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HomeMy WebLinkAboutBP22-160PERMIT #ZZ4 '6/ Q0.DATE: 3� �� EXPO, SECTION BLOCK LOT, TYPE OF WORK JOB LOCATION OWNER tiI P CO E i CD c?e) if�o// TCO # FEE DATE r r-• DATE INSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS 0 SPRINKLER ELECTRIC 0 LOW -VOLT C� ALARM C� i C//C-Aa Q�d �XIme /xj 1,✓acy �ICl2. OTHER APPROVALS ARB BOT PB ZBA OTHER Qy 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 August 22,2023 Jean Follansbee 57 Greenway Circle Rye Brook,New York 10573 Re: 57 Greenway Circle, Rye Brook,New York 10573 Parcel ID#: 129.84-2-46 Building Permit#22-160 issued on 8/31/2022 to Repair Retaining Wall& Extend Fence This certifies that the repair of the existing property line retaining wall between 57 Greenway Circle and 58 Greenway Circle& the extension of the privacy fence,under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D BUILDING DEPARTMENT For o PERMIT# -office u e only: Gj� VILLAGE OF RYE BROOK ISSUED: --3/- a AUG 16 2023 38 KING STREETS RYE BROOK,NEW YORK 10573 DATE: (914)939-0668 FEE: ,//Of PAIDX VILLAGE OF RYE BROOK www.aerook-.org BUILDING DEPARTMENT APPLICATION OR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS st►rss*tsssssrrttsstssr*rs*tts*rss**str*r*rrt*ststsssstsssstr*s*rrtrr*rsrrrrr*rrrsrsr**rs*s**t*s***ttsrsstr**ttrrrttttsrtt►tr Address: Occupancy/Use:GCS i dene.� Parcel ID#: / 4 /• c� Zone: Owner:huh ro L n s b ee Address: 5 r ee-n L0 G r P.E./R.A. or Contractor: tt I Address: I I'- Person in responsible charge: - . U \10 To� �.11�-e Address: Id 7 Wa 4`a p y<Sf I-LtckQhQe Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a 7 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: JP Y) Po �Q h s b e e being duly sworn,deposes and says that he/she resides at 5-7 (Print Name of Applicant) (No.and Stree � K in V ,in the County of �e� iE'S r in the State of-Abl_,that (Cityfl'own/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:$41, 1 (DO for the construction or alteration of: PQQ` C- 'O '�n'e 1 it l o r't v 10 Deponent further states that he/she has exam ned 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 , 20—V— day of ,20 Sig ure of Property Owner Signature of Applicant kPQn F�I 1(a ns be e Print Name of Property Owner Print Name of Applicant l/� Notary Pub is AREGORY M.RIVERS Notary Public Notary Pu!k,State of New York No.01 R164413M QwNfiw!In Westchester County 8/122021 Contnrl�Nr!EX^ires September M, QyE aR��, • �9a2 BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - ADDRESS : 1 ATE• 1 PERMIT# ISSUED: 3tiCT: BLOCK: LOT: LOCATION: �`� r OCCUPANCY: ❑ Violation Noted �cS THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION w1 �N 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 �E BRC��. '9a2 BUILDING DEPARTMENT ❑,B[UILDING INSPECTOR EPASSISTANT 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 - - - - - - - - - - - - - - - - - - - - '1 C ADDRESS ' 5 -o_ . C \ ( cJ o DATE' \ c) PERMIT#_ �� ` �� ISSUED: & , �JECT: -u BLOCK: '-?--LOT: I LOCATION: ( S�` `��' OCCUPANCY: (7, L VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ,REJECTED/ REINSPECTION SITE INSPECTION _ L� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION [� n o� ll ❑ NATURAL GAS O S ) �\ !e -- ❑ L.P. GAS S ` Q `0 �S ��► ❑ FUEL TANK f , ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION V INAL ❑ OTHER a O = W � a _ � W N M • � v � E a - d a a W N c , o d H ,WL, U a� o 7 W z o H � o z � w ■ y ~ cCe ti N Q W o ay H— O a: V H 04 � Lny Lei A V o q V �I � U z Cyr W (� M et c7 v, Ts u M � � �� v CIA or. E a oo oo0-0 �� � iU � w cn U ° J-4 z zW f..r O Q W o v BUILDING D RTMENT TF VIL AGE OF R ROOK —`]938 KIN &BEET RYE BR ,NY 10573 3 2022 U Q (914 9-066ff ��vw• ok•or� VILLAGE OF RYE BRZOOK BUILDING DEPARTMCNT FOR OFFICE USE ONLY. AUG 2 5 20 2 Approval Date: Permit# Q4 = Application# Approval Signature: - �A ARCHITECTURAL REVIE BOARD: f` Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: L"A.L_1L'Zr4-hot-J 7SG• "� V Application Fee: Permit Fees: t �Q FENCE / WALL / GATE PERMIT APPLICATION Application dated: ,,�( ":� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,constructio ,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the V illage of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Job Address: 5Tl. d� g 4l (2 lf- 2. Occupancy/Use: ke!�MencS.B.L.#: 2i . '9y�{ Z" 't`l Zone: I— D 3. Proposed Fence/Wall/Gate(describe in detail):I I � `� �;h n Y6? Cir ace r -Y 4. Property Owner: n r Address: Phone# lqqO Cell# email: Applicant: Lso Address: S Q r Phone# Cell# email: Archit n err: Addr . Phone#_ Cell# i email: Contracts + Address&Phone 5. if building is located an a Garner lot,which s eet does it front on: 6. What is the estimated cost of construction ,y5y (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: d rn I 8112/2021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. 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. Swom to before me this 3 Sworn to before me this day of , 20 day of , 20 Signature f Property er Signature of Applicant eat, r�j 1',"1" ZP ' t Name of Pr Owner Print Own Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County Commission Expires January 29,20L; 2 8/1212021 w a- 0 N rn ea 41 u = �r�Tii 1.1 Q� ~ W \p 00 Q ao H = Qt " A o , ° 4? PLO 00 w a w � �} �+i to A V a U O © 0� O M U z u c Cn Vr A � IV, coo 0 Zd_ ~ Z w � � � � �.aaBaFq ^� v W0 oCIN 00 a A a 0 ,5 -0 a W zz .0� � o �� � a o o -0:, 2 um © PLO ovvv � 11 ►�A] ✓� 0 a wt v d Cl� �I � R� W ►� 2v��, � �� b BUIL G DEPARTMENT , ii \,; `�=' VIL OF RYE`- ROOKit D �j I. :' 938 KIN �EET RYE BROOK,NY 10573 AUG 2 3 2022 L_) z. (914)9�39-066s brook.ort3 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: AUG 2 5 20 2 1` I Approval Date: Permit# Application # Approval Signature: ARCHITECTURAL REVIE BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: _L S4 AJA?-A'AOrJ% 7 S A Application Fee: Permit Fees: L OQ FENCE / WALL / GATE PERMIT APPLICATION Application dated: p , is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,.constructiorf,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of Rye Brook,as per detailed statements described below. Swimming pool fences must conform to the State Code. 1. Job Address: aretnwad 01mit 2. Occupancy/Use: e!� l S.B.L.#: �-�l .J' Z` Zone: PLID 3. Proposed Fence/Wall/Gate(describe in detail): %rb5 lace r 4. Property Owner: Address: Cl C 1'e Phone# 30, jq yQ Cell# email: cra Applicant: .SAI Me Address:—so M Phone# Cell# email: Archit n er: Addr Phone#_ Cell# { email: _ Contracts Address& Phone 5. [f building is located on a corner lot,which s eet does it front on: 6. What is the estimated cost of construction ;y;l y (NOTE:The estimated cost shall include all site improvements, labor,material,scaffolding,faced equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: 8/12/2021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. 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. Sworn to before me this 'I Sworn to before me this day of , 20 r:�D day of , 20 Signature f Property er Signature of Applicant P ' t Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,2 2 8/12/2021 The Arbors Homeowners' Association 173 1/2 Ivy Hill Crescent Rye Brook, NY 10573 IDJuly 21 , 2023 JUL 2 6 2023 Jean Follansbee VILLAGE OF RYE BROOK 57 Greenway Circle BUILDING DEPARTMENT Rye Brook, NY 10573 Re: Extension of Privacy Fence as per Village of Rye Brook. Dear Jean, The Architecture and Grounds Committee (A&G) has reviewed your application for the above-named work. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Please note the approval included your proposal for a step down dropping equally and finishing at 4 feet above grade. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Nicholas Salzarulo Property Manager EUG2 3 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 1731/i Ivy Hill Crescent Rye Brook. NY 10573 914-939-2440 July 20, 2022 Jean Follansbee 57 Greenway Circle Rye Brook, NY 10573 Re: Retaining Wall Repair Dear Jean Follansbee, The Architecture and Grounds Committee (A&G) has reviewed your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained. a copy must be provided to A&G for final review and consideration. Work on the project may not begin until you receive written notice of acceptance from A&G_ If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing_ Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines andior work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Interim Property Manager -.From: Arbors Property Manager manager@arbors-ryebrook.com ' Subject: Letter Date Jul 21, 2022 at 1:41:20 PM To,- Jean Follansbee jef52@optonline.net Good Afternoon, Please see the attached letter. Kind Regards, Ashlee Pasquale Property Manager The Arbors Homeowners' Association, Inc. P: _(914)939-2440 August 22, 2022 To the Board: Regarding the repair of the retaining wall for which this permit is requested, my ignorance of the Village regulations and proceeding without the appropriate approval is my mistake. The mistake is solely mine and no other person or entity should shoulder any responsibility or consequences. I am hopeful that my mistakes can be rectified to your satisfaction. Sincerely, Jean Follansbee 57 Greenway Circle Rye Brook, NY 10573 A & G APPLICATION FORM Page I of 2 Q/!Wew A&G Guidelines,AHOA Declarations and By-Laws pertaining to your project. Consult with the Property Manager for any clarification of pertinent A&G Guidelines. Include in Request Section: a) Exact measurements of affected area&materials to be used b) Detailed description of project c) For fences and patios:exact location to be marked with stones,stakes, and/or paint, preferably done by installer © Submit with Application: a) A "Before"picture b) Contractor's license&insurance(if applicable) c) Permit from VRB (if applicable) d) Plot plan (if applicable) (� e) Architectural drawings(if applicable) f) Oil Tanks, Fencing and Painting: requires an additional form to be filled out and submitted with this application (consult with Property Manager) Q If any information is missing,the Property Manager can NOT accept the application. P AHOA and A&G are not liable for the cost of any plans,regardless of approval or denial. 0 Once A&G receives the complete application, the area will be inspected and A&G will respond to the request in a timely manner. �? If approved, Homeowner is then responsible to notify the Property Manager when work Begins and Finishes. p' Once the project is complete, an "After" picture must be submitted to the Property Manager to be kept on file.A&G and/or the Property Manager will then inspect the work done for adherence to the approved application. C] If work Is not in compliance with the approved application, Homeowner is subject to fines and/or assessments and/or restoration of the property according to A&G Guidelines and the original approved application. Note:Any work done without proper Prior author¢ation is also subject to fines Wor assessments, as well as possible removal and/or restoration. Please check each box as read, and then sign and date this page. 07 63 2ZZ3 —Y��—Hoirn�'66wner Signature unit pft A & G APPLICATION FORM Page 2 of 2 Homeowner!Name(prinblype): jea Address: J Phone: Email: Date: 6 3 20Z Print or type a detailed explanation of your proposed project: �-e►�d FYI r I vQ eQ nd. yn oceck on -f� e- 57 5� crderlv WeJ s ip- J O S -j e no i 15 (r u �51 -donJ � � -- � �� . S�,ta ±clpd s. ka 3 202-3 Homeowner gnature J�u R �a Ks �te 51 C-rl ee c rat Y. JUL 2 6 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ir y 4 Y 4 cro 0V S =�� ,` _ �_ �/ --�;_ f � � � � r' ' { I . � .�..,m.. ('� - � � 6� . � - •�.{ �.,. .:,�, ; -. �. � � ,o._ =�-- I �:i";� �; � /� ! . � / /, Building Permit Check List&Zoning Analysis Address: �9 7 a7Z��rN wX'f (f 2 GL SBL Zvi .QJ� 2— Zone: Use: Z Const.Type:-2M Other. LE.4 A L i -L A-h Dt-� Submittal Date: ZIT Z 2-Revisions Submittal Dates: Applicant r J L-L A t-+ S:�j W-o- Nature of Work 2 o L i•+t'` Reviews:ZBA: AUG 2 5 2022 PB• BOT• Other: hMIP OK ( ( ) FEES:Filing: S- BP: C/O Flood Plane: Legalization: 7 S',D ( ) (4APP: Dated. otarized: ✓ SBL: ✓Truss I.D. Cross Connection: ✓ H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current Archival• Sealed. Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed. Copies: Electronic. Other. (t (�License Workers Comp: Liability Comp.Waiver.-tZ—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:Plates: Permit Fuel Type: Other. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER. Other. ( ) ( ) Other. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: REQUIRED EXISTING PROPOSED NOTES APPROVED AUG UG 2 5 2022 LL Front: Sides: Main Coy: Accs,Coy: F S H S CjFA. Tom: EL IMP: R&Lking Hight/Stories notes: I BUILDING DEPARTMENT VILLAGE OF RYE BROOK AUG 2 3 2022 938 KING STREET RYE BROOK,NY 10573 ( VILLAGE OF RYE BROOK\4 9 9-0 8 BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: feerll C�CC e. Da of Submission: Parcel ID#: 1 2-' •P Zone: I� Z OZ2. Proposed Improvement(Describe in detail): Rerpair 0�ey►z�nQ it4dIAMa WaIk b en APPLICANT CHECK LIST: Jer MUST BE COMPLETED BY THE APPLICANT �p The following items must be submitted to the Building C M-her- Department by the applicant- no exceptions. Property Owner: `JeQn�L anSbee 1. (✓) Completed Application 2. (4Two(2)sets of sealed plans. (one full size {maximum Address: W re tt allowable plan size=36'x 42"1, and one I I"x 1 T) Phone# q1q30 — Applicant appearing before the Board: 5. ( Ane electronic/disc copy of the complete je0n IF2l61sbe� application aterials. nn I 6. ( Filing Fee. Fr(5,00 Address: �sq GXea ti, Al l;l rd-e 7. (J�&ny supporting documentation. 8. ( ) HOA approval letter. (if applicable) Phone# RI1 30E� —1yq 0 9. (4Photographs. �0 Architect/Engineer: 10.( ) Samples of finishes/color chart. (a sample briar or n model may be presented the night of the meeting Phone# 14S l W6 "k& bL 6U')jd1 a3,I(ISPvC r By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this a Sworn to before me this day of , 20_ day of , 20 Signatur f Pro erty OW)tov Signature of Applicant (_/er (;'1jqnS&e-C nt Name of Property Owner Print Name of Applicant - .\---\—L Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME616OOr&3 Qualified In Westchester County Commission Expires January 29,202Z 8/12/2021 OZ spy cu l_J IL C ' O ��J N Q� o cv N O L) ? O l�J z J > CO CMI* LU o LOLM W Z c) Q �. -0 Owl ,77 VAI 1 r _ _ __. I ��' � 1 -� _ � .� F _ _ a--��� T� r _ � � u-� � , f��'`' .r- . . J-- v ���- -.L.. � _:_ , � ,�. Y n � � t 'If I 1 ��-.y 1 � '_ -� � -. PAGE 1 < < MAIL-GENR-I USAA® HOMEOWNERS POLICY PACKET WEEFFECTIVE: 10-15-21 TO: 10-15-22 I MII pIH'N tiF' 6 UH {02-POO878-1 -(10957-55456418111i JEAN E FOLLANSBEE 57 GREENWAY CIR RYE BROOK NY 10573-1503 CIC 0012695 87 91 A IMPORTANT MESSAGES Refer to your Declarations Page and endorsements to verify that coverages, limits, deductibles and other policy details are correct and meet your insurance needs. Required information forms are also enclosed for your review. 1) USAA considers many factors when determining your premium. Maintaining your property to reduce the probability of loss is one of the most important steps you can take toward reducing premium increases. A history of claim activity will affect your policy premium. 2) Go to usaa.com to view policy coverages and home features. 3) Your policy does NOT cover loss due to flood from any source. For information about obtaining flood coverage from the National Flood Insurance Program (NFIP) , call USAA at (800) 531-8722, or contact the NFIP directly. If you already have a flood policy, you should review it to make sure: you have the appropriate coverage and limits. No automatic increases or adjustments are applied to your policy. Coverage for loss of household contents due to flood may be available at an additional cost. If you have questions, please call a member service representative at the phone number above. This is not a bill. Any premium charge or return for this policy will be reflected on your next regular monthly statement To receive this document and others electronically or view your policy summary online, go to usaa.com. For U.S. Calls: Policy Service (800) 531-81 1 1. Claims (800) 531-8222. HOCS1 49709-0406 PAGE 3 USAA CASUALTY INSURANCE COMPANY MAIL-GENR-I Ste^ 9800 Fredericksburg Road - San Antonio, Texas 78288 RENEWAL DECLARATIONS PAGE Named Insured and Residence Premises Policy Number JEAN E FOLLANSBEE C I C 00126 95 87 91 A 57 GREENWAY CIR RYE BROOK , WESTCHESTER , NY 10573- 1503 Policy Period From: 10/15/21 To: 10/15/22 (12:01 AM. standard time at location of the residence premises) SECTION I - COVERAGES AND AMOUNTS OF INSURANCE COVERAGE A - DWELLING PROTECTION $432,000 COVERAGE B - OTHER STRUCTURES PROTECTION $43,200 COVERAGE C - PERSONAL PROPERTY PROTECTION $324,000 COVERAGE D - LOSS OF USE PROTECTION (UP TO 12 MONTHS) $86,400 SECTION II - COVERAGES AND LIMITS OF LIABILITY Personal Liability - Each Occurrence $300,000 Medical Payments to Others $5,000 DEDUCTIBLES (Applies to SECTION I Coverages ONLY) We cover only that part of the loss over the deductible stated. HURRICANE $8,640 (2%) ALL OTHER PERILS $500 POLICY PREMIUM for Section I and Section II Coverages Above $1 ,755.60 CREDITS AND DISCOUNTS (Included in policy premium above.) $572.95 CR Details on the following page (If applicable) OTHER COVERAGES AND ENDORSEMENTS Forms and Endorsements are printed on the following page. STATE SURCHARGES AND TAXES (Shown below if applicable) TOTAL POLICY PREMIUM Including Credits, Discounts, Optional Coverages, Endorsements, State Surcharges and Taxes $1 ,755.60 PREMIUM DUE AT INCEPTION . THIS IS NOT A BILL . STATEMENT TO FOLLOW. In witness whereof, this policy/ isc signed on 08/16/21 Karen Morris,Secretary lames Syring,Presdent REFER TO YOUR POLICY FOR OTHER COVERAGES, LIMITS AND EXCLUSIONS. HO-D1 (07-08) ATTACH THIS DECLARATION TO PREVIOUS POLICY 87028.0708 USAA CASUALTY INSURANCE COMPANY PAGE 4 USAW RENEWAL DECLARATIONS PAGE Policy Number Policy Term: 10/15/21 10/15/22 CIC 0012695 87 91 A Inception Expiration POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US. REMAIN IN EFFECT (Refer to prior Policy Packet (s) for documents not attached.) : QR3CIC (07-08) QUICK REFERENCE-SPECIAL FORM HO-3R (02) (07-08) HOMEOWNERS SPECIAL FORM HO-ACP (07-12) AMENDMENT TO CONTRACT PROVISIONS HO-NY (08-17) NEW YORK SPECIAL PROVISIONS HOSLS3 (02) (07-08) SPECIAL LOSS SETTLEMENT NY HHO (01-15) NEW YORK HURRICANE ENDORSEMENT HO-125 (07-08) HOME PROTECTOR HO-208 (07-12) WATER BACKUP OR SUMP PUMP OVERFLOW HO-728 (07-12) REPLACEMENT COST COVERAGE ADDED: HO-176NY (07-08) NEW YORK HOMEOWNERS RATING INFORMATION HO-90NY (07-08) NEW YORK WORKERS COMPENSATION YOUR PREMIUM HAS BEEN REDUCED BY THE FOLLOWING CREDITS AND DISCOUNTS: AUTO AND HOME COMBINATION DISCOUNT $185.43 CR CLAIMS FREE DISCOUNT $185.43 CR INSURANCE-TO-VALUE DISCOUNT $87.84 CR HOME AGE DISCOUNT $114.25 CR HO-D2 107-081 08/16/21 87029-0708 PAGE 5 C I C 00126 95 87 91A HO-176NY (07-08) HOMEOWNERS RATING INFORMATION - NEW YORK Effective Date: 10/15/21 Expiration Date: 10/15/22 Form: HO-3R(02) (07-08) Square Footage: 1200 Home Age: 43 Construction: FRAME Roof Type: COMPOSITION SHINGLE Territory: 79 Protection: 4 Fire Department: 1 miles Tier (Relationship Level): 32 Deductible: HURRICANE $8,640 ALL OTHER PERILS $500 Copyright, USAA, 2008. All rights reserved. 91282-0709 HO-176NY (07-08) Page 1 of 1 PAGE 6 C I C 00126 95 87 91A HO-90NY (07-08) WORKERS' COMPENSATION - NEW YORK Certain Residence Employees We agree, with respect to covered "residence The covered "residence employee's" last day employees": of last exposure to the conditions causing or aggravating such "bodily injury" by disease Who Is Covered must occur during the policy period. A covered "residence employee" under this Policy Provisions endorsement is a "residence employee" who is engaged in regular employment of less than This insurance is subject to all the provisions of 40 hours per week or is engaged in casual this endorsement and the following provisions employment. of this policy However, as stated in New York Insurance Law a. Under Sections I and II-Conditions: section 3420 (i)(1), coverage does not apply to an employee who is not required, under New 3. Waiver or Change of Policy Provisions. York Workers' Compensation Law, to be covered. Attachment of this endorsement does 4. Cancellation. not constitute a voluntary election of coverage 6. Subrogation. under New York Workers' Compensation Law. 8. Assignment. Under Coverage I b. Under Section II-Conditions: To pay when due all benefits required of an 4. Duties After Loss. "insured" by the New York Workers' Compensation Law, and 7. Suit Against Us. Under Coverage II B. Bankruptcy of an Insured. To pay on behalf of an "insured" all damages c. Our agreement to defend the "insured" as for which the "insured" is legally liable provided under Coverage E-Personal because of "bodily injury" sustained by a Liability. covered "residence employee". The "bodily injury" must be caused by accident or disease d. Under Section II-Additional Coverages: and arise out of and in the course of employment by the "insured" while: 1. Claim Expenses. a. In the United States of America, its e. The definition of "bodily injury", territories or possessions, or Canada, or "business", "insured" and "residence employee." b. Temporarily elsewhere if the covered Additional Provisions Applicable to "residence employee" is a citizen or resident of the United States or Canada. Coverage I Application of Coverage The following provisions are applicable to Coverage I: This insurance applies only to "bodily injury" a. As between the covered "residence which occurs during the policy period. If the employee" and us, notice to or knowledge "bodily injury" is a disease, it must be caused or aggravated by the conditions of the covered of the "occurrence" of the injury on the "residence employee's" employment by the part of an "insured" will be deemed notice or knowledge on our part. "insured". 91222-0709 HO-90NY (07-08) Page 1 of 2 6418.02-1.1 O(K) 78411M 18.OMM PAGE 7 C I C 00126 95 87 91A b. The jurisdiction of an "insured" will, for Exclusions the purpose of the law imposing liability for compensation, be our jurisdiction. This policy does not apply: Additional Provisions Applicable to a. To liability for "bodily injury" arising out Coverage II of "business" pursuits of an "insured." Coverage II does not apply to any suit brought b. Under Coverage ll: in or judgment rendered by any court outside the United States of America, its territories and 1. To liability assumed by the "insured" possessions, or Canada, or to any action on under any contract or agreement. such judgment 2. To any obligation under a workers' compensation, unemployment or Limits of Liability Coverage II disability benefits law or any similar law. We may not limit our liability to pay damages 3. To punitive or exemplary damage for which we become legally liable to pay because of "bodily injury" to a because of "bodily injury" to an "insured's" covered "residence employee" covered "residence employees" if the employed in violation of law. "bodily injury" arises out of and in the course 4. To "bodily injury" to a covered of employment that is subject to and is "residence employee" employed in compensable under the Workers' Compensation violation of law with the knowledge of Law of New York. an "insured." Other Insurance 5. To "bodily injury" intentionally caused or aggravated by an "insured." If a loss covered by this insurance is also 6. To damages arising out of the unlawful covered by other insurance, we will not pay discharge or coercion of, or unlawful more than our share of benefits and costs. The discrimination against, a covered shares of all applicable insurance will be equal "residence employee." until the loss is paid. However, if a loss covered by this insurance is also covered by Except as specifically modified in this insurance written to cover "business" endorsement, all provisions of the policy to employees of an "insured" who is a sole which this endorsement is attached also apply proprietor, this insurance is primary. to this endorsement. Conformity to Statute If any term of this insurance is in conflict with the New York Workers' Compensation Law, such term is amended by this statement to conform to that law. Copyright, USAA, 2008. All rights reserved. Includes copyrighted material of Insurance Services Office, with its permission. HO-90NY (07-08) Page 2 of 2 PAGE 8 C I C 00126 95 81 91A USAA' CREDIT DISCLOSURE NOTICE As part of our normal underwriting process, we use a credit-based insurance score in addition to traditional underwriting factors to determine the premium for your property insurance policy. This score uses information from the primary policyholder's credit report to help predict the likelihood of future losses. Typical items from a credit report that could affect a credit-based insurance score include, but are not limited to, the following: • Payment history • Number of revolving accounts • Number of new accounts • Presence of collection accounts • Bankruptcies • Foreclosures LexisNexis was the consumer reporting agency that provided the information used to develop the insurance score. USAA CASUALTY INSURANCE COMPANY 9800 Fredericksburg Road • San Antonio, Texas 78288 • 1-800-531-USAA (8722) 60676-0312 CDI-NYP02 Rev. 03-12 Page 1 of 1 PAGE 9 C I C 00126 95 81 91A New York Hurricane Deductible Program In addition to your All Other Perils deductible, your policy also contains a separate deductible for hurricane losses. Your policy covers damage due to windstorm during a hurricane. It does not cover damage caused by storm surge or flooding. Flood insurance may be purchased to cover this type of damage. The Hurricane deductible applies only to losses caused by, or resulting from, a windstorm during a hurricane, and may be higher than your All Other Perils deductible. This means, in the event of a hurricane loss, your out-of-pocket expenses will be greater. The Hurricane deductible is mandatory and cannot be removed from your policy. About your Hurricane deductible • The deductible can be either a fixed dollar amount or a percentage. A percentage deductible is based on the Coverage-A Dwelling limit of liability. The Declarations page lists both the percentage and the corresponding dollar amount of the hurricane deductible. • If you have a percentage deductible, it will increase when your dwelling limit of liability is increased due to inflation protection. Increases also occur if you make improvements or request a change to your dwelling limit of liability. • Non-hurricane windstorm losses are not subject to the Hurricane deductible. The All Other Perils deductible will apply for non-hurricane losses. When your Hurricane deductible is activated • Your Hurricane deductible activates when the National Hurricane Center of the National Weather Service declares a Category 1, 2, 3, 4 or 5 hurricane with sustained wind of at least 74 miles per hour. • Activation begins 12 hours before, and ends 12 hours following a hurricane declared anywhere in the coastal counties of Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and Westchester, regardless of the specific location of your property. Coverages to which your Hurricane deductible applies • Coverage A-Dwelling. • Coverage B-Other Structures. • Coverage C-Personal Property (if included on the policy). The deductible applies to the entire loss, not each coverage separately, 61490-0914_01 NY HUR1 (Rev. 01-15) Page 1 of 2 PAGE 10 C I C 00126 95 87 91A , Here are examples of how your Hurricane deductible works in the event of a hurricane loss: Policy coverages and deductibles Coverage A - Dwelling $300,000 Hurricane deductible 2% (2% X $300,000) $6,000 Hurricane loss scenario 1 Hurricane loss scenario 2 Total covered damage s30,000 Total covered damage s3,500 Hurricane deductible-2% - $6,000 Hurricane deductible-2% s6,000 (your out-of-pocket expense) (your out-of--pocket expense) Amount recovered from $24,000 Amount recovered from $0 insurance insurance The entire loss is your out-of-pocket expense since your damage is less than your Hurricane deductible. If you are interested in changing your deductibles or have questions about your policy, please call a member service representative at (800) 531-81 1 1. If you wish to purchase coverage for storm surge or flooding during a hurricane, please contact USAA Flood Operations at (800) 531-8444. Please read your policy for the specific terms, conditions, exclusions, limitations and provisions. NY HURL (Rev. 01-15) Page 2 of 2 6416-07.614 XXX18784 XXI I84M 14 PAGE 11 cic 00126 95 87 91A IMPORTANT FLOOD INSURANCE NOTICE Your homeowners or dwelling 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 the USAA Flood by calling 800-531-8722 or directly from the National Flood Insurance Program by calling (800) 638-6620 or via their wehsite at http://www.floodsmart.gov. 25288-0220 25288 Ed. 2-20 Page 1 of 1 rAUt z cic 00126 95 87 91A THIRD PARTY INSURANCE NOTIFICATION DESIGNEE NEW YORK A NAMED INSURED WHO IS 65 YEARS OF AGE OR OLDER AND A RESIDENT OF NEW YORK STATE IS ENTITLED TO DESIGNATE A THIRD PARTY TO RECEIVE ANY CANCELLATION, NONRENEWAL OR CONDITIONAL RENEWAL NOTIFICATIONS INVOLVING THIS NEW YORK INSURANCE POLICY. SUCH NOTIFICATIONS WILL BE MADE TO THE DESIGNEE IN ADDITION TO ANY NOTIFICATIONS MADE TO YOU, THE NAMED INSURED. SHOULD YOU QUALIFY AND ARE INTERESTED IN APPOINTING SUCH A DESIGNEE, PLEASE CONTACT US. YOU MAY CALL 1-800-531-8111. ADDITIONAL INFORMATION WILL BE MAILED TO YOU. NEW YORK INSURANCE LAW PROVIDES WE MAKE THIS NOTIFICATION ANNUALLY. YOU NEED NOT CONTACT US IF YOU HAVE ALREADY APPOINTED A DESIGNEE. NATURALLY, PLEASE FEEL FREE TO CONTACT US SHOULD YOU NEED TO CONFIRM OR MAKE ANY CHANGES TO YOUR DESIGNEE. 40NY(O 1) 3-91 6418-074+1(IIKM78(W184M16 PAGE 13 C I C 00126 95 87 91A CHARACTERISTICS OF YOUR HOME Our mission at USAA is to help protect your financial security. One way we do this is by helping you determine if you're adequately covered in the event of a loss. We can calculate the minimum rebuilding cost of your home based on your home characteristics, but only you can decide if this is enough coverage. Our estimates are based on average construction costs and labor costs for geographic areas and may not reflect the unique features of your home or the area you live in. On the back of this page, you'll find your home characteristics. If any of the information is incorrect, the rebuilding cost may be affected, so please revise any inaccuracies by: • Logging on to usaacom, selecting your policy and then Home Characteristics, or • Calling us at 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722. Should 1 adjust the coverage on my flood or wind policy? If you have a separate flood or wind policy for this property, please call your agent or insurer to confirm that your coverage is adequate. For flood or wind policies serviced by the USAA Insurance Agency, please call us at the numbers listed above. Wind coverage is available in Alabama, Florida, North Carolina, South Carolina, Texas and Mississippi. 60321-0519 60321(04) Rev. 05-19 Page 1 of 2 PAGE 14 C I C 00126 95 87 91A CHARACTERISTICS OF YOUR HOME YEAR BUILT : 1978 *TOTAL SQUARE FOOTAGE : 1200 NUMBER OF STORIES: 2.0 *Total Square Footage.- Includes: Additions and Finished Attic Space Excludes: Basements and Built-in or Attached Garages GENERAL SHAPE AND STYLE : STANDARD EXTERIOR FINISHES & FEATURES: STANDARD INTERIOR FINISHES & FEATURES: STANDARD KITCHENS AND BATHS: STANDARD EXTERIOR WALL CONSTRUCTION : SIDING - CEDAR (CLAPBOARD) FOUNDATION TYPE : CONCRETE SLAB ROOF TYPE : COMPOSITION - 3 TAB SHINGLE YEAR ROOF INSTALLED/REPLACED : 1978 GARAGE OR CARPORT TYPE/STYLE : NONE FLOOR COVERING MATERIALS : CARPET, HARDWOOD - PLANK, TILE - CERAMIC NUMBER OF BATHROOMS: FULL 2 FIREPLACES : 1 60321(04) Rev. 05-19 Page 2 of 2 1.11tl n!h' MMNii +. V* Ifl-Irtl19 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'compensadon rights or obligations of any party.•* Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): ❑ I am performing all the work for which the building permit was issued. ❑ I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work for which the building permit was issued or helping me perform such work. I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that 1 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 ork indicate0on the building permit. (Signatt r f Homeowner) ome owner) ate igned) (� eon Fdwsbee_ Home Telephone Number q LI 5 I �l H 0 (Homeowner's Name Printed) Sworn to before me this day of Property Address that requires the building permit: -,5,rf Gr,eeM 3rCAt �( ♦ ( ou ty Clerkpi11 Sf1 rxlj r 0 • ��� i` Notary Public,State of New York No.OiMES160063 Qualified In Westchester county r 29 20 Z commission Ex y Commis Tres January P Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB