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HomeMy WebLinkAboutMP10-009 4R 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.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 28,2025 David Mintz&Jill Mintz 3 Pine Ridge Road Rye Brook,New York 10573 Re: 3 Pine Ridge Road,Rye Brook,New York 10573 Parcel ID#: 135.41-1-56 This document certifies that the work done under Mechanical Permit#10-009 issued on 10/26/2010 for the installation of a gas fired furnace has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE Bkj�' o`` tim cu � �c BUILDING DEPARTMENT �❑BBUILDING INSPECTOR .�QASSISTANT 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 t,e. 91 ld Q„�LSC� DATE: Z� 00L,r PERMIT#. [r ioa"1 ISSUED: SECT:BLOCK:_LOT: S IO LOCATION: Q AAQ rr.A.�, 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 {� �- � L NATURAL GAS 1� p W) t o . )c (j , ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER FINAL PLUMBING ❑ CROSS CONNECTION ,FINAL Er-OTHER/4,V 'g, VILLAGE OF RYE BROOK - BUILDING DEPARTMENT 938 KING STREET,RYE BROOK,NY 10573 OCT 2 6 2010 (914)939-0668 FAX(914)939-5801 www.ryebrook.ore APPLICATION TO INSTALL AND/OR REMOV - t:r FUEL BURNER, BOILER OR HOT WATER HEATER Permit#: 10 U a 01 Building Inspector: Fee Paid: Date of Approval: p Z (fees are non-refundable) 7klktket9c�Fnk91r71tit�Itit747k11ttktktYlt**irxirir**iriritKX*�***kx*irxFFxixir*ic�c>F9cFis<<F****>F*icF*Fic>F*k*FF* 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&Fede1rall laws,codes,rules and regulations. 1. Property Owner's Name: b,A v t W 11 Aj 2 Phone#: 6 2. Job Address: 2--- R Nj(W- V�_s Phone#: Q 3 3. Parcel I.D#: 135-q I-1—5(.p 1_Jr C-Cj) Zone: 4. Contractor:R>P J'.,y I L(G V_ Phone#: -5-1-S-_� 5. Contractor Address: 3GL► 09j)A ra Fax: "-5 7,k 3 6. Scope of Work: Install.k.�Remove ❑;-Fuel Burner ❑; Boiler ❑; Water Heater ❑ 7. Type of Equipment&Fuel: 8. Location of Equipme Signature of Applicant: Date: Printed Name of Applicant: r►^ /t/ k eeit cg, Phone#: INFINITYTM 80 VARIABLE SPEED Input4—WAY MULTIPOISE GAS FURNACE • • Btuh turn to the experts Series 1 Product Data natural or propane gas,and the 58CVX is also approved for use in Low NOx Air Quality Management Districts. INEINt Y0reiE_. (,ilttrtJTt{�y11 -_ (�(ptf�fjyttulrt„ Carrier Infinity' System When the Infinity 80 variable-speed f f gas furnace is matched with the Infinity Control and an air conditioner or heat pump, you will experience the ultimate in ComfortHeat and IdealHumidity through unparalleled control of temperature, humidity,indoor air quality,and zoning.The Carrier ° Infinity System also provides unprecedented ease of use through ®®10� ® on-screen, text-based service reminders and equipment ®®®® malfunction alerts. For even greater comfort and convenience, O ®®®® match the Infinity 80 furnace with an Infinity air conditioner or 0 ®®®® heat pump. This will create a fully communicating system, requiring only 4 thermostat wires between system components,and O ®®� troubleshooting can even be done in the future from the outdoor ®®®® unit without entering the home. ®®�® Optional remote access through telephone or Internet is also available when combined with a remote connectivity kit. ®®®® STANDARD FEATURES ° • Infinity System-match with the Infinity Control for Infinity System benefits _ • ComfortHeat Technology Intelligent microprocessor control I • Two-stage heating with single-stage thermostat with patented Adaptive Control Technology • Very low operating sound through low-stage operation and QuieTech' system • Integral part of the IdealHumidity System Maximum dehumidification selection for summer time cooling Full IdealHumidity benefits including"Super Dehumidify" SmartEvap"'-Humidity control when using a Thermidistat- / 1 v Infinity control • Variable-speed ECM blower motor Increased SEER ratings for AC and HP systems as compared to the Air Conditioning Heating and Refrigeration Institute's A10250 standard coil-only rating when paired with selected Carrier THE INFINITY" 80 GAS FURNACE evaporator coils. The Infinity- 80 Variable-Speed,4-way Multipoise Gas Furnaces Perfectly matches CFM to cooling system at all static points offer unmatched comfort with ComfortHeat"' and . Comfort Fan'-Up to 12 cooling airflow selections from IdealHumidity"" technologies in an 80%AFUE gas furnace. You thermostat with a wide range of capability get all the benefits of a ComfortHeat technology furnace:reduced drafts,reduced sound levels,longer cycles,less temperature swings • Microprocessor based control center between cycles, and less temperature differences between rooms. Enhanced diagnostics with LED and reflective sight glass With the variable speed blower motor, homeowners can now Stores fault codes during power outages economically run constant fan to help eliminate temperature Adjustable heating air temperature rise differences throughout the house and to get better indoor air quality. This furnace with IdealHumidity'" technology also Adjustable cooling airflow increases comfort in the summer by wringing out extra humidity Dehumidification selection for summer-time cooling when needed.The Infinity 80 furnaces are approved for use with . 4-way Multipoise furnace,13 vent applications • Compact design-only 33-113 in.(847 mm)tall STANDARD FEATURES (CONTINUED) • Power Heat" Igniter condensate drain port(s)sealed. • Draft Safeguard switch to ensure proper furnace venting • HYBRID HEAT®Dual Fuel System compatible • Insulated blower compartment •All models are chimney friendly when used with accessory • Inner door for tighter sealing vent kit • Certified to leak 2 percent or less of its nominal air • Residential installations eligible for consumer financing conditioning CFM delivered when pressurized to l-In. through the Retail Credit Program Water Gauge with all present air inlets,air outlets,and MODEL NUMBER NOMENCLATURE 58CVA 070 100 12 58CVA Variable Speed 4-Way Multipoise—T-- Nominal Cooling Size 58CVX Low NOx Version (Airflow at.5 ESP.) (400 CFM per 12,000 Btuh) 12-1200 CFM 100 16-1600 CFM 110 20-2000 CFM 120 22-2200 CFM Input Capacity 130 070-66,000 Btuh 135-132,000 Btuh 140 090-88,000 Btuh 155-154,000 Btuh 150 110-110,000 Btuh Series Number FURNACE COMPONENTS o 0 00 ..•..,. >�.� o ^� o O A02169 A10286 A02170 HEAT EXCHANGER CONTROL BOARD INDUCER BLOWER 2 FURNACE COMPONENTS INDUCER MOTOR VENT ASSEMBLY ELBOW 0 ' PRESSURE O MAIN LIMIT SWITCH SWITCHES (BEHIND GAS VALVE) o o I BLOCKED VENT SWITCH FLUE COLLECTOR BOX 1 0 FLAME GAS VALVE 8 SENSOR e O a� o MANUAL RESET GAS MANIFOLD LIMIT SWITCHES e e e HOT SURFACE a a IGNITOR 0 GAS BURNER BLOWER DOOR SAFETY SWITCH _ Q 0 FURNACE CONTROL BOARD BLOWER AND o _® MOTOR CAPACITOR/ v POWER CHOKE I 0 0 A10312 NOTE: The 58CVA/CVX furnaces are factory shipped for use with natural gas. These furnaces can be field-converted for propane gas with a factory-authorized and listed accessory conversion kit. 3 CARRIER ACCESSORIES { - - 0 I o � . 00 i� o A01484 C04009 A03149 CONTROLS: MECHANICAL MODEL HUMCCLFP THERMOSTATS OR ELECTRONIC HUMIDIFIER AND ZONING AIR CLEANER Available in programmable and By adding moisture to winter-dry non-programmable models, Carrier Cleans the air of smoke,dirt,and air,a Carrier humidifier can often thermostats maintain a constant,comfortable many pollens commonly found. improve comfort and keep temperature level in the home. Saves decorating and cleaning furniture, rugs, and draperies in For the ultimate in home comfort, Cartier's expenses by keeping carpets, better condition. Moisturizing 2,4, and 8-zone systems allow temperature furniture,and drapes cleaner. household air also helps to retain control of individual "zones" of the home. Electronic air cleaner is shown. normal body heat and provides This is accomplished through a series of comfort at lower temperatures. electronic dampers and remote room sensors. Infinity'" Control shown. 4 CARRIER ACCESSORIES DESCRIPTION ELECTRONIC AIR CLEANER(EAC) Model EACB MECHANICAL AIR CLEANER Models EZXCAB,FILCAB HUMIDIFIER Model HUM HEAT RECOVERY VENTILATOR Model HRV ENERGY RECOVERY VENTILATOR Model ERV UV LIGHTS Model UVL For use with 1-speed Air Conditioner—deg.F/C,Auto Changeover—TP—NAC,TC—NAC For use with 1-speed Heat Pump—deg.F/C,Auto Changeover—TP—NHP,TC—NHP* THERMOSTAT — NON-PROGRAMMABLE For use with 2-speed Air Conditioner—deg.F/C,Auto Changeover—TP—NRH* For use with multi-use/stage configurations—deg.F/C,Auto Changeover/Temperature and Humidity Control—TP—PRHt For use with 1-speed Air Conditioner—deg.F/C,Auto Changeover,7-Day Programmable— TP—PAC For use with 1-speed Heat Pump—deg.F/C,Auto Changeover,7-Day Programmable— TP—PHP* THERMOSTAT — For use with 2-speed Air Conditioner—deg.F/C,Auto Changeover,7-Day Programmable— PROGRAMMABLE TP—PRH* For use with 1-speed Air Conditioner—deg.F/C,5-2 Day Programmable—TP—PAC For use with multi-stage applications—deg.F/C,Auto Changeover,7-Day Programmable—TC—PHPt For multi-use/stage configurations—deg.F/C,Auto Changeover,7-Day Programmable/Temperature and Humidity Control—TP—PRHt Comfort"Series 3-Zone Kit—ZONECC3ZAC01,ZONECC3ZHP01 2 Performance"Series ComfortZone"II Zoning/Temperature and Humidity Control—ZONECC2KIT01—B 4 Performance'"Series ComfortZone'"II Zoning/Temperature and Humidity Control—ZONECC4KIT01—B 8 Performance"Series ComfortZone'"II Zoning/Temperature and Humidity Control—ZONECC8KIT01—B Infinity"'Control Deluxe 7-Day Programmable(Wall-mounted system control.)—SYSTXCCUID01 Infinity'" Control Deluxe Zoning 7-Day Programmable(Wall-mounted control for a ZONING CONTROL multi-zone system.)—SYSTXCCUIZ01 Infinity'"4-Zone Damper Control Module(Wall-mounted for a 4-zone system.)—SYSTXCC4ZCO2 Infinity'"Smart Sensor(Optional wall control used to monitor temperature and/or fan control in an individual zone.)—SYSTXCCSMS01 Infinity'"Remote Room Sensor(Monitors temperature in an individual zone.)—SYSTXCCRRS01 Infinity'"System Access Module(Hardware for wireless access and control via phone or internet.)— SYSTXCCSAMOt Infinity—Network Interface Module(Connects Heat Recovery and Energy Recovery Ventilators or older two-speed outdoor models to system.)—SYSTCCNIM01 tt Decorative Back Plate for Infinity Control(Decorative wall plate.)SYSTXXXBPU01 *Model HP and 2S thermostat must be field converted to air conditioner operation. t Thermidistat Control can be configured for multiple use and staging,it must be configured for each specific application. t Dual Fuel thermostat is used with furnace and heat pump application. **When applied with Carrier's IdealHumidity'"series 58CVA/CVX and FE Indoor Models tt Must be installed in Dual—Fuel Infinity system applications 5 CARRIER ACCESSORIES DESCRIPTION PART NO. 070-12 090-16 110-20 135-22 155-22 FILCABCC0016 X Media Filter Cabinet FILCABCC0020 X FILCABCC0024 X FILCCCAR0016 X X G Filter FILCCCAR0020 X FILCCCAR0024 X X EXPXXUNV0016 X X EZ Flex Uft du Filter with End Caps EXPXXUNV0020 X EXPXXUNV0024 X k. EXPXXFIL0016 X X Replaceir.ens=Z Rex Filter"."e^.a EXPXXFlL0020 X EXPXXFIL0024 X X KBAFR0401B14 X KGAFR0501B17 X External Bottom Return Filter hack KGAFR0601B21 X KGAFR0701B24 X r External Side Return Fitter Rack KGAFR0B01SRE X X X X KGAWF1301 UFRt S S KGAWF1401UFR S KGAWF1501UFR S Unframed Filter 3/44n.(19 mm) KGAWF1306UFRt X X KGAWF1406UFR X KGAWF1506UFR X X Flue Extension KGAFE0112UPH X X X X X Combustible Floor Base KGAS60201ALL X X X X X Downflow Vent Guard KGBVG0101 DFG X X X X X Vent Extension Kit KGAVE0101 DNH X X X X X Chimney Adapter Kit KGACA02014FC X X X Chimney Adapter Kit KGACA02015FC X X Natural-to-Propane Conversion Kit* KGANP4601ALL X X X X X Propane-to-Natural Conversion Kit KGAPN3901ALL X X X X X Label Kit KGAI-B0101 KIT X X X X X Air Leakage Kit(City 10) KGBAC0110DGK X X X X X ECM Motor Simulator KGASD0301 FMS X X X X X Advanced Product Monitor KGAFP0301APM X X X X X KGAHA0150N42 KGAHA0250N43 (factory supplied) KGAHA035ON44 KGAHA045ON45 KGAHA0550N46 Gas Orifice Kit KGAHA1550N47 (�'50) See Installation bOYIrOChOI1S for model,altitude,and heat value usages. KGAHA1650N48 KGAHA0650P54 KGAHA0750P55 KGAHAO850P56 KGAHAS750125 KGAHA5750130 *Factory-authorized and field installed.Fuel conversion kits are CSA(formerly AGA/CGA)recognized. t Suitable for Side Return Filter Rack X=Accessory S=Standard 6 PHYSICAL DATA UNIT SIZE 070.12 090.1e 110-20 135-22 155-22 All 58CVA;58CVX Upflow High 54,000 71,000 89,000 107,000 125,000 OUTPUT CAPACITYBTUH• Low 35,000 47,000 59,000 70,000 82,000 (Nonweatherized ICS)t 58CVX Downflow/Horizontal High 51,000 68,000 85,000 102,000 119,000 Low 35,000 47,000 59,000 70,000 82,000 58CVX Upflow;all 58CVA High 66,000 88,000 110,000 132,000 154,000 Low 43,500 58,000 72,500 87,000 101,500 INPUT BTUH• 58CVX Downflow/Horizontal High 63,000 84,000 105,000 126,000 147,000 Low 43,500 58,000 72,500 87.000 101,500 SHIPPING WEIGHT-LB(KG) 115(52) 1 130(59) 155(70) 166(75) 175(79) High 30-60 40-70 40-70 40-70 45-75 (17-33) (22-39) (22-39) (22-39) (25-42) CERTIFIED TEMP RISE RANGE-°F(°C) Low 30-60 30-60 25-55 25-55 30-60 (17-33) (17-33) (14-30) (14-30) (17-33) CERTIFIED EXT Heating High 0.12 0.15 0.20 0.20 0.20 STATIC PRESSURE IN.WC Cooling Low 0.5 0.5 0.5 0.5 0.5 Heating-High/Low 1180/735 1210/985 1475/1320 1915/1700 1970/1715 AIRFLOW CFM# Cooling 1225 1400 2095 2100 2095 AFUE%' Nonweatherized ICS 80.0 80.0 80.0 80.0 80.0 LIMIT CONTROL SPST HEATING BLOWER CONTROL Solid-State Time Operation BURNERS(Monoport) 2 1 2 3 3 3 4 1 4 GAS CONNECTION SIZE 1/2-in.NPT GAS VALVE(Redundant)Manufacturer White-Rodgers Minimum Inlet Pressure(In.W.C.) 4.5(Natural Gas) Maximum Inlet Pressure(In.W.C.) 13.6(Natural Gas) IGNITION DEVICE Hot Surface Gas input ratings are certified for elevations to 2000 ft.(610 M).In USA,for elevations above 2000 ft.(610 M),reduce ratings 4 percent for each 1000 ft.(305 M)above sea level.Refer to National Fuel Gas Code NFPA 54/ANSI Z223.1-2009 Table F4 or furnace Installation Instructions. t Capacity in accordance with U.S.Government DOE test procedures. t Airflow shown is for bottom only return-air supply in comfort mode(as shipped).For air delivery above 1800 CFM,see Air Delivery Table for other options. A filter is required for each return-air supply. ICS-Isolated Combustion System BLOWER PERFORMANCE DATA UNIT SIZE 070.12 090-18 110-20 135-22 155-22 DIRECT-DRIVE MOTOR Hp(PSC) 1/2 1/2 1 1 1 MOTOR FULL LOAD AMPS 7.7 7.7 12.8 12.8 12.8 RPM(Nominal) 300-1300 300-1300 300-1300 300-1300 300-1300 BLOWER WHEEL DIAMETER X WIDTHS -IN.(MM) 10 x 6 10 x 8 11 x 10 11 x 11 11 x 11 (254 x 152) (254 x 203) (279 x 254) (279 x 279) (279 x 279) ECM-Electronically Commutated Motor,Variable Speed 7 i b 1 I i f SEE NOTES: 1,2,4,7,8,9 SEE NOTES: 1,2,3,4,7,8,9 SEE NOTES: 1,2,4,5,7,8,9 UPFLOW UPFLOW DOWNFLOW A02058 A02059 A0206/ i n - 1 SEE NOTES:1,2,3,4,5,7,8,9 SEE NOTES:1,2,3,4,5,7,8,9 SEE NOTES: 1,2,4,5,6,7,8,9 DOWNFLOW DOWNFLOW DOWNFLOW A02060 A02063 A02062 Venting Notes 1. For common vent,vent connector sizing and vent material:United States,latest edition of the National Fuel Gas Code(NFGC),ANSI Z223.1/NFPA 54. 2. Immediately increase to 5-in.(127 mm)vent connector outside furnace casing when 5-in.(127 mm)vent connector required,refer to Note 1. 3. Side outlet vent for upflow and downflow installations must use Type B vent immediately after exiting the furnace, except when Downflow Vent Guard is used in downflow position. 4. Type B vent where required,refer to Note 1. 5. 4—in.(102 mm)single wall vent must be used inside furnace casing and the Downflow Vent Guard Kit. 6. Accessory Downflow Vent Guard Kit,required in downflow installations with bottom vent configuration. 7. Chimney Adapter Kit required for exterior masonry chimney applications. Refer to Chimney Adapter Kits for sizing and complete application details. 8. Secure vent connector to furnace elbow with(2)corrosion-resistant sheet metal screws,space approximately 180° apart. 9. Secure all other single wall vent connector joints with(3)corrosion-resistant screws spaced approximately 120' apart. Secure Type B vent connectors per vent connector manufacturer's recommendations. 8 _.. . .._- o or SEE NOTES: 1,2,4,5,7,8,9 SEE NOTES: 1,2,4,5,7,8,9 HORIZONTAL RIGHT HORIZONTAL RIGHT A02068 A02070 U i' 1 ,:d SEE NOTES: 1,2,4,7,8,9 HORIZONTAL RIGHT A02069 { G l O SEE NOTES: 1,2,4,7,8,9 SEE NOTES:1,2,4,5,7,8,9 HORIZONTAL LEFT HORIZONTAL LEFT A02064 A02005 €I? ICI ! Mmz=m== ! _ `J O ! SEE NOTES: 1,2,4,5,7,8,9 SEE NOTES: 1,2,4,5,7,8,9 HORIZONTAL LEFT HORIZONTAL LEFT A02066 A02067 9 AIR DELIVERY - CFM (With Filter)* External CFM Static External Static Pressure(ESP)(IN WC) Unit Size Operating Mode Airflow Pressure Setting Range* 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 (In.W.C.) Low Heat 735 615 0-0.50 735 735 735 735 725 High eat 1180(1060)t 0-1.0 1160 1165 1175 1180 1180 1180 1 1180 1 1180 1 1180 1 1175 tt 1-1 2- on Cooling 525 0-0.50t 515 500 500 490 485 2- on ooing 700 0-0.50t 690 680 675 680 675 2-1/2- onCooling 875 0-1.0# 875 875 875 870 865 1 855 850 835 825 820 3-TonCooling 1050 0-1.OF—1050 1050 1050 1050 1050 1050 1045 1035 1020 1000 3-1/2-Ton ooing 1225 0-1.0 1220 1225 1225 1225 1225 1220 1205 1190 1185 1170 Maximum 1400 0-1.0 1395 1400 1400 1400 1395 1385 1370 1340 1300 1245 Low Heat 985(825)t 0-1.0 950 970 985 985 985 985 985 985 985 980 High Heat 1210 1090 0-1.0 1190 1205 1210 1210 1210 1210 1210 1210 1210 1200 tt 1-1/2- on ooling 525 0-0.50# 525 520 525 495 475 2- on Cooling 700 0-0.50t 680 680 680 675 670 2-1/2- on Cooling 875 0-1.0 815 845 845 855 850 850 845 835 820 805 3- onCooling 1050 0-1.0t 1005 1005 1015 1035 1040 1040 1035 1030 1025 1010 3-1/2-Ton ooing 1225 0-1.0 1190 1200 1200 1205 1205 1215 1205 1200 1185 1170 4-TonCooling 1400 0-1.0 1350 1370 1390 1390 1400 1390 1380 1380 1360 1340 Maximum 1600 0-1.0 1595 1600 1 1600 1600 1595 1 1555 1505 1465 1430 1390 Low Heat 1320 1110 0-1.0 1275 1295 1315 1320 1320 1320 1320 1320 1320 1315 High eat 1475 1330) 0-1.0 1460 1465 1475 1475 1475 1475 1475 1 1475 1465 1465 tt 2-Ton A/C Cooling 700 0-0.50# 700 700 700 700 700 tt 2-1 2- on Cooling 875 0-0.50 875 875 875 875 875 3-TonCooling 1050 0-0.50t 1050 1050 1050 1050 1050 3-1/2-TonCooling 1225 0-1.0# 1225 1225 1225 1225 1225 1 1225 1225 1225 1225 1225 4- onCooling 1400 0-1.0 1400 1400 1400 1400 1400 1400 1400 1400 1400 1400 5-TonCooling 1750 -0-1.0T 1750 1750 1750 1750 1750 1750 1750 1750 1740 1725 6-TonCooling 2100 0-1.0 2100 2100 2100 2100 2090 2075 2055 2040 2005 1970 Maximum 2200 0-1.0 2200 2190 2190 2180 2155 2145 2125 2100 2080 2020 Low Heat 1700 1430 0-1.0 1700 1700 1700 1700 1700 1695 1700 1695 1685 1670 Higheat 1915(1725) 0-1.0 1900 1905 1915 1915 1915 1915 1915 1915 1915 1915 t 2- on Cooling 700 0-0.50t 700 700 700 700 665 tt 2-1/2-Ton Cooling 875 0-0.50 870 870 865 865 [:n 5 3- on ooing 1050 0-0.50f 1010 1030 1050 1050 1050 3-1/2-Ton A/C Cooling 1225 0-1.0# 1155 1180 1200 1210 1220 1225 1225 1225 1225 1225 4- onCooling 1400 0-1.0 1395 1400 1400 1400 1400 1400 1400 1390 1375 1355 5- onCooling 1750 0-1.0T 1740 1750 1750 1750 1735 1740 1735 1730 1715 1700 6- onCooling 2100 0-1.0 2075 2085 1 2090 2100 2100 2100 2090 2080 2055 2025 Maximum 2200 0-1.0 2180 2195 2200 2200 2200 2200 2185 2165 2140 2095 Low Heat 1715(1440)t 0-1.0 1715 1715 1715 1715 1715 1705 1710 1705 1 1705 1695 High Heat 1970 7775 0-1.0 1955 1965 1965 1970 1970 197 1970 9970 1970 1950 2- onCoo ing 700 0-0.50t 700 700 700 700 680 2-1/2- on oo mg 875 0-0.50t 865 875 875 865 865 tt 3-Ton A/C Cooling 1050 0-0.50# 1015 1020 1 1035 1045 1050 3-1/2-TonCooling 1225 0-1.-of 1160 1185 1215 1225 1225 1225 1225 1225 1225 1225 4-TonCooling 1400 0-1.0t 1385 1400 1400 1400 1400g1400195 1395 1380 1360 5- on ooing 1750 0-1.0# 1745 1750 1750 1750 174545 1745 1740 1735 6- on ooing100 0-1.0 2055 2070 2080 2085 209500 2100 2090 2065 aximum 2200 0-1.0 2175 2190 2200 2200 220000 2200 2180 2160 *Actual external static pressure(ESP)can be determined by using the fan laws(CFM 2 proportional to ESP);such as,a system with 1180 CFM at 0.5 ESP would operate at cooling airflow of 1050 CFM at 0.4 ESP and low-heating airflow of 735 CFM at 0.19 ESP. tComfort airflow,values are shown in parenthesis. Comfort airflow is selected when the low-heat rise adjustment switch(SW1-3)is OFF and the comfort/efficiency switch(SW1-4)is ON. #Ductwork must be sized for high-heating CFM within the operational range of ESP. ttOperation within the blank areas of the chart is not recommended because high-heat operation will be above 1.0 ESP. ***All airflow on 110 size furnace are 5%less on side return only installations. 10 DIMENSIONS >I the 6tq �t] 1 �q G py� erw 3 NSAOM M e a �Ej esw �S 413m RfA �F nna 5 P i tyN six LLLJJJ nwq e7A *AMrnw j' e7APaxne *wnorr nvu —�y-+1II ems�p � v t1�aA eAARw I I� nwot,sn. W„1 paA n7aA e foa 0lntt7 "OFCAaaWN mrac�w 197 nw QQQ D= Atw RisMA A q( �Q �na.A n7lB�iWM�B/IM n 0"11771e � 9!w WA DlN 1!lwpeypAe[B1111Y� 1 pp 7►M � A�AIrIIOtII04 L7�71 OId BiAY V1aA N3MM XUIA " r AA 117A �OIM QOIMlE� RL9 +1 — IL OgOlOMPM �Or10 ellT d�'8.T1 I R11 ]ll YA 11.1 plNy1A1 n1�» pNMOA IIVie 1 Riq :I.te W^" atelier Rr.A DYiy RM1Aso� >a oeeq A10270 NOTES: 1.Two additional 7/8-in.(22 mm)diameter holes are located in the top plate. 2.Minimum return-air openings at furnace,based on metal duct.If flex duct is used,see flex duct manufacturer's recommendations for equivalent diameters. a. For 800 CFM-16-in.(406 mm)round or 14 1/2 x 12-in.(368 x 305 mm)rectangle. b. For 1200 CFM-20-in.(508 mm)round or 14 1/2 x 19 1/2-in.(368 x 495 mm)rectangle. c. For 1600 CFM-22-in.(559 mm)round or 14 1/2 x 22 1/16-in.(368 x 560mm)rectangle. d. For airflow requirements above 1800 CFM,see Air Delivery table in Product Data literature for specific use of single side inlets.The use of both side inlets, a combination of 1 side and the bottom,or the bottom only will ensure adequate return air openings for airflow requirements above 1800 CFM. C A B TOP& I D VENT SHIPPING ACCESSORY CABINET OUTLET WIDTH BOTTOM BOTTOM CONNECTION FURNACE SIZE WIDTH IN.(mm) FLUE INLET WIDTH SIZE WT. MEDIA LB(KG) CABINET SIZE IN.(mm) COLLAR IN.(mm) IN.(mm) IN.(mm) IN.(mm) 070-12 14-3/16(360) 12-9116(319) 9-5/16(237) 12-11,16 1322) 4(102) 115(52) 16(4u6) 090-16 17-1/2(445) 15-7/8(403) 11-9/16(294) 16-1/8(410) 4(102) 130(59) 16(406) - ..........._.._..-- — -- - --- ---......... - -----— - 110-20 21(633) 19-3/8(492) 13-5/16(338) 19-1/2(495) 4(102) 155(70) 20(508) 135-22 24-1/2(622) 22-7/8(581) 15-1/16(383) 23(584) 4(102)* 166(75) 24(610) 155-22 24-1/2(622) 22-7/8(681) 15-1/16(383) 23(584) 4(102)* 175(79) 24(610) _. ._........_ ---'- rn--- -- - e-- -- o------------ *135 and 155 sae furnaces require a 5 or 6-in.(127 or 152 m.m)vent. Use a vent adapter between furnace and vent--stack. See Installation Instructions for complete installation requirements. 11 WARNING INSTALLATION FIRE,EXPLOSION, MINIMUM INCHES CLEARANCE TO COMBUSTIBLE CONSTRUCTION ASPHYXIATION HAZARD This forced air furnace is This furnace is approved for equipped for use with natural UPFLOW, DOWNFLOW, and Improper adjustment,alteration,service, gas at altitudes 0- 10,000 ft HORIZONTAL installations. maintenance,or installation can cause (0-3,050m). Clearance arrows serious injury or death. An accessorykit, supplied b �� furnace not change with PP Y � furnace orientation. the manufacturer, shall be used Read and follow instructions and to convert to propane gas use precautions in User's Information Manual or may be required for some BA $ S,oE provided h this and service ttmust be performed b a furnace. Installation natural gas applications. 0K JR�pG� P Y This furnace is for indoor F N� qualified service agency or the gas installation in a building Flo Sep supplier. constructed on site. aE F" This furnace may be installed S 20' "T e A CAUTION on combustible flooring in alcove *o" .b "" or closet at minimum clearance 3 Check entire gas assembly for leaks after as indicated by the diagram lighting this appliance. from combustible material. o. This furnace may be used with t Clearance in inches INSTALLATION a Type B-1 Vent and may be Vent Clearance to combustibles: 1.This furnace must be installed in vented in common with other For Single Wall vents 6 inches(6 po). accordance with the manufacturer's gas fired appliances. For Type B-1 vent type 1 inch(1 po). instructions and local codes. In the absence of local codes,follow the National MINIMUM INCHES CLEARANCE TO Fuel Gas Code ANSI Z223.1 /NFPA54 COMBUSTIBLE CONSTRUCTION or CSA B-149.1 Gas Installation Code. 2.This furnace must be installed so there are DOWNFLOW POSITIONS: provisions for combustion and ventilation air. See manufacturer's installation t Installation on non-combustible floors only. information provided with this appliance. For Installation on combustible flooring only when installed on special base, Part No.KGASB0201ALL or NAHAO1101 SIB,Coil Assembly, OPERATION Part No.CAR,CAP,CNPV,CNRV,END4X,ENW0,WENC,WTNC, This furnace is equipped with manual reset WENW OR WTNW. limit switch(es)in burner compartment to 0 18 inches front clearance required for alcove. protect against overheat conditions that can result from inadequate combustion air * Indicates supply or return sides when furnace is in the horizontal supply or blocked vent conditions. position. Line contact only permissible between lines formed by 1. Do not bypass limit switches. intersections of the Top and two Sides of the furnace jacket, 2. If a limit opens,call a qualo and building joists,studs or framing. condition IIIII�'IIIIIII'IIIIIIIII'II I I' serviceman to correct the condition and reset limit switch. 336996-101 REV.C A10269 ILA 5 I C't' Always Ask For rl� i 1 Use of the AHRICenifiedTM Mark indicates a C manufacturer's participation in the program. For FR T I F\�O verification of certification for individual products. IS0 9001 go to www.ahridirectory.org. GM1-SAI Global 12 TYPICAL WIRING SCHEMATIC ----FIELD 24-VOLT WIRING ----FIELD 115-,208/230-,460-VOLT WIRING FACTORY 24-VOLT WIRING —FACTORY 115-VOLT WIRING NOTE 2 1-STAGE FIVE w C v a c THERMOSTAT FIELD-SUPPLIED WIRE I I I TERMINALS FUSED DISCONNECT THREE-WIRE HEATING- 208/230-OR ONLY I -- --- 460-VOL i i l--I -- --- THREE AABLK 0 i _--___ ___ PHASE -- I C0 I WHT HT -I----------+--I---I I I I -- -- ----- -- .�, -I-----i --- 1208/230- —1— I I L_____ _ __ ___(VOLT __ I --- — 115-VOLT FIELD- JUNCTION nZ J_i ~♦ SINGLE SUPPLIED BOX R -----------i i ! ri i —�cND — PHASE FUSED CONTROL I CONDENSING DISCONNECT BOX O -------------I UNIT 24-VOLT TERMINAL NOTES:1. Connect Y/Y2-terminal as shown for proper operation. BLOCK 2. Some thermostats require a"C"terminal connection as shown. FURNACE 3. If any of the original wire,as supplied,must be replaced,use same type or equivalent wire. A95236 ELECTRICAL DATA OPERATING MAXIMUM UM MAXIM UNIT SIZE VOLTS HERTZ VOLTAGE RANGE MAXIMUM WIRE FUSE MINIMUM PHASE UNIT AMPS LENGTH WIRE GAGE Maximum* Minimum* FT(M)# BKR AMPSt 070-12 115-60-1 127 104 9.0 30(9.1) 15 14 090-16 115-60-1 127 104 9.6 29(8.8) 15 14 110-20 115-60-1 127 104 15.1 29(8.8) 20 12 135-22 115-60-1 127 104 14.9 30(9.1) 20 12 155-22 115-60-1 127 104 15.0 29(8.8) 20 12 Permissible limits of the voltage range at which unit operates satisfactorily. t Time—delay type is recommended. * Length shown is as measured one way along wire path between unit and service panel for maximum 2 percent voltage drop. 13 TYPICAL INSTALLATION CONDENSING UNIT Q HUMIDIFIER 0 pppp +pi�Op ppppq 0 GAS-FIRED ELECTRONIC WATER HEATER AIR CLEANER AIRFLOW C� A10211 14 GUIDE SPECIFICATIONS Gas Furnace Casing 58CVA/CVX Casing shall be of .030 in. (.76 mm) thickness General minimum,pre-painted galvanized steel. SYSTEM DESCRIPTION Two Speed Inducer Motor Two Speed Inducer motor shall be soft mounted to Furnish a Variable speed gas-fired reduce vibration transmission. furnace for use with natural gas or propane (factory Flame Rollout Switch authorized conversion kit required for propane); furnish Flame Rollout Switch shall be factory installed near cold air return plenum. burner area to further reduce the possibility of a stuck gas QUALITY ASSURANCE valve or failed inducer motor. Unit will be designed, tested and constructed to the Heat Exchangers current ANSI Z 21.47/CSA 2.3 design standard for Heat exchangers shall be a 4-Pass 20 gage corrosion gas-fired central furnaces. Unit will be 3rd party certified resistant aluminized steel of fold-and-crimpsectional by CSA to the current ANSI Z 21.47/CSA 2.3 design design when applied operating under negative ressure. standard for gas-fired central furnaces. Controls Unit will carry the CSA Blue Star@ label. Unit efficiency testing will be performed per the current Control shall include a micro-processor based DOE test procedure as listed in the Federal Register. integrated electronic control board with at least 11 service Unit will be certified for capacity and efficiency and troubleshooting codes displayed via enhanced flashing listed in the latest AHRI Consumer's Directory of LED diagnostic light on the control,a self-test feature that Certified Efficiency Ratings. checks all major functions of the furnace within one Unit shall carry the current Federal Trade Commission minute, and a replaceable automotive-type circuit Energy Guide efficiency label. protection fuse. Multiple operational settings available DELIVERY.STORAGE AND HANDLING including separate blower speeds for low heat, high heat, low cooling, high cooling and continuous fan. Continuous Unit shall be shipped as single package only and is fan speed may be adjusted from the thermostat. Cooling stored and handled per unit manufacturer's airflow will be selectable between 350 or 400 CFM per ton recommendations. of air conditioning. Features will also include temporary WARRANTY(for inclusion by specifying engineer) reduced airflow in the cooling mode for improved U.S.only.Warranty certificate available upon request. dehumidification when an Infinity' Control or products Thermidistat- is selected as the thermostat. EQUIPMENT OPERATING CHARACTERISTICS Components shall include:slow-opening two-stage dual Heating Capacity shall be Btuh input; P P g g Btuh output capacity. fuel gas valve to reduce ignition noise, regulate gas flow, Fuel Gas Efficiency shall be 80%AFUE. with electric switch gas shut-off;flame proving sensor,hot Air delivery shall be CFM minimum at surface igniter, dual pressure switch assembly, flame 0.50 In.W.C.external stat►c pressure. rollout switch, ICM blower and two speed inducer Dimensions shall be: depth in. (mm); assembly, 40va transformer; low-voltage (heating) width in; height mm) (casing (heating/cooling)thermostat. only). Height shall be in. (mm) with A/C coil Blower Wheel and ECM Blower Motor and in.(mm)overall with plenum. Galvanized blower wheel shall be centrifugal type, ELECTRICAL REQUIREMENTS statically and dynamically balanced. Blower motor of Electrical supply shall be 115 volts, 60 Hz, variable speed ECM type shall be permanently lubricated single-phase (nominal). Minimum wire size shall with sealed ball bearings, of hp, and supplies be A G; maximum fuse size or circuit breaker delivers requested airflow CFM as efined by signals shall be Amps. received from furnace control. Blower motor shall be SPECIAL FEATURES direct drive and soft mounted to the blower scroll to reduce variation transmission. Refer to section of the product data sheet identifying Filters accessories and descriptions for specific features and Furnace may have reusable-type filters. Filter shall be available enhancements. in.(mm)(x) in.(mm)An accessory high efficiency Media Filter is available as an option. Media Filter. 15 Copyright 2010 Carrier Corp* 7310 W.Morris St.* Indianapolis,IN 46231 Printed in U.S.A. Edition Date: 09/10 Catalog No: 58CV-6PD Manufacturer reserves the right to change,at any time,specifications and designs without notice and without obligations. Replaces: 58CV-5PD 16 � ���'�;��� lil►/►It/i'r9 �' ,rlllj/►(jll �T�► ���Ifl �i1►►1/lull 'i'il'►i'r ;rrl►f/j� , �if�l�ij�u Ir'rlr , )(uo)► 3.='.'N11d 'N11►1. • ;*_ st,r�►1i►1 �4�•IIJ _ irl►;� _.\'i►1111►�r r 1�rl r ; \f y of r' `� • 11•, w y R' C3 • a' NCN 1� W � Ln l�_ '�t Ni <co)sr� tpi UJ co 06 D . O Q o f 3r FAQ t i •': Z W> 4 F� 'ice 1c J �' Uy O+ ;: r WU CL cd � rz„ G O N00 00 V 0 ��. �• L C O S�• i' 67 r •s a. �:�- 1,f 1►lh''(w; '3. a:j/11►11 `•., 5+ 4�'.,�: •r1►1►�' } a'.Su 11►11h...;,�. .'.Ja,{I .Il. . . .S _..3:*ii,• ►I •►•:its. . .,t 3 1 s'•Y ,lli:o 0 2 ,1►/�ll,l 9 ► INIh 1 ►►►►11 ►;�► ► v�1Ni i!� liil� `if. =q :� P am? A 9 fit � Air 'I .< CIA ��ll�l►l1. t T A�� ►//�►Il! f: Ai f�( 1 1 1��1 1 i ^ ��1�I I►1 .t 1 i�N1� _�y�� i N ,., 9 tea! .,•:( � y ?1�k� z i:1� f /} �,SRv {(•' •. y �r%.>� rdrr,tBT.4r rkv tjyi v �r ". �. `•,• � �`�"��� ' h..11 y j,�v,,�{ ' ®'A��,v�1Jr.�`,s�i y, ��Y`.:�v.,�''► �-i,v�r r� ,,�,�L�� k �u� f I CERTIFICATE OF LIABILITY INSURANCE BRUNT 1 DATE(IVWDDMWY 09/14/10 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 Lrax:914-909-5321 INSURERS AFFORDING COVERAGE NAIC9 INSURED INSURER A Excelsior insurance C*mpany Bruni & Ca INSURER B. Peerless insurance Company mpisi Plumbing & Heating Inc.INSURER 'me ■itst Rehabilitation Life 300 Central Avenue INSURER White Plains NY 10606 INSURER E COVERAGES THE POLICES 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 EFFECTIVE POLICY EXPIRAT10M LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYYYY) DATE(MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERALLIABILITY CPP101852710 02/16/10 02/16/11 PREMISES(Eaoccurence) $ 100000 CLAIMS MADE X❑OCCUR MED EXP(Any one person) $5000 X Contractual & PERSONAL B ADV INJURY $ 1000000 X Hold Harmless GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIESPER PRODUCTS-COMP/OPAGG $2000000 POLICY X JEo- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 B X ANY AUTO BA101852710 02/16/10 02/16/11 (Ea accident) ALL OWNED AUTOS 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 EA ACC $ OTHER THAN AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5000000 B X OCCUR CLAIMSMADE CU101852710 02/16/10 02/16/11 AGGREGATE $5000000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION X TORY LIMITS ER AND EMPLOYERS'LIABILITY YIN B ANY PROPRIETORIPARTNER/EXECUTIVE ❑ WC8198741 09/15/10 09/15/11 El EACHACCIDENT $500000 OFFICER/MEMBER NH)EXCLUDED? E.L DISEASE-EA EMPLOYEE $500000 (Mendffiory In NH) If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT 1$500000 OTHER C NY Disability DBL273565 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. 938 King Street AUTHOR ZED RE ESENTATIVjj e Brook NY 10573 ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW Y ORK WORKERS' C0114PENSATION BOARD CERTIFICATE OF NYS NVORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name and address of Insured(I-?se street address only) lb.Business Telephone Number of Insured Bruni &Campisi Plumbing& 914-220-5300 Heating, Inc. He Central Avenue I c.NYS Unemployment Insurance Employer Registration Vbliite Plains,NY 10606 Number of Insured Work Location of Insured (Onh• regr iced if coverage is 1 d.Federal Employer Identification Number of Insured or specifically limited to cet7ain locations in New I"ork State, i.e. a Social Security Number by icup-L'p Policy) 2.Name and address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Village of Rye Brook Peerless Insurance Company Building Dept. 938 Ding Street 3b.Policy Number of entity listed in boa"In": Rye Brook NY 10573 WC8198741 3c. Policy effective period: 09,15.110 to 09.,1.5,111 3d. The Proprietor,Partners or Executive Officers are: ❑ included. (Only check box if all partners!officers included) ❑:III excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Connpensation'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". The Insurance Carrier will also notifi,the above certificate holder within 10 days IFa policy is canceled due to norrpcnmrentof premiums or within:30 days IF there are reasons other than nonpcnmrent of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices map be sent by regular mail.) Other►ise.this C'e?ificate is valid for a ma imunt of one year after this form is apprm•ed 1r the insurance carrier or its licensed agent,or until the polio,expiration date listed in box'VC",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. Linder 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 John M Glover Agency (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _ 5v'i' September 14 2010 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 914-909-5320 C-105.2(9-07)