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Home My WebLink AboutMP13-125 tO 19 ,� 4t' anniumaW 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 Michael J. Izzo Stephanie J.Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 6,2022 Yuzo Kura&Fumiko Kura 48 Talcott Road Rye Brook,New York 10573 Re: 48 Talcott Road, Rye Brook,New York 10573 Parcel ID#: 135.50-1-13 This document certifies that the work done under Mechanical Permit#13-125 issued on 10/21/2013 for the installation of a new warm air furnace has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �yE BRC�k. O� 2� 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: ( � ` V V �� DATE: V v PERMIT# ' ISSUED: �` SECT: , BLOCK: LOT Cy( ' ) ` C � _2- ku ��LOCATION: n� m OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... [3 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING l� ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER r k 'IN 6 2022 t �E 4RX . O� 2m 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 - - - - - - - - - - - - - - - - - - - - Y �\ ADDRESS : ( DATE: I U 1 �_ l i ; PERMIT# ISSUED: 'uI�t` SECT: BLOCK: LOT: LU ( ; . LOCATION: trA 0--� C a- (- Lr�`J�� 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 ` ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Ln e E N h b F c x w -o r!; w a C '" u W ' W a° ' E o a .CC M o � an'° ° ti � �' • MCI w CU O C a �° w e a i° c W a A mo Z o E� - W zZ N CQ� Q E" n o.•C' M w � 9 E `o •� .a A � 0� cCO 0 T c z v� oFay w z o V o � .. A v� C, i..1 Z p U d o c00 a Ln z a. ONOo O U U "or 0- x Z a W O Q yob c •• � � E.r ^� O W W o a o •= �I = 0.0 U 0'a 0.( .� w � � F C E m VILLAGE OF RYE BROOK Q BUILDING DEPARTMENT J ; 938 KING STREET,RYE BROOK,NY 10573' CT 10 1013 .3 -0668 FAX(914)9-9-5801 www.rvebrook.orsl-A--- -- - _. _. j OOK GEOFA _ OK � J(914)9 RYE _ 13UILDING Dt� ryE NT APPLICATION TO INSTALL AND/OR REMOVE FUEL BURNER, BOILER OR HOT WATER HEATER Permit#: r I 13- l a5 Building Inspector: Fee Paid: Date of Approval: OCT 7013 (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: $75 per unit. 4. Inspection by Building Department for removal and/or installation. 5. Certificate of Compliance will be provided when all requirements are fulfilled. 6. Any electrical work requires an Electrical Permit and Electrical Inspection. 7. Any gas/plumbing work requires a Plumbing Permit and Plumbing Inspection. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the installation and or removal of the equipment as listed below.The applicant,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local, County, State & Federal laws, codes, rules and regulations. 1. Property Owner's Name: fum,Kb kv✓4 Phone#: 9iy_q3 y- �S2o 2. Job Address: z/eTr�lcal` id 3✓"'le &y/ Phone#: 3. Parcel I.D #: Zone: 4. Contractor:�,�{ 8,,� J�yo% (� 1,.� Phone#: ��y-yi•�yz3 5. Contractor Address: gA4 lti/olei' SFr 6,"sG/c , dA Fax: 6. Scope of Work: Install M,; Remove ❑; - Fuel Burner ❑; Boiler CJ; Water Heater ❑ 7. Type of Equipment & Fuel: 7k,pene ide 14jA vm, ,6 , fy✓/✓",e_ 8. Location of Equipment: ydr 7so/�irf�-��l �,y./ .p /V, S/ Signature of Applicant: /n� Date: /0%y13 Printed Name of Applicant: 614we f A1A*e1'a/ Phone#: 91y_,93S- ;1 y7.3 r ' ;•.v,.;{• v•:...•.•}'f»tt?..:v;.::..:}:" v>v'Li+ •.:>"t::•.:i:.::::.�v":w::x ................................ .. ................ .. Yn.4 v....ti.2•m:i:24}: n.n 2x.A.?ii T:•%.::;:.i:.y:.. .2 n. ..... .O. , �'YiT:2•:5+,•ii:SC•:�:+:Ti:i•:i:....+ 4'?�: ::. :C�# 2 :Yq•x 4': fS:' '':Y ;'<'.v,.;22:>:"•C+:<O.?".To`.%+;2;5<`C"i DATE(MMIDD/YV) KT to" +•$ •n" •.:;>, +f•• :ii NAP - ,+•.•. '4t#?:i!•;;x•`,:{u::::v�a:4Tx.••;:.:Ys.Y ACORD fir(' n t . ilY•> ntJr:.:;2.a}:.:Ga:'•Y::::::2 » ...A....... ..:h..v.......4.... .. :............................. ..... ...�:. ...N.; ...,... •:;•.x:., .,..+n.. +f•t w{:.} n,.H,.. 06 01112 :.:.4 ...:. ,xvYam.. .:.} .,{...,,,nnr+ }: n.•x.•...x....,..... ._. __....::...}. .......:n..:.,.,..,....:n•:gin•::.t.....r..n.•..t Rn.,:....,..4h.s,.,.p....,...:..v....,.... .....:.>:::x�a:...,::;;:x:.<,..::.};:y: PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.O. Box 328 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Owatonna, MN 55060 —COMPANIES AFFORDING COVERAGE Phone: 1-888 333-a9a9 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR A FEDERATED SERVICE INSURANCE COMPANY --- - _-- -._. -.._----------- ------- ------------------- INSURED WESTMORE FUEL COMPANY 330-130-6 COMPANY INCORPORATED a — ---------------------------- 86 NORTH WATER STREET COMPANY GREENWICH CT 06830 C COMPANY D a{•%,:::c.:b••2>•::��:•:.2:�:::Y:�'�;':;.;:::.r'•;::�.r::}:/•.;,::}:;�o:::�:. C?Q.' p uoa•2 [ :4.':f. 'x .2.: '.�e•tv:ji1":%TSv?{C}:S'ii'!:�:i�:<,'.;�:v:��'%<�:?:t�:i:�:;::j; 2;::::�:':::�:..5.?:•n..).......................:i........:. � ....:.: is4'r:"Y.•.n.;}S:•i?ai:�ii:{�}i:T;•;.:2.:}::(. %.}:4%•fi:'f.<4Y....n.1.:...•:S.:4$W..f .. X%:Y ,.. ... :,•..:..,.,:.:h•.yv.:},. .....,. ,..:. ... 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDIYY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE— b 2000000 X COMMERCIAL GENERAL LIABILITY PRODUCTS•COMP/OP A_G_G b 2,000,000 A CLAIMS MADE [X]OCCUR 9062815 06/01/1 2 06/01/1 3 PERSONAL 6 ADV INJURY b 1 000 000 OWNER'S 6 CONTRACTOR'S PROT EACH OCCURRENCE b 1,000�000 _ FIRE DAMAGE(Anyone fire) b 100J000._ MED EXP(Any one person) b AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT b 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY b A _ SCHEDULED AUTOS 9062815 06/01/1 2 06/01/13 (Per person) X HIRED AUTOS ----.— .---'-'----------- BODILY INJURY b X NON-OWNED AUTOS (Per aoa(Cent) PROPERTY DAMAGE b GARAGE LIABILITY AUTO ONLY•EA ACCIDENT b ANY AUTO OTHER THAN AUTO ONLY: — EACH ACCIDENT b AGGREGATE b EXCESS LIABILITY EACH OCCURRENCE $1 0 000 000 A N UMBRELLA FORM 9062816 06/01/12 06/01/13 AGGREGATE $1 O OQQ,OOO_— OTHER THAN UMBRELLA FORM b WC STATU- OT WORKERS COMPENSATION AND H. _ T I EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE,POLICY LIMIT b �` PARTNERS/EXECUTIVE ------ - OFFICERS ARE: EXCL EL DISEASE•EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS :..?.0 S•::.}a:::'.i:2:::•?T?::::•T'c•'••:':r:?"•>;�:ct::;::;:;;::::2:'1:`:::::::::c:2:t:}22::::2:;:2:�Y2::,y�;,:;::::.��{...y�.�•.�::.;�::.:::::o}:<•a>}:;ai}:5.1>:c'a:�?:.1:�1:•::�::.:x:�::>:�5:�:S:.S:o»:o:.1T:c1:11:0>1:.:�:2•>:.:�S:..T:�T}T:{•T:.:T:•?:•:{c22•'{<t:'!.a:: 2p:n u.y:. E � N?G tD• � :f3LlD��t�= 4::GA 6�l�Atrbrit>::::>:; :»>: :>::>::>::»>:z#:><<::##:::>x2a:<;:>s:;:,>.:;;»:;::rs>#f:;:at::z::e1!;:^::;;>>>.;>::r�>-<>s<<# ... .: ...........:.1.... „):h,v.a.t:...:an,.n,•.•..rxn....wr..•n:n.,..............nxn...n,.G,n .................... ...;a:.:................:.:1:is}.:T:::}i:•i�'.S::ri:::.S:v::�1}1:.�.>':::::::.:1:.;..1'2.:::::<4T:h':.:< :S�Si:C::i:�:::1i:i{v1}i.�:::1:.i:.}.vn:riL5:2::iJ:v'�Yii:•i:• 330I306 VILLAGE OF RYE BROOK 38 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 938 KING ST EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL RYE BROOK NY 10573 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. . AUTHORIZED REPRESENTATIVE ..:::..,•::::,.::::::•::�.,:::::.�:::.::.::..:.....::..:,:...:.,::. Win•::;.,.,,.•;•::•::..... .. ..::::.::..•.:::.::•:.:::.,...::::...::.,.... :..... ..P.9ESIDEMT........ .,}:.,+.,..>.1...:w>..n....:...,..,.... T...2.:.,. .:p:.:n•Ynv,: .{. nl. ... , .: .:.�.: ..:•. s .......{h,:{.::J:{vY.•:J:•?T:!v..{,.}:::•:::::�:^.:}:.;n.},.;........ ,,•,.:nip... �.i::. .... ..........p.'2.�:i:.:'Y:{•'.'{:nY.:+},;::�}:}v::.:':.::::'.�:::.:'{:.:.- �( ..;S.n::::�:M•nvnr:::w:::::•:::::••v:•:••.v ........... K. +' ,1:{,•}:•.tt{4;;}}Xp:tt:p}}:{{2::}t•::::::::;•}:.T:.::.tv:.,v:}:.v„•.2:•.•..2•::::•..n..vv.�!:v::::?}:2:.i:':•hv.n<................. :v.:. .:t:vi:2ii:::•'v+:•1?:::.+.{<;Y'i:: . ...i... ...5.:... w} ... {{tp};::•i:•Y t::::{•};:::.�.1'::'4i:p;{•}Yi{aT:4'v w:.:n........................•i %.:11»T:::.::::::::::::::.vn:•::::..•:}:.}':..::.:^:::•YTT::+.SpaaT:oai:ii:par+:;:td•?: t...........................................................{:...2...,......:..............,...,.............::....:.:n<....,:,,....�•::.�:::.:,•.,,,.,.{.:.:.::.� �:>LOl'#P�?F��'�D.N:'t988> STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) 1 b.Business Telephone Number of Insured ADP TotalSource FL XIX, Inc. 203/531-6800 10200 Sunset Drive, Miami, FL 33173 L/C/F lc.NYS Unemployment Insurance Employer Westmore Fuel Co, Inc. Registration Number of Insured 86 N Water Street 45998486 Greenwich, CT 06830 Work Location of Insured(Only required if coverage 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) 060739367 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) New Hampshire Insurance Company 3b.Policy Number of entity listed in box"la" Village of Rye Brook WC 038096605 938 King Street Rye Brook, NY 10573 3c. Policy effective period 7/1/2012to 7/1/2013 3d. The Proprietor,Partners or Executive Officers are X 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 "Y' 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 notes 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 of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be 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 referenced above and that the named insured has the coverage as depicted on this form. Approved by: Marilu Perez (Print name of authorized representative or 108ORSOd&gSfit gfiRSUFAAGA AAFF;A) Approved by: 6/26/2012 (Signature) (Date) Title: Technical Assistant Telephone Number of authorized representative or lieensed agent of insur-aftee eafr-i 00.743.8130 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorised to issue it. C-105.2(9-07) 92541 1203