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HomeMy WebLinkAboutBP25-048 VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK Certificate of (occupancy This is to certify that -- J ` ,h of, Rue &Lo V , N y having duly filed an application on 0 Y02 a 20__L>?�requesting a Certificate of Occupancy for the premises known as, Q/ �ya Rye Brook,NY, located in a PU ID Zoning District and shown on the most current Tax Map as Section: Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building *5 Permit No.� , issued 7 20 , such authority and permission is hereby granted 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: R-� - z Construction: V3 If L for the following purposes: 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, shall the building be moved from one location to another until a permit to accomplish such change h een obtain from th B ' ng Inspector. Building Inspector,Village of Rye Brook: Date: APR 10 2025 ^ &p'_ For office u e only: BUILDIN KTMENT PERMIT# MAR 2 8 2025 VILLAGE OF RYE BROOK ISSUED: a 7-3 _R_j 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 3— VILLAGE OF RYE BROOK (914)939-0668 FEE: 15 D PAIDMI BU1LDIN(-' r-- -?T!k'-":T w ww.ryebrooknv.aov 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 iittitittitiii#iii*i#t*i#i#*####i4ffiftii#tii#tf#fif tfitif 4i#rtrt#*rt#rtrtrt##i##lilt#iit#iiiiftffiif#rt#iitirt iii*#*rt*##t#i#iiif till Address: zU Occupanc Use: ,74 Parcel ID#: /D / i 7 4— /—/z)- Zone: u+� Owner: Address: P.E./R.A. or Contractor: —_r_ 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: being duly swom,deposes and says that he/she resides at (Print Name of Applicant) _ (No.and Street) ,� in �� G� ,in the County of � iz in the State of 14/,�' ,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 Sworn to before me this day of_l La P7.h 20-QL day of , 20 zy"At��_ Signature of Property O)t7 er Signature of Applicant Print Name of Property Owner Print Name of Applicant 'b�kr�llm Notary Pub Notary Public GREGORY M.RNERA Notary Public,State of New York 6/l/2024 No.01 R16441398 Qualified In Westchester County Commission Expires September 26, �E BRC�� ,9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR El"A'SSISTANT 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 : O t ; 1A 1 L L 4-0Jr DATE: � Z PERMIT# ISSUED:-'Z 7-1 �'SECT: 2/ 1. 7L BLOCK: LOT: /l LOCATION: 7-�;>A r 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 f t� ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER f ❑ FINAL PLUMBING `- ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BR IN 1982 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 : DATE: J Z S PERMIT# ISSUED: SECT: BLOCK: LOT: 7 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 SPRINKLERS FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER x e o y o a w ' � � � off' •� � a = x N � N v GL� ■ e MaM M M � y 'y � ■ s F+N ■ F"' A FC � a � -d u rw d A-i ■ � N W � �J z PS Q. q�o�� � C, ~ I--+ I� V to x N91be00N s � O �D � �ci o "o a c V) : 00 o j u ° A Wo 'f' � Ca02 � c Ln Jq CA W © /� w w pq d ` g ° CRC J _ 1�"1 Wi �' W O � � �T+ w Cw� � � o ,� c� •v �fj a Q v J s 0 Q s � �,,� j•••1 � � (� � � T p � Q p p- � x ■ (�,� l ��j c�1 z O a � O a O W 00 z a UZ � � U x W Q ca er a W i �n z OM , 2e Q Z I d a P. an d`+r �_'� x■ PZ 00 � W an, o aCl 1-1 oz o o z � as N � W � d ^� w � •' H o � W off v cu � � -cu - BUILPJNG DEPARTMENT 'VIdOWE OF RYE B OOK ]IF A� 2 5 2025 938 KING STREET RYE BROO NY 10573 _ (914�9 9 961 VILLAGE OF RYE BROOK `ov BUILDING DEPARTMENT INTERIOR BUILDING PERART APPLICATION FOR OFFICE USE ON Y: Approval Date: ermit / 4eApplicationFee:$ Approval Signature: Permit Fees:$ Disapproved:— Other: Application dated: aS is hereby made to the Building Inspector of 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 belloow.. (� 1. Job Address: �I �Vyyku W-ecru SBL: a✓c /� /� Zone: i 2. Proposed Improvement.(Describe in detail): Lill Zf * �w A /r r J'a .Ji91K if 3. Does the proposed 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 It: 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 1 Hood,etc...) :No: Yes: (if yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;((:, f .,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 117. Property Owner: _USrM11,B/n16tP_ Address: Zo/t6i�� f Phone Cell# /y��'y S'W email: ahi&i_M4,1u'A_' J8. Applicant: L)IVPA i'�4f/�/�G Address: Phone# /y Cell# Z6 —<,Vf' ©F63 email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# G Cell# email: 11, General Contractor: F Address: Phone# Cell# email: 12. Estimated cost of construction $ al,1 Qd (MOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (1} 6/l 2024 BUILD.�N MENT VIL �qE OF RY OOK MAR 2 5 2025 938 KING ET RYE BR611 ,NY 10573 4 - . VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE `PILLAGE 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: -S�'M d J&,U y_,-le ,residing at, Z,11/ .l✓/171iZL-CIC11'5SC fN i (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; V>" /7/(GC C��a 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. 17 (Signature of Property Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this Q 5 day of n_, , 20Z�L (Notary P e) GREGORY M,RIVERA Notary Public,State of New York (2) No.01 R16441398 Qualified in Westchester County Commission Expires September 26,26 6/l/2024 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: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications, as well as in accordance with the New York State Uniform Fire Prevention & Building Code, the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of , 20 day of , 20 Signature of Properly OV9 Signature of Applicant , %/S'l441,14i l6,-e PrinV,N,ame of Property Owner Print Name of Applicant Notary Pub Notary Public GREGORY M.RIVERA Notary Public,State of New York No.01 R16441398 Qualified In Westchester County Commission Expires September 26,2t1 (4) 6/I/2024 , � N U VJ R. fn u y 6J CA �so logoLn z a W ao or 6J "' a � $ Q �, . o W A O w , �+ 3 w MM a3 C cc Apoll Ln co or r w x z 00 z u 0*4 w o CC CY c ? z 8 v c ZLO p < cn U a a � 04 W � o z H w z a or x Q < �I 0-0 ~ pQf ��I � BRnv� BUIL MENT MAR 15 2025 VIL E OF RYE OK VILLAGE OF RYE BROOK 938 Knva,ST' ET RYE B ,NY 10573 BUILDING DEPARTMENT nov PLUMBING PERMIT APPLICATION FOR OFFICE USE O7\Al BP 'Q ,� PP#: ��'D y 7 /\ Approval Date: Permit Fee: $ ��Q J`_ V Approval Signature: Disapproved: (fees are non-refundable) 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 TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, c)J—47�— 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 Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,cState,/County and Local Codes. 1.Address: � 1/V/ /��� Cfg SBL: Zone: 2.Proposed Work: 3.Property Owner: %�.�� t� lJ��/�� Address:ZG /- 4'Z-//& Zo'r'r"-'/0 Phone#: Cell#:Q/y email: JIS 2W y,9 4.Master Plumber- J lon Address: Lic.#: CJ�'( Pho a#: w11#: \email. Company Name: ress: 53 INDICATE FIX URES&LIN O BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement Ist Floor 2nd Floor l 311 Floor 4'h Floor 5w Floor Exterior 5.*List Other Equipment/Provide Details: (Notarize Signatures Required Next 2 Pages) b/I/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, (p int n f individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. 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 iC5 Sworn to before me this day of ,20 Z da of ,20 ignature of Property O r Si nature f pp X// Print Name of Property Owner int N e of pplicant arp�7PZ)X2 LY46 /In Notary Pu o EGO M.RIVERA ORY M.RNERA Notary Public,State of New York Notary Public,State of New York No.01 R16441398 No.01 R16441398 Qualified in Westchester County Qualified In Westchester County C I%$ Ex�res SenptemIer T6 20 Commission Expires September 26,20 'llc ion ust e pto y 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. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/l/2024 . BUILDING DEPAR MENT VIL 6E OF RYE OOK i MAR 2 5 20�25 938 KING ET RYE BR ,NY 10573 `t 4�939-0668� VILLAGE OF RYE BROOK ao` BI iIl_DIN(I DFOARTR LENT ��x;.xxxxxxxxx*xxxxxx�xx****x�xxxKxxxxxxxx�x*�**********,�,�x,������xxKKxxxxx;*x**,�,�xxxxxxx��xx�,��xx�xxxx AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 • 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: 3J, /�' S?44�11-M e-/� , residing at, � (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; Aa_-CA dW,"j-24a , Rye Brook,NY. (Job Address) Further that all state me 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 Owner(s)) Print Name of Property Owner(s)) Sworn to before me this day of tv , 20 11"aT/,//'�?&oy ( otary Pygycv GREGORY M.RIVERA Notary Public,State of New York No.01 RIS441398 Qualified In Westchester County Commission Expires September 26,204 6/1/2024 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 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 i 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 ork indicated on the building permit. ,.Z z,� (Signature Homeowner) (D to Signed) Home Telephone Number (Homeowner's Name Printed) • Sworn to before me r s __ day of Property Address that requires the building permit: _ n 4,Y( er od Notary P b ----- • ��. EG0kY M.RIVERA f r,Vubtic,State of New York N(j-01 R16441398 i s x(J m'Westchester County s :n Fr-)ires September 26 20 Once notarized,this BP-1 form serves as an exemption for both porkers'compensation and disability benefits insurance co%erage. BP-1 (12 08) NY-WCB ataie rarm rrre ana t;aeuany t;ornpany A Stock Company With Home Offices in Bloomington, Illinois PO Box 2355 Bloomington IL 61702-2356N H 28 PROD F HW 3200 RENEWAL DECLARATIONS 3200 STRAUBINGER, WILLIAM A 201 IVY HILL CRES RYE BROOK NY 10573-1605 AMOUNT DUE: $1,424.00 Payment is due by JUL 131024 Policy Number 32-88-3524-3 0 0 y Policy Period: 12 Months Effective Dates:JUL 13 2024 to JUL 132025 The policy period begins and ends at 12:01 am standard time at the residence premises, Your State Farm Agent Location of Residence Premises THE LANZA INSURANCE AGENCY IN18 HALSTEAD AVE 201 IVY HILL CRES HARRISON NY 10528-4003 RYE BROOK NY 1 0573-1 605 Phone:(914) 835-6000 Construction: Frame Roof Material: Composition Shingle Year Built: 1980 Roof Installation Year: Default to Year Built Automatic Renewal If the POLICY PERIOD is shown as 12 MONTHS,this policy will be renewed automatically subject to the premiums, rules, and forms in effectfor each succeeding policy period. If this policy is terminated,we will give you and the Mortgagee/Lien- holder written notice in compliance with the policy provisions or as required by law. IMPOR-IANT IMESSttOES NOTICE: Information concerning changes in your policy language is included. Please call your agent with any questions. Zone: 12 Subzone:09 Please help us update the data used to determine your premium. Contact your agent with the year each of your home's utilities (heating/cooling, plumbing,or electrical) and roof were last updated. PREWUM Annual Premium $1,424.00 Your premium has already been adjusted by the following: New York Tier Rating Total Premium $1,424.00 Prepared MAY222024 p /� Page of 4 H O-2000 Ka d"o. &xSf', W d�LW CY�I' L /p 001881 220 1 1!- E G,AL,J,TR,GB,GA JOHDeoe) 04rK?n1e slat a arl:x i NAMED INSURED MORTGAGEE AND ADD(i ZONAL INTERESTS STRAUBINGER, WILLIAM A Mortgagee WELLS FARGO BANK NA#708 Loan Number: ITS SUCCESSORS AND/OR ASSIGNS 0278816459 PO BOX 5708 SPRINGFIELD OH 45501-5708 THE ARBORS HOA INC Loan Number: 173 112 IVY HILL CRIES N/A RYE BROOK NY 10573-1604 Sru f iON I PROPERTY COVERAGES AND LIMITS Coverage limit of Liability A Dwelling $ 467,800 Other Structures $ 46,780 Building Ordinance/Law- 10% $ 46,780 B Personal Property 0,850 0,85 $ 35 C Loss of Use $ 35 Fungus (including Mold) Limited Coverage $ 20, 0340 Additional Coverages Credit Card, Bank Fund Transfer Card, Forgery, and Counterfeit Money $1,000 Debris Removal Additional 5%available/$1,000 tree debris Fire Department Service Charge $500 per occurrence a Fuel Oil Release $10,000 Locks and Remote Devices $1,000 Trees, Shrubs, and Landscaping 5%of Coverage A amounV$750 per item SEC!iON II - LiABILITY COVERAGES AND LIMITS Coverage Limit of Liability L Personal Liability(Each Occurrence) $ 300,000 Damage to the Property of Others $ 1,000 M Medical Payments to Others(Each Person) $ 5,000 1Nri; 110N Inflation Coverage Index: 443.9 0 ED"k I r"TI B LE S Section I Deductible Deductible Amount Other Losses 1/2% $ 2,339 Hurricane 5.00% $ 23,390 LOSS SETTLEMENT PROVISIONS Al Replacement Cost- Similar Construction B1 Limited Replacement Cost- Coverage B HO-2= Page 2 of 4 wState �orrt� 32-68-3524-3 �7 i{I�i,�^i. i.�f'TM INS. AND ENDOBSUMEN S HW-2132 Homeowners Policy Option ID increase Dwig up to$93,560 Option JF Jewelry and Furs $1,500 Each Article/$2,500 Aggregate HO-2687 Work Comp Select Residence Emp HO-2807 Back-Up Of Sewer Or Drain - 10% of Coverage A/$46,780 HO-2404 Addl Insured- Association HO-2684 Hurricane Deductible HO 2304.1 Amendatory Endorsement HO-2373 `Ting Labs Ting Service Endorse .9 'New Form Attached ADD !ONAL,M,. ES SAG ES State Farm®works hard to offer you the best combination of price, service, and protection. The amount you pay for homeowners insurance is determined by many factors such as the coverages you have, the type of construction, the likelihood of future claims, and information from consumers reports. Other limits and exclusions may apply-refer to your policy nV other rms and Your policy consists of these above asthe Homeownrs we I as thoseessuedlcy shown subseque above,to the ss trance of th�s policy cy endorsements that apply, including those shown This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation,as amended. In Witness Whereof,the State Farm Fire and Casualty Company has caused this policyto be signed by its President and Secretary at Bloomington, Illinois. Secretary President Page 3 of 4 Prepared NIAY222024 H 0-2000 001882 220 E _ _ r S[FttRS JQ� l i t, x y uj 13, Q �V? vJA►.K- I J LLvSc 1 .L Ututi�y SLL014C1 yt-A5S DOOR