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HomeMy WebLinkAboutBP20-247PERMIT # iJm aO-0?L17 DATE: // /q nQ EXP:ld/o/go/ SECTION a BLOCK I LOT 5'a TYPE OF WORK C310121f,it l IIV? Sheol b0Sehr)er,+ JOB LOCATION OWNER S`i `WC jDYQQY=: il.l m rY N LLB /W I'oZJiao CONTRACTOR 1 ►) S ' LJ� o� %EST COST l-_ FE L %,51 PA 1 CO # CD FEES (DId--Ab DATE TCO # FEE DATE INSPECTION RECORD FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING m RGH PLUMBING/ GAS SPRINKLER �-,/ ELECTRIC ISM LOW -VOLT F"'I/ ALARM Ltd AS BUILT L7 FINAL �'LE✓ TD,C� � t�z�\' Z r REQUIRED PRIOR TOY FINAL INSPECTION ece�v /0 �3 90 7slIrW cc e4. 512;gAs, t��'� • r � 3�/�� �� fir/ se �e C�r�...,^-� OTHER APPROVALS ARB BOT OTHER FINISHED BASEMENT NOT APPROVED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT THIS BUILDING MUST BE POSTED NfRH A PERMANENT CONSTRUCTION TYPE IDENTIFICATION SIGN; V PRIORTDTHEISSUUANCEOFA C/O, AS REQUIRED BY NY STATE LAW. 059 03 �a3- ©3 7 � � %�� ale va -for(forA -- cam- l 6Pc33 — /Oa�,��dr/oris� ��e�►-iC/ VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK > L; NO: 23-086 Certificate of ®ccupaurp This is to certify that dC R 8roc) I7/ers 4L 6 of, /�y/ .Byoo k' / V' 1 having duly filed an application on �0 20 requesting a Certificate of Occupancy for the premises known as, ZL60(f , Rye Brook,NY, located in a -Pub Zoning District and shown on the most current Tax Map as Section: I q.ZQ5 Block: J Lot: 5 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.C�YQ , issued 20U, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: if" 'pal-nIh-1 Construction: 'Clfor the following purposes: Jln* a'l"'�" i� / t , � 1 � S Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: FINISHED BASEMENT NOT APPROVED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,n all the building be moved from one location to another until a permit to accomplish such change I abeeni from th Bbild' nspector. MAY 2 6 2023 Building Inspector,Village of Rye Brook: Date: (QyF DR �. 19 L� 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.orgg TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morhno CERTIFICATE OF COMPLIANCE May 26,2023 SC Rye Brook Partners LLC c/o Warjam Group LTD 4 West Red Oak Lane Suite 325 White Plains,New York 10604 Re: 8 Jasmine Lane, Rye Brook,New York 10573 Parcel ID#: 129.25-1-1.52 Mechanical Permit#20-178 issued on 11/19/2020 for Fire Sprinkler System This certifies that the fire sprinkler system,installed under the above captioned permit,has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to tc�4.\aJJ V G C�CL + V C VV Vu�J 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.or TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 26,2023 SC Rye Brook Partners LLC c/o Warjam Group LTD 4 West Red Oak Lane Suite 325 White Plains,New York 10604 Re: 8 Jasmine Lane, Rye Brook,New York 10573 Parcel ID#: 129.25-1-1.52 Mechanical Permit#23-037 issued on 4/4/2023 for a New Residential Elevator This certifies that the three story residential hydraulic elevator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE QR 4" 19 Q JJVG'lI"W J VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 26,2023 SC Rye Brook Partners LLC c/o Warjam Group LTD 4 West Red Oak Lane Suite 325 White Plains,New York 10604 Re: 8 Jasmine Lane, Rye Brook,New York 10573 Parcel ID#: 129.25-1-1.52 This document certifies that the work done under Mechanical Permit #22-059 issued on 4/11/2022 for the installation of a new gas furnace,a new condenser and related ductwork has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to ' R.<i , For office use 9 Bw1.1N, ? � MENT PERMIT y7 REc [E �wF IAPR 10 2023 VILLA OF RYE OK ISSUED: /-/9 a o VILLAGE OF RYE BROOK 938 KING STRE �( YE BROOK, W YORK 10573 DATE: y—/o—o13 9 -0 o /p BUILDING DEPARTMENT ,� . �� FEE: � /D PAID 1W APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: 9 1BS pc fv k- 2 y 4 B 000IL N V 1 Q5 7"3 - kt-�1 Tft� 4'3 Occupancy/Use: S Parcel ID#: 1 2- Z5 ' I - k •5 PZ Zone: P k 7 Owner: S C 10 yq 0000V- PROT N4Q< (, tf Ad ress: ' V"�I b iL S'f�c Z N I -! f N` P.E./R.A.or Contractor: le�5 A� ess: Whit O b b tL LN,�'11 37-5 W N 1[A 'P "S Person in responsible charge: (N I Ll I AM 014 k L_ A dress: 4 PkST raO l4/C- LN STh 325 W u f—Jk FM t�S Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: w(L�I P,M (Z 1 k 1t L, being duly swom,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in S f k M GD P_7 ,in the County of 601 a 21%(&�lr_0 in the State of_Lf_,that (City/Towtv Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:5 61 gi 3. S D D• 0 U for the construction or alteration of rprAI(L I 60 r "' 1b S�C/YIrL�f Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-I O.A.of the Code of the Village of Rye Brook. Sworn to before me this i Sworn to before me this 4' d�ayl of AM,L_ , 20 2.3 day o AP�L-` , 20 2� Signature of Property Owner Signature of Applicant ,1 JJXX ktirt-4 l SARAHAARNDT Iyit.Lla" P—IlrgZ Print Name of Property Owner Notary Public-State of New York P' Name of Applicant NO.01AR6435014 n '— Qualified in Putnam County lcf" "j' At MY Commission Expires Jun 2t, 2026 Notary Public Notary Public �E Mcb, ID 1982 BUILDING DEPARTMENT UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- ` V + DATE' PERMIT# ISSUED: 1` $CT: ' BLOCK: LOT: LOCATION: OCCUPANCY:- 2 `V ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED 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 ❑ .,ROSS CONNECTION `;FINAL ❑ OTHER 2 BUILDING DEPARTMENT ILDING 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 :— DATE: _ T A t S PERMIT#\1 ISSUED: ` 1 ' \ LECT BLOCK: ' LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION n `� ` ( ❑ Natural Gas `� ❑ L.P. Gas Q Q p c4Vt�) (- k ❑ FUEL TANK C G l �C �\ \ ❑ FIRE SPRINKLER L3 k ❑ FINAL PLUMBING ❑ CROSS CONNECTION INAL ❑ OTHER �yE BRC�vk w � BUILDING DEPARTMENT UILDING 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:_ NPR `__ DATE: (-2-0 2 Z PERMIT#- r;'Z 0 Zy / ISSUED: SECT: BLOCK: LOT: LOCATION: > � ��" OCCUPANCY• Z� ❑ VIOLATION NOTED THE WORK IS... [ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION / REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E BRC�k. cu � 1982 BUILDING DEPARTMENT ,❑BUILDING INSPECTOR [1ASSISTANT 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 - - - - - - - - - - - - - - - - - - - - b-3 04� ADDRESS : c2< J A� DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: .r 1 =' ❑ VIOLATION NOTED THE WORK IS... ❑/ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING INSULATION �] NATURAL GAS —' ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��. BUILDING DEPARTMENT ❑BUjkDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK s` ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.or¢ - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - -1- - - - - - ADDRESS: DATE: t PERMIT# ISSUED: SECT: I I BLOCK: ' LOT: LOCATION: C 1 ` '�--- OCCUPANCY: �1 t ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ .INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER * o f * ✓ * * u 7-3 E, c � z v Q Q Q as ol C. Cd � � s v wx v * V crlp" ELiiz � y ►-1 w.- cb iv M � O * ** v ai .cz o O a �E BRCuk. w � 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: � f �V DATE: PERMIT# ISSUED: I CT: l BLOCK:LOT: S �- LOCATION: �.�n OCCUPANCY: C ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING qtQc7f (7, e c ❑ 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 QyE BR(�jk- 982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR /%SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STgEET•RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrookorg -- - - - - -- - - - - - - ------ INSPECTION REPORT - ---- - - - --_ - Lcc� ADDRESS_ (� DATE. PERMIT# �`� ISSUED: t SECT: Z- BLOCK:"LOT:-L,.� OCCUPANCY: L! ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPE TION n` n REQUIRED ' FOOTING' 'LREQUIREDy' W LJ 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 �E BR��, • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR -IPASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.aebrook.org - - - - - - -- - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— v ( C ,` -tom' DATE: Qp'ZL lj�(f PERMIT# "ISSUED 1 ` l SECT:BLOCK: LOT: LOCATION: OCCUPANCY: z� ❑ VIOLATION NOTED THE WORK IS... •Ef ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED FOOTING Q t2fln"j� ❑ 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 QyE BRC�� o`` tim 1982 BUILDING DEPARTMENT ❑ VILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - \nt ADDRESS l 1`' \ DATE: i PERMIT# 20 � � ISSUED: t SECT: ` ( BLOCK: LOT: � LOCATION: C� `.��l/{�- - OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING -�J+ ❑ INSULATION ❑ NATURAL GAS C V) ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL 'J�W:�OTHER QyE BR(��, O�` tim 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 : 1 � _ DATE: PERMIT# y`�k v ISSUED: L I ECT: 1 LOCK: I LOT: LOCATION: 1 1 l l �I OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER I QyE BRC��, O� Zm • 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: , �\� DATE: 01 PERMIT# �.�� l ISSUED: ` , ECT: ,Z5 LOCK: ' LOT: LOCATION: ��t`� ` --- OCCUPANCY: c ❑ VIOLATION NOTED THE WORK IS... d R ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION C ' ❑ NATURAL GAS ✓ \\ �' ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑:JOTHER �yE 4RC��. 1982 BUILDING DEPARTMENT ❑BWLDING INSPECTOR XAsSISTANT BUILDING INSPECTOR VILLAGE OFRYEBROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.aebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - -- - - - - - ADDRESS : � N PDATE: PERMIT# 2C�2 ISSUED: CT: rZ5--�-kOCK: LOT:---"Z LOCATION: �GL� OCCUPANCY: Z t ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED a 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 QoC BR��• O� Zm BUILDING DEPARTMENT E�BUILDING INSPECTOR LJ 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.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: ��`�1 DATE: PERMIT# ISSUED: 11 iJECT: BLOCK: LOT: LOCATION: " OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... a' ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION 12%4INDERGROUND PLUMBING NOTES ON INSPECTION: �] ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ' ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 4 QyE BR(�k. cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: �'��-6'\\ Lc' DATE: \� 1 PERMIT# _ �O ` ��� ISSUED: \ ,1 ECT:�� BLOCK: ' LOT: t LOCATION: vv� \ OCCUPANCY: `v ❑ VIOLATION NOTED ` THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION l► yY� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION G 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 QyE BR(��. O� 2m 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 : ! N`C 1 ;14K DATE: \ �_2D �Z ' PERMIT# (3 -2 a G 1_f --) ISSUED: I NECT: �. Z LOCK:LOT:I_ LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Ld ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION / REQUIRED ❑ FOOTING A-F'OOTING DRAIN�AAGE - ❑ 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 QyE BRC�k. O� tim 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR /MSSISTANT 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 :— U- DATE: I � k �' PERMIT# �l 2 O- ��� ISSUED:�, SECT: BLOCK: LOT:i LOCATION: OCCUPANCY: 2k ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE [ �rFOUNDATION t,�c�j ( A6c�C M '❑ 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 1 z a H 7 � E� Go y Z � E V) 33 j-1 A ri 1-4 en M 9Q w z x O �, O E• z.z. O a U O " W y WIC„ W ° Zaa�� i xw A ° oaao � x -z z U '� V i x 04 x r��}� k C, IQ'd '" F F Z W Gx7 ix7 ►a p,V►�' ,�.a r� taal i z IQ z 04< i a ` �" F 0 0 0 z O O `n Q a+ x PO4 x F F w , A a yv� wwwaaa � ZawwwUO ' a a° 0 ❑ ❑ ❑ ❑ ❑ 6'❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 aQ� QyE BRC�uk 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�ebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:— � DATE. l PERMIT# cv - ISSUED: �Af l z3ECT: Z BLOCK: I LOT: a L LOCATION: {^� OCCUPANCY: L ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ ,SITE INSPECTION REQUIRED fOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: .� ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER M MM � • !1 N N N W = N O o =n 11 N G1 G] A z all w Hx � � _ O N a N z ° N a o O s N �J � O W Ln , ILJ Ln 00 w Z F ►-� w M N `n z L0-4 Z C7 A z � z a V w °o a z � z z w C � � � ] W N F S v w z a _ �B QQ ' n" cn � .. Q a z w A a � °� QI as a a � as w = R D BUILDING DEPARTMENT JUN 2 8 2022 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.iyebrogk.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 20-247 _ EP#: � - l a 3 Approval Date: JUN 2 9 2 Permit Fee: $ P6 Approval Signature: VV Other: ***a«**rt**s******************** *r**��s�***s*s****�*************************:********r******s*�s• Application dated, 6-24-22 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 8 Jasmine Lane SBL: 129.25-1-1.520 zone:. PUD 2.Property Owner: SC Rye Brook Partners LLG Address: 5 International Drive Phone#: 914-481-1531 Cell#: 914-761-2500 email: 3.Master Electrician: Denis M. Fortino Address: PO Box 713 Rye, NY 10580 Lie.#: E-51 Phone#: 914-760-5226 Cell#: 914-760-5226 email: dfortino(alenterpriseelec.com Company Name: Enterprise Electrical Consulting Address: 3881 Danbury Road Brewster, NY 10509 4.Proposed Electrical Work/Fixture Count: Wiring for new house 100 points Wiring for Smoke and Carbon Detectors line voltage 5.3`a Party Electrical Inspection Agency: State Wide Inspection Services, Inc. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Denis M. Fortino ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual 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 Electrical Contractor 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 tis day of ,20 day of 0 ZZ Signature of Property Owner Signature of Appficafil Denis M. Fortino Print Name of Property Owner VAt Name of Applica Notary Public 901ary Public SHARI MELILLO Notary Public,State of New York No.OiME6160063 6/23/2022 Qualified In Westchester County commission Expires January 29,202.3 STATEWIDE • Service With bitegrity 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION : Office Use Elect. Permit# E 3 Date' Bldg Permit# Utility ID# �o- a,�17 I h c- 2;-395 Final Certificate# City/Village Q �i �{ v Zip D15 Township County Address /�� f' ' Cross Street S �" Block 7 Oar Nam d (I iff ent ta�oygl e/` t \ 0/t l / o -t N A asement �Tst FI. ❑�d FI. ❑3rd FI. ❑More Than 3 FII. ,arafgeef s ❑Attic v❑' Outside 04esidential [:]Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact ArPt Amps /� / Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw t Incand�5cent Fluorescent SERVICE Amperage Voltage iP 3P #Meters #Disconnect 10 Underground [3New ❑Reconnect IE]Overhead iEl Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection r/,AJA4- Additional Information y' L�U ��C1�55Cp C�5 3- LrV, UC LIGNDD `�5 J UN 2 8 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.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.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name6jf Date / "� ,77 Signature Address 3 08/ v �D City/State Zip Code License# / Phone# /�` State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 a 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: officeLaswisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Enterprise Electric Corp. SC Rye Brook Partners PO Box 713 4 West Red Oak Lane Rye, NY 10580 White Plains, NY 10604 Located at: 8 Jasmine Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: 22-123 129.25 1.520 Certificate Number: 2022-3518 Building Permit Number:20-247 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:8 Jasmine Lane, Rye Brook, NY 10573 The Basement, First Floor,Second Floor, Exterior,and Detached Garage were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 5th day of July 2022. Name Quantity Rating Circuit Type Receptacles 73 Receptacle 01 20AMP GFCI 16 Switches 48 Smoke Detectors 03 C/O Smoke Detectors 05 Range 01 Dishwasher 01 Refrigerator 01 Disposal 01 Microwave 01 Luminaires Name Quantity Rating Circuit Type Recessed LED Luminaires 44 LV Under Cabinet Lights 03 HVAC System 02 Sump Pump 01 Service 01 200Amp Meter 01 Panel 01 Disconnect 01 Grounding and bonding of service to current codes. State Wide Inspection Services did not perform a Rough inspection. A Visual inspection and Final inspection were conducted only. Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Page 2 Ln m �D � N CV4 O O OTC e a s1-1 ell 4n Old o � W � �" v " - E• , Ogz w W G M� ON W USG p FW„ g F � OC N w � U = 96 N E � °, O d � 00 R V_C_ E_ 7E CO BUILDING DEPARTMENT VILLAGE OF RYE BROOKUN 938 KING STREET RYE BROQ�C',NY 10573 (914)939-0668 FAx 914 939-5801 VILLA F RYE BROOK ( . ) BUILDING DEPARTMENT wwuv;rvebr0gk.org ELECTRICAL PERMIT APPLICATION Westchester Coun er Electricians License Required FOR OFFICE USE ONLY BP Approval Date: JUN 20Permit Fee: S a� Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated,06-7-21 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. 1.Address: 8 Jasmine Lane SBL: 129.25-1-1.52 zone: PUD 2.Property owner: SC Rye Brook Partners,LLC Address:SC Rye Brook Partners, LLC Phone#: 914-481-1531 Cell#: email: 3.Master Electrician: Denis M. Fortino Address:PO Box 713 Rye, NY 10580 Lic.#:E-51 Phone#: 914-760-5226 #: email: dfortino@enterpriseelec.com company Name: Enterprise Electrical Cons Address: PO Box 713 Rye, NY 10580 4.Proposed Electrical Work/Fixture Count: Wiring for new house 100 points Wiring for Smoke and Carbon Detectors line voltage STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Denis M_ Fortino .being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual 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 Electrical Contractor 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 t o me is day of ,20 day of 0 ffA Signature of Property Owner Signature of Applicant DES j It ii ��g Print Name of Property Owner Print Name of Applicant Notary Public Notary Public ALEXANDRA H.FRANK elAOV 1) Notary Public,State of New York No.01FR6363711 Qualified In Westchester County Commission Expires August 28,20� 3/21/t9 Westchetter Rockland Electrical Inspection Services, Inc. Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: -347-3596 Elmsford, NY 10523 1 P MIT NO. TEMP# DATY/ CITYVIL E CO�`. TOWNSHIP STREET _ I POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? V J/BLOC' LOT OCCUPANT'S NAME BUILDING OCCUPANCY � � L_ OWNER'S NAME AN 2� i /� � HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM`THEIR l/ OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EOUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FlXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT V'FL. 3-FL. VILLAGE OF YE BROOK REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 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❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. E OF O P.ANY DATE OF APPLICATION SIGN�TUI�OF AP LI ANT �TAEETAD TELEPHONE NO. -,7 LICENSE NO.WHEN APPLICABLE N �o w O N N v W Ln y oA ILn Ono Q; z CQ A . � N F.l �""' a0 ��. � •q E'� O zo Z �` O •r A N H 00 N O . rrLn U W w z C! 0-, Coe. H H O w w w u Zz a Cn z00 U W a a o p--q z z � z W Z � � w z N z M A 7 ^ \° u 00 M � E., N H �, v a� �+ p4 � z � gNA � TWA � V W z o W z a o F H V CZ V Z a N u 0 $ G; W " d .. ua W w Z E• z o Z 7 a wW c Z c cn v O W Z a44- W " x z a w z FO 00 A w z w A a 05 O V "" wF �I � 9 a z � w 0 � yE DRCv�, 3D Bum I�EP�K MENT APR 2 7 2023 VIL AGE OF RYE OK 938 KIN 4REFT RYE B ,NY 10573 VILLAGE OF RYE BROOK (914)939-0 BUILDING DEPARTMENT wwwxyebr or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICF USE ON LY BP#: QDQ --,_� Ll 7 LP#: �- C� Approval Date: 2023 Permit Fee: $ &VV, ,� Approval Signature: Other: Application dated,04-26-23 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 8 Jasmine Lane SBL: 129.25-1-1.52 zone:/0Ub 2.Property Owner: SC Rye Brook Partners LLC Address: 5 International Drive Phone#: 914-481-1531 Cell#: 914-761-2500 email: 3.Master ElectriciawLicensed Installer: Dens M, Fortino Address:PO BOX 713 Rye, NY 10580 Lic.#:E-51 Phone#:914-760-5226 Cell#: 914-760-5226 email: dfortino(a,enterpriseelec.com Company Name: Enterprise Electrical Consulting Address: 3881 Danbury Rd Brewster, NY 10509 4.Proposed Electrical Work/Fixture Count: Wiring for new elevator access 3 floors 5.3`d Party Electrical Inspection Agency: State Wide Inspection Services Inc. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Denis M. Fortino being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the master electrician for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) 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 be,---me this day of ,20 day ,20 Signature of Property Owner Signature of Appli ant Denis M. Fortino Print Name of Property Owner Pt%ntiVame o� t Notary Public Notary PRI MEULLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County Commission Expires January 29,20 / /2023 STATEWIDE • 1:1 Main Street,Fishkill, NY 12524 1 emod:office@swisny.com SWIS JOBAPPLICATION tel845.202.7224 • • 1•2 SWISNY.com I SWISTraining.com Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village 13(�rx�K Zip U�J, Township County���_-T Address � s 11 1�/ / — Crops Street Section - Block, Lot [� l��TlJ� a, /i L Owner Name/Address(If different than above �{i 2�k jj7�1 21��� Contact Number 0 Basement 1 st FI. 2nd Fl. 3rd FI. :]More Than i3'Fl.f [—]Garage El Attic D Outside �Residential �Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect Underground New Reconnect ❑Overhead ❑Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information FLOvR'S (Z)/06. D DD :APR 21 2023 j VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.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.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# i Company Name�jJ�i`� ✓ �,; Date �� Signature Addres956 �� � '> y City/State 5� �L Zip Code lo� License# - / Phone# !� _ _ !7'77 pC� � � � � State Wide Inspection Services MAY 1 2 2023 1080 Main Street Fishkill, NY 12524 U 5 VILLAGE OF RYE BROOK 845 202-7224 Phone -low V/ BUILDING DEPARTMENT 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Denis M. Fortino SC Rye Brook Partners Enterprise Electric Corp. 8 Jasmine Lane PO Box 713 Rye Brook, NY 10573 Rye, NY 10580 Located at:8 Jasmine Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-102 129.25 � 1.52 Certificate Number: 2023-3408 Building Permit Number: BP20-247 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:8 Jasmine Lane, Rye Brook, NY 10573 The Basement was inspected in accordance with the NYS and NFPA 70-2017 and the details of the installation,as set forth below,was found to be in compliance on the 9"Day of May 2023. Name Quantity Rating Circuit Type Elevator Motor Circuit 01 30 Amp Cab Lighting Circuit 01 15 Amp Smoke Detector 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. i i (V N N = oG 96 ( 1• N 1414 NN 3 C u r. z ' M -. ~ m ■ zco 16 00 �. ° >0cc ■ a,, CA 3 � w ¢ ; c � � � � A oo Q z w � a ..� o co� Doo �% 4 r V) M 0 G7 Q O A o Z a! o, < InU J � ^ z z = � w 4 ' UP) � � � Q c � � o � ° � � r ■ � � w m Fr o c F E.. O F � a Q •• A. �EQRnuk ECEO V E BUILDILYG`D AR MENT i�/t, ` MAY 2 5 2021 VILEAI'GE OF I2YE'BROOK 938 KING E T RYE BRP4.'K,NY 10573 / VILLAGE OF RYE BROOK (914)939;0668:F -l'�7 S 939-5801 \\�� � BUILDING DEPARTMENT w�v�fV�!b�oo .org PLUMBING PERMIT'APPLICATION FOR OFFICE USE ONLY BP#: aO^,Q47 PP#: I_ 073 Approval Date: MAY 2 5 2021 Permit Fee: $ oct Approval Signature: Other: Disapproved (fees are non-refundable) Application dated, 1 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. 1.Address: 8 in:c L'n Ck,m-ev*q xlall*q3 SBL: 0-g. Q5-1—/ , 5 02 Zone: 2.Proposed Work:�lUmtnVn4 �( tnowsr qt�,e QAmN dimewma a �misvva_ hogma= 3.Property Owner:' 9'emoo iL?o %&s I -Le Address: 1hJ{S} (fin, (�X ,STE`a''396 Phone#: 9EL 10 - a1500 Cell#: qIN - 9LA 4-'505(D email:4&uboiS afo .on% 4.Master Plumber: 1 t4C6)r ELFf Address: ��11 Lic.#: a10 Phone#:rgy5� (�(,61 Cell#: nemail: jr%ky1,r v lL oumb, -con1 Company Name:�r &VM 31 rM1%bQ �ltaRoo ~�nOhlY� Address: 1OVq • ,� 1-M STG �11nlnC re, K3T j 109 60 INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 1 1st Floor 2nd Floor dN LA , 1 31 Floor 41,Floor 51 Floor Exterior n 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 00 -1- 10 • 3/21/19 STATE OF NEW YORIe,,COUNTY OF WESTCHESTER ) as: lu\ ^ futfl� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name or individual signing as the applicant) and further states that(s)lie is the legal owner of the property to which this application pertains,or that(s)he is the CQ f\Aowke:g� 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 die 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 3 Sworn to before me this day of ( c ,20"?o day of _/t ,20 Signatu F erty Owner Signatur of licanttJ J ' D t-tel: f S Paul N JebY-as Print Name of Property Owner Print Name of Applicant Notary Public A Boyd Notary Pu )I ubfic,Stage Of New Fork N0,OIB4`166307 Quaw in W County Coamo bWon Exam May 21,2W dC 0�3 This application must be properly completed in its entirety and must include the ,v.arrzver-o,"Mt tOtt*;w•,: the legal owner(s)ol'tlie subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. WENDY J ABBAGLIATO NOTARY PUBLIC-STATE OF NEW YORK No.0tABB378708 Qualified In Orange County MY Commission Expires 07-30-2022 -2- 3/21/19 Or "' fil � ai a�i •� .o .. rr r, lO sV R 3 R. N, fr" 026 as a av ° -- z 77 • r M, I•,M La Cn M M o roc. 1■■r ~ 4 w r oo c i1 Ey - '' a •} . Z W � x � a � � o� �' o � a a� NO W Z 10 .. 96 oG oc 96 C 40 60) • VJ > � ss • dl U OF y 'a 2 as#46 441 r l� BUILDJMY &ARTMENT G C E V 9 KIVllNG E OF OK D T R RB NY 10573 AUG 2 5 2020 38 K I , I (914)9- 0 (•9-i 39-5801 VILLAGE OF RYE BROOK i WW*- BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY:Approval DaAO 19 I '#: D-0?T`/7 MP#: Application Fee:$ Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: Q is hereby made to the Building Inspector of the Village of Rye Brook NY fur the issuan(xofa Permit to install a lin; Suppression System as per detailed statement described below. 1. Job Address: 8 M51mmr e- L„ _ �� Parcel I.D.:1a4.1S- 1 .SX/,one: PUP 2. Proposed System(Describe system in detail including suppression agent): �3� n:x,r,1C\er 9u3�crn •ohm �tiouk he 1�rn _ __ _ __ 3. Number&"types of Fire Sprinkler Heads: 5 L+ 4. N.Y State Construction Classification: 5B N.Y.State Use Classification:g3 5. Cost of Installation:$ _1145 M (Cost shall include all labor.materials,fixed equipment,processional fees•and materials and labor which may be donated gratis.) 6. Property Owner: So-- Address:g() att Phone# Cell# email: Applicant: Moto-1L I ire Uro\ci*t►orL" Address: FQr-IL Picker M;�►�Eny, �T Phone# - b-S Cell#(&O)$q l;, email: r_1,ern�r�ler k�mrOL LLe,.e Architect/I;ngineer: R"W • �u\I��tar��E-r—\ eCrkr�C. Address: �ja9 ,MAi �+r��t- �i%-F,�C� t .MftrN k `- � oa%aq- Phone aaa-� Cell# _ _ email: r L_, Su\\were . esom General Contractor: aB Address:? . -1 morn\ A.yonu� Pa�.�1i �\`►�( \1 56� Phone# -9406 Cell#_ email: 12.8.t 6 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE.OF NEW YORK,COUNTY Of WES I CH1 S'I ER ) as: w&WD yt.".A r_ ,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 �1Qd1r_ Vie. P.A:.d 'b for the legal owner and is duly authorized to make and file this application. (indicate architcet.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 betbre the this Sworn to belbre me this day of , 20 day of I , 20� Signature of Property Owner Signature of`Applicant Il s+IIK.,C7 0 �r rya vd e-t-� — Print Name of Properly Owner Print Name of Ap�pliica�nt Notary Public Notary Public MICHAEL SILVA NOTARY PUBLIC MY COMMISSION EXPIRES OCT 31,2022 -2- I2816 Ln W 4 I to 0 a .D CJ a Fs7" W a U ci r > 91. n. G. o a 1. s N Lr 1w1 x U ry o G m Q u z >4 ' Z x O w W g r o g a L O C u a O >W TJ J Z a QLo 00 wE_O. c� ov3G _ ^ 00 CN Ln CO O F� oo to r- co W o,, � ` ° � g � V Ln o C�j7 fw� � ZI Osa. C v 0 ,4 z 9)� it z H > = E � l M••, � V A H O � ° c ct W �„� x e ON ''" Q w w � MON c 5 66 C/1 a v F� O pR'Q Fez > ' c/) Q Z g ` ate'. b `= cps - - C" �j OG w O C ►-1 z 7 aS < 00 A ° o H "'" O U a W C. PHr, BUILD NG DEP 'MENT ll v VIL E OF RYE TOOK APR 1 1 2022 938 KnvG I ET RYE BROOD,NY 10573 <�J ,4 - 8 VILLAGE OF RYE BROOK or BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: "R a0 -0 cl Approval Date: APR 1 1 1012 Permit Fee: $ oRn C Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: I. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit•COMMERCIAL=$350.00/unit. 5. Inspection by the Building Department for removal and/or installation.(48 hour notice required) 6. Electrical work requires a separate Electrical Permit&Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. Application dated,41 o is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. 2 1 Address: $_�,CA$n► PC q SBL: �� q : S -f.5`Zone: 2. Property Owner: �G �yb# Address: Phone#: II Cell#: email: 3. Contractor: �b?o L 6%. Address: a 0 a e>< Phone#: e Cell#: email: P J�0xv 1 Q }� C . R�- ��/✓` 4. Applicant: % 4M t .gyp Address: Phone#: '.�61.115.-$ 1 J Cell#: email: 5. Scope of Work:New Installation( •Replacement( )•Removal( )•Other( ): 6. List Equipment: C24 9 7. Location of Equipment: R A ff w� 8. Method of Installation/Removal(list all equipment needed to perform job): ' / L k, pis N-11 Or b^r I t 8/12/2021 STAjTE OF NEW YOM COUNTY OF WESTCHESTER ) as: 11 v o ,being duly swom,deposes and states that he/she is the applicant above named, (print name f individual signing as the applicant) and f ti lair states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the f for the legal owner and is duly authorized to make and file this application. (indiate 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 Sworn to before me this A y r•t day of ,20 day of ,20 , 1 Signature of Property Owner Signa of Applicant Print Name of Property Owner Prin ame of Applic t Notary Public Notary Public This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. E NE SCHREIBER tate of New York-&42Z514Ulster Courity pires Dec 2-7, 2025 2 8/12/2021 N9MSE Product Specifications HEATING& COOLING PRODUCTS Up to 96% AFUE, Single Stage, PSC Gas Furnace EASIER TO SELL • Up to 960%AFUE in upflow,and horizontal positions, ----- ---- Up to 95%AFUE in downflow positions • Cabinet air leakage less than 2.0%at 1.0 in.W.C.and cabinet air leakage less than 1.4%at 0.5 in.W.C. when tested in accordance with ASHRAE standard 193 • Approved for Twinning applications(0601410 through 1202420) with accessory(order separately) • Approved for Manufactured Housing/Mobile Home applications (0401410 through 1202420)with accessory (order separately) . • 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 i requirement. f TOUGHER • Flame roll-out sensors standard 1 • Adjustable heating blower OFF delay • Factory set blower ON delay • RPJ" primary heat exchanger • Stainless steel secondary heat exchanger • High temperature limit control prevents overheating Illustrations and prro o are only represer»aDve Some prodductuci models may vary. • Direct ignition with Silicon Nitride ignitor • High ualliry1 corrosion-resistant, prepainted steel cabinet t . • EASIER TO INSTALL AND SERVICE • Direct vent(2-pipe). single-pipe venting or ventilated combustion Failure to follow this warning could result in personal injury. air death,and/or property damage. • 24 VAC humidifier terminal&electronic air cleaner terminal This furnace is not designed for use in recreation vehicles or • 35"(889mm)high,for ease of installation outdoors. This furnace is designed for use in manufactured • Simplified,factory installed internal condensate drain system (Mobile)homes when an optional Mobile Home accessory kit is • Innovative knobs for easydoor removal and secure installed. Failure to follow this warning could result in personal injury, attachment death,and/or property damage. • Factory shipped for natural gas, with propane gas conversion kits available • Four position- upflow./downflow/horizontal (left/right) installation ' ots 1 s y • At least twelve different venting configurations • Through the casing flue pipe for counterflow or horizontal applications with accessory (order separately) """fw0°ae"E'"°"`"1 • Concentric vent available TL • Self diagnostics with super bright LED • Slide out heat exchanger and blower assembly LIMITED WARRANTY • 7 - 881 9� ��, • 20 heat exchanger limited warranty • 5 year parts limited warranty - With timely registration, an additional 5 year parts limited , CERTIr IED warranty " For residential applications only. See warranty certificate for complete details and restrictions, including warranty coverage for LJ••or th•AFMFI Cauheo TM Mar Batas a manuractu—a paracam m tM p,.grem For other applications. vargwat ,or c«mc,00n fix,netiauao products go to ram..anna..ctay ag Efficiency AFUE Cooling Capacity Input CFM range Dimensions H x W x D Shipping Wt. Model Number (MBTUH) Upflow/Hz Downflow @.5 in.w.c.(125 Pa) Inches(Millimeters) Lbs(Kg) 9 SE0261408A 40,000 96.0% 95.0 �- 400-775 35 x 14-3/1 x 29-1/2 9 x 361 x 7 120(54) NgMSE04011410 40,000 96.0% 95 01, 625-905 35 x 14- /16 x 29-1/2(889 x 361 TM7 123(55) 9 040171 40,000 96.0 95.0". 650-1050 35 x 1 - x 29-1 2 889 x 445 x 750) 1 4 1 N91VISE06W410A 60.000 95. 9 0 6 -11 0 35 x x 29-1/2(889 x 361 x 750) 127(57 9MSE0601714A 60,000 96.0% 95 0°� 650-1420 35 x 1 -1 x 29-1 2(889 x 445 x 7 ) 144(65 9 0801716 8 000 96. 95 OP, 810-1600 35 x 1 - x -1!2(889 x 445 x 750) 154(69) N9 S 0802120A 80 000 96.0% 95.0% 1335-1970 35 x 21 x 1/2(889 x 533 x 750) 162—(73T-- N9MSE1002114 100,000 96. 91 -1 45 35 x 21 x 29-1/2 889 x 533 x 750) 1 9(76) 9 1002120 100.000 96.0 95.6% 1345-2065 35 x 21 x -1/2(889 x 533 x 750) 169(76) N9MSE1202420A 1 120,000 1 96.0% 95. 1320 105 35 x 4-1 x 1/ z 622 x 1 B6(84) N9 140 42 140.000 96.0 94. % 1290-2035 x 2 - x 1,2 889 x x ) 190(86 Specifications are subject to change aathout nonce. 440 11 4403 05 12/3/18 NXA6 "MEANS Performance Series HEATING& COOLING PRODUCTS Product Specifications HIGH EFFICIENCY 16 SEER AIR CONDITIONER ENVIRONMENTALLY BALANCED R-410A REFRIGERANT 11/2 THRU 5 TONS SPLIT SYSTEM 208 / 230 Volt, 1—phase, 60 Hz REFRIGERATION CIRCUIT • Scroll compressors on select models • Filter-Drier supplied with every unit for field installation •Copper tube/aluminum fin coil EASY TO INSTALL AND SERVICE • Easy Access service valves on all models • External high and low refrigerant service ports I • Only two screws to access control panel • Factory charged with R-410A refrigerant BUILT TO LAST • Baked-on powder coat finish over galvanized steel • Post-painted (black) coil fins • Coated, weather-resistant cabinet screws • Coated inlet grille with 3/8" (10mm) spacing for extra protection LIMITED WARRANTY* r, ENERGY° sr�n°a�°� "eknn • 5 year compressor limited warranty rrwcr*d "M appro"afe cool nnvorwrm . Toper refngerart diarge ano proper arr,NDw are aroral • to achieve rated cepaoty and effioency. knt ation of year parts limited warranty (including compressor and mrs proauc*should fnlln the man+ad ars refnge,v coil) ev end°y -With timely registration, an additional 5 year parts limited warranty (including compressor and coil) * For owner occupied, residential applications only. See CERTIFIED warranty certificate for complete details and C US r"1111111111 On IL restrictions, including warranty for other applications. & LISTED Uae of the AHRI Cart tea rr,,Ma•M noicates manufacturers paMCipatiOn n the program t o wrrf,Cation of certifiCffi,on for indN,dual Droduc!s go to www ahndirectory orq Model Size Nominal Min. Circuit Max. Fuse Operating Dimensions Ship I Operating Number (tons) BTU/hr Ampacity or Breaker height x width x depth In. (mm) Weight lbs.(kg) NXA618GKA 1- 18,000 11 8 20 28-11/16 x 25-3,14 x 25-3/4 154/ 125 (729 x 654 x 654) (70/57) NXA624GKA 2 24,000 17.7 30 28-5/16 x 31-3,116 x 31-3/16 147/ 183 (719 x 792 x 792) (83/67) NXA630GKA 21.1_ 30,000 16.8 25 32-5/16 x 31-3/16 x 31-3116 188/ 153 (821 x 792 x 792) (85/69) NXA636GKB 3 36,000 17.5 30 28-5/16 x 35 x 35 204/ 165 (719 x 889 x 889) (93/75) NXA642GKA 31/z 42,000 23.6 40 39-1/8 x 35 x 35 254/213 (994 x 889 x 889) (115/96) NXA648GKA 4 48,000 26.1 40 39-1/8 x 35 x 35 317/264 (994 x 889 x 889) (144/ 120) NXA660GKB 5 60,000 324 50 45-11 i16 x 35 x 35 318/280 (1161 x 889 x 889) (144/ 127) SDec,fications subfed to change without nonce 421 11 6201 05 5/17/19 a c e � w � ry.1 � M Vi F-+ V r W vi N V -- a 4a N ~ o go v g w �- 1� e > oW � Q Ln N x Z q _ � M�■�1 � � � .�-� � N O W W � ai o v C .� � N � co. L h�' p"., 7 �y t.. a0• M a ,1� O Woo C� z °: A4 � Q O wv vo � o _V a 'No O V U F" ° S g tv G. M■■�i od r/) M w M p M Ca � o� q � G1 '� x w � O w � � t H c � co V 2 Q > x E co 1 L� Ulu 41 Ca 2 s H - t 2 M rA wo � z x Q+ a w zz .0 U 0 �, z N a a z u " V w V p C a y � s ZN w z off a p z cn V O V W � a � ~� Z W W 00 IT, z a o � g � � �I a]a a aV w x � b VILLAGE OF RYE BROOK 3D BUILDING DEPARTMENT APR - 3 2023 938 KING STREET,RYE BROOK,NY 10573 (914)939-0668M;Mjyebrook.org VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL, MODIFY AND/OR REMOVE MECHANICAL EQUIPMENT OFFICE USE ON Y fj_ ?? �j R O 1�3 Permit#: C�J -' / Building Inspector: Application Fee:Al — Date of Approval: Permit Fee: .6/ SO Bldg/Use Class: Res. ( ); Comm.'( ); REOUI REMENTS FOR RELEASE OF PERMIT: (A CERTIFICATE of COMPLIANCE 1s REQUIRED To CLOSE OUT THLS PERmrr) 1. Properly Completed& Signed Application. 2. Payment of Application Fee: Residential=$100.00; Commercial=$250.00 (fees are non-refundable) 3. Site/Staging Plan as required by the Building Inspector. 4. Sealed Construction/Installation Documents& Specifications as required by the Building Inspector. 5. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form (Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 6. Payment of Permit Fee: Residential=$15.00/1000.00 of Construction/Materials Cost with a minimum fee of$100.00. Commercial=$25.00/1000.00 of Construction/Materials Cost with a minimum fee of$275.00. 7. Inspection by Building Department for removal and/or installation. (48 hour notice required) 8.Any electrical work requires a separate Electrical Permit and Electrical Inspection. 9.Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection. Application dated, 04,03,23 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit for the installation,modification,and/or removal of the specific Mechanical Equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with the approved plans,and with all applicable Local,County,State&Federal laws,codes,rules and regulations. 1.Address: 8 Jasmine Ln. R e Brook NY SBL: /,Z--)9,45—/—�• 5,4 Zone: 2.Property Owner:_SC ye a Address: Q Phone#: //1/— 7&/—QSUO Cell#: email: 3. Contractor: Champion Elevator Address: 1450 Broadway, 5th Floor, NY, NY 10018 Phone#: Cell#: 203-606-9599 email: J.BlaschkeJr@champion-elevator.com 4,Applicant: John Blaschke Address: Phone#: Cell: 203-606-9599 email: J.BlaschkeJr@champion-elevator.com 5. Scope of Work:New Installation�•Replacement( )•Removal( )•Other( ) 6.Type of Equipment: Residential Elevator 7. Location of Equipment: Residence(8 Jasmine Ln., Rye Brook, NY) 8. Cost of Equipment including Installation Cost: $30,000.00 1 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: • (print name of individual signing as the applicant),being duly sworn,deposes and states that he/she is the applicant above named, and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the 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 Sworn to before me this ` day of ,20 day of n ,20 a2� Signature of Property Owner C5i afore of cant Print Name of Property Owner qfr4t Name of Applicant Notary Public No u IIC,5tate of New YorK No.OIME6160063 Qualified In Westchester County Commission Expires January 29,20Z? This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 8/12/2021 L E V O T O R ,,.� of NFw�ti,,,, manufacturing company, Inc . ��� �•.077142 .�� P.O. BOX 749, 5191 STUMP ROAD, PLUMSTEADVILLE, PA 18949 .q�FESS�aNa�•`'�,` PHONE# 215-766-3380, FAX# 215-766-3385, WEBSITE: CUSTOMELEVATORINC.COM ROPED HYDRAULIC RESIDENTIAL ELEVATOR LAYOUT DRAWING SUBMITTAL CUSTOMER: NORTHEAST ELEVATOR SERVICE CORP. ADDRESS: P.O. BOX 171 STAMFORD, CT 06904 PHONE#: 203-353-0099 FAX#: 203-975-9592 CONTACT: JOHN BLASCHKE PROJECT NAME: 8 JASMINE LN. LOCATION: RYE BROOK, NY CUSTOMER P.O. &/OR REFERENCE#: 8 JASMINE LN. DRAWN BY: SCOTT GEIGER PRELIMINARY DATE: 05/17/21 APPROVED BY: JOHN BLASCHKE APPROVED DATE: 06/28/21 RELEASED BY: SCOTT GEIGER FINAL DATE: 08/02/21 REVISIONS FINAL REV. DATE DESCRIPTION: 1 08/02/21 H/W WAS 5'-0"D, PIT WAS 1 1", TRAVEL WAS 20'-9", FINALS. S.G. JOB NAME: 8 JASMINE LN. DRAWING NUMBER: NEAST-22220 CONTRACT DATA CHARACTERISTICS: CAPACITY: 750 LBS. OPENINGS: 3 IN—LINE SPEED: 40 F.P.M. TOTAL TRAVEL: 20'-9" •'• ! : l LANDINGS: 3 OPERATION: S.A.P.B. q''•-•• • '''���.:`` EQUIPMENT: MOTOR HORSEPOWER: 3 RPM: 1725 PLUNGER: 2 3/4" .188 WALL PIECES : 1 F.L.A.: 14 L.R.A.: 56 CYLINDER: 4 1 2" .237 WALL PIECES : 1 G.P.M.: 6.2 UP DOWN OVERTRAVEL: 3" 5" WORKING PSI: 557 HOIST CABLES: (2) 3 8" DIA. — 6 x 19 RELIEF PSI: 696 GUIDE RAILS: 8 LBS./FT. OIL LINE: 3/4" NOM. SCH. 80 1.05 O.D., .154 WALL) CAR SAFETY: TYPE "A" OIL REQUIRED: 35 GALS. TYPE: AW68 BUFFERS: RUBBER PIPE RUPTURE VALVE: 3/4" HOISTWAY DOOR LOCKS: E.M.I. CAR CAM: N/A ELECTRICAL: CAR WEIGHTS: MAIN POWER: 220-1-60 HZ — 30 AMP SLING: 210 LBS. MISC.: 90 LBS. LIGHT POWER: 1 10-1 -60 HZ — 15 AMP CAB: 367 LBS. PLUNGER: 90 LBS. SIGNAL VOLTAGE: 24 VDC EMPTY CAR: 667 LBS. EMERGENCY POWER: 110 VAC U.P.S. CAB DESCRIPTION: SIGNAL FIXTURES: 1 -2-3 CAB MODEL: CLASSIC SERIES CAR STATION: FINISH: BRUSHED ST. STL. WALL FINISH: MAPLE VENEER—UNFINISHED ®CALL BUTTONS W/ACK. LIGHTS CEILING TYPE: C-1 ®ALARM SIREN W/PUSH BUTTON CEILING FINISH: MAPLE VENEER—UNFINISHED ®PUSH/PULL EMERGENCY STOP SWITCH CAB LIGHTING: 2) DOWN LIGHTS ®CAR LIGHT ROCKER SWITCH CAB SILL(S): ALUMINUM ®DIGITAL CAR P.I. W/ARROWS HANDRAIL: BRUSHED STAINLESS STEEL — FLAT ®EMERGENCY CAB LIGHTING FINISHED FLOOR: 3/4" (BY OTHERS) ❑KEYED (OPTION) CAR DOOR DESCRIPTION: DOOR TYPE: ACCORDION OPTIONAL: DOOR FINISH: H/W MAPLE—UNFINISHED ®PHONE BOX FINISH: BRUSHED ST. STL. OPERATION: ® MANUAL El POWER HALL STATIONS: FINISH: BRUSHED ST. STL. OTHER OPTIONS: ®CALL BUTTON W/ACK. LIGHT • PRE—WIRE CAR ONLY ADJ. MACHINE ROOM ®CAR HERE LIGHT • 6'-0" LONG x 3/4" DIA. HOSE ASSY. W/ 90'S & DBL. SWIVELS El KEYED (OPTION) • PIT STOP SWITCH • DISCONNECT SWITCH PACKAGE • ADJUSTABLE RAIL BRACKETS • CONTROLLER PROVISIONS FOR E.M.I. LOCKS FINAL P.O. BOX 749 5191 STUMP RD. NORTHEAST ELEVATOR SERVICE CORP. PLUMSTEADVILLE, PA. 18949 PROJECT: 8 JASMINE LN. RYE BROOK, NY 80 PRELIMINARYDATE: APPROVED BY FINAL 215176663385 O1 00 /02/21LEVTO DRAWN BY: S.G. REV. #: DRAWING NUMBER: m A n " ' a ` ` " c ' n 9 ROPED HYDRAULIC company, Inc. RESIDENTIAL ELEVATOR SCALE: N.T.S. NEAST-22220 PLAN NUMBER: Contract Data nnr n nr � REVISIONS REV DATE DESCRIPTION FINAL 4'-5" CLEAR FINISHED HOISTWAY 9" 3'-2" PLATFORM 6" 3'-0" INSIDE CAR 4 3/4" RAIL I 4 1/4"(NOMINAL) J z � 0 z ,n �r a V) M U n HANDRAIL Z 0 N = 0] m o Z p ao 2 < y Y Q O Z �-Y U l� Of = 1 Li m CAR OPERATING z I N w PANEL = d U _ 0 _ r7 CAR COLUMN I N 2'-10" CLEAR CAB OPNG. ------------ 3/4" MAX. LJw HOISTWAY DOOR a ACCORDION TYPE LOCK (TYP.)% \ N UNui � uuut1'"olk CAR GATE 0 • O 9" 3'-0" WIDE SWING DOOR 8" = 0 REF. Z_ ONLY z 2 * aT 9L•* � Z r Q rn �. p HALL STATION TYP. Of zz n I' AT ALL FLOORS s '� y OFESStONA��•�`` "hrrnnrrr",�` GENERAL NOTES AND PROVISIONS REQUIRED BY OTHERS 1. FINISHED HOISTWAY MUST CONFORM TO THE DIMENSIONS INDICATED ON LAYOUT HOISTWAY PLAN DRAWINGS. ALL WALLS AND SIDE MEMBERS MUST BE SQUARE AND EXTEND FROM SILL TO BEAM ABOVE. INSIDE SURFACE OF HOISTWAY MUST BE FLUSH. �I^R-�_750� 2. ADEQUATE SUPPORTS MUST BE PROVIDED FOR FASTENING RAIL BRACKETS AS INDICATED ON THE LAYOUT DRAWINGS. SUPPORTS MUST WITHSTAND RAIL FORCES INDICATED. 3. ALL BLOCKOUTS FOR HALL BUTTONS MUST BE PROVIDED. LOCATION TO BE P.O. BOX 749 5191 STUMP RD. COORDINATED WITH ELEVATOR CONTRACTOR. tlr// yyy� PLP ONE21766�338049 4. KILN DRIED, SOLID CORE, WOOD OR STEEL HOISTWAY DOORS, ENTRANCES, SILLS, �L E VRTOR FAX: E: 215 766-3 AND ASSOCIATED FRAMING TO BE PROVIDED AND INSTALLED BY THE PURCHASER -3385 OR GENERAL CONTRACTOR. DOOR CLOSERS OR SPRING LOADED HINGES ARE %%."9 ROPED HYDRAULIC REQUIRED. ALL HOISTWAY DOOR OPENINGS MUST BE PLUMB FROM FLOOR TO FLOOR RESIDENTIAL ELEVATOR WITHIN 1/8' (NO DEVIATIONS). IT IS RECOMMENDED THAT ENTIRE WALL AROUND EACH NORTHEAST ELEVATOR SERVICE CORP. OPENING BE LEFT OPEN UNTIL ALL HOISTWAY FRAMES/DOORS ARE SET IN PLACE. 5. DISTANCE BETWEEN HOISTWAY DOOR AND SILL MUST NOT EXCEED 3/4- AND CLEARANCE PROJECT: 8 JASMINE LN. RYE BROOK, NY BETWEEN HOISTWAY DOOR AND CAR GATE MUST REJECT A 4" DIA. BALL AT ALL POINTS PRELIMINARY DATE: APPROVED BY FINAL DATE: PER ANSI/ASME A17.1-2016 CODE. 05/17/21 1 08/02/21 6. ALL WALL PATCHING, PAINTING, AND GROUTING BY OTHERS. DRAWN BY S.G. REV. /: DRAWING NUMBER: 7. FINISHED CAB FLOORING IS TO BE FURNISHED AND INSTALLED BY OTHERS. SCALE: N.T.S. 1 NEAST-22220 PLAN NUMBER: IR-1-750 PAGE 3 OF 7 GENERAL NOTES AND PROVISIONS REQUIRED BY OTHERS Q�Qr 1.A FINISHED HOISTWAY GUARANTEED PLUMB WITHIN 1/2' FROM TOP TO BOTTOM, AND 00 J CONFORMING TO THE DIMENSIONS INDICATED ON LAYOUT DRAWING PROVIDED. ALL WALLS U AND SIDE MEMBERS MUST BE SQUARE AND EXTEND FROM SILL TO BEAM ABOVE. INSIDE SURFACE OF HOISTWAY MUST BE FLUSH. INTERIOR OF HOISTWAY SHOULD BE iFINISHED PRIOR TO INSTALLATION. HOISTWAY DOORS MUST BE PLUMB FROM FLOOR TO FLOOR WITHIN 1/8' (NO DEVIATIONS). HOISTWAY MUST BE CONSTRUCTED IN ACCORDANCE N WITH ASME A17.1 AND ALL STATE AND LOCAL BUILDING CODE REQUIREMENTS. Qp 2.WHERE WOOD FRAME CONSTRUCTION IS USED, DOUBLE 2- X 12's SPACED AS INDICATED LU ON LAYOUT DRAWINGS, AND EXTENDING THE FULL HEIGHT OF THE HOISTWAY ARE = RECOMMENDED. II p F > 3.FOR MASONRY WALLS. INSERTS SHALL BE PROVIDED BY ELEVATOR CONTRACTOR AND 0 O INSTALLED BY THE GENERAL CONTRACTOR. w 0: = 4.TOTAL TRAVEL DISTANCE FROM FINISHED BOTTOM FLOOR TO FINISHED TOP FLOOR I Q DoU MUST BE HELD WITHIN 1" OF THAT SHOWN ON LAYOUT DRAWING. U U 5.OVERHEAD CLEARANCE: (TOP FLOOR TO UNDERSIDE OF HOISTWAY CEILING OR OBSTRUCTION) TO BE MAINTAINED PER THESE LAYOUTS. IF 9'-6' CANNOT BE ACHIEVED, CONTACT FACTORY FOR ALTERNATE ARRANGEMENT. O 1 6,A POURED PT CONFORMING TO THE DIMENSIONS INDICATED ON THE LAYOUT DRAWINGS Y am MUST BE PROVIDED. THE PT MUST BE DESIGNED FOR THE IMPACT LOAD INDICATED AND 0 11 ^ MUST BE GUARANTEED DRY AND LEVEL FROM WALL TO WALL V) I I I 7.A SUMP PUMP AND SUMP PUMP HOLE WITH COVER IS RECOMMENDED IN THE ELEVATOR PIT WHERE WATER SEEPAGE IS ENCOUNTERED. A RECEPTACLE IS REQUIRED IF A Z SUMP PUMP IS FURNISHED. COORDINATE LOCATION WITH ELEVATOR CONTRACTOR. O In 8.A PIT LIGHT WITH SWITCH IF REQUIRED BY LOCAL. CODE a 9.ALL SCREENS, RAILINGS, STEPS, AND LADDERS AS REQUIRED FOR LEGAL HOISTWAY. N \ I 3 10.BARRACAUES OUTSIDE ALL HOISTWAY OPENINGS FOR PROTECTION SHALL BE PROVIDED AND INSTALLED BY GENERAL CONTRACTOR, O I _r N U U RAIL BRKT. SPACING CHART W 0 a BRKT. ELEV. FROM PEDESTAL CYL. RAIL w a 0 NO. PIT FLOOR BRKT. BRKT. BRKT. Z Z 8 LB/FT GUIDE W a RAILS REQ'D. 3 a CL a 6 29'-8" NO. OF RAIL PCs. LENGTH \ o z 5 24'-6" 6 1 10'-0" r1 -j 4 19'-4" I N 3 14'-6" U 0 2 8'-2" ui 10 `1 LANDING LOCATION CHART MJ 0 N = M LANDING FRONT REAR SIDE ~z a 3 o ,'`1„uuuUuega, 2 o CON pF NFIV tii,, rr LA •.•Y0'�.,; 1 z _t��� ti9 9� $ rn. LE LLJ0fir• I 2a F i. 0 LL 0- a 77t42.. ' � PIT REACTIONS r ,, ." LOAD ON JACK 13675 LBS w LOAD ON BUFFERS 4050 LBS `1 Z 3 STOP HOISTWAY ELEVATION w 0 P.O. BOX 749 5191 STUMP RD. 0 / "i PLUMSTEADVILLE, PA. 18949 �/�1/LEVOTOR ()P7PHONE: 215-766-3380 fff � FAX: 215-766-3385 J Q= f0 iU.) U)F I m e n u I e c t u r I n g ROPED HYDRAULIC o J 1 company, Inc. RESIDENTIAL ELEVATOR a NORTHEAST ELEVATOR SERVICE CORP. o 0.I 0. PROJECT: 8 JASMINE LN. RYE BROOK, NY PRELIMINARY DATE: APPROVED BY FINAL DATE: N 05/17/21 08/02/21 DRAWN BY: S.G. REV. #: DRAWING NUMBER: 00 SCALE: N.T.S. 1 NEAST-22220 PLAN NUMBER: 3 STOP ELEVATION GENERAL NOTES AND PROVISIONS REQUIRED BY OTHERS 1. ADEQUATE SUPPORTS MUST BE PROVIDED FOR FASTENING RAIL BRACKETS AS INDICATED ON THE LAYOUT DRAWINGS. SUPPORTS MUST WITHSTAND RAIL FORCES INDICATED. R3 r� 2. WHERE WOOD FRAME CONSTRUCTION IS USED, DOUBLE 2" X 12" SPACED 20 AS INDICATED ON LAYOUT DRAWINGS, AND EXTENDING THE FULL HEIGHT OF THE HOISTWAY ARE RECOMMENDED. 3. FOR MASONRY WALLS, INSERTS SHALL BE PROVIDED BY ELEVATOR CONTRACTOR AND INSTALLED BY THE GENERAL CONTRACTOR. S 3 0 F I NAL %`NtttOF m * ' � 2� R1 R2 FQ '• 5 O OT7142 '','�TIq�FE S S BONA�.•`��` I � �rr �'I ''hrrnrurrN,� G NOTE: 8RI(f �IIP�R2) RAIL BRACKET AND PEDESTAL ,r L 5O, BASE MOUNTING HARDWARE IS I (2 TO BE FURNISHED BY ELEVATOR CONTRACTOR 8�15 R52�) FIXED RAIL BRACKET ff, (STANDARD) a 0 RAIL FORCES R1 71 LBS R2 220 LBS R3 3,205 LBS 0 O � / W� 6 a� � RAIL BRACKET I RS�P�R2 ) �(, 2 P.O. BOX 749 5191 STUMP RD. )��/1 P PHONE: 215 E 49 766-3380 FAX: 215-766-3385 ELEVl�TOR m fin utect u ► In9 ROPED HYDRAULIC company, Inc. RESIDENTIAL ELEVATOR G►� RA CE COR I�PPoR2) NORTHEAST ELEVATOR SERVIP. 5 PROJECT: 8 JASMINE LN. RYE BROOK, NY PRELIMINARY DATE: APPROVED BY FINAL DATE: ADJUSTABLE RAIL BRACKET 05/17/21 08/02/21 DRAWN BY: S.G. REV. #: DRAWING NUMBER: (OPTIONAL) SCALE: N.T.S. NEAST-22220 PLAN NUMBER: Rail brkts. TYPICAL MACHINE ROOM LAYOUT O TELEPHONE CONNECTION a N PUMP UNIT (SEE DETAIL FOR SIZES) WITH CONTROLLER ° T (24"x24"x9') MOUNTED ABOVE P U M n t Do N J V) Z o 12 1/2- (#1 TANK) D O 0 TT_ — — 00 I v II O Cr I 29 3/4 (11 TANK II QJ II 00 U w JOf 1)ESH�OWN WITH CONTROLLER MOUNTED TO PUMP UNIT. w 2) #2 TANK ISUSED WHEN PE FOR WALL MOUNTING.0 TRAVELS EXCE D 50'-0- � 0 Q II Z AND FOR 10 HP MOTORS. 1_11�O 3) OIL OUTLET LOCATED ON RIGHT OR LEFT SIDE. 3'-6" CLEAR PER t LL NATIONAL ELECTRICAL CODE a— 001pF INEWy LL LIGHT SW. & GFI DUPLEX RECEPTACLE �4,�''•.077142 "�q�FESSIONP MAIN LINE p�•�`\``• „„0% DISCONNECT & CAB LIGHTING DISCONNECT ABOVE 1'-3" 2'-6" MIN. CLEAR 1'-0" 4'-9" RECOMMENDED MINIMUM FINAL ASME A17.1.RULE 3,19.3.3.1 FLEXIBLE HOSE AND FITTING ASSEMBLIES SHALL NOT BE INSTALLED WITHIN THE HOISTWAY GENERAL NOTES AND PROVISIONS �WALL ECT INTO OR THROUGH IAL AND ASSOCIATED REQUIRED BY OTHERS FITTIN'cs SHALLR COMPLY WITH ASME A17.1, SECTION 3.19 AND SHALL BE 1. AN ADJACENT MACHINE ROOM BUILT TO CONFORM TO THE LAYOUT DRAWINGS, FURNISHED BY THE ELEVATOR N.E.C., ASME A17.1, AND ALL STATE OR LOCAL CODE REQUIREMENTS. IT SHALL CONTRACTOR. HAVE SUITABLE ACCESS, A LOCKABLE DOOR, A CONVENIENCE OUTLET, AND LIGHT SWITCH. MACHINE ROOM TEMPERATURE MUST BE MAINTAINED BETWEEN 60 AND 100 DEGREES FAHRENHEIT. RELATIVE HUMIDITY NOT TO EXCEED 95X. MACHINE ROOM 2. A 220V, SINGLE PHASE, (30 AMP.O 3HP or 60 AMP.O 5HP) SERVICE WITH NEUTRAL TO A LOCKABLE SAFETY DISCONNECT SWITCH, FUSED WITH TIME DELAY FUSES SHALL BE FURNISHED IN THE MACHINE ROOM IN ACCORDANCE WITH N.E.C. A NORMALLY OPEN ELECTRIC INTERLOCK CONTACT IS REQUIRED IN THE P.O. BOX 749 5191 STUMP RD.PL SWITCH FOR BATTERY ISOLATION. (3 HP) SOURCE FOR SINGLE PHASE I UMSTEADVILLE, PA. 18949 HEAVY DUTY SWITCHES (OR EQUAL): SQUARE 'D' CAT#H-221 N; � PHONE: 215-766-3380 ELECTRIC INTERLOCK #EIK-031. TTE CAT.#SN-321; ELECTRIC INTERLOCK #SC-3. FAX: E: 215 766-3 CUTLER HAMMER CAT. #DH221 NGK; ELECTRIC INTERLOCK #DS200EK1. / L E V A T O R (5 HP) SOURCE FOR SINGLE PHASE HEAVY DUTY SWITCHES (OR EQUAL): SQUARE -D- CAT#H222N ELECTRIC INTERLOCK EK-300-1; m a n u t a c t u ►I n g ROPED HYDRAULIC company, Inc. TTE CAT.#SN-322 ELECTRIC INTERLOCK #SC-5. RESIDENTIAL ELEVATOR CUTLER HAMMER CAT. #DH222NGK ELECTRIC INTERLOCK #DS200EK1. 3. A 120V AC, SINGLE PHASE, 15 AMP. SERVICE TO A LOCKABLE FUSED DISCONNECT NORTHEAST ELEVATOR SERVICE CORP. SWITCH, OR CIRCUIT BREAKER LOCATED IN THE MACHINE ROOM SHALL BE PROVIDED PROJECT: 8 JASMINE LN. RYE BROOK, NY FOR THE CAB LIGHTING IN ACCORDANCE WITH N.E.C. PRELIMINARY DATE: APPROVED BY FINAL DATE: 4. A TELEPHONE LINE TO THE MACHINE ROOM AND TIED INTO THE ELEVATOR CONTROLLER AS PER ASME A17.1 CODE. 05/17/21 08/02/21 5. MACHINE ROOM VENTS IF REQUIRED BY LOCAL CODE. DRAWN BY: S.G. REV. #: DRAWING NUMBER: 6. KNOCK—OUT IN WALLS BETWEEN THE MACHINE ROOM AND ELEVATOR HOISTWAY FOR ROUTING HYDRAULIC AND ELECTRICAL LINES SHALL BE COORDINATED SCALE: N.T.S. NEAST-22220 WITH ELEVATOR CONTRACTOR. PLAN NUMBER: Machine rooms n�nr c nr -s ALTERNATE MACHINE ROOM LAYOUT 0 "rof�NFiy'Y*,. CO.. TELEPHONE 2 t 94 ' O Z. = ' . - CONNECTION - T i ) W c SSIONA "hrrnrn N"% PUMP UNIT (SEE DETAIL FOR SIZES) WITH CONTROLLER (24"x24"x9") MAIN LINE III MOUNTED ABOVE P U DISCONNECT & CAB -j � LIGHTING DISCONNECT 04 .-. ABOVE J = Q V) Z Z) O uJ J � O 0 LIGHT SW. & GFI z_� a O w c) DUPLEX RECEPTACLE J Q Of U e W U aL ounE7 U uJ J K1 in L`I n I J m M Z N LD I 12 1/2 (#1 TANK) Z 29 3/4- (/1 TANK 3'-0" MIN. CLEAR 6" 1) SHOWN WITH CONTROLLER MOUNTED TO PUMP UNIT. CAN BE SUPPLIED LOOSE FOR WALL MOUNTING. 4'-9" RECOMMENDED MINIMUM 2) /2 TANK IS USED WHEN TRAVELS EXCEED 50'-0- AND FOR 10 HP MOTORS. 3) OIL OUTLET LOCATED ON RIGHT OR LEFT SIDE. FINAL ASME A17.1.RULE 3,19.3.3.1 FLEXIBLE HOSE AND FITTING ASSEMBLIES SHALL NOT BE INSTALLED WITHIN THE HOISTWAY GENERAL NOTES AND PROVISIONS �WALL INTO OR THROUGH REQUIRED BY OTHERS PIPE AL AND ASSOCIATED FIT'f1NGS SHALL COMPLY WITH ASME A17.1, SECTION 3.19 AND SHALL BE 1. AN ADJACENT MACHINE ROOM BUILT TO CONFORM TO THE LAYOUT DRAWINGS, FURNISHED BY THE ELEVATOR N.E.C., ASME A17.1, AND ALL STATE OR LOCAL CODE REQUIREMENTS. IT SHALL CONTRACTOR. HAVE SUITABLE ACCESS, A LOCKABLE DOOR, A CONVENIENCE OUTLET, AND LIGHT SWITCH. MACHINE ROOM TEMPERATURE MUST BE MAINTAINED BETWEEN 60 AND 100 DEGREES FAHRENHEIT. RELATIVE HUMIDITY NOT TO EXCEED 95%. MACHINE ROOM 2. A 220V, SINGLE PHASE, (30 AMP.O 3HP or 60 AMP.O 5HP) SERVICE WITH NEUTRAL M n 'V TO A LOCKABLE SAFETY DISCONNECT SWITCH, FUSED WITH TIME DELAY FUSES SHALL BE FURNISHED IN THE MACHINE ROOM IN ACCORDANCE WITH N.E.C. A NORMALLY OPEN ELECTRIC INTERLOCK CONTACT IS REQUIRED IN THE P.O. BOX 749 5191 STUMP RD. SWITCH FOR BATTERY ISOLATION. (3 HP) SOURCE FOR SINGLE PHASE HEAVY DUTY SWITCHES (OR EQUAL): SQUARE 'D' CAT#H-221 N; / )))/) (\I//Y{J� /) PLUM NE: 215 E, 6 180 ELECTRIC INTERLOCK /EIK-031. ME CAT./SN-321; ELECTRIC INTERLOCK ISC-3. / /� /!/1./ / ,�(/ PHONE: 215-766-3380 CUTLER HAMMER CAT. /DH221NGK; ELECTRIC INTERLOCK /DS200EK1. 111/IE L E V0TOit FAX: 215-766-3385 (5 HP) SOURCE FOR SINGLE PHASE HEAVY DUTY SWITCHES (OR EQUAL): SQUARE -D- CAT#H222N ELECTRIC INTERLOCK EK-300-1; m n n u t e c t u r I n g ROPED HYDRAULIC ITE CAT.#SN-322 ELECTRIC INTERLOCK #SC-5. company, Inc' RESIDENTIAL ELEVATOR CUTLER HAMMER CAT. /DH222NGK ELECTRIC INTERLOCK /DS200EK1. 3. A 120V AC, SINGLE PHASE, 15 AMP. SERVICE TO A LOCKABLE FUSED DISCONNECT NORTHEAST ELEVATOR SERVICE CORP. SWITCH, OR CIRCUIT BREAKER LOCATED IN THE MACHINE ROOM SHALL BE PROVIDED PROJECT: 8 JASMINE LN. RYE BROOK, NY FOR THE CAB LIGHTING IN ACCORDANCE WITH N.E.C. PRELIMINARY DATE: APPROVED BY FINAL DATE: 4. A TELEPHONE LINE TO THE MACHINE ROOM AND TIED INTO THE ELEVATOR CONTROLLER AS PER ASME A17.1 CODE. 05/17/21 08/02/21 5. MACHINE ROOM VENTS IF REQUIRED BY LOCAL CODE. DRAWN BY: S.G. REV. #: DRAWING NUMBER: 6. KNOCK-OUT IN WALLS BETWEEN THE MACHINE ROOM AND ELEVATOR HOISTWAY FOR ROUTING HYDRAULIC AND ELECTRICAL LINES SHALL BE COORDINATED SCALE: N.T.S. ' NEAST-22220 WITH ELEVATOR CONTRACTOR. PLAN NUMBER: Machine rooms n•nr -• nr -� p ECEWED Westchester AUG 13 2021 govcom VILLAGE OF RYE BROOK BUILDING DEPARTMENT George Latimer County Executive shcrlita:1mh•r,Dill Conuui�.,ioner of Health August 2, 2021 Russell Palucci, P.E. 140 Princeton Drive Shelton, CT 06484 RE: Log #: 13332-21-DCDA Application for Backflow Prevention Device Kingfield Development 8 Jasmine Lane Rye Brook Dear Mr. Palucci: The plans and specifications for the above project have been reviewed and approved by this office pursuant to the provisions of Chapter 873, Article VII, Section 873.707.1 of the Laws of Westchester and Section 5-1.31, Subpart 5-1, of Part 5 of the New York State Sanitary Code. A Certificate of Approval is attached. Form NYSDOH-1013 is to be utilized as a Request for Completed Works Approval. This form can be downloaded from the following link: https://health.westchestergov.com/images/stories/pdfs/crossconnection doh1013.pdf .. NYSDOH- 1013 consists of two parts: (A) the initial test of the device(s) by a certified backflow prevention device tester, and (B) a certification by a Professional Engineer or Registered Architect, licensed and registered in the State of New York that installation is in accordance with the approved plans. The completed NYSDOH-1013 must be sent to our Department within 45 days of installation of the device(s). This form can be emailed to DOH-BFiow(a-westchestergov.com . Respectfully, AW Delroy Taylor, P.E. Assistant Commissioner Bureau of Environmental Quality DT/RB:pm cc: Jeff Dubois — SC Rye Brook Partners, LLC Frank McGlynn, Manager— Suez Water Michael Izzo, Bldg. Insp. — Rye Brook File001 t.} ~ REfYLE Department of Health 25 Moore Avenue Mount Kisco,NY 105 19 Tek-phon,,: (91 (91 1)813-I(i91 NEW YORK STATE DEPARTMENT OF HEALTH CERTIFICATE OF APPROVAL FOR BACKFLOW PREVENTION DEVICES This approval is issued under the provisions of 10 NYCRR, Part 5, Section 5-1.31, and Chapter 873, Article VII, Section 873.707.1 of the Laws of Westchester County. _ I Log No. 13332-21-DCDA Facility: Kingfield Development City, Village, Town: County: 8 Jasmine Lane Rye Brook WESTCHESTER Owner's Mailing Address: Jeff Dubois SC Rye Brook Partners LLC 4 West Red Oak Lane-Suite 325 White Plains, NY 10604 Physical Location of Backflow Prevention Device(s): Dog House Description of Device(s): One 1 —2 inch Wilkins 950XLTDABF DCDA) Water Supplier: Suez Water Name Designated Representative: Frank McGlynn. Mailing Address: Zip: 10801 2525 Palmer Avenue, Suite 3, New Rochelle, NY Conditions of Approval: A. THAT the device(s) shall be installed within 90 days, and that within 45 days of installation the attached New York State Department of Health Form DOH-1013 shall be completed and returned to the water supplier and the Westchester County Department of Health. B. THAT a certified back-flow prevention device tester test the above backfiow prevention device(s) at least yearly and report the results to the water purveyor indicated above. C. THAT any connection made prior to the backflow prevention device(s) shall render this approval void. D. THAT the proposed works be constructed in conformance with plans and specifications approved this day and any amendments thereto. E. THAT certification that installation of device(s) is in accordance with the approved plans, Form NYSDOH-1013, Part B, must be completed by a Professional Engineer or Registered Architect, licensed and registered in the State of New York. 1. F. THAT the approved device(s) shall be so set that the test cocks are faced for easy access. G. THAT if facility construction has not commenced within 90 days of the issuance of this Certificate of Approval, then this Certificate shall become null and void unless an extension to the 90 day installation period is secured from the Westchester County Department of Health by the facility owner. Designated Representative ISSUED FOR THE STATE COMMISSIONER OF HEALTH BY: DATE: August 2, 2021 ADelroy DTaylodr,RP.E Assistant Commissioner NEW u of Fl Alic W t]EPgRTMEMTOF APR 1 O 202J Bureau o/to Oe Water3uooly Prpredipn Report on Test and Maintenance 6npire Stem Plera-Cxning Tvwer Ru T�10 lJbany,NY 12237 1 of Backflow Prevention Device t BUILDING DEPARTMENT Pleases use a separate form for each+device, For the year C> _ -21 Initial test-Complete 9nfire form ,annu3l test-Gompfefe Par!A w ly NIN PsbHc IKa�Buoply Aodotnt No. I:.auMy� I Block Lot Q SC�CC I Facility Name_-Yt•r\�{�L C.�, L=attDn Df Device Address Sheet cltyj ZP Device i Manufacturer Information Type =RPZ Model Size(In inches) Serial Number Ik�nS DCv 95'�nt_ �- C�3ca7 chant Valve No.1 cbmkvwft tdo,2 Differential Pressure Relief Line Pressure .v oai Vatvs Test Leaked Leaked 0 Opened at psid DatteTF�fl before Glesed tight Closp�light Q LJ—J repair Pressure drop across first check valve lji IA M D y paid D"CAM hpaha and Repaired by rrmrtartats Name used Lie# Date repaired; m p M 0 y Foal test Closed fight Gosed tight � Opened at psid (U71 7 u Pressure drop across first Q l A M D y check valve :J•7 paid a -t Water Meter Number Meter Reading Type of Service:(check one) 1 9 Domestic Fre 9 other Remarks(Describe dertcienuea:bypasses.outlets before the device,connections between the device and pant of entry,messing w Inadequate airpaps,at, Certification:Tfus device El meats. 0 does NQT covet,the requirements of anja �lll can i eat device at the time of testing I t ereby certiix th�eifrs going datambeoortedt _a'JA�IZ;+r4.�Pnrd nameCsra6ed Teeter lb. E '>tBon p' Property owners(or owner,s agent)certification that laid was perfarrned: J f"-51— Pram Narra Title gntkIDra Telephone Certification that installation Is in accordance with the apprnved plans. fro be compieted by the design aneincor or archiled ar weict s"PlIer.) 11 hereby FceroTy that this,ihrdaYation is n accordance with the approved plaA n Name Russell Palucci me Engineer �, O y Z z IVYS DOH Lag# License Number 78721-1 Phone(�5 )337-6040 m d y I3 Representing rime Solutions, LLC ConSulling trigineers Describe minor installation changes Address 140 Princeton Drive pity Shelton State CT Zip 06484 Sigrta:vre _ Send ere comp tad copy to the n e near pa meni nwcsonr 've and one copy to the water ap or vat to oays a trio:sung eavne. Nowy owner and water wppUor Immedletoty if device falls"and.'i i.cannot immedtately,be made. DCH. 10IN9191) D C��L i_ ``1 Is 8 Jasmine Lane Rye Brook NY 10573 APR f 0 2023jD 2015 IECC Energy VILLAGE= OF RYE BROOK Efficiency Certificate BUILDING DEPARTMENT Insulation . Above-Grade Wall 19.00 Below-Grade Wall 14.00 Floor 30.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): R_ Glass& Door Rating U-Factor SHGC Window 0.29 0.30 Door 0.30 0.30 CoolingHeating & Heating System: Heil#NgMSE100 1 nA 95.5° Cooling System: Heil 4 Ton#NXa648GKA 16 SEER Water Heater: Model VSCE32 119R 119 Gallon Electric Name: Jobe Leonard Date: 2119119 Comments Envelope Leakage Test D [ECIEVE Testing Company: Technician: R ID Name: ProChek Name: Andrew F ti APR 10 2023 Address: 100 Mill Plain Road Credentials: BPI VII._I_AGE OF RYE BROOK Danbury, CT 06811 Email: info@prochek.com-NG DEPARTMENT Phone: 8003385050 www.prochek.com Building Information: Customer Information: Project ID: ORDER 5555 Name: Address: 8 Jasmine Ln Address: 8 Jasmine Ln Rye Brook, New York Rye Brook, New York 10573 Geo-Tag Data: 1106RWe: 41.048437 Longitude: -73.693116 Ti mesta m p: 2023-02-15 10:12.30 Measured Leakage: 1.41 ACH50 Leakage Target: 3.00 ACH50 Compliance with Leakage Target: Pass Test ID: 5555 Purpose of Test: IECC 12/15 Env. Leakage Measured CFM50: 1,022.0 (+/- 8.0%) Effective Leakage Area: 54.0 in Building Volume: 43,397.0 ft3 Enclosure Surface Area: 4,726.0 ftz Coefficient (C): 75.7 (+/- 60.2%) Exponent (n): 0.665 (+/- 0.166) Correlation Coefficient: 0.97026 Test Standard: ASTM E779 (single mode) Test Mode: Depressurize Test Characteristics: Pre Indoor Temp: 68 °F Post Indoor Temp: 58 °F Pre Outdoor Temp: 58 °F Post Outdoor Temp: 68 °F Altitude: 199.0 ft Time Average Period: 30 seconds Test Date and Time: 2023-02-15 10:46.13 2000 Depressurize 600 0 500 J 400 01 300 =o m 200 100 4 5 6 7 8 910 20 30 40 50 60 70 Building Pressure(Pa) Envelope Leakage Test Test Readings: Target (Pa). Bldg-(Pa). Adj Bldg-(Ea). Fan (Pa). Flow (cfm)_ Config Baseline -3.2 -60.0 -62.2 -60.5 -38.5 1,126.6 Ring A -54.0 -57.8 -56.1 -38.7 1,129.0 Ring A -48.0 -49.1 -47.3 -32.2 1,032.3 Ring A -42.0 -44.8 -43.0 -26.8 944.6 Ring A -36.0 -39.6 -37.8 -23.3 881 .1 Ring A -30.0 -30.8 -29.0 -109.5 621 .3 Ring B -24.0 -26.0 -24.2 -107.4 615.7 Ring B -18.0 -21 .1 -19.4 -99.1 591 .5 Ring B Baseline -0.4 Test Equipment: Flow Device: Model 3 110V Fan Pressure Gauge: DG1000 Serial #: 6006 Calibration Date: 2020-07-01 Deviations from Standard: • Correlation coefficient is outside of normally accepted limits. Comments: None Report by TEC Auto Test 1.9.0 (132), © 2023 The Energy Conservatory, Inc. Page 2 of 2 \ Building Permit Check List&Zoning Analysis )Address: Y> Nl t Ll t Nri SBL G Z'j' Zone:��L U e: Zt o Const.Type: Other. Submittal Date: o 2 Z D Revisions Submittal Dates: Applicant: {C ��� �= o 04-c_ Nature of Work l �^-� Er l C � w r' —1—S�`'ok t . Reviews:ZBA: NOV 1 9 2020 PB. BOT: Other. L` Q_K ( ( ) FEES:Filing S• N BP: �'-t ��Z - s1 C/a -- ( ) APP: Dated Notarized: SBL Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO: Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( e� Y RVE :Dated Cut Archival Sealed Unacceptable ( ) ANS:Date Stamped �e� 7 J i�License: Workersty V Comp.Waiver Other. ( ) ( ) CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. FIRE ALARM/SMOKE DETECTORS:Plans: Permit H W.I.C.:_Battery-_Other. (,�( ) PLUMBING Plans: Permit Nat.Gas: LP Gas: N/A/: Other. (aC (v f FIRE SUPPRESSION:Plans: ✓ Permit ✓ N/A: Other. H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit Fuel Type: Other. (�O 2020 NY State ECCC: N/A: Other. Final Survey- Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval notes: ( )ZBA mtg.date approval notes: ( )PB mtg.date: approval notes: REQUIRED EXISITNG PROPOSED NOTES APPROVED nnlea• N�V 1 9 �n�n Circle: Fron�taee Front: Front: Sides: Main Cov. Accs,Cov Ft.H Sd.H/Sb: -GFA- TOL imp HH Stories: notes: Residential Building Permit Fee Work Sheet Permit#: Date Issued: SBL: Zone: Address: 4S I " � Property Owner&Contact Info: Job Description: For all new dwellings and for additions measuring 800 sq. ft. or more made to existing dwellings, the following fee schedule shall apply: (plus any alteration fees) Total Sq. Ft. (excluding basements)x $225.00 x $I 5.00/$I,000.00 Basement Sq. Ft. x $65.00 x $I5.00/$I,000.00 -------------------------------------------------------------------------------------------------------------------- New Construction Sq.Ft. • New Construction Cost • Building Permit Fee Basement= ��sq. ft. x $65.00 = $ 'x$I5.00/$I,000.00 = $ �L 0' -3 L I"Fl. = 2 sq.ft. x $225.00 = $ 50-3 SSD, x$I5.00/$I,000.00= $ 2,-5 2"d Fl. = sq. ft. x $225.00 = $ x$I5.00/$I,000.00= $ (03-0;� Attic= _sq. ft. x $225.00 = $ x$I5.00/$I,000.00= $+ Total Sq.Ft._ l sq.ft. Total Cost= $ �'IS 3 - �• Total B.P.Fee= $ t ( ?,)2 .Sl °Includes Attached Garage if Applicable. Total Amount Paid = $ v° .. Total Amount Due= $ / 0 Z ' s, Date: NOV 1 9 2020 Signed; l This form must be properly completed &notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. Title 19 Part 1264 & 1265 NYCRR To: The Building Inspector of the Village of Rye Brook. From: J30(Anf S N k jo(:�) LL - 001Z nTS�c�1 DkJ f<� ��►ru t�T/�c.Pk- 1I11 Subject Property: M 1 r)e L� C SBL J'qC)/ Zone: �U V Please take notice that the subject; ❑'bne or Two Family; ❑ Commercial, ET New Structure ❑ Addition to an Existing Structure R ECENED O Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; [S:EP 2 4 2020 B'Truss Type Construction(TT) VILLAGE OF RYE BROOK BUILDING DEPARTMENT C3'Pre-Engineered Wood Construction(PW) ❑ Timber Construction (TC) in the following location(s); ❑ Floor Framing, including Girders & Beams(F) ❑ Roof Framing(R) 2'Floor Framing and Roof Framing (FR) Please note that prior to the issuance of the Certificate of Occupancy,the subject dwelling or building utilizing truss type, pre-engineered wood,or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§iz65 for One&Two Family Dwellings. 112, 1 V_1$ P'_ k-'_ Dale Dcsi �l Datc Pr crty Cr q/ C) 14,11 _ Datc Ndary Public (7) CbrWm boyd �&A of A,Yak No.of W616M Qum"in Caamiw�oa spina May 21C°»seyjft a o Z. R n CERTIFICATE OF LIABILITY INSURANCEF77� 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 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 m certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Aon Risk Services Northeast, Inc. PHONE (866) 283-7122 Boston NA office (A/C.No.EXt): FAX (800) 363-OIOS y 53 state Street E-MAIL. v suite 2201 ADDRESS: ° Boston MA 02109 USA 2 INSURER(S)AFFORDING COVERAGE NAIL f INSURED INSURER A: Navigators Insurance Co 42307 SC Rye Brook Partners, LLC INSURERS: Guideone National Insurance Company 14167 230 Park Ave. New York NY 10169 USA INSURERC: Starr Indemnity iL Liability Company 39318 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570082993250 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. Limits shown are as requested LTR TYPE OF INSURANCE D WVD POLICY NUMBER MIA DO,YYYYILIMITS B X COMMERCIAL GENERAL UABNITY EACH OCCURRENCE S5,000,050 CLAIMS-MADE ❑x OCCUR EATEN— f1OO,000 PREMISES Ee oocuner>ce MED EXP(Arty one pwwnl Excluded PERSONAL 8 ADV INJURY S 5,000,000 ,QI GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE Ss,000, POLICY OOO PRO, X OTHER JECT LOC PRODUCTS-COMP/OPAGG S5,000,OOO m g n AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT `n ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) m AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE A ONLY AUTOS ONLY 'Per acealent f UMBRE LLA LIAR OCCUR 1000579693201 0 / 1110112021 EACH OCCURRENCE v EXCESS LIAR CLAIMS-MADE AGGREGATE f 5,000,OOO DED I RETENTION WORKERS COMPENSATION AND PER STATUTE I JOTH- EWPLOYEFtS'LLAOLfrY Y I N ANY PROPRIETOR,PARTNER EXECUTIVE E.L.EACH ACCIDENT OFFICERMEMSER EXCLUDED'' F N/A flaundromy IR I" E.L.DISEASE-EA EMPLOYEE n yypp,.desvw under DESCRIPTK)N OF OPERATIONS below E.L.DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) e~� CERTIFICATE HOLDER CANCELLATION 254 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ►� POLICY PROVISIONS village of Rye Brook AUTHORIZED REPRESENTATIVE 938 King street Rye Brook NY 10573 USA c�L�fi �`�LldtG c/61�t�21Cf0 c//�✓s7� t� (0988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016 03) The ACORD name and logo are registered marks of ACORD Certificate of Attestation of Exemption from New York State Workers' Compensation and/or Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit SC Rye Brook Partners,LLC 1100 King St Ste 114 From:The Village of Rye Brook NY Rye Brook,NY 10573-1057 PHONE:914-481-1531 FEIN:XXXXX6509 The location of where work will be performed is 110 King Street,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from March 17,2020 to March 16,2021. The estimated dollar amount of project is over S100,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Robert Dale Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Janice Heusser,am the Office Assistant with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that 1 have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately fumish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGHEIR Signature: �� Date: ;. /-7.ZoZ O ExempttopAC s ate Number 44 `A ti v`d 24 NO 020 :NYS Work nation Board CE-200 0112018 '4� �'�(M� 'CERTIFICATE OF LIABILITY INSURANCE 04/13/2020 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 policy(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 CONTACTNAME CONTACT CLIENT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 A CNNo EXe:888-333-4949 FAX NO);507-4464664 OWATONNA, MN 55060 E-MAIL CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 149-868.2 INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 MACK FIRE PROTECTION INC INSURER C: 15 INDUSTRIAL PARK PL MIDDLETOWN,CT 06457-1501 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:466 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. rB TYPE OF INSURANCE DL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $100,000 P CM" Ea ocarrence MED EXP(Any one person) $10,000 N N 6042334 05/11/2020 05/11/2021 PERSONAL&ADV INJURY $1,000,000 G NT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X POLICY JECT �LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) SCHEDULED - B OWNED AUTOS ONLY AUTOS N N 6042334 05/11/2020 05/11/2021 BODILY INJURY(Per accideno HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per acc i X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 B EXCESS LIAB CLAIMS-MADE N N 6042337 05/11/2020 05/11/2021 AGGREGATE $10,000,000 DED I I RETENTION WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N X PER STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? NIA N 6042338 05/11/2020 05/11/2021 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached if more space is required) RE: KINGSFIELD 1100 KINGS ST RYE BROOK NY CERTIFICATE HOLDER CANCELLATION 149-868-2 4660 VILLAGE OF RYE BROOK NY BUILDING DEPARTMENT 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 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 860-632-8053 MACK FIRE PROTECTION INC 149-868-2 15 INDUSTRIAL PARK PL MIDDLETOWN.CT 06457-1501 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 04.3814418 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 NY Building Department #466 938 King St 3b.Policy Number of Entity Listed in Box"1a" Rye Brook NY 10573-1226 6042338 3c- Policy effective period 0 511 1/20 2 0 to 05/11/2021 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) ❑X 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"la"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3 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. Th s 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: Elizabeth Petersen (Print name of authorized representative or licensed agent of insurance carrier) Approved by: - _ Q '— 04/13/2020 (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 (9-17) www.wcb.ny.gov '4C�� CERTIFICATE OF LIABILITY INSURANCE72;1/2022 ATE(MM/DD+YVYY) 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 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 OTT AGENCY NAME aC No EXt (845) 895-8873 PO Box 659 ac No Wallkill, NY 12589 ADDRESS ottins2001@yahoo.com INSURER(S) AFFORDING COVERAGE NAILA INSURER Main Street America INSURED Total Comfort Inc INSURER B National Grange PO Box 359 INSURER C 7 Ohara Rd INSURER D Milton, NY 12547 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 INS LTR TYPE OF INSURANCE INSD VWD POLICY NUMBER Mllil YYY MM/D R D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 00,000 CLAIMS-MADE I :X 1 OCCUR PREMISES Ea occurrence s 500,000 MPU7919F 1/21/2022 1/21/2023 MED EXP(Any one person) s 10,000 A 7{ X I PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2,000,000 POLICY 7 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,00 OTHER AUTOMOBILE LIABILITY 'UMLIINLU SINGLE LIMIT Ea accldenn OWNED $ 1,000,000 O OWNED SCHEDULED B1U7919F 1/21/2022 1/21/2023 BODILY INJURY(Per person) $ B AUTOS ONLY x AUTOS BODILY INJURY(Per accident) $ x HIRED NON-OWNED AUTOS ONLY x AUTOS ONLY Per accident $ X UMBRELLA LIAB X OCCUR B EXCESS LIAB CUU7919F 1/21/2022 1/21/2023 EACH OCCURRENCE s 5,000,000 CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY STATUTE I IER N B �ANY,,IROPRIETOR/PARTNER/EXECUTIVE YrN WCU7919F 1/21/2022 1/21/2023 OFFERIMEMBER EXCLUDED' E L EACH ACCIDENT $ 1,000,000 /A !Mandatoryfyes stlesc IR NR)e under ❑ E L DISEASE-EA EMPLOYE $ 1,000,000 f yes DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,may be anached if more space is required) CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 KING STREET ACCORDANCE WITH THE POLICY PROVISIONS RYE BROOK, NY 10573 AUTHORIZED REPRESEN7TIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD r NEW i Workers' PORK CERTIFICATE OF 4'—" ,E Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 203-223-6700 TOTAL COMFORT INC PO BOX 359 1c. NYS Unemployment Insurance Employer Registration Number of 7 OHARA RD Insured MILTON,NY 12547 Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State.i.e.,a Wrap-Up Policy) 1d. Federal Employer Identification Number of Insured or Social Security Number 141829022 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NATIONAL GRANGE VILLAGE OF RYE BROOK 3b.Policy Number of Entity Listed in Box"'Ia" 938 KING STREET WCU7919F RYE BROOK,NY 10573 3c. Policy effective period nvwgmg to n1/91/9ros 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) Qx 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: WILLIAM C OTT (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) (Date) v Title: PRESIDENT Telephone Number of authorized representative or licensed agent of insurance carrier 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 CHAMELE-01 130ZDA1 A�OR� CERTIFICATE OF LIABILITY INSURANCE DATE(M 3/22/202YYI� 2023 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 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 endorsements . PRODUCER CONTACT HOTALING PROPERTY&CASUALTY LLC PHONE 2678 South Road (Arc,No, FAX 845)454-8363 � No):(845)471-7494 Suite 102 %Mss.certificatesmel&gfin.net Poughkeepsie,NY 12601 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:Accredited Surety and Casualty Company,Inc. 26379 INSURED INsuRERe:3tate Farm Mutual Automolb_le Insurance Co 25178 Champion Elevator Corp. INSURERC: 1450 Broadway 5th Floor INSURERD: New York,NY 10018 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. INSRLTR ADDLTYPE OF INSURANCE Imak SU D POLICY NUMBER POLICY EFF POLICY EXP mmmpryyyl LIMA A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 2,000,000 CLAIMS-MADE FX]OCCUR 1-TPM-NY-17-01268951 8/10/2022 8/10/2023 DAMAGE TO RENTED 300,000 JMMISES(Ea occurmnoe) III X Contractual Llab MED EXP oneperson) 5,000 PERSONAL&ADV INJURY 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000 POLICY❑X JECT LOC PRODUCTS-COMP/OP AGG 111 4,000,000 OTHER: ESL AGGREGATE 11000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO �298 5428-B31-32 841/2022 841/2023 BODILY INJURY Perperson) OWNED SCHEDULED i AIURTEO�S ONLY AUTOS yy E BODILY INJURY Per axkeM AUTOS ONLY AUOTOS ONL� "RTY AMAGE A UMBRELLA LIAR X OCCUR EACH OCCURRENCE 31006,000 X EXCESS LIAB CLAIMS-MADE 1-TPM-NY-17-01268952 8/10/2022 8H0/2023 AGGREGATE 3,000,000 LIED I I RETENTION$ A WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER ANY PROPRIETOR/PARTNEWlEXECUTIVE YIN 1-TPM-NY-16-01285898 8/10/2022 8HO/Z023 1,000,000 OFFICER/M Mg��EXCLUDED? �N M rA E.L.EACH ACCIDENT ndatory�A NH) E.L.DISEASE-EA EMPLOYEE 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below 1,000,000 E.L.DISEASE-POLICY LIMIT A Excess Liability 1-TPM-NY-17-01268953 8/10/2022 8/10/2023 Aggregate/Occurence 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:8 Jasmine Ln.Rye Brook,NY Village of Rye Brook is included as additional insured on a primary and non-contributory basis as required by written contract.Waiver of Subrogation applies where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 938 King Street, Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PORK I Workers' CERTIFICATE OF STATE , Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE [New a.Legal Name a Address of Insured(use street address only) 1 b Business Telephone Number of Insured hampion Elevator Corp. 212-292-4430 450 Broadway,5th Floor Y. NY 10( 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required it coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 47-4285250 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Accredited Surety and Casualty Company,Inc. Village of Rye Brook 938 King Street, 3b.Policy Number of Entity Listed in Box"1 a" Rye Brook, 1-TPM-NY-16-0128589 NY 10573 3c.Policy effective period 08/10/2022 to 08/10/2023 3d.The Proprietor,Partners or Executive Officers are ❑X included.(Only check box if all partnerwoMcers 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"I a"for workers' J compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under He 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,1 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 forth. Approved by: Daniel Emerson (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 1/13/2023 (Signature) (Date) Title: Account Manager Telephone Number of authorized representative or licensed agent of insurance carrier. 516-344-6900 Please Note: Only Insurance carriers and their licensed agents are authorized to Issue Form C-106.2.Insurance brokers are NOT authorized to Issue It. C-105.2 (9-17) www.wcb.ny.gov n < a � c� N N N N N N N N N z N .� � o z V °� 30 °. o N N N N N N N N = CO)N n 0- CDr INN � •� o 0 0 0 0 0 0 o C rn ..� CD N � O o �t = �p = 3 �D =, _. m -rh--% W-4 . 0 3 -1 0 X z (D PIL C) cr m z �o < -I m< , .� N n' tQ Ci o L0. 'f'1 0 o > CA �v rn Z Z oCCD = n p C) N) (D 0 0 a �v 0 C O Z p 0� o X 0 MEN tD =. 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