HomeMy WebLinkAboutMP20-173 40* anniuema W
VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
www.tyebtook.org
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Michael J. Izzo
Stephanie J. Fischer
David M. Heiser
Salvatore W.Morlino
CERTIFICATE OF COMPLIANCE
September 20,2022
Scott Plasky&Nicole Plasky
19 Woodland Drive
Rye Brook,New York 10573
Re: 19 Woodland Drive, Rye Brook,New York 10573
Parcel ID#: 135.44-1-73
This document certifies that the work done under Mechanical Permit#20-173 issued on 11/10/2020 for the
installation of a new oil fired boiler has been satisfactorily completed.
Sincerely,
0� 7�--
Michael J. Izzo
Building&Fire Inspector
/to
BUILDING DEPARTMENT
❑BUILDING INSPECTOR
,,,O-ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAx (914) 939-5801
www ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - -- - - - - - - -
^ '
ADDRESS: , � ,�-�i 1� � DATE• -2-0 Z-Z
PERMIT# t ! 'Z� ISSUED: `UZI SECT: IS� 'LOCK: LOT:
LOCATION: �" ` OCCUPANCY: --2I 6
❑ VIOLATION NOTED THE WORK IS... ff, 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
pIMENSIONS
STANDARD EQUIPMENT:
,..... ■ Factory Tested and Assembled
Cast Iron Section Assembly
(jacket and collector hood are
not assembled on 7,8,and 9
section blocks)
■ Insulated Steel Jacket
N ► ■ Aluminized Steel Flue Collector
s,a. A.WGO From B•ck Hood with Flue Cap on Top
0 oC y a Outlet(convertible to rear outlet)
Q / r' Q ; ■ Swing-Away Burner
°0 �; J144 % Mounting Door
■ Refractory Blanket and Target
Alternate return-"A"units only Wall in Combustion Area
E� 'h Pressure/temperature gauge
■ Circulator(when ordered)
H Drain Valve
Sizes 2-4: Taco 007e
L I High limit/circulator control
N '.; Piping to expansion tank or automatic air vent Sizes S-6:Taco 007
R, Relief valve ■ High Limit Control with Circulator
Relay, LWCO Function,and
integrated service switch
Supply°C"(inches) Olmonslon(Ittelus) ■
Two Vent Pipe Brackets
/ Dm 300 S;o ■ Pressure/Temperature Gauge
r° d Q 1111114 v ■ 30 PSIG ASME Relief Valve
'- (boiler sections tested for 50
WGO-2 1'/.(circulator flange) 1'/2 1'/2 to Y2 13 3i. PSIG working pressure)
WGO-3 1 1'/.(circulator flange) i t lh 114 13 K I 16% ■ Drain Valve
WGO-4 j 1'/.(circulator flange) 1'/, 11/1 13% 16 r/. ■
Barometric Damper
wGo-s I 1 v.(circulator flange) 1'/, 1 b4 16% � 20 ■ Built-in Air Separator
WGO-6 1'4(circulator flange) 1'h 1'/2 20 231/6
WGO-7 not applicable 134 134 23% 2r.%
WGO-8 not applicable 1's 1'/2 26114 ' 29 V.
wc0-9 not applicable j 1t4 IV, 293G 32% OPTIONAL EQUIPMENT:
RATINGS
■ High-Efficiency Flame-Retention
Burner AHRI Minimum Oil Burner(Beckett AFG,Carlin
Input Certified Chimney EZ or Riello).Specify 2-Stage Fuel
/ Rating Ratings /s size Unit(optional)if Required.
`1 �? ��� Q ■ Vent Damper Kit
�,� ����� �� /sue e� ! }ram ■ W-M S&10 Year Homeowner
%m m �J ��$; c^ Q_d Protection Plan
r °m ■ W-M Indirect-Fired Water Heaters
WG0-2RD 0.70 98 86 75 87.0 .010 8X8 s 15 140 NOTES:
wco-2 0.70 98 SG 75 86.4 010 8X8 6 15 540 Add"P-for packaged boiler(WGO-
WG0-3RD 0.80 112 98 85 87.0 j .010 8X8 6 1S 595 2 through WGO-6 only).Add"A" for
WGO-3 0.96 133 115 I 100 185.3 I .020 8X8 I 6 15 S95 boiler only(WGO-2 through WGO-9).
WGO-4RD 1.00 140 123 107 87.0 .010 8X8 6 1S 64S (1) No. 2 fuel oil-Commercial Standard
WGO-4 1.20 168 145 I 126 85.0 + .010 8X8 6 15 i 645 Specification CS75-56. Heating value
WGO-SRO 1.20 168 148 129 87.o I .015 8X8 7 15 'I. 760 of oil-140,000 BTU/Gal.
(2)Based on standard test procedures
wco-s 1.45 203 175 152 85.0 I .015 8X8 7 15 760
prescribed by the United States
WGO-6RD 1.40 196 173 160 87.0 i .01S 8X8 7 1S 960 Department of Energy at combustion
WGO-6 1.75 245 212 184 8S.0 .015 8X8 7 1S 860 condition of 13.5%CO2 and-0.02"
WGO-7RD 1.60 224 191 171 87.0 i .015 8X8 8 15 930 W.C.draft.
wco-7 2.00 280 242 1 210 i 85.0 .015 8X8 8 ! 15 930 (3)MBH refers to thousands of BTU
wco-8 2-10 322 266 1 231 .025 8X12 8 20 1030 per hour.
I { wGO-9 ,2.S5 1 357 295 I 257 ( - .030 ; 8X12 8 j 20 1135 (4) Net AHRI ratings are based on net
'ENERGY STAR'compliant with Version 3.0 Baler Specification of 87%AFUE only when installed installed radiation adequate for the
at the reduced burner rate(R)and with the optional vent damper kit(D)-Burners shipped with requirements of the building,including
standard rate nozzle.reduced rates achieved through nozzle change-refer to burner instructions or a piping and pickup allowance of
boiler's rating label for correct selection. 1.15-sufficient for normal conditions.
In the Interest of continual improvements in product and performance.Weil-McLain reserves Provide additional allowance only for
the right to change specifications without notice. unusual piping and pick up loads.
rr�
WMI90S_BR0_018_WGO � Sr DOE
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ACCORD CERTIFICATE OF LIABILITY INSURANCE 704/20/2020
O/YYYY)
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. It
SUBROGATION IS WAIVED, subject to the terms and conditions of the polity, certain policies may require an endorsement. A statement on this
certificate does not confer rights to the certificate holder In Ileu of such endorsements.
PRODUCER CONTACT
NA E: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX
HOME OFFICE: P.O.BOX 328 IA/C No Ent):888-333-4949 A/C H.:507-446-4664
OWATONNA, MN 55060 E•Doness:CLIEN CO CTCENTE EDI S.COM
INSURERS AFFORDING COVERAGE NAIC p
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 330.130.6 INSURER B;
WESTMORE FUEL COMPANY INCORPORATED INSURER C:
86 N WATER ST
GREENWICH,CT 06830.5886 INSURER D:
INSURER E;
INSURER F:
COVERAGES CERTIFICATE NUMBER:36 REVISION NUMBER:0
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 TYPE OF INSURANCE OL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
L INS WVD MIDDI Y Y MIDDI Y
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $11000,000
CLAIMS-MADE a OCCUR DAN PREIAISE TO:EEI TTID $100,000
MED EXP(Any ono parson) $5,000
A N N 9062815 06/01/2020 06/01/2021 PERSONAL&ADV INJURY $1,000,000
GE 'L AGOR OA E LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO-CT
X POLICY POT LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COIE,MBINED SINGLE LIMIT $1,000,000
X ANY AUTO BODILY INJURY(Par parson(
S
OWNED AUTOS ONLY CHEDULED
A AUTOS N N 9062815 06/01/2020 06/01/2021 BODILY INJURY(Par sccld,nQ
HIRED AUTOS ONLY NON•OWNEO PROPERTY DAMAGE
AUTOS ONLY
r
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $7,000,000
A EXCESS LIAR CLAIMS•MADE N N 9062816 06/01/2020 06/01/2021 AGGREGATE $7,000.000
DED I I RETENTION
WORKERS COMPENSATION OTH-
AND EMPLOYERS'LIABILITY Y Y/H X PER STATUTE ER
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT S500,000
A OFFICERIMEMBER EXCLUDE07 NIA N 9917566 06/01/2020 06/01/2021
(Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $500,000
II yet,describe under
DESCRIPTION OF OPERATIONS below E.I. DISEASE•POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be rthChad If more space It requlraa)
CERTIFICATE HOLDER CANCELLATION
330-130.6 35 0
VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
RYE BROOK,NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
4",
0 198W-2015 ACORD CORPORATION.All rights reserved,
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
YTW Workers' CERTIFICATE OF
STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE
la,Legal Name&Address of Insured(use street address only) Ib.Business Telephone Number of Insured
WESTMOREFUELCOMPANY INCORPORATED (203) 531-5656
330-130-6
86 NORTH WATER STREET to.NYS Unemployment Insurance Employer Registration Number of
GREENWICH, CT 06830-5886 Insured
Work Locatlon 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, 1.a., a Wrap-Up Policy) y
Number
06-0739367
I
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Federated Mutual Insurance Company
Village Of Rye Brook
938 King St 31b.Policy Number of Entity Listed in Box"1 a"
Rye Brook, NY 10573-1226 9917566
3c,Policy effective period
06/01/2020 to 06/01/2021
3d.The Proprietor, Partners or Executive Officers are
Included.(Only check box If all partnorslofficars Included)
® all excluded or certain partners/officers excluded,
This certifies that the insurance carrier indicated above in box"T'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 ZA
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".
Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if
cancelled for any other reason or If the insured Is otherwise eliminated from the coverage indicated on this certificate prior to the end of
the policy effective period? ®YES [:]NO
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, l 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: Amber Madrid
(Print name of authorized representative or licensed agent of Insurance carrier)
Approved by: 4/20/20
(Signature) (Date)
Title: Authorized Representative
Telephone.Number of authorized representative or licensed agent of insurance carrier: (888) 333-4949
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 (9-15)
www.wcb.ny.gov