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HomeMy WebLinkAboutMP20-163 L d -VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 1,2021 The Estate of Joseph Gianfrancesco 545 '/z Westchester Avenue Rye Brook,New York 10573 Re: 545 '/2 Westchester Avenue, Rye Brook,New York 10573 Parcel ID#: 135.83-1-20 This document certifies that the work done under Mechanical Permit#20-163 issued on 10/29/2020 for the installation of three new gas fired furnaces have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg E BRO, F0T • lga2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR f�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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - -- - -- --- --- ' �5 a a ADDRESS :— � DATE" �� PERMIT# ISSUED: �ECT: BLOCK: LOT: LOCATION: � OCCUPANCY: CI VIOLATION NOTED THE WORK IS.. ACCEPTED C� 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 q,.FINAL r,�] OTHER f,BRC�� O`` tim � f • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK„NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - -- - - - - - - - - - - ADDRESS :— a �1 V1 DATE: 1 � V 6 PERMIT# ISSUED: C l'3ECT' BLOCK: LOT: LOCATION: 1 L��J E V G lG O PANCY: (r 11 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 f'"� NATURAL GAS � � (� (�n c l/ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O_ © V .Cfj C �✓ * C = cd * U) M r■d k O ccl cl � Rs Lm * co 66 Wj a cd Cd cz 4 o c sy a, a o Z �w = N N = p o c e N N a sv96 o � a 01. co to- 43 U gz M � � � Oi0 1 � "C7 � • � r an W a " = < t P z z r r 4 r \ � e� r D CC ENE BUILDING DEPARTMENT VILLA'GE OF RYE BROOK OCT 2 1 2020 91)8 KING STREET RYE BR(,x)K,NY 101 (914) 933q-06694�AX'(9114) 939-580,1 VILLAGE OF RYE BROOK G DEPARTMENT BUILDING - ­ ' - JI _ _j PLUMBING PERMIT APPLICATION POZ-I(o3 ao /ate OCT 2 9 Permit Fee: S 4W-" P2L Approval Date: . V, Approval Signature: Other: Disapproved. (fees are non-refundable) Application dated, 1011212020 —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 Plumbing as per detailed statement described below. The applicant&property owner, by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes.[--?/)-F 1.Address: 545 1/2 Westchester Ave — SBL: 135 .93-1 -20 Zone: ky 2.Proposed Work: New gas lines to HVAC units ConEdMC-403636 3.Property Owner jinczeph GJanfra.njrec;c-n Address: 545 1/2 Westchester Ave Phone IT7: 937-55.96 Cell #: email: gary@arconics,net 4.Master Plumber: Ken McCabe Box 650 Briarcliff NY 10510 Lic. #: 983 Phone 4: Cell 4: 914-804-5412 email: Company Name: VFR CONTRACTING Address: P.O.BOX 650- BRIARCLIFF NY 10510 INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location —WI—a—ter Urinals Drinking sillIci Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Tutal Closets Fountains Fuhs Tubs Service Service Sewer LP Gas Basement 2 1st Floor l i 2nd Floor Flo—or —TF—loor 5. List Other Equipment/Provide Details: NPw nic qprvire and Qns lines for HVAC-units (Notarized Signatures Required Next 2 Pages) STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as; Ken McCabe ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Contractor for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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 2 Sworn to before me this t 2th day of G rat-._b c,- 2020 day of OCT. 12020 2 Sijhature of PropelOy Owner Signature o Applicant Jose>7h Gi anfranr_pgnn Ken McCabe Print Name of Property Owner Print Name of Applicant Aublic Notary Public LAURA E SMITH JOY MARIE BARRESE Notary Public,State of NOW York NOTARY PUBLIC-STATE OF NEW YOM Rog.No.o1SM6387739 No. 01 BA6280931 Qual fled in WestOiestw County G allflpd In Wesichester County Commlasi n Expires 0212WO23 This �1�� }�l'sslorr�xpiies'iiitd��1'3, 20,11lpleWd in its entirety and niust include: the notarized sig (s) of the legal o\k-ner(r,) of line "ub.jccl propQrty. and the applicunt of"record in the spaces provided. 1pplicationS not properk Completed i1i its entirety and or not pre}perl,, signed shall he deemed null and void and will be returned to the applicfrnt. -2- 3/21/19 BUILDING--0190ARTMENT D `Uv VILLA E OF RYE,�t00K 938 KINGS ET RYE B1106K,NY 10573 0 C T z 1 2020 (914) 930 4668 (9,1'4:039-5801 wti;WANe Q yl o a VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216 -STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANTY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED PORN, WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, Joseph Gianfrancesco residing at. 545' Westchester Ave. , Rye brook [%nC ,Uii jlA' being duly sworn. deposes and states that (s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 545 L Westchester Avenue , Rye Brook, NY. Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps. or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. Joseph Gianfrancesco (Print %aanc Sworn to before me this 2 da of t-. , 202f JOY MARIE BARRESE NOTARY PUBLIC-STATE OF NEW YORK No. 01 BA6280931 _3_ Qualified In Westchester County My Commission Expires May 13, 20,11 3/21/19 800SA/801SA ! I Non-Condensing 33-113 in. Gas Furnace 1 nt Sizes 0' Product Data PERFORMANCE ® ® • QuieTech- noise reduction system • Microprocessor based"smart"control center Fan on Plus'-Continuous Fan speed adjustable from thermostat Adjustable heating air temperature rise Adapts heating stages to meet demand Dehumidify mode Enhanced diagnostics with LED and reflective sight glass, non-volatile fault code memory,and self test feature On-board fuse for transformer protection • Perfect Light- Igniter ' [ • Patented blocked vent safeguard to ensure proper furnace r ' q venting • Inner door for tighter sealing INSTALLATION FLEXIBILITY • 4-way Multipoise furnace,13 vent applications • HYBRID HEATO Dual Fuel System compatible • All models are chimney friendly when used with accessory vent kit APPLICATIONS ' • Compact design-only 33-1/3 in.(847 mm)tall • Propane convertible with gas conversion accessory a Convenient Air Purifier and Humidifier connections CERTIFICATON A10252 • Cabinet air leakage less than 2.0%at 1.0 in.W.C.and THE 800SA/801SA GAS FURNACE cabinet air leakage less than 1.4%at 0.5 in.W.C.when The 800SA/801SA 4-way Mutipoise Gas Furnaces feature tested in accordance with ASHRAE standard 193 Bryant's QuieTech' noise reduction system for incredibly quiet a Residential installations eligible for consumer financing induced draft operation. Applications are easy with 4-way through the Retail Credit Program multipoise design, through-the-fumace downflow venting, 13 different venting options,and designed for easy service access.An inner blower door is provided for tighter sealing in sensitive applications. The 800SA/801SA furnaces are approved for use with natural or propane gas,and the 801SA- Low NOx units are designed for California installations and meet 40 ng/J NOx emissions.Can be installed in air quality management districts with a 40 ng/J NOx emissions requirement. QESIGN (® IPA Rrif` ® 1S09001 Use of the AHRf Certified TM Mark indicates a manufacturer's participation in the program. For verification of certification for individual products, go to v .ahndirectory.org. SPECIFICATIONS UNIT SIZE 36045E014 36045EO17 36070E014 36070EO17 48070EO21 E017 RATINGS AND PERFORMANCE Input Btuh* All Standard 44,000 44,000 66,000 66,000 66,000 88,000 All Low NOx Upflow Nonweatherized ICS All Low Nox 42,000 42,000 63,000 63,000 63,000 84,000 Downflow/Horizontal Output Capacity(Btuh)t All Standard 36,000 35,000 54,000 54,000 53,000 71,000 All Low NOx Upflow NonweatherizedlCS All Low Nox 34000 34,000 51,000 51,000 51,000 68,000 Downflow/Horizontal AFUEt 80.00 80.00 80.00 80.00 80.00 80.00 Certified Temperature Rise Range-°F(°C) 30-60 30-60 30-60 35-65 25-55 40-70 (17-33) (17-33) (17-33) (19-36) (14-30) (22-39) Certified External Static Pressure Heat/Cool 0.1010.50 0.10/0.50 0.12/0.50 0.12/0.50 0.12/0.50 0.15/0.50 Airflow CFMt Heating 710 760 982 985 1305 1203 Cooling 1080 1215 1005 1005 1545 1210 ELECTRICAL Un it Volts-Hertz-Phase 115-60-1 Operating Voltage Range Min-Max 104-127 Maximum Unit Amps 5.6 7.6 5A 5.6 10.0 8.3 UnitAmpacity 7,8 10.3 7.8 7.8 13.3 11.0 Maximum Wire Length(Measure 1 Way in Ft(M) 47(14.3) 36(11) 47(14.3) 47(14.3) 27(8.2) 33(10.1) Minimum Wire Size 14 Maximum Fuse or Ckt Bkr Size(Amps)** 15 Transformer(24v) 40va External Control Heating 12va Power Available Cooling 35va Air Conditioning Blower Relay Standard CONTROLS Heating Blower Control Solid State Time Operation Burners(Monoport) 2 2 3 1 3 3 4 Gas Connection Size 1/2in.NPT GAS CONTROLS - ,- Mir. WhiteRodgers Gas Valve(Redundant) Min.inlet pressure(In.W.C.) 4.5(Natural Gas) Max,inlet pressure 13.6(Natural Gas) (In.W.C.) Ignition Device Hot Surface Factory installed orifice Size 43 BLOWER DATA Direct Drive Motor HP 1/3 1/2 1/3 3/4 3/4 1/2 Motor Full Load Amps 4.4 6.4 4.4 8.8 8.8 6.8 RPM(Nominal)Speeds 1050-5 1050-5 1050-5 1050-5 1050-5 1050-5 Blower Wheel Diameter x Width -In.(mm) 10 x 6 10 x 8 11 x 8 11 x 8 10 x 10 11 x 8 (254 x 152) (254 x 203) (279 x 203) (279 x 203) (254 X 254) (279 x 203) * 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 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 for the as-shipped speed tap.For air delivery above 1800 CFM,see Air Delivery table for other options.A filter is required for each return-air supply.An airflow reduction of up to 7 percent may occur when using the factory-specified 4-5/16-in.(110 mm)wide, high efficiency media filter. ** Time-delay type is recommended. ICS Isolated Combustion System 2 SPECIFICATIONS (continued) UNIT SIZE 48ME021 60ME021 60090E024 60110EC21 60110ED24 6013SE024 60155E024 RATINGS AND PERFORMANCE Input Btuh* All Standard 88,000 88,000 88,000 110,000 110,000 132,000 154,000 All Low NOx Upflow Nonweatherized All Low Nox 84,000 84,000 84,000 105,000 105,000 126,000 147,000 ICS Downflow/Horizontal Output Capacity All Standard 72,000 71,000 72,000 90,000 90,000 107,000 125,000 (Btuh)t All Low NOx Upflow Nonweatherized All Low Nox 68,000 68,000 69,000 85,000 86,00D 102,000 119,000 ICS Downflow/Horizontal AFUEt 80.00 80.00 80.00 80.00 80.00 80.00 80.00 Certified Temperature Rise Range*F(*C) 35-65 25-55 30-60 30-60 30-60 40-70 45-75 (19-36) (14-30) (17-33) (17-33) (17-33) (22-39) (25-41) Certified External Static Heat/Cool 0.15/0.50 0.15/0.50 0.15/0.50 0.20/0.50 0.20/0.80 0.20/0.50 0.20/0.50 Pressure Airflow CFM# Heating 1418 1650 1565 1890 1930 1760 1995 Cooling 1445 1960 1960 2040 2005 1810 1965 ELECTRICAL Unit Volts-Hertz-Phase 115-60-1 Operating Voltage Min-Max 104-127 Range Maximum Unit Amps 8.3 13 10.3 13.4 10.7 10.7 10.7 Unit Ampacity 11 16.90 13.50 17.40 14 14 14 Maximum Wire Length(Measure 1 Way in 33(10.1) 34(10.4) 27(8.2) 33(10.1) 26(7.9) 26(7.9) 26(7.9) Ft(M)) Minimum Wire Size 14 12 14 12 14 14 14 Maximum Fuse or Ckt Bkr Size(Amps)" 15 20 20 15 20 20 20 Transformer(24v) 40va External Control Heating 12va Power Available Cooling 35va Air Conditioning Blower Relay Standard CONTROLS Heating Blower Control SolidState Time Operation Burners(Monoport) 4 4 4 5 5 6 7 Gas Connection Size 1/2in.NPT gaAS CONTROLS Mfr. W h iteR odge rs Gas Valve(Redun- Min.inlet pressure 4.5(Natural Gas) dant) (In.W.C.) Max.inlet pressure 13.6(Natural Gas) (In.W.C.) Ignition Device Hot Surface Factory installed orifice Size 43 SLOWER DATA Direct Drive Motor HP 1/2 1 34 1 3/4 314 14 Motor Full Load Amps 6.80 11.50 8.80 11.50 8.80 8.80 8.80 RPM(Nominal)Speeds 1050-5 1050-5 1050-5 1050-5 1050-5 1050-5 1050-5 Blower Wheel Diameter x Width-In.(mm) 10 x 10 11 x 11 11 x 11 11 x 11 11 x 11 11 x 11 11 x 11 (254 x 254) (279 x 279) (279 x 279) (279 x 279) (279 x 279) (279 x 279) (279 x 279) * 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 Table F.4 or furnace installation instructions. t Capacity in accordance with U.S.Government DOE test procedures. # Airflow shown is for bottom only return-air supply for the as-shipped speed tap.For air delivery above 1800 CFM,see Air Delivery table for other options.A filter is required for each return-air supply.An airflow reduction of up to 7 percent may occur when using the factory-specified 4-5/16-in.(110 mm)wide, high efficiency media filter. ** Time-delay type is recommended. ICS Isolated Combustion System 3 MODEL NUMBER NOMENCLATURE 1 2 3 4 6 8,7 8-10 11 12-13 14 15 16 Heel Maur awfrlp Ynrepe MFnar f3e1rl1per TWN0K APUEM(At HNft Oft= Bales CCws*OK Heat Input Mebr Type W10 If yfleee) Unused Serles Y 8 7 M B 42 DR] C 17 A A C.Corn.Variable- 8.Bali Speed L—, f!-9Wx 0.80% CoreW Airflow 80%low Nor (VGA)!CM 14:142A.11 t7Vl8dtr LeawyLko &Fbad-Spseds 17=17-T - 2=p-101. 2.%% Cmlamm Torque 21.21-(r 3=UN M tow Nst 5.96% (FCT)ECM 24.24B 24-800 CFM B=EVrltlm e•98% V.VerlaNe-Spaed 7.9M 36=1200CFM 020-28.W0BTUM M-ModWemp A 30=1200 CFM 040-40 000 MT h (VCT)El Torque B 9fA6 B 42-1400 CFM (VCTJ ECM 5-51nae Smile Of10-80.Oo0 B rUM 7-Two fta C 48.1 e00 CFM _ 0 W 2000 CFM — 88.22m CFM Al9W42 For California Residents: For installation in SCAQMD only:This furnace does not meet the SCAQMD Rule 1111 14 ng1J NOx emission limit,and thus is subject to a mitigation fee of up to$450.This furnace is not eligible for the Clean Air Furnace Rebate Program:www.CleanAirFumaceRebate.com FURNACE COMPONENTS INDUCER MOTOR VENT ASSEMBLY ELBOW MAIN LIMIT SWITCH PRESSURE — (BEHIND GAS VALVE) SWITCH BLACKED VENT SWITCH FLUE COLLECTOR BOX + c � FLAME r SENSOR GAS VALVE D el O 0 0 MANUAL RESET GAS MANIFOLD LIMIT SWITCHES A HOT SURFACE IGNITOR O 6 GAS BURNER BLOWER DOOR SAFETY SWITCH D FURNACE CONTROL BOARD m BLOWER AND MOTOR A �Ll Q e A190086 NOTE: The 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. 4 ACCESSORIES DESCRIPTION PART NO. 36041 E014 3BD45EO17 36070EO14 3B070E017 48070E021 42090EO17 KGBFR0401B14 X X External Bottom Return Fitter Rack KGBFR0501B17 X X X KGBFROB01B21 X KGAWF1306UFR X X X X X Unframed Filter 3/4-in.(19 mm) KGAWF1406UFR X Flue Extension KGAFE0112UPH X X X X X X Combustible Floor Base KGASBO201ALL X X X X X X Dowrtftow Vent Guard KGBVG0101 DFG X X X X X X Vent Extension Kit KGAVE0101DNH X X X X X X KGACA02014FC X X X X X X Chimney Adapter Kit KGACA02015FC Natural-to-Propane Conversion Kk* AGAGCBNPS01A X X X X X X Propane-to-Natural Conversion Kit AGAGCBPNS01A X X X X X X Blower Speed Tap Jumper Kit AGABLRJMP10A X X X X X X (10 pack) *Factory-authorized and field installed.Fuel conversion kits are CSA(formerly AGA CGA)recognized. X=Accessory DESCRIPTION PAFrt NO. 48090E021 6OD90EO21 60090E024 60110E021 60110EO24 6013SE024 60155EO24 KGBFR0601B21 X X X External Bottom Return Filter KGBFRO701 B24 X X X X Rack KGAWF1406UFR X X X KGAWF15MFR X X X X KGAWF1406UFR X X X Unframed Fiter 3/4 n.(19 mm) KGAWF1506UFR X X X X Flue Extension KGAFE0112UPH X X X X X X X Combustibe Floor Base KGASBO201ALL X X X X X X X Downflow Vent Guard KGBVG01010FG X X X X X X X Vent Extension Kit KGAVE0101 DNH X X X X X X X KGACA02014FC X X X X X Chimney Adapter Kit KGACA02014FC X X Natural-to-Propane Cornrerskm AGAGC8NPS01A X X X X X X X Kit* Propane-to-Natural Conversion AGAGCBPNS01A X X X X X X X Kit Blower Speed Tap Jumper Kit AGABLRJMP10A X X X X X X X (10 pack) *Factory-authorized and field Installed.Fuel conversion kits are GSA(forrnedy AGA(CGA)recognized. X=Accessory ORIFICES LH32DB207 LH32DB202 LH32DB200 LH32DB205 LH32DB208 LH32DBO78 See Installation Instructions for model, Gas Orifice LH32DBO76 altitude,and heat value usages. LH32DB203 LH32DB201 LH32DB206 LH32DB209 LF132DB210 5 ACCESSORIES (continued) DESCRIPTION ACCESSORY HUMIDIFIER Model HUM HEAT RECOVERY VENTILATOR Model HRV ENERGY RECOVERY VENTILATOR Model ERV UV LIGHTS Model UVL Bryant has a wide variety of thermostats for your system,please visit www.Bryant.com to see all thermostat and IAQ products. DESCRIPTION ACCESSORYLim Bryant Carbon Monoxide Alarm(10 pack) COALMBBNRB02-A10 X X X X Bryant Evolution Air Purifier-16x25(407x635 mm) DGAPAXX1625 X X Bryant Evolution Air Purifier-20x25(508x635 mm) DGAPAXX2025 X X Bryant Evolution Air Purifier Repl.Filter-16x25(407x635 mm) GAPBBCAR1625-A05 X X Bryant Evolution Air Purifier Repl.Filter-20x25(508x635 mm) GAPBBCAR2025-A05 X X Cartridge Media Filter-16"(407 mm)(MERV 11) FILXXCAR0116 X X Cartridge Media Filter-16"(407 mm)(MERV 8) FILXXCAR0016 X X Cartridge Media Filter-20"(508 mm)(MERV 8) FILXXCAR0020 X Cartridge Media Filter-20"(508 mm)(MERV11) FILXXCAR0120 X Cartridge Media Filter-24"(610 mm)(MERV 8) FILXXCAR0024 X Cartridge Media Filter-24"(610 mm)(MERV11) FILXXCAR0124 X EZ Flex Cabinet Side or Bottom-16" EZXCAB--0016 X X EZ Flex Cabinet Side or Bottom-20" EZXCAB--0020 X X EZ Flex Replacement Filters 16" MERV 10 EXPXXFIL0016 X X EZ Flex Replacement Filters 16" MERV 13 EXPXXFIL0316 X X EZ Flex Replacement Filters 20" MERV 10 EXPXXFIL0020 X EZ Flex Replacement Filters 20" MERV 13 EXPXXFIL0320 X EZ Flex Replacement Filters 24" MERV 10 EXPXXFIL0024 X EZ Flex Replacement Filters 24" MERV 13 EXPXXFIL0324 X EZ-Flex Fifter with End Caps-16"(407 mm)(MERV 10) EXPXXUNV0016 X X EZ-Flex Filter with End Caps-16"(407 mm)(MERV 13) EXPXXUNV0316 X X EZ-'Flex Filter with End Caps-20"(508 mm)(MERV 10) EXPXXUNV0020 X EZ-Flex Filter with End Caps-20"(508 mm)(MERV 13) EXPXXUNVO320 X EZ-Fiex Filter with End Caps-24"(610 mm)(MERV 10) E)(PXXUNV0024 X EZ-Flex Filter with End Caps-24"(610 mm)(MERV 13) EXPXXUW0324 X Media Finer Cabinet-20" FILCABXL0020 X Media Filter Cabinet-24" FILCABXL0024 X Media Filter Cabinet-16" FILCABXL0016 X X TYPICAL WIRING SCHEMATIC ---- FIELD 24-V WIRING ---- FIELD 115-,208/230-,460-V WIRING - FACTORY 24-V WIRING FACTORY 115-V WIRING NOTE 2 THERMOSTAT FIVE WIRE w e a G r TERMINALS FIELD-SUPPLIED THREE-WIRE DISCONNECT HEATING-ONLY I I BLOWER DOOR SWITCH I I I 460-V 0-OR I I -- -- 460-V THREE eM e_ Q ' i i r _-�__------ PHASE ---i--' I l C -- ------__ O I I l N i -- ---1 208/230-V - 7GND GND T _ ' __ __L SINGLE R G ---L-------i Ft- ►i I PHASE 115-V FIELD- AUXILIARY _ __ SUPPLIED J-BOX ® --- ___! i -_--- DISCONNECT Y ____NOTE 1 ; I CONDENSING --------------- UNIT 24-V TWO TERMINAL WIRE BLOCK FURNACE NOTES: 1. Connect Y-terminal in furnace as shown for proper blower operation. 2. Some thermostats require a"C'terminal connection as shown. 3. If any of the original wire,as supplied,must be replaced,use same tvoe or eauivalent wire. Representative drawing only,some models may vary. Ais0079 6 AIR DELIVERY - CFM (With Filter) Wire Test Airflow Delivery @ Various External Static Pressures Furnace Lead Function Color 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 ray Cooling.Do not use for heating. 115 7 e ow t Cooling or aft HeFt—ing 980 45 920 890 855 815 77 735 690 45 36045EO14 range Alt Cooling or at Heating 770 72 6 5 64 60 560 52 475 430 385 ue Heating or at Cooling 710 660 580 540 4 455 415 375 335 Red Alt Cooling.Do not use for heating. 0 540 500 455 415 5 345 305 235 - ray Cooling.Do not use for heating. 1370 1335 1295 1255 1215 1175 1135 1095 1055 1020 e ow Alt Cooling or a t Heating 1130 1085 1040 995 955 91 5 825 78 73 36045E17 range Alt Cooling or at Heating 930 885 835 795 745 70 55 6Q 545 4 5 ue eating or a# oo Ing 7 7 670 625 0 515 460 410 355 300 Red Alt ooing. o not use for heating. 6 Q 5 445 375 26 135 - - ray Cooling.Do not use or eating. 1 5 4 1 1 1925 885 ue Heating or at Cooling P715 10 10 995 960 25 885 40 800 735 36070EO14 ellow t Cooling or at eating 845 805 765 7 685 20 560 51 range t oo Ing. o not use or heating. 50610 5755 04 5410380305 245 e t oo Ing. o not use or heating. 490 445 375 15 7 2 5 230 190 140 ray oo ing. o not use or eating. 1-4 1 55 t ooing or at eating 940 995 80 750 695 650 600 555 36070E17 Heating or all Cooling 990 935 895 845 790 740 690 640 590 535 rangeAlt Cooling or at eating 855 775 720 660 605 495 435 385 5 e t Cooling. o not use or eating. 860 5 515 445 5 340 275 205 - - ray Cooling.Do not use for eating. 7 5 4 4 14 14 5 1 39U- Yellow Alt Cooling or at Heating 1480 1435 1395 1340 12 00 1240 1190 1135 1 85 10 48070EO21 ue eating oral ooing 1 15 1 75 1225 1180 1135 1085 10 0 75 915 8 -ffrange Alt Cooling or all Heating 1135 1080 1030 985 935 885 835 770 705 645 e t Cooling.Do not use for heating. 80 930 875 820 775 7 5 5 555 530 455 Gray I Cooling.Do not use for heating. 1 55 1 2 1285 45 1210 11 5 11 5 1080 1025 815 W ow Alt Cooling or at Heating 1 5 1 55 122 1185 1140 11 1 55 1005 955 815 42090EO17 Blue eating or all Cooling -1-2-2r 1185 7171-5771=5 1065 1025 975 915 840 740 range Alt Cooling or all Heating 1030 985 940 900 45 7 0 715 655 5 5 e t Cooling.Do not use for heating.N1425 905 855 80 750 67 0 540 490 435 Gray Cooling. o not use or eating. 1580 15 5 1490 1445 1 95 1340 1260 1135 995 e ow t Cooling or all eating 1380 1335 1290 1235 1 51 251 75 1020 640 48090E021 ue eating or at ooing 5 1 5 1 5 4range t ooing or at eating 1 1 1160 11 5 1050 99 35880820 755 e t oo Ing. o not use or eating. 4 980 5 845 78 7 50 5 5 520 ray Cooling.Do not use for heating. 2180 2130 2080 2030 1 1980 1925 1870 05 1745 1680 Ye ow Alt Cooling or a t Heating 190 1845 1795 1740 1685 1635 157 1500 1435 1375 60090E021 ue eating or a t oo Ing 1 1 5 5 49r_= 1320 1260 1200 114 Orange Alt Cooling or a t Heating 1390 1315 1240 1175 1095 1 70 900 8 5 -T6-0— Red Alt Coo Ing. o not use for heating. 124 1155 i 75 990 915 5 765 9 615 555 ray Cooling.Do not use for heating. 1 2135 075 2 15 1 1 0 1835 1775 1705 1630 e ow Alt Cooling or a t Heating 1 70 181 1745 1685 1 25 1565 1495 1420 1345 1280 60090E024 ue eating or a t Cooling 15 445 1385 1 5 7 range t Cooling or a t eating 1305 1220 1160 1075 1000 93 5 77 1 e t Cooling. o not use or eating. 1210 1 75 915 845 765 675 595 515 4 5 Gray Cooling, o not use or eating. 2255 5 21 1 04 1 5 1 1835 1735 1615 ue eating or at Cooling 1945 1 90 183Q 1770 1715 1 55 i 1545 148 1 60110E021 Alt Cooling or at eating 1600 1525 1465 4 5 1275 1210 11501 range t oo Ing.Do not use or eating. 14 1340 1280 1200 1140 1065 1005 925 865 790 eAlt Cooling.Do not use for heating. 1 0 1 05 1140 1 55 990 910 840 760 695 630 Gray Cooling.Do not use for heating. 256--T17 W 713-0 2070 20 5 1950 1885 1 20 1755 1685 ue eating or a t Cooling 1995 1 1 5 1800 1740 1 7 1 5 1535 1465 1400 60110E024 a ow Alt Cooling.Do not use for heating, 1540 1460 17=7=5 1 55 range Alt Cooling or at eating 1345 1195 11 5 1055 9$0 2 45 770 695 620 e t Cooling.Do not use for heating. 1335 1075 965 890 820 7-5 5 580 555 4To— Gray Cooling.Do not use for heating. 2065 5 1940 1875 1810 1740 1670 1600 1530 1470 ue Heating or a t Cooling 18 5 17 16 5 1630 1560 1490 142 135 1 75 1 5 60135EO24 a ow t Cooling or a t eating 77 M_ 1555 4 4 4 1 11 range Alt Cooling.Do not use for heating. 1620 1550 1480 1405 1335 12 11 5 1 30 77675 5 e t Cooling.Do not use for heating. 1325 1265 7165— 11 715T57 955 885 5 735 670 ray oa ing. not use for heating. 2205 2150 2090 2030 1965 1 5 1 4 17 1710 1 5 ue eating or at Cooling 2055 19 5 1935 1875 -TF10--77'gU--l-99(7--1-915-79TO--7460 60155EO24 a ow Alt Cooling or at eating 1 Pr 1 147 1 1 range Alt Cooling.Do not use or heating. 1495 1 1 55 1 85 121 11 1 5 995 930 850 Red Alt Cooling.Do not use for heating. 1295 1085 10 910 835 7 670 5 er is require o eeac i return-air inlet.Purtlow performance included 3/4-in,It 9 mm was a e I er me la suc as RTri­tainei I in factory-aut or¢e accessory filter rack.To determine airflow performance without this filter.assume an additional 0.1 in.W.C.available external static pressure. 2. Adjust the blower speed tabs as necessary for the proper air temperature rise for each installation. 3. --Indicates unstable operating conditions. 4. if the same motor speed tap is needed for heating and cooling,a Jumper Wre accessory kit is available(see Product Data sheet for the current Jumper Wire accessory part number).see Function column for applicable limitations. 7 111111 W Q 1' z , SEE NOTES 1,2,4,5,7,8,9 SEE NOTES 1,2,4,5,7,8,9 HORIZONTAL RIGHT A02068 HORIZONTAL RIGHT A02070 1' O ( I I II F_I I i SEE NOTES 1,2,4,7,8,9 HORIZONTAL RIGHT A02069 u�ul W 'I II �� lill II O O Q Q .1 SEE NOTES 1,2,4,7,8,9 SEE NOTES 1,2,4,5,7,8,9 HORIZONTAL LEFT HORIZONTAL LEFT A02064 A02065 uiu-u! 1 1 F 0 0 Q Q .1 ,1 SEE NOTES 1,2,4,5,7,8,9 SEE NOTES 1,2,4,5,7,8,9 HORIZONTAL LEFT HORIZONTAL LEFT A02066 A02067 8 X i I II A Fi-- i i I II /CI I X I O rig . C C o 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 A02061 uuu- I I I _ I I I I I I I I I I I I I I 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 JNFPA 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 wail vent connector joints with(3)corrosion-resistant screws spaced approximately 120' apart. Secure Type B vent connectors per vent connector manufacturer's recommendations. 9 DIMENSIONS J - CID a 1 Ill]Illl] � r _ µ 8R �� li II g I I rs i( A190084 C - - TOP AND D VENT A B BOTTOM FLUE BOTTOM CONNECTION SHIP WT.LB. FURNACE SIZE CABINET WIDTH OUTLET WIDTH COLLAR INLET WIDTH SIZE (KG) 36045E14 14-3/16(360) 12-9116(319) 9-5/16(237) 12-11/16(322) 4(102) 104(47) 36045E17 17-1/2(445) 15-7/8(403) 11--9116(294) 16(406) 4(102) 119(54) 3607OE14 14-3/16(360) 12-9/16(319) 9-5/16(237) 12-11/16(322) 4(102) 114(52) 36070E17 17-1/2(445) 15-7/8(403) 11-9/16(294) 16(406) 4(102) 120(54) 4807OE21 21 (533) 19-3/8(492) 13-5/16(338) 19-1/2(495) 4(102) 142(64) 42090E17 17-1/2(445) 15-7/8(403) 11-9/16(294) 16(406) 4(102) 131 (49) 48090E21 21 (533) 19-3/8(492) 13-5/16(338) 19-1/2(495) 4(102) 137(62) 6009OE21 21 (533) 19-3/8(492) 13-5/16(338) 19-1/2(495) 4(102) 140(64) 6009OE24 24-1/2(622) 22-7/8(581) 15-1/16(383) 23(584) 4(102) 146(66) 6011OE21 21 (533) 19-3/8(492) 13-5/16(338) 19-1/2(495) 4(102) 146(66) 601IOE24 24-1/2(622) 22-7/8(581) 15-1/16(383) 23(584) 4(102) 161 (73) 60135E24 24-1/2(622) 22-7/8(581) 15-1/16(383) 23(584) 4(102) 167(76) 60155E24 24-1/2(622) 22-7/8(581) 15-1/16(383) 23(584) 4(102) 168(76) *135 and 155 size furnaces require a 5 or 6-in. (127 or 152 mm)vent. Use a vent adapter between furnace and vent stack. See Installation Instructions for complete installation requirements. 10 GUIDE SPECIFICATIONS Gas Furnace Casing 800SA/801SA Casing shall be of .030 in. (.76) thickness minimum, pre-painted steel. General Inducer Motor SYSTEM DESCRIPTION Inducer motor shall be soft mounted to reduce vibration transmission. Furnish a fixed capacity gas-fired Draft Safeguard Switch furnace for use with natura gas or propane (factory Draft Safeguard Switch (blocked vent safeguard) shall authorized conversion kit required for propane); furnish be factory installed to reduce the possibility of vent gas cold air return plenum. infiltration due to a blocked or restricted vent pipe. QUALITY ASSURANCE Heat Exchangers Unit will be designed, tested and constructed to the Heat exchangers shall be a 4-Pass 20 gage aluminized current ANSI Z 21.47/CSA 2.3 design standard for steel fold-and-crimp sectional design when applied operating g under negative pressure. gas-fired central furnaces. Controls Unit will be 3rd party certified by CSA to the current ANSI Z 21.47/CSA 2.3 design standard for gas-fired Control shall include a micro-processor based central furnaces. integrated electronic control board with at least 11 service Unit will carry the CSA Blue Star@ label. troubleshooting codes displayed via enhanced flashing LED diagnostic light on the control,a self-test feature that Unit efficiency testing will be performed per the current checks all major functions of the furnace within one DOE test procedure as listed in the Federal Register. minute, and a non-volatile memory replaceable Unit will be certified for capacity and efficiency and automotive-type circuit protection fuse. Multiple listed in the latest AHRI Consumer's Directory of operational settings available including, separate blower Certified Efficiency Ratings. speeds for heating, cooling and continuous fan. Unit shall carry the current Federal Trade Commission Continuous fan speed may be adjusted from the Energy Guide efficiency label. thermostat.Cooling airflow will be selectable between 350 or 400 CFM per ton of air conditioning. DELIVERY. STORAGE AND HANDLING Unit shall be shipped as single package only and is OPERATING CHARACTERISTICS stored and handled per unit manufacturer's Heating Capacity shall be Btuh input; recommendations. Btuh output capacity. Fuel Gas Efficiency shall be 80% AFUE. Air delivery WARRANTY(for inclusion by sneci ,ing engineer) shall be CFM minimum at 0.50 In. W.C. Warranty certificate available upon request. external static pressure.Dimensions shall be: depth in. (mm); Products width in. (mm); height in. (mm) (casing only). Height shall be in. (mm) with EQUIPMENT A/C coil and in. (mm) overall with Components shall include: slow-opening gas valve to plenum. reduce ignition noise, regulate gas flow, with electric ELECTRICAL REQUIREMENTS switch gas shut-off; flame proving sensor, hot surface igniter, pressure switch assembly, flame rollout switch, Electrical supply shall be 115 volts, 60 Hz, blower and inducer assembly, 40va transformer; single-phase (nominal). Minimum wire size shall low-voltage(heating)(heating/cooling)thermostat. be AWG; maximum fuse size or circuit breaker Blower Wheel and Blower Motor shall be Amps. Galvanized blower wheel shall be centrifugal type, statically and dynamically balanced. Blower motor of SPECIAL FEATURES fixed-speeds, constant torque ECM type shall be Refer to section of the product data sheet identifying permanently lubricated with sealed bearings, of accessories and descriptions for specific features and hp, and shall be multiple-speed direct drive. available enhancements. Blower motor shall be soft mounted to the blower scroll to reduce vibration transmission. Filters Furnace may have reusable-type filters. Filter shall be in. (mm) (x) in. (mm). An accessory hig�iciency Media Fi this available as an option. Media Filter. 11 02019 Bryant Heating&Cooling Systems 731 O W.Morris St Indianapolis,IN 46231 Edition Date:04/19 Catalog No. PDSOOOSA-02 Marrulacturer reserves the right to arscontinue,or change at any time,specitications or designs without notice and without incurring coligations. Replaces. PDSBDOSA-01 12 � .. i� .•y41:r'Ipy 9S' 1ie„+ f{ .? ��il"s — t.i`'."t^�fi .. - 1•Seii Auj(f vG .4 k ^ fh.•`•«.!�� .[ Ali `...grray y wW 1:1 � NT: r1J i,. 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ADVAN-4 IDw BM CERTIFICATE OF LIABILITY INSURANCE DATE{MMiD6lY0 10I27/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) 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 endorsements. PRODUCER 845-278-7070 JACT Brendan Mulvihill Feehan insurance Agency PHONE 845-278-7070 FAX 845-27$-2886 P.O.Box 870 ac,No,Ext: A/C No Carmel,NY 10512 brendanm@feehan nsurance.com Brendan Mulvihill INSURE S AFFORDING COVERAGE NAIC 9 INSURERA:Selective Insurance Company 12572 INSURED INSURER 8: Advanced Heating&Air Conditioning P$r9OX 296 INSURER C Carmel,NY 10512 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTRTYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF -POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 11000,000 EACH OCCURRENCE CLAIMS-MADE ❑X OCCUR X 2399554 05/08/2020 05/08/2021 PREMISESDAMAGE TO RENTEDoccurre $ 500,000 VIED EXP IAMI oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 rX1 POLICY j F-] LOC PRODUCTS-COMPIOPAGG $ 3,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY Per reon $ OWNED SCHEDULED AUTOS ONLY AUUTNOSWNEp BOOqDILY INJURY Per eoddent S AUTOS ONLY AUTO ONLY PPorr aarE.dRZt AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS WORKERS COMPENSATION PER LITE OTH- AND EMPLOYERS'LIABILITY Y I N ISTAT ER ANY PR ROPR IET gO ER/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ (Nand Cory n NHj EXCLUDED? NIA I E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) THE CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INUSRED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING ST Port Chester,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) D 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) f b.Business Telephone Number of Insured ADVANCED HEATING&AIR CORP 845-821-3301 PO BOX 296 CARMEL,NY 10512 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 061224300 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) HARTFORD INSURANCE COMPANY VILLAGE OF RYE BROOK 938 KING ST 3b. Policy Number of Entity Listed in Box"ia" PORT CHESTER,NY 10573 16WECAG3E6V3c. Policy effective period 05/08/2020 to 05/08/2021 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partnerslofficers included) ®excluded.(Only check box if all partners/officers excluded) This certifies that the insurance carrier indicated above in box"T'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"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: Matthew Feehan (Print name of authorized representative or licensed agent of insurance carrier) Approved by: // LQ I.u- 1012712020 (Signature) (Date) Title: Principal Telephone Number of authorized representative or licensed agent of insurance carrier: 845-278-7070 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-145.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov