STit1:FT- RYE BROOK, NY 10573 (914) 949-0668 FAX (914)939-5801 wlny rp,chr(►A. )rg -. - - - - - - - - - - - - - - -- - - - - INSPECTION REPORT - ----- - - - - - - - _ ADDRr.ss 2. 01 Cua rta R4A6, CAtCt4 ._ DATE: hliltMl'f:: f5T !�D IStil;l'.1):�•lf*O-Zrtil ,: l2�• �� BLOCK: l.Oc;ATION: 64 t '-A.00,91._.. .__.-__-._ OC(:ul'ANCY: ❑ VIOLATION No'r1:1► TIII-, wolm 15... ❑ At;CIiP'1'ED ❑ It ElF.CTL'D/ Rr:INSI'r;cTION ❑ SITE INSPECTION Rt:Quljam ❑ FOO H NG ❑ FOOTIM.1 DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND hLLIMRIM, 'W TFS ON INSPECTION: ❑ ROUGH I)LUMBIN(; ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURA1.GAS 1 ❑ I..P. GAS ev, c " _ � lmn. 6,4�k. 1'411;.1..�I�ANF ❑ FIRE SPRINKLER ❑ FINAL PLl?hlltlNl, /� F,IMSS CONNECI'ION �"�INAL CDAJI ❑ U'.rH ER a 'V Ln o a T-4 O _ w n f T. w 10, W n _ W O a Tu y H U N Ow CA /0 a y n I.., A ° boa = V W a o f�l ao �. Sao a N z a N m a� a �o c y o 4o c cia C4 _ �J y bA H 00 00eq in 00 A � � Ei M 00 owl 1�{ ~/ wa C7 W w uo � umCR o U v - Z o 0 F, U v z z w Ho0 � � H i 4 BUILD MENT I VIL E OF RY OOK JUL - 1 2025 DD 938 KING ET RYE BROOK,NY 10573 Q ,l4A990-066&fj VILLAGE OF RYE BROOK Wov I BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: JUL Application /�/'� Approval Date: it pp ' ation Fee:$ �-/L/ Approval Signature: Permit Fees:$ Z- ' ✓�� Disapproved: Other: Application dated: i l` J is hereby made to the Building Inspectorof the Village of Rye Brook,NY,for the issuance of Permit forthe interior alteration of an existing building.or for a change in use.as per detailed statement described bellow. ' 1. Job Address: D lQ (O V r%Y K I DI., (11 C E SBL: /edJ?,7/—/`3 3 Zone: 1 � 2. Proposed Improvement.(Describe in detail): S Et Ori D Root BATH Rf rio y.4ricti, �f V EIk rZAU -/Q CPAtJbE 1✓ L8X0Q< 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:_X__ Yes: If yes, indicate: TIER 1: 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;(I fain.,2 fam.,comm.,etc...)Prior to Construction: j FNA . After Construction: rh M 6. MY State Construction Classification: N.Y.State Use Classification: 1/7. Property Owner: A L/ 1� E l F t Address: )y L©u J 7 ty Q 10/F 'C I!1 A L E Phone# t Cell# q 1� `i 9 5J E_R�email: PA U i D C AAL a b AiNt. Coh L 8. Applicant: 10 Ii& PF Ww Address: '4 4 V 1 TTi sT /-IFW LANAAi , (�T- Phone# Cell# /� email: pHf J o Cr Pr 0� &LAAl L _(rv1 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: It. General Contractor:PFAw o T:) I4W Address: V I J't r -) T �&v fp/►��+ ,C r Phone# Cell#Q I j 3,11 )f/y email: PHL L(,((A,-o 0 I--A A I I <� 12. Estimated cost of construction $ I q,000, 00 (NOTE: The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees.and material and labor which may be donated gratis.) Iv C 13. Job Timetable: Start:_ _Finish: (1) 6/I/2024 BUIL EPARTMENT VIL 'OF RYE BROOK 938 KING Q ET RYE BRO NY 10573 AJ U L - # 2025 I -066$j VILLAGE OF RYE BROOK U oV BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: residing at, q C�r� Y ��/�r_k i Print name) (Address where yuu'Ii N r) 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/ pIx , Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Prope wner(s)) (Print Name of Property vner(s)) Sworn to before me this a`1 dav of ,, .e 20 a SHARI MEtJI_Lo Notary Public,State of New York No.01ME6160063 Qualified in Westchester County (2) Commission Expires January 29,20 - 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: Luo A�2 lwrrs�Z7 ,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 _ �r/a 1 9 tori= Lam. 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 1--e- Sworn to before me this day of Q 7 , 20 S day of 14 , 20 Signature of Property er Si f ue of AppliqAt Print N afPrope O r 7�7 c t V\A Notary Public Notary Public SHARI MEULLO Notary Public,State of New York CHRISTOPHER J.BRADBURY No.OIME61WO63 Mowry Public,State of New YOM Qualified in Westchester County No.01 BR6159986 Commission Expires January 29,20 Z� C)uallfied in Westchester CourdyZ--� nuary Commission Expires Ja 29120 ow (4) 6r1no24 �I ''�d ii�'r����i�il�il��l "�nl��`li �ii��`ii�ii��il�� `9��1�1 • �il��l�i1i �`il�ii��i �il�il�l��� M N oo � H �k � Z W � � • . F., v, N � � • v ° A ce Z r U ■, tL _ fCA w rM-. • OZ � wCD A • ■ W '� Z N c7 $ Z Z cn ' A � z F O • O C � • W x A a w o V �„� C z Q p w w 'r '-' � Z a ram. a • W • z o < C qui p IE C IE ME BUILDING DEPARTMENT AUG 2 5 2025 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT w ww.xyebrookny.;ov PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY B PP#: C3 6? Approval Date: Permit Fee: $ / I Approval Signature: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, b-I y-)5' 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. I.Address: a q C O V t✓ uy IZINpF O RUE SBL: V g• 7a 33 Zone:k—_/5 2.Proposed Work: E Pl A C TV R, T T 1�A y S*O6a E(t Pier-1 6 . 3.Property Owner: DO V( D O tR tie Il. Address: a (01 --rr y Rt Q'le C/ e t F_ Phone#: Cell#: Q it- 3 4 Z/ 5 q S) email:�A 1i10 L t3EL/,Fg /�-A f t. fog`^ 4.Master Plumber: �4'6C,y �J C I Sea— Address/fig 3E 4--ki �� �/j Lic.#:kVl6 Phone#: yiy.1�l`i17S'� Cell#: e/mail:f,7!.LC 4 c r� ` C dd J &I luu&- Company Name: f �� � Address: 7�v.*c e/d,,.� }��y.,lr,,re I o 7a? 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 t 3`d Floor l 4ch Floor 5`h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of Oa S day of ,20 Signature ktyroperty Owner Signature of Applicant t Name of Property Owner Print Name of Applicant NcllnodttllRic,State of New York Notary&Hli No.OIME6160063 GREGORY M.RIVERA Qualified In Westchester County ^ Nay public,State of New York Commission Expires January 29,2Z I No.01 R 16441398 Qualified In Westchester County This application must be properly completed in its entirety and must Ga�atk*P!l�xA*0fi0@@WL s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/l/2024 BUILDING DEPARTMENT D v �" VILLAGE OF RYE BROOK EAUG 2 5 2025 938 KING STRF,F'r RYE BROOK,NY 10573 Do (914)939-0668 VILLAGE OF RYE BROOK N�'Nvw.rvebrookny.2ov BUILDING DEPARTMENT iiexis i<ic ie c it ix*ir is ie ie ie ie xir c ie ie ie ie is is ie iexisKxie ie ie is is ie is is sc cx is iic r,is is ie ie r.ier.icr.ie it iYie is is ie ix i.it it is iir ie ie it ie ie it ie x>c is is ie>F F 9r is irxir*:'c is is k 4xxix iexix* AFFIDAVIT OF COMPLIANCE VILLAGE CODE �216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 3, �d�jj �,y-� .Q/ , residing at, k.•,4 ' C j'e- Wrinl ruunc (:1'111-c..\cl erc�ru Ii\cl 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; ry ry+/y lr-� �,,.J , Rye Brook, NY. Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Pro erty Owner(s)) Du v: c3 113e'ems (Pruit Nance of Property Owner(s)) Sworn to before me this 3 LJ day of S„—e , 20a"S ( tary Public) SHARI MEULLu Notary Public,state of New York No. DIME6160063 Qualified in Westchester county _3_ Commission Expires January 29,20 6/l/2024 Buil4g Permit Check List&Zonisw Anal is Address: 1 SBL: Zone:_ use; e Const.T Other. Submittal Date: �� Revisions mittal Dates: Applicant cC Nature of Work 06-71\ Reviews:ZBA: PB: BOT: Other. NEED OK �L (v� ( FEES:Filing. 04)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. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: ArchivaL• Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic Other. (� ( ) License: Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. (�( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. 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 mrg.date: approval notes: APPROVED REQUIRED EXISTING PROPOSED NOTES Area: pate:.,U L1 6 2. 025 Circle: Fie: Front Front Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot : Ft.ImR: P� Hei k Stories: notes: M r1 V n C><a \ TV �0 � ��I;1"iA/r+� ��,�„� '�: _y +�� 4� h'� «ems)►) C J t1F. CD / •�� •_^ �A' � .a �' co N i '1ST"' i 00 X N E o In F 1 V J ' O r \\ co I�..i > w o .� ction OLU «AD •i LL OLLI F- z - Y _ Z > z I i. Fiisaui�,. �• G� 4� � o I �.• � LLJ }a<iMPco / ` • � � ° N rs N F'.. 1 La7 _ u co y u C v y �Z t Is '',�r�,- .a :,i v*�'.may":-O±►�ii'c-` ' h� - ��y RE0� CERTIFICATE OF LIABILITY INSURANCE DAT / 03/25l25l2025 V) 025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT NAME. CT AJC Insurance Agency PHONE .(AIC.No.Exl)-(860)721-0922 Lai&,No1;S86J 529-21f32 _. 1850 Silas Deane Hway E-MAIL ADDRESS: PRODUCER -- -- Rocky Hill CT 06067 CUSTOMER 100: T-- - INSURERLSSS]AFFORDING COVERAGE NAIL S INSURED INBugERA_UTICA FIRST INSURANCE COMPANY _ 15326 PERINOTO HANO OME IMPROVEMENT LLC _ LUCITO INSURERS:HARTFORD UNDERWRITERS INS.CO. 30104 OT --- -" — 20 MAPLE RIDGE ROAD INSURERC. - -- - TRUMBULL CT 06611 INSURERD: _ __-- 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. wis—IC--- -- - PDIICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMUD Y MMlD LIMITS A GENERAL LIABILITY 11i07i2O24 i 11-07-20 EACH OCCURRENCE = 1,000.000 -6AMA?;ETOTtE COMMERCIAL GENERAL LIABILITY F�F PREMISES IEs occu f �Q _ CLAIMS-MADE :X I OCCUR J( ART 5046626 06 so MED EXP(Any one pern) 5 DOQ I —" - - PERSONAL ADV INJURY f GENERAL AGGREGATE i_ _ _ _2,000,0.00 GEWL AGGREGATE LIMIT APPLIES PER:POLICY�-1 PRO- PRODUCTS-xCOMP/OP AGO 2 X � i -- _ - - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT : (Es asru) ANY Ir ocldBODILY INJURY(Per Perm) SC OWNED AUTOSHEDULED AUTOS IIIt: - - - -- --- I j BODILY INJURY(Per soddent) SC - - HIRED AUTOS I I P TY DAMAGE _ NON-OWNED AUTOS iS XXXX�UMBRELLA LUIS ^ OCCUR08 EACH OCCURRENCE $ 1,000_000 EXCESS LIAR CWMS44ADE r—r— AGGREGATE DEDUCTIBLE f f -- S --- - - RETENTION S f B WORKERS COMPENSATION 09/30/2024 5 STATU- AND EMPLOYERS'LIABILITY ANY,PROPR IE TOR,PART NEH)EXECUTr46 YIN 6S60UB-4N64529-8-19 E.L.EACH ACCIDENT S - OFFCERrMEMBER EXCLUDED? E NIA — ,000,000_ {Mandatory in NMI E.L.DISEASE-EA EMPLOYE 5 - d yes,des dbe under _1,000,000- E.L.DISEASE-POLICY LIMIT I t 500,000 1 � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schodule,H more space Is required) PAINTING CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE Village Of Rye Brook POLICY PROVISIONS 938 KingStreet AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 Paul Siqueira n 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Cloar All NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) iv a ^^^^^^ 471282340 PERINOTO HOME IMPROVEMENT LLC (CT LLC) t 22 VITTI ST NEW CANAAN CT 06840 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PERINOTO HOME IMPROVEMENT LLC VILLAGE OF RYE BROOK (CT LLC) 938 KING STREET 22 VITTI ST RYE BROOK NY 10573 NEW CANAAN CT 06840 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2569 700-4 255401 05/13/2025 TO 05/13/2026 6/8/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2569 700-4. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/(WWW.NYSIF.COMICERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S7NCE FUND /�YV DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 740369637 U-26 3