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HomeMy WebLinkAboutRB25-0018DATE: EXP: PARCELID:_ TYPE OF WORM JOB LOCATIOP OWNER: CONTRACTOR: EST. 'T_. COSTS:o FEE: $ C� / PAID `eO:-1 ? I Q ` � FEE:$ �v� AID DATE:�� � TCO#: FEES ❑PAID DATE: DATE INSPECTION FOOTING FOUNDATION FRAMING ROUGH FRAMING INSULATION PLUMBING ❑ ROUGH PLUMBING GAS SPRINKLER ELECTRIC ❑ LOW VOLTAGE ❑ ALARM ❑ AS BUILT ❑ ,► n/J�! FINAL PERMIT #: VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 26-004 Certif ico.te of ®rrupaurp This is to certify that Lena Y I ads l of, ) (L J f PWWk . N having duly filed an application on �P�'QVY]J�Pr 20�requesting a Certificate of Occupancy for the premises known as, GY-een Q(I L1,�/t- , Rye Brook,NY, located in a Pu/b Zoning District and shown on the most current Tax Map as Section: Block: _Q Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. — 6 , issued 5— 20 ,2)7such 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: — Q,eW%IZ 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 buildin cr'in thO)exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in ight s made,nor shall the building be moved from one location to another until a permit to accomplish such change as en'o tain d in the Building Inspector. BuildingInspector,Village ofR a Brook: JAN 12 2026 P � g Y Date: �yE BRC�k. O�` tim cu � 1932 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 : �K �. 9 '^� } \'1� DATE: C-n PERMIT# ` k'(�t ,)� ^, `ISSUED:__ SECT: BLOCK: LOT: LOCATION: 1 �� .' , ��aJS. � O 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 Certificate of Occupancy, Certificate of Compliance, Village of Rye Brook and Certification of Final Costs Application 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information Address of Project Parcel ID# Zone Description of Work Performed on Permit 52 Greenway Lane 135 PUD Re-do Patio in Brick Pavers Occupancy/Use (1 Family, 2 Family 3 Family, Commercial? 1 Family attached Owner Address P.E./R.A.or Contractor Address Person in responsible charge Address Lena V Same Final Total Cost of Project 10500 Certificate of Occupancy,Certificate of Compliance,and Certification of Final Costs Application,page 1/1 0 00 CL '# O aJ N o Y ❑' _t g�� CM > > > a�i 0 a c c c L L 41 a.N �n 'p N L.L • >O C cu Q Q :2 N to 7 __ ^, �+ E 7 ^W W M C m L.� v p-�•, N of a) a 3 cn E a, d LLi a a; " �a LL x o a o LLi W cn � E c a > a, s M cu m > o y m a, �j v r lI --i LJ u ^ - s N W Ln O Lug 3 ` 0 0 NO � } '� N Z O � � > 3 tx0 ram^ \ Q s o s a Z p v I 00 0 ~ O a. O w Y � O w W a o c 1 o 0 p N m M H Y o f C7 p �/ N N — v 0 a, 0 Z � � `� >,� Ow '6 -m '0 3 EIt Q m T m C O d CO 0 3 u W v v C .� �- E o c y ac, o J } L J -J } Ln O Q to 0 mm 3 Z C;6 « c ° c a 3 V p vv) O Q oY W — W tou - > p a ILI oO w 00 0 Uso < 10 � t~nO wo co a` JL() � O � i a) o am } Za V — � u > � , .2 Y Lf) LLB O ao U o a) ac) > LL p7 V = m r p w E i O C G* .-i H aQd= Z2 sc ' � xwO Na, i0 a 0 0v)} 00oo LLI ua E "a 0 > m2R c .c tO 0 -0 0mv Z O j u m a La cu w to w N w- Cl) w 0 LL } as � 3 o y c Lu d v C p 0 0 LLd d E a 0(LI E V 00 m a4 v Y m N O ao " � 3 CO O Y m > m a� = U &N aXi ,`c > y a v w Ln Ln < ,.4 N 0 + (14 a+ E O 'in O Co U Q C i `� a) W = 0 o C y yv a 0.M E _ U W 0 o a V � E - tm 0mC)F— c o ob NWyop bu FE v r N N > E m .R J O } a c co w w oo E M v '� ti U H 0 a) Z W 0 a' > > ay oL C BR(� VILLAGE OF RYE BROOK ■ . 938 King St Rye Brook,NY 10573 � W � Q Phone:(914)939-0668 1 www.ryebrook.gov �O Ob ��• 02• Building Department Certificate Of Occupancy/(Residential) Permit Permit Set 52 GREENWAY LN P#RB25-0074 R#129.84-2-41 PERMIT INFORMATION Address Permit number Date issued 52 GREENWAY LN RB25-0074 12/08/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Steven Fews stevefews@ryebrook.org INSTRUCTION AND ATTENTION It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection. TABLE OF CONTENTS Cover page 1 Building Permit 2 Required Inspections 3 Certificate of Occupancy,Certificate of Compliance,and Certification of Final Costs Application 4 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BR(1v� VILLAGE OF RYE BROOK O 938 King St Rye Brook,NY 10573 tv O.� Phone:(914)939-06681 www.rVebrook.gov ��• 02 •`i Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQU IRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE ❑tr REQUIRED INSPECTIONS Name Description Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) � O N } u qe � � { / U \ (U m \ 3 \ / y o f OL / a / 5 w L: / ( § 22 {aa § vE _ ± x k ( \ ; u E E E m L ( \ t J / 0 w w 5 3 -a 2 w e = o w � ■ 04 Z / \:2 2 Z E 0 g D - 2 < w N w LU [ ) 1 z 0 o $ G G E \ z2 � 2 b j2 ) [ / \ ry -j w � r" -j V) 0 Ln m Z) 9 >, 5 \ / Z) 2Lf) co;t 0 � � `� ? T E k ) 0 / $ L a � 2 / § } / � � � u o ) = e ._ m U u , » \ / w % � { 2 0 q \ { u \ } % \ `§ t � 0 \ U \ - \ 0m � o « D / ƒ & kt / / » � q 2 , _ § }/ Q V) 2 e � LU 3 \ } § 0E § q � &§ g / / { � \ � � � � Z 2 \ & 7 a c 0 / \ (U ƒ \ k z q 2 o w >M aLn y a m 0 ƒ \ > § m O k02E ±\ O U / § U ? u \§ § \ \ / q q a q < CLLJ \ 2 £ e ® � G / E0 0-a 5oOL LU Ukm (U> o , G © 7 o ® e , f R 2 E G D \ ƒ ± / � g V) k>m / ƒ ® / � 0 %M0 E m U \ � 02 = 0 Q ® 0 = < a a } / \ \ / ( Administrative Exterior Building Permit Application Village of Rye Brook w � �'79b2 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Administrative Exterior Building Permit Application,page 1/3 Project Information Parcel ID# Zone N.Y. State Construction Classification N.Y. State Use Classification Occupancy Pre-Construction 129.84-2-41 PUD N/A N/A PUD/One Family Occupancy Post-Construction PUD/One Family Proposed Improvement Area of lot Dimensions from If building is located on a Replace existing pavers in proposed building or corner lot, which street does back patio of approximately Lot Square 350.0 structure to lot lines it front on: 350 square feet with new Feet sq.ft. ones. Replace stair treads Front Yard with similar looking wall cap to match patio. Acres Rear Yard Right Side Yard Left Side Yard Other Area of proposed Total Square Footage of the For additions,total Total Square Footage of the building in square proposed new construction: squarefootage proposed renovation to the feet added existing structure: Basement Basement 1st Floor 1st Floor 2nd Floor 2nd Floor 3rd Floor 3rd Floor Construction Type Located Number of stories Overall Height Median Height Basement Basement ❑ Full ❑ Partial ❑ Finished ❑ Unfinished What material is the exterior finish? Roof style Roofing material What system of heating 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...) ❑ Yes © No Administrative Exterior Building Permit Application,page 2/3 Will the proposed project disturb 400 sq.ft. or more of land, or create 400 sq.ft. or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? ❑ Yes © No Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? ❑ Yes © No Will the proposed project require a Steep Slopes Permit as per §213 of Village Code? ❑ Yes © No Is the lot located within 100 ft. of a Wetland as per§245 of Village Code? ❑ Yes © No Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? ❑ Yes © No .Will the proposed project require a Tree Removal Permit as per§235 of Village Code? ❑ Yes © No Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? ❑ Yes © No What is the total estimated cost of construction: Note: estimated cost shall include all site improvements, labor, 10500 USD material, scaffolding,fixed equipment, professional fees, including any material and labor which may be donated gratis. If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. Estimated date of completion 08/01/2025 Administrative Exterior Building Permit Application,page 3/3 �yE 13R— VILLAGE OF RYE BROOK F 938 King St Rye Brook,NY 10573 ' W � Phone:(914)939-0668 1 www.ryebrook.gov 198 Building Department Other Structures/(Repair) Permit Permit Set 52 GREENWAY LN P#RB 25-0018 R#129.84-2-41 PERMIT INFORMATION Address Permit number Date issued 52 GREENWAY LN RB 25-0018 07/25/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Steven Fews stevefews@ryebrook.org INSTRUCTION AND ATTENTION It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection. TABLE OF CONTENTS Coverpage 1 Building Permit 2 Required Inspections 3 Photograph 4 Application Materials 5 Application Materials 6-7 General Contractor's Home Improvement License&Insurance 8 Site plan 9 Survey(Required Recent Survey) 10-11 Photograph 12 Administrative Exterior Building Permit Application 13-15 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 E 13Rnv� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W � Phone:(914)939-0668 1 www.ryebrook.gov 1982 Building Department INSTRUCTIONS THE PERMIT HOLDERAND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQUIRED/APPLICABLE INSPECTIONSARE SCHEDULED AND THAT THE PERMIT IS COMPLETE ❑�r REQUIRED INSPECTIONS Name Description Final Inspection Completion of all required items under the permit including the site grading and the surveyor's final grading certificate. z �'°' -�'4 �jfJe i •p1ls - ,p �- .x�� ems. _.-..� r • ,.. a --.... 1.. kea� r�• ° �— �.. Tom` • _ f i �d _ ! r G 1p P lee -_eel Id r � r NL I ,may xwrr , . ■ 1 4 1 1 L i I I L L c L lo` ; - � A F � F Y ■ k "L The Arbors Homeowners' Association 173 1/z Ivy Hill Crescent Rye Brook, NY 10573 May 13, 2025 Lena Vladsky 52 Greenway Lane Rye Brook, NY 10573 Re: Replace existing patio pavers Dear Lena, The Architecture and Grounds Committee (A&G) has reviewed your application for the above-named work. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me. Sincerely, Nicholas Salzarulo Property Manager ESERV v% Q� L'aVC OLIO WAG' ESERV ESERV /v o W w�� A y ANEWALK w ESERV�\ P mO \\ `\S EblN7HX �, 0 A�CO\ gyp 3 ; V EMN l' " `Ro Di ` MR \( \ q, SNN 6 0 � ESERV O• `�\ �ry�Wy j,' 9���'\ \\ADO �� Q O��///� '// / PA WRS `cv11AIK �`1G o• nMnfR /' A 4 2, eErWAu �' RO �\�O OOF i \\ \ ABC ESERV 44Kfox Ply W��� I ��p6W� i \�\ A/c DMR THE ARBORS REDLINE PLAN VILLAGE OF RYE BROOK,NEW YORK J M PROPOSED PROPERTY LINES JOHN MMRCONSULTING,PC BUILDING NO. 12 SlTr..-OPMENTCONSl1LTANTS DATE:05IM2013 JMC PROJECT:10006 1220BE DROM•MMM14 NY10504 1914)2]35225•r 1912]32102 WrV W JOIINMEY£FCONSULTIM4.cUM FIGURE:12 10006—REDLINE-8LDG5-1-15 dwg r�m:.saea�'o0••w. � LL � .w a � ti �,sla+•w z a y 0.3o oo ZZH Wti� o ��: sde're us•r 'Y -�� i �� i rc i W h<m O �d 4�t F• Y am jo `1� �1 j�,i / __— .�.. x j� a� k'''.tom✓' PDP�. / a;g" :� LLn .H - LLawa _ - I °a k a� 5 b/ \Ob �� ay v •tf O � • ''a'&ffi LL '�a�x -a,E s R° M � o C� i ��° e< F$& 4:g h : ti 5 A�. P•\ 4x s - - e $IP ��°^ 4a Ew8 � :1�8 nw 3qiY � r -.4a a. � ` ? „� ��pt � o '` Q se .' m ��..fi '' `¢`•> �i4i.p.�i. `qa. �fxtl F Wc ti a .. It � i e, `•:�} k CBI � • � T x• 'r µ ..w � �,d DP ------------ Re 10111 g bd� caves.. 5!ii �'a# llilst First American Title Insurance Company Title Number: FLT-45050 SCHEDULE A DESCRIPTION OF PREMISES ALL that certain plot,piece or parcel of land,situate, lying and being in the Town of Rye, Village of Rye Brook, County of Westchester and State of New York, being known and designated as Lot No. 52 on a.certain map entitled, "Amended Subdivision of Berco Rye Town Co.,situated in the Town of Rye, Westchester County,N.Y."filed in the Westchester County Clerk's Office(Division of Land Records)on 1 1/23/1977 as Map No. 19322. Subdivision map superseded a map filed in the Westchester County Clerk's Office(Division of Land Records)on 08/01/1977 as Map No. 19202 being more particularly bounded and described as follows: BEGINNING at a point on the Southeasterly side of Greenway Lane where the division line between Lots 51 and 52 on the aforementioned map intersects said Southeasterly side of Greenway Lane; RUNNING THENCE South 40 degrees 58 minutes 00 seconds East, 90.00 feet; THENCE South 49 degrees 02 minutes 00 seconds West, 18.00 feet; THENCE North 40 degrees 58 minutes 00 seconds West, 90.00 feet to the Southeasterly side of Greenway Lane; THENCE along the Southeasterly side of Greenway Lane,North 49 degrees 02 minutes 00 seconds East, 18.00 feet to the point or place of BEGINNING. FOR INFORMATION ONLY: Said premises being more commonly known and designated by the street address 52 Greenway Lane, Rye Brook,New York 10573;tax map designation Section 129.84 Block 2 Lot 41. 1 \ '�b +`` It 11� „ •..'�;1_II v�/� ��1� ��/��IF •� 11 �v�l��'�IpiA��v, ��1^� ��fvl } $i{�,lv "'�; �t(ss)► ���s �N/i'�. �\i4 ��:�11.•�!�.,�f!!e_,_r.1�U, .�.:SS'� -:f ilaq.�11�Lr,�,r1 ei� 11 1j•� ��i. ,r :�f � u *��,� � _f-!n._>.'i.. y� llb...a l._ �1 /ca►_,.xut��.1:.� i c >. u �.` c d N - Wt' t r [ !r � JC.0 • S:i � C •;sue- ^es, /rAWE � acl +a w ° " _ ': C ••" > o f V. r C O z = 00 to •'1 4 :. u J �. . i 1� �S rrli 4T+� rrr� 1 1� ts€4_ rp r fI4��1 �,1 !1 1a 4i`"� �_.1 WNW=`�s�r' l(t�s)>� o To �I�►1'111 ��)��� � ��1 1 iv�.� ♦ �777 c►I . ll , I l�i�l , •. l�l i�1 •. ci1.1�1 •�. IAi ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYriI `ems 08127/25 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME VICTOR BERMUDEZ PHO BERMUDEZ INSURANCE AGENCY INC WCNo.Extt: 41664-1000- FAx L1 —_.--LA . 191 6L64.1004 E-MAIL 75 Gramatan Avenue ADDRESS: BERMUDEZAGENCYAGMAIL.COM Mount Vernon, NY 10550 INS. uRER(S)AF oOROINGCOVERAGe NAM# _ INSURER A. ATLANTIC CASUALTY INSURANCE CO 428" INSURED INSURERS: ALEXSANDER R LINO INSURER C: DBA-AK PAVING INSURERD: 15 GRANT ST INSURER E: WEST HARRISON NY 10604 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INS JRAN E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDL SUER POLICY EFF POLICY EXP -- TR TYPE OF INSURANCE POLICY NUMBER POLICY POLIO EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f 1,Q00L000 AMAGE TO RENTED - C,AI'.IS-MADE X OccUR PREMISES tEa occurrence) S — 50,000 __. .. MEO EXP An y one Qe— _ _non S 5 �—------ --- - -1000 A X M044000322-4 02/08/25 02/08/26 PERSONAL_&ADVINJURY f 1000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f 2,000�000 X POLICY JEIOT _ LOC I PRODUCTS-COMPIOPAGG f 2 OOO 000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ,_(Ea accident) BODILY INJURY(Par Person) S OWNED SCHEDULED B- AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE - $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR -- ------ - - _ CLAIMS4AADE I � AGGREGATE $ rc L RP TENTICN I $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N T T 1 -ER ANY PROPRIETORIPARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑I N/A' E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE PLOYEE $ If yes,descnbe uncer _- ik EM_ DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS,LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may b,:attached if more apace is req Wredl VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL 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 938 KING ST ACCORDANCE WITH THE POLICY PROVISIONS. RYE BROOK, NY 10573 AUTHORIZED,RE�AFSENTATIVE s)1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF NOW York Stato Insurencc fund PO Box 66699.Albany NY 122rA nyaif.com CERTIFICATE OF WORKERS'COMPENSATION INSURANCE �AAAAA 161643414 ALEXSANDER LINO ] DBA AK PAVING Q 1,5 GRANT STREET WEST HARRISON NY 10604 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ALEXSANDER LINO VILLAGE OF RYE BROOK DBA AK PAVING 938-KING STREET 15 GRANT STREET RYE BROOK NY 10573 WEST HARRISON NY 10604 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2385 094-4 732306 03/22/2025 TO 03/22/2026 8/27/2025 _] THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2385 094-4. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK. EXCEPT AS INDICATED BELOW. AND. WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:I/WWW.NYSIF.COWCERT/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 ZCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER.722318400 U-26.3