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HomeMy WebLinkAboutBP22-014PERMIT # dam'-©I DATE: S Z>� ExP: a SECTION 13420 oZ �/ " BLOCK IF LOT / TYPE OF WORK o4e.4O/% ze � /% a�� l ke,407lam' JOB OWN �4=0 11111116 CONTRACTOR ST. VC0 # y _ FEE `� DATE FEE DATE INSPECTION RECORD DATE FOOTI N G FOUNDATION INSP FRAMING RGH FRAMING INSULATION �� 1 PLUMBING RGH PLUMBING - --�� GAS o - SPRINKLER rqcz� ^�z WA_ ELECTRIC LOW4OLT ALARM C� AS BUILT C7 FINAL 7/as�aoa3 SF PIr Poi`3 '0 �C C`��� OTI iER APPROVALS OTHER VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 23-096 Certificate of ®ccupaucp his is to certify that &ama Yam. of, r having duty filed an application on 20J requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a o��5 Zoning District and shown on the most current Tax Map as Section: c::?, / Block: / Lot: 3 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.c>2>9 o� , issued L,,-)5 20,2a, 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 following New York State Classifications, Use: �—` �' Construction: for the following purposes: / z /C,./ (f/7 ba�hroor� r>�G y��-io� 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 he' sha ade,nor shallow-building be moved from one location to another until a permit to accomplish such change has o tained om the i ding Inspector. 5 1013 Building Inspector,Village of Rye Brook: Date: p hC� [� OMC� DBUILDING DEPARTMENT For office use onl PERMIT# MAY 12 20233 VILLAGE OF RYE BROOK ISSUED: 38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: //Q-- PAID1K BUILDING DEPARTMENT www,rvebrook.on APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLLI,NCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ►tttttttt►►t►##t►###t##tttt/ttttt►ti►ttt►ttttt####t##########tttttttt■ttttt►t►ttt#tt####t#•ttt##ttt►►t►t►ttt►►tt####►###tt##tt Address: 13 L A Occupancy/Use: Parcel ID#: /,? (p 3 Zone: Owner: ,Q�/©�Q� 7�1���/��,O Address: A? P.E./R.A. or Contractor: 1117r Address: Person in responsible charge: fgc ilar 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,/CO/UNTY OF WESTCHESTER as: / r5�.•jfi ���/►/1being duly swom,deposes and says that he/she resides at r? Z ll ry L"� t Name of Applicant) gg� / (No.and Street) in A A'0'.,a, 'A ,in the County of w/" S r S 7-�-e_ in the State of l� ,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:$ } , for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this I a Sworn to before me this day of ,20_ZL day of , 20 i Property er 1 `n Signature of Applicant Print ne of Property Owner Print Name of Applicant §�jl Notary Pule c Notary Public GREGOW M.RNM Notary Public,State of New York 8/12/2021 No.0111I644098 Qualirwd in Westchester County d Conon Expires September 26,20 �E BRC�v� o`` tim • 1982 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 - - - - - - - - - - - - - - - -- - - - t� 0 LGn�Q J !� ADDRESS :- DATE: PERMIT# ISSUED: � T: BLOCK: LOT: LOCATION: 1�- l y� OCCUPANCY: 2 k(--�5 ❑ Violation Noted THE WORK IS... IEJ PASSED ❑ FAILED 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 i ❑ OTHER QyE BRC�k, 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 'gkSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK -f]CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 1 �-D C" �C" _ DATE: �l7 PERMIT# G , �J\�` ISSUED: o' CT: BLOCK: LOT: LOCATION: 1 OCCUPANCY: O ❑ VIOLATION NOTED THE WORK IS... �], ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION C REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: �}J ROUGH'PLUMBING `/❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER m = - z = z x x � N N 'l5 � ■ = N u ■n W v ■ a � �. � v w N � a o 4-4 CA a.. W o a ' GA W r v w N o ■ r4 C3 Z z o 66 � Cl) W woe "oCIIIAI , - 0-4 z o w 0 U (� CO W °O04% ° w M B A w ° � Q 61Y 1.10 W H w "' v w � � � QCvtiU z _ ■ ~� o o 00 1 W O N a � p � v , � ■ ►� a w z A � y S1)4 OMNI W x w o o V a a � •• V O z 4 z z BUILDING DEPARTMENT D VILLAGE OF RYE BROOK JAN - y 2022 938 KING STREET RYE BROOK,NY 10573 ! (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.org LBUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: J AN 2 4 2022 crmit #: / d` V/ Application Fee: $ Approval Signature: Permit Fees: $ Disapproved: Other_ Application dated: Z Z is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: /3 Z-zo CA /—& SBL: 310/0l� "�� Zone. 2. Proposed Improvement. (Describe in detail): a f�L, n� ��'Lla h S 3 e-Y } A2"00ArJs POYA S7Q ,77 l' S� r 4?D c �'T Lt/4 JX I Pig al Ad jl(i/ �I Le kfi'41'0 S 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system (Fire Sprinkler,ANSI, System,FM-2(X)System,Type I Hood,etc...) :No: Yes: (I i I a separate Automatic Fire Suppression System Permit application& 2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: /'cI-"h After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: /4V O&P C �i � &?/* dress: 12 L(2M Z/a Alf Phone# / <-2 L — CeII# email: 8. Applicant: rie/ 1'�7 ob 1.401-pp Address: Phone# 91 Y-5-,-12 3 Z 3 Cell# email: /10 , :f 4 ,7 9. Architect: Address: l d h) Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of construction $ r 9 74&&'� (NOTE:The estimated cost shall include all labor material,scaffolding.fixed equipment.professional fees.and material and labor%+hick may be donated gratis.) 13. Job Timetable: Start: Finish: (1) 8/12/2021 BUILDING DEPARTMENT DECENE DD VILLAGE OF RYE BROOK =- 4 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK n=,M&rook.or1 BUILDING DEPARTMENT �7yc'_ AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER } as: v lee) , residing at, /3 L 6 G L,A`v e Ni'rir�tnamei (Ak":fiL — «mere � Iic I being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; /f ' , Rye Brook, NY. i 1r�h�1��.1rc5.,r Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. zi ISILntllnl�L! � - (Print Nantr olTropci-t Sworn to before me this y day of 7frv %, 20 1 olary Ptr'hli, SHARI MELILLO 14otary Riblic, State of NeW York 0'+alifi�3d in West& ��rer COUntY (2) Cc�mrnission Exnirc�s,7?ni�-�^�?n 2O 8112/2021 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 NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Swom to before me this q Sworn to before me this day of Z501&fs.,r�, 20�_ day of 220 si e of droperty Owner Signature of Applicant pw Atioo E *, /1A-M nt Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELiLL O Notary Public, State of New York i lo. 0'ay'i Of f`T'33 o,iai+fed !n WVest&, ster County Commission Exnires Janunni 29.20 (4) 8/I2/2021 M e 0 • c� o o � v w � k �, N W a � � ►—� CIO a -. en ``, a ran q �i Q � 00eq o a � w W " w a W O A � w M u z �,z oz Z � / 04% V w Z x M zz w UI Z ( it w a V a3 3 x w N W w N z H CA Z a' z a V U U g W oG a; z w o H pr = w � c Z z � V o w z w a e BRCS BU yE MENT R II. JAN 1 Vu. E oFR OK 9 2023 ID 938 KIN NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .0riz ELECTRICAL PERMIT APPLICATION Westchester County MasterElectricians License Required FOR OFFICE USE ONLY BP#: C7d O/ EP#: Q13—o l 3 Approval Date: JAN 2 O Permit Fee: $ Approval Signature: Other: Application dated, S is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install d/or Amove 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,County and Local Codes. 1.Address: 0 C AZ Af SBL: Zone: 2.Property Owner: yak/ ",,}./, AK,2T Address: 3 L Gam_i-/ L /V ' Phone#: yj I//-- S Z :7 3 z Cell#: email: 3.Master Electrician: ­—TIZ41�-V41e "ioe G< Address: 3 S—r o 6 0-3 Lic.#: Phone#: Cell#: 06So email: z Company Name: 2 49 641 e Ge)-PAddress: 3% 66� �. wi,�rT,� Pl�g,,✓ `�"'��—�' 4.Proposed Electrical Work/Fixture Count: n y 1 a 0 3 5.31 Party Electrical Inspection Agency: �� l STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,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 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned fiuther 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 before me this Sworn to before this day of ,20 day of Signature of Property Owner S' attite of Applicant Print Name of Property Owner PrintName 6-f Applicant L Notary Public Notary Public 6/23/2022 STATEWIDE INSPECTION SERVICES, INC. Service With hilegriq 1080 Main Street,Fishkill, NY Iemoil:office@swisny.com SWIS JOB APPLICATION . i I , Ifax • I • ,• • • 011"<'U"e' Elect.Permit# Date Bldg Permit# t Utility ID# Final Certificate# City/Village ` Zip Township County - Address / vCy - Cross Street Section Block Lot Owner Name/Address(If different than above) f Contact Number asement 0 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent 1 SERVICE Amperage Voltage 1 P 13P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information �" !/v/4/N6-- Fri, D [EC EN - 1 DO 19 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.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.The applicant declares that there is no open applications for the above address with any other Inspection company,The applicant owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# i Company Name j'! r Date Signature Address,7 r+ its; City/State _: Zip Code License# Phone# y R State Wide Inspection Services CA- 1080 Main Street Fishkill, NY 12524 Kria S 2023 845 202-7224 Phone j 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com Service With Integrity BUILDING DEPARTMENT Website: www.swisny.com ' BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Phase 2 Electric Corp Andrew Malhorta Trevor Meikle 13 Loch Lane 39 A Beech Street Rye Brook, NY 10573 White Plains, NY 10003 Located at: 13 Loch Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-013 136.21 Certificate Number: 2023-2287 Building Permit Number: BP 22-014 A visual inspection of the electrical system was conducted at the Residential occupancy described below. The electrical system consisting of electrical devices and wiring is located in/on the premises at: 13 Loch Lane, Rye Brook, NY 10573 The First Floor Kitchen, Livingroom, and Bathroom were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 5th day of April 2023. Name Quantity Rating Circuit Type GFCI 06 AFCI 02 Switches 04 Dishwasher 01 IL- ,9 7Q.ay Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. O c c w a � Ln � c � W � w 0-4 W vwi W O N M U N O i ■ O ,n O w0 x z z W Z � ' NA z cn cn MM� 00 F■�I 0Z-4 M..� h■��1 �"'� a w o zCf Z x z .. oo W vW zz a � go H .. o, W AN a go �� � aa z aw = � BUIL EPARTMENT VIL E OF RYE BROOK JAN 21 2022 938 K1NM'541ETRYEB11 NY 10573 VILLAGE OF rs YE BROOK or BUILDNG DEPARTMENT ELECTRICAL PERMIT APPLICATION West a County Master Electricians License Required FOR OFFICE USE ONLY '� EP#: p�p1 O JAN 4 Approval Date: Permit Fee: $ Approval Signature: %­V1Other: Disapproved: (fees are non-refundable) Application dated, a�c'�- 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 in conformance with all applicable Federal,State,County and Local Cod/es. 1.Address: /.3 LL oCN l_r9-r/� SBL: /310. a 1-/—3 Zone:e DS 2.Property Owner: /9/yd tZ.4s w /`7141 f�Fv Til,,g Address: / 3 L c2 C L r9-r/E Phone#: 91JI-Sac-)-3 a3y Cell#: email: 3.Master Electrician: /yam/A-Loc- Address: 3Q�Bse c,,� 3 T h1s�-iTE fL�4>.ys ,vt l Lic.#: / J 9 Phone#: Cell#:9//f JQ46,Z 665CP email: Company Name: � a L,Ar_GT2/G CD/ZPAddress: 39 4.Proposed Electrical Work/Fixture Count: J�ijrd j c-.167-a- L.)NW Q 0=012 An,r_,T L '7-4 2 cZ)' �j jq P?4-/Mw1 Cj9%. a ve j4-P4uS PP-r� v/ S N /L.,d,,rj STATE OF NEW YORK,COUNTY OF WESTCRESTER ) as: �j J2,4_rVO/L "ey k LE ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the a I_a l_Opp state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,c2njrLct6_D agent,attorney,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 tgbefore me this Z Sworn to before me this day of \�i1d ,20 7 Z� day of Vim ,20 ZZ► Si a perty Owner n re t 49^!46 rE wJ t4A L 14-0-7724 Name off P�rt} Ow� ri Name of Applicant Notary Public SHARI MELILLO Notary PutWdARI MEULLO Notary Public, State of New York Notary Public, State of New York No. 0';:, r;;"' "?3 Pi Oi".1 =61(^ 3 0,.ialified in V e,-,i;i' er County 0,ln!!fied in Westch County Commission Expires Jamlary 29,202::� Commission Expires January 29.20� 8/12/2021 Westchester Rockland Electrical Inspection Services, Inc. P nj 7-95 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue F 14- 7-3596 Elmsford, NY 10523 J MR NO.. —7— TEMP# DATE ZVI CITY OR VILLAGE ZIP CODE TOWNSHIP OU ti,/'g;� STREET AND NO.OR ROAD POLE NUMBER f—r /tJ BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME /T BUILDING OCCUPANCY j,ram OWNER'S NAME AND ADDRESS _.J- 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 _- --, ✓ —1 I I' FL. 2nO FL. V 3-FL. VIL LAG - _,,WOK REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: � T 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 J ADDITIONAL F7 EXPOSED O CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND L] 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 APPLICANTr X STREET ADDRESS TELEPHONE NO. 7/4 66, _ o CRY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE i , a. p N r N 0 rA w ri ' v F A 94 p- a N W = L M 0 x O ccl r. 0. � W F. � :j F.i4 � g z i = � . z z �; wA+1 o 00 W wl o V 0 C� W o N z a =, M � o� W I z ' 00 �., z a CY } w`n zz N of W U U 4 x F W � of z 2 W M z ram. D BUILDING DEPARTMENT SEP 2 8 2022 DD VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573� VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.r cbrook.o PLUMBING PERMIT APPLICATION 1 FOR OFFICE USE ONLY BP #: i PP#: t:jl� 3O Approval Date: SEP 3 0 2022 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ******************************** ***************************************************************** Application dated, O 9' L is here ade to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an or rer ove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: �/.3 L e C'i /_/¢/Y/'G SBL: a/340,0 c_V-/-E Zone: 2.Proposed Work: '6'1D &d s/wL 3.Property Owner: 7Address: 3 C d G t� ` 4-416- Phone#: 7 �L L 'j Cell#: email: 4.Master Plumber: Address: Lic.#:f A6! Phone#• p /�! ell 4 1/14)-�22Gl-�g 10 email D6,G o a -7 Company Name LaLT p� Address:1bU Q(L4 ,NY L451 INDICATE FIXTURES&LINES O BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 31 Floor 4"Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 2 8 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.r,*-ebrooi&I! BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, �llplj5rW /1 d T�� , residing at, (Prins namr i ii, being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Rye Brook,NY. Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. �tiit,na:uIC 4tff Propffly O«'ner(s)I 4P't E w (Print;\ame of Property Owner(sl) Swom to before me this day of OkA LZr , 20-1,2- \0t.iI ub is I Stephen Smith Notary Public, State of New York Reg. No. 02SM6418527 Qualified in Westchester County Commission Expires June 14, 2025 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: b Serf'(- J K(/C/�� being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and f4fther states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the 1F ~y Al *.,W for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this t^ rj_ Sworn to before me this day of ,20 day of '�,, 20 _ Si a e o roperty Owner Si re of pplicant Print Name of Property Owner Print Name of Applicant Ith No Public Notary Public, State of New York Nismith Reg. No. 02SM6418527 Notary Public, State of New York Qualified in Westchester County Reg. No. 02SM6418527 Commission Expires June 14, 2025 Qualified in Westchester County Commission Expires June 14 2025 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. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 9/12/2021 Laura Petersen From: Steven Fews Sent: Wednesday,January 18, 2023 2:27 PM To: Andrew malhotra Cc: Laura Petersen;Tara Orlando Subject: RE: 13 loch lane Expires: Thursday, May 18, 2023 12:00 AM Good Afternoon Mr. Malhotra. You currently have 2 open permits. Permit number BP22-084 expires 5/31/23. This permit is for window replacements. Permit#BP22-014 for the interior renovations is set to expire 1/25/23. I am assuming this is the permit hat you need the extension on. I will grant you a 6 month extension on that permit. Your new expiration date will be 7/25/23. Please arrange for all work, filings and inspections to be done prior to this date to avoid the $500.00 dollar expired permit fee. I should also mention that in folder for your property is an old permit#1712 for a tool shed in year 1970. A new as built survey and C.O. app filing is needed to set up an inspection to close it out. Thank You. Steven E. Fews Acting Building Inspector & Fire Inspector Office (914) 939-0668 -----Original Message----- From: Andrew malhotra <andymall967@gmail.com> Sent: Wednesday, January 18, 2023 12:20 PM To: Steven Fews <Steve Few s@ryebrook.org> Subject: 13 loch lane Hello Mr Fews. I'm requesting a six month extension On the On the permit because my electrician did his job however the electrical company who inspected it went out of business. I spoke to laura this morning and she suggested I email you this request. Please let me know and thank you very much for your help. Happy New Year. Sent from my iPhone i Building.Permit Check List&Zoning Analysis Address: l L.o c-44 L A-(-� SBL ( 3 G .Z Z( � LF,4 AL 1-2- 9 ,� Zone: 'Z� Use: Const.Type: Other. Submittal Date: 1 Lj Z Z Revisions Submittal Dates: Applicant: A Nature of Work: A L l ZV-- N T Reviews:ZBA: J A N 2 4 1011 PB• BOT• Other. OK (vj FEES:Filing. � BP: � 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. ( ) ( ) SURVEY:Dated: Current: Archival Sealed: Unacceptable: PLANS:Date Stamped: Sealed Copies: Electronic Qther 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 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 DENLA L LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approvaL notes: REOLUED EXISTING PROPOSED NOTM APPROVED J AN 2 4 2022 Cu EmaW� Front Front: Sides: Main Cov Accs,Cot. Ft,HS : Sd.H/Sb SF—A. Tot,Imp: EL Imp >�king Hight/Stories: notes: �y �t4�UJJ tr JUSTICE COURT OF THE TOWN OF RYE STATE OF NEW YORK: COUNTY OF WESTCHESTER---------------------------------------------------------------------------X 19 PEOPLE OF THE STATE OF NEW YORK, -against- No . E . 1098 MR. ANDREW MALHOTRA ------------------------------------------------------------------------------ X Be it known that I, STEVEN E FEWS, the complainant herein and duly authorized Code Enforcement Officer of the Village of Rye Brook, do hereby accuse the defendant(s) named above, residing at 151 NORTH RIDGE STREET RYE BROOK NY who is the OWNER of the property at which the following offences were committed, at 13 LOCH LANE. Rye Brook NY 10573 on or about DECEMBER 17th, 2021.at or about 10:30 am. 2� COUNT ONE: Village Code 6107-2.A DEMOLITION PERMIT REQUIRED TO WIT: In that the above name defendant did allow or cause to allow interior demolition work to done at the subject residence without first obtaining the required demolition permit. Said work is including but not limited to the demolition of existing kitchen and two bathrooms at the subject premises. Demolition work includes the removal of cabinetry,tiles,countertops, sinks, plumbing,and electrical components, COUNT TWO. Village Code 591-2. A BUILDING PERMIT REOUIRED. TO WIT: In that the above-named defendant(s)did allow or cause to allow the interior renovation of two bathrooms at the subject premises without first having obtain the required Building Permit. Said renovated bathrooms are a master bathroom and hall bathroom on the upper level. 2�5T COUNT THREE: Village Code 491-2. :% BUILDING PERyll'l REUtIRFD. TO WIT: In that the above-named defendant(O did allow or cause to allow the commencement of an interior kitchen renovation at the subject premises %%ithout first having obtained the required Building Permit. COUNT FOUR: Village Code k250-10. A CERTIFICATE OF OCCUPANCY REQUIRED TO WIT: In that the above-named defendant(s)did allom, or cause to allo% failure to obtain the required Certificate of Occupancy for the INN o bathrooms renovation work. COUNT FIVE Village Code 4250-10. A CERTIFICATE OF OCCUPANCY REQUIRED. TO WIT: In that the above-named defendant(s)did allow or cause to allo%% failure to obtain the required Certificate of Occupancy for the kitchen renovation work. ('()I N-F SIN. Village Code 4113-6 ELECTRICAL PERIN1IT REOUIRED TO %N IT: In that the above-named defendant(s) did allow or cause to allow the electrical work to be done to facilitate the renovation of two bathrooms at the subject premises without first having obtained the required electrical permit, to be filed by a Westchester County licensed Electrician. Said electrical work is including the demolition of existing electrical components, wiring, and/or fixtures for the installation of new. .,,,,=vCOUNT SEVEN: Village Code 4113-6 PLUMBING PERMIT REOUIRED TO WIT: In that the above-named defendant(s) did allow or cause to allow the plumbing work to be done to facilitate the renovation of two bathrooms at the subject premises without first having obtained the required plumbing permit, which need be filed by Westchester County licensed Plumber. Said renovation includes the demolition of exiting plumbing systems and fixture and the installation of new. All the above is contrary to the provisions of the statutes in such case made and provided. The above allegations of fact are made by the complainant herein on direct knowledge and upon information and belief provided by Steven E. Few_s Code Enforcement Officer and Building Department Official. Some of which being an inspectio (s) of the subject pr�rrlises on, December 17th, 2021 and January 3rd 2022 by Code Officer Fews. Any false statements mad he pun a e as a Class-A" Misdemeanor p77' urs ant o 210.25 of the NY Penal Law. ` s aC7 as Dated Code Enforcement O rcer APPEARANCE TICKET You are hereby directed to appear before the Justice Court of the Town of Rye, 350 North Main Street. Port Chester, New York 10573. (914)-939-3305, at 9:00am on the 21" da} of January 2022. in connection with your alleged commission of the above-described offense. NOTE: UPON FAILURE TO APPEAR A WARRANT MAY(ii)ISSUMFOR YOUR ARREST I s aoaa Dated Code Enforcement O rcer 1313/09/328639 VI 1/5/22 C BRO, Q�x 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT 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 :— i Yam-o(—,� U" (-A Q- DATE: ✓ 20- L PERMIT# N ISSUED: SECT: BLOCK: LOT: LOCATION: �'V 1 y ��+ '� ``V� OCCUPANCY: 2 ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED �,a REJECTED/ REINSPECTION ❑ SITE INSPECTION M / REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMINGD INSULATION ❑ NATURAL GAS `� ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER \� ` 1_ Yew o U►J ti C��y 6��� �w`' ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER CA t Cat J � LOG IN DATE: BUILDING DEPARTMENT VILLAGE OF RYE BROOK COMPLETION DATE: 938 KING ET RYE BROOK,NY 10573 ASSIGNED TO: ' 993.2 ASSIGNED BY: COMPLAINT#: COMPLAINT FORM DATE: /c; 17 RECEIVED BY: LOCATION: 43 �U / PARCEL I.D.#: �J (p ! d/ /— 3 Zone:44� USE: / OWNER: `��/'E7 Z-Z-C Address& Phone: 597 JO,17k" /T vP SOURCE: 0—/?/g Q/IG/J'yOL/ Phone/ tter/Other: Address&Phone: COMPLAINT: / POSSIBLE VIOLATION: INSPECTORS LOG DATE STATUS INSPECTOR op- 1 !, ".." 79m ' Photo March 2017 Photo 1 of 12 Photo for 136.21-1-3 in Village of Rye Brook • FOR COUNTY USE ONLY y.us or PHONE(518)473.9791 New York State Department of C1.SWIS Code 5 5 4 8 0 5 Taxation and Finance C2.Date Deed Recorded 04 / 29 / 2020 Office of Real Property Tax Services C3.Book 6 0 0 5 2 C4 Page 0 3 1 0 2 RP-5217 Real Property Transfer Report(8110) PROPERTY INFORMATION PREP 1.Property 13 LOCH LN. Location IMEET raal9ER SIREE—F RYE TOWN RYE BROOK 10573 ary w lava' Vs1A6E ry Eom 2.Buyer JJPE LLC Name l Tra.IrEeoidr ry ralal RAPE LAST NAa¢iColdi Fe1ST PAYE 2.Tax Indicate where"we Tax Bats we to be sent JJPE,LLC Billing if other than buyer addrerss(al bottom of farm) LAST YAI�.CarBANY FIRST r1AYE Address 584 YONKERS AVENUE YONKERS NY 107D4 StWET YlI iXER Ano—f .1 OR lmA elA1F nPfaaE 4.indicate the number of Assessment 1 p of Parcels DR Poll of a Parcel (Only if Pont of a Parcel)Check as they apply: arcels Roll p transferred on the deed 4A.PWnnUTg Board with SubdMslon Authority Exists 0 s.Deed 0.00 X 0.00 OR 0,59 Properly Faun FEE* 01 ACRES 48,Subdivlsbn A Wdval was Required far Transfer Size 4C.Parcel Approve!far Subdivision with Map Provided DENNIS E KROLIAN ESQ 8.Seller LW uAEEKAA a nova nAwe Noma LAST nAYElco v— FucsT YAAo=, 7.Select the description which most accuralety describes the use of the piopeny Check the boxes below as they apply: of the Ilmo of Gale: 8.Ownership type is Condominium El A.One Family Residential 9.New Conslndion an e vacant Lend ❑ 10A.Property Located within an Agriculture]District 10B.Buyer received a disdosuro notice indicating that the property is in Elan Agricultural District SALE INFORMATION 15.Check one almoner of these conditions as oppU-ble to transfer. A_Sale BelweEn Relatives or Formal Relatives 11.Sale Contract Date 2/3/2020 B.Sale between Related Companies or Partners in Business. N C.One of the Euyers Ia afro a Seller 316/2020 D.Buyer or Selm is Government Agency or Lending Instituum Q 12.Data of Salafrronsler E.Deed Type at Warranty or Bargain and Safe(Specify Below) N o F.Side of Frectonal or Less than Fee Interest(Spealy Below) n 17.Full Salo Price 700,000.00 G.Significant Change in Property Between Taxable Status and Sale Dates oN H.Sale of Business is Included in Sale Prim (Fun Sale Price Is the total amount paid for the property mdudurg personal property. 1.Other Vnuscal Fadars Melting Sale Price(Specify Below) This payment may be in the to"of cash,other properly or goods,or the assumption of mortgages Orother obGgallans.)Please routs to the neanesl whole dollar amount. J.None Cornmenl(s)on Condition: 14.Indicate the value of personal REFEREE'S DEED property Included In the..to 0.00 ASSESSMENT INFORMATION-Data should reflect the lalest Final Assessment Roll and Tax Big 19.Year of Assessment Roll from which Information taken(YY) 17.Total Assessad Value 20 1,224,900.00 18-Property Class 210 _ 19.School District Name Elind Brook-Rye 20.Tax Map IdentitierairRotl Identifier(s)(If more than four,attach sheet with additional Identifier(it) 136.21-1-3 CERTIFICATION I Certify that all of the Items of Information entered an this form are Vue and correct(to the best o1 my knowledge i nd better)and 1 understand that the making of any willful false statement of material fact herein subject me to the.p!ovlalonp o!JHe.pen�aw retalive to the making and filing of false Instruments. / sEr—LE/111NATURE BUYER CONTACT INFORMATION Infomu:ian r Wya..Yae:a lour ar b LLC, ryrssadawn,w.yFa.i jrmn slook.eampvry,mtace v, emry arum h rIm sn ogern or ftlueTry,ttrn one mnlau Infvmahn or ern hillMduouresponstele Z� parry wino can anc er ovation gwdvig M uan are—,-,Typo prlm clearly) SELER a`ru`ruRF JGTE 1/jj y I� 1 JJPE,LLC f p�- /z G20 r"6i FiRsr reAYE BUYER SIGNATURE 203 9236311 '�A� TEtEPtwEYUIaRIE.'. ellrER uAAIWE 584 YONKEF:S AVENUE an s SIRE ET Y.YE YONKERS NY 10704 uTT OR Town. SWE ZIPCOaE BUYER'S ATTORNEY BOND.ESQ. JACK tr Wr-W FMO 0141E 914 4476790 AR WDE TEIFPMOYE MlY9ER IEA:aerMa91 State Farm Fire and Casualty Company Applicant Name: MALHOTRA,ANDREW D Binder Effective Date: 12-13-2021 NY Homeowners Application/Binder-Receipt 32-CX-P712-5 NEW BUSINESS APPLICANT: MALHOTRA,ANDREW D MAILING ADDRESS: 13 LOCH LN PROPERTY LOCATION: 13 LOCH LN RYE BROOK, NY 10573-1706 RYE BROOK, NY 1 05 73-1 706 BILLING: Put application on SFPP: Yes COVERAGES/PREMIUM SECTION: Type: HOMEOWNERS Policy Deductible: 10,000 Rate IV: 101% Hurricane Deductible: 2% 12,500 Policy Coverage Limit Premium Endorsements Limit Premium Dwelling(Coverage A) 625,000 2,318.00 Increased Dwelling-Option ID 125,000 Back-Up Sewer/Drain-Dwelling/ 10%62,500 63.00 Dwelling Extension 62,500 Contents, 10%of Dwelling Personal Property(Coverage B) 468,750 Fire Department Service Charge 500 included Personal Liability(Coverage L)each 1,000,000 108.00 Fungus(Including Mold)Coverage 20,000 occurrence Limitation included Medical Payments(Coverage M)each 1,000 Hurricane Deductible (119.00) occurrence Credit Card/Bank Card and Forgery 1,000 Damage to Property of Others(Each 1,000 Occurrence) Loss of Use 187,500 Loss Settlement Options Loss Settlement Option-Dwelling Al - Replacement Cost-Similar Construction Loss Settlement Option-Personal B1 -Limited Property Replacement Cost Accepted Options Declined Options/Endorsements Jewelry and Furs 1,500/2,500 Additional Insured Option JF included Silver/Goldware Theft-Option SG 2,500 included Addl Insured-Special Event Business Property-Option BP 1,500 included Away From Prem Theft Exclusion Building Ordinance or Law-Option OL(% 10%62,500 Back-Up Sewer/Drain-Dwelling/ of Coverage A) Contents,5%of Dwelling Firearms-Option FA 2,500 included Building Ordinance or Law-Option 25% OL(%of Coverage A) Building Ordinance or Law-Option 50% OL(%of Coverage A) Business Property-Option BP 2,500 Business Property-Option BP 5,000 Business Pursuits-Option BU Common Construction Rplc Cost Cyber Event,Identity Restoration,and Fraud Loss Coverage Earthquake Energy Efficiency Upgrade Fire Department Service Charge 1,000 Fire Department Service Charge 1,500 Fire Department Service Charge 2,000 Firearms-Option FA 5,000 Fungus(Including Mold)Coverage 50,000 Limitation Home Rental EB 2540 NY.9 Rev.05-2019 Page 1 of 3 State Farm Fire and Casualty Company Applicant Name: MALHOTRA,ANDREW D Binder Effective Date: 12-13-2021 NY Homeowners Application/Binder-Receipt 32-CX-P712-5 Declined Options/Endorsements(Continued) Limit Home Systems Protection 50,000 Hurricane deductible 5% Incidental Business-Option 10 Jewelry and Furs 2,500/5,000 Option JF Jewelry and Furs 1,000 Special Limit Loss Assessment Nurses'Professional Liability Off Premises Structures Personal Injury Rented Personal Property Service Line Coverage 10,000 Silver/Goldware Theft-Option SG 5,000 Silver/Goldware Theft-Option SG 7,500 Silver/Goldware Theft-Option SG 10,000 Waterbed Liability Discounts/Charges Home/Auto discount (685.00) Tier Rating 422.00 Year built adjustment 24.00 Policy deductible (41.00) Total Premium: $2,090.00 Amount Paid: $0.00 Credit Amount: Balance Due: $0.00 UNDERWRITING: Has applicant had any losses, insured or not, in the past 5 years: No APPLICANT(S)ACKNOWLEDGEMENT: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information,or conceals for the purpose of misleading,information concerning any fact material thereto, commits a fraudulent insurance act,which is a crime,and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. By submission of this application,you agree that:(1)You have read this application,(2)your statements on this application are correct,(3)the coverages, including options and endorsements,and the amounts of coverage on this application are those chosen by you,and(4)the premium charged must comply with State Farm's rules and rates and may be revised. BINDER: State Farm will provide coverage to the applicant and his or her legal representative on the property described for up to ninety(90)days from the Effective Date,subject to all terms and conditions of the policy and endorsements for which application has been made.If no Effective Date is indicated,this Binder does not provide any coverage.This Binder will be void when the declarations page is issued on the policy for which application has been made or when coverage under this Binder is canceled in accordance with policy provisions. The premium due State Farm for the coverage provided by this Binder will be the full annual premium for the policy for which application has been made,and will be pro-rated for the length of time coverage is provided under this Binder. AGENT INFORMATION: App date and time: 12-13-2021, 01:07 PM Agent: Bob Weber Agent/AFO Code: 32D7/17FCAC Agent Phone: (914)712-3000 Location Address: 626 North Ave New Rochelle, NY 10801-2614 EB 2540 NY.9 Rev.05-2019 Page 2 of 3 State Farm Fire and Casualty Company Applicant Name: MALHOTRA,ANDREW D Binder Effective Date: 12-13-2021 NY Homeowners Application/Binder-Receipt 32-CX-P712-5 IMPORTANT NOTICES REGARDING CONSUMER REPORTS... Consumer Reports, including credit and insurance loss history reports, may be ordered in conjunction with this application. We may also obtain and use a credit-based insurance score developed from information contained in these reports. We may use a third party in connection with the development of your insurance score. These reports give us information that helps determine your eligibility for insurance and predict the likelihood of future claims. Typical information from these reports that may be used includes: prior insurance losses, number of revolving accounts, late payments and collections. Your credit and insurance loss history information is provided by LexisNexis Risk Solutions Inc., a consumer reporting agency. A brochure explaining how State Farm uses consumer reports is available upon your request. For additional information, please contact your State Farm agent. REGARDING YOUR COVERAGE AMOUNT.... It is up to you to choose the coverages and limits that meet your needs.We recommend that you purchase a coverage limit at least equal to the estimated replacement cost of your home.Replacement cost estimates are available from building contractors and replacement cost appraisers,or,your agent can provide an Xactware estimate using information you provide about your home.We can accept the type of estimate you choose as long as it provides a reasonable level of detail about your home. State Farm®does not guarantee that any estimate will be the actual future cost to rebuild your home.Higher limits are available at higher premiums.Lower limits are also available,which if selected may make certain coverages unavailable to you. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your home. IMPORTANT FLOOD INSURANCE NOTICE... Your homeowners policy does NOT provide coverage for loss caused by flood or mudslide,which is defined,in part,by the National Flood Insurance Program as: A general and temporary condition of partial or complete inundation of normally dry land areas from overflow of inland or tidal waters or from the unusual and rapid accumulation or runoff of surface waters from any source. If you are required by your mortgage lender to have flood insurance on your property,or if you feel that your property is susceptible to flood damage, insurance covering damage from flood is available on most buildings and contents in participating communities through the National Flood Insurance Program. Information about flood insurance and whether your community participates in the program can be obtained from your insurance company,from your insurance agent/broker,or directly from the National Flood Insurance Program by calling 1-800-638-6620. INFORMATION REGARDING THE FAIR CREDIT REPORTINGACT... The Fair Credit Reporting Act,enacted into law by the state of New York,effective January 1,1978 serves to protect consumers against circulation of inaccurate or obsolete information by a consumer reporting agency. The act requires that the insurance company inform the applicant at the time application for insurance is made that:(1)a consumer report may be requested in connection with such application;and(2)the applicant upon request will be informed whether or not a consumer report was requested,and if such report was requested,informed of the name and address of the consumer reporting agency that furnished the report. Subsequent consumer reports may be requested or utilized in connection with an update,renewal,or extension of the insurance for which application was made. REGARDING CLAIMS AND TENURE UNDER THE TIER RATING PLAN... Generally,the longer you are insured with State Farm and the fewer claims you have with State Farm,the better the impact on your rate.Whether you receive a discount under State Farm's Tier Rating Plan depends on a number of other factors considered in rating your policy,but remaining claim free for a 3 year period while insured with State Farm has a favorable impact on your rate under the Tier Rating Plan.Certain claims you have with State Farm and,depending on your tenure with State Farm,those you had with your prior carrier may also have an influence on your premium. EB 2540 NY.9 Rev.05-2019 Page 3 of 3 Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence **This 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 famil .,_ow=,.,DccupJed_ro5' specific nproof of orkers hcompensati nu insurance coverage for suchresidenc a ��/ + (including ) g P applying q_m o appropriate box): ,—,/ JAN - 4 2022 L� I am performing all the work for which the building permit was issued. VILLAGE OF RYE BROOK g,paying P g Y Y ( ) s f afire �Lpul luiCm>�t><g P1F thea� ❑ I am not hiring, or compensating in an way, individual s that a 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 t tal of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indi o the building permit. Nl� - a-a (S' of Homeowner) (Date Signed) 4 Home Telephone Number 9/4 S'a­Q 7 (Homeowner's NamePrinted) Sworn to before me this _�_ day of Property Address that requires the building permit: �'��,�-� �V d� II /S L/>C�i 1.4Aie- (County lerrk or otary ubwel d _zoo SHARI MELILL O � Notary Public, State of New York No. 01*1.'I Gtrr J3 Oiialified in Westch-cer County Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disabiUty bene5ts insurance coverage. BP-1 (12/08) NY-WCB