Loading...
HomeMy WebLinkAboutMP16-116 (�yE DR L r7 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.iyebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 21,2024 Tania Vernon 4 Lee Lane Rye Brook,New York 10573 Re: 4 Lee Lane, Rye Brook,New York 10573 Parcel ID#: 135.66-1-23& 24 This document certifies that the work done under Mechanical Permit #16-116 issued on 9/16/2016 for the installation of a new furnace and condenser has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �QyE BRC��. O tim /�• 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 : LI L r Z // N r DATE: L U G PERMIT# r ISSUED: f-A- /L SECT:/3- BLOCK: LOT: _ LOCATION: /� /G �G, S / �Lc OCCUPANCY: �;/=J ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION I ❑ Natural Gas Y, A , ❑ L.P. Gas ! D � ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 13"FiNAL ❑ OTHER r o y '9a2 BUILDING DEPARTMENT ❑ BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 0 ASSISTANT BUILDING INSPECTOR (914)939-0668 FAx(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - ---- - - -- -- ADDRESS: �.. ( '�Q DATE: ( I 1 1 / r PERMIT# ( ! ISSUED: �''r ? SECT' , the BLOCK: LOT: . LOCATION: ` V OCCUPANCY: Z �, ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/REINSPECTIO'N. 0 SITE INSPECTION -- REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE 0 FOUNDATION 0 UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ,__ �J� ` ���I Q� (•� 0 ROUGH FRAMING ' y(A� `U } 1 Uc C ❑ INSULATION A . ❑ NATURAL GAS 1❑ L.P. GAS ❑ FUEL TANK l IJ�Q� 0--,c� ' o k f n c Af't5 aC I ❑ FIRE SPRINKLER l ❑ FINAL PLUMBING t `� ❑ FINAL ❑ OTHER AIRPINC-01 SSAMSON CERTIFICATE OF LIABILITY INSURANCE DATE 911412016H 4116 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 cerlHicate holder In lieu of such endorsements. PRODUCER CONTACT N Dalggle&Travers Ins Agency LLC PHONE FAc 662-9361 22 Thorndal Circle,Ste.2 -IAIL N,Eul(203)655-6974 203 Darien,CT 06820 EMAIL ADDRE �_ INSURE S AFFORDING COVERAGE NAICN INSURER A Utica National Assurance 10687 INSURED INSURER s-Gra p hies Arts Mutual Insurance 25984 { Airplus Inc. INSURER C Utica Lloyds Of Tx 10990� 78 Fort Point Street INSURER D Utica National Insurance Co 125976 Norwalk,CT D6855 INSURER E 1 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 PER OD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH'S CERTIFICATE MAY BE ISSJED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SJBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR L POUCY F POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM100(yYri MM(DDIYYYY LIMR9 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 CLAIMS-MADE FK OCCUR 4946362 05/05/2016 05/0512017 PREMISES RE EU S 50,00 MED EXP(A^y ono person) S 10,00 PERSONAL d ADV INJURY S GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 X POLICY PRO- LOC nPRODUCTS-COMPtOP AGG S 2,000,00 OTHER 3 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMB $ 1,000,000 B X ANY AUTO 4446364 05/0512016 0510512D17 BODILY tNUURY(Pe,Person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Pow amdent) S HIRED AUTOS AUTOSYVNED RTY DAMAGE Is f X UMBRELLA LIAR OCCUR -- EACH OCCURRENCE S 1,000,00 C I EXCESS LIAB GIvMS-MADE 4946365 05/0512016 0510512017 AGGREGATE S 1,000,00 X I RETENTIONS 10,000 S WORKERS COMPENSATION PER AND EMPLOYERS'U OTH. A8IUTY YIN X STATUTE 1 R_ D ANY PROPRIETOR/PARTNEWEXECUTiVE 946366 OSMS12016 05105/2017 E.L.EACH ACCIDENT s SOO,DO OFFICERIMEMBEREXCLUDED? NIA (Mandatary In NH) E L DISEASE-EA EMPLOYE S 500,00 H YYes.descnbe under DESCRIPTION F O RATIONS Belo.+, E L DISEASE-POLICY UMR 5 500,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.AddlUonal Rems k■Schedule,may be enached N more space H raqulred) EVIDENCE OF INSURANCE 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 ©1968-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) Ib.Business Telephone Number of Insured Airplus, Inc. 78 Fort Point St. Ic.NYS Unemployment Insurance Employer Norwalk, CT 06855 Registration Number of Insured Work Location of Insured(Only requiredifcoverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 770656379 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Utica Mutual Insurance Company Village of Rye Brook 3b.Policy Number of entity listed in box"la" 938 King St. 4946366 Rye Brook, NY 10573 3c. Policy effective period 05/05/2016 to 05/05/2017 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "la" 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"T'. The Insurance Carrier will also notify the above certificate holder within 10 days IFa policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box "3c",whichever is earlier. Please Note: Upon the 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 I 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: Tony Sychtysz (Print name ofaudiorized representative or licensed agent of insurance carrier) Approved by: 09/14/2016 (Signatu ) (Date) Title: SVP, National Sales Director Telephone Number of authorized representative or licensed agent of insurance carrier: (315)734-2000 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(9-07) www.wcb.state.ny.us