Loading...
HomeMy WebLinkAboutRB25-0063 c O O ` 41 N oY c� > ❑' '❑ > > T U 4-j O C a`�i C v 4.1 +� v L CA E >o N +� 02 aQ� W U OC— c N � E o a W C U a, a .O W 3 > cn L .n MA'�'� O O z >� m > v a �o Zo "p "p N vi O LU u ^ v z W L -1 '� � WH 3 L00 O N > O C I N o y n i o C C � a aJ E— Z N 3 mo Q } d N °v sio r LLIZ OOv- 0 r- NC C U E rN U WHY G LEO O O q o7wo v o a $ vZ m m « 0c,0 Es M J N E o � 0 0 o o0 — m EL m 3 O C Y O S > m C 3 Ca } O N oc = o Q a Yw — W o � Z `^ u � �c > C O 10 � --' Z dJ Qp c o m E a } � 3L � 0 �> LN Z 0W � O Oa ra Zco C N Y C u r- U > cEv +' v M 0 o0 o c > LL 00 a�i .O w Z �O 1 J O m Ln O a E i O M O� �O a im Z t w � v Y Na � ,;, c o � W O O � Q o > o 0 U ao, Q 4-j N W U Q E J_ Z Q Q � QJ v m 0 -q 0 -0 a W W V J Z LL � = a� O ai \ Z J C E U O � c� N � co (B Z (B J C O W >- c Ln 2 Y r .cu C N } O C6 co � Ya o E O as EQ E �= Q N OU � aim V) O 9Z u y 3m 4--1 O n ao v = � 2 U Q D x •g' v O �` a i Lr) >t a a1 iy N ai >CD C14 t LE ^, Lr) Q cn > a` a ON rj nl p o p W N E c � yu a Zn ooa r Oq •r am E O MW a10 > O m D F v C SEa -0 E J W W 0W O rtG CD C _ Q +; co G Q U H o � E u ^ u iCL., O ._ y� 39d1� a Q a a = � � � � Interior Building Permit Application Village of Rye Brook 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information SBL Zone Address Line 2 129.25-1-1.64 PUD 20 JASMINE LANE Proposed Improvement ALTERATION TO EXISTING FINISHED BASEMENT BY ADDING A BEDROOM AND FINISH STORAGE AREA. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? ❑ Yes 0 No Will the proposed project require the installation of a new, or (if yes, applicant must submit a separate Automatic Fire an extension/modification to an existing automatic fire Suppression System Permit application & 2 sets of detailed suppression system? (Fire Sprinkler, ANSL System, FM-200 engineered plans) System, Type I Hood, etc...) © Yes ❑ No N.Y. State Construction Classification N.Y. State Use Classification Occupancy Pre-Construction TYPE VA-WOOD FRAME-PROTECTED R-3 1 FAMILY Occupancy Post-Construction (1 fam., 2 fam., comm., etc...) NO CHANGE What is the total estimated cost of construction: (NOTE: The estimated cost shall include all labor, material, 25000 USD scaffolding,fixed equipment, professional fees, and material and labor which may be donated gratis.) Interior Building Permit Application,page 1/1 BRnuk VILLAGE OF RYE BROOK � 938 King St Rye Brook,NY 10573 .� uJ Q Phone:(914)939-0668 1 www.ryebrook.gov /� 19p2 i Building Department Residential/Interior(Remodel/Renovation) Permit Permit Set 20 JASMINE LN P#RB25-0063 R#129.25-1-1.64 PERMIT INFORMATION Address Permit number Date issued 20 JASMINE LN RB25-0063 10/31/2025 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 2-3 Required Inspections 4 Building Inspector Stamped&Signed Set of Plans 5 Architectural drawing 6 Westchester Home Improvement License 7-8 Interior Building Permit Application 9 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BRnv� VILLAGE OF RYE BROOK O Z 938 King St Rye Brook,NY 10573 W � Q Phone:(914)939-0668 1 www.ryebrook.gov >���• 1 82• Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQUIRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE ❑� a REQUIRED INSPECTIONS Name Description Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) Rough plumbing Installation of all plumbing including drains,waste,vents and water supply lines.A test for this portion is required including a 100 psi test on all water supply lines. Rough Electric Rough Electric Framing Construction of all structural framing and stairs.(Rough Plumbing and Heating passed and doors,windows& roofing installed.)Engineered drawings must be provided for roof trusses. Insulation Installation of the insulating material and vapour barrier.Blown-in insulation can be installed after the ceiling drywall is applied and confirmed at the Occupancy inspection. Final Electric Final Electric HVAC-Mechanical-Furnace Installation of furnace,air conditioner(if included in the permit)and grills/registers.An Air Balance Report Heating/Cooling Final may be required. Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) 10 c O ❑ t 5 c 2Y •~ 0 L L ^ 0, o ❑' ❑' u �--� .� QED a N L c v c L a 00 v o, i- c Cl a( v _ y m m �, E W m H c m a= �a v a 3 o. Lij L) E O x ul o Cl w LLI Q/) LLI " m Em O sya Lac+ ti1-1 ^-Z w o N ,O N 0 F- O O F- Z 3 W, 0 Q N o C4 O - ou,- v aZzOv b u aO l a- p Z 0 o ac 2,0 � C) < U LLJ W O o Yc iEL um = o aQUQ OLL' o � 0 f W = � a06 , = Ca N> Z w J (~ E 5 tcv p yo cu Q i a o > •- m � Y � of � � co :t M a 06 YW — W < UQ �-+ � � Z kn} u � E� 0 � _ r U Q Q c o m E a _ O Z D w L f0 O c C m w -0 o c } Z o� L z U > v o � u Y W O 06 u o v a>i 0 aG ., �-j p m � � o w v E LLJ X o M F' a aoi Z L ,v_ o `o Q m � W u } 0 0 06 0 v J Z ; O = two 0 N c .0 t O r7 J v O v C W � E J Z L.L > = 0 , '= v > u m 0 Q� Z `� a w0 � v � a, 0o o f �_ YO W } c in 3 Y y c z M a E p dd EQm E � N m aim V) 0 aov � 3m Oi O (V a � O > HQ wN 2 > c i c " N Q r-I d N r-I CV o , o L U N E -0 'No m a ar � o o ate " �L W c� q o oi 10 °U � `° E 0O o O � �c g - m2 g ' c E v m E>uj � ,c G� r blo w J w_ O p " atea, w W Q E " � U 1- c � u ^ u t-! LlJ 0 Q Q 7 v+ u s CL Q a a = N H v L N Electrical Permit Application Village of Rye Brook WW 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information SBL Zone 129.25-1-1.64 Proposed Electrical Work/Fixture Count 3rd Party Electrical Inspection Agency Wiring Bedroom in basement wiring lights in storage room- 5 SWIS receptacles&1 switch Master Electrician/Licensed Installer Information Name Lic# Address email Phone# Cell# Company Name Company Address DARWISH ABDALLAH 1935 914 217 8322 Address of Work? Homeowner Information 20 Jasmine Electrical Permit Application,page 1/1 BUILDING DEPARTMENT VILWE OF RYE BROOK 938 KING' ET RYE BROOK.NY 10573 (*l , -0668 WWWAVewookn ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP it: Z. EP#: Approval Date: Permit Fee: S Approval Signature: _ Other: DO NOT START WORK or CONSTRI CTION 11, 1 11 I'LRMI I IIAS BI I N 1­1 LD Bl THE BI'ILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR(WORK PROGRI -F.D OR CONIPLI.I LD 1%I I'HOUT A PERMIT IS 12%0F"THE: TOTAL COST OF CONSTRI ( I ION WITH ,% MININII N1 FEE OF S7S0.00 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 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.Couny and Local Codes. 1.Address: �—b U Q S M/9 e /I'1 SB L: 12-A • 21:l • (J Zone: 2.Property Owner: .��� L_ Address: L-Q Phone#: Cell#: y wig /�163 email: ec»'J 3.Master Electrician'Licensed Installer: fit h a/der L 1)Q yd.l f Address:f�jY t.oK-i CIY�Lt.r+ /¢pt a L Lic.#: Phone#:!1/N 21 t33 2.Z Cell#: email:�+I�S cer�+eler fr r/T� Company Name:C'I'Y4<<.a G/,eLt r-,< Address/ t C/ls,-.en+ 4.Proposed Electrical Work/FixtureCount: w/ii'a,r �l^.vay„ ,' JJ4?la'Qr�� S.3rd Party Electrical Inspection Agency: 5%_I S STATE OF NEW YORK,COUNTY OF WESTCHESTER I as: ak",& A ��., �e being duly swom,deposes and states that heishe is the applicant above named,and does further 1 print name of individual signing as appljcanh 1_ state that(s)he is the h All l� / for the legal owner and is duly authorized to make and file this application. i Master Electnctan/Licensed Installeri The undersigned further states t at all statements contained herein are true to the best of his/her knoll ledge and belief.and that am work performed.or use conducted at the above captioned pmpertq vvill he in conformance+kith the details as set forth and contained in this application and in am accompany ing appro+ed plans and specifications,as well as in accordance with the Nev+ 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 daN of 20 day of r 20 Signature of Property Owner Signature /o Applicant `a-6 l /r /4,(/ -Da Print Name of Property Owner Pri ame of Applicant Notary Public N14RFOWWRIVERA Notary Public,State of New York 611/2024 No.01 RI6441398 Qualified In Westchester County Commission Expires September 26.24 y BR VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 � W Q E Phone:(914)939-06681 www.ryebrook.gov Building Department Electrical/New Fixtures And Wiring(Remodel)Permit Permit Set 20 JASMINE LN P#RB25-0133 R#129.25-1-1.64 PERMIT INFORMATION Address Permit number Date issued 20 JASMINE LN RB25-0133 12/01/2025 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 Property Owner/Homeowner Government ID,and/or Proof of Ownership 4-33 3rd Party Electrical Inspection Form 34 Electrical License-Photo-Westchester County 35 Application Materials 36 Electrical Permit Application 37 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BRnv� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W Q Phone:(914)939-0668 1 www.ryebrook.gov �O �982' Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSI BLE FOR ENSURI NG THAT ALL REQUI RED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE RN N 7 31' 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. Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) STATE WIDE INSPECTION SERVICES, INC. 0.0 • • SWIS JOB APPLICATION0. • Office Usr Elect.Permit# Date Bldg Permit# Sci Ft Plumbing Permit# Final Certificate# C^/Village / �,J,o x Zip Building Dept. County Address 6 Q I e Cross Street Section Block Lot Owner Name/Address(u different man above) Contact Number Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Residential ❑Commercial Receptacles Special Recept GFCI AFC1 Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact j Amt Amps I Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P I 3P tt 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 w,KI Y1j i:y *S S 1LcyrA� rc�0l1'f - "Ns appkatlon s valid far one I t l year ham the date received by SWIS.Thts application is intended to cover the above listed items to be Inspected A at any time of inspection additional items have been installed.you are .uthonzed to mate die"section and WOW the he for the addmorW items inspected the applicant declares that there n no open appacatsons for the above address with any omen inspection company The applicant. owner a&~zed agent agrees to as the above to and conditions as tet forth for the application. Email Address C re$C iie—yi f e/ie C.f rr L Name License# Date�� 2 ao� - S Signature Address / y cryT C�'C�CCrt i 2 City/State �(/ Zip Code Company Cr�S C e—o-1 O r— le,- e Phone# 9/eY 7i/ 7 2 p3 Z Z �O > O *: N c � 3 O >, ERR,E O > > > Q, E � N icy a v (U Y ; v o � u aQ� a, mE W o H 0 C L c a ~ a cua Li `) -o X +, ~ o a o W C (%) L m o L O m � a a L ^^,, O W u Ln - s H /�W W I..L � W 3 ` z O N a�i F-- N Y 3 �' 0 O N y GD Q } p oU L Lw Z O_0 o UJ LLJ wa0YY � O Y ( EO ° N U) o O ' OW 3 Z m � E o ° cao a) 0coH cy0 J Lu L + J N m — m o E .� C >• m L � � g � 8a >.o Yw — L W o000 DZ � - � � �6o Q � Y W w .- L C< V n 0� u u U-) . y Cl m O (� L- f W7vCZ M � L. ZQ -0 0 W Z Ln +1 4 ' W 3 ; a, ° a } Zu00 C C O c = ma � UO � m UU O N Wp ICJ ov a) > O M O, Z Q � CD ra ca m a w�i Z � : L W Ol v W O O UO } C C N . N c LLJ } O 0Oc 0Q Z dE E wa�E p > Uu 0 oMZ � Q � O O U) 0) C H M- J U w v a Z UJQW c JJ Od J_ C D WO cv� YEc O W J = > C7 } O N L!j a �' Q C) U N o C C W T 0 a a y N •� O O O_ m mu z u y 3 m O QU ct� Nv � _ = a� 2U Q� X > r O N u v C C .� >> c 0 Q o a� N Q d J l7 Q Q N > a d N Q' rj N O r o o CN � '- ° � m a a, r L O O a.-0 yCC L a C W ooa � m � w E m (UmV O m 2 G � c co , wm g9 :o = E NEW Yp�� N c > E ", � c (� c� C~ W J W O p > ' a a� ai CC)d 0' C U H Lij 00 MwU >d �r W Q Q oi- .-^ va� u y��9d1 a Q a a m V) � v y L v v a C N L L1 c I-, CO LL C m N 3 v L.i c v N ° Plumbing Permit Application z. Village of Rye Brook 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information SBL: Zone: 129.25-1-1.64 Sprinkler App Filing Proposed Work: Modifications to existing fire sprinkler system in basement to coordinate with new basement layout. 4 relocated teliable sprinkler heads Indicate Fixtures&Lines to be installed as per the following schedule: 1st 2nd 3rd 4tj�t Other§fWipment/Provide Details: FIXTURES Basement Floor Floor Floor Floor Floor Exterior Water Closets Urinals Drinking Fountains Sinks Showers Bath Tubs Laundry Tubs Domestic Service Fire 4 Service Sanitary Sewer Natural/LP Gas Other* TOTAL Plumbing Permit Application,page 1/1 BRnv VILLAGE OF RYE BROOK . . 938 King St Rye Brook,NY 10573 ; Q Phone:(914)939-0668 1 www.ryebrook.gov �O a ��• 1942• Building Department Plumbing/Other(Remodel)Permit Permit Set 20 JASMINE LN P#RB25-0143 R#129.25-1-1.64 PERMIT INFORMATION Address Permit number Date issued 20 JASMINE LN RB25-0143 12/01/2025 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 2-3 Required Inspections 4 Building Inspector Stamped&Signed Set of Plans 5 Application Materials,Property Owner/Homeowner Government I D,and/or Proof of Ownership 6-7 Plumbing Permit Application 8 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 �yE BRnv� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W � Q Phone:(914)939-06681 www.ryebrook.gov >���• ©2 • ��o Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSI BLE FOR ENSURI NG THAT ALL REQUI RED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE a ;k Ri 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. Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) VIOLATION RR�CTED it lots w � a Ono Cc E 2g C41u H .. p 0 d � m � - acr, w [� 04 c Q U ZIca Lb wg ; - A 5 zwo � 00 00 -8 � 00to A w I Ecim Z w 3RCi, !�'Q 4S LiW ��jg WZJg26^.�, r� lo`Oa 91� i 9 P"101dldvw NOLLY�OIT"3AOSUON'S11 AMr37rNMWUr3I71NRIdS1N3W3SVY 1 t n a i A...mess k W i / W R 2f t j s t,. ta"� I 3 Yfi 6u,;)png awoi� g �' so a C, a • ,�' �� �i p 1 LL x a � D J LY J w r awo � © ���� r� ���� ` �� � E xt �•�,� ESP ��sa 5 S�yef�@X r& 2p 3�X �!' Sra 3:� F �el�ls �� �6° �3■ e ; gP $y� y;�, £tl Eg ��s4a$E Y r G R S �R t �'�S� €. i & M IN Y s�1g51 Yj Y� ts Q >fk ��� . � �4 �. e � I � � ���tS.�yyft SK;=E3r�ee�RrRe yCRs*{.sS ���K(B_o}R•p.kE�•%, ��@o L&PR�e1` �t�I��sFP�°Y gi�g@Y@btl2p ��=FCC F 4�p3 5�§E a'y.R �Oz� ��y5R'�k��S$"{C�¢j e�^3�Frdd������������g e�RnP� ayPye`�����a{E�EF§��4�+eY�rz�ya�c'FI rgF�z'Ft4�F�d3a.beP.FEe�Fka�K��6ICi 8G°�k��@��t:x>YiaYt}a3���[y>Y�kaY�}8�r1 �.y sqYry">4e,9 till giRmweyes '$ xYaAR upw .P.96!��5i7 i5 eEe 3��'`(S< k�s r3 cSr�dv� - w X . w _t X - st■id �� a� �. �ttta►� - car tf ttf 9C id Its < }}} XXX XXX XX XXX XSXX XX XX x ii ti'gill, ii� ° iitt %� ,• x �KXXXX m °� x IY ¢§ X Z t ` XIft Dt•� < z t 0 ES X ` I=1 ,x iii Z\ 11 � i i X X / X I W r I = X � F lift t• d�§ •, y �Eti:d BUILD, NG D.-ENATMENT C c "i VILI OF Rl"E BROOK 938 KING Q ET RY BR001i ,NY 10573 NOV 13 �j 4)939-0668 vvv c jt2okM.tjov APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Approval Date:NO V Z 6 �11 Application Fee:S 1 O ED ' --- Approval Signature: _- Permit Fees: S Disapproved: Other ****************** ********i*+ ****:':*****-''k *';i:*****4. Application dated: October 27,2025 is hereby made to the Building Tnspector of the Village of Rye Brook NY for the issuance of a Permit to install or modif\ :t Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. lob Address: 20 Jasmin Ln, Rye. Brook. NY 10573 2. Parccl LIB.: 129.25 / 1 / 1.64 /one: 08-1 3. Proposed Work I Describe system in detail including suppression agent): Modifications to existing fire sprinkler system in basement to coordinate with new basement layout I 4. Number 8t Types of Fire Sprinkler Heads: 4 relocated Reliable sprinkler heads 5. N.Y State Construction Classification: 58 N.Y.State Use Classification: R2 6. Estimated Value of Job:S, 54000 (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may be donated grain, 7. Property Owner: Philip DiLemme Address: 20 Jasmine Ln.. Rye Brook. NY 10573 Phone# Cell# email: pdilemme0gmai1.com Mastrogiacomo Engineering PC 8. Architect(Engineer: Michael Mastrogiacomo, PE, LS Address:10 Midland Ave, Ste100, Port Chester,NY 10573 Phone# 914.920.6372 Cell email michaelm@masengpc.eom 9. Sprinkler Contractor: TBD Address: Phone# Cell email: t 6/tno24 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 N ;W YORK,COI TNTY OF WESTCHESTER Q1��LI P bV t Lt►NMC_ being duty sworn, dt poses and states that he/she is the applicant above named, ipnnt name of individual signing as the applicant/ and further states that (s)he is the Sprinkler Contractor Em the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best ofhis/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 hire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and reaulations. Sworn to before me this 3G'�` 5wom to before me this day of 69C day of "sigmirum of PropMy twaQ Signature„f Applicant Print Name of Prope _ wn 1 rint Name of Applicant NoLvN Public Notm Public TERINA L MASSAREGLi LN!ary Public-State of New Yor, No 0I MA504gXy nfiedin yyestcnester c,,,,tvttrrtist�,Ori es t420 2 6/I Rt124 N 2 � y _ I• , N �• N co u I - Er- O III. r a�i f _ V O c. L W ? uco " j - a •�" 0to c Z w C) �, O � U Z C� Q LLJ Lu c , Z ' I w Q a a Cl.0 vCD N = 4. .N �O �G L _ u I. A IN <t0v�i Ca to L; c D Y Acoar� CERTIFICATE OF LIABILITY INSURANCE DATE(MMI00lYYYYI 1 0/2 712 02 5 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 NAj EA T _M_atthew Daley PHONE FAX 631-744�3.950 AfC,No). 631-744-3363 The Daley Agency Irc No.E101t _._____ t 1010 Route 112 Ap E-MAIL matt daley@farm-fam;y.00m Sidle 200 AFFORDING COVERAGE NIMCS Port Jefferson Station NY 11776 INSURER A: United Farm Family Irtsutartoe Company 29963 INSURED wwwm III, Farm Family Casualty Insunum Company 13803 Anthony Loddo General Contracting Inc INSURER C: _- 21 Waldo Ave INSURER0: INS_U_RERE. __--- White Plains NY 10606 INSURERF: 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 W TH 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. IN3R TYPE OF INSURANCE �SUBR POLICY NUMBER POLICY EFF P CY EXP LM LTR A X COMMERCIAL GENERAL LIABILITY 3102X9397 06/25/2025 06/25/2026 SUMOOCURRENCE = 1.000,000 CI AIVS-MADE X OCCUR PF!EkMKS-T -gpmr r10E1 _ j_._ 5' _ 1 MED EXP one arson $ 100.000 — PERSONAL aADV INJURY s 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 11 2,000,000 X POLICY r 7 PRD. LOC PRODUCTS-COMP/OP AGG >< 2,000,000 OTHER: JECT : A AUrOMomnuAasJrY 3102C2580 06/=025 06I23IZ026 aCOM�nti' I $ 1,000,0-ffA00 ANY AUTO 1 BODILY INJURY(Par parson) $ XX OWNED X SCHEDULED BODILY INJURY(Par accident) $ AUTOS ONLY AUTOS ----- -------- HIRED NON-OWNED PROPERTY DAMAGE : X;AUTOS ONLY AUTOS ONLY Ertl B X UMBRELLA LIM �OCCUR 3101 E6623 07/1012025 07/102026 EACHOCCURRENCE $ 1.000,000 EXCESS LIAR AMIDE AGGREGATE $ 1,000,000 DED RETENTION$ WORKERS COMPENSATION I PERT UTE ER AND EMPLOYERS'LIABILITY YIM A ANYPROPRIETORIPARTNER'EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? ❑ MIA -- - (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ -- n as descnoe under 7 E.L.DISEASE- LIMITOE SCRIPT ION OF OPERATIONS below DESCRIPTION OF OPERATIONS,LOCATIONS I VEHICLES (ACORD 101.Additional Romano Seheoule,may be attached if more space is required) INTERIOR CARPENTRY Job Location: 20 Jasimine PI, Rye Brook, NY 10573 CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 King Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i(_NEW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name & Address of Insured (use street address lb. Business Telephone Number of Insured only) 914-490-2802 Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, lc. NYS Unemployment Insurance Employer Registration i.e., a Wrap-Up Policy) Number of Insured ANTHONY LODDO GENERAL CONTRACTING INC j lid. federal Employer Identification Number of Insured or I 21 WALDO AVE social Security Number: WHITE PLAINS NY 10606-1603 146-0571498 2. Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage United Farm Family Casualty Insurance Co. (Entity Being Listed as the Certificate Holder) 3b. Policy Number of Entity Listed in Box "1a" Village of Rye Brook 3104W9415 938 King Street 3c. Policy effective period Rye Brook, NY 10573 08/10/2025 to 08/10/2026 j 3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included) j o all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of 7-7 the policy effective period? x 'YES IN0 This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may he used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Matthew Daley (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _ October 28, 2025 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 631 744-3350 7 , i gadCL ui Jug ��tjtlni,i}4##' i,f #ftj�i W p L ZO¢� Q O � J 0r-Dz U �- w � oW � � m00 = w Ssm 51 Q�� f — LLI zed uj " _ w � LJJ a- ul m :D V � p � �� � O zwW 1 Zui F- s; w CC a: w v �� ire •i��i It„ {� 0 #�I , a a 0 q f E: a- } Z w J x ll 0 fiI � J� i 0 W W O 0 CD !- -- 020 W lr zap 0 G W Id z � � z A kZ x --E - i g i o w u. Z c _ o Y f= J 1 LL F- _ W C/ z W I m rc ' t 0• y m C C. L L d d } a _ w w+ - W cf)CD c_ f - Q C Q z — J J H `� 4--- W 0 Q av� o 66 P e ta@ !' �� pp � IQpgji��aitlP� @ Ills g � 7 3 pf z a:'o Z r p�4 � m v t LL I t � u. r ~ i t 3 Z ® � w co A S if W �� � o dCL ��pa � � d z �q�6 fil �i ly{ w� {f lef ti R n e i z {f fl{ � ' o o g 8{t ® o s uj € c Q zm co lu U et O x w w z y b 0 z d C G 20 �I