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HomeMy WebLinkAboutMP17-192 Qy� DR(i,� s "J`ij Y b O a c Ctc J �'UVW V �C 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.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 5,2024 Lawrence Engle&Bethany Engle 12 Churchill Road Rye Brook,New York 10573 Re: 12 Churchill Road, Rye Brook,New York 10573 Parcel ID#: 135.26-1-22 This document certifies that the work done under Mechanical Permit#17-192 issued on 12/12/2017 for the installation of a new gas fired furnace and a new condensing unit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to QyE BR(��. cu � • 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: 1 Z o f c.` 1 �. DATE: 1- y' 2 D z 1 PERMIT# `1P I ! ' `1 Z ISSUED: 2' 1Z -11 SECT: , z BLOCK: LOT: LOCATION: OCCUPANCY: 2 I J ❑ Violation Noted THE WORK IS... E3 YASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION //�� 1 ❑ Natural Gas (� f�S ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL 6/OTHER a t � _ i O � ^• o t N N N 7C ,� 19 00N W J i s w G 0 rl r.> > p rrrJ � ii+ co mm 00 r .r� '10 CL g Z 1, ,,,,, f J w; • W � J F Q pii U U ' 'o" coil U 'o Z e BOIL qD tJAN ����DING DEPARTMENT ;VILLAGE OF RYE BROOK , - 8 2018 938 KING;STREET RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 V. 1.CE OF RYE BROOK www.ryebrook.or L:L—_ _"FDARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master tlectriclans License Required FOR OFFICE. LIS ONII.1' Hitt! - l -7 - I -1 a EP#: l(F±) "C)C)q Approval Date: JAN - 9 2010 Permit Fee: $ } Approval Signature: Other: Disapproved: (tees are nowrerom66te) Application dated, ti hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrica equipment,wiring, fixtures ,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address:12 1fl/��r; lei- SBL: Zone: 2.Property Owner: `4 �e-- /), f%l�e��e` Address: Phone d/�� Cell #(/� �S-*� email: c� , 3.Master Electrician: Lm6i M-mqFe1R,TF Address: Ac- �E �0CRWr.,�V�Q�1 . Lic.C-904 Phone#:�(36-b-220 Cell#: cmail:�is-&Amgrr Gnr�w*,,M Company Namc:A fi t - A Fcal f Address: �Q 7"`CKEUENJ L486! 4.PToposed Electrical Woric/Fixlure Count: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that heishe is the applicant above named,and does further Iptint nanlr .nl indr.ido'd.,:;tiu tti Ih::yiplic,ul i state that Whe is the legal owner of the property to which this application pertains,or that(s)hc is the for the legal owner and is duly authorized to make and file this application. (indicate arcitart.-., cunnactut.agent.a[till n'n.etc 1 The undersigned further states that all statements contained herein are true to the best of histher knowledge and belief,and that any work performed,or use conducted at the above captioned property wi11 be in conforniance with the details as set forth and contained in this application and in any accompanying approved plans and sliccilications,as well as in accordance with the New York State Unil'omi Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to bsfone nie this oV'� day /" "-a` ZO l� Sworn tohef'ore me this _ day of .20 . at a of Property wne% ignaw pl' n-t—' ����� '"� - �'�'j� �► IJ /YID,fz� Print Name Owner P ' at e of pplicant rr cc Not is Notary Public AMY KRUSE SHARI MELILLO Notary Public, State of New York Notary Public,State of New York No. 01-KR6 048360 No.01ME6160063 Qualified in Westchester County COualified in Westchester County Commission Expires tYi '!�t7 q $ Commission Expires January 29.20-1---t- Wesfcliester Rockland Electrical Inspection Services, Inc. Phone: 914-34-7-359' 5 DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDING PERMIT rNO. / TEMP# DATE C� f I C) tJ Al' CITY 7VILLAGE ZIP CODE TOWNSHIP COUNTY STREET STRE AND NO.OR ROAD POLE NUMBER "/R Ct4!Lt. r BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME .O BUILDIN CCUPANCY I7� OWNER'S NAME AND SS HOME TELEPHONE NUMBER .)I"/ CURRENT SUPPLIED BY ,L 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.EAC N OUTSIDE ry BASEMENT .r 1 1s'FL. ' A 2—FL A ILL.;G i ILDI G DEPARTMENT 3'�FL t 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 CI EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD L I UNDERGROUND 1 I A 11 DI URATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAYBE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT /i 7 x ,SMEET TELEPHONE NO. 7 C Lk� ZIP CODE ` t LICENSE NO.WHEN APPLICABLE _ WESTCHESTER ROCKLAND ELECTRICAL INSPECTION 1WEISISERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: A Perfect/Goldman Electric Lawrence & Beth Engle 48 Potter Avenue New Rochelle NY 10801 Located at: 12 Churchill Rd, Rye Brook, NY 10573 Certificate Number: 476907 Section: 135.26 Block: 1 Lot: 22 BDC: Permit Number: EP:18-004 BP:17-192 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 12 Churchill Rd, Rye Brook, NY 10573 ❑X Basement ❑1st Floor 02nd Floor ❑3rd Floor ❑Garage ❑Attic OOutside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation, as set forth below, was found to be in compliance therewith on 2/25/2018 Name Quantity Rating Circuit Type HVAC System 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in anyway. This certificate is valid for work performed before date of ins ection onl . YYY DATE IMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/5/2017 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 pci 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). PRODUCER CONTACT Wendy Harden NAME: Associated Insurance Agency of Westchester, Inc. PHONES (914)273-8511 IFAAIXCNo:(914)273-8082 200 Business Park Drive AMR�ESS:wendy@avantiassociates.com Suite 206 INSURER(S)AFFORDING COVERAGE NAIC 0 Armonk NY 10504 INSURERA:Main Street America Assurance Co. 29939 INSURED INSURERB:NGK Insurance Coupany 14788 ACCU TEMP HVAC INC INSURER C: 39 ARROWHEAD RD INSURERD: - INSURERE: _ WILTON CT 06897-4402 INSURERF: COVERAGES CERTIFICATE NUMBER:CL176525839 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. ILTR TYPE OF INSURANCE ' NSD WLSU D POLICY NUMBER MWDDIYYVY POLICY MIDDfYYY - LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMSMADE ®OCCUR PREMISES Ea occurrence $ 500,000 MPZ5404B 6/1/2017 6/1/2018 MED EXp(Any om Person) $ 20,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑j� LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER.- DATAC $ AUTOMOBILE LIABILITY COMBIN SI - $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aaident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accid $ UMBRELLALIA13 I OCCUR EACH OCCURRENCE $ EXCESS LIAR El CLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION X OTH- ANDEMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B FFIC(mandatory EXCLUDED? NIA ( ry in NH) INCZ5404B 6/1/2017 6/1/2018 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMB I S 500,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job Loc: 12 Churchill Road, Rye Brook, NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE John D'Amato/WEH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE ta.Legal Name&Address of Insured(use street address only) lb. Business Telephone Number of Insured 203-627-9586 Accu-Temp HVAC Inc 39 Arrowhead Road Wilton,CT 06897 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to td.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i e.,a Wrap-Up Policy) Number 562400803 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NGM Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street WCZ5404B Rye Brook,NY 10573 3c.Policy effective period 06/01/2017 to 0 610 1/2 01 8 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers mduded) QX all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item_3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or If the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? EYES Xx NO This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by. John D'Amato (Print name of authonz pr entaUve or licensed agent or insurance car ier) L15 I� Approved by I (Sig / (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 914-273-851 1 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-15) www wcb.ny gov