Loading...
HomeMy WebLinkAboutBP24-225PERMIT # DATE: I D SECTION a g.BLOCKLOT 3 _ TYPE OF WORK W&MO 0/01 i / k4 gP1gCec dui FP1/�1 Bch 'c Vi JOB LOCATION aI Za/,s o/ of c) ewe 7,L OWNER Lv#Pe44e S 41 M � / //t? /1�1 7L4? s'h /- ('3 91p CONTRACTOR EST. ✓CO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CI RGH PLUMBING GAS 0 SPRINKLER ELECTRIC O LOW -VOLT C7 ALARM C� AS BUILT O FINAL rcc DATE INSPECTION RJ=CORD DATE 1 INSP OTHER APPROVALS ARB BOT P8 ZBA OTHER VILLAGE OF RYE BROOK WESTCHES71i COU ', NEW YORK � NO: 25-106 II2 :7�b Certificate of ®ccupoucp This is to certify that 1W//')/'" Irene ene tAaI7717? of, Ruip ewk' having duly filed an application on 5 requesting a Certificate of Occupancy for the premises known as, l.! Rye Brook,NY, located in aD Zoning District and shown on the most current Tax Map as Section: / q- Block: Lot: I , and having fully/complied with the requirements of the Building Code and the Zoning Ordinance under Building O � Permit No. Y'Z2.?� 5 , issued /0 20 c�, such authority and permission is hereby granted If to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: /'tf ; Construction: , for the following purposes: �� �S� O�(: X&C)� reolac e 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 facili 'es shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made, or sh the building be moved from one location to another until a permit to accomplish such change ha a tai from uilding Inspector. Building Inspector,Village of Rye Brook: Date: AUG 14 2025 D �J Lam, �33R For office use only: DBUILD 7ETMENT PERMIT# —a�J JUL 18 2025 VIL OF RYE$)''LOOK ISSUED: 938 KING STRE YE BROOK, juv YORK 10573 DATE: '-7— VILLAGE OF RYE BROOK -,6 �Y FEE: y� /�' PAID� BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION stt***s*s**tt**t**s**s***s*s**t*******ssst**s**s*s*sss*ssssss**sssssss*sssss*s****ssss*ss**********tss*s*s***sttssssss*s**ss* Address: -- Occupancy/Use: Parcel ID Zone: u Owner: Address: P.E./R.A. or Contractor: Address: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: fret e,. being duly sworn,deposes and says that he/she resides (Print N e of Appli ant) (No.and Street) in A �( �1) ,in the County of in the State of that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ , for the construction or alteration of. Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this l b Sworn to before me this of L , 20s4S�- day of 920 . eo;—3 ';�-'A&," Signature of Property Owner Signature of Applicant 1 ;;U *- f Property m Owner �1 Print Name of Applicant � o X ; �X Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.01ME6160063 6/1/2024 Qualified In Westchester Countyy—� Commission Expires January 29,20li� QyE BR(luk. 1932 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 - - - - - - - - - - - - - - - - - - - - I � ADDRESS : � ) DATE: PERMIT# L ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ 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 o ti W � 1902 BUILDING DEPARTMENT 43 BURDING INSPECTOR VILLAGE OF RYE BROOK ❑VujAoE ENGmm 938 KING STREET RYE BROOK,NY 10573 0 ASSISTANT BUILDING INSPECTOR (914)939-0668 FAx(914) 939-5801 - - - - - - - - - - - -- - - - - - - - - INSPECTION REPORT - - - - - - - - - - - --- - - - - - - - kA - k- '!- -' l ADDRESS: 1 DATE: PERMIT# ISSUED: t , , SECT: 1 BLOCK: LOT: LOCATION: OCCUPANCY: 0 VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTMG ❑ FOOTING DRAINAGE ❑ FOUNDATION 0 UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBm 1 ® ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ( \ ❑ FUEL TANK \�1 U� SPRRalxR ❑ FiNALPLu G 0 FINAL \ OTHER '�C'o C CA Y 0L NO EA Q-C-YM� x is\ K� Lin Ln H y F+.1 O O • v D _ �y„i 0 h a ae a 1 a o W = t �- 14 z � a v W a co v o � .. W V �o W a � � � v � W o�, 1�.1 • v A w to 48 F'� o M w � � o � a•� cn QI/ © '-o � � � ✓ N � w P3 �i `�' ° O 3 � r� 114 W x x x H (L"o � :3 ' ;E '- zoo " 14 � U v C7 w O Q H O O Z v v a o Z W W w W o � bn °' u 14 i--i Cl) aw o o v v W 00 CN ICI ^ W ✓ f1; W p ,.a w oc o �wZo �j 1�—� U "P p Q a ` �Q oz o U c [� a z p z H A 0 >4 .!2 .. A w o � " 0 _ P. x � � �� � BUILD DEPARTMENT D C E Q V VIL j OF RYE BROOK OCT , 6 2024 938 KING ET RYE BROOD,NY 10573 114)939-0668 VILLAGE OF P W ov YE BROOK �9 I BUDDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: APPROVAL DATE: OCT• 2 � � E &x_/_,,��,PLICATION FEE: ion APPROVAL SIGNATURE: PERMIT FEES: W `so—6 U H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: D is 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 f r a change in use,as per detailed statement described below. 1. Job Address: n 2. Parcel ID#: c} — 3 Zone: 11014 3. Propose Improvement(Des ribe in detail): 1� 4. Property Owner: 6-- Address: Phone# Cell# , e-mail List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: Address: Phone# Cell# e-mail (1D 6/1/2024 5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 6. Area of lot: Square 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 corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 11,fl: 2"a fl: 311 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 11,fl: 2nd fl: 31d 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:( )Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; ( )Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];()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. 2L 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&1 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 Stormwater 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: (if 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: (if 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: (f 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 9/28/07? 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: (tf 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 1: TIER If: TIER III: (ifyes,a dome Occupation Permit Application is required) /cu 29. What is the total estimated cost of construction: $_ 10 ,000 Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equ pment,professional fees, including any material and labor which maybe donated gratis./f 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: (2) 6/1/2624 BUILD DEP IViENT VIL E OF RYE` OOK 938 KING ET RYE BIRO; NY 10EQ1t,,1G Y 16 2024 �4 14) �; w ov, OF RYE BROOK n[nPARTMENT 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 YO K, COUNTY OF WESTCHESTER ) as: I, �---�as,L ,residing at,� l� \`c1,1, {Print name) (Address where you live) QS\A 1 r3 `q 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; t �1 t3 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. QQ_e7t� ignatureofProperty Owner(s)) rml ame o9 Properlc(h%ner(s)) Sworn to before me this �L d f� e X , 20 (Notary Public) SHARI MELILLO Notary Public,State of New YOrk No.01ME6160063 Qualified In Westchester Gounty-7-1 (3) Commission Expires January 29,20- 6/1/2024 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 storrnwater 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 ,201L- day of , 20- SiLmature of Property Owner Signature ofApplicant -t—\ ,,, C ��\,, P 'nt ame f Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME61.60063 Qualified In Westchester County, Cotrimisslon Expires January 29,20 L 1 (4) 6/l/2024 r The Arbors Homeowners' Association 173 '/2 Ivy Hill Crescent Rye Brook, NY 10573 June 19th, 2025 J U N 2 3 2025 DD Irene and William Stamm i 124 Brush Hollow Crescent VILLAGE OF RYE BROOK Rye Brook, NY 10573 BUILDING DEPART MENT Re: Removal of Building Department Stop Work Order Conditions of Approval Dear Irene and Willian, This letter serves as confirmation that the Architecture & Grounds (A&G) Committee and the Arbors Board of Directors has reached agreement with you in a separate settlement agreement to have the Building Department remove their stop work order and proceed with the work under the following conditions of Approval. 1 . The steps previously shared with unit 125 that were cut must be restored in a professional manner. 2. The increase of deck size which exceeds Arbors deck policy by 2 and 1/2 feet has been approved. 3. Two concrete pads poured must be painted to match the Trex Deck Color. 4. The color of the Trex deck as originally submitted must be Trex Enhance Saddle for the deck and steps and Bronze Aluminum for the railing. 5. Your AC condenser can be relocated to the poured concrete pad to the left of the new stairs when viewing from the ground and lattice installed and painted to screen said compressor. The lattice must be painted with the house trim color. 6. Stairs going down to the concrete pad from the middle of deck is approved as per the previously mentioned deck and railing colors. 7. A 4-foot Cryptomeria globosa nana must be planted to the right of the stairs as shielding when looking from the rear yard. This approval is valid for six (6) months from today's date. If any changes need to be made to these additional approvals during construction, the Committee must be notified in writing, and your application must be amended. Work must stop and cannot proceed until you receive written approval for those changes. A new permit or permits from the Village of Rye Brook must be presented to the property manager before work begins if applicable. You are also required to inform the Property Manager when work begins. When the project is complete, the Property Manager must again be notified so that an inspection may take place. Please include a photograph of the work as well. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, contact me at: Property Manager. Nicholas Salzarulo Property Manager Shortening Deck-Yahoo Mail 6/4/25, 3:04 PM Shortening Deck Dom Franco<dommerlO@yahooxom>To: irenchil17100gmail.com June 4,2025 at 2:50 PM To:Irene&William Stamm Here is a quick explanation of why there is a high cost to shorten the deck 2 liner feet: -Existing framing will have to be removed to gain access to existing new footings and underside. existing new footings will have to be demolished below grade 3 new footings need to be installed at the new 25'mark(code requires footings to be at least 42"deep at 10"round with a Bigfoot form base on the bottom) -2 footings will have to be added for the top stair landing. Currently the landing is cantilevered off the existing new framing. 2'more will put this over code maximum for cantilevering. (code requires footings to be at least 42"deep at 10"round with a Bigfoot form base on the bottom). Stairs are required being the oil tank is on the deck. Framing will have to be reinstalled and additional framing will have to be added being the new landing will no longer be cantilevered and be on its own footings. More gravel will have to be brought in by hand for under the deck. Most municipalities require this for proper drainage so I always install on every deck job. I also want to add that if the AC condenser is installed then the refrigerant lines and electrical conduit will have to be removed and reinstalled yet again. Costs: 5 footings @$1200ea$6000 Labor to disassemble existing new framing and demo existing new footings below grade. I am also not sure if the code required hurricane strapping will survive so I included and allowance for replacement hardware.$3,500 Labor and materials for hand gravel install$300 The spoils removed from the 5 new footing holes will have to be removed from the premises as there is no where to dispose of it. I cannot back a dump truck back there so it will have to be wheelbarrowed to the front and hand loaded. I need at least $750 to accomplish this. If there is and issue brought by the association there with extending the top landing another 2',then the wall will have to be taken apart and an alcove be installed to recess the stairs into. Being it was about$5000 to repair that particular failing wall there will be a charge of$3000 to take the wall down and build an alcove. There will also be a cost associated with changing the architects drawings and as-builds. Please let me know if more info is needed. Dominick Franco Principal Franco Industries LLC https://mail.yahoo.com/b/folders/l/messages/AEj_UBpzfuOYaECVjwJde yc&folderType=INBOX&offset=0&unblockNow=false&action=printMessage Page 1 of 1 - -- �--Vic_,-�_ � ( i � i j S` ,t A,il .,•a r r• is l(�,� f - - �i �� r ,k:` � s' S�;.I 1 : i �I'1II I� 1 � � ' rai � + ��� �• ,1•ie I� a 77 � 1 I'IT I'iTITL 1 r?-r•M I { 13 v I r ' r -K•n 40 '111 � � �.�r� Y• A• -eX i.. 1 E 1 1 i. , 'N3'. I.'�•• J �1 r ' E f h��� a�t. r n i 1 1N1, � �� f I �� � •�, 1 ` 4� 4 : qlrrRLff j,wl, 5 �" �l LL, :� . ,. �. _ y'fi �;� �: r -__ :v. ��.. ��`� ..! �, ,g�! �' , _ --� ; ; i ��� ���; � it ��� . a 1�; . �� '. .! r hanydyi ian ................... ...................... -- - - .F T - �rr ii. Picture this:you and your family gathered outside, seated on comfortable cushioned furniture. Charming string lights hang above as you roast marshmallows over a fire pit table. Sounds perfect, right?You can create a cozy scene like this with the help of an outdoor deck. But, before the deck of your dreams can become a reality,you must make a lot of choices and one is to choose a deck color. Here are our tips for picking just the right hue of decking to complement your home. On This Page 1.What is Trex Decking? 2. How to Choose Your Trex Decking Color 2.1.Trex Decking Color Options 2.2.Consider the Color of Your Home 2.3.Think About Style 2.4.Order Samples What is Trex Decking? Trex decking is a composite wood product that will last for years. It resists termites,won't rot, warp or splinter, and never needs staining or painting. Plus,you can have peace of mind regarding the environmental impact of your deck because Trex decking is made from 9S% recycled materials. � � O r—, F O W I LO U w Q .0 0 z O W4 EO Z H - d 3 w w c EW � z O 1 O In o Z A o Q ne as Cl) z Q W •O c o. I 1 a o V CT z Q I 'w Q z ^ C/, 7 y 1 O ICL I / LL � LL 3co a , 0 W = (/1 a cr o J a � Q � wo00 LLI O � o� cu .� �; _ LLJa o � o � � A ^ a O (1) W ICI 0 D E (Dw ca LL _ z v W ocn en Q x 1� aMo °� Q ' .3 � W _ 1 1 � O ac M F N `� 1 cr- W � W c ) � oo � 3W 1 = Liu N 0 � t W O � O J d O 0� c .`I F- O 1 Q � Ow Z W w 1 ) 0 LCO Ool A 1 1 0_ W w w w /a �I U Q i O A o z i m �� n c m�� , New York Central Mutual Fire Insurance Company 1899 Central Plaza East,Edmeston NY 13335-1899 INSURANCE 800-234-6926 www.nycm.com Named Insured and Address Agency Address IRENE E STAMM ACRISURE INS PARTNERS WILLIAM F STAMM SERVICES OF NY LLC 124 BRUSH HOLLOW CRES 90 S RIDGE STREET RYE BROOK NY 10573-1631 RYE BROOK NY 10573 Insurance Provided By New York Central Mutual Fire Insurance Company Policy Information Policy Number 4648585 Transaction REVISED RENEWAL Type HOMEOWNER Transaction Effective 06/01/2024 12:01 AM EST Inception Date 06/01/2015 12:01 AM EST Transaction Expiration 06/01/2025 12:01 AM EST Protected Since Date 06/01/2015 12:01 AM EST Tier 9 Effective Date 06/01/202412:01 AM EST Expiration Date 06/01/2025 12:01 AM EST Term Length 12 MONTHS Agency Information Name ACRISURE INSURANCE PARTNERS SERVICES OF Office 914-937-1230 NY LLC Code 06226 Fax 800-847-3129 Territory 31 Email nycarriernotifications@acrisure.com Paper Off YES Website www.acrisure.com Direct Mail YES Insured Summary NAME TYPE MARITAL STATUS GENDER IRENE E STAMM PRIMARY INSURED MARRIED FEMALE WILLIAM F STAMM NAMED INSURED MARRIED MALE Location Summary NUMBER ADDRESS PREMIUM 1 124 BRUSH HOLLOW CRES RYE BROOK,NY 10573-1631 $1,345.00 TOTAL PREMIUM $1,345.00 BILL WILL FOLLOW 0 s S N O O M N n N O (+l O 8 04/29/202415:17:58 H2/P2 INSURED:IRENE E STAMM POLICY:4648585 Page 3 of 7 DECLARATIONS-'INSURED COPY' nyq m�� New York Central Mutual Fire Insurance Company 1899 Central Plaza East, Edmeston NY 13335-1899 RANCE 800-234-6926 www.nycm.com Coverage Information for Location 1 of 1 Location Address Information Street 124 BRUSH HOLLOW CRES County Code 119 City RYE BROOK County Name WESTCHESTER State NY Sub County 9 Zip 10573-1631 Location Details Construction Type FRAME Doublewide N Year Built 1979 #of Apartments 0 #of Families 1 FAMILY #Units between Fire Walls 3 Lead Abatement Protection Class 4-PROTECTED Town/Row House Y Fire District RYE BROOK Secondary NO Feet to Hydrant 1000 Territory 490 Miles to Fire Department 01 Premium Group Coverage Information Basic Form NYC HO 7-PREMIER PROTECTION POLICY Inflation Protection Coverage 0.00% ADJUSTED UNDER XACTWARE APPRAISAL SYSTEM Deductible $1,000 Seasonal Policy Number Coverage Details COVERAGE DESCRIPTION LIMIT AMOUNT PREMIUM Coverage A DWELLING 460,000 $1,004.0 Coverage B OTHER STRUCTURES 92,000 INCL. Coverage C PERSONAL PROPERTY 322,000 INCL. Coverage D LOSS OF USE 138,000 INCL. Coverage E PERSONAL LIABILITY PER OCCURRENCE 500,000 $41. Coverage F MEDICAL PAYMENTS TO OTHERS PER PERSON 5,000 $10.0 Modifications and Credits Information FORM NAME EDITION DESCRIPTION SAVINGS NYC HO 04 16 0508 ALARM SYSTEM $131.00 NYC HO 7 0518 COUPLER $297.00 Surcharge Information *** NO SURCHARGES EXIST FOR THIS LOCATION *** TOTAL LOCATION PREMIUM $1,345.00Cn s Cn It 04/29/2024 15:17:58 H2/P2 INSURED:IRENE E STAMM POLICY:4648585 Page 5 of 7 DECLARATIONS-*INSURED COPY* nyq m�� New York Central Mutual Fire Insurance Company 1899 Central Plaza East, Edmeston NY 13335-1899 RANCE 800-234-6926 www.nycm.com Detailed Form Information PREMIUM 'NAME EDITION DETAILS ,NYC HO 7 0518 PREMIER PROTECTION POLICY $1,055.00 CL-100 1.0 INLAND MARINE COMMON POLICY CONDITIONS INCL. CL-264 1.0 INLAND MARINE AMENDMENT OF POLICY TERMS-NEW YORK INCL. CP-184 1.0 INLAND MARINE AMENDMENT OF POLICY TERMS- NEW YORK INCL. HO 04 41 1000 ADDITIONAL INSURED-RESIDENCE PREMISES INCL. INTEREST NAME/ADDRESS ASSOCIATION INTEREST THE ARBORS HOMEOWNERS HOMEOWNERS ASSOCIATION ASSOCIATION INC 173 1/2 IVY HILL CRES RYE BROOK NY 10573 HO 24 93 0502 WORKERS COMPENSATION CERTAIN RESIDENCE EMPLOYEES- NEW YORK INCL. NYC 114 1219 UTILITY LINE EXPENSE COVERAGE $50.00 DESCRIPTION AMOUNT 00 DEDUCTIBLE 10,000 LIMIT IL N 160 0908 FLOOD FORM INCL. IM-175 1.0 PERSONAL ARTICLES COVERAGE $126.00 PERSONAL ARTICLE COVERAGES COVERAGE.AMOU�NT ��DETIBLE JEWELRY TOTAL COVERAGE AMOUNT 1 NYC237 1106 INS SCORE NOTICE INCL. NYC 211 8/91 IMPORTANT SENIOR CITIZEN INFORMATION INCL. NYC HO 04 16 0508 PROTECTIVE DEVICE CREDITS INCL. DISCOUNT DESCRIPTION PERCENTAGE PROFESSIONALLY MONITORED FIRE ALARM 8% PROFESSIONALLY MONITORED BURGLAR ALARM _ 8% NYC HO 219 0518 HOMEOWNER QUICK REFERENCE GUIDE INCL. NYC HO 23 95 0311 OFF PREMISES THEFT EXCLUSION -NEW YORK INCL. NYC HO 278 0311 WATER BACK UP AND SUMP DISCHARGE OR OVERFLOW-NEW YORK $109.00 LIMITAMOUNT 20,000 NYC HO 500 0703 REPLACEMENT OR REPAIR COST PROTECTION -COV.A DWELLING _ $5.00 COVERAGE DESCRIPTION GUARANTEED REPLACEMENT COVERAGE ADJUSTED UNDER YACTWARE APPRAISAL SYSTEM 04/29/2024 15:17:58 H2/P2 INSURED:IRENE E STAMM POLICY:4648585 Page 6 of 7 DECLARATIONS-`INSURED COPY' ��� New York Central Mutual Fire Insurance Company 1899 Central Plaza East,Edmeston NY 13335-1899 nyq 800-234-6926 www.nyem.com Inland Marine Schedule IM-175-PERSONAL ARTICLES COVERAGE CATEGORY ITEM# DESCRIPTION SERIAL NUMBER AMOUNT APPRAISAL DATE 1 14K WHITE/GOLD DIAMOND ENGAGEMENT RING W/1.01C 8,100 09/25/2013 JEWELRY COLOR K CLARITY VS2 CUT 15 FOREVER MARK r 0 0 ri N r N c4i I 04/29/202415:17:58 H2/P2 INSURED:IRENE E STAMM POLICY:4648585 Page 7 of 7 DECLARATIONS-'INSURED COPY* Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence "This form cannot be used to waive the workers'compensation rights or obligations of any party." Under penalty of perjury, I certify that I am the owner of the 1. 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to sho'A 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. El 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 indi7dontlhe building permit. (Signature of Homeowner) (Date Signed) 1 S��C111.-Vc-s­1% Home Telephone Number, V_ (Homeowner's Name Printed) Sworn o efore me this da_1 ,j Property Address that requires the building permit: (County'Cl-di rk or otary Public) MAUREEN SOCKETT Notary Public State of New York No.OIS04647093 Qualified in Westchester County Commission Expires July 31,20 Once notarized,this BP-I form series as an exemption for both workers'compensation and disabilitN benefits insurance co-,erage. BP-1 (12/08) NY-WCB