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HomeMy WebLinkAboutMP21-056PERMIT # mil- C���Io DATE. -Dj IXP: SECTION /,:;09, �51 BLOCK LOT_ 4�3 TYPE OF WORK JOB LOCATION _ OWNER CONTRACTOR__ EST. COST ✓co # G TCO # :-�d 9376 �bell a��oc,�la�7ic(gl�illod' ��d�l FEE `� 0 - FEE�I JO-P'6 DATE 3 FEfim E DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS ®' SPRINKLER LE ECTRIC LOW-VOLT R ALAI AS BUILT FINAL INSP OTHER APPROVALS ARB I�4/,)3',&\5000D0 po/D `GXJO7 r eol l'/M/ ?L -0 4 ���/-05 3� yos� # C'an�1�1r o�,�0�,�14�►�c M��l- 05 7 �su �`•b°" G(CJ V . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 3,2023 Joel Hecker&Loraine Hecker 80 Country Ridge Drive Rye Brook,New York 10573 Re: 80 Country Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 129.59-1-23 Mechanical Permit#21-056 issued 4/16/2021 for a New Generator This certifies that the 22kw LP gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building& Fire Inspector /to 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 ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 3,2023 Joel Hecker&Loraine Hecker 80 Country Ridge Drive Rye Brook,New York 10573 Re: 80 Country Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 129.59-1-23 This document certifies that the work done under Mechanical Permit #21-057 issued on 4/16/2021 for the installation of four(4) above-ground LP storage tanks have been satisfactorily completed. Sincerely, Steven E. Fews Acting Building& Fire Inspector /to V ` For office use oniv: D `/ BUILD •�2. IENT PERMIT; N�L�/—O S� VILI,A ' OFRVIE OK ISSUED: JAN 10 20230 8 KiNC STREEI4, YE BROOK, W YORK 10573 DATE: /—/0—a3 9 -Q6C> FEE: PAtDJW VILLAGE OF RYE BROOK ww*'r okire BUILDING DEPARTMENT 1 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 tttttitittttttt!♦tttttiiitlttttiiliititttttittitlitittit!!!►♦!i!!it!!!♦Ilitil+liiittitttilttttlttiitititiitttiitit!!!i!!!liii! Address: Occupancy/Use: /C Parcel ID •Zq , rjC{ —1 _2 3 Zone: Owner: �, 4c-cK4r Address: � &4 p rl P.E. R.A. or Contractor: rn M%, 0 Ch Address: 2 { 0 3rC0 6Ct4, rJI ►4 Person in responsible charge: UST 1 Q4fA/)y Address: << 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: Q 136 \�CC` � being duly sworn,deposes and says that he she resides at C ' JI Print Namr of Applicant) 1•' L (Nu.an ertl in_ L" in the County of W ,y in the State of ,that (Crty town 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: S for the construction or alteration of: e r p ti v Deponent further states that heishe 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 shalt 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§250-10.A.of the Code of the Village of Rye' Brook. 6�� Sworn to before me this Sworn to before me this tam day of TC wv ta':_. 20 2-3 dV of 01 20 �J\ ELISS daii1wW rc of AZ,, N f'1o�►Y F'ublq It HECK "T No.02 li�J Qualified in Wmt Va a utCommion RKrotary Publrt n ? ��. 01 FI6402089 ''s��N EXP�R�'• ' _ Y '4 QyE BRCv� o`` tim 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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - 3 I _? ADDRESS : '2�-J ��1� � DATE: zZ� �J PERMIT# \ 1 ISSUED: SECT: BLOCK: LOT. LOCATION: A 1 -2 ZOCCUPANCY: � C-1 �/�y� ❑ VIOLATION NOTED THE WORK IS... [ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION w REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING / ❑ INSULATION I f ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 'FINAL ❑ OTHER �E BR�k, - cu � 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 - - - - - - - - - - - - - - - - - - - I I ADDRESS : Q<1 �+ i" �1 �) DATE' PERMIT# �� L-� ISSUED: SECT: `. 1 BLOCK: LOT23 LOCATION: Sr\ �SGt / OCCUPANCY: ZJ0 ❑ 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 ��Ir\} ❑ NATURAL GAS Of o ❑ L.P. GAS C�6 ❑ FUEL TANK ❑ FIRE SPRINKLER \ ❑ FINAL PLUMBING ❑ ,CROSS CONNECTION FINAL �C� �CD C d OTHER �E BRC�� o`` tim 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 - - - - - - - - - - - -- - - - - - - - C� ADDRESS : 1' � DATE: -Lc, I PERMIT# f ` 1 CJ J ISSUED: SECT: BLOCK: LOT: LOCATION: �--�1�=1(` / OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION ��5 REQUIRED ❑ FOOTING ,W) ` \ V:) Q ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING S NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION j Li ❑ NATURAL GAS o k L.P. GAS -��� c1 ❑ FUEL TANK ?rV c+ �l I 1 c c� f� "\ (er�c1-� �� l- • rc �n ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �3 i f vi 0 O O i N N . Q0 'IN�7 W U Old ►� tn U m OF O cz: r O i � � w x � C 33 Ooo _ w t z �, -�C-) co C i w Z o ►..� O = ` z u z woo C7, ' A � ccn, i Q' a ? � Q N ? > = c a � � � A 3 wso MAd i ONO �4 GIN � O rrwh� � � ¢ w �> W Z = rr d R F. g z � i w z V fA y 00, E O Z I,^S w F' z r Q � • WM ✓: Q � i 0 .i i iytyC, �yt yE OR�v� R CC� E ��IC� ID BUIL MENT APR 2 2 2021 VIL E OF ;; OK 938 KIN ET RYE B ' ,NY 10573 VILLAGE OF RYE BROOK (914)9 939-5801 BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY 13Ie M10a 1-0 549 EP#: —0 APR 2 2 021 { , Approval Date: Permit Fee: $ I JV rb Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, �/ �22(Z ( 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: $0 Q0 .141'Y Q. r'--3r-• SBL: 12.q.5 9 2 Zone: 2.Property Owner: U t-a 4^'Q N*-CAL4 T- Address: BQ &..#A t y Phone#:q 1Z—BY8'74 3T 3 Cell#: email: 3.Master Electrician:t}J;C.\14*._ U` . -C t!F* c� Address: 101 wl t 1\ Cat e&%►%4 tc.4 cz_ C(4 30 Lic.#:_1—7 L Phone#:203-53Z'15S2 Cell#: 9141.S 19V—80S g email:✓y/lkQ 14 Company Name: Wo i q o Id, E le- 41'C Address: -f 4.Proposed Electrical Work/Fixture Count: 2 V kvJ STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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 bef re me this o7 a day of ,20 day of !'i 20a/ Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347-3595 .00 NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 Ir BUILDING PER NO. TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY t. J STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLU RE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE If,' BASEMENT 15 FL. 2-FL. VIL GE OF RYE BROOK 3-FL. i R 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 APPUCATIONS 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 p 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. NAME OOF]CONI MMY DATE OF//APPUCATION SIGNATURE OF APPLICANT � i4L1.�[� / f� l � 1 X- - STREET ADDRESS TELEPHONE NO. 02 CITY OR POST OFFICE ZIP LICENSE NO.WHEN APPLICABLE C -r- inj2j';� =16� i IF Ift WESTCHESTER RDCKLAND ELECTRICAL INSPECTION INE15SERVICES.INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Weigold Electric Joel &Loraine Hecker 101 Mill Street CT, Greenwich 06830 Located at:80 Country Ridge Dr Rye Brook, NY 10573 Certificate Number: 1028919 Section: 129.59 Block: 1 Lot:23 BDC: Permit Number: EP:21-098-BP:MP#21- 056 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at: 80 Country Ridge Dr Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 06/08/21 Name Type Quantity Generator Up to 25 KW ------- 1 Automatic Transfer Switch ----- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. // S _ in 96 IT N � � Z o W Q cC*4 co O LL' `° E"" z U •LU Z r--� M x ~ C Ar- W A ICI -■ w x � e, i I I yE BR ' BUIL E` k MENT D � � � � v VIL E O 'RYE OK OCT 16 2020 938 KIN I TRYE 3 ,NY 10573 (914)9 939-5801 VILLAGE OF RYE BROOK Org BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY ,I�P'1 �/^-c�I— `5 PP#: Approval Date: A P R 1 5 2021 Permit Fee: $ 75 Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, � d is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an r re ove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said / lumbing work will be' conformancKjt th all applicable Federal,State,County and Local Codes. 1.Address: Q V lA��f C� SBL: \. ` 1 ' X3 Zone: . R 1,5 2.Proposed Work: \11n A K ^O✓►-I (yCi►<r%6( U +Ot- 3.Property Owner:�O /�� Address: Phone#: -11�I- R 1� 13�,,��� Cell r#: email: � p e( -Ca K 4.Master Plumber: �,dvl,4LS ATQI 4,�XgtA Address: c /U I0f-r0 Lic.#:�_Phone#: Cell#: email:41 2 4^a�d '.X-, Oft, cou-I tAM'cad Company Name: 0.1/l 0L4^,QkO- Address: �U �rvo d Q j2 Q(- ,(/ , �J�I I°I'6`t! 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 st Floor 2nd Floor 31 Floor 4"Floor 5"Floor Exterior ` I 5.*List,Other Equipment/Provide Details: W C1 S C i40 wA� (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 ST TAATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: _LU.A �ti9, 0kk /\ ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further s test Vq(J-vr- )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, gent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and beliet 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 J r" Sworn to befor e me this r day of ��-" �-�r _,20 z..e)- day of QC'I V�J LJ" 20 i afore of Property Owner tgnawre of Appli _�-BRA-r�l E T f��K� �t;mGl� �• �IyYliti�w�l , �. Print Name Owner J 'P�h' Print ame of Applicant i 44W—tl Aid Notary Public JOEL L. HECKER Notary Public Jlttll4>'J Public, State of New York No. 60.1732560 , „pprrtlrrp„N, Quetified in Wostcnettar Coutrtq Commission Explros March 30, ►lk—ZLt ,,,\SPF1TZGfg4�'' STATE O This application must be properly completed in its entirety and must include the nclari (s�,of the legal owner(s) of the subject property, and the applicant of record in the spaces per' lotion not properly completed in its entirety and/or not properly signed shall be deemed null ',vi1f, Zreturned to the applicant. ;?s,'• , �. .. • `tip 321/19 2 in = N N N a 17 z � s J7 = . 2 W aF >aw �' cc _ Z M r r- o LTJ co A ¢ L6 Q X � va 0* 96 Li. Ot c .v � 04 Omni C4d , Ell z a u u V� w� II11 of s ZD 16 i� � p Q 4 z 'r• � � � � e�i a�i E .. U W cc • aCL QI m a m BUIL MENT VIL E OF RYE OOK MAR 2 5 2021j JD ' _ 938 KING T RvE BR ,NY 10573 VILLAGE OF RYE BROOK (914)9 39-5801 BUILDING DEPARTMENT o r Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: /-/)0C;v'05-7 Approval Date: A P R 1 5 2021 Permit Fee:$ Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1.Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C 105.2 or Form# U26.3/or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment, or Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 811): 6. Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. 74 Application dated, (/'' ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,an7ol install I Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and regulations. Indicate Permit Type: Installation( •Removal( )•Abandonment( )/Above Ground O• Buried in Ground ( ) 1 � 1�p l j I. Address: V SBL: / 0D7�J 74-43 Zone: 2. Property Owner&Addre s: �t Phone#: "� Cell#: emai : e l , C0 3. Contractor A Address: Q-r) no, Phone#: email: APT 4. Applicant: Ll Phone#: Cell#: email: 5. Indicate Fuel Type:Fuel Oil( )•L.P.Gas •Gasolhle( )•O her 6. Vzd Capacity of each T 7. Exact Locatio s)oi�each Tank: Q� 6/1/2020 STATE OF NEW YORK,COUNTY OF WESTCHESTER K,C I- ,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,ortltat{s)1>te4s-0w and is duly authorized to make and file this application. (mdicale 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. Swom to before me this Sworn to before me this day of 20 day of .20 Si rotor Poe Owner ' rg Property Signature of Applicant sr Jam t L' H t=,'Ic Z k 71 Print Name of Property Owner Print Name of Applicant Notay Public Notary Public This application must be properly completed in its entirety and must include the notarized signature(s) ot'the legal owner(s)of tltc 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. 611 C'020 Building Permit Check List&Zoning Analysis Address: cJ CP�tixT�z`7���5'� Z . SBL. i�i' • �C( — l Z3 Zon 2- S Use: Cont.Type: Other Submittal Date: l(o h -� Revision Submittal Dates: Z L Applicant 'c IF-Q Nature of Work: N a',-(1 L L, ZZ L � • Gas ���n��- Reviews:ZBA: 0 C T 2 1 2020 PB: BOT: Other. NEE1Y OK ( ( ) FEES:Filing: � D�- -f��$P: C/O: Legalization: ( ) (,yAPP: Dated:/Notarized ✓SBL: --'I`russ I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) O:Long. Short Fees: N/A: ( ) ( SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current: Archival• Sealed Unacceptable: ( ( ) PLANS:Date Stamped Sealed; Copies: Electronic: Other. ( (Jf License: f Workers Comp: L/ Liability mp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated N/A: HIGH-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plan: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE • DETECTO Plan: Permit: H.W.I.C.:_Battery:_Other. � G( (Jf PLUMBING:Plan: Permit: 7 Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ( ) H.V.A.C.: Plan: Permit: NIA Other. (%,k V FUEL TANK:Plans: Permit V Fuel Type: i-f7, Cn Other. O O 20I7 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter: As-Built Plan: 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: APPROVED REQUIRED EXISTING PROPOSED NOTES Date: A P R j 5 2021 A� Cir FopM Front: Front: Main Cov Accs.Cov Ft.H Sd.H/Sb Tom: He ht/Stories: notes: /_j�> l.7 • �1 A Y4 Ci l 0 Z GENERAC$ 16/20/22 kW GUARDIAN° SERIES _ Residential Standby Generators Air-Cooled Gas Engine r INCLUDES: • True Power'" Electrical Technology Standby Power Rating • Two Line LCD Multilingual Digital Models G007036-0, G007037-0(Aluminum -Bisque)- 16 kW 60 Hz Evolution'" Controller (English/Spanish/ Model G007035-0(Aluminum-Bisque)- 16 kW 60 Hz French/Portuguese) Models G007039-0,G007038-0(Aluminum -Bisque)-20 kW 60 Hz • Two Transfer Switch Options Available: Models G007043-0, G007042-0(AluminLm-Bisque)-22 kW 60 Hz 100 Amp, 16 Circuit Switch or 200 Amp Service Rated Smart Switch. See Page 4 for Details. • Electronic Governor • System Status & Maintenance Interval LED Indicators • Sound Attenuated Enclosure GENERAC • Flexible Fuel Line Connector • Direct-To-Dirt Composite Mounting Pad - • Natural Gas or LP Gas Operation CODS Qv' � • 5 Year Limited Warranty LSTO Note.CUL certification only applies to unbundled units am units packaged with • limited circUx switches.units packaged with the$mart Switch are UL certified In Capability to be installed within 18" (457 mm) 1he USA only of a building*9 •ony it located away from doors,w,ndows and tress air intakes. and unless otherwise duetted by local codes. FEATURES O INNOVATIVE ENGINE DESIGN 3 RIGOROUS TESTING are at the heart of Generac's O SOLID-STATE,FREQUENCY COMPENSATED VOLTAGE REGULATION: success in providing the most reliable generators possible Generac's G-Force engine This state-of-theart power maximizing regulation system is standard on lineup offers added peace of mind and reliability for when you need it the most.The all Generac models.It provides optimized FAST RESPONSE to changing G-Force series engines are purpose built and designed to handle the rigors of load conditions and MAXIMUM MOTOR STARTING CAPABILITY by extended run times in high temperatures and extreme operating conditions electronically torque-matching the surge loads to the engine. Digital voltage regulation at_t%. O TRUE POWER" ELECTRICAL TECHNOLOGY Superior harmonics and sine wave O SINGLE SOURCE SERVICE RESPONSE from Generac's eraensive dealer form produce less than 5%Total Harmonic Distortion for u0lity quality power.This allows network provides pans and service know-how for the entire unit,from the confident operation of sensitive electronic equipment and micro-chip based appliances. engine to the smallesl electronic component such as variable speed HVAC systems. TEST CRITERIA: r, GENERAC TRANSFER SWITCHES: Long life and reliability are PROTOTYPE TESTED NEMA MG1.22 EVALUATION synonymous with GENERAC POWER SYSTEMS. One reason for this SYSTEM TORSIONAL TESTED MOTOR STARTING ABILITY confidence is that the GENERAC product line includes its own transfer systems and controls for total system compatibility. = GENERAC . �• �.•�w PROMISE ` ...�' •M1MI N N USA Illy�Yr14 MI�'�,pYr. GENERAC° 16/20/22 kW features and benefits Engine • Generac G-Force design Maximizes engine"breathing"for increased fuel efficiency.Plateau honed cylinder walls and plasma moly rings helps the engine • run cooler,reducing oil consumption resulting in longer engine life. • "Spiny-lok"cast iron cylinder walls Rigid construction and added durability provide long engine life. • Electronic ignition/spark advance These leatures combine to assure smooth quick starting every time • Full pressure lubrication system Pressurized lubrication to all vital bearings means bener performance,less maintenance and longer engine lite Now teatur- ing up to a 2 year/200 hour oil change interval. • Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil • High temperature shutdown Prevents damage due to overheating Generator • Revolving field Allows for a smaller,light weight unit that operates 25%more efficiently than a revolving armature generator • Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. • Displaced phase excitation Maximizes motor starting capability • Automatic voltage regulation Regulates the output voltage to_t 1%prevents damaging voltage spikes • UL 2200 listed For your safety Transfer Switch (if applicable) • Fully automatic Transfers your vital electrical loads to the energized source of power • NEMA 3R Can be installed inside or outside for maximum flexibility. • Remote mounting Mounts near your existing distribution panel for simple,low-cost installation Evolution'" Controls • Auto/Manual/Off illuminated buttons Selects the operating mode and provides easy,at-a-glance status indication in any condition • Two-line LCD multilingual display Provides homeowners easily visible logs of history,maintenance and events up to 50 occurrences. • Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations. • Utility voltage sensing Constantly monitors utility voltage,setpoints 65%dropout,80%pick-up,of standard voltage • Generator voltage sensing Constantly monitors generator voltage to ensure the cleanest power delivered to the home. • Utility interrupt delay Prevents nuisance start-ups of the engine.adjustable 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer. • Engine warm-up Ensures engine is ready to assume the load,setpoinl approximately 5 seconds • Engine cool-down Allows engine to cool prior to shutdown setpoint approximately 1 rrinute. • Programmable exercise Operates engine to prevent oil seal drying and damage between power outages by running the generator for 5 minutes every other week Also offers a selectable setting for weekly or monthly operation providing flexibility and potentially lower fuel costs to the owner • Smart battery charger Delivers charge to the batery only when needed at varying rates depending on outdoor air temperature Compatible with lead acid and AGM-style banenes • Main line circuit breaker Protects generator from overload • Electronic governor Maintains constant 60 Hz frequency. Unit • SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature,withstanding winds up to 150 mph.Hinged key locking roof panel for security Lift-out front for easy access to all routine maintenance items.Electrostat- ically applied textured epoxy paint for added durability, • Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries • Small.compact,attractive Makes for an easy.eye appealing installation as close as 18"away from a building Installation System • 1 ft(305 mm)flexible fuel line connector Absorbs any generator vibration when connected to rigid pipe • Direct-to-dirt composite mounting pad Complex lattice design prevents settling or sinking of the generator system. 0 Integral sediment trap Prevents particles and moisture from entering the fuel regulator and engine,prolonging engine life. GENERAL' 16/20/22 kW specifications Generator Model G007035-O,G007036.0, G007038-0,G007039-0 G007042.0,G00704" G007037-0(16 kW) (20 kW) (22 kW) Rated 16,000 Wafts' 20.000 Watts' • Rated MaximloCodkwaq Power C lelft(NG) 16,000 Wafts' 18.000 Watts' �19, 500 Rated 240 ra�� Pa:ed Maximum CorylWwLad Current-240VA(WAIG) 66.066 333%75 916/81 Total HOW 5% Less than 5% Less than 5% :1an une Cucuil lMeeMer 70 Amp 100 Amp 100 Amp P ,, Der a Rear Pole 2 :. .: 6G Hit .._ F:•we!Facbr 1.0 10 1.0 12 M�II'E.Grou a L a weigh(lD kq) 406/186 418/203 411/11fl x �318x Sound oulliout in dBW ei 23 I(T no wish OMlefab►apaaWp Y normal bill" 66 66 W mode" 58 58 Exercise duration 5 min 5 rr n S min Engine Type of Engine GENDK Worce 1000 Series Oft 999 cc 999 cc 919 a Akr i/� V"Arregen C+erneadVai�e OrertmeadValve Off~Valve Im System Solid-state w/Magneto 1110110 w/Magneto 11�/Magneto Governor System Electronic Electronic Electronic Compression Ratio 9.5:1 9.5:1 9.5:1 Stare, 12 Vdc 12 Vdc 12 Vdc Oil Capacity Including Filter Approx 1.9 gV1.8 L Approx.1.9 gV1.8 L ApprolL 1.9 gV1.8 L C�e•alnlg rpm 3,boo 3.600 3 600 Fuel Consumption Natural Gas hz/hr(m;/hr) a 1/2 Load 21 B(617) 204(5.78) 216(6.12) Full Load 309(8.75) 301(8 52) 310(8.78) Liquid Propane 011hir(gaVhr)[Vhr] - 916(2.52)19 531 86(2.37)[8.991 )[9.701 106 8(2.94)(11.111 129.6(3.56)[13.481 ' a14s5J e Fuel pipe must be sized for full load.Requked fialpessuelp gerraslor hbl rrlaerrl ladrages water column(7-13 mm merc ry)for nit:orai gas.I J-12'water cW,v(19-22 min mercury) :or LP gas.Fa Btu confer' ,•1ply Ilamr x 2500(LP)or l'M x 1000(NG).For Mepelo*toMerd,multi;,,—'nr x 93 15(LP)or mI/hr x 37 26(NG) Controls 2-Line Plain Terd Multilingual LCD Display Simple user interface for ease of operation. 011 Utility failure.7 day Sb d wltit IWW eenka,lrrl stays on ll uli l ny tads Irwrslor to load flews place Reedy to fbaysldrtM WO van" of and des. IIIIIIIFIIII Starrdara Programmable atal OMfy bMween 2-1500 aecordt Stadad 0reneON Ulela . Wire Sell CapebM Ew m*fm"Set Error tMenrktp Stadod E= Cyclic aartYrg:16 sec on,7 to(90 see mmdne f duatlen). sm Be" SYrdarA Low Battery/Rauery Problem PreleChon and Battery Condition Indication Slerr aia w ? M&C voltage rind Under Volgpe Under-Frequencyi0�ecoal/$tepper Owcuirerd Protection Slendard Safety Fuseffuse Problem :u'orna c Low Oil PressurwHigh Ol Temperallrs S4lldown Stallard Over High Eng,ne Tem PM*Skew $hll�ld Common External Foull Capebilly Stadrd ••sw.dre"lli,wetai. "Milleswelftg.i.ewr Saud«.awneems.etdeeele.wwwwwbeM n.dpw�ae.��wry..wre lrelpreu.-sresr roecruaa9orr„o•1.w■�oowaerawar a the rNbpo e saw wmwardrsoeewr,b&W Wlo(eusr+ra uer+rreeare000rslo.ekesedu.Lso,oeaaneaetnl.•earreenleoueenpareerwnanwgexe.rderrrerdey■rrnraoRskrea,M.eyor,u aiiaw,awwawaipewaerora.errerrelro.wwowr ,.n� Mai,xnoo..awer.eewupdareawrnl.aoorew(>aamraeldeowerawtwre.reea..owlp.anaeanrat(to Fteeor.ta c(eo Fl. GENERAC` 16/20/22 kW switch options CD Limited Circuits Switch Features M1om M?N"(i t" • 16 circuits,breakers not Included. Current Re"W1111Ds) 100 • Electrically operated,mechanically-held contacts for fast,positive connections ubbly voltage Morft(Plaed)• • Rated for all classes of load. 100%equipment rated,both inductive and 4`10ip 80% resistive. aoaou+ 65% of • 2 pole,250 VAC contactors. appm 15 sec • 30 millisecond transfer time. Exercuesa-rweeldy for 5l►wri.0-s'• snit^ alb d • Dual coil design. roglCiraMSAweNenie 16 • Rated for both copper and aluminum conductors • Main contacts are silver plated or silver alloy to resist welding and sticking Circuit BraW Protected • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor Available RIMS Syrtrrletrlal mounting flexibility. Faun Current @ 250 volts 10,000 • Mulh listed for use with 1"standard,tandem,GFCI and AFCI breakers from Function of Evolution Controller Siemens,Murray,Eaton and Square D for the most flexible and cost effec- Exercise can be set to weekly or monthly live install. Dimensions Height W1 Width W2 Depth H1 H2 In 26.75 301 105 13.5 691 min 619 4 764.3 266 7 343 0 1754 Wire Ranges Conductor Lug Neutral Lug Ground Lug ovrw L we 1ro-#14 210-M14 210-M14 Service Rated Smart Switch Features Model G007037-0(15 kW)/13007039-0(20 kW)/ • Includes Digital Power Management Technology standard(DPM). No•,R! G007043.0(22 kW) law • Intelligently manages up to four air conditioner loads with no additional Current Rating(Amps) 200 Hardware. Voltage Rating(VAG) • Up to four more large(240 VAC)loads can be managed when used in u1,liry Volage Monitor(Fixed)' conjunction with Smart Management Modules(SMMs) vrct�a 80% • Electrically operated,mechanically-held contacts for fast,clean connections 65% • Rated for all classes of load,100%equipment rated,both inductive and resis- tive E�srdsesW weeldykxSrrYeees• SWtdrd . • 2 pole.250 VAC contactors. Enclian Type 1EAAAMl3R • Service equipment rated.dual toll design. • Rated for both aluminum and copper conductors Lug - • Main contacts are silver plated or silver alloy to resist welding and sticking. • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor mount- 'Function of Evolution Controller ing flexibility. Exercise can be set to weekly or monthly Dimensions 200 Amps 120240.1 a Open Transition Service Rated Height Width H Depth Ht H2 Wt W2 in 26 75 30.1 10.5 13.5 6.91 min 679 4 764.3 266 7 343.0 175.4 owrrH L—xq GENERAC 16/20/22 kW available accessories Description Generac's Moblle Link allows you to check the status of your generator from anywhere that you have ac- G006463 4 Mobie Link'" cess to an Internet connection from a PC or with any smart device. You will even be notified via e-mail or text message when a change in the generator's status occurs. Available in the U.S.only. 61005819.0 26R Wet Cell gay Every standby generator reWi es a battery to start the system.Generac offers the recommended 26R wet cell battery for use with all air-cooled standby product(excluding PowerPact(&). 0007101-0 Battery Pad Warmer The pad warmer rests under the battery.Recommended for use if the temperature regularly falls below 01F. (Not necessary for use with AGM-style batteries). W07102-0 Dal Warmer Oif rectly warmer slips di over the oil fitter.Recommended for use If the temperature regularly falls below,GW103-0 Breather Warmer The breather warmer Is for use In saw,b COW weather applications. For use with Evolution controller; only in climates where heavy kdng occurs. 0005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical load Contact Kit you may not need.Not compatible with 50 amp pre-wired switches. Fascla Base Wrap Kit The fascia base wrap snaps together around the bottom of the new air cooled generators.This offers a G007027-0-Biome (Standard on 22 kk1A) sleek,contoured appearance as well as offering protection from rodents and insects by covering the lifting holes located in the base If the generator enclosure is scratched or damaged,it is Important to touch-up the paint to protect from M703-0-BIWA Paint Kit future corrosion.The paint kit Includes the necessary paint to property maintain or touch-up a generator enclosure. G00648M Scheduled Maintenance Kit Generac's scheduled maintenance lots provide all the hardware necessary to perform complete roubne maintenance on a Generac automatic standby generator. G006873-0 Smart Management Module I Smart Management Modules are used In conjunction with the Automatic Transfer Switch to Increase Its (50 Amps) power management capabilmes.It provides additional power management flexibility not found in any other power gement system. dimensions & PCs Dimensions stxnm are doDroxitnle Refer to msORahon manual V exacl dlmensxx,s.00 NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES. :,. 7 Model UPC 1 — —-- G007035-0 696471070354 I G007036-0 696471070361 i G007037-0 696471070378 °";T' G007038-0 996471070385 G007039-0 696471070392 _ G007042-0 696471070422 G007043-0 696471070439 .. LER 6i0E v,EW IwCMIT VEW GENERAC• Generac Power Systems,Inc. •S45 W29290 HWY.59,Waukesha,WI 53189 • generac.com 02016 Generac Power systems.Inc al rights reserved All specifications are suetect to eranW wshout notice Var1 No 10000000'94 0 1024!16 GENERAC Automatic Transfer Switches Service and non-Service rated Automatic Smart Transfer Switches 100 - 400 Amps, Single Phase C &S LISTED CUL only applies to non-service rated switches Description Generac Automatic Transfer Switches are designed for use with single phase generators that utilize an Evolution" or Nexus'" Controller. The 100. 200, and 400 amp open transition switches are available in single phase in both service equipment rated and non-service equipment rated configurations. The 150 and 300 amp open transition switches are only available in a service rated equipment configuration. Standard Features Service rated (RXSW) Generac Automatic Transfer Switches are housed in an aluminum NEMA/UL Type 3R enclosure". with electrostatically applied and baked powder paint. The Heavy Duty Generac Contactor is a UL recognized device, designed for years of service. The controller at the generator handles all the timing, sensing, exercising functions, and transfer commands. All switches are covered by a 5 year limited warranty. Non-service rated (RXSC)switches are housed in a steel enclosure. DPM Technology Through the use of digital power technology (DPM), these switches have the capability to manage up to 4 individual HVAC (24 VAC controlled) loads with no additional hardware. When used in tandem with Smart Management Modules, up to 8 more loads can be managed as well, providing the most installation efficient power management options available. GENERAC' GENERAC' 100-400 Amps, Single Phase P � 9 Automatic Smart Transfer Switches Functions All timing and sensing functions originate in the generator controller Utilityvoltage drop-oul......................................................................................................................................................................................................................<65% Timer to generator start..................................................................................................10 second factory set.adpsdble belrreert 2-1500»cords tly a psldied diseW, Enginewarm up delay ............................................................._..__..........._.......... _...._ _ ...........................................................................................5 seconds Standbyvoltage sensor.................................................................................................................................................................................................65%for 5 seconds Utilityvoltage pickup .......................................................................................................................................................................................... ..>80% ......................... Re-transfer time delay ..............................................................................................................................................................................................................15 seconds Engine cool-down timer.........................................................................................................................................................................................................60 seconds Exerciser ....................................................................................................................... ..............................5 or 12 minutes adjustable weekly/Bi-weekly/Monthly.. The transfer switch can be operated manually without power a0lied. 'When used in conjunction with units utilizing Evolution'controls "Adjustable via the controller Specifications Model RXSC100A3 RXSW10OA3 RXSW15OA3 RXSC20OA3 RXSW20OA3 RXSW300A3 RXSC40OA3 RXSW400A3 Amps 100 100 150 200 200 300 400 400 Voltage 120/240,Is 120/240.Is 1201240.1 e 120/240.Is 120/240.1 e 120/240.Is 120/240.Is 120/240,Is I.Dad Transition Type Open Transition Open Transition Open Transition Open Transition Open Transition Open Transition Open Transition Open Transition (Automatic) Service Rated Service Rated Service PAW Service Rated Service Rated Enclosure Type NEMA/UL 3R NEMA(UL 3R NEMANL 3R NEMA/UL 3R NEMANL 3R NEMA UL 3R NEMA/UL 3R NEMA/UL 3R UL Rating UL/CUL UL UL ULICUL UL UL UL/CUL UL Withstand Rating (Amps) 10,000 10.000 22,000 10.000 22,000 22,000 22,000 22.000 Lug Range I/O d 14 250 MCM-#6 600 MCM-M4 or 1/0-250 MCM Dimensions wr � N1 Model IUfSC100A3 RX$W10IM3 RXSW150A3 RXSC200A3 RXSW200A3 MMW30OA3 MGC40OA3 RXSW40OA3 HIfpIM HI 17.24/437.9 1Z24/437.9 26.7$1679.4 1724,4379 26.75AT91 2.91/1089 3125M.6 .91/1089. (InJrrm) ornN_ � H2 214508 2M508 3W762 207508 38J752 4W1219.2 35/914.4 48/1219.2 w1 W1 1 ZYM 7.5 12.5/317.5 10.5266.7 12.5/317.5 10.5✓M.7 15.0423.9 19.1 N4872 16.60/4231 Wier (fnlmn) W2 14.67370.8 14.6/370.8 13.5/342.9 14.6✓370.8 13.5✓342.9 21 BM54 2 20609.6 21.82 M.2 Depe1(Inhnm) 7.09/180.1 7.01111601 6.3/160.1 7.09/180I 6.3M60.1 1005/255.5 10.06/255.5 10.06/255.5 HE rn W 0(Ou/tllrlla 2419.07 22.5710.21 39/17 69 21109.07 3W17.69 14WO.5 133r60.33 140/63.5 Davin L— „2—J GENERAC• Generac Power Systems.Inc. • S45 W29290 HWY.59, Waukesha,WI 53189 - generac.com C2017 Gererac Power Systems,Inc. A i rights reset Art spec if cations are Mired to change without notice Bulletin 10000013459-A 04/24/17 I I I � �•�A .tP• °t`�, ��iaa���A�,g�• 7� Oi �r .r ;•9ti�w�I¢°; ��. `''ter ,�_ D �� , x• e /�+ �Al x r -tAyy __ £�A(['f - -- ��AH� �_ r'� A1�y '�.,p�A�.'`.:.. 't ��t(�,,� � /•11'1- 11.1/•1 �� 11•••••� � •�'/i'1 ti��f � 11•�/lclll t•"•� .f��v 1 1•'c'c : ��:,;�. /;. )►".,F- ice•+k 41Nd:�G�r •+.t:lil�ii'.'Tarr �'�, =y'�IIJ�t E'*:�t::4h 1/'v•. ¢`►,,�:\yl/lr'��er - 1 YID%/� �r i s�ka'IN/l��i�l�i��<(ss)! � ' aye ` < >. NCD a- y cy • Mot<c i , '� .•'•mot ' ° O � � �_ �'. •::r u U z cq ci W ,• 4a. _ 3 . Z W O X fu cotecdal, ' > 2 .:�. CA "" W r —aba �+ G� W W Q Q. c uell co T Clq LU kj ui U) 1 `':11•. �' �..► Q a�i "o I �:' tip ! L. sr iiww i f�M 11 ♦�� ./►'�c,��r.-•g: 111 f/ K? 4 ? 1 1 .ls,sf d ,_• y!` ?'' ,,..� 1 •�1'- •f..Illl/llyl' f.r IIIlII l.�a 1 11 1 1 H <` 4 rr •1• }} 11111� I•'•,•I k! Y^i I•1/1•III1/11tI t►�^ 11/1.11 Aa " III•�111 if, A4 �1 / r�A� •• A ` f ♦• , .A •♦ A 4� •u.♦ ' • �./.• ` A •./.• A 1 •.•�• t OAT( ---..., VMIS•'�• �:•�4V�. a_ lRwV - - Y Y � t N A� CERTIFICATE OF LIABILITY INSURANCE °ASE,(M020°IYYYY' 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 MARSH USA,INC. NAME: 445 SOUTH STREET PHONE FAX No): MORRISTOWN,NJ 07960-6454 E-MAIL Attn:Morristown.CeiRequest@marsh.cem Fax:212.948.0979 ADDRESS: INSURE S AFFORDING COVERAGE NAIC# SP LP CLIE INSURER A:Liberty Mutual Fire Insurance Company 23035 INSURED SUBURBAN PROPANE PARTNERS,L.P. INSURER B:LM Insurance Corporation 33600 240 ROUTE 10 WEST INSURER C:Liberty Insurance Corporation 42404 WHIPPANY,NJ 07981 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-009138921-40 REVISION NUMBER: 4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITH STAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WVpPOLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TB2-631-507975-080 10/01/2020 10/01/2021 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTE CLAIMS-MADE 1XI OCCUR PREMISES Ea occurrence $ 250,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E PRO- LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ A .AUTOMOBILE LIABILITY AS2-631-507975-070 10/01/2020 10/01/2021 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ X OWNED X AUTOS SCHEDULED AUTOS ONLY BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per acc dent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WA5-63D-507975-090 (AIDS) 10/01/2021 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C ANYPROPRIETOR/PARTNER/EXECUTIVE YIN WA7-63D-507975-100 (MA) 10/01/2020 10/01/2021 E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? ❑N N I A (Mandatory in NH) WC5-631-507975-110 (WI) 10/01/2020 10/01/2021 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) VILLAGE OF RYEBROOK IS SHOWN AS AN ADDITIONAL INSURED SOLELY WITH RESPECT TO GENERAL LIABILITY COVERAGE AS SHOWN HEREIN AND SOLELY IN THE EVENT THIS STATUS IS REQUIRED BY WRITTEN CONTRACT BETWEEN SUBURBAN PROPANE,L.P.OR ITS SUBSIDIARIES OR AFFILIATES AND CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYEBROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 KING STREET ACCORDANCE WITH THE POLICY PROVISIONS. RYEBROOK,NY 10573 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YYORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Suburban Propane Partners LP 973-887-0500 240 Route 10 West Whippany NJ 07981 1c.NYS Unemployment Insurance Employer Registration Number of Insured 892-18602 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 22-3410353 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) LM Insurance Corporation Village of Rye Brook 3b.Policy Number of Entity Listed in Box"I a" 938 King Street Rye Brook NY 10583 WA5-63D-507975-090 3c.Policy effective period 10/1/2020 to 10/1/2021 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box"la"for workers' compensation under the New York State Workers'Compensation Law.(To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, 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 form. Approved by: Karyn Lessard (Pri��'`A"�'•L-,','--��A� ----•—insurance carrier) Approved by: -�'` 9/28/2020 (Signature) (Date) Title: Client Service Coordinator Telephone Number of authorized representative or licensed agent of insurance carrier: 781-647-8140 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 57802709 1 LM_686 1 10/20-10/21 C105.2 I Linda eradfiah 1 9/28/2020 9:36:00 AM (CDT) i Page 1 of 2 i r w ••� �I,Y L'. �41��)� � 7���}.Is\ `¢� .� !�•\�,�jjp �t61�N •v w�t�� '��� �29� h �� ''Y < ;4c+'+/i; � M 4 0910if '' ,1++'IS� � 1 1 f/•+•c � �•• � 4 • �� .�• { 1� x�i01.1 '�� ,11 � ,,1�/+4f 1 ,t►"111� , (lt2a1 - e.da.3i.:-J3Ei'1I�'.I��t;�,..r.`�} y�ti°.:�11��ha.�r I2�ai_�s��ll�i�/i�l' 7.a�:.; °•aYst;11! ►I�d a..• s a,.1�{Il tr. s �'.111�fl::�aae ice' . . . . . . . . . . . . . . . . . . . . O rA �1y O u > A I•co 1 (•tis)31 -6-W O o s 1••1 VJ y . PRO a Z ULL LU }�}.. Quo •G�, F �y L.LCA LLJ J O w p > PS y O g m z CN "!mot W Q � ��� � � � •� a •era '�. t N Ik/� � q N O Aw` � Ez:-! oo y rA O z `N l y a LO �'-. U ^ o V) N +. st �'� � •y U U U F.w 't ��<CftyDf�-�" �•-,-�--'ems..�^^r,•rTT.� . . . ._ - - . . . . -ar,• oW = 'i,lflf f/fll�'��c b. t11�N s i�: -111�°'szv'' ''�1+1f1 A f 1 11 .8 '` 1 . . . . r '+ 4 1 11 1 v1,f I H�1\ f�i l{I/1!1 A ' S /I f111/jr n , a s ,lf, ,1 %.f,1 I' '�e�a�' I,f 1 (f1A) � 1 1 1/0 g 11N1 111,1 ,11N,1 t 11 I •:•� � �_yD '*7.��,g,. ♦• ,y i► /• S AM sue\`.hha ..w`yy,K, �; r �-• y '' �iyr i;K!+_�y, _...�%; �, y�j<'t �� oP, - i A1RO® CERTIFICATE OF LIABILITY INSURANCE DATE'11/2D/YYYY) sillizozo 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 CON ACT Arthur J. Gallagher Risk Management Services, Inc. NAMPHONE Sora a Rivera 250 Park Avenue 3rd Floor A/c t 212-530-7504 A/C No:212-981-3386 New York NY 10177 ADDRESS: Sora a Rivera a' .com INSURERS AFFORDING COVERAGE NAIC p INSURERA:Selective Insurance Company of America 12572 INSURED YOST&CA-01 INSURER B: Yost&Campbell, Inc. 20 Brookdale Place INSURERC: Mt. Vernon, NY 10550 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1177726323 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. IN SR AD-LE B POLICY EFF POLICY EXP LTR TYPE OF INSURANCE iNsD wvn I POLICYNUMBER MWDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY S2390242 9/15/2020 9/15/2021 EACH OCCURRENCE $1,000,000 -15AMAuETO IN CLAIMS-MADE a OCCUR PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 _GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY[X] PECOT- I-XI LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SIN LE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED --- AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Par accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $_ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0 H- ANDEMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACC OFFICER/MEMBER EXCLUDED? ❑ N/A ACCIDENT $ _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION 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) Village of Rye Brook is included as Additional insured for general liability as per written contract and as per policy terms,conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS, 938 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NY S I F 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 New York State Insurance Fund nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE """A"" 132866714 YOST&CAMPBELL OF ROCKLAND INC DBA YOST&CAMPBELL INSTALLATIONS 20 BROOKDALE PL MT VERNON NY 10550 ❑� SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER YOST&CAMPBELL OF ROCKLAND INC VILLAGE OF RYE BROOK 20 BROOKDALE PL 938 KING STREET MT VERNON NY 10550 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLIC�PERIO�D Z 2261 808-6 823759 04/01/2020 �O�3 /220 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2261 808-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR, INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 116146095 111111 Hill11111 Hill 1111111111111111111111111111111111 11111111111111111111 0 III IIIIIIII II I I III IIIII II 0000000000079765017 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Polity-22618086] U-26.3 62 [00000000000079765017][0001-000022618086][ssZ][15336-64][Cen NoP-CERT_1][01-00001] f .M.wV�.v..'.•Y .•1I N6.. H i NEV IOUN r/?Y It . 1 { RID GE PLAN APR 14 2021 . i M' low k F BUILDING A Dl?l RTMENT ,< ••IV,49004'00 _%3 vgc?wvli j 47 0VE m 3n low '< P�p,�' 2 Z �t kt L•.fit �:: o + � r (AxIN iN QLl,. C.��•.A21,� G� S •. .. 4zo qs; = D 5 0 , rN6151101,1,117 •� � � rr'eCt to/h e t., zt.' ond i i ust C0177POn V 17d/ the Ninth F,'ederol - 7 �k•� �� , ��� ����"`I f'!�" SOvh79S Ord L 001,74 `S 4 04 00 100.00 SoOatt,,n.H ^r,% "W-� AV c 4 '. cov�t� — Land 0" COuntiry RiOfOe L andY. sto to ic. `rr� - , In ., C� Prefn'ses here o� �b�� 1 i '; ,t0 �. ol?mop entitled?sub 1 �.%vr P19��ISEY HS REOt�Jj4-1jVG 1. .F- Rid , '` o , .tr, c - PERMIT Roll t ( ' i s e tc- file d A #h a W,eS� k s.9s8 /'V WF$rCHES°S?t C041 -Y� T# X MAPS s AVp Nci. AfAP SBL# �i 3 � � PRop � .. APR 1 0 ZUZJ Thy js i 14erj f Jhol h ` �4 ' � t3 . . .».���- �� QATE AP 0 D • .0 h� survey 0/7 hiCh INS mop is based Wog end this ��m���'����lu/� �,t,��� Y RID GE" � IC1s �'U�"1 f BUILDING It OR,Village of IN ed dill' 1956 CHA � �d�ll�r� �,�� g Ry.��oolc. SITUA 7ED 11V Ll • S LS/ �` . 91Yvers 46 � orscivil 6 7 1 Wlil�/v. Y. � OF • 6 z CO. N Y Y. slot , . �"`�/' S �L�E':I"=3�► y� �g��++,��++ �tYRlS?yii@7r,,ZM117RiQb'$!►#t iy lf0lf d iriG: �� JUL/ f+�+JLJ. ar•s