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HomeMy WebLinkAboutMP12-079 QyE BRC�v�. • 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 - - - - - - - - - - - - - - - - - - - - ADDRESS : r? 1< �Z DATE• /�- Z-S ' Z )Z 7 PERMIT# ISSUED: SECT: BLOCK: LOT:9/- 2- LOCATION: C' 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 1 I ❑ NATURAL GAS ❑ L.P. GAS p �. S� i'G .Jf ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER rn _� r O a _ N A � N W P4 .. O N 1� y � � x � w •v a�i W N U a-i W O ao ° W lip h+y ~ `t cd 00 OW Q . J. A n �•+ cn gz az ..� Z a U r � > - W \ � � � O O'ER U ►x � U � a w b � � •� � rz O Or- � � [••i .-:0 Z Q ram. -s, @ N U U � > l\ q W Z � cA •� � •ca �il al a ra W � � > t p f�C� f� OMC VILLAGE OF RYE BROOK BUILDING DEPARTMENT I %T 2 4 2V 938 KING STREET,RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 ►►N►N .rvcbrook.or2 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING EQUIPMENT Permit#: HT f a�079 Building Inspector: Fee Paid: �d,,, Date of Approval: S E P t 5 2 Parcel ID#: 1901010- Bldg/Use Class: Res. (Comm. ( ); REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly Completed& Signed Application. 2. Site/Staging Plan if required by the Building Inspector. 3. Copy of Licensed Contractor's Insurance including Liability& Workers Compensation naming the Village of Rye Brook as Certificate Holder. 4. Payment of Fees/Unit: Residential: Commercial: `_250.UU. (fees are non-refundable) 5. Inspection by Building Department for removal and/or installation. (48 hour notice required) 6. Any electrical work requires a separate Electrical Permit and Electrical Inspection. 7. Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the installation and or removal of the HVAC equipment as listed below. The applicant, by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local, County, State & Federal laws, codes, rules and regulations. 1. Site Address: P-0W (,t oo-b P-C-1-er, 2. Property Owner& Phone: P l C/4A e 0 'b 6 M,q p`, 91Y. 4735 •9 de gAy 3. Applicant: L C-4WOSA 4. Contractor name, address, contact phone: A41 /d GO N/l_cf NA.11 C t4 <SER y/C C CZ/LP, P6. 4ex t/7$- 3/ *o.-IZO Rit Ls 5. Scope of Work:New Installation (V, Replacement Removal ( ); Other( ) 6. Type of Equipment: IRC^lout .cr.,ci -/,� �1 r+u••M►au`A"r► 9 /�-L- ra -i0-4.3 � s 6+ 4-4, t n CLNJ�7 u�'�. 'M$1►g•I► /V�d..� G'w,rr1 V�►fr��s Sb�.sQ +•St�fc Cvgc;,-- i` SSF-0- Cc),-de-iln LA...4 . 5*8CuAllo-!-?x., S LyL;GG(,o3(Ao0'3 7. Location of Equipment: v." ►) 4,ft 5. 6,.1,_ '.a A. dA-,c i ccn=►t'-- r*.s 8. Applicant Signatur . Date: Z z anosa P.E.;President DBA: Mt.Kisco Mech Sere.Corp. 6.1.12 MTKIS-1 OP ID: CN A�ORO CERTIFICATE OF LIABILITY INSURANCE 1 DAT 09,21DIYYYYI 9121/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ACT PRODUCER 845-877-9901 NAAME: Donald B.Dedrick Agency Inc PHONE FAX Mill Street,PO Box 319 845-877-6771 laC.No.Exit): lac.No): Dover Plains,NY 12522 E-MAIL Jay H. Dedrick ADDRESS: INSU S AFFORDING COVERAGE NAIL A INSURER A:Central All America 20222 INSURED Mt Kisco Mechanical Sery Corp INSURERS:Hartford Fire Insurance Co. 162 397 Bedford Rd PO Box 478 INSURER C:Central Mutual Insurance Co 20230 Bedford Hills, NY 10507 - — - INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE DDL SUB - POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LL481LnY CLP8874493 07/30/12 07/30/13 PAMAGE TO I REMISES EaIENTED occurrence $ 300,00 CLAIMS-MADE FX1 OCCUR MED EXP(Any one person) $ _5,00 X Contractual Liab. PERSONAL BADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 2,1000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/012 AGG S 2,00_0,0_0 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident A X ANY AUTO BAP8874492 07/30/12 07/30/13 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acc dent s X UMBRELLALWB X OCCUR EACH OCCURRENCE $ 5,000,00 C EXCESS LIAS CLAIMS-MADE CXS8874494 07/30/12 07/30/13 AGGREGATE S 5,000,00 DEC) X RETENTION$ 10000 S WORKERS COMPENSATION X WC STATU- I JOTH. AND EMPLOYERS'LIABILITY TORY LIMITS I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 01WECDQ5163 12/31/11 12/31/12 E.L.EACH ACCIDENT $ 600,00 OFFICER/MEMBER EXCLUDED? ❑ N/A -- — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 600,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACOI , ► V'D i required) As per policy tw CERTIFICATE HOLDER ON VILLRYB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE �4'0�'`8\U"' `-� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r-I N N � W a 5 W � � x o w a rF.i A NV. - s M e O W N d - Nx � ON w Qz a 00 A `r' M M� o0o w V w o, U O : a U H zo w O < CA 00 14 cF y� BRnu D D BUIL MENT R VIL E OF RYE OK OCT _ 3 2012 938 KIN ET RYE B ,NY 10573 (914)9 939-5801 VILLAGE OF RYE BROOK A Org BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION *MUST BE FILED BYA LICENSED MASTER PLUMBER ONLY* Date: JV 3 � 1 ILPlumbing Permit#: ���o`? 7 Building Permit#:HP /c� " Q-7q Fee: 1 Approval Signature: (fees are non-refunds le) Application is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install Plumbing as per detailed statement described below,and in accordance with all applicable Federal, State, County and Local Codes,at the following location: Address: AC—QQvJ WOo() C�ZCL—, Phone #: � >y 984S Owner: Mt 6CHn.-2 DD&MA — Address & Phone: Use/Occupancy: Parcel I.D.#: Zone: LICENSED MASTER PLUMBER'S INFORMATION: Name(please pri (Ll�'Ct�j Phone#: 1`f ZK l -7 Yqj Signatu Westchester County License#: S? 9 Company N 't 4 4 tl Company Address:�::�q J LZ X J City/Town: State: Zip Code: J OS'-11 Phone #: ZL(l —7`f� ...................................................................................... FIXTURES&LINES ARE TO BE INSTALLED ACCORDING TO 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 1 st Floor 2nd Floor Outside *Other: Detailed Description of Appliances etc...: �Pt S Fuf-vj kvb- Oc OT d, al � w N Q� M � � w x .F". °w Z w` .- N.S. 0-4 o O N z` - W I Y V1 ono a a O Q a a 00 Q o ,`7 W w a '� U z L� W w Q 3 o 0-4 v O w os c z � z a w ° < [� w `n o � ow U �I a WWI Z � R EC ENE BUILDING DEPARTMENT D VILLAGE OF RYE BROOK OCT - 2 2012 1 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 FAx(914)939-5801 VILLAGE OF RYE BROOK www.ryebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION This application must be filed in person at the Building Department by the Licensed Electrician of Record and must be accompanied by the completed Electrical Inspection Agency application form. Office Use Only: I� Date: /V /haApproval Signature: Inspection Agency: welcl-s Elected Permit#: Fees: 1� 16-D paid due Permit#: - l2`^ 07 Application is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit for the installation/removal/repair of Electrical Equipment as per detailed statement described below,and in accordance with the Code of the Village of Rye Brook,NYSUFP&BC,NEC,NFPA and all other applicable State,County and Local Laws. Address: q #qr k) c l Phone#: Owner: 1 Address&Phone: S 0n E Use/Occupancy: Parcel I.D.#:Lot c--— Zone: Proposed Electrical Work: LICENSED ELECTRICIAN'S INFORMATION: Name(Please t): Phone# Signatur : Westchester County License#: F 3 Company Name: 1 Company Address:'2(' L Se--3 Q)c 4d City/Town: State: A I U Zip Code: f OS-4 Qj Phone#: C— gzy— q&2�fX�22-) Field Contact&Phone: Revised 9/6/11 IV AJ r Westchester Rockland Electrical Inspection Services, Inc Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY L y Fax: 914-347 M, 43 North Lawn Avenue , , Elmsford, NY 10523 ;BUILDING PERMITNO. TEMP# D CITY OR ET % TOWNSHP STREET ANtfNO.O 11//Y7p D � E NUM ✓I BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT nCCUPANT'S NAME BUILDING OCCUPANCY c CA OWNER'S NAME AND ADDRESS HOME T LEP E NUMB CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1'FL. 2ro FL. 3' FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 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 AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS,INC.IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER � jr] SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND[] AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN 111OR APPLICATION MAY BE RETURNED. NAME OF COMPANY a ';r DATE OF APPLICATION SIGNATURE1 OF, AN } X '." ADDRESS C OL--j u � TELEPHONE NO. %// _ / CITY O T OFF,CE 1 ZIP M. LICENSE NO.WHEN APPLICABLE / }(/ �') (