Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BP21-150
�CRMIT # �.T SECTION __.Li TYPE OF WORK JOB LOCATION OWNER CONTRACTORS � � BLOCK � LOT. �.nl®r'P ��i.�C� �i�il�/1C � i. � I�r r i �� TCO # FEE DATE _ {NSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING L� RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT CI ALARM AS BUILT FINAL INSP I�ec� ��y C�� ��7c�-�93s -l;.�o �� y�a�o-�59a OTHER APPROVALS � ARC? J BOT P8 `ZBA II OTHER VILLAGE OF RYE BROOK WEBTCH1H;SrrER CouNTY, NEW YORK No: 22-011 (ferttftrate of Orrupaurp 'This is to certify that 5emeU 9"z'he yski u 5�-Twyara Duz.4 ys% 4— of, Ede, 'RYCXn L Ir]y having duly filed an application on 4 4 20 c� _requesting a Certificate of Occupancy for the premises known as, 4__ �� LC --)c , Rye Brook,NY, located in a -7 Zoning District and shown on the most current Tax Map as Section: 135-44 Block: Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. J)- ),170 -, issued CO I )S 20 02 ) , 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: &,k7 i° �" / I L� ,for the following purposes: e e-C i iin S 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 hall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has b tained-fre the Building Inspector. Building Inspector,Village of Rye Brook: Date: —JAN 2 0 2022 WE � ; For office use onI : BUILDING E"P" MENT PERMIT# C , I- ��N 2022 VILLAGE OF RYE BROOK ISSUED: 38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: - VILLAGE OF RYE BROOK (914)939-06" FEE: PAID BUILDING DEPARTMENT 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 +s++s+srrsrrrrrrsrrrsrrwwrwwtrwt*wtutu+t***tt*t*+*r****tr+rr►rrrr*srr*rtrrrtwwrrw++rrr+*sr*t*t+rrrrrrsrrsssssrrrrrstsrrrrrrrs Address: Ly Occupancy/Use: -FapC Parcel iD#:_ 13 5. qL.). - l- 3 Zone: )2-7 Owner: Zj Iq It Ot (/ 7 f/4C y. / Address: P.E./R.A. or Contractor:�� M(//l-('ILLu Address: /3dt, �• /TGi1� Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: (� STATE OF NEW YORK,COUNTY OF WESTCHESTER as: — f HAl A 0 R ,TJtgLgE V5J��'being duly sworn,deposes and says that he/she resides at `7► CAmp y LA t✓� rmt Name ofpof Applicant) �/' (No.and Street) in ) yE D�op i� Al / ,in the County of We 54 cA es4e r in the State of Y,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:$ 1? (fa y for the construction or alteration of y / `.t 7 t� i L l iL t_- �/'L/Jt-e , —-;e_Z—, 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 l U day o 70 v b� ,20 7 Z day of �/J.� i-'-r/j ,20 2-Z- o= l eV Signature pY e����H���/ � signature of 6 R -TAMAkA S�Lt42HEVsKI y lArnAP-a AjLu��rCVSK� }� Print Nam of Property Owner /P'rinn!-N�e of Applicant Notary Public Notary Public utt cut }�,FO .�P 'POA-v wwt� NcAreY LA McAt�Y�+'x''`'lr" 'G'' 1�s�21 � �t 4E BRC�v� w � BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑,KSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914)939-0668 FAx (914) 939-5801 www rnbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - --- - - I �`c k ` Z ADDRESS :— �-1_ `-�-L �'`` ,� _ _ DATE: 1 1 PERMIT#�`�a ` •� ISSUED: C ` SECT: BLOCK: LOT: LOCATION: \'"�'� / �� ' { � � OCCUPANCY: 1L� C. ❑ VIOLATION NOTED THE WORK IS... Q 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 Building Permit Check List&Zoning Analysis Address: L C�N�� LA,1� SBL: 1 Zone:2- I Use: Z l a Coast.Type: 3 Other. Submittal Date: - Z Z t Revisions Submittal Dates: Applicant: L v z 44 EV S h:1 Nature of Work. Ic-1nj !ES N xt3—trJ �FLr'(Z Reviews:ZBA: 1 PB• BOT• Other. 4K ( ( ) FEES:Filing: 1T�� BP: so C/O: Legalization: ( } ( ) APP: Dated Notarized: ✓SBL: --Truss I.D. Cross Connection: ✓ H.O.A.: ( } ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review Street Opening. ( } ( ) ENVIRO: Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( } (L}'SURVEY:Dated: Current: Archival Sealed Unacceptable: ( } ( ),,PLANS:Date Stamped: Sealed: Copies: Electronic Other. ( ) (0f License: 6/'Workers Comp: � Liability: Camp.Waiver. Other. ( ) ( } CODE 753#: Dated: N/A: { ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL Plans: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 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.( ) � 1 (P 2 ) pp GARB( mt .date: a rovah notes: ( )ZBA mtg. date: approval notes: ( )PB mtg.date: approval notes: REOUiRED EXISTING PROPOSED NOTES AvrKUVLU AMA. pate: J UN 17 2021 Front Front l?� Main Cov Acts,Cov Ft.HS : Sd.H/Sb: Im I=: - Ft Imp P Hight/Stories: notes: BUILDING DEPARTMENT R [E C IE 0 v E VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 MAY 2 1 2�2� (914)939-0668 FAX(914)939-5801 VILLAGE OF RYE BROOK www.ryebraol:,or� BUILDING DEPARTMENT 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: 4 Candy Lane Date of Submission: 5/c'�7/20 a ) Parcel [D#: I_55. ' 14—/- 3—Zone: 9-7 Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: Remove existing decking and railing and replace with M UST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building new. Cap all posts and header under deck. Install lattice Department by the applicant-no exceptions. under deck.All material to be PVC/composite. 1. (,,,,Completed Application 2. ( )Two(2)sets of sealed plans. (one full size(maximum Property Owner:Tamara Dluzhevskiy allowable plan size=36"x 42")and one I I"x17") 3. ( wo(2)copies of the property survey. Address:4 Candy Lane Rye Brook, NY 10573 4. ( wo(2)copies of the proposed site plan. Phone#216-702-4935 5. (�ne electronic/disc copy of the complete a lication materials. Applicant appearing before the Board: {, ( Filing Fee. Sal Morlino 7. ( )Any supporting documentation. Address:l Bonwit Road, Rye Brook, NY 10573 8. ( )H9A approval letter. (fapplicable) 9. (u4thotographs. Phone# 914-260-1592 10.( )Samples of finishes/color chart. (a sample board or Architect/Engineer; NIA model may be presented the night of the meeting) Phone# N/A 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 c.,2 ?� Sworn to before me this r,-7 day of , 20 'Z day of , 20 oC Signature of Property Owner Si ure f Applicant Arne ��w� 1-PCsxl y SQL 14� L14 0 Print Name of Property Owner Print Name of Applicant Notary Public Notary Public III 3121/14 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, June 16, 2021 Due to public health and safety concerns from COVID-19, the Architectural Review Board meeting on June 16, 2021 will be closed to members of the public. The public can still watch the live meeting online through Zoom through the app or through the following _hops://us02web.zoom.usli/85411174403 If any interested members of the public would like to provide comments during the meeting, comments can be emailed to stevefews@ryebrook.org or called in during the meeting at +1 (929) 205-6099, meeting ID: 854 1117 4403 NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 78 Woodland Ave - Replacement of Railing 5186 (Freeman) and Decking on Front Porch 5 Charles Lane Re-Do Existing Front Consent 5208 (Gasparini) Walkway In Blue Stone Agenda 1 Lincoln Ave (Parr) Replace Wood Retaining Consent 5209 Wall, w/Masonry Liberty Agenda Stone, & Walkway 4 Candy Lane Replace Decking & Consent 5210 (Dluzhevskiy) Railing On Existing Deck Agenda 1\C' (PVC Paramount �J Sandstone) 2 Charles Lane New 6' High Rear Yard Consent 5211 (Kaplan) Fence Agenda 16 Legendary Circle New Deck,New Patio, 5213 (Abramsohn) Retaining Wall, Expand Driveway & Landscaping 18 Rocking Horse Amendment To Prior Consent 5214 Trail (Feist) Approval Fence Change to Agenda Vinyl & Steps 23 Hawthorne Ave Outdoor Fire Place& 5215 (Quinson) Chimney ML 1! NM MR SE JM SE AC MI KC 39 Lountry Ridge Amendment To Prior 5216 t Drive (Austrian) Approval (Pool House Wrap Bottom In Stone Veneer) 65 rock ridge Drive Relocate Patio Door,New 5217 (Ayala) Windows, To Facilitate Inteiror Alterations 13 Knollwood Road Rear 1 Story Addition, 5218 (Luceno) Rear Deck, & Masonry Patio ML NM MR SE JM SF AC MI KC . " . < , 7 - � $ � t } kk � � I—!c § : § § ■ E ■ - ® E ) � 40 232 2 p K m / ■ R 2 ] \ 7 $ 3 ` � b K § k & ( ) D } c � - ca / � � \ @ $ / � 2 @ � E - � ƒ 0 � - 0 . o § � ■ � - ^ + � \ 2 - & ' / \ � E ■:. ƒ $ : � � i .a. r •: 11 r 7 7 v E n © c U g OL Y rs 3 s = c O LL c a $ a - owl Q t f� •� N .' RAMU ` V _ way WWI 3 A r •� Q. •. � � � 0 Mom'►,t• -•�-� _ ItNORO LL q i Q _ s � 3 rn - c _ w p,r y � ..,.djf,�t�- !rr44Y✓h o ��� r .� 4�'iS'V'{ a •. ' � r '''t �"F�ti `.�k�� �,g,� •1'♦ M i' ♦• 'I 00 ai � e♦ • a t�4 ` 01♦ �► •:; �:..,, �IIl4114�1� > �e°��'�€�ea',L, 1�1111411� � ��`, 11111114`i ���s$�' ��1114 1 411 1� _•�q ..I�Il�lllliyl - �s �If4 111�:... �-.111{I��{IIM�;�� 3.� � �,.t�M �Mel1 i� .i.N{ 111,�� .., Uy-� 11�I�,�F;a"� s,�eW I��;e.. s�•s'-' 11 liid #� saee-il�ll ?�3 s'x�ill II�.fi3: '� ll�il a'?;� rum *' ' . . . .. ... . . . . . . . . . .. d .. . . .. . ... . . . Ail 1 ,.ter� \ �. fin. a W,f rJ ,• ^ —j >s CM fC1G? CD mg O � its �..: : •�I W irinca, r ,1r O w 'wrinrll i w4.4 ,7IRtN <o)b ,tul� : 0 41. �' 'k•• ` r �' � v1 tigCtlQnso •�+ Jz = I Q 0 _j C 1 •E ryr O 1.1� L W i.-+ •-� ( �t'�,j��d�'� tip. { O ee UJ dBa , OF uj , 00 00 CD �<(0)D�vnrru ice��! ..�+ •� n,u r�<Ce'�)1 &" cv i ,! 11 }�h�, •`����°�?'.'`re�e�"�i+y � IllNpp'{,4 111 k "r`�i_ ��r�'.it�'-.I l•i1e{Ie{/lal i�11,, .:•�w �thual }, ����'o�3 1���r i�11!41�1�1{I1Ie!I!Is�'+'a-a- 1141e/�{.l�a1l1 11l'i'rY-.rs4 a w '$�,3r,�1I'1i1.1e/�4/♦,1 111!1 w.,rF#�`r a�ww,� isi,•E�1�e1/1e1�4/e411a,� Syr, ��41441;14.14 2'.10 w- � th ACo CERTIFICATE OF LIABILITY INSURANCE °ATE"MM°°' `` ii 0 511 812021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: NORTHEAST AGENCIES, INC. PHONE 833-250-9900 FAX (EIC.14%ExW - _ A1C No): 820+ IBM DR,BUILDING 102 E-MAIL ADDRESS: CHARLOTTE,NC 28262 INSURERS AFFORDING COVERAGE NAIL 0 INSURER A: LIBERTY MUTUAL INSURANCE COMPANY 23043 INSURED INSURER B: " SM BUILDERS INC. DBA WESTCHESTER INSURtERc: _ PLUMBING&HEATING INSUR_ER0: _ 1 BONWIT RD INSURERE: FORT CHESTER,NY 10573 INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE D POLICY Eft= POLICY YY LIMITS LTR POLICY NUMBER MM1DD MMlDD GENERALLIA51UTY EACH OCCURRENCE $ 1,000,000 ENTE - X COMMERCIAL GENERAL LIABILITY PREMISESIg6 nce $ 300,000 CLAIMS-MADE IX]OCCUR MED EXP(Any one person $ 15,000 A Y N BKS(22)61273032 05/22/2021 06/22/2022 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIDP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT La accident S__ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per aoddent) $ AUTOS AUTOS — - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acrid t $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N RY�IMITS ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? -- I(Mandatary in NH) E.L.DISEASE-EA EMPLOYE $ _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD i0i,Additional Remsrks Schedule,if more space is required) CERTIFICATE HOLDER LISTED AS AN 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 STREET ACCORDANCE WITH THE POLICY PROVISIONS. RYE BROOK,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD Y ' F New York State Insurance rund WESTCHESTER ONE:,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS,NY 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 0 ^A^A^A 133452720 S.M.BUILDERS, INCORPORATED T/A WESTCHESTER PLUMBING&HEATING 7 TOWER HILL DRIVE PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER S.M. BUILDERS, INCORPORATED T/A VILLAGE OF RYE BROOK WESTCHESTER PLUMBING& HEATING 938 KING STREET 7 TOWER HILL DRIVE RYE BROOK NY 10573 PORT CHESTER NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1316 251-6 489325 03/02/2021 TO 03/0212022 5/3/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1316 251-6, 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:IIWWW.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. SALVATORE MORLINO-PRESIDENT S M BUILDERS INC ONE 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 STATE INSURANCE FUND C,— 20---Z� DI RECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 888652965 O N Q a Z iV W O 3 � .� .r �.-i � z Zoc >- W �- ;��, qt a Q W „Qa Z = V Z Q . CV w to F- Nl �. n �'" cma o c� w �i Ln (A IL z (A N CL 1 z V a �6, J/ `► 1 w O W - LaJ � N LL-L3 Q Z m -' r >- O c� to m _ �- J - W Z 0 O . ♦ -- Q m � y o Z 0 f� I. Q �' `� W o < o �0 m �" N O a z 2 I - J Q W < , Q, o �; 0 > 3: In [off w uj J u (n w < cc P) IL D 00 qIO 0 0Q N O-J V� Y Ott 0 " a 0 z 0" N z a o// /" bi u U • c Op U. �' O O 0 z u t�. \1 - _ uj W k Z .�" >. • ° 0c) 0 �` V� az = > q**z WNV ` .. U� W > --- W y 0 > A rya [� cl Z C Z cc 1 �7= O llOF 0 1� : Q W tA W ZLAM W h 1� 1 V o b --N u z Q �A z �1 c ui who �`� O 1 col � „ � �. �.. �. � �_ 0 d c� u i Q yLv 10) QO cr W Oc a 90 Z j �a �� a � _ 0 � uf Qf J v V Z � 4c0: CO w � � � J � p . o �• Q WQ � 4) < _ Z 0 W .. w c O Nk V > W Z slo- w a �X— 0 w x D U) U. w w cc Cap d'r1l w (A J 0 Q ♦ _ = W W V) _ V < - ow U Z 0 m t- w < 2 > � w �i U) t CL 0 U W W "" of cr► �- t� h z a — o z / • w ,Q V > > ,� V d I. � cr. i •- w o 0 0 &1 x >- oVNzZuw Qcri >= W = Z a: W � LLJ W :E > W J W Z WLnO0 > < V .. w Ir = W Co pC oc J a J J 0 = 4 < J Q tl� U. o w si = o L w 0 amm zz 4-