Loading...
HomeMy WebLinkAboutMP10-28 QR. 190 t7 t[ t 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 November 9,2023 Daniel Wurtzel& Helene Wurtzel 43 Meadowlark Road Rye Brook,New York 10573 Re: 43 Meadowlark Road, Rye Brook,New York 10573 Parcel ID#: 129.84-1-9 This document certifies that the work done under Mechanical Permit #10-28 issued on 7/9/2010 for the installation of a new gas fired furnace has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to QyE BR(��, 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: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: t {`'v ( '� �� �.' p`kA t OCCUPANCY: � F ❑ 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 ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ~FINAL r ❑ OTHER a.Q� k 982 , BUILDING DEPARTMENT (BUILDING INSPECTOR VILLAGE OF RYE BROOK ILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: f L'i t-v 1 �1— �G DATE: .� PERMIT# D Z J ISSUED: SECT: BLOCK: LOT: LOCATION: - OCCUPANCY: 2 VIOLATION NOTED THE WORK IS... AcC I'"1'GU REJECTED/REINSPECTION SITE INSPECTION ( REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS *L Axt ❑ FUEL TANK , Cl FIRE SPRINKLER , ❑ FINAL PLUMBING ❑ FINAL _ ❑ OTHER &A � r VILLAGE OF RYE BROOK fir` J BUILDING DEPARTMENT 938 KING STREET,RYE BROOK,NY 10573 JUL — 8 2010 (914)939-0668 FAX(914)939-5801 www.ryebrook.ore i \lll I Ar _ Ci" P t t I.� APPLICATION TO INSTALL AND/OR REMOVE "T FUEL BURNER, BOILER OR HOT WATER HEAT Permit#: Building Inspector: Fee Paid: J Date of Approval: JU 9 2010 (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly Completed & Signed Application. 2. Copy of Licensed Contractor's Insurance including Liability& Workers Compensation naming the Village of Rye Brook as Certificate Holder. 3. Fees: $75 per unit. 4. Inspection by Building Department for removal and/or installation. 5. Certificate of Compliance will be provided when all requirements are fulfilled. 6. Any electrical work requires an Electrical Permit and Electrical Inspection. 7. Any gas/plumbing work requires a 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 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. Property Owner's Name: Daa WvC+�e� Phone#: 61D -AOM 2. Job Address: Phone#: rjar\Q. 3. Parcel I.D#: Zone: 4. Contractor: a Phone#: q q G' SS S L 5. Contractor Address: /00 W 1 Fax: t-5 S- S N3 6. Scope of Work: Install Gam; Remove C; - Fuel Burner ❑; Boiler ❑; Water Heater 7. Type of Equipment&Fuel: Game( CAJA 0 mqv `` 8. Location o Equipment: A v\e Signature of Applicant:c-�u�C— r��T Date: Printed Name of Applicant: Phone#: C lA(C) •• `� DATE(IdMIDDM'W) .�CC)R CERTIFICATE OF LIABILITY INSURANCE PIDBRU LA 03/16/10 PRODUCER� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE J.M. Glover Agency/Elmsford HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 45 Knollwood Rd, 5th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Elmsford NY 10523 Phone: 914-909-5320 Fax:914-909-5321 INSURERS AFFORDING COVERAGE NAIC4 INSURED INSURER A cxcelsior Insurance company INSURER B Peerless Insurance Company Bruni & Campisi Plumbing 6 Heating Inc. INSURER "a first Rehabilitation Cite 300 Central Avenue INSURER 0 White Plains NY 10606 INSURER E COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLI POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYYYY) DATE(MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY CPP101852710 02/16/09 02/16/10 PREMISEs(Eaoccurence) s 100000 CLAIMS MADE Fx]OCCUR MED EXP(Any one person) s 5000 X Contractual Sr 02/16/10 02/16/11 PERSONAL BADVINJURY $ 1000000 X Hold Harmless GENERAL AGGREGATE s 2000000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG s 2000000 POLICY XEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B X ANY AUTO BA101852710 02/16/09 02/16/10 (Ea accident) $ 1000000 ALL OWNED AUTOS 02/16/10 02/16/11 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $50 0 0 0 0 0 B X OCCUR EICLAIMSMAIDE CU101852710 02/16/09 02/16/11 AGGREGATE $5000000 3 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION X TORY LIMITS UER AND EMPLOYERS'LIABLI TY B ANY OFFICER/MEMBERE.(C UDED ECUTIVE WC8198741 09/15/09 09/15/10 E.L.EACH ACCIDENT $ 500000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $500000 OTHER C NY Disability DBL27356S 02/06/07 Contin. Statutory DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Village of Rye Brook REPRESENTATIVES. Building Dept. AUTHOR ZED RE ESENTATrV 938 King Street Rye Brook NY 10573 ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD