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HomeMy WebLinkAboutBP22-084PERMIT #2);-)�nvns DATE: 3 / SECTION . o�i _ BLOCK TYPE OF WORK 10B LOCAT ON , OWNER CONTRALTO EST. vcO # TCO # INSPECTION RECORD DATE INS P FOOTING FOUNDATION FRAMING P:H FRAMING INSULATION PLUMBING ED RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW-' :_rl_T 0 ALARM CJ AS BUILT L7 FINAL ER APPROVALS ARB PB ZBA �- OTHER DR k tC� YV LI�J V . 19 L�V4 VuJ� VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 15,2023 Andrew Malhotra 13 Loch Lane Rye Brook,New York 10573 Re: 13 Loch Lane, Rye Brook,New York 10573 Parcel ID#: 136.21-1-3 Building Permit#22-084 issued on 5/31/2022 for 27 Replacement Windows This certifies that the twenty-seven new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to ME D [E C IE For office use only.. BUILDING DEPARTMENT PERMIT# MAY 12 2023 DD VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: .s—/��c33 VILLAGE OF RYE BROOK (914)939-0668 FEE: �6 / 0 — PAQX BUILDING DEPARTMENT wwwxygbrook.org 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 tttttttR►ttt4ttttttttttt/tttttttttttt\t\t\\■ttttt\t\\•♦tt\\\t►►\tRR\►■t►■♦\►Rt\tt\\►ttt►t►ttttt►\Rtt►tR\t\\\•\tt#t\tt►\t►•\ttt Address: f? Zee- LA/f/e 40X- Occupancy/Use: r,�/// 144 Parcel ID#: /f/P , 1/r / —_� / Zone:� a�� Owner: nC1,e_je z Address: L /1 l h Z"'O&G P.E./R.A.or Contractor: dc� pp& &���,[ ddress: 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: / 4/hQ o w /f/Ph 1111/4_'*ing duly swom,deposes and says that he/she resides at L /l % ZA A4-f- (Print Name of Applicant) (No.and Street) in .Q rE �'/&i in the County of in the State of 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:$— / �'?19 , for the construction or alteration of: ep 1,( � �L� n 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 � Sworn to before me this day of G ,20I day of , 20 Signa f Amperty Owner Signature of Applicant A t)r 6�!Z41 Print Name of Property Owner Print Name of Applicant R-�vw7u;/rr Notary Pub' Notary Public GREGORY K RNERA Notary Public,State of New York No.01R16441398 a/lz/zozl Quailfied in Westchester County Commission Expires September 26,Zfl QyE BRC��. cu � Q,x • 1982 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 : L cJc L(KnQ- DATE: 3 PERMIT# ISSUED: 5�_23ECT: BLOCK: I LOT: .J LOCATION: �uv OCCUPANCY: 'V ❑ Violation Noted THE WORK IS... 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 `� OTHER ■ bG N N 1 O v N \ � W Le) • ■ f T , � p j..� a O a � �� ►. ICI a .ti W � �a a 04 A QWo -� ° o " a o ° _ w v J n � a H .��'�' o q V � z a � L Q0 � � � a N a ° ,c d a. a ., 1+1 H pp I�/ N N W 4 u o44 V C00 !�1 ON w N v x aQ � � � bc. wc zz E:y � U � u O © a W z {77 O R bC z woN � �j _ ,o z •y v(71 M� a r-r Q W � d � o � •� � ob IEWIED BUILDING DEPARTMENT R E C VILLAGE OF RYE BROOK MAY 12 2022 938 KING NMEET RYE BRo y,NY 10573 4)939-Q668 VILLAGE OF RYE BROOK o BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: APPROVAL DATE: MAY 2 4 7 011 PERI1NrC#: APPLICATION FEE: 7,5 d— APPROVAL SIGNATURE: PERMIT'FEES: H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: a ?- hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 13 L © C X L-4rVC' 2. Parcel ID#: 13 LP•P 1 )—3 Zone: J2..-,15, 3. Proposed Improvement(Describe in detail): IMP% n 7 LL'`/!/i d 4. Property Owner: ITAza Address: / .4 t - .e Phone# 9/ Z/—SZ Z- L Cell# rum e-mail List All Other Properties Owned in Wye Brook: Applicant: -gm E j�,A✓ Address: f—T 41 ('X /_,4 L� : — Y [, F�ri �'— l� Y I r Phone#— ' /y 5 I.2—)2 3 y Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: Address: C Phone# Cell# e-mail (1} an212021 5. Occupanc 2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 6. Area of to . quare feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 11,fl: 2na fl: 3'd fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 1"fl: 2'fl: 3nd fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N,Y. State Construction Classification: N.Y. State Use Classification: 14. Construction Type&Location:O Typical Western Lumber Frame;()Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No:_ (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storrnwater Management Control Permit as per§217 of Village Code? Yes:_No: Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (f yes,applicant must submit a Site Plan Application, &provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (f yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28107? Yes: No: (if yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER I: TIER II: TIER III: (ifyes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: CU C( (2) 811=021 BUILDING R&PARTMENT D C [E�IF VILLAGE OF RYE"BROOK 938 KliNG MET RYE ftowI ,NY 10573 MAY 11 2022 .r a +iit VILLAGE OF RYE BROOK 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 PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: / ,residing at, /3 L 0 L/1 4 t4 ov e- (Print name) (Address where you live) 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; 3 G� C fi r�u �s a • �C� r ,Rye Brook,NY. {lob Address 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 Co (Sigma a Owner(s)) Acuv (Print Name of Property Owner(s)) ` Sworn to before me this of n :' !t a (Notary Public) SHARI MELILLO Notary Public, State of New York No. 01 ME61 E0063 Oualified in Westchester County t�,� (3) Commission Exnires January 29,20�1 a/1212021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also 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. Sworn to before me this Sworn to before me this day of ,20 day of , 20 St e o perty Owner Signature of Applicant Print Name 116mr-?- of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO 14otary public, State of New York No. 011M Ef 160063 Ounlified in WeStuhec ter County 3 Commission ExnireS January 29,20 (4) 8/12/2021 Building Permit Check List&Zoning Analysis Address: l `OC 4 LA n r— SBI_ 17 6 •Z( — l — Zone:Z--Z Use: Z(J Const.Type: —_227> Other. Submittal Date Z% Revisions Submittal Dates: Applicant: ;,� a0 l�I��c,I—Cw Nature of Work I U2'p C,,Q C F Wt�,J�� ►.�� i C eviews:ZBA: MAY 1 2 2022 PB• BOT: Other: NEW QK o S, ( ( ) FEES:Filing BP: C/. r O: Flood Plane:�_Legalization: ( ) (✓7 APP: Dated:_�Notarized SBL: ✓Trans 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 Other. License: Workers Comp: Liability: ✓Comp.Waiver: ✓ Other. ( ) ( ) CODE 753#: Dated; N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL.Plans: Permit N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit 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. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval: notes: REouiRED EXIMNc PROPOSED NOTES APPROVED Date. MAY 2 4 2011 l� F� Sids�: Ks�r. Main ec Ft H Sd.H/Sb: sf&: Tot.Imo= HHci& Stoaes notes A_{_� Mike Izzo From: Andrew malhotra <andymal1967@gmail.com> Sent: Friday, May 13, 2022 11:52 AM To: Mike Izzo Subject: 13 loch lane Hello Mike, Here's my receipt it was a 4000 deposit. total cost 6990 sorry for my mistake . Thank you ,fL6 -p'�.tal�A:: , .. -r-romp 4 �•op s3 . Co.. ttT I1).Y 7376P205091 Lt1,14_;{v-061.t rA7 Mo-760�09iT _q•,y ; .,rx, 65Y�R" 2J17!).11 011,)TATIdt •• il<)•nl�� 44ifA c6PPN7i10t:to" f �Cr� 68 3'rN STP"Z ':'v9PM-Nr Isles 39t>• C:.i1MS3 e 1)iJtt71)6 -AY�J ��Q�. ? :'PIT ♦_ /TL48084 )�?'- iX'447 PFOC--PCT TYPR CC UNIT it1PTN NRICMT 8 (Ayta; 31: PXC S. U-Nk- 2 NR:._Tgj sv 0!N TILT PIT 16 10.083t 49130 O� 13A II ?RR0-it4tli'.,n7 •�J a�,4 sc�1ltlTa+. 1NAu1 aA:v PAfa1c : 1 eauceriu cutrDl SV•iN 1 3V vir r1LT WT 7 261OIX 61-.0 3 1A cis µ 3'iL.10tViX,. 1CM3:Y.N; 1NALP1 . G,A7D PANZY t 2 1 L"6LkIiAL CO�LDt IV•1N 1 SV P/M j�F WT L 60.Obx 42.00 o Di Rr� x To)_771 a?= 71 1f—.—i 3^_It4PCN1 INCI 3V DIM TILT 1" 2 30.00X 49.50 0#;"4 21A M (—*,CRLE31: I xvx r *;04tl PANEL t ? ) COZI=.AL p110; 2V-IV Sl' CASEMENT K: _ 1D.Cox 35.00 U Lt :IA a 4:1S.101241.44 24 11B8t1: 1`.:Al10Af10 !;rvzYt1 Y",7, 1 L2?IML N f'T'7 ,� ffGR26 PAIfSL 1 1 } CQL9113AL GRID: 1`J•2N l��S.1] 6 fsv CAa&WXNT WT 30.0DY 34.00/ LJZ 12A 5 493.101241.8h 0 iVf SCR ER*. (STANDARD I L1tEr51 L CA20 PARLL ! i ) %DLODIIAL CHID: lV•28 `k�dd`i E>i A S 8AR73: r _ - Ax.RGLW.vAB.F:Y:.F,'C 2 1 :'1v1: '+.tl rJ T^TAL #ilMOW ITEM 6 TOTAL 'N:. j REG TOTAL: S19,c,-z•4b / U';AA CHARGE: $0.t O {/ .t{. D:SPONTI $4P196.ri8 L 1kJs''- 1 - E`. SAUS TAXI $S70.14 PAYl6E1:: TEAM: /f!h/� OEF0.�I'r: 'r54 59r242.97 P'RT---FS FrFF=111E V-P M DAYS. ,FDELIVERY h)� Sent from my iPhone 1 M4500 Series Fully Welded Vinyl Double Hung Mullion Options: 0 0 a I • H Mullion Available 1 1 1 i t 1 1 i i l 1 1 1 Glazing Options: • Low-E Glass • Argon Gas Enhanced Insulated Glass • Tempered/Tinted/Frosted/Pattern/Obscure/Clear Wire Finishes: • Cream White Color Thermal Performance: Glazing U SHGC Condensation Visual Transmittance Value Resistance Low-E ARGON 0.27 0.30 58 0.54 5309 971 Place, Corona, NY 11368 - www.modenawindow.com • Tel: 718-760-0668 1 M4500 Series Fully Welded Vinyl Double Hung PRODUCT SPECIFICATION Frame Depth: 3- 1/4" AAMA H-R50 Features: • Clear Insulating Glass Unit Size: 7/8" Overall Thickness. • Integral Interlock for Increased Strength, Durability and Security • High-density Woven Pile Weather stripping with Concealed Drainage • Intercept/DuraSeal Warm Edge Spacer System • Fully Extruded Lift Handles for Durability and Easy Operation • Tilt-in Sash for Easy Cleaning • Equal Leg Frame with integral J Channel • Fiberglass Mesh Insect Half-screen Options: • Heavy-Duty or Ultra-Lift Balance • Fiberglass Mesh Insect Optional Full-screen • Colonial, Prairie or Golden Pencil Diamond Grids • Snap-on Fin Available • Architectural Shapes Available • Unequal Sash Design Available • Exterior Grids Design Avaialble Combination Design: I I 1 1 1 1 1 1 l f l f 5309 97' Place, Corona, NY 11368 - www.modenawindow.com - Tel: 718-760-0668 1 3 1/4" '0 O 3 2 4 /a' c� w O O z � I I I M4500 DOUBLE HUNG I 0� 0 WINDOW WIDTH 3" 3„ C 'v ❑o o❑ M +� + J + o❑ O O MONDA WINDOW&DOOR SYSTEMS INC. PRELIMINARY PART a 53-09 97th PLACE,CORONA,NY 11368 TITLE TEL:718-760-0668 FAX:718-760-0812 M4500 SERIES DOUBLE HUNG SECTION DRAWN BY: DESIGNED BY: DATE SCALE COPYRIGHT 2018 NITS DRAWING AND ITS CONTENTS ARE THE SOLE PROPERTY OF MONDA WINDOW&DOOR MFG.ANY UNAUTHORIZED CHECKED BY: APPROVED BY: DRAWING No. USE OR REPRODUCTION IS STRICTLY PROHIBITED. No. REVISION BY DATE C3 C ,--P U v > T3CD °� + J C � w j, >` a a) o� �. o -Q u 41 a `� ,- -c t © -" • c rCD ` U , s p u o c ° ) Q) Q) ._ (3) -0 C *'� m L- - Q) -0 U*j a)> 1 i C Qq a� a) v 0 o cu C:CD Qj C] u to ,M U, ,> • t p Q) U, Ij - - - cap .�.� - > ' (1) — - - 4-- �--� ME --__----- _ �INN MiOWE ; 1 u _ ;r' -�'•-ram, �: �. ,. �s.r:'�rxr--' � _1��� ���t-� F Et y ,;:��rx=•� :—�:..�:°3";� � i �.4��" "�,�, i'1 �1 i��it � .:.5 ��. n'�yh I ��11, n i ` Iq iIIU I lili�l 116 ;1, Laura Petersen From: Laura Petersen Sent: Thursday, May 26, 2022 11:36 AM To: Andrew malhotra Subject: Building Permit Application for windows - 13 Loch Lane Good morning, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office; General contractor's contact name & phone number. Copy of general contractor's valid Westchester County Home Improvement License. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 5. Building permit fee $105.00 (due once permit is issued and ready for pick-up) Thank you ' �i Laura a'I�� 1��(/� o S e,?cl �y �I Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 1 laetersen aOryebrook.ora 1 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 10573-1706 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.D0 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 I 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 terns 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: 3207/17FCAC 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 Faun®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 tamer may also have an influence on your premium. EB 2540 NY.9 Rev,05-2019 Page 3 of 3 Page 1 o kff9dn{t of Examp000 to show spectnI,proof of Worker'Cumperttstinn lnturunet Coverage fist a 1.2.A or 4 Family.Owner-oc•uplrtl rtraidence ••rtW h'�.�rY.r.r r•I,.h�r..'.wryi./.rit•A•r.r- --..I..r r.b.. I ntic peoaley of prrlrry.I cnnrV tr 1 1 trrt tl,r n.'ttrr of/M 1,T,1 u,• ".. 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