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HomeMy WebLinkAboutMP11-047 R 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.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 16,2024 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 112 South Ridge Street,Rye Brook,New York 10573 Parcel ID#: 141.27-1-6 This document certifies that the work done under Mechanical Permit#11-047 issued on 11/17/2011 for the installation of a new rooftop HVAC unit has been satisfactorily completed. Sincerely, Steven E.Fews Building&Fire Inspector /to O 2� BR cu � 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 : I 12— DATE: 1 Z Z CAL PERMIT# 'M C I ` - Q' ISSUED: 1/-/ '- // SECT: J411. Z-7 BLOCK: LOT:_�� LOCATION: 130 OCCUPANCY: ❑ Violation Noted THE WORK IS... Ef PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 15 P C7 Oq \l '%i ❑ L.P. Gas W k —c k ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION [-•FINAL ❑ OTHER 9z O = M O z �.� OC) C) m '91 r-kr) kr)00 0-0 O Z �'" °� � � z � w V bf 00 w Q � °�' C—' �, a0 � 3 M V : OC7Ho � w w � Z � � _ 3 cn a*, Q >: < o) o Q N w a a w _ ITT P4 z C) � a0 a � � z z O H � o Z z � A � � °� z � p�gA kr) Aw -ot o � d a V U V a w A w � � w O a � w W A � � � w VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET,RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 www.ryebrook.ort! APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT Permit#: Building Inspector: 1 -7 J Fee Paid: 7_' -, Date of Approval: k l (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. Site Address: aS, L�, 2. Property Owner:: b,) ,j�yQ Oq� y Phone#: nd t-{aQ S� 3. Parcel I.D #: I Lk I • 2 — [, L Zone: Ct 4. Contractor: p fey -�C p p Phone#: 5. Contractor Address: �) ` v 94 Fax: 6. Scope of Work: Install � Remove 7. Type of Equipment: l C�IJ PP<,LN9 c U ty► 8. Location of Equipment: �� p Signature of Applicant: Date: 1 !� Printed Name of Applicant: `Scj�Au Ricer W Phone#: CURBS & WEIGHTS DIMENSIONS - CHASSIS 2 dJ JIB +( NOTES: 0761 1. DIMENSIDNS ARE IN INCHES,DIMENSIONS IN ( ) ARE IN MILLIMETERS. to 3/4 ECONOMIZER IONAR MOOD l5271 2. � CENTER OF GRAVITY IOPTIONALI l 3. DIRECTION OF AIR FLOW ——— —E 1e (925 lz-sf6 9251 1J211 RETURN AIR IT U RN AIR C - -•�!/ E AL I JI[•(" DRAIN OPENING7— COWDEN IN 6ASEP AN 26-374 I7311 J1-518 40-1/6 y /� • Y SUPPLY (95S1 11027) `([,J,y,1v,1•//1 X SEC IIIRU AIR F-- Y THE BASF SUPPLY IB I6 2 CfIA RI AIR (1691 14121 14 [3551 IZ791 175 S 16 IID01 Lill,DID 3-1r4 1159i ld (8l1 H (356) 4• TOP n181161 25-1/2 - 16471 /—ELECTRICAL - DISCONNECT CON IAOL 801 CONDENSER 9, LOCATION ACCESS PANIL COIL G J�] OPTIONAL ® INDOOR DE OYCR OPT I OYAL ",+{f FACTORY 4C CCSS FACTORY 27-7/e INSIALLED (DYYEY][NC( IYSTALLCD 1709) DI SC DYN[T.T OUiIEI C� C �HANDLE 6-SIB HANDLE—�� - T� 11681 3 J!f 00 00 195) 59-112 2 5r6 (1510) (6 T1 8-3/e J7 (2141 LEFT CURB WIDTH ee-fr6 -- �71e . S 7•-- 1 FRONT (22381 IJ u21 n !� ufrl FILTER ACCESS PANEL 1LTIR (TOOL-LESS) DR AIN t s7o COwO[AAlu ' CONDENSER u COIL ' RuueN "IA INDOOR COIL i J.r6 ii°e i4 0111 IDE ACCESS PANEL I J141 SUPPLY AI 26 16591 f1/8 (IS1) An fsre 1 - 11.71 11/71 f 1r6 n-ve nssl BACK nfn 4r 3/e THRU-THE-BASE CHART SliT 11oTsi eAea[Tntc THESE HOLES REQUIRED FOR USE AIR 4EIUAN RELIEF CRBTNPWR002A01, 00001 RIGHT All nrn COWDUITDED SI SIZEU USESIZES (MAX.) UNIT J K N WUpPL, ONNECTION SIZES W 1/2' 2.2) 48TC-A08 dt 1/4 33 IS 1/8 X 1/2' .21 110481 [6581 (403) A 7 3/85] FIELD POWCA SUPPLY HOLE 49 3/8 37 1/4 23 7/8 B 2 112IA POTTER SUPPLY KNOCKOUT Y 1 114. 1002,00444.4) 48TC-A09 (12531 [946) I6001 (►Ar �"2 n,e TOOU J/4' FPTN' T1.31 /9 3/8 31 114 15 7/8 /7 Fy�/ C 1 3111] GAUGE ACCESS PLUG 48TC-Al (1253] [946] (403] .lf'wMA/•l� FOR 'THRU-THE-BASEPAN' FACTORY OPTION, D 7/0' FIELD CONTROL WIRING HOLE FITTINGS FOR ONLY X. Y, 4 2 ARE PROVIDED a 48TC-DOB E 33 15 7/5 E 3/4'-1NDENSATE DRAIN FOR HEAT SIZES 'D' a 'S' - A FIELD 16581 [4031 f SUPPLIED 112' ADAPTER IS REQUIRED 37 1/4 15 718 F 1/2'-1AS CONNECTION BETWEEN BASE PAN FITTING AND GAS VALVE. 48TC-D72 (946] [403] 3/4'-1AS CONNECTION (; 2 ' DIOWER SUPPLY KNOCK-OUT Ye (662) PROVIDES 3/4' FPT THRU CURB FLANGE a FITTING- FOR TWO STAGE COOLING MODELS WITH Y NOVATION CONDENSER COILS. Fig.6- Dimensions 48TC 68-12 CO8519 18 Base unit dimensions — 48DJO129014 FILTER ACCE`;.S DOOR (DISPOSABLE FILTERSI UNIT ECONOMRER CDRNE AWEIGHT CORNER WEIGHT STD UNIT WEIGHT ON MIT 0•-4_ IBI 0'-7 5/I6-- (IOII LEIS KG LBS. KG. L85 KG 1J19J I µ 20 225 102 L1[Iasi2%46/ B OS/B_ 4BOJE/pJD 03b 4g9012 1 1321) 40DJDO14 1050 476 44 20 22B 103 195 88 �11 T IUNIT CORNER WEIGHT CORNER WEIGHTRETinACCE550RY IC) IDI AIR II T-03/B" H000 F11 TFR JSKG LRS KG. A- OPENING' 19241DJE/GJDO72 )29NTALI 33151 2'-10 7/B" BB5 4BDJl 314 131 338 163 1'- 2 7/B' 378 - --_ SUPPLY AIR I OPENING ( 2'-1 7/B- 13621 II (HORIZONT.LI — 16571 i )1 _—r ' _= 7�TSTDE�7ITTa- X-1 1/0" 0'-G I/8- O'J 16/16" 1943{ IIS6) 11251 o•- e7/le As. I I67 01 SUPPLY AIR RETLON AIR E STD. CONDENSATE DRAIN V-11 1/2- 19021 0'-3 9/16- 1901 OUTSIDE AIR97 Censer of Gravity FILTER/ECONOMIZER ACCESS PANEL 1•-5 7/B' CONDENSER C011. ECONOMIZER HOOD E4541 Diroction of Airflow CDRfFR 'A- 3'-0 3/0- 0'-3 1/8' _ 19241 179J NOTES: ______ __--� CORNER "0- 1 Dimensions In are h mOlime:Rrs -------_ _Nr _( ) i o'-S v2' 2 Minimum clearance to combustibles: I EYAPORAlOA I 1 --t 11401 ,B in flue tide,ZCTo h all Other!ides II RETURN Al.OPENING • COIL I ) 1 1'-0 5/B' /�0 3 Minimum clearance from condenser coil for proper pn,-9j, h I IUERTIGL 1 13201 `(��/ alrflow.36in.opposito one side of coi l 2 in opposilo �"'�''Y/ i1 -� RETURH AIR other side of call(optional an to whlch side);00 In R -•--------- overhead E�---="�_ , 4'-9 3/4- AL1. COIIOENSATE I-=__ 4 Minimum recOmmendDd clearance far sOrvlca:48 in (14671 GRAIN OPENING I 1 O'�659/16- all nverlsides:60In avertiohand IN BASEPAH 1 6UIN'Lr 5 On vertical app!IGltions.ductwork to be attached to 3/4' 2'-, I accessory roof curb only 0 I GP AIR AIR I 17301 1 (VERTICAL) I I ELL!{i/CONLNECTIOrI 512E5 169051 _ I I SUPPLY AIR A 13/B DIA, f35) FIELD POWER SUPPLY NRAE 0"-2 15/1 0--4 II6 B 2 I/2 DfA (611 POWER SUPPLY KNOCK-OUT (75) 11 (1 t9)/1 C1 13/4-DIA 1441 CHARGING PORT HOLE —urO--S 7/I5 " D 7/B- DIA. (22) FIELD CONTROL MIRING HOLE CORNER -D- 2'-I1 1/4- I -2- f138] E 3/4 -14 NPT CONDENSATE GRAIN (B95) - I I—� 1355) 0'-3 1/B"" F 3/4-14 NPT GA5 CDMNIECT ID<1 3'-1 I/,' —J CORNER "C" (1022 41 '-B 3/i6 (79] G 2 DIA [51] POWER SUPPLY KNDCK-OuT r20B) 7'-3 3/B" 12213) MOUNT DISCONNECT HERE \ H 0-7 3/6' • O'-D 3/9' (I B71 1101 -- 0'-3 13/16- (971 i 0 1 A G J2'-9' � ,,gyp, LDIICE4SER FLUE HCOJ CONTROL Box/ (MI O30) INDOOR FAN MOTOR H I COIL / COME550n/ NE ® BLOWER ACCESS PAL 4'-0 112- i BURNER ACCESS (12321 3'-B' 2'-B Val' PANEL IB) [8727 I L ` 0 0.4" --e 1101) (95) ILL .II 0'-5 3/4" (8211 FORK TRUCK SLOTS • 4'-6- (t,61 O'-2"TYP 113721 0'-7 7/16"IS 11 [1891 (TYP B PLACES) 10 Performance Summary For 10 ton Project: -Untitledl 11/07/2011 Prepared By: 10:50AM Part Number:48TCED12A2A5-OAOAO ARIEER:............................................................................................ 11.10 IEER: ................................................................................................... 11.8 Base Unit Weight:................................................................................. 940 lb Base Unit Dimensions UnitLength:......................................................................................88.1 in UnitWidth:.......................................................................................59.5 in UnitHeight:......................................................................................49.4 in Unit Voltage-Phase-Hertz:............................................................208-3-60 Air Discharge: ................................................................................Vertical FanDrive Type: ....................................................................................Belt Actual Airflow:.....................................................................................3200 CFM SiteAltitude:..............................................................................................0 ft Cooling Performance Condenser Entering Air DB:.............................................................95.0 F Evaporator Entering Air DB:.............................................................80.0 F Evaporator Entering Air WB:............................................................67.0 F Entering Air Enthalpy: .................................................................... 31.44 BTU/Ib Evaporator Leaving Air DB:.............................................................. 55.2 F Evaporator Leaving Air WB:............................................................. 54.9 F Evaporator Leaving Air Enthalpy:................................................... 23.12 BTU/Ib Gross Cooling Capacity: .............................................................. 119.72 MBH Gross Sensible Capacity:...............................................................85.84 MBH Compressor Power Input: ................................................................8.80 kW Coil Bypass Factor:........................................................................0.033 Heating Performance HeatingAirflow:............................................................................... 3200 CFM Entering Air Temp:........................................................................... 70.0 F Leaving Air Temp:.......................................................................... 123.1 F Gas Input Capacity: ............................................................180.0/224.0 MBH Gas Heating Capacity:................................................................. 183.68 MBH TemperatureRise: ........................................................................... 53.1 F NOTE:.... .........................................................................Second Stage Supply Fan External Static Pressure:.................................................................. 1.00 in wg FanRPM:.......................................................................................... 902 FanPower:................................................................................. ..._ 1.75 BHP NOTE:.........................I.............Selected IFM RPM Range: 838 - 1084 Electrical Data Minimum Voltage:............................................................................. 187 MaximumVoltage:............................................................................ 253 Compressor#1 RLA: ....................................................................... 15.6 Compressor#1 LRA: ........................................................................ 110 Compressor#2 RLA: ....................................................................... 15.9 Compressor#2 LRA: ........................................................................ 110 Outdoor Fan Motor Qty:....................................................................... 2 Outdoor Fan FLA(ea):....................................................................... 1.5 Indoor Fan Motor Type:...................................................................MED Indoor Fan Motor FLA:........................................................................ 10 Combustion Fan Motor FLA(ea):.....................................................0.48 PowerSupply MCA:.........................................................................48.5 Power Supply MOCP (Fuse or HACR): .............................................. 60 Min. Unit Disconnect FLA:................................................................... 51 Packaged Rooftop Builder 1.291 Page 1 of 2 ' Performance Summary For 10 ton Project: -Untitledl 11/07/2011 Prepared By: 10:50AM Min. Unit Disconnect LRA:........................................................... .... 301 Electrical Convenience Outlet:...... ....._............... ... ._._..._.. None Acoustics Sound Power Levels, db re 1 OE-12 Watts Discharge Inlet Outdoor 63 Hz 97.5 94.6 89.0 125 Hz 92.1 85.9 83.1 250 Hz 77.5 70.9 80.5 500 Hz 71.0 65.7 78.5 1000 Hz 67.0 63.2 75.5 2000 Hz 65.1 58.6 71.6 4000 Hz 67.9 58.4 69.6 8000 Hz 69.3 57.4 69.3 A-Weighted 79.6 73.8 82.0 Fan Curve 2.0 1200 M 1300 RP 1.8 1.6 1 PM _1.4 rn 3 c 1.2 0) N 1.0 N N D_ U 0.8 0.6 0.4 400 R 3.00 B 0.2 2.0%.. 0. 8HP 0. BHP 1. HP 1.50 8 0.0 0.0 0.6 1.2 1.8 2.4 3.0 3.6 4.2 4.0 5.4 Airflow(CFM-thousands) RPM=902 BHP= 1.75 Maximum RPM= 1084 Maximum HP=4.70 Note:Please contact application engineering for selections outside the shaded region. SC-System Curve RP-Rated Point Packaged Rooftop Builder 1.291 Page 2 of 2 E t i B i t i W z H 88 a OOO z c U 04 U LT" Q w Q o r vt k w u U xi a cW7 0 • OOP z .I N ~ � i o Ao 0-4 a � z *41 401 AO, 9z, w *4 �-Ol 0-01 ��l Qw� wr� HazU � W � �I D � . ��, BUILDING DEPARTMENT 4 ' VILLAGE OF RYE BROOK �� 938 KING STREET RYE BROOK,NY 10573 VI`LE�(,E O� R BEY ROOK (914)939-0668x(914)939-5801 1 uiti[�INc � �'- - ---: www.ryebrook.org 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 O 1 Date: t� 2 , < < Approval Signature: z' Inspection Agency: kAJ Electrical Permit#: Fees: paid ((rdue O mg Permit#: ++xaaxwxwx+xr+w++aw++aaw+a+aa+xa++aaa++xrwrrr+wa+rw+:aa+aaaxa,r+++r+axarxxxraxxr:w+rxwwwww++++waaa+w+awwwxwrwrwxawarwrw+w+aaawwwrwwwww+w+x+ 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: 1 4V S 4. Phone#: Owner: W',Qe- iZ�dt~p_ Z e_ts, -1 j . Address&Phone: Use/Occupancy:I�Xc-p_ a z D�.�a r ci Parcel I.D.#: + y 1 e oZ 7 - /_6 Zone: Pd Electrical Work: `N TC Z _ f-Dz T .r LICENSED ELECTRICIAN'S INFORMATION: / Name(Please Print): 'DFk ��a �"� c(lr o�. Phone# q y ' ,?Q3•'3/03 Signature: )' A� Westchester County License#: -Z2 Company Name:�)A/V A A Q � �P-- -A T '% Company Address: Pp golf 14 r\ n City/Town: SC.(NJ-%flyk (Q.- State: Zip Code: 10593 Phone#: "� Y 7d S- /730 Field Cont Phone: ��/ 7,03 ' !R/0 9 . Revised 9/6/11 .. -,a[.--?Air-.�aa�:�:-::I... "_ alili�.�...r..J�..7�►T�L..w+.. Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347-3595 DO N6T WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BLI 1 G PERMIT TEMP# DATE CIO VILLAGE ZIP CODE TOWNSHIP COUNTY /O Q tS STREET A S NO.OR ROAD POLE NUMBER / it et BETWEEN WHAT TWO CROSS STREETS IS PREMISES L CATED7 SECTION BLOCK LOT \4 7 OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADD SS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY --TRWTKEIR 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 7-FL. 3-FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: V O �� Iw` JO III Q S FA (� S 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 /v— , CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED , CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND'S AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COOM`PA,NY DATE OF APPLICATION SIGNATURE OF APPLICANT i ADDRESS TELEPHONE NO. 9/y— V J CRY OR POST OFFICE ( ZIP C E` LICENSE NO.WHEN APPLICABLE . J BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 Office 914-347-3596 Fax CERTIFIES THAT Upon the application of: Upon premises owned by: DanMar Electric (E) - Dan Margiotla Win Ridge Realty Ace Hardware - P O Box 122H 112 South Ridge Street Scarsdale, NY 10583 Rye Brook, NY 10573 Located at: 112 South Ridge Street, Rye Brook, NY 10573 Application Number: 2020573 Certificate Number: 2020573 Section: 141,27 Block: 1 Lot: 6 BDC: 003 Permit Number: EP11-206/11-047 A visual inspection of the electrical system at this premise described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 112 South Ridge Street, Rye Brook, NY 10573 Outside was inspected in accordance with the NYS and NFPA 70-02 and the detail of the installation, as set forth below, was found to be in compliance therewith on the 28 Day of November 2011. Name Date QuantitN hating Circuit Type Disconnect Switch I This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work preformed before date of inspection only. sfellin 2 Thursday,December 01,2011 Page 1 of I a s a 6 a = N M A 00 oo a oQ � Q oa _ � � p�q ¢ o ►_--� w z � z � O s Q M W � wcvw wz wz � A o PLO � wwx ww zxOQ, BUILD NG`DEPikRTMENT VILL�E OF RYE HROOK 938 K1N�,`§,TnET RYE Blzt� - ,NY 10573 (914) 93A ;449\1. )939-5801 wwwlnyook.org PLUMBING PERMIT APPLICATION *MUST BE FILED B Y A LICENSED MASTER PL UMBER ONL Y* Date: I Plumbing Permit#: I Fee: Approval Signature: (fees are non-refundable) 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: �(�� �"?S- J 1 - hone#: Owner: W i rin A-'LI�g- 'zet 'hj Address & Phone: � am Use/Occupancy: Parcel I.D.#: Zone: LICENSED MASTER PLUMBER'S INFORMATION: f �j G Name(please pri SI�U� ,' �;11 O Phone#: �� t! - % "! �'?� Signature: ` Westchester County License#: Company ame: ,��-5 �� min.-AY-1- 17 n Company Address: 2 if N�, 1'wk Give City//Town: CCAr 5 ic-,t� State: _Zip Code: /05'F3 Phone#: g ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ 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 l st Floor 2nd Floor Outside j *Other: Detailed Description of Appliances etc...: ge -Coff) r I -0 ait, 11/18/2011 15:47 9149376023 PAGE 06/06 �-�ACCORD® CERTIFICATE OF LIABILITY INSURANCE11/18/2011 DATE(MMIDOIYYYYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C1 1:71FICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFF: iDED BY THE POLICIES BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING P,5URE:R(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the Pollcy(les)must be endorsed. H SUBROGAT I' N IS WANED, subject to the terms and Conditions of the policy,certain Policies may require an endorsement. A statement on this certificated i I:&not Confer rights to the Certificate holder in)feu of such endorsements. PRooucEa COI11NTA Brian Gallagher SNC Insurance Agency, Inc. PHONE (g14)937_1230 -aX Ill South Ridge St. B.MAIL 191a)937-212d .bgallagher@bncagency.com Rye Brook NY 10573 INSURE $ AFFORDING COVERAGE NAICN INSUREP INSURERA:Nat.i.onal Gran, a Mutual ns 14788 Alex Heating s Cooling Lt1tC INSURER B: - - 73 Rolling Way INBURER C: -.. INSURER D: New Rochelle NY 10804 INSURER E:ER P • - COVERAGES CERTIFICATE NI,IMBER:CL11111847220 REVISION NUI 1'3ER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABQ1 E I-OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT! RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU! ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TR TYPE OF INSURANCE A O POLI NUMBPJ! POLICY EPF POLICY EXP LIMITS GENERAL LIABILITY IMMIDONMI .,EACH OCCURREN s 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA tN !I E S 00 OQQ K6EN'L CLAIMS•MADE X OCCUR X 881B7 /2/2011 /2/2012 MED EXP one t1 anon S 10,000 PERSONAL d AOV PI•IIRY $ 11000,000 GENERAL AGGRIE o,r. S 2,000,000 REGATE LIMIT APPUES PER - Y X PRO- 71 LOC PRODUCTS-COMI l;F>AGG $ 2,000,000 AUTOMOBfLE I,IgBILITY COMBINED BINGLE I.MIi S ANY At ITO ALL OWNED SCHEDULED BODILY INJURY(Pt• E.reon) S AUTOS AUTOS BODILY INJURY IPt• celdml) S HIRED ALfT06 NON-OWNED _ AUTOS PROPERTY OPERTY DAMAC[* S UMBRELLA LrAQ a OCCUR "' EXCESS LIAS EACH OCCURRENT F Z CL UMS-MADE ` AGGREGATE $ D 0 RETEN ON S •-- WORKERS COMPENSATION _ 4 AND EMPLOYERS LIABILITY fLEL OTH- ANY OFFIC RIMEMBEOR EXCLUDED?ECUTIVE El NIA T S (Mandatory In NN) _ tl y98.Oenrft under %I°'OYE S EBCRIPTION OF OPERATIONS eptov LIMIT $ DESCRIPTION OF OPERATIONS t LOCATIONS I VENICLES(AtlaeA ACORD 101,Additional Remarlu SotledUle,H more eySce IS r Cr) Agreement. s an additional insured The Certificate Holder is listed a when required under written _ )ntract or CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICII = HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE 1,II-L E3E DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 Tong St. Rye Brook, NY 10570 AUTHORIZED RE?PRE$ENTATW - 0 CO1abells/JMAD20 � ACORD 25(2010/05) ® N. INS025 t201oosl of All 1988-2010 ACORD CORPORA"I ;ot The ACORD name and 1 rights reserved. ogo titre registered marks of AC 11/18/2011 15:47 9149376023 PAGE 02/06 STATE OF NEW YORK WORKERS'COMPENSATION 1130ARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE CO I.IERAGE Ia. Legal Name& Address of Insured(Use street address only) lb.Business Telephone Number of I r.,;ured Alex Heating &Cooling LLC (914)637-0077 73 Rolling Way New Rochelle NY 10804 1c.NYS Unemployment Insurance I•i iployer Registration Number of Insured Work Location of insured(Only required if coverage isspecifically 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) 208341068 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) National Grange Mutual Ins ViApge of Rye Brook 3b.Policy Number of entity listed in 1 tax"I a" 938 King St. WCV88187 Rye Brri NY 10570 3c. Policy effective period 06/02/2011 -06/02/2012 3d. The Proprietor,Partners or Ex, tltive Officers are E included. (Only check ham if all p ii tners/ntFcery ioclnded) X all excluded or certain parts i -s/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above i,, box "la" for workers' compensation under the New York State Workers'Compensation Law,(To use this form,New York(NY)must tie listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or it; icensed agent will send this Certificate of insurance to the entity listed above as the certificate holder in box"2". The insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to,+;npayment of premiums or within 30 days IC there are reasons other than nonpayment of premiums that cancel the policy or elimin: e the insured,from the coverage indicated on(his Certificate, (These notices nta))be sent by regular mail.) Otherwise,this Certificate.s valid for one year after lh is form fs approved hV the insurance carrier or its licensed agent,or until fire polfcy expiration date listed ii 'tax 113c",whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the t a ainess continues to be named on a permit,license or contract issued by a certificate bolder,the business must provide that certil i i ate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complyi 1 ;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 insur,i i tie carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: _Onofrio A.Colabella (Print name of authorized representative or licensed agent of insurance cam r) Approved by: ignature) (Date) Title: V.P. Telephone Number of authorized representative or licensed agent of insurance carrier: 91 4-937-1230 _ Please Note: Only insurance carriers and their licensed agents are authoriF;ed to issue Form C-105.2, Inst, race brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.nv.us Workers' Compensation Law