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HomeMy WebLinkAboutMP19-040 E. tea. i3G4�.�y 19 7 V WnnawmaW 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 Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 2,2022 Andres Cevallos 17 Lincoln Avenue Rye Brook,New York 10573 Re: 17 Lincoln Avenue, Rye Brook,New York 10573 Parcel ID#: 135.65-1-50 This document certifies that the work done under Mechanical Permit #19-040 issued on 3/25/2019 for the installation of a new ductless split system and two new condensers have been satisfactorily completed. Sincerely, i Michael J. Izzo Building&Fire Inspector /to �E 4Rnv� 1 982 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 : 1 \ n C. 0� DATE: -1 PERMIT# \� ISSUED: VSECT �J.. U\BLOCK- ' LOT: V LOCATION: v �� �-� ,\ '� �� \� " OCCUPANCY: t,_.. ❑ VIOLATION NOT6 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 �yE BRC�uk 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 :— --�J DATE: PERMIT# ISSUED: �1-- E����CT: BLOCK: �OT: -!CA 14o ` � LOCATION: �� C�UC.\ \Q �� -� 1 OCCUPANCY. .'i\ ❑ VIOLATION NOTED HE WORK IS... ACCEPTED 0-R 4ECTED/ REINSPECTION ❑ SITE INSPECTION C� �/�� REQUIRED ❑ FOOTING V ❑ 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 ❑ INAL �J OTHER, ' `C 441— OSMS1202/1802/2402 QIUICK- SLINgf U.S. Patent No. 8,827,232 B2 The safe & affordable install Applicable for residential or light commercial installations 4 ` QSMS1202 OSMS1802 QSMS2402 A Close Up: Dual Fan Mini Split Stand SPECS Each foot is slotted to receive 1/4"/20 hardware which allows the stand to bolt to concrete, QSMS1202- 12" height. cement, or wood for stability & security. QSMS1802- 18" height. 4 points of anti-vibration isolation washers QSMS2402-24" height. are provided while using four 50-derometer *QSMS1802 & QSMS2402 rubber pads on each foot. come with an extra stability arm. ' Our Quick Sling Dual Fan Mini Split Stand is made of 14- gauge square tubing & 7 gauge steel. 30.5" width X 38" depth. Holds up to 400 lbs. *Powder Coated. Quick-Sling Dual Fan Mini Split Stand provides you with an elevated platform that is safe, stable and affordable. Our QSMS1202/1802 is the only way to mount your dual fan condenser to ensure its up off the ground safely, with no tip overs. Quick-Sling 391 West Water Street Taunton, MA 02780 P:1.800.699.0453 F:1.800.699.0423 www.Quick-Slina.com *As of 1/1/2015 Quick-Sling otters a 2-year warranty on steel&workmanship.Quick-Sling products are coated in accordance with ASTM D3451-06. SUBMITTAL DATA: MXZ-4C36NAHZ MITSUBISHI MULTI-INDOORELECTRIC Job Name: System Reference: Date: ACCESSORIES The outdoor unit is delivered with the base pan heater factory installed. AVo Airflow Guide(PAC-SH96SG-E) ❑ Three-port Branch Box(PAC-MKA30BC) ❑ Five-port Branch Box(PAC-MKA50BC) ❑ Distribution Pipe for Flare Connection (MSDD-50AR;necessary for installing two branch boxes) In Distribution Pipe for Brazed Connection (MSDD-50BR;necessary for installing two branch boxes) a 3/8"x 1/2"Port Adapter(MAC-A454JP) a 1/2"x 3/8"Port Adapter(MAC-A455JP) ❑ 112"x 5/8"Port Adapter(MAC-A456JP) a 1/4"x 3/8"Port Adapter(PAC-493PI) ❑ 3/8"x 5/8"Port Adapter(PAC-SG76RJ) Outdoor Unit MXZ4C36NAHZ (For data on specific indoor units,see the MXZ-C Technical and Service Manual.) Specifications Model Name Unit Type MXZ-4C36NAHZ Rated Capacity Btu/h 36,000/36,000 Cooling* (Non-ducted/Ducted) Capacity Range Btu/h 6,000-36,000 Rated Total Input W 2,570/3,180 Rated Capacity Btu/h 45,000/45,000 Heating at 4 Capacity Range Btu/h 7,200-45,000 te I Ducted)Du(Non-ducted/ Rated Total Input W 3,340/4,250 Rated Capacity Btu/h 34,000/36,000 Heating at 17°F* Maximum Capacity Btu/h 45,000/45,000 (Non-ducted/Ducted) Rated Total Input W 3,500/4,590 Heating at 5*F* Maximum Capacity Btu/h 45,000 Power Supply Voltage,Phase,Hertz 208/230V, 1-Phase,60 Hz Electrical Requirements Recommended Fuse/Breaker Size A 50 MCA A 42 Voltage Indoor-Outdoor S1-S2 V AC 208/230 _ Indoor-Outdoor S2-S3 V DC±24 Compressor Hermetic Fan Motor(ECM) F.L.A. 0.4+0.4 Sound Pressure Level Cooling in dB(A) 49 Heat53 External Dimensions(H x W x D) In/mm 52-11/16 x 41-11/32 x 13+1 1338 x 1050 x 330+25 Net Weight Lbs/k9 276/125 External Finish Munsell No.3Y 7.8/11 Liquid(High Pressure) 3/8/9.52 Refrigerant Pipe Size O.D. Gas(Low Pressure) In I mm 5/8/15.88 Max.Refrigerant Line Length Ft/m 492(150) Max.Piping Length between outdoor unit and branch boxes Ft/m 180(55) Max.Piping Length after branch box Ft/m 82(25) Max.Total Pi in I Length between branch boxes and indoor units Ft/m 311 (95) Max.Refrigerant Pipe Height If IDU is Above ODU Ft/m 131 (40 Difference If IDU is Below ODU 164(50) Connection Method Flared/Flared Refrigerant R41OA 'Rating Conditions per AHRI Standard: Cooling I Indoor.80'F(271 C)DB/67'F(19'C)WB Heating at 47T I Indoor:701 F(21'C)DB Heating at 17o F I Indoor.700 F(21*C)DB Coding I Outdoor:95°F(35°C)DB/75°F(24-C)WB Heating at 47T I Outdoor.47°F(8'C)DB/43°F(6*C)WB Heating at 17'F I Outdoor.17*F(-8*C)DB/151 F(-9*C)WB Specifications are subject to change without notice. ©2017 Mitsubishi Electric US,Inc. SPECIFICATIONS: MXZ-4C36NAHZ, • • OPERATING RANGE: ENERGY EFFICIENCIES: Outdoor Indoor Unit Type SEER EER HSPF COP COP @ 47°F @ 17°F Cooling D.B 23 to 115°F[D.B.-5 to 46°C]'1 Non-ducted 19.10 14.00 11.30 3.95 2.85 Heating W.B.-13 to 59°F[W.B.-25 to 15°C] when an optional Air Outlet Guide Ducted and L17. 12.67 10.70 3.53 2.58 is installed. Non-ducted Ducted 11.30 10.10 3.10 2.30 NOTES: • Minimum of two Indoor Units must be connected to the MXZ-4C36NAHZ. • Minimum installed capacity cannot be less than 12,000 Btu/h. • Total connected capacity must not exceed 130%of outdoor unit capacity. • System can operate with only one Indoor Unit turned on. • Information provided at 208/230V. • For Reference: MXZ-C Technical&Service Manual for detailed specifications and additional information per Indoor Unit Combination. MXZ Series Multi-Zone Indoor/Outdoor Combination Table for allowed unit combinations. MVZ CONNECTION RULES: • Up to 2 MVZ's may be connected to this system'. • When 2 MVZ's are connected,no additional indoor units can be used'. • When 1 MVZ is connected,additional indoor units can be connected. • When 1 MVZ is connected,total connected capacity must not exceed 130%. "No limitation to the number of units connected when the SPTB1 accessory is used,total connected capacity must not exceed 130%(refer to SPTB1 documentation for more information). Notes: Specifications are subject to change without notice. ©2017 Mitsubishi Electric US,Inc. MXZ-4C36NAHZ SYSTEM DESIGN 4HP Rated capacity Cooling 36 (kBTU/h) Heating 45 Refi erant R410A Connectable Capacity Type 06 to Type 36 indoor unit Caution: The indoor unit which rated capacity exceeds 36 kBTU/h(Type 36)can NOT be connected. Number of units 2 to 4 units Total system wide capacity 33 to unit capac outdoor 12 to 46.8 kBTU/h Connectable Number of units 1 or 2 units branch box Branch box Branch Box Combinations Number of branches 5 branches 3 branches Three-port Five-port /Indoor unit that \ (MAX.5 units l can be connected J ) (MAX.3 units) 1 0 0 1 Note:A maximum of 2 branch boxes can be connected to 1 outdoor unit. 1 1 2 0 ■If Using One Branch Box 0 1 2(Up to 8 IDU Flare connection employed(No brazing) 0 Branch box Piping connection size A A B The piping connection size differs B B B B e 09.52 mm according to the type and capacity of Liquid (3/8 inch) indoor units.Match the piping connection size of branch box with indoor unit.If the piping connection size ■If Using Two Branch Boxes of branch box does not match the piping connection size of indoor unit,use 2 branches pipe(joint) Gas 015.88 mm optional different-diameter(deformed) 0 optional parts (5/8 inch) joints to the branch box side. A / A (Connect deformed joint directly to the branch box side.) /Branch box#1 A B B ` B B B \Branch box#2 ■Installation procedure(2 branches pipe(joint)) Refer to the installation manuals of MSDD-50AR-E and MSDD-50BR•E. Specifications are subject to change without notice. C 2017 Mitsubishi Electric US,Inc. MXZ-4C36NAHZ COOLING , AND HEATING CAPACITY { AND CHARACTERISTICS 1.Method for obtaining system cooling and heating capacity: To obtain the system cooling and heating capacity and the electrical characteristics of the outdoor unit,first add up the ratings of all the indoor units connected to the outdoor unit(see table below). For Standard Capacity Diagram, please refer to the MXZ-C Technical&Service Manual. (1)Capacity of indoor unit Model Number for Model 06 Model 09 Model 12 Model 15 Model 18:Model 24 Model 30 Model 36 indoor unit M series 6.0 9.0 12.0 14.0" 17.2'3 22.5 - - 15.0'2 18.0'4 P series Model Capacity - - 12.0 - 18.0 24.0 30.0 35.0 SEZ [kBtu/h] - 8.1 11.5 14.1 17.2 - - - SlZ - .4 11.1 15.0 - - - - MVZ - - 12.0 - 18.0 24.0 1 30.0 36.0 "The value is for MSZ-GE15NA. "2 The value is for MSZ-FH15NA. e3 The value is for MSZ-GEIFH 1 BNA. '4 The value is for MSZ-FE18NA or MFZ-KA181%A (2)Sample calculation 1 System assembled from indoor and outdoor unit(in this example the total capacity of the indoor units is greater than that of the outdoor unit) •Outdoor unit MXZ-5C42NAHZ •Indoor unit MSZ-GE09NA x 2+MSZ-FH15NA x2 2 According to the conditions in 1 ,the total capacity of the indoor unit will be:9.0 x 2+15.0 x 2=48.0 3 The following figures are obtained from the 16.8 total capacity of indoor units,referring the standard capacity diagram in "4-3-3.MXZ-5C42NAHZ<cooling>"and"4-3-4.MXZ-5C42NAHZ<heating>". Capacity(kBTU/h) Outdoor unit power consumption(kW) Outdoor unit current(A)/230 V Cooling Heating Cooling Heating Cooling Heating A 42.0 1 B 48.0 3.46 4.37 15.26 19.31 2.Method for obtaining the heating and cooling capacity of an indoor unit: (1)The capacity of each Indoor unit(kW)=the capacity A (or B)o model capacity total model capacity of all indoor units (2)Sample calculation(using the system described above in 4-1-1.(2)): During cooling: IDuring heating: •The total model capacity of the indoor unit is: •The total model capacity of indoor unit is: 9.0x2+15.0x2=48.0kBTU/h 10.9x2+18.0x2=57.8kBTU/h Therefore,the capacity of MSZ-GE09NA and Therefore,the capacity of MSZ-GE09NA and MSZ- MSZ-FH15NA will be calculated as follows by FH15NA will be calculated as follows by using the using the formula in 4-1-2.(1): formula in 4-1-2.(1): Model 09=42.0 x 9=0 =7.88 kBTU/h Model 25=48.0 x 10�9=9.05 kBTU/h 48.0 57.8 Model 15=42.0 x 15.0 =13.13 kBTU/h Model 50=48.0 x 18.0 =14.95 kBTU/h 48.0 57.8 Specifications are subject to change without notice. 0 2017 Mitsubishi Electric US,Inc. OPERATIONAL ■ • PERFORMANCE NON-DUCTED: Total Indoor Operational Cooling Indoor#of Total Norninal Unit Performance for ge(Btu/h) indoor Capacity unit (x rig (Unit A+Unit B+Unit Unit A Unit B Unit C Unit D rr 1 6 6,000 6 6,000 7.200 7,200 1 9 9,000 9 9,000 10,800 10,800 1 12 12,000 12 12,000 14,400 14.400 1 15 15,000 15 15,000 18,000 18,000 1 18 18,000 18 18,000 21,600 21.600 1 24 24,000 24 24,000 28,800 28,800 1 30 30,000 30 30,000 36,900 36,900 36,000 36,000 1 36 45,000 36 45,000 2 12 12,000 6+6 6,000 6,000 14,400 7,200 7,200 2 15 15,000 6+9 6,000 9,000 18,000 7,200 10.800 2 18 18,000 6+ 12 6,000 12,000 21,600 7,200 14,400 2 21 21,000 6+ 15 6,000 15,000 25,200 7,200 18.000 2 24 24,000 6+18 6,000 18,000 28,800 7,200 7' 6'100 2 30 30,000 6+24 6,000 24,000 36,900 7,400 29,500 2 36 36,000 6+30 6,000 30,000 45,000 7,300 37.700 2 42 36,000 6+36 5,100 30,900 45.000 6,200 38 800 2 18 18,000 9+9 9,000 9,000 21,600 10,800 10,800 2 21 21,000 g+ 12 9,000 12,000 25,200 10,800 14,400 2 24 24,000 g+15 9,000 15,000 28,800 10,800 18,000 2 27 27,000 g+ 18 9,000 18,000 32,800 10,900 21,900 2 33 33,000 g+24 9,000 24,000 40,900 11,200 29,700 2 39 36,000 g+30 8,300 27,700 45,000 10,200 34.800 2 45 36,000 g+36 7,200 28,800 45,000 8,700 36.300 24,000 12,000 12,000 2 24 28,800 12+ 12 14,400 14,400 2 27 27,000 12+ 15 12,000 15,000 32,800 14,600 18.200 2 30 30,000 12+ 18 12,000 18,000 36,900 14,800 22,100 2 36 36,000 12+24 12,000 24,000 45,000 15,000 30,000 2 42 36,000 12+30 10,300 25,700 45,000 12,600 32.400 2 30 30,000 15+15 15,000 15,000 36,900 18.500 18,500 33,000 15,000 18 000 2 33 40,900 15+ 18 18.600 22,300 Specifications are subject to change without notice. ©2017 Mitsubishi Electric US,Inc. MXZ-4C36NAHZ OPERATIONAL PERFORMANCE, contd. NON-DUCTED: Total Indoor Operational Cooling . .• Indoor#of Total Nominal Unit Performance for indoor Unit Combinations unit 000 • ri 2 39 36,000 15+24 13,800 22,200 45,000 17,300 27.700 2 45 36,000 15+30 12,000 24,000 45,000 14,800 30.200 2 36 36,000 18+ 18 18,000 18,000 45,000 22,500 22,500 2 42 36,000 18+24 15,400 20,600 45,000 19,300 25.700 - 3 18 18,000 6+6+6 6,000 6,000 6,000 21,600 7,200 7,200 7,200 3 21 21,000 6+6+9 6,000 6,000 9,000 25,200 7,200 7,200 10,800 3 24 24,000 6+6+ 12 6,000 6,000 12,000 28,800 7,200 7,200 14,400 3 27 27,000 6+6+ 15 6,000 6.000 15,000 32,800 7,300 7,300 18,200 3 30 30,000 6+6+18 6.000 6,000 18,000 36,900 7,400 7.400 22,100 3 36 36,000 6+6+24 6,000 6,000 24,000 45,000 7,500 7,500 30,000 3 42 36,000 6+6+30 5,100 5,100 25,700 45,000 6,300 6.300 32 400 3 24 24,000 6+9+9 6,000 9,000 9,000 28,800 7,200 10,800 10,800 3 27 27,000 6+9+ 12 6,000 9,000 12,000 32,800 7,300 10,900 14,600 3 30 30,000 6+9+ 15 6,000 9,000 15,000 36,900 7,400 11.100 18,500 3 33 33,000 6+9+ 18 6,000 9,000 18,000 40,900 7,400 11,200 22.300 3 39 36,000 6+9+24 5,500 8,300 22,200 45,000 6,900 10,400 27,700 3 45 36,000 6+9+30 4,800 7,200 24,000 45,000 5.900 8,900 30,200 3 30 30,000 6+ 12+ 12 6,000 12,000 12,000 36,900 7,400 14.800 14.800 3 33 33,000 6+12+ 15 6,000 12,000 15,000 40,900 7,400 14,900 18,600 3 36 36,000 6+ 12+ 18 6,000 12,000 18,000 45,000 7,500 15,000 22,500 3 42 36,000 6+12+24 5,100 10,300 20,600 45,000 6,400 12.900 25,700 3 36 36,000 6+ 15+ 15 6,000 15,000 15,000 45.000 7,500 18,800 18,800 3 39 36,000 6+ 15+ 18 5,500 13,800 16,600 45,000 6,900 17.300 20,800 3 45 36,000 6+ 15+24 4,800 12,000 19,200 45,000 6,000 15,000 24,000 3 42 36.000 6+18+ 18 5,100 15,400 15,400 45,000 6,400 19.300 19,300 3 27 27,000 9+9+9 9,000 9,000 9,000 32,800 10,900 10,900 10,900 3 30 30,000 9+9+ 12 9,000 9,000 12,000 36,900 11,100 11,100 14,800 3 33 33,000 9+9+ 15 9,000 9,000 15,000 40,900 11.200 11.200 18,600 3 36 36,000 9+9+ 18 9,000 9,000 18,000 45.000 11,300 '1.300 22,500 3 42 36,000 9+9+24 7,700 7,700 20,600 45,000 9,600 9,600 25,700 Specifications are subject to change without notice. ©2017 Mitsubishi Electric US,Inc. MXZ-4C36NAHZ OPERATIONAL PERFORMANCE, contd. NON•DUCTED: Operational Cooling .• Indoor#of Total Nominal Total Indoor Performance for indoor .. unit 0i• • 3 33 33,000 9+12+ 12 9,000 12,000 12,000 40,900 11,200 14.900 14.900 3 36 36,000 9+ 12+ 15 9,000 12,000 15,000 45,000 11,300 15.000 18,800 3 39 36,000 9+ 12+ 18 8,300 11,100 16,600 45,000 10,400 13,800 20,800 3 45 36,000 9+ 12+24 7,200 9,600 19,200 45,000 9,000 12.000 24.000 36,000 8,300 13,800 13,800 3 39 45,000 10,400+ 15+ 15 10,400 17.300 17,300 3 42 36,000 9+ 15+ 18 7,700 12,900 15,400 45,000 9,600 16,100 19,300 3 45 36,000 9+ 18+ 18 7,200 14,400 14,400 45,000 9,000 18.000 18,000 3 36 36,000 12+ 12+ 12 12,000 12,000 12,000 45,000 15.000 15,000 15.000 3 39 36,000 12+ 12+ 15 11,100 11,100 13,800 45,000 13,800 13.800 17,300 36,000 10,300 10,300 15,400 3 42 -15,000 12+ 12+ 18 12.900 12.900 19,300 36,000 10,300 12,900 12,900 3 42 45,000 12+ 15+15 12,900 16.100 16,100 3 45 36,000 12+ 15+18 9,600 12,000 14,400 45,000 12,000 15,000 18,000 3 45 36,000 15+ 15+15 12,000 12,000 12,000 45,000 15,000 15,000 15,000 4 24 24,000 6+6+6+6 6,000 6,000 6.000 6,000 28,800 7,200 7,200 7,200 7,200 4 27 27,000 6+6+6+9 6,000 6,000 6,000 9,000 32 800 7.300 7.300 7,300 10,900 30,000 6,000 6,000 6 000 12,000 4 30 36,900 6+6+6+ 12 7,400 7,400 71400 14,800 4 33 33,000 6+6+6+15 6,000 6,000 6,000 15,000 40,900 7,400 7,400 7,400 18,600 36,000 6,000 6 000 6,000 18,000 4 36 45,000 6+6+6+18 7,500 7,500 7,500 22,500 4 42 36,000 6+6+6+24 5,100 5,100 5,100 20,600 45,000 6,400 6,400 6,400 25,700 4 30 30,000 6+6+9+9 6,000 6,000 9,000 9,000 36,900 7,400 7,400 11,100 11,100 33,000 6,000 6,000 9,000 12,000 4 33 40,900 6+6+g+12 7,400 7,400 11,200 14,900 4 36 36,000 6+6+g+15 6,000 6,000 9,000 15,000 45,000 7,500 7,500 11,300 18,800 4 39 36,000 6+6+g+ 18 5,500 5,500 8,300 16,600 45,000 6,900 6,900 10,400 20,800 4 45 36,000 6+6+g+24 4,800 4,800 7,200 19,200 45,000 6,000 6,000 5.000 24,000 36,000 6,000 6,000 12,000 12,000 4 36 45,000 6+6+ 12+ 12 7,500 7,500 15,000 15,000 36,000 5,500 5,500 11,100 13,800 4 39 45,000 6+6+ 12+ 15 6,900 6,900 13.800 17,300 4 42 36,000 6+6+ 12+ 18 5,100 5,100 10,300 15,400 45,000 6.400 6,400 12,900 19,300 4 42 36,000 6+6+ 15+ 15 5,100 5,100 12,900 12,900 45,000 6.400 6,400 16,100 16,100 36,000 4,800 4,800 12,000 14,400 4 45 45,000 6+6+ 15+ 18 6,000 6,000 15,000 18.000 4 33 33,000 6+g+9+9 6,000 9,000 9,000 9,000 40,900 7,400 11,200 11.200 11,200 Specifications are subject to change without notice. m 2017 Mitsubishi Electric US,Inc. MXZ-4C36NAHZ OPERATIONAL PERFORMANCE, contd. NON-DUCTED: Operational Cooling Indoor#of Total Nominal Total Indoor Performance for indoorUnit unit i00 Btu/h) Capacity (Unit A+Unit B+Unit Unit A Unit B Unit C Unit D 4 36 36,000 6+9+9+12 6,000 9,000 9,000 12,000 45,000 7,500 11,300 11,300 15.000 4 39 36,000 6+9+9+15 5,500 8,300 8,300 13,800 45,000 6,900 10.400 10,400 17,300 36,000 5,100 7 700 7,700 15,400 4 42 45,000 6+g+g+1g 6,400 9,600 9,600 19,300 4 39 36,000 6+9+ 12+ 12 5,500 8 300 11,100 11,100 45,000 6,900 10.400 13,800 13,800 4 42 36,000 6+9+ 12+ 15 5,100 7,700 10,300 12,900 45,000 6.400 9,600 12,900 16,100 4 45 36,000 6+9+ 12+ 18 4,800 7,200 9,600 14,400 45,000 6,000 9,000 12,000 18.000 4 42 36,000 6+ 12+ 12+ 12 5,100 10,300 10,300 10,300 45,000 6,400 12,900 12.900 12.900 4 45 36,000 6+ 12+ 12+ 15 4,800 9,600 9,600 12,000 45,000 6,000 12.000 12,000 15.000 4 36 36,000 9+9+9+9 9,000 9,000 9,000 9,000 45,000 11.300 11,300 11,300 11,300 4 39 36,000 9+9+9+12 8,300 8 300 8 300 11,100 45,000 10,400 10.400 10,400 13,800 4 42 36,000 9+9+9+15 7,700 7,700 7,700 12,900 45,000 9.600 9,600 9.600 16,100 4 45 36,000 9+9+9+ 18 7,200 7,200 7,200 14,400 45,000 9,000 9,000 9,000 18,000 4 42 36,000 9+9+ 12+ 12 7,700 7,700 10,300 10,300 45,000 9,600 9,600 12,900 12,900 36,000 7,200 7.200 9,600 12,000 4 45 45,000 9+9+ 12+ 15 9.000 9.000 12,000 15,000 36,000 4,800 7,200 12,000 12,000 4 45 45.000 6+g+ 15+ 15 6,000 9.000 15,000 15.000 4 45 36,000 9+ 12+ 12+ 12 7,200 9,600 9,600 9,600 45,000 9,000 12,000 12,000 12,000 Specifications are subject to change without notice. ©2017 Mitsubishi Electric US,Inc. 1 • • , , 0- 1 PAC-MKA50BC BRANCH BOXES PAC-MKA30BC Unit: mm <in> SUSPENSION BOLTPITCN When installing the conduit`1 I Set the attachment to the inner side of each panel. 58<2432> 20Tt to QSpb <t-Y32> SUSPENSION BOLT:W3/8(M70) CALI , REFRIGERANT PIPE FLARED CONNECTION A 18 IC I I I TO OUTDOOR UNIT «L B p LIQUID PIPE 114F 114E I 1/4F 3/8F I @ R GAS PIPE 3I8F 318E 318E SIBF ---- — ;�, �"°" 12aro 15<1973b I ss<2.1a32> q �~'--------L21--- --_� 45007.23(32> 9101m, 208 AY18> a73 -Tt5> 42Y32> 21001-11132> 40<1-17132> TOOJAPO BLOCK LO K UNIT TO INDOOR UNT �W!12> 07n® Q-Yb 54AECTRIC WNE NLET T 94000f�IMT C e _ — I ® „ J rw 25 25 coNTlTacovElL �' {�""nJt'roA1o�°1�rar 1 t 1 To OUTDOOR UNIT $E{�CE p�NEL burr PLATE ctyy Q 3°l4> f1m IElST71EW.9sTOR) PAC-MKA50BC Unit: mm <in> I When installing the conduit. 1 Set the attachment to the inner side of each panel. 5B<2-W3b SUSPENSION BOLT POCH 20 3zo<tt vS> <2s 32> <tyy> I I 1st I � I I SUSPENSION BOLT W3/8(M70) I olit 4 $ REFRIGERANT PIPE FLARED CONNECTION E I UTD00Q UNIT I I e V LIQUIDPIPE 1/4F 1/4F 114E 1/4F 1/4F 3/8F sI22<7e ry 9 GAS PIPE 318E 318E 318E 318E 112E 518E �w 15<1W32> 86<2-1913b d 2<1ro ` 4 91 96 150<17.2372> 41W32> 114Y3b 280<11-1T32> 40<1-1H3b 974W16> 77 03 57 70 TERMNhL gLOCK TO PC"UNIT 5-ELECTRIC WE ALET TO INDOOR U E E DO Cc a B AAI. �O I _ o I •Wm J 1 t 1 NCCNTROLCOVER Loma 70 70 10 70 T T LIT PLATE To0UT00dl UNR Q-Y4>Q34><2-3N><23W LL ° sraRt Specifications are sub)ect to change without notice. 0 2017 Mitsubishi Electric US,Inc. ■ eMXZ-4C36NAHZ Unit: mm4» [ . , | . -- � � ) ! \° [ � ! � � �� C� . | k 1E ` 9 |. r ! i • ! � d � — ( � ( . ! # # m !/ a! � 2 � 7 7i15 ) � : § MITSUBISHI AW'% ELECTRIC COOLING & HEATING ,an4 Satellite Boulevard.&_w bl024 U Free:Bno43 ka22 www.mehvac.com . \ ' ' cK_ a Fo m AzcamHZ for Multiple IndoorUnit Styles-322 mt■k Specifications are subjectmchange__notice. =32 Mitsubishi EleGc+ac SUBMITTAL DATA: • 6,000 • •INDOOR UNIT FORMULTI-ZONE Job Name: System Reference: Date: Indoor Unit: Wireless Remote Controller MSZ-GL06NA •�5�d GENERAL FEATURES Slim wall-mounted indoor units provide zone comfort control • The outdoor unit powers the indoor unit,and should a power outage occur,the system is automatically restarted when power returns • Multiple fan speed options:Quiet,Low,Medium,High,Super-high,Auto • Multiple control options available: Hand-held Remote Controller(provided with unit) kumo cloudy smart device app for remote access Third-party interface options Wired or wireless controllers • Hot-Start Technology:no cold air rush at equipment startup or when restarting after Defrost Cycle • Quiet operation • Smart Set:recalls a preferred preset temperature setting at the touch of a button Specifications are subject to change without notice. ©2019 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. SPECIFICATIONS: MSZ-GL06NA Cooling Capacity',3 Btu/h 6,000 Heating Capaaty2.3 Btu/h 7,200 Voltage,Phase,Frequency 208/230V,1 phase,601-11z Guaranteed Voltage Range VAC 187-253 Electrical Voltage:Indoor-Outdoor,S1-S2 VAC 208/230 Voltage:Indoor-Outdoor,S2-S3 V DC 24 Voltage:Indoor-Remote Controller Wireless Type MCA A 1 Blower Motor Full Load Amperage A 0.76 Blower Motor Output W 30 Airflow Rate at Cooling,Dry CFM 145-170-237-321-399 Airflow Rate at Cooling,Wet CFM 109-134-201-286-364 Airflow Rate at Heating,Dry CFM 145-170-237-321-406 Sound Pressure Level(Cooling) dB(A) 19-22-30-37-43 Sound Pressure Level(Heating) dB(A) 19-22-30-37-43 Drain Pipe Size In.(mm) 5/8(15.88) Heat Exchanger Type Plate fin cal External Finish Color Munsell 1.OY 9.2/0.2 W:In.(mm) 31-7/16(798) Unit Dimensions D:In.(mm) 9-1/8(232) H:In.(mm) 11-5/8(295) W:In.(mm) 33-1/2(850) Package Dimensions D:In.(mm) 12(300) H:In.(mm) 14(350) Unit Weight Lbs.(kg) 22(10) Package Weight lbs.(kg) 26(11.5) Refrigerant Type R410A Gas Pipe Size O.D.(Flared) In. (mm) 3/8(9.52) Piping -- -- — -- - Liquid Pipe Size O.D. (Flared) In. (mm) 1/4(6.35) Notes: 'Cooling(Indoor/1 Outdoor) °F 80 DB,87 WB H95 DB,75 WB Nominal Conditions 2Heating at 47°F(Indoor//Outdoor) °F 70 DB,80 WB H 47 DB,43 WB !Capacity varies based on the number of Indoor units operating and the model of the Multi-zone Outdoor Unit.For reference to connected capacity charts,please refer Multi-zone Outdoor Unit Operational Performance. Specifications are subject to change without notice. C 2019 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. ACCESSORIES: 06 Anti-allergy Enzyme Filter ❑MAC-408FT E Backlit,Wall-mounted,Wireless Controller ❑MHK1 Portable Central Controller ❑MCCH1 Wired MA Controller) ❑PAR-33MAA Simple MA Controller' o PAC-YT53CRAU Touch MA Controller' o PAR-CT01 MAU-SB Wireless Temperature and Humidity Sensor ❑PAC-USWHS003-TH-1 Outside Air Sensor for MHK1 ❑MOS1 System Control Interface2 ❑MAC-3331F-E Wireless Interface ❑PAC-USWHS002-WF-1 Thermostat Interface ❑PAC-US444CN-1 kumo station'*' ❑PAC-WHS01HC-E USNAP Interface o PAC-WHS0IUP-E IT Extender o PAC-WHS011E-E BACnet®and MODBUS®Interface o PAC-UKPRC001-CN-1 Lockdown Bracket for Hand-held Remote Controllers ❑RCMKPICB Blue Diamond Sensor Extension Cable—15 Ft. ❑C13-103 Blue Diamond Alarm Extension Cable—6.5 Ft. ❑C13-192 Blue Diamond MultiTank—collection tank for use with multiple pumps ❑C21-014 Blue Diamond Rubber Foot Pads ❑F10-010 Mini Condensate Pump—230 volt application ❑SI30-230 MegaBlue Advanced Blue Diamond Condensate Pump w/Reservoir&Sensor ❑X87-835-110 to 250V MaxiBlue Advanced Blue Diamond Mini Condensate Pump w/Reservoir&Sensor(110V)up to 48,000 Btu/h o X87-711-110V [recommended] Advanced Blue Diamond Mini Condensate Pump w/Reservoir&Sensor(208/230V)[recommended] o X87-721-2081230V MicroBlue Blue Diamond Mini Condensate Pump(110/208/230V)up to 18,000 Btu/h ❑X85-003 Fascia Kit for MicroBlue Pump—mounts the MicroBlue and sensor directly beneath the indoor unit ❑T18-016 Drain Pan Level Sensor ❑DPLS2 (30A/600V/UL)[fits 2"X 4"utility box]-Black ❑TAZ-MS303 (30A/600V/UL)[fits 2'X 4"utility box]-White ❑TAZ-MS303W Requires MAC-3331F-E 2Allows indoor units to connect to an MA Controller Specifications are subject to change without notice. ©2019 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. 1 • MSZ-GL06NA Unit: inch 1/16x1 Oblong hole 7/16xl3/16 Obl000 hole Insfollofi n plofe 3 IIB 1/8 8.7/8 -1/8 ,o I-7/16 0 30.15/16 1/4 N T 6•I/ 6-I/8 2 3l 13 /16 13 9/16 2-1/8 9-1/8 3/16 Indoor unit 11 In all hole 03 �1 Insfollafion plofe Pi in N N � Lid N �O • M � � I " 1-15/16 24-3/8 S /8„ -5l -- -_---- 4-3/I6 _; Drain hose 2 5/I_ 6 �_ 3l l 4 3/ Air out r, Ehose at-3/8 O.D el/4 19-11/16(Flared connection a1/4) o3/8 16-15/16 /I I I I II 1 116� (Flared oonnecdon:a3/8(GLa8N9/12NA),e12(GL15NA)) Insulation of-1/8 0.13 Connected part o5/8 O.D JfftMITSUBISHI w ELECTRIC COOLING & HEATING 1340 Satellite Boulevard,Suwanee,GA 30024 Toll Free:800-433-4822 www.mehvac.com FORM#MSZ-GL06NA FOR MXZ-C MULTI-ZONE HEAT-PUMP 0. SYSTEMS-201901 Vert m „ffuk Specifications are subject to change without notice. ©2019 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. �o O vi - r O tog Out E- N z w w ►� � � � � 3 x � F co O A � �, O � w00 Z oo a W w y cc � t rnwo Q o " W O 3 f Z .< z •• c g OL � 7Now C7 F. c � C6 �• Im _�E t3Rn BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KINGS*ET RYE BROOK,NY 10573 v (914)939-066Ax(914)939-5801 www.ryebrook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY Fi : I q V 4b EP#: 19-07(0 Approval Date: MAR 2 6 �01 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures ,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. L Address: 11 L 1 rJ C O r-N A V F d ',y 1E- SBL: %35 , 6.5- -- ) -- Zone:ffi10 2.Property Owner: Q 4 D R,g S C 1=v'A L 6 S —Address:-1-7 A%j a j,,F Phone#: l 6-'7 Ol SD (<�ell#: email: 3.Master Electrician: 6JeE60C MC'j-'"/-1Z11= Address: I LP wt 5'4 r�' :i>LAG E P_`JTpx /ony Lic.#- 5 7 4P Phone#.k q 4 q b 1 - 1 1$"1 Cell#0 A 49,0-7653 email: ��-„���(Dcj o+,nn1-ne,rv�1" Company Name: MCI(, CnAE Pg, Address: 14 Mto A pk ?'L&e_E + 2 y tom. ,.t y 16L9,0 4.Proposed Electrical Work/Fixture Count: (A I P_F T►Jd COS.)o)'("1 i)tL F-A 1A •*****r*,►•****,rr••*,r*****a,r•*•.r►*•,r.*w*,r,r,r**,r*«*****+r,►**,►•*rr►*r,r**•r►**,r,►**.•*****,t***rr*+r**rr***w**,r****r** STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: G 2 trao(G t M being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of incdvidual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the OfJT CAGT QIZ for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this 1,q-te, day of ,20 day of Iei,44 u a vh ,20 19 Signature of Property Owner Signatur of Applican Greyorti AA(,LKeK1,1e— Print Name of Property Owner Print Name of Applicant Notary Public Notary Public MARY SLATER NOTARY PUBLIC-STATE OF NEW YORK No. 01 SL8130888 Qun!ifird in Westchester County My Commission Expires 07-25-2021 611/18 Westchester Rockland Electrical Inspection Services, Inc. � . y _Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDI PERMIT NO. TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY V i r /() -73 1 It )av r STREET AND NO.OR ROAD POLE NUMBER 1`7 / , ,!C �;,- A FP/4. BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT f % . 65 OCCUPANT'S NAME BUILDING OCCUPANCY 1A OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER t v,: _CQ S ' ILL'? r— CURRENT SUPPLIED BY FROM THEIR OFFIZ 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 p F' BASEMENT 1''FL. 2-FL. 3'm FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: So Am VO4-7- � PGt✓+ 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 CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND[] _j 1 AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. SIGNATURE OF APPLICANT NAME OF COMPANY DATE OF APPLICATION MaeKENZIE ELECTRIGAL Zvi. LinP-),- .j STREET ADD&WRACTORS• INC. TELEPHONE NO. 14,MEAD PLACE RYE,NY 10580 CITY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE WESTCHESTER REI ROCKLAND ELECTRICAL INSPECTION SERVICES.INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: MacKENZIE ELECTRICAL CONTR.Ir Andres Cevallos 14 MEAD PLACE RYE NY 10580 Located at: 17 Lincoln Ave, Rye Brook, NY 10573 Certificate Number: 576764 Section: 135.65 Block: 1 Lot: 50 BDC: Permit Number: EP:19-076 BP:19-040 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 17 Lincoln Ave, Rye Brook, NY 10573 ❑X Basement 01st Floor ❑2nd Floor ❑3rd Floor ❑Garage ❑Attic [E Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation, as set forth below, was found to be in compliance therewith on 4/26/2019 Name Quantity Rating Circuit Type A/C Unit 1 Ductless System/Split Condensing Unit(s) 2 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. r `W This certificate is valid for work performed before date of inspection only. A��® DATE(MM/DD/YYYY) `.� CERTIFICATE OF LIABILITY INSURANCE 03/07/2019 THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTENDOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEACONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certlf sate holler is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT NAME: Lanford P.Henry,Broker Insurance Noodle LLC DBA Insureon Solutions PHONE FAx 30 N.LaSalle.25th Floor (A/C,NO,ERT)-914 668 2000 (A/C,NO):914 668 2009 Chicago IL 60602 E-MAIL ADDRESS: I-0nford.Henry@gmail.Corn INSURER(S)AFFORDING COVERAGE NAIC p I INSURED INSURERA: United States Liability Insurance Group 25895 INSURER B: Ivor Heating and Air Conditioning Inc -- 106 Esplanade INSURERC: Mount Vernon NY 104553 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS�FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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. INSR TYPEOFINSURANCE ADOTL �� POLICY NUMBER POLICY EFF POUCYEXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYY17 COMMERCIAL GENERAL LIABILITY - ----- EACH OCCURRENCE S 1,000, 000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea Occurrence) S 100, MEDEXP(Any oneperson) S 5 CP 10067443 02/19/2019 02/19/2020 PERSONAL&ADV INJURY S 1,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000 POLICY PROJECT LOC PRODUCTS-COMP/OP AGG S 2,000.00( OTHER: $ AUTOMOBILEUABILiTY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY IN)URY(Per person) S OWNEDAUTOS SCHEDULED ONLY AUTOS BODILY INJURY(PeraccidenU S HIRED AUTOS NON-OWNED PROPERTY DAMAGE S ONLY AUTOS ONLY (Per accident) _ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ EXECUTIVEOFFICER/MEMBER N/A EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE Ifyes,describe under DESCRIPTION OF OPERATIONSbelow E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B more space Is required) Location: 17 Lincoln Ave Rye Brook,NY 10573 it CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Rye Brook Building Department DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION& 938 King Street AUTHORIZED REPRESENTATIVE Rye Brooky,NY 10573_ ACORD 25(2016/03) Cs'1988-2015 ACOR CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD IENWR Workers' CERTIFICATE OF ATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured (914)774-6607 IVOR HEATING AND AIR CONDITIONING INC 1 c. NYS Unemployment Insurance Employer Registration Number of 106 ESPLANADE Insured MOUNT VERNON,NY 10553 Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 800717316 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) THE PHOENIX INSURANCE COMPANY 3b. Policy Number of entity listed in box"l a" THE VILLAGE OF RYEBROOK UB-41_005704-18 938 KING ST RYE BROOK,NY 10573 3c. Policy effective period 09/18/2018 to 09/18/2019 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 "3" insures the business referenced above in box "1 a" 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"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums 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. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend,extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon 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: Misty Kuckelman (Print name of authorized representative or licensed agent of insurance carrier) „ram �C�'Efif�� Approved by: D 03/22/2019 (Signature) (Date) Title: 2VP BI Small Commercial Operations Telephone Number of authorized representative or licensed agent of insurance carrier: (877)362-6785 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 (9-17) www.wcb.ny.gov