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Home My WebLink AboutBP24-018PERMIT # JJ/''47 O /W DATE: 113 SECTION % I to 3!v BLOCK LOT TYPE OF WORK W JC/STl/!Z S�jrloolQ &4Cry1 JOB LOCATION OWNER CONTRACTOR EST. COST 00 FEE I'(Z)00` O # FEE,+1 �J D DATE TCO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS ED FEE DATE DATE I NSP SPRINKR ��C� ELECTRIC LOW -VOLT O ALARM O AS BUILT O FINAL OTHER APPROVALS ARB SOT PS ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-011 Certif irate of ®rrupaurp This is to certify that 7-a L/(_1� rT� 7 of, Pate &106Y_ j , having duly filed an application on Jaoaar61 jgj6 20_,2V requesting a Certificate of Occupancy for the premises known as, 5'7 /,�) //(/yj �r1Zye Brook,NY,located in a j& Zoning District and shown on the most current Tax Map as Section: 124J. 4369 Block: 3 Lot: Z , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.C:�q-01E�5 , issued 20,,,?4, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises orb ing orpart thereof listed under the following New York State Classifications,Use: - —i / Construction: 10 for the following purposes: o bdQ6n-� d I"� Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made, hall the building be moved from one location to another until a permit to accomplish such change h b n obta' m th uilding Inspector. i7Building Inspector,Village of Rye Brook: - Date: FEB 0 8 2024 D IE C IEME BUILDMdVER '`AUTMENT For office use nl PERMIT # "C.J' ID VILLAGE OF RYE BROOK ISSUED ! JAN 3 0 2024 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE /- o-' (914)939-0668 FEE / PAID VILLAGE OF RYE BROOK www.ryebrook.org Bllll.''r"!r= �-,r=PARTMENT 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 srss#ssrssss#sssrr**rrr»srsssrrr/rr/rs/rrsssssrrrrss*r**ssr*ss *rr##s#ssss#s#lrr#sssrssasrrsrs*srssrr■*i//*srrr#s**rr#r#r#rr**rr Address �a 'Z Occupancy/Use:s)rt:df'sl Parcel ID#: �3 4 —3—9 Zone Owner: Address:_ Z cv-zj P.E./R.A. or Contractor: Address:_ _ Person in responsible charge:_ _ —Address:_ w� 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 Y�O�RK, COUNTY OF WESTCHESTER as: ,( Q S C y Of Z- being duly sworn,deposes and says that he/she resides at : U Z W �� S / (Print Name of Applicant) / , /� / (No.and Street) in 13&V D /C ,in the County of W �C '/ �� 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 v� have been donated gratis was:$ O , for the construction or alteration of.� C, U /Z/V 6/e S 7' /U O 2- G pa 2 e 't/ (-,a0 �j 1 ed le- oy '" /-n 2c-) 0 /Z-1,7 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 C� Sworn to before me this day of , 20 r'� day of , 20 Signature of Property Owner Signature of Applicant Est; -7' 1 Ida Z P " e of Property Owner Print Name of Applicant Notary Public SHA I MELILLO Notary Public Notary Public,State of New York No.01ME6160063 Qualified in Westchester County ` 1'2021 Commission Expires January 29,201"7 BRnuk W 19a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914)939-0668 FAx(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - ------ ADDRESS: - u� � � 1 Cf�l ,�'� DATE: � +PERMIT# � ISSUED: � �j� SECr: iLOCK: LOT: LOCATION: � � 1C, CX�� U OCCUPANCY: ? 0 VIOLATION NOTED THE WORK IS...XACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED 0 FOOTING ❑ FOOTING DRAINAGE 0 FOUNDATION O UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING .� 0 ROUGH F RAmING ► (�" Y C �C' ` � � 0 INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING p FINAL ❑ OTHER r 1 N N fiT cy N x if L 04 F p" bi -4 Z O PSG � 1oo *� 114 x z GO . coi w C*4 0 .5 ~ z o y p o Q " � o � u V U Z ) t a o I-4 = PO i M W I v Q ar k _ oc cn N .-. • v _ �. � � C/) U N � v � Jy a .a .v � eta ��► I � N Ati U : 0 (� v� �' w o off W o o ° V E~ c �° � y � cn M _ _ - D ' BUIfE bkkR MENT D [E F VILF R YE OOK 938 KINGRYE BR�I NY 10573 939-066�� VILLAGE OF RYE BROOK wv y.Yyebrook. lz BUILDING DEPARTMENT r" INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: J A N 3 1 2024 P r Application Fee:$ Approval Signature: Permit Fees:S Disapproved: Other: Application dated: / -3o a} is hereby made to the Building Inspectorof 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, rr 1. Job Address: _`_O Z W,-j 0, S� �L 6/,? ,? ekJ SBL: I'�I i 3(0 —3r� Zone: Proposed Improvement.(Describ in detail): 74 h , � 2420 .� 3. Does the roposed 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,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit 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: After Construction: 6. MY State Construction Classification: �, N.Y.State Use Classification: 7. Property Owner: S l!t +(C Z Address: S y Z "I ed f aZ Z,d a M Z s '� Phone# Cell# /'/ :),3 3 7.3 ql email: 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: q12.12. Estimated cost of construction $ 00 a OTE:The estimated cost shall include all labo ,material,scatTolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13, Job Timetable: Start: Finish: (1) 6ni2o23 U LDV40.DEFARTMENT VIL E OF RYE B OOK JAN 3 0 2024 938 KING ET RYE BROOk,NY 10573 (k44)939-0668 VILLAGE OF RYE BROOK www.ryebrook.or2 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: I, ram► ' n 2 e Z ,residing at, v 7 W-1 f (l//ln�i SJ� ✓�n4 (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; _J 7 W/ /// 15�'V 5- Rye Brook, NY. (Job 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 Codes. (Signature of Property Owncr(s)) -7�_oSe- (Print Name of Property Owner(s)) Sworn to before me this d fI�`��, 20� (Notary Public) SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Comnil6slon Expires January 29,202 (2) 8/1 21202 1 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: (print name of individual signing as the applicant) being duly sworn,deposes and states that he/she is the applicant above named, 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 0 (� Sworn to before me this day of , 20 2` day of , 20 Signature of Property Owner Signature of Applicant Pri Kjhy Owner Print Name of Applicant V\ I UL Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County commission Expires January 29,20il (4) 8/12/2021 O N O N W i O O a � � o W � T Z v cn ;D a oo z 6 via. pro., o w O A i y Ocq44 z v, a N � O a s0 O 0-4 U U w � o a ` �+ �, z w Ax O H z o 000en 0 �j w `� Z N cn z w Vz Z Z o o x ' � O i W I-* N M • r� ,,,., U, � p�. M U Q V � A ' t� � � v J � a � O "(� N � 2 cn U N W rP70,< i � W a w a A o O z z V Z ■ w r.4 z H a O � o w H W a H W w H C �' GQ z a $ V w o a U cn W v w cw7 o o x L 8 . o � LC) w z A a 09 .. a w a w w � �I M a a z w x (A i l�R� BUILDING DEPARTMENT -- VILLAGE OF RYE R BROOK JAN 3 12024 DD 938 KING STREET RYE BROOK,NY 105 3 (914)939-0669, VILLAGE OF RYE BROOK www.ryebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION WestchesV County Master Electricians License Required C-) FOR OFFICE USE Y 1 101 ' O EP#: g q- o�� `Approval Date: Permit Fee: $ � Approval Signature: Other: ********************************************* **************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTALCOST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated,—3 I_3 L/ 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. 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: . D a IA/ t J 111/AM 5y' SBL: SOC, l g Ud- U Lo T y Zone: 2.Property Owner:)0 se,-�wU wC-tI' Address: Phone#: ClN - ' - 7 �4 l Cell#: email: 3.Master Electrician/Licensed InstallerL)6Le✓Ph M/GD L./ Address: Lic.#:3 a la Phone#:'NY OW,/ SOD Cell#:g 1 Y V90 7`'/6 U email: i ae. (9Q.cLc, y { i�4 t� � n►n Company Name:7-h e l2 Q L Gorr a G m b F N 1f S&Jv— Address: ///2 2 R A h Nn 57 4.Proposed Electrical Work/Fixture Count: IZZ10 CtiT L 5 w ltol, 70 N -t • /2 nit Tn) sT4,11 0,Ailr Awl vu 1'L0vwt. 6n-5 J�l�4)1? - l�e,d0,00 ,d >t 5.31 Party Electrical Inspection Agency: !!�:W ********************************************************************************************************* STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: O St,0 H Al I t-a iA' 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 hi Y t L $I e Cf^i G t A.) for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) 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,th Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this GREGORY M.RIVERA Sworn to before me this day of ,20 9 Newy Ptbiic,State of New York day of � L C& ,20 _ No.01 R16"1398 Signature of Property Owner QuaWiad Westchester County ature of Applicant / Connnission Expires September 2 6,20 PP �o S� (/Q/Le Z L► �✓ll ��L, Priqtpame of Property Ovtr r„ CHEVON DEIERLEINPrint Name f A NOTARY PUBLIC,STATE OF NEW YORK Notary VWic I Registration No. O1 DE62 Pu is Qualified in Putnam County 10/30/2023 Commission Expires JULY 27,20�5 STATE WIDE INSPECTION SERVICES, INC., 0:0 • • SWIS . : APPLICATION0. • Office Use Elect. Permit# '� / - �, • Date / 7 Bldg Permit# Scl Ft J Plumbing Permit# v Final Certificate# City/Village ` Zip �J Building Dept. „� (2�� , ,� County Address 5 u a Nk W 1 J//4 M S r Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st A. ❑2nd Fl, ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation ..L tts�:r7 i/ !>��" 1 r i►v tie.,-� l2 J�,-„+ !�-n S- /'/�� JAN 3 12024 VILLAGE OF RYE BROOK BUILDING DEPP\RTMENT 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. Email Address Vie, ,� ��a�N �(. C bM. Name yZ "$Cpt,, License# 3 a(o Date Signature Address �j fl,.R 4 rt-; nv F City/State N Zip Code /J S.�,Lj Company'-Ohe /z c CJM tNc. Phone# iy -yciJ 7y6v State Wide Inspection Services 1080 Main Street C—A:) FEB - / 20,2.4 Fishkill, NY 12524 as%V 0 4 845 Phone 914-2194-219-1062 Fax STATEWIDE INSPECTION SERVICES Email: off ice(d)swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: The R.D.C.Company of NY Inc Jose Tavarez Joseph Micoli 502 West William Street 11 Bradhurst Avenue Rye Brook,NY 10573 Hawthorne, NY 10532 Located at: 502 West William Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-020 141.36 � [ 1 i 8 Certificate Number: 2024-0668 Building Permit Number: BP 24-018 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: 502 West William Street, Rye Brook,NY 10573 The First Floor Bedroom was 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 February 2024. Name Quantity Rating Circuit Type Receptacle 01 Switches 01 AFCI 01 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. --------+ .Buildin Permit Check List 8t Zonin sis j Address: Zone: Use: Z Cont.Type: V Other. Submittal Date: ions Submittal Dates: Applicant: \ , Nature of Work Reviews:ZBA: J AN 3 I 4224 PB: OT• Other. Q �1 ( ) FEES:Filing. �� BP: W C/O: Flood Plane: 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. 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. License: Workers Comp: Liability: Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other. 1, ( ) ( ) 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. 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. ( )AM mtg.date: approval: notes: ( )ZBA mtg. date: approval:- notes: ( )PB mtg.date: approval• notes: REOLnRFD EXISTING PROPOSED NOTES Am Circle: Fro Fronc: Front: Sim: RAW Main Cov Accs.Cov F S S .HS • Tot.imp: EL Imp: P HH6&/Stories• notes: Residential Building Permit Fee Work Sheet Permit#: Date Issued: SBL: Zone: Address: Property Owner&Contact Info: Job Description: For all new dwellings and for additions measuring 800 sq. ft. or more made to existing dwellings, the following fee schedule shall apply: (plus any alteration fees) Total Sq. Ft. (excluding basements)x $300.00 x $I8.00/$I,000.00 Basement Sq. Ft. x $65.00 x $I8.00/$I,000.00 -------------------------------------------------------------------------------------------------------------------- New Construction Sq.Ft. • New Construction Cost • Building Permit Fee Basement= sq. ft.x$65.00 = $ x$I8.00/$1,000.00= $ Attached Garage= sq. ft.x$300.00 = $ x$I8.00/$I,000.00 = $ I,Fl. = sq. ft.x $300.00= $ x$18.00/$1,000.00= $ 2"d Fl. = sq. ft. x $300.00= $ x$I8.00/$1,000.00= $ 3,d Fl. = sq. ft.x$300.00= $ x$18.00/$1,000.00= $ 4d' Fl. = sq. ft.x $300.00= $ x$18.00/$1,000.00= $ Total Sq.Ft.= sq. ft. Total Cost= $ Total B.P.Fee= $ Total Amount Paid = $ Total Amount Due= $ Date: Signed: ALLSTATE VEHICLE AND PROPERTY INSURANCE COMPANY Evidence Of Insurance Policy Number.94362603; First Mortgagee Loan Number :0219560279 Second Mortgagee Loan Number Insured's Information ;OSE TAVARES AND DIOSA Y MOLINA 502 WILLIAM ST ORT CHESTER, NY 10573 Location of property insured 502 WILLIAM ST PORT CHESTER, NY 10573 Mortgagees(listed in order of precedenceyAddidonal Interested Parties BANK OF AMERICA NA ITS SCRS&/OR ASSIGNS ATIMA P O BOX 961291 FORT WORTH, TX 76161 US SMALL BUSINESS ADMINISTRATION RE DLH 2670989105 2 NORTH 20 ST STE 320 BIRMINGHAM, AL 35203 Policy period beginning on 10/18/2023 through 10/18/2024 at 12:01 A.M.Standard Time. Coverage detail for the property insured POLICY TYPE- House & Home Policy Limit of Liability Section I Dwelling Protection $754392 Section 1 Optional/increased Coverages Building Structure Reimbursement Extended Limits(Dwelling INCL &Other Structures) Total Annual Policy Premium $3113.00 Replacement Cost up to the Dwelling Covg Limits (Note:This policy contains a payment schedule for wind and hail roof surface claims.) Personal Property Reimbursement Subject to applicable policy terms,conditions,limitations and exclusions,the policy includes coverage for sudden and accidental direct physical loss to covered property caused by wind. Deductibles $500 Water Back-Up Hurricane 5%of Dwelling Protection Limit $1000 to loss to the covered property from all other perils. Provisions: This Evidence of Insurance is issued as a matter of information only and confers no rights upon the additional interest named below.This Evidence of Insurance does not amend,extend or alter the Page ] of 2 ATE VEHICLE AND PROPERTY INSURANCE COMPANY _.:::ce ui insurance :vumocr.Y43626039 .ra¢e attotueu ov the Policies above.This form is not the contract of insurance.The Provisions of -aucv snau orevati in aii resoccts. All Premiums for the insurance oolicv shall be computed in accordance with Allstate's rules.forme Premiums and minimum Premiums aPnlicablc to the insurance afforded which are in effect at the inception of the insurance and upon each anniversary thereof:mctuumY the uate of interim cn:_._ It is understood that if this insurance Protection terminates for anv reason,due notice will be etven to the insured,to the mortgagee,and to all other interested panics to acconiance with the smnoo.., mortgagee claua... nv or the t'olicv Declarations retlectine the annual Premium will be sent.if required,to the mortgagee and to any other interested parties. "-e:01/29/2024 Authorized Agent: :SONET AGENCY �:.antcrsigned at: PORT CHESTER 238 WESTCHESTER AVE NEAR US PO PORT CHESTER. NY 10573 914.934.8800 FAX 966.476.hc„v -T6 ( x fth I.�k-)A Ef, Agent atgnalurc Lender Please do not make a Payment from this document.Only pay from a policy invoice.All payments should be forwarded to: t nndcr Relations P ().Box 660649 Dallas.TX 75266 Lender Relations Overnight Address: Lendcr Relations 8711 Frecoort Parkwav North Mail Station 4A Irving.TX 75063 Page 2 of 2 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 wave the workers'compensation rights or obligations of any parry." Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): ❑ I am performing all the work for which the building permit was issued. ❑ 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 I am applying for,provide appropriate proof of workers'compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indi ted on the building permit. (Signature of Homeowner) (Date Signed) S e", //� /4, Qe z Home Telephone Number 3 .5 73 (Homeowner's Name Printed) Sworn to before me this 10 day of Property Address that requires the building permit: o Z v////C"W5^ (County Clerk or Notary Public) 1 b f 7 j SHARI MELILLO Notary Public,state of New York No.OIME6160063 Qualified In Westchester County Commission Expires January 29,20 2� 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 t 71 101 All-it - FILE COPY n n n u n o0 30 x 42 3011x 56 30 x 56 N o o N OEl il N °zap "' DN N H z Q o4< uP7 FOYER -o w 3 z M � O U � N x :OD ¢ 3 N HALL QaQu A �BATHROOM � KITCHEN p � ; p ; I I IL--- ---� 18'-7r' I IQ'0 �Q US X LIVING/DINING ; ; � o "' S D CD i i e I I in I I x PERMIT# i I M , - II SMA.ft 11t.0 — - DATE APt ROV t e j SD BLIll..DING INSPECT R, Rye Brook,NY -------------------------= rT1 � E C° L W oLc) Q x U cn°Q co - W !—o o zI BEDROOM 3 BEDROOM 2 BEDROOM 1 X [--� P4 Area: 1S.F. Area: Area: 12 S.F. o co CO o 65 S. ea. 116 S.F. 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