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HomeMy WebLinkAboutRP21-060PERMIT # /`r SECTION TYPE OF WORK JOB LO( TION . OWNER -- C� DATE. E (P: BLOCK C 0T y)939-4 yaa CONTRACTOR _ _ EST. COST _ �di - FEE �CO # FEES I /O �P- 6 DATE 5 O TCO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS L� SPRINKLER ELECTRIC 0 LOW -VOLT CO ALARM ALARM AS BUILT 0 FINAL FEE DATE INSPECTION RECORD DATE INSP OTHER APPROVALS ARB PB __ ZBA OTHER �yE 6R C �'4•oa a�v . 19 � VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.cMbrook.org TRUSTEES BUILDING&FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J.Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 15, 2021 Dominick Tavoletti& Gwendolyn Tavoletti 107 North Ridge Street Rye Brook, New York 10573 Re: 107 North Ridge Street, Rye Brook,New York 10573 Parcel ID#: 135.67-2-5 Roof Permit#21-060 issued on 10/20/2021 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg D DBUICLDTNtTMENT For office use only: ��.1/ PERMIT# p1I�CJrDC� NOV -8 20210 vILI,AG of RYE BROOK ISSUED:/8--aoY&1 S DING STREIGT,RYE$ROOK,Ntw YORK 1I.0573 DATE:�t- VILLAGE OF RYE BROOK 4J14)4 -06b8 ' FEE: 10— PAIDJIK BUILDING DEPARTMENT vry( y, eokrg APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ssssssks*ssk+ss+rk*k**krrrrkrrrs+krs+srrsrssssrsrsssrsrrrrswsrsrrsrssrsrsarrssrrrsrrsrrrrssrs+r+kkrkkrs++rsass*+srssssk+ssr*+s* Address: N-0 -7 � - � S� 3�� c�ACC 5 "":�� t o 7 3 Occupancy/Use: } Parcel ID#: /35. 4 7 Zone: R 7 Owner: ',Q ML to t c ks. -C ci Address: '�-0 T � } C fiJ� 4a 5�i P.E./R.A. or Contractor: S C— f--'EF Address: Person in responsible charge: -Lt. Address: ' L Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: -q>-Cl "`-C%< owe. i�--W, being duly sworn,deposes and says that he/she resides at ti 0 z &L-- Qk�%�V C E 5'C (Print Name of Applicant) (No.and Street) in_ -4 9: in the County of in the State of I.� ,that (Cityaown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ >, Ct.C7 U Q , for the construction or alteration of 4e- 0 C V— 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.f Sworn to before me this !' &` Swom to before me this day of ,20 `N day of , 20 r ' Signature of Pro Signature of Applicant a'tift fit:& -��0:46' � Print Name of Property Owner Print Name of Applicant otary Public r Notary Public ALEXANDRA H.MARSHALL Notary Public,State of New York 8f12/202 i No.O1FR63637J-t Qualified in Westchester County f commission Expires August 28,20'A' E BR(�k o`` tim BUILDING DEPARTMENT ❑ UILDING 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 • 1 V t + DATE: PERMIT# G- IOU� ISSUED: SECT: BLOCK: -Z LOB': 5 LOCATION: itclut � 1 W�3'`-� OCCUPANCY: 2—P ❑ VIOLATION NOTED THE WORD IS... 1CCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION v 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 ❑ SS CONNECTION INA L rf OTHER .r OEICO Insurance Agency, LLC Renewal,Declarations Underwritten by Homesite Insurance For Policy Number 36309427 Company of New York, a Stack Company Policy Period This policy covers the listed 1 Federal Street location(s) Boston, MA 02081 From 12:01 AM August 24, 2021 Phone number: 1-866-372-8903 Through 12.01 AM August 24,2022(local time) To Report a Claim: 1-866-621-4823 Dominick Tavoletti Gwendolyn Tavoletti 107 N RIDGE ST PORT CHESTER, NY 10573 < Issued by Homesite Insurance Company of New York Insured Location 107 N RIDGE ST PORT CHESTER NY 10573 Location ID: 000000058 Description of Dwelling 1964 Wood siding, Single family home, Primary residence Deductible— Other Covered Perils $1000 In case of hurricane loss under section 1, we cover only that part of the loss over the deductible stated. Hurricane Deductible 5% ($21800 please refer to Important Messages Coverage Limit Premium Section I - Property Coverage A - Dwelling $436,000 $1,561,00 Coverage B -Other Structures $43,600 Included Coverage C - Personal Property $305,200 Included Coverage D - Loss of Use $130,800 Included Section 11 - Liability Coverage E - Personal Liability $300,000 $74.00 Coverage F- Medical Payments to Others $1,000 $3,00 Coverage Modifications $67.00 See Coverage Modifications on reverse side for details Additional Premium $0,00 See Additional Premium on reverse side for details Discounts -$244.00 See Discounts on reverse side for details Total $1,461.00 Authorized Representative Policy Number 36309427 HA D1 01 NY 11 17 �s+oon w,w o.maimo,r*rxnrw awon mro w.a Mm Coverage Modifications $67.00 Additional Limit Premium HD-0171298 Deductible -$127,00 HO 04 20 0511 Specified Additional Amount of Insurance for Coverage A- Dwelling 25% $32.00 HO 04 90 0511 Personal Property Replacement Cost Loss Settlement $162.00 Additional Premium $0.00 Limit Premium F Discounts -$244.00 Limit Premium HA 80 80 0218 Hurricane Percentage Deductible - New York -$82.00 HD-063 1101 Drive Home Discount -$162.00 Contracts and Amendments HO 00 03 0511 Special Form (HO 00 03 0511) HA 01 31 1116 Special Provisions - New York HA 80 66 0520 Diminishing Deductible Credit HA 90 05 0417 Amendatory Endorsement- Pollution Exclusion HO 24 93 0502 Workers Compensation Policy Number 36309427 HA 1)1 01 NY 11 17 — eQe,oan�pr o acz,ora,narvrrw 000e,o m,r .o.•a zu I Important Messages These Declarations are not the entire Insurance policy. All information contained in the Declarations regarding the insured, covered property, coverage limits, deductibles, and premium charges is subject to the specific terms and conditions of the policy contract. Please read your policy contract and amendments carefully. We relied on the information you provided to underwrite and issue your insurance policy. Making sure the information we have about you is correct and up-to-date will ensure your home is adequately protected. Please review your "Declarations" page and check the description of your dwelling, occupancy, deductibles,coverages, and contracts and amendments. If any of this information needs to Y be corrected, you must advise us within 30 days of receipt. You stated that: • you occupy the insured property and do not rent out to more than two (2) roomers/boarders no commercial or retail farming is conducted on the premises • you do not have a dog As an Auto policyholder of one of our affinity partners, you are eligible for a discount on the base premium of your Homeowners policy. This discount is shown in the Discounts section of our declaration pages as Drive Home Discount. You are entitled to this discount as long as you remain with your current Auto Insurance carrier. If at any time that policy is cancelled and you no longer have auto insurance with this affinity partner, you will no longer be eligible for this discount. While it is your responsibility to ensure the amount of Coverage A(Limit of Liability for this structure) is sufficient to rebuild your home, we make every effort to assist you in determining the proper amount of coverage. Any coverage recommendation you may have received is based in part on an estimate of the Replacement Cost of your home. We may increase your Coverage A during your policy term or at renewal based on additional information we receive from an inspection of your property. Replacement Cost is generally defined as "the cost to replace a structure with materials of Like kind and quality without deduction for depreciation". It is a good idea to reevaluate your home's replacement cost after you have completed any remodels, upgrades or modifications to your home. If you have made any alteration to your home, please contact us. Poky Number 36309427 HA D1 01 NY 11 17 �•9m0IN M 09 i®9RI09 Y18RYY1i"]0.1„9p m Y P i e91!4 GEICO FOR YOUR HOME GEICO Insurance Agency, LLC S--d lhr xh C.iKI INSURANCE AGENCY Underwritten by: Homesite Insurance Company of New York PO Box 9503 Fredericksburg, VA 22403-9503 Tel: 1-866-372-8903 To File a Claim: 1-866-621-4823 RENEWAL BILLING STATEMENT Dominick Tavoletti Policy Number: 36309427 Gwendolyn Tavoletti Policy Term: August 24,2021 —August 24. 2022 107 N RIDGE ST Payment Plan: Full Pay PORT CHESTER, NY 10573 If you have any questions, please call us at 1-866-372-8903 Property Address: 107 N RIDGE ST PORT CHESTER, NY 10573 ti See reverse for other important information. Billing Summary (reflects activity this billing period) PRIOR BALANCE 06-30-2020 $1,388.00 RENEWAL POLICY PREMIUM 08-24-2021 $1,461.00 PAYMENTS RECEIVED 08-01-2020 -$1,388.00 NEW BALANCE 06-30-2021 $1,461.00 Minimum Amount Due: $1,461,00 Important Note: You can pay by phone with your credit card or an electronic check. Any check or electronic payment returned by our bank may be subject to a $10.00 fee. For your convenience and installment fee savings, please consider paying via automated recurring deductions from your checking account. For fee details, please see page 2. Bill Schedule (based on current payment plan) Statement Date: July 4, 2021 Dee Date Amount Due 08-24-2021 $1,461.00 Access your policy online and Go Paperless at www.homesite.com/mypolicy. REMITTANCE SLIP GFJCd.IFWYOUR HOW Please detach and return with your payment Remember to write your Policy Number on your check. Make check payable to HOMESITE INSURANCE HOMESITE INSURANCE Due Date: August 24, 2021 P O Box 414356 Amount Due: $1,461.00 Boston, MA 02241-4356 Amount Enclosed: Ill—110-1.Ill.1 I,,,II.LJ.JL..IJ 11-11I.JI„1 I,II 006936309427720210630202108290001461,0000000146100142007 Policy Number 36309427 HH A101-0401 uzraw—ar 12W 1091 1rt1nranw a '"apn Billing Statement (P.2) Important Information Payment Plan Options Plan Amount Due Details One Payment The full policy premium, any applicable state fees, and any $1,461.00 outstanding prior installments,are due on the effective date. No service fee applies. Four Payment(Quarterly)* 40%of policy premium, any applicable state fees, and any outstanding prior installments,are due on the effective date. $584.40 Remaining balance will be billed in 3 quarterly installments. An installment fee will be applied to each installment after the first bill. Ten Payment (Monthly)* 25%of policy premium, any applicable state fees, and any outstanding prior installments,are due on the effective date. $365.25 Remaining balance will be billed in 9 monthly installments. An installment fee will be applied to each installment after the first bill. '4nstallment fee is$5.00. EFT fee is$3M Service Charges: You may be charged a$15.00 service fee if we issue you a legal notice of cancellation for non-payment of premium. Recurring Payments: To eliminate check writing, sign up for payment deductions from your checking account. Your premium due will be paid automatically. For enrollment details,contact Customer Service at the phone number shown on the front side. wmo r.,+w m atrt+mrt rra.nwn oom no m, P.o.a d ro i Information Used to Underwrite Your Policy We use information obtained from a combination of data sources to determine eligibility, calculate an estimated replacement cost and determine a premium during your initial quote. Below you will find some of the information we used to help create your policy. Please review this information carefully and identify any changes that may be necessary to properly insure and rate your home. If you need to make any changes, please call us at 1-866-372-8903. Estimated Replacement Cost of your Home (Dwelling Coverage A Limits) The Dwelling Coverage Limit of Liability ("Coverage A°amount)of your policy is provided on your declarations page.This Coverage A amount is based on an estimate of the Replacement Cost of your home, which has been calculated from the following information based on the Exterior, Interior, and other Characteristics of your Home: Home Exterior Characteristic Information Used Style of Home Ranch Number of Living Units 1 Number of Stories 1 Original Year of Construction 1964 Approximate Living Area (Sq. Footage) 1,568 Occupancy Type Primary Is Home Built on Slope NO Type of Exterior Siding Wood siding Foundation Type Closed Basement Type of Garage & Size 2 Car Attached Roof Shape Gable Roofing Material Asphalt shingles Year Roof Installed 1999 Home Interior Characteristic Information Used Inside Wall Material—Type & Percentage Lath and Plaster 100% EB loors —Type & Percentage Tile-Marble/Granite 100% asement in home 784 Ceiling Height 8 ft. or less Number of Rooms with Cathedral or Vaulted 0 Ceilings Number of Rooms with Crown Moulding 9 Primary Heating Source GAS HOT AIR Number of Fireplaces 0 Fire Place Type(s) Kitchen Countertop Material Silestone Number of Full Baths Number of Half Baths Electrical Wiring Type YES Central Air Conditioning Central Indoor Sprinkler System NO Fire Alarm Type HH1276GE0619 caFrmo r�nn a aoz ao iNrawrw c a x m,a yea+a a© Burglar Alarm Type In addition, the following information was used to determine eligibility and additional rating of your policy-. Additional Information Information Used Swimming Pool Y Y Dog(s) 0 CommerciaVRetail Farming on the Premises Portion of Land Leased to a Td Parry Exotic Pets N Y Presence of Solid Fuel Burning Stove N Business Conduced on the Premises Number of People Living in Your Household 2 Does your Property have 60 ft. or more of NO Fence? Partner Auto Policy 4204490561 New Home Purchase NO Policy cancelled in the last 3 years for non-pay? 0 Length of Residence 18 Customer Age 86Y Finished Basement Square Footage 784 Residents beyond immediate family 0 ***Which factors and how they are used for rating, determination of an estimated replacement cost and program eligibility vary by state,policy type, policy terms and underwriting company. Any corrections requested to the above information will be used to underwrite your policy. HH 1276GE0619 WSIM-M ai M101Wr Nu"­­ F.p.awrn Menu of Optional Endorsements A complete list of your policy's coverage limits can be found on your declarations summary. In addition to these coverages, we offer a wide range of optional endorsements that can be added to your policy to enhance the protection of your home and personal property, as well as extend additional protections for liability and related risks. We also have a number of discounts and credits that may reduce your premium. We urge you to review these coverage and premium options. Please note, if coverages do not appear on your declarations summary, they are not included in your policy. It there are other coverages that you would like to add, or if you have any questions, you can check out more information online at www.homesite.com or you can contact Customer Service at 1-866-372-8903 to discuss any changes to your policy. Optional Endorsements and Coverages Below we have outlined a list of our most common endorsements as well as a few more ways Homesite can help protect your home and your peace of mind. Dwelling_Coverages Description of Coverage Extended Replacement Cost on This endorsement provides additional coverage of up to 25%or 50%of your Dwelling Dwelling Coverage it the amount to replace your home exceeds the amount of coverage provided by your policy. Increased Limits on Other To protect structures other than your home you can purchase this Structures endorsement It provides an additional limit for specified structures on the residence premises covered under Coverage B. Personal Property Coverages Replacement Cost on Personal When you purchase this endorsement, you can replace stolen or destroyed Property personal property with items of like kind and quality without deduction for depreciation. Increased Limits on Personal This endorsement offers you the ability to increase certain personal property Property coverages from the standard homeowner's limit. For example, the base homeowner's policy covers the theft of valuable silverware for up to$2,500. With this endorsement you can choose to increase that coverage to$10,000. Increased Limits on Business For an additional premium, this endorsement increases your coverage for i Property "business" property on and off the "residence premises". Scheduled Personal Property This endorsement allows us to offer open perils coverage for your valuable items such as jewelry, furs, cameras, musical instruments, silverware, fine arts, and golfer's equipment. Losses on scheduled items are not subject to a deductible and these items would be covered up to their insured value. Special Computer Coverage We know your computers are important, that's why we offer this endorsement. It broadens the coverage for your computer due to direct physical loss. For example, if you accidentally spill a glass of water on the computer, the resulting damage would be covered. Identity Theft Recovering from identity theft can be time-consuming and costly. In the event your identity is stolen, this endorsement covers up to $15,000 of expenses you incur as a direct result of identity theft. This coverage is only subject to a deductible ranging from$250-$500. Liability Coverages Loss Assessment Coverage This endorsement provides additional protection for assessments made by your homeowners or condominium owners association resulting from loss to association property or from a claim for bodily injury or property damage arising out of the property. Persona!Injury With this endorsement, you can extend the limit of Personal Liability on your homeowner's policy to cover you against libel, slander, and invasion of privacy. HH 12 48 CW 05 15 {C=5,000-W.,-I0701-w�'.-) Other Coverage Options Earthquake You may add this endorsement to cover your property against loss caused by an earthquake. This coverage is subject to a separate deductible. In California, this coverage is offered through the California Earthquake Authority (CEA). Water Back up and Sump Provides coverage for direct physical loss due to water backing up Overflow through sewers or drains and water that overflows from a sump. This is not flood coverage, which requires a separate policy. Discounts and Credits Check out our discounts and other ways to save. Discounts Welcome Home/Home As our way of congratulating you on your new home purchase, you could Y Purchase Discount receive a discount when you buy a new home. Moving In Discount Moving from an apartment or condo into a new home? Congratulations! You could receive a discount just for staying with Homesite. We appreciate your continued business and will always be there for you as your needs change. Drive Home/Affinity Discount We're happy to help with all of your insurance needs. If you bundle your home and auto policies together, you could receive a 10%discount. Roof it Over/ of Roof When your roof is less than 10 years old or you decide to purchase a Discount new roof make sure to let us know, you may quality for a discount on your homeowners insurance premium. New Construction/Age of Home New homes have the benefit of advances in building technology and are Discount less likely to have a claim. We understand this and offer a discount based on the age of your home. Safety First/Premises Alarm or We like that you value home safety as much as we do. If you have either Fire Protection System Discount central monitored or direct-line fire or burglar alarms,or if you have sprinklers in every room of your home, you could receive a discount. Better Together Now you can save on those endorsements that you would have purchased anyway. Homesite offers two endorsement package options that cost less than if you bought the endorsements by themselves. Gets Better with Age/Retired If you're above a certain age or retired, you could receive a discount. Occupant Discount Eligibility may vary depending on your area and availability. Check with us to see if you qualify. Other Ways to Save Increased Deductibles By increasing your deductible(s) you can lower the cost of your annual insurance premium. For instance, increasing your regular deductible to $2.500 may decrease your premium significantly. ***Availability and eligibility requirements vary by state, policy type, polic)r terms and underwriting company. Discounts will be automatically applied based on your eligibility. Additional endorsements and credits are subiect to availability and qualification. HH1248CW0515 SCSI JX Nu IY'ul�lOa�I Y+P[WINI OOIU'►]S19 � a ti]f! GEICO insurance Agency, LLC Underwritten by Homesite Insurance Company of New York PO Box 9503 Fredericksburg, VA 22403-9503 Phone number: 1-866-372-8903 To Report a Claim: 1-866-621-4823 Property Loss Report Customers with prior property claims may have an increased premium. Homesite Insurance Company of New York uses company records as well as data obtained from A-PLUS to determine { claims history. To determine if your claims history has impacted your premium, please call: GEICO Insurance Agency, LLC Customer Service Telephone: 1-866-372-8903 Under Section 612 of the Fair Credit Reporting Act you have the right to obtain a free copy of your property loss report within 60 days by request to: A-PLUS Consumer Inquiry Center 545 Washington Boulevard 22"' Floor Jersey City, NJ 07310 - 1686 Telephone: 800-709-8842 Under Section 611 of the Fair Credit Reporting Act you also have the right to dispute the accuracy or completeness of any information A-PLUS furnished in this report, by notifying them directly of the dispute. Please note that A-PLUS does not participate in determining your premium, and cannot give the specific information on our rates. Consumer Report Information The premium for your policy was based in part on a consumer report provided by Trans Union Corporation. There are marry factors which are used in producing the consumer credit report. According to Trans Union, the following criteria had the largest impact in determining your insurance score: The consumer has made no bank credit card applications in the previous 12 months but 1 or more in the previous 24 months. Optimum value is 0 in the previous 24 months. Most recent credit application was 24 months ago. Optimum value is 25 months or more; score will improve as months since last application increases. Homesite Insurance uses your insurance score as one factor to determine your overall premium level. One or more of the reasons shown above has led to a premium other than the lowest premium level. In many cases, customers who have above average credit pay less than those with average or below average credit, but may not qualify for the absolute lowest premium. Policy Number 36309427 HH1201CW 0605 iFSi Wm NI nc 09 iOQ,aro ­.X IN X" v­iaaw Cans imer R .port Information, continued _ Under Section 612 of the Fair Credit Reporting Act you have the right to obtain a free copy of this report from Trans Union upon request within 60 days to: Trans Union Corporation Consumer Relations - East 2 Baldwin Place P.O. Box 1000 Chester, PA 19022 1-800-916-8800 1-800-645-1938 (automated) Under Section 611 of the Fair Credit Reporting Act you also have the right to dispute the accuracy or completeness of any information Trans Union furnished in this report, by notifying them directly of the dispute. Please note that Trans Union does not participate in determining your premium, and cannot give the specific information on our rates. Policy Number 36309427 HH1201 CW 0605 !q!�rN�Da 102 i0i0t YlilltllYill OOOOa p 00 s vsy.i!a xo NEW YORK HOMEOWNERS PROGRAM CATASTROPHE WINDSTORM DEDUCTIBLE MANDATORY DISCLOSURE NOTICE THIS NOTICE IS TO ADVISE YOU THAT YOUR HOMEOWNER POLICY IS SUBJECT TO A CATASTROPHE WINDSTORM (HURRICANE) DEDUCTIBLE. ELITHIS DISCLOSURE NOTICE DOES NOT PROVIDE COVERAGE NOR DOES THIS NOTICE REPLACE ANY PROVISIONS OF YOUR POLICY. YOU SHOULD READ YOUR POLICY AND REVIEW YOUR DECLARATION PAGE FOR COMPLETE INFORMATION ON THE COVERAGES YOU ARE PROVIDED. IF THERE IS ANY CONFLICT BETWEEN THE POLICY AND THIS NOTICE, THE PROVISIONS OF THE POLICY SHALL PREVAIL. Your policy insures against the peril of WINDSTORM. When covered property is damaged or destroyed by a hurricane, a catastrophe windstorm deductible will apply to the total of the loss for all Section I Property Coverages. We have briefly outlined below the key points associated i with the catastrophe windstorm deductible. Please see your policy declarations page for the catastrophe windstorm percentage deductible and corresponding dollar amount. This is the amount that you are responsible for in the event of a covered loss due to a catastrophic windstorm (hurricane). Your policy contains a basic deductible that is shown on the Policy Declarations Page included with this policy. The higher windstorm deductible applies when a Category 1, 2, 3, 4 or 5 hurricane, as described in the Windstorm Deductible endorsement attached to this policy, makes landfall anywhere in New York State as a declared Category 1, 2, 3, 4 or 5 hurricane as determined by the National Weather Service, or makes landfall outside of New York State, but which is determined by the National Weather Service to provide Category 1 or higher force winds in the area within New York State in which losses occur. This means that any windstorm loss to covered property that occurs within a period of 12 hours before or 12 hours after the storm which caused the loss makes landfall anywhere in New York State as a declared Category 1, 2, 3, 4 or 5 hurricane as determined by the National Weather Service, or makes landfall outside of New York State, but which is determined by the National Weather Service to provide Category 1 or higher force winds in the area within New York State in which losses occur, will be subject to the higher deductible. Otherwise the lower basic deductible applies. I The National Weather Service currently uses the Saffir/Simpson Hurricane Scale to categorize hurricanes. This scale specifies that a Category 1 hurricane is a storm that originates in the tropics and results in sustained wind speed of at least 74 miles an hour. This scale also sets forth criteria for Categories 2, 3, 4 and 5 hurricanes, which have greater associated wind speeds. HH1202NY01It o W wnoq mom nwuom"W ou,o If your catastrophic windstorm deductible is in the form of a percentage, you can compute the actual dollar amount by: Multiplying the Coverage A limit of liability by the percentage amount when insured under a Homeowners policy. If the Coverage A limit of liability is changed during the policy period, the dollar amount of the deductible will be revised to reflect the new limit of liability. For example: $100,000 (Coverage A limit) X .02 (2% Deductible) = $2,000 (Deductible Amount) E Therefore, if you experience a loss to your dwelling, you would be responsible for the first $2,000 of any loss, caused directly or indirectly by any windstorm due to a Category 1, 2, 3, 4 or 5 hurricane, to property covered under your policy. The deductible is then applied to the total of the loss for all property coverage. This deductible does not apply to Coverage D. LOSS SCENARIO #1 $16,000 dwelling building (Coverage A) $ 3,000 dwelling garage (Coverage B) $ 1.000 personal property (Coverage C) $20,000 - 2,000 deductible $18,000 amount we will pay for loss Under this loss scenario, since the $20,000 loss amount is greater than your $2,000 catastrophe windstorm deductible amount, we would pay the difference, or $18,000 of the loss. LOSS SCENARIO #2 $1,000 dwelling building (Coverage A) $ 200 dwelling garage (Coverage B) $ 100 personal property (Coverage C) $1,300 -2,00fl deductible $0 amount we will pay for loss Under this loss scenario, since the $1,300 loss amount is less than your $2,000 catastrophe windstorm deductible amount, we would not pay for any amount of the loss, When the amount of the catastrophe windstorm deductible that is actually applied to a windstorm loss is more than the amount of the basic deductible, we will not apply a deductible to any claim made for additional living expenses and/or loss of rental income. Otherwise, additional living expenses/or loss of rental income will be subject to a deductible. HHl202NY0114 scs,aoa.N rw o+mmar rnra�aaouno w, e.a. aa:o II J Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a X, 2, 3 or 4 Family, Owner-occupied Residence **Tlrfs fom cannot be wend to welve the workers'eompensedon fighn or obtiaalrons of any parry.** 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): ❑ I am performing all the work for which the building permit was issued. Sd 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 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 indicated on the building permit. - (Signa a of omeowner) (Date Signed) 4 q VC ,\�`L\C- _V'A\3 Q\ �� Home Telephone Number t" � !- (Homeowner's Name Printed) Sworn to before wee this �� day of Property Address that requires the building permit: rho _ (County a twrblie) Notary Public,State of New York No. 01 ME6160063 Oualified in Westchester County Commission Exoires January 29.20 Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage. BP-l (12/08) NY-WCB