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HomeMy WebLinkAboutBP21-050PFUR IIT # �UI"o7/-' oJ�d DATE: �� _ UP: 3 �� 1 a SECTION S -p :S� BLOCK LOT 'y S TYPE OF WORK /i/)17` C2serne�71- r S71D� nl J JOB LOCATION Q V QJIV Ll r1W C G OWNER.y CONTRACTOR ZCO TCOST � FEE # told - �ic� J FEE 0 Ot DATE Da TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C7 RGH PLUMBING GAS 0 5PR!NKLER EI_E#."TKau r LUVV—VOLT f ALARM AS BUILT FINAL iNSP if 'C=ol —/� 8i/ OTHER APPROVALS ARB BO? PB ZBA OTHER F�AliSHED EASEMENT NOT APPROVED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT VILLAGE OF RYE BROOK WESTCHEST R COUNTY, NEW YORK -021 NO: 22 Certifiraze of Orrupaurp This is to certify that [j U/ koinesh ,/ t,�y�'l/l s tati 1/ U{if cru Z J`V_oy 1 of, 9 Y C BYC)nk—, NY Y having duly filed an application on =ebVl�a�Y I 20c� requesting a Certificate of Occupancy for the premises known as, 50 V Terrac e , Rye Brook,NY, located in a � — � Zoning District and shown on the most current Tax Map as Section: . J'q Block: 1 Lot: '4L4 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. c;� —��� , issued / 20 such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the New York State Use Classification of: IC-, Q e " Fa �-) l`/ ,for the following purposes: b0 sue.m en-� rQge- or) IV 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 a made nor shall the building be moved from one location to another until a permit to accomplish such change has beeh Qb g Inspector. uilding Inspector,Village of Rye Brook: Date: F EB 1 0 2022 L �] BUILDG DEN` '�MENT For office use on] D E C E � VE ]D . , ,ti PERMIT# I-U�G 'VILjE OF RYE'BROOK ISSUED: - C / FEB - 4 2022 938 KING STRE RYE BROOK, NIJw YORK 10573 DATE: - - �? FEE: / PAID VILLAGE OF RYE BROOK w BUILDING DEPARTMENT APPLICR 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 wwrwrwwwwwwwwwr+rwwwwsswwwwxxxk+sxx+ww*wwwwwr+ww+w++++w++++++++++++**+++**+++*+********+++*+*+***+++++++*++*+**+++++***++**+++ Address: 50 `v CJ(fl� Terr j%x e Occupancy/Use: -6 Parcel ID#: �JG ~ 4L - Zone: R -4 Owner: N Aa,I t Address: �o Val It�, T L P.E./R.A. or Contractor: Address: Person in responsible charge: 11 1X1 I y l+ Address: '5b Va g e r C Application is hereby made and submitted to the Building Inspector of the Village of a Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OFNEW YORK, COUNTY OF WESTCHESTER as: yie't 1 r)N t being duly sworn,deposes and says that he/she resides at (Print Name Applicant) I - 11 __ ( nd Street) in (Zy-2 6r&o k ,in the County of eS 4-G d- in the State of N `` ,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 1 have been donated gratis was:$ I o, MO for the construction or alteration of: gQ Sp- 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 /0 Sworn to before me this f d4ig. !e f v�'� � , 20 � day off , 20 4#r0per2ty0,j' gna a of Applicant V ( 1 t Pri me of Property O n Print f Applicant ms- o Notary P&M6"', 'e I"" -DtC7t f N NoWIAIig- State O No ';` 5284153 No. 01 i,'-.16284153 Qualifir,c, !-\,rigs County Qualified i+, i,lrtysCounty 8/12/2021 Certificate filr3c! in Bronx County Certificate filed M irk County c: oss.o:. ,r expirct;J ,e 17,20 2� 25, QyE BRC�j'�. o`` tim w � 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 : Vp DATE: 1 �� PERMIT# l.?C — 0� ISSUED: 1 l31 �tjLOCK: I LOT: �(c f r LOCATION: ~ C1� l OCCUPANCY: ❑ VIOLATION NOTED THE WORK I3:.. 6--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 INAL .r! ❑ OTHER 198'2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK LJ CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - -- - - ` air ADDRESS :- T1- S\ Q C-C- DATE: q - PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED HE WORK IS... -ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION v REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑�j TROUGH FRAMING NSULATION �`❑� NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER E BRC7uk 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ""SS'STANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑COE ENFORCEMENT OFFICER 938 KING STREET+ RYE BROOK,NY 10573 l (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - -- - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— V (, cs (c, DATE: ` D { 07 f PERMIT#'V l' ISSUE : SECT1 BLOCK: t LOT: t� LOCATION: Nt S `�� �' Pm ��' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/ REINSPECTION ❑ SITE INSPECTIONS REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING , I ROUGH FRAMING /❑ INSULATION ❑ NATURAL GAS ' `-� , �^ \ CAS \ 4_ ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER i* fi�+i+ w�• � T i 9 lr w � � � 6 � 1� �� � i� � � + iC; 41 4f4.C; 4' 4*tit41.-ts1� Go co ' I N h s V 0000 cc ►� J :J V7gz tn > co r = lu ON w _ z O V Fr w 0-0 C v C G W � U z Q On m 0.1 Z r~ m Lw6 41 REcE�VIE yEaR��� JuLj �;4 L IL$UIEARTMENT VILLAG Va.Wa�.'E OF RYE BROOK BUILDI G 938 KING ik&EET RYE B4 'NY 10573 (914)9t-w 6 AX`( )939-5801 r .or 61 ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 'Z 1 G 5-7) EP#: 1 Approval Date: J U Permit Fee:S Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, 'I 1`l 2-1 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. The applicant & property owner, by signing this document agree that all electrical work performed will be jjinn�conformance with all applicable Federal,State,County and Local/Codes. `!� �'7 I.Address: V VC( � 1- .i '�-�r✓ SBL: /,55t J 7 -"�'21,q Zone:� f 2.Property Owner: Address: . "G(,1 ?P�i'►i Phone#: Cell#: email: f 3.Master Electrician: j I S[!t"1 Ve i t"Z Address: L&Wn AVC, D L,I Lic.#: i L40-1 Phone#: 203 2}.{t! ITO Cell#: 'ZU3 nQ- �q71 email: W Company Name:__ACA VLl f'1-tl A .5j Cc-t t i eQ l 1 dress:�"rs 4.Proposed Electrical Work/Fixture Count: , ti , y .2 U' 36 ii STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: W d San r`/e)<Z being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the CC) 6.C'tlS for the legal owner and is duly authorized to make and file this application. (indicate architect.contractor,agent,anomey,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to be ore me this Sworn to before me this 44" day p 20 Z I -day of ,20 y( Signs a if Property Owner Signa e o pplicant t -Son VIPAC t Name[of Propefty O t ame of Applicant r � ry Public �-'rj7j� � Public 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. r A n-9q4-3'7-3595 DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue Fax 914 34i-3596 Elmsford, NY 10523 EILDING PERMIT NO. TEMP k DATE 21 p}�I CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY / - STREET AND NO.OR ROAD - POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS'PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH iNCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT s'FL. 2 FL L 3-FL PgMEW REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPUCATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS, INC.IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT. MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW L] ADDITIONAL❑ EXPOSED O CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND I_] AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT X STREET ADDRUB TELEPHONE NO. CITY OR POST OFFICE P CODE LICENSE NO.WHEN APPLICABLE t�. -j- --' WESTCHESTER ROCKLAND %WE la ELECTRICAL INSPECTION SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Advanced Electrical Contractors Inc. Fany&Vipul Nay! 51 Giles Ave CT, North Haven 06473 Located at:50 Valley Terrace Rye Brook, NY 10573 Certificate Number: 1032595 Section:135.59 Block: 1 Lot:44 BDC: Permit Number: EP:21-188-BP:21-050 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located inlon the premises at: 50 Valley Terrace Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 02/02/22 Name Type Quantity Switch Single Pole ------- 5 Receptacle Convenience ------- 20 Fixture;other Flush Mounted 16 Smoke Detector/Co2 Combo ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. / , �E BR�k. 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.orl; - - - - - -- - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 0(-fJt p V:k DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: �S ��r � OCCUPANCY: 0 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 �` \) W T '� (!:l` ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ` ❑ FINAL12Q ❑ OTHER 17 �r Steven Fews From: Steven Fews Sent: Wednesday, December 9, 2020 3:15 PM To: Steven Fews Subject: Stop work orders : . ORK ■ r«F: „ 4 l�,lu� t cam'RVIL BROOh.. NY YOU ARE IIEREB` „ i 6 i.11 -10 STOP ALL W011�F,&NID T()UTNf'R1 L%C CEASE& DES]S'1 ALL UNLAWFUL. LASE OF THIS PROPEJtTY/PRLMISES .1T; 1- u�ar.traetuiar, + _�• .�71teRN�q; �-.-,.-. .__rle�'.rs.il�k�ni�i � bC#�i.. c"._ E$1 t] F.�urtpawidaW"- O.tVgJW.4Tt.AfliRl/0lodctf kin #ETc a BEt►Txis 1�At�CE 12 a'rRMB EUNJSMAN LU f Building Permit Check List&Zoning Analysis Address: !��--::- SBI_ i 3 S, S T1 Zone: :2`7 Use: Cont.Type: Other: Submittal Date: i -Z ti Revisions Submittal Dates: Applicant: N A Y Nature of Work k SC7-V-1zN� S 6ki L Re vi w:ZBA: M A R 1 6 ?021 PB: BOT: Other. �S•� Z$ �F C/O: Legalization; { ( )OK FEES:Filing. ✓ BP: Leg . ( } (--Y"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: Z 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: I-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: ttEOUIRED EXISTING PROPOSED NOTES MAR 16 2021 Am Date: Circle: Fi°�taQe Front: Front: sidz: Ear. Maul Cov: - Accs•Cov Ft.H/Sb: Sd.H/Sb: SzF: Tot. F=Tmo: Earkiug Hsig /Stories: notes: Mett-ife Auto & Home Metropolitan Property and Casualty Insurance Company 12123/2020 Platinum Homeowners Declarations ST 31 Policy Number: 2844447000 Page 1 of 3Change 01 Policy Term: From 02/18/2021 to 02/18/2022, 12:01 A.M. Standard Time Policy Change Effective Date: 02/18/2021 at the location of the property Bill To: Insured insured as stated in the olic . Named Insured: First Mortgagee: Loan 0572281129 FANY NAYI WELLS FARGO BANK NA#936 VIPUL NAYI ISAOA 50 VALLEY TERRACE PO BOX 100515 RYE BROOK NY 10573 FLORENCE SC 29502 The residence premises covered by this policy is located at: 50 VALLEY TER RYE BROOK NY 10573 Basic Policy Coverages Limits Premiums A- Dwelling $ 301,000 $ 640.00 B - Private Structures $ 60,200 C - Personal Property $ 225,750 F - Personal Liability: Each Occurrence $ 300,000 $ 13.00 G - Medical Payments to Others: Each Person $ 1,000 Loss of Use $ 90.300 Causes of Property Loss Comprehensive Perils Building Property Loss Settlement Coverage A Plus Incl Personal Property Loss Settlement Replacement Cost on Contents Additional Coverages Ordinance or Law Limit 50% of Cov A $ Incl Personal Injury Coverage Back Up of Sewer, Drain and Sump Pump Coverage $10,000 Limit, $1,000 Deductible Prior Annual Premium: $ 653.00 Current Annual Premium: $ 653.00 Change in premium from 02/1812021 through 0 211 8/2 0 2 2: $ .00 This change to your policy is effective back to 12/23/2020. Zhange in premium from 12/23/2020 through 0211 812 02 1: $ .00 Deductible(s) $1000 deductible applies to each loss Other Than Hurricane and any other coverage(s) with distinct deductibles noted. $1000 deductible applies to each Hurricane Windstorm Loss except Loss of Use =orms and Endorsements: H'P1000 0902 HP2200 0902 HP3500 0904 HP4330 0902 HP5100 0105 HP6100 0902 H P7000 0902 HA01 NY 0910 HA05AA 0920 HA1001 0205 HA30NY 0204 HF10NY 1207 Wci MdLik A�tO&Horn is a bland of Melropohtan Properly and Casualty InsuranceCornpany and its aH�hales Warwick.RI MPL 1380-000 Printed In U.S.A.0298 0077W20030,0000001031H;844447000040000 MetLife Auto Homey Metropolitan Property and Casualty Insurance Company 12/23/2020 Platinum Homeowners Declarations ST 31 Policy Number: 2844447000 Page 2 of 3 Policy Term: From 02/18/2021 to Change 01 0211812022, 12:01 A.M. Standard Time Policy Change Effective Date: 02/18/2021 at the location of the property Bill To: Insured insured as stated in the policy. ' Discounts for the following have been included in the current annual premium: *10% Superior Home Discount Applies A Special Group Rate Applies Rating Information Territory 56 1 Family Frame Construction Composition Roof Insured DOB 04/29/1984 Built in 1942 Roof Age 02 Years Co-Insd DOB 12/23/1985 Updated in 2019 A 1% Lead Exposure Exclusion Credit has been applied to your premium. Messages This Declarations Page does not supersede any cancellation notice issued prior to this change. THE STATE OF NEW YORK REQUIRES THAT WE DISCLOSE THE FOLLOWING INFORMATION ABOUT OUR FEES IF A PAYMENT IS NOT MADE DUE TO INSUFFICIENT FUNDS FROM YOUR BANK ACCOUNT (NSF FEE) OR IF YOUR PAYMENT IS LATE (LATE FEE): UNDER THE CIRCUMSTANCES LISTED BELOW, WE WILL CHARGE YOU FEES ASSOCIATED WITH THE COST OF PROCESSING CERTAIN POLICY TRANSACTIONS. THESE FEES ARE NOT PREMIUM. BUT ARE REGARDED AS AN OBLIGATION OF YOURS INCURRED IN CONNECTION WITH THE PAYMENT OF YOUR PREMIUM THEREFORE, NONPAYMENT OF THESE FEES CAN RESULT IN CANCELLATION OF YOUR POLICY. FEE CHARGES WILL BE SEPARATELY NOTED ON YOUR INSTALLMENT BILLS. NSF FEE - IF YOUR REMITTANCE FOR PAYMENT OF YOUR OBLIGATIONS TO US IS DEEMED NSF BY A BANK, WE WILL CHARGE YOU A$20 NSF FEE. LATE FEE- IF WE DO NOT RECEIVE YOUR PAYMENT OF A BILL AND A NOTICE OF CANCELLATION FOR NONPAYMENT IS ISSUED, A$25 CHARGE WILL BE ADDED TO YOUR NEXT BILL. The cost of any coverage indicated as "Intl" is included in the Basic Policy Coverages premium amount. Your policy tier level is 01. This Policy Does Not Provide Coverage for Flood Damage. Additional Insured/Mortgagee First Mortgagee: Loan 0572281129 WELLS FARGO BANK NA #936 I SAOA PO BOX 100515 FLORENCE SC 29502 MetL.te Auto&Home is a brand of Metropolitan P,opedy and Casualty msutance Company and its afriates Whwck Rt MetLife Auto & Home" Metropolitan Property and Casualty Insurance Company 12/23/2020 Platinum Homeowners Declarations ST 31 Policy Number: 2844447000 Page 3 of 3 Policy Term: From 02/1$/2021 to Change 01 02/18/2022, 12:01 A.M. Standard Time Policy Change Effective Date: 02/1812021 at the location of the property gill To: Insured insured as stated in the policy. Updated Policy Information First Mortgagee Replaced For service or claims, call 800-GET-METE or write to: MetLife Auto & Rome PO Box 6060 Scranton, PA 18505 955-ODF-1 yyUU,, Mel Life Auio&Homers a brand or Metropolitan Properly and Cawalty Inwrance Company and its afhuate5.Warvwck.RI {•� Y+C 00775001007010000001131H2844447000000000 Renewal EZ400033805 PRIVATE FLOOD INSURANCE POLICY DECLARATIONS Authority Ref,No,: PTPR02100209 Certificate No: EZ400033805 Insurers: Certain Underwriters of Lloyd's of London,One Lime Street,London EC3M 7HA,UK Policy Period: 02/18/2021 to 02/18/2022 Both days at 12:01 a.m.standard time For claims reporting or payment status,call: 1-844-640-2522 For all other inquiries,Contact the producer identified below. 1. Name and Address Information Insured: Fany Nayi Producer: METLIFE AUTO&HOME INSURANCE AGENCY 50 Valley Ter PO Box 751525 Port Chester,NY 10573-2136 DAYTON,OH 45475-0000 (877)638-0022 First Mortgagee: Wells Fargo Bank,NA#t936 ISAOA Second Mortgagee: PO BOX 10OS15 Florence,SC 29502-0515 Loon No.: 0572281129 Loan No: Z. Property Information Property Location: Flood Risk Zone: AE 50 Valley Ter Port Chester,NY 1OS73-2136 Post-Firm/Pre-Firm: Pre-Firm Primary Residence: Primary Building replacement cost: $290,000 Contents replacement cost: S50,OOD 3. Coverage and Costs Coverage: Limit: Deductible: Premium: A.Building For Flood $250,000 $2,000 $625 For Catastrophic Ground Collapse $100,000 $2,000 Included B.Personal Property $50,000 $2,000 $250 C.Other Coverages Various N/A Included D.Increased Cost of Compliance $30,000 N/A $70 Optional Coverages Subtotal Premium: $945 SL Broker Charge $50.00 SL Tax $34.02 Service Fee $1.61 Please reference your certificate forms for specific coverage details,limitations,and exclusions. Total Paid: $1,030.63 4. Forms Attached and Special Conditions PRIVATE FLOOD PLUS INSURANCE PROGRAM STANDARD FLOOD AND CATASTROPHIC GROUND COLLAPSE INSURANCE POLICY DWELLING FORM EZ-1(05/15),LSW 1001(08/94),LMA3100(09/10)and LSW1135B(06103). S. Surplus Lines Broker&Compliance Wordings Surplus Lines Broker: Date Issued: 02/04/2021 John Dickson Aon Edge Insurance Agency Inc. License: EX- 544056 MSC 85096 PO Box 803507 Dallas,TX 75380 COUNTERSIGNATURE: Dated: 02/04/2021 This policy meets the definition of private flood insurance contained in 42 U.S.C.4012a(b)(7)and the corresponding regulation. THE INSURER(S)NAMED HEREIN IS(ARE)NOT LICENSED BY THE STATE OF NEW YORK,NOT SUBJECT TO ITS SUPERVISION,AND IN THE EVENT OF THE INSOLVENCY OF THE INSURER(S),NOT PROTECTED BY THE NEW YORK STATE SECURITY FUNDS.THE POLICY MAY NOT BE SUBJECT TO ALL OF THE REGULATIONS OF THE DEPARTMENT OF FINANCIAL SERVICES PERTAINING TO POLICY FORMS. Form: EZ-200-1(05/20) Certificate#:EZ400033805 Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence "Thu form cannot be used to waive the workers'compensation rights or obligations of any party.** Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): U I am performing all the work for which the building permit was issued, © I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work for which the building permit was issued or helping me perform such work. ❑ I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that I am applying for,provide appropriate proof of workers'compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work i dicated on the building permit. 3A1b\ a 1 (Signs of Homeowner) (Date Signed) lovi /^ I Home Telephone Number (Homeown 's Name Printed) • Sworn to before me this _ 1 day of Property Address that requires the building permit: Est; u-2 5c) VCk1. (County Clerk or Notary Public) gr IQ�J S r '� SHARI MELILLO Notary Public, State of r4ewYork No, 01IVIE6160063 O+.ia1 lied in Westchester County 7 2 ('!nrr•-^,ic,rin.n �Yr,.Sr!`.n,E, 'l',�r,.7� ?(1 !// ♦ a Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB