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HomeMy WebLinkAboutBP25-217PERMIT A SECTION TYPE OF WORK JOQ LOCATION OWNEr% "IL CONTRACTOR �t. COST VCO#__C 6 OD Jam/ c FE DtP; LOT. TE TCO � FEE DATE �N PE^T10N RECORQ DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMB{a GAS SPRINKLER 0 ELECTRIC LOW -VOLT Q ALARMFall lllor2J� AS BUILT` - FINAL {NSP gcy*74419 77 OTHER APPROVALS AS-BUIIoil PRIOR 4Y REQUIRED P EiNAL iNSPECTJi= l �yE DR t Ct� v J,CnG'Vyy�V, O\ VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrooknX.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 28,2026 Bhargavi Panjala&Arun Acharya 16 Country Ridge Circle Rye Brook,New York 10573 Re: 16 Country Ridge Circle, Rye Brook,New York 10573 Parcel ID#: 129.74-1-24 Building Permit#25-217 issued on 9/30/2025 to Legalize New Fence This certifies that the six foot high white pvc fence and gates,installed under the above captioned permit, have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILDING DEPARTMENT For office use onl : PERMIT) 7 VILLAGE OF RYE BROOK ISSUED: NOV 0 7 2025 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: (914)939-0668 FEE: PAID N'WR'.I' COOIivtlV.gOV APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION /ttt####tttttt#k#tkk#iiif Address: u 7�' G��A c j('wl l /� Occupancy/Use: — Parcel ID#: f Zone: /� —/'5 Owner: ��,,AIp — ,Qeh�i�a Address: P.E./R.A. or Contractor: f;&y Address: / Person in responsible charge: Address: 5 7 q Ar1w 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 /Ol F NEW YORK,COUNTY OF WESTCHESTER as: i S l being duly sworn,deposes and says that he/she resides at (Printf4ame of Applicant) (No.and Street) in in the County of in the State of 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:$ y OW 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 r� day of Novf-%-A 6 e,, , 20 day of Tj���- '-, 20 Signaturet6f Property Owner AjZdature of Applicant Print lame of Prop rty O�Oher SUSAN RIVERA Name of Applicant ( NOTARY PUBLIC,STATE OF NEW YORK Registration No.01R15043088 Notary Public Qualified in Westcheste Co my My Commission Expires �_b iTo ry Public SHARI MEULLO Notary Public,State of New York 6n/2024 No.01ME6160063 Qualified in Westchester County Commission Expires January 29,20.0 �yE 4R(�j� W � l� 1982 BUILDING DEPARTMENT ❑B ILDING 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.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: Jf J.Z - ZOL(0 PERMIT# .. ' 2 177 ISSUED: SECT: /a9.7�/BLOCK:_LOT: Zf LOCATION: Le f � * 1t&l top r,�gp,p 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 4 met- M ❑ L.P. GAS SS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Z' FINAL Ef'OTHER �E O Z 04 BUILDING DEPARTMENT ❑ B 1.11ING INS1►ECTOR ASSISTANT 13U1LDING INSI►E.CTOR VILLAGE OF RYI BROOK ❑CODE ENFORCEMENT 01-14WE•.R 938 King;Street • Rye Brook, NY 10573 (914) 939-0068 FAX (914) 939-5801 www.rycbruc�k.ur�; - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :._• I A'�1 ct2e-� DATE":._� - 1� hI:RMI'I'# 746' 2 -7 _ ISSUIiI): SFICT: lil.c)CI:: LOT: LOCATION: 40- G OCCUPANCY: ❑ Violation Noted I I r. WORK IS... 0 PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTFIS ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION c ❑ Natural Gas ❑ I,.P. Guff //►►�� r ❑ 1'UFL TANK l��l/I►�e i► w J fl� _, T- S! . ❑ DIRE.SPRINKLI R PN[Q- 0,J014 ❑ FINAL PLUMBING ❑ CROSS CONNECTION �.1�� .�' I'INAI. g� x s w Ln N W k x a �' EF py O p a H W' W w � x a c, R+ W O a a 0 '..� N l� In z A o8a � w � p VN o to �' rr � ggoo W ON CS � � cW. °" -o r�i • o z Z a � O w F Y � o uoc � "b bA w H n z g > aso 0 o A Z V °; o ,; � ° a � W Z O ��Tw ALn p 0 O V Fr-1 W N H E" d U c°i ° O, w � p �, o e C a U C p v V id ri O W o yw U = p o z x z A E• A v ° c a 7� W O � N d W H rT . � \ I� cn � v W M•� H F� M z O U W a V C7 n I"+ `J w Fv^ w w M o . N W a cn ICI w w ,w W ��r WavSb � o • H z z b o 0-0 • V oy ° 6t V 0g ° N � „ �e a LIJ>Qj o O a�i �y U �, z O w cnLD V O NSw � ;I Lu _ zaN V c�7 O A z o W N > J�J l� A W z d 0Q ob C a .. 04 � W W a � A o. � a = a a a BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NV 10573 (914 9-0668 FOR OFFICE I SE ONLN : / . ll _ Approval Date: SEP 2 Z Per J"� 7 Application# A�7�JJ-- 01 Approval Signature: ARCHITECTURAL REVIEW BOARD' Disapproved: Date: 2 BOT Approval Date: Case# ; Chairman: zzy PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: Permit Fees: FENyyC,,--E�� / WALL / GATE PERMIT APPLICATION Application dated: 00tXGla� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,constructs n,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(I)(g),of the Code of the Village of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Job Address: �Pw�.tr.� 'R� g e L-rc-L 1Z , b001-�, '►J Y I 0 5a-3 2. Occupancy/Use: S.B.L.#: Zone: 3. Proposed Fence/Wall/Gate(describe in detail): AaA-a j ors nti.e A A Me SWr < < Cc if, 4. Property Owner: Nr1..%T\ Address: 1(e � NY ibS � Phone# (�k�a5c, — 39 7 Cell# email: 6 nL!c .czv, r--1 4. oNJ Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: Contractor: e r e�, Address&Phone: E; -7 1-4iU N`/ CgICF) g06-25-f-1 5. If building is located on a corner lot,which street does it front on: 6. What is the estimated cost of construction 8 1►-0 0 O (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.) 7. Estimated date of completion: �' F5 a 0 a 6/112024 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: B Ft 41V 1 ,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 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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this i SF Sworn to before me this 2 t S F day of 2015 day of „c, , 20 a-5 Signature of Property Owner Signature of Applicant BHPrRp ;\v% rgtA.TRt_A 134ARc ptv 1 'PArt3Air-:� Pr a of Pr rty n Print Name of Applicant Print t Ea Notary Public Notary Public SCOTT J.GOWE SCOTT J.GOWE NOTARY PUBLIC OF NEW YORK NOTARY PUBLIC OF NEW YORK I.D.#01GO6357188 I.D. ION#01 EX IRES MY COMMISSION EXPIRES �1 � MY COMMISSION EXPIRES 6/1/2024 Buildin Permit Check List&Zoning Anal sis Address: " () ( SBL: Zone: Ok',5 Use U Const.Type: Other. Submittal Date: Revisions Submittal Dates: Applicant Qn Nature of Work t F ��C, y �ec._� 1 C\ �-n C�C -4Q_ l Reviews:ZBA P 10 2025 PB: BOT: Other. '� NEE OK `UU ( � ES:Filing. BP: �y � C/O: Flood Plane: Legalization: ( ) ( �P: Dated. Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone 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:DVtamped: Sealed: Copies: Electronic Other. (1� License: `� Workers Comp: b tymp.Waiver. Other. CODE 753#: Q.�D C�0 J �C� 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. ( ) ( ) 2020 NY State ECCC: N/A Other. Final Survey- Final T o RA/PE Si off Letter: As-Built Plans: Other. Y op � Sign-off ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. mtg.date: , 2 ,cZ> approval -/7- notes: Ar'.3. 5.-1// ( )ZBA mtg.date: approval: notes: ( )PB rntg.date: approval: notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Area Circle `�i Fron e Front Front Sides: Rear. Main Cov Accs.Cov: Ft H Sb: Sd.H Sb: GFA: Tot Imp- Ft.imp Paz ' Height/Stories: notes: BUILDING,DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (%4)9 9706.68 W wi� Ili Off' #######tt##ttttt###t###tttt#ttt#t##tt#t########ttttttt##t##ttt########tttt#t#tt###tttttt#ttttttttt#####t### ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: 16 CO3,rA-r a R-, 1 ac Cif CJ ��J Date of Submission: Parcel ID#: I aq. "74 -1 - j:!j- Zone: Proposed Improvement(Describe in detail): .5i2 APPLICANT CHECK LIST: M ST BE COMPLETED Bl' THE APPLICANT } r The following items must be submitted to the Building 01�e_r 3 s;Ane knvc 4�n� Department by the applicant-no exceptions. was r "T b 1. (vfCompleted Application Property Owner: , l.b 2. ( )Two(2)sets of sealed plans. (one full size (maximum B Address: �°`r '"' al allowable plan size=36"x 42"' and one l l"x 17") 9 � a �y 9< <` �� K 3. (VfTwo(2)copies of the property survey. Phone# (q)4) a55 - g 3 9 7 4. (a'`fwo(2)copies of the proposed site plan. Applicant appearing before the Board: 5. ( One electronic/disc copy of the complete a plication materials. 6. (.Ailing Fee. Address: e &,.n(1, 7. ( )Any supporting documentation. 8. ( ) OA approval letter. (ifopplicable) Phone# Cq t� � ASS - Ts35 � 9. (VPhotographs. Architect/Engineer: 10.( )Samples of finishes/color chart. (a sample board or model may be presented the night of the meeting) Phone# By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this !�k I S t Sworn to before me this `it S~ day of 20 ar day of Nugtig k , 20 2 J Signature of Prolferty Owner Signature of,gyp icant BHPI Vq H V I P( ►N TR�R 2 RRR G A v 1 J'p t.1 ►1A�A Print Name of P er 7-'s ' PrinS7""W� ` vv/ Notary Public f Notary Public SCOTT J.GOWE NOTARY PUBLIC OF NEW YORK SCOTTJ.GOWE I.D.#01GO6S5718y NOTARY PUBLIG,&NEW YORK• MY COMMISSION EXPIRES T f I.D.#01008W188 WIRES ,��� MY COMMISSIWIRES�'j 6/1/2024 13Rnv� Village of Rye Brook ML �/ MR +yAgenda FB SE Architectural Review Board Meeting ui c c`��'uuJw lam' AC AD Q t Wy a.0 Wednesday,September 17,2025 at 7:30 PM JM SF �•W Village Hall,938 Sing Street ITEMS: 1.1. ARB25-108(Consent Agenda) (Amendment to Approved Plans) Adam Polay&Bari Polay 31 Mohegan Lane Change to rear stairs. 1.2. ARB25-109 (Consent Agenda) Dziugas Reneckis&Cristina Pires 9 Maple Court 3'&4'high split rail fence. 1.3. ARB25-110(Consent Agenda) Ajai Bhagavan Venkatapur&Truti Yeshwanth Patil 5 Heritage Court 3 1/2'high split rail fence. 1.4. ARB25-111 (Consent Agenda) �eovp 1 Bhargavi Panjala&Arun Acharya v`` 16 Country Ridge Circle Legalize 6'high white pvc fence and gates. 1.5. ARB25-112(Consent Agenda) Liam McNeill&Sarah McNeill 46 Roanoke Avenue 6'high wood fence. 1.6. ARB25-113 (Consent Agenda) Prakash Krishnan&Raji Krishnan 29 Meadowlark Road Legalize 6'high driftwood vinyl fence. 1.7. ARB25-114(Consent Agenda) Suchit Kaul&Vaishali Bansilal 28 Legendary Circle Rooftop solar array. 1.8. ARB25-115 (Consent Agenda) Vipul Nayi&Fany Nayi 50 Valley Terrace 6'high gray pvc fence. 1.9. ARB25-116 (Consent Agenda) Alex Patchen&Alexandra Patchen 11 Fellowship Lane Rooftop solar array. Page 1of3 Architectural Review Board September 17,2025 Consent Agenda Approvals: Motion-M Second ft2 Abstention Aye; -S Nay; Adjournment; T Notes y 4 1.10. ARB25-117 Tian Tan&Yiyang Liu 2 James Way Legalize existing walkway replacement with brick. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB25-118 Jillian Hochfelder 32 Country Ridge Drive Construct a two-story rear addition,one-story rear addition,interior alterations and renovations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB25-119 8 Elm Hill Drive LLC 8 Elm Hill Drive Addition&alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB25-120 Doral Greens Homeowners Association Doral Greens Drive New halo lit monument entrance sign. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2of3 • Architectural Review Board September 17,2025 1.14. ARB25-121 Pak Yun Chan&Jaclyn Chan 745 King Street Rear pergola,new roof and siding. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.15. ARB25-122 Craig Jacobs&Kate Bartow 22 Reunion Road Add stairs to existing deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.16. ARB25-123 Mark Diamond&Lois Diamond 11 Longledge Drive Replace existing decking and railings. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.17. ARB25-124 Andrew Wels&Lauren Wels 4 Hills Point Lane Replace existing decking and railings. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: October 15,2025 Page 3 of 3 q may. a CK a- "� �+j •aF l` ?p DM .. DPP-- .„. i I � r i - ��� �✓. t- a IL w NO .�[•sj��( T •C�. NIL q ; xx ��,•{ ,�, r. may'+ . Ix lit J � ( _ c k - � � � � ! - - %/\�� - f � ? \ i § . - s e _ C :z_ •dry.�.k��, � '' , Mt � �.�• `ram ¢O,P!�� � �. - _ INr f j I � t �l � �� h �j �` ,- �4 .:� �- d t' `^~ \I� ��-. it.<. .R�i.�i�': 2_ ' "e, � �". _C.., � � _ i E � � - , � �., )yam --.r. .:.Y� . i y'_ ! ? �� -J �M i Tara Orlando From: Tara Orlando Sent: Wednesday,September 24,2025 11:15 AM To: 'bhargavipanjala@gmail.com' Subject: Fence Permit application-16 Country Ridge Circle Good morning, The fence permit application has been approved by the Building Inspector.Before we can issue the building permit,the following items must be submitted to our office: General contractor's contact name(first and last)&phone number. Copy of general contractor's valid Westchester County Home Improvement License. 3l General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 40"General contractor's valid workers compensation on a NY State Board form(C105-2 or U26.3) (the Village Of Rye rook must be the certificate holder) f/. Ticket number from U-Dig(free service that marks the underground utilities call 811) 6. Building permit fee$162.00(due once permit is issued and ready for pick-up) Tara A Orlando Secretary - Planning Board Zoning Board of.Appeals and .Architectural Review Board Village of Rye Brook Building Department 938 Xing Street Rye Brook, New York io573 Office (914)939-0668 Village of Rye Brook Building Department Hours Monday-Friday 8:30am-4:00pm *Closed for lunch,between 1:00pm-2:00pm 1 rti < O 3T 1 fj i y mt CD f l� . U. W Ln C Gam. i y� } J .�s Gt10A �`r=�i. :,.�T• 1 to � O O W a, � � v�i �•4-- ,a U `- % cn , awu as y1Q 1 ap ALP ci co r. CL .-4 u N / 5 w 04 a: C y tV z u w (h a u A A {/17t1 A ® DATE(MM/ Y) CERTIFICATE OF LIABILITY INSURANCE 01114/20252025 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 Jenny Eduardo NAME: D.C.Ranieri Insurance Agency A/CNNo Ext: (914)376-2560 a/c,No: (914)376-1772 457 Palmer Road E-MAIL Jenny.E@dcranieri.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Yonkers NY 10701 INSURERA: James River Insurance Company 12203 INSURED INSURER B Tri State Construction&Renovation Inc. INSURER C: 574 Anderson Hill Rd INSURER D: INSURER E Purchase 10577-1701 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2511429377 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 CONTRACTOR 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 AUUL bUk3H POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 100,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence S MED EXP(Any one person) $ 5,000 A 00126086-3 01/06/2025 01/06/2026 PERSONAL&ADV INJURY s 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER I GENERAL AGGREGATE $ 2,000,000 POLICY ❑JECT PRO ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A 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 S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of insurance CERTIFICATE HOLDER CANCELLATION 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 Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i� N YS I F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 � ^^^^^^ 843871920 1• DC RANIERI INSURANCE AGENCY . i 457 PALMER RD YONKERS NY 10701 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TRI STATE CONSTRUCTION & VILLAGE OF RYE BROOK RENOVATION INC 938 KING STREET C/O HERGEN-574 ANDERSON HILL RD RYE BROOK NY 10573 PURCHASE NY 10577 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2497 904-9 629414 01/07/2025 TO 01/07/2026 1/14/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2497 904-9, 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:/NVWVV.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT PAUL HERGEN TRI STATE CONSTRUCTION& RENOVATION INC (1 OF 1 PERSON CORP) 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 TT �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 928046375 U-26.3 Tara Orlando From: UDig NY Exactix<tickets@exactix.udigny.org> Sent: Tuesday,September 30,2025 12:49 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for:VIL RYE BROOK Taken:09/30/2025 12:48 To:VIL RYE BROOK PRIMARY Transmitted:09/30/2025 12:49 00001 Ticket:09305-001-694-00 Type: Regular Previous Ticket: --------------------------------------------------------------------------- State:NY County:WESTCHESTER Place:RYE BROOK Addr: From: 16 To: Name: COUNTRY RIDGE CIR Cross:From: To: Name: Offset: --------------------------------------------------------------------------- Locate:WORKING IN THE BACK YARD NearSt. COUNTRY RIDGE DR Means of Excavation:POST HOLE DIGGER Blasting:N Site marked with white:N Boring/Directional Drilling.N Within 25ft of Edge of Road:N Work Type:INSTALLING FENCE Estimated Work Complete Date: 10/05/2025 Depth of excavation: 2 FEET Site dimensions:Length 30 FEET Width 2 FEET Start Date and Time: 10/03/2025 07:00 Must Start By: 10/20/2025 ------------------------------------------------------------------------- Contact Name:PAUL HERGEN Company:TRI STATE CONSTRUCTION&RENOVATION INC Addr1: 574 ANDERSON HILL RD Addr2: City:PURCHASE State:NY Zip: 10577 Phone: 914-906-2577 Fax: Email:paulie1972@hotmail.com Field Contact:PAUL HERGEN Alt Phone: 914-906-2577 Email:paulie1972@hotmail.com Working for.HOMEOWNER ---------------------------------------------------------------------- Comments:Lookup Type:PARCEL ------------------------------------------------------------------------------ Members: CON-ED SUEZ WIR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 i I ' CYO 28 GI� S �N �O U E ? 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