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HomeMy WebLinkAboutRP24-102PERMIT # /Lcz�w) — D cc�-- DATE: / fXP: 7 SECTION '% BLOCK OT ....�. TYPE OF WORK P-7, ey/S17,01�i L�/� i�G JOQ LOCATION / // p/ OWNER i <0I CONTRACTOR Q C e//OrS q %SIoti C&3/ c 70- w4/3z/9 EST. COT JS 3 J O FEE / ✓CO #.0 LOOP FEE AL DATE II TC• # FEE DATE DATE FOOTING I NSP FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT C7 ALARM AS BUILT FINAL 11' �i OZ.`-I YA1��`■�.- ;��_ OTHER APPROVALS ARB 60T PB ZBA OTHER C° QR . 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE November 7, 2024 Kaushik Gopal&Archana Gopal 61 BelleFair Road Rye Brook,New York 10573 Re: 61 BelleFair Road,Rye Brook,New York 10573 Parcel ID#: 124.64-1-7 Roof Permit#24-102 issued on 9/17/2024 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to DFor office use onl -: \ BUILD NT PERMIT# 5 —/O cy NOV - 4 2024 w[E DD VIL OF RYE OK ISSUED: /7—a L/ 8 KING STRE ( YE BROOK,, YORK 10573 DATE: / VILLAGE OF RYE BROOK 9 -06 U� FEE: 4 /SO-- PAID9 BUILDING DEPARTMENT � 20V 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 Address: 611 bfLLFFAik go", QyE 9406K Ny loS-43 r Occupancy/Use: / F)-�­-' Parcel ID#: 1 2-4 (64 — 1 —:� Zone: G'/) Owner: AQc ttANA I KAUS h l< eoPAL Address: d P.E./R.A. or Contractor: Af L-ANT)c Ex;i(Z,as T_Aj C Address: Person in responsible charge: A,�A&I `(vS E8 H 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: p ��vS a Il GAO P� being duly sworn,deposes and says that he/she resides at 6 of<<� A/ (Print Name of Applicant) )No.and Street) in gyF —e-,-°")< ,in the County of 'JjE S-F 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,profes tonal fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ I J) 3 S C) for the construction or alteration of- /V F 4 2 oa F 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 be ore me-this A Sworn to before me this day of - I � , 20 " day of , 20 _ Ad Signature ro rty Owner Signature of AlWcajW Print Name of Property Owner Print Name of Applicant CW 4NotajyjILic Notary ublic ANGELINA LLOYD ANGELINA LLOYD 6/1 NOTARY PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK o24 Registration No.01 LL0003053 Registration No.01 LL0003053 Qualified in Westchester County County Qualified in Westchester County County Commission Expires March 20. ?^ Commission Expires March 20,20 �yE BRC�uk '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 - - - - - - - - - - - - - - - - - - - - INSPECTIONREPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : b , e L1.0 DATE: PERMIT# 1`� 2 q O L ISSUED: SECT: /Z/ •b7 BLOCK: LOT: 7 LOCATION: V OJ A OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0- ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �] FINAL ❑ OTHER N Ln w O N N V- W v a N n -4 a d :3 W x FE- A 04 w z A a xU4 M p 0 O Q r,a cn 0 H A ° �2 p � 73 0.4 O � z4. I—I ' p y J �p v w V � Z � ~ T� O �--r R-+ z u Z .d �a o Cn �-I t.n cQw O = A Oro A it en I Q ° a rj V W W O � o � � w � � oa ?. F4 aidvo 'S ,Ba a I o o uv -° p F' O F' Q zoa� vE G4 �I C U o S v a u U �+ � - W O V O A Z C� U u b - f� C v 96 �I r� aaw � xo Ja, a s ECIEE BUILDII,t-DEPARTM>ENT R v VILLAGE OF RYE BROOK SEP 13 2024 ID 938 KING STREET RYE BRO0k,NY 10573 V14j939-06 VILLAGE OF RYE BROOK www t tt`e ' ov _ BUILDING DEPARTMENT FOR OFFICE USE ONLY: Q Approval Date: S Z rmit# / (�� Application# Approval Signature: ARCHITECTURAL REVIEW BOARD Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: -- Application Fee:4WW 6 Permit Fees: G ROOF PERMIT APPLICATION / Application dated: 7 ( 3 12, is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below.&1. Job Address: ( -&,., II-Z T4(Y ! 0011� -_ SBL: r Z 411 G V - `/X " Zone: Up Property Owner: A 6W S*k r% 11 ._Address: 61' Phone#: 4qj �Ttl�� ���+(a �" Cell#: IFt 6 1A, _ _email: 0A/t)jG h,61rA *t PAR,7. Coll, 2. Applicant: ka`fstiI/t vI'iLr Address: C.� ( 60I e4c iY flood Phone#: e7 1. PCs Cell#: email: ! ( � . cgn4 3. Roofing Contractor: -f'rG, Ja iD,rs Address: 13 Cd,"iV K 131 vee +0 Phone#: G3 ZZv �t3" -Cell#: 631 "".0Y3 S/ email.. 4. Job Description,list all Methods&Materials: (A ! lic&Gleed •�o 5. Estimated Cost of Job:$ l � i(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.) 6. If corner property,indicate street frontage: 7. Construction Type: W U d r) NYS Construction Class: /'-41 a 4.NT/ i $. Number of stories: Z Height: Z 7 9. is garage being re-roofed:No:(V�•Yes:( )Attached No:( )•Yes:{ )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: PE "O 11. Estimated date of completion: f(J I s Z y Plei,se*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: ~ J6S6pH , 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 C e&T�'2zhT�TPYL, 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 Sworn to before me this day of t , 203.11 day of 20 a - Signature o arty Owner Signature of Applicant bus g1 K a Z- r� f/ Print Name of Property Owner Print Name of Applicant Notary V7, Notary PuVic ANGELINA LLOYD NOTARY PUBLIC,STATE OF NEW YORK Registration No,01 LL00030b3 Qualified in Westchester County County ARRl50N f`rnnt�lliREli4C1 EXpirns M1ns.-ph 20 27 U20 ate of New York Mea6446347uffolk CaLV,2o2lires Janp -2- 'Poueaeadde ploq 'enliaulislp a 6UIP!noad ellgna lie u61sep peja.Ael algnop `)iolWi-813x1a sii fq ;ooj .rnoA to suave ssauis-g6le4 ie uopejoid ivalleoxa saal.l.o xaiaagwrl •sajWgS deO 96plU -V dIH Aid oml wnlwaad xajjagwij �t1!D Ilupul '0l VaR BuliVllivan aGJJ tau to fool leaurl aad se43ua -bsi,•I,L iueaipu6rs a epinad pue 'adeose of ajnlsloLu pue leaq sMolln waisAs slut 'wa�SAS uolVellivah a6p!H eigoo jyq lmsul '6 'aublt uaaa6-anlq 4lig6lsun 1suteBe low jnoA io Aineaq agi aansue sdleg uorpaioid aebIV `Mld pjvnE)ulelS AiutJlel4+ popwl-I jeeA 9? agl 'uollepwll peals pum% wnwlxtw ou gJim A4ut,ljl m Pura~ uanoad PuIM a SJalllo AbOJOuuoei alfiuNs Mau slq,L •uorsatlpe aoljadns pun Mori }Sul .10l eaae 6wlaeu auoza-�lalS au1 to aoelans alnuea6-omp ulooaus aqi L41I siIFd iueites dl�t7 Bjna IGepue6el s,-qb'E) •a16ut4s )ad slleU paz?uenle6 .Z/L-C xis 6uisn salbui4S lood awrlalrl lejn4oeir4,ojV ZQH aull agwlI JVU Ileisul '8 -swan 6urgwnid eqj punon, IFas aadoid a-jol s6ulllseg adid eisnm Buaislxe eoaldad -L 'a6uwep Itanjonjis anlsualxa put `,Mepl!w `Plow esneo ueo 4ojgm 'waisAs 6ugoor aql ui paddEai ewooeq ueo ieyi amisiow aplsul 6uionpoi se clam se wap ;ool aqi pue sal6u;qs anof ueaMiaq uoliaaload mare to .oAul lROlilJ3 E Sepinold ionpoid 'sWi 'M09P looa eUi -Iar,00 of luawr4elaepun alia41uAS Jaisn93la:j JVE) Ileisul 9 •sa)iej PUB sanea ayi ie sabpa 1001 aql uMop s5tool Alig6li lanpoad slq j 'anlsagpy du!D ears(] palldde fJoiael 4irM sal6ulq-S dui5 aaiaeiS 9)Jie>dlene3 aaVolsaagi'e(W JVO Iltisul •9 'boo.+ iletldsp amok}o sme algeaaulnn isow a4i to ino aol pue moos �aaiem daa)l sdlag aagatq �1eal s141 suolieor !Dads s,aaanioe4num jad sr aaweg Mt,,9-1 aaieAA pue aal goleNJagiaaM �H! ;o asano-) elgnop F aalnbei lleus .2 Fr «ui .teite16 su$ip 1!_40S 'suolie.risuad loo) Ile punwe pue sAalltn ui 'sar,aa ag1 Fuale jOuleS Nea-1 aaieMl put a'ol ga}eM JeyiUaM AVE) Iltisul _r aalinb aql oiul pue m9sel aul woal Fumt! galena bul;,Oajlp jgjuAA to gourd .1adoad aol apino,rd of loos aql lO sa�qel pue sanea a4i Buolrr afipa dup wnUilunie ,,Zi'l -j IleiSUl ' -isoo leuollippe ue anoul llegs Jana ps-janbaa pQomAld jamiilppe Aub •poomAld la siaa4s (C) o} do eaeidaa il!M saol-1aix3 ar4uepV 'f3w4ieeys ;o suem pesiwwdwoo pue peftwep aol Tap loop log dsul 'asnoq aUl to siaoel flu uo 6ulg4ea4s ayi of uMop sel6ulgs looj iQ saaAel buiis!xa egi anouaad :;uaWa3vjd98 }ood joaai(] Additional Comments 'Fabricate and install new two part Custom Copper Chimney Flashing with step f3ashings and cuounter flashing set into masonry on the c1hi mney. Chimneys greater than 24" wide shall roquire the construction of a "Cricket" {small diverting roof] for preventing build up water behind a. structure by redirecting it away. 'If applicable: Inspect existing skylights for compromised flashing once the roof shingles are removed. IA the flashing is compromised then a replacement skylight with a warranty will be suggested. If the homeowner declines, they agree to not hold Atlantic Exteriors Inc responsible for any leaks to the said unit. Upon agreement of replacement of the skylight units, an additional charge will be applaud to do the said work. Atlantic Exteriors Inc. is not responsible for any interior disturbances when working on existing units or replacing existing units with new. Any interior finish such as sheetrock, sparkle and paint is not included if needed. 'Replacement of dai"naged fascia hoards shall incur an additional per linear foot. 'Atlantic Exteriors Inc. will not be meld responsible for any unforeseen, improperly located electrical or HVAG lines located below the roof deck. "Atlantic Exteriors Inc. will not be held responsible for any disturbances to the interior drywall on the ceilings or walls such as 'popped fasteners" in which the nails or screws on the drywalfl can cause the joint compound to expose. the fasteners. This rareiy occurs and is caused by the weight of the existing roof shingles being removed as well as the fastening of near; material being installed_ 'Atlantic Exteriors Inc. will not be held responsible for any debris that may enter the attic space which may occur during the replacement of the roof. It is suggested that the homeowner remove or cover .any belongings. "Removal and proper disposai of debris from the lob site, after the removal of debris, we shall walk the property with a high powered magnet to ensure a thorough cleanup of nails from the premises. "If applicable, all permits are to be submitted by the homeowner, xThis roof systern will be installed according to manufacturer's specifications. `This scope of work carries a Transferrable Non Pro-Rated GAF Lifetime Manufacturer's Warranty, an Unlimited 'd'u'irid Warranty and an Exclusive GAF Golden Pledge Twenty Five Year Workmanship Warranty, These warranties can only be offered by a GAF Certified Master Elite Roofing Contractors. ••T Ci YC � v 75 ri cu r VI LULU 4 O w m � w o sci .. V 'C E = o U Q IN • �+ i 4m Y, �7 1 L f"' I � ' CERTIFICATE OF LIABILITY INSURANCE J"`'""�''""`'� _� -- u��c�xaza THIS CERTIFICATE IS 1lIi Cl)AS A MATTER 01:INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER FJFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEC3AITIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- THIS CERTIFICATE OF INSURANCE OOF;Sr NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INWREMS),AUTHORIZE!] REPRESENTATIVE OR PRO(MUCER,A:NO'!HE CERTIFICATE HOLDER. IMPORTANT- If the certificate holder is an ADDITIONAL P1ISURED,the poiicy(ics)must have ADDITIONAL INSURE13 prgwwpoCu1 of be endoJscd- ir SUBROGATION IS WAIVED,SUbtect to the terms and rnnditlonY of the policy,cartam pollcie&may require an endomement. A stakelnent on IhiB Cettificate does ncd Confer ughts to the oerlrtls,Tte tK)-kkr in lieu of such endorTseimmms). rllpcucCa 111Ntwfi gw�I:: ►urr: EdwarGa act]Carnpinr AX (631)4724MOD (8!4)+ITZ a4r5F, t AL Graore Aurr4 w `rvc_No,ill6 >ro: aa01� Y161JrtGpIS}APPpp(�WY1:1MGt IMCI.S NY 11782 IwsuteYtr• Adnral Irsa.rar.cs C,oil!pany WBUt+IBR is Marne F)ooctws Inc, INSUM riC 'SO Carolyn Bt. -- - RNIIIIHIO: L,r1I J �'§MKIIIW57 i f•aimr4qdal¢ f,4 1-;35 p COVERAGES CERTIFICATE NUMBER: 24.25 M-lar REVISION NUMBER MIS IS TO CERTIFY THAT Thr POLICILS OF*MRANC:F 1 1STFD L C10W KOWE KEN ISSL1EDTO THr*AM:D NAMl6D 18OVE FOR THE MI ICY'rIbW INDICATED. NOTYINIHS:ANDINO.ANY tN_ISURLMENT,TEFW OR 0()N1Dr Dh Of MY t4AI RACT OR OTHER OOCLIMEN 1 WI1 H REsrr'ECT r01h1-+:(�,•r-Ills C.EKiIFICATE MAY HE ISSL:ED OR MAY PUUAIN,I HE INSLARANC,F AFFORDED BY TIDE POI-Es MSC1i7;iFT)HIFREW IS SL)DJEC 1 I GALL THE TERMS. EXCLUSIONti AND CONDR IONS OF SUCH P0.I0175 UMI I S SHOVM MAY KWE BF.FN Rr f)rit:1_U BY FWD CLAM. Ron L TYPE OF W81]I1Awct Amlmm . .-. 1 ')—%W Pali"II MM jYminG M Lori ICOWAMOAL GENERALLIANIM — — 1,DOl#.0013 I I EACH ICLA1ti11LNA]R. ®OODIIR ' i ml tv ` 300.Ot1 — NED EXP ar.1 pwaml31000 A CALCO040?160A D113 ;024 G 3112025 I ►esactNu WRY S 1,000.030 � P� � cietlEwu.Aar�cATtc 2,{1C0.40C --- POL1oY AIR DILOC I'MOOUCIS-U%WOPAGG ; 2=0 000 AMlfoflftNtt!UAeaBr rei s uwl uRt s rw,o m011111160 n.u r u+�r• •o s NNW 4DlY rkmrA414� I1Api Y DUCK'JFW&rJSM Ml ! tww N(11W&PAI 10 i ALffMOILY AMMOMY PR�r TY 4 IAIOIIiiLAum cccm rWH OCR 87ICWRi NMi rttics COY/lAiAT10tI - a�R ':�G°fx- MY D CMpLone>Ir LIAMLITY Y_i M thi A PA+�FrAETCMbfaFllrttxn-XiY:I"h�F r'`'i W.A. C-l. rK11 M^l]IY'NT y 11 m4jc 1 ^118EA9E-EAEIwtEx•tt ; C1SIWMV!M Or OPFRAPDW Deaw tl 31%rA r Prll l,^._Y;, T OEAIvIM'tt0�l i0I0AlMti1f71M/l.4CA1"xlrrs i 5rtauctss Iu�Ao:#i,AQOlwnil Msnruka•slnO�lc,mllr 0ltalta4tlef II mM's µ.co M�I,sel C I-KT IF(GATE t10L 0M CANCELLATION SMONLD ANY OF T-4E ASCME DESCR;Sf.' ALfLIGIES BE CANCEL c]BEFORE THE iXPOtATION DATE THEREOF,NOTICE'IfW�I HI• DELIVERED M Vilego of R)v$rcaa. ACCCOC P=WITH T-f POLCY PROVISHMS. A1�'FI•KMK2Eu RtPraectN�a-vc Rye Brook NY 1:1573 0 19RE-2015 AMR13 r.0RPnRA'rI I. All riohis rasarved fi� NYIF NOW WA.%Ute i n surancc r a:.d PO Bcx Gb1G99,Albany.NY 122M 1 ny$#f.D4i11 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE © d• a A.A A A 11363r�W{ 1 LEVI TT-FUIRST ASSOCIATES i.TO 920 WHITF PLAINS ROAD,2ND FL f ARRYTOWN NY l ob91 SCAM TO VALIDATE AND SUBSCRIBE POLICYHOLDLR CF-RTIFICATE HOLDER ATLANTIC EXTERK)R5,INC. VILI AGE-. OP RYE BROOf( 130 CAROI YIN BLVD,UNIT D 938 KING,STREE-C FARMINGDALE NY 11135 RY=BROOK NY 10573 POLICY NUMBER CERTIFICATI•r NUMBER POLICY PERIOD DAI E G2433 723-O 195027 06P29V2024 10 0612912025 B13112024 THIS IS TO CF;RTIFY THAT 111E POLICYHOLDER MVALD AHOVF IS INSURED WITH I EE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2433 723-0, COVERING THE ENTIRE OSUGATION OF THIS POLICYHOI-,)FR FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW WYOU WISH TO RECEIVF 9011FICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS. OR TO VALIDATE THIS CFR.TIFICATE,VISIT OUR WESSME AT HTTPS!IIWWW.NY$IF,COM(CERTICERTVAL..ASP. 1HE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISF FROM BODPLY INJURY SL;F=FRED EiY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT ROBERT SODA OF ATLANTIC EXTERIORS,INC. (ONE PERSON CORP) THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES FO WAIVE ITS RIGHT OF SUBROGATION TO BRINGS AN ACTION AGAINST THE CERTIFICATF r".DER TO RECOVER AMOUNTS WE PAID IN WORKLRS'COMPFNSATION AND/OR MEDICAL BENEFITS TO OR ON 130IALF OF AN EMPLOYEL OF OUR INSURED IN THE EVENT THAT, PRiL)K 1'0 THE DATE OF THE ACCII]ENT, THE CERTIFICATE HOLl}LR HAS ENTERFD NTO A WRtrMN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SLISROGATION BF WAIVED. M418 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR FNSURANCF COVERAGE UPON THE CERTIFICATE HOLDER TWS CERTIFICATE DOES NOT AMEND, EXTEND OR At-TER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STAT SU NCE FUND 4 DaECTOR.I#SURAWC-F FUND UNO(-RWRIIWo