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HomeMy WebLinkAboutMP21-130 4' 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J. Bradbury w ww.ryebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A.Klein CERTIFICATE OF COMPLIANCE November 17,2021 Nancy Raider 145 Brush Hollow Crescent Rye Brook,New York 10573 Re: 145 Brush Hollow Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-115 This document certifies that the work done under Mechanical Permit #21-130 issued on 9/16/2021 for the installation of a new oil fired boiler has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg E BRC�,� w � + 1932 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.or - - - - - - - - - - - - - - -- -- - - INSPECTION REPORT - - - - - - - - - - -- - - -- - - - - ADDRESS: 1 +U��O�JId �SDATE: PERMIT# -2 ,N) ISSUED: C� l SECT: BLOCK: LOT: LOCATION: OCCUPANCY: T ❑ VIOLATION NOTED THE WORK IS. -_-- ACCEPTED ElREJECTED/REINSPECTION [I SITE INSPECTION L �����r REQuiRED FOOTING 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 ,a—FINAL ❑ OTHER � D D IE ' 1/ L� SEP 1 5 2021 VILLAGE OF RYE BROOK � � BUILDING DEPARTMENT 1 Al&M ESTREET J-0- S-rp E 0 JAJ rJ ?o GC C7 DIMENSIONS -14-"5'. }7r�� ?W wr y SpiC1 a STANDARD EQUIPMENT: a I � ■ Factory Tested and Assembled � rer r © Cast Iron Section Assembly + �:... Nt Es t I (jacket and collector hood are L14-- not assembled on 7,8 and 9 section blocks) ` 40 ■ Insulated Steel Jacket `+x H ■ Aluminized Steel Flue Collector P-WOO Front S40 A WGO Front Back Hood with Flue Cap on Top a ok- y rn Outlet (convertible to rear Outlet) Q +-100.9 hh L o�°¢ ■ Swing-Away Burner Mounting _-7/ Door B, - Alternate return- A"units only ■ Refractory Blanket and Target E, 1/2 Pressure/temperature gauge Wall in Combustion Area H 3/4 Drain Valve ■ Circulator(Taco 007)-When L 3/4 High limit/circulator control Ordered N 112 Wiping to expansion tank or automatic air vent ■ High Limit Control with Circulator R, 3/4 Relief valve Relay and LWCO Function r ■ Electrical Junction Box with Supply"C"(Inches) Dimension(inches) Wiring Harnesses p 0 m; ■ Junction Box Cover Plate with /4� 4 Service Switch n ` w ■ Two Vent Pipe Brackets wco-2 1 114(circulator flange) 11/2 1 1/2 10112 13 3/4 ■ Pressure/Temperature Gauge wG0-3 11/4(circulator flange) 11/2 11/2 13 7/2 16 7/8 ■ 30 PSiG ASME Relief Valve WGO-4 1 1/4(circulator flange) 1112 1 112 13 5/8 16 718 (boiler sections tested for'SO PSIG working pressure) WGO.S 1 1/4(circulator flange) 1 1/2 11/2 16 7/8 20 ■ Drain Valve wGo_6 1 1/4(circulator flange) 11/2 11/2 20 23 1,P ■ Barometric Damper wGO-7 notapplicable 11/2 11/2 231/8 261/4 ■ Built-in Air Separator WGO-a not applicable 1 112 1112 26 1/4 29 3/8 wG0-9 not applicable 11/2 11/2 293/a 321/2 OPTIONAL EQUIPMENT: ■ High-Efficiency Flame-Retention RATINGS 'au AHRI Minimum Oil Burner(Beckett AFG,Carlin ►nor Input certified Chimney EZ or Ri0o).Specify 2-Stage Fuel Rating Ratings g Size o'er rr0) Unit(optional)if Required. tiP `~ 4� ��30v �� �Qo ■ Vent Damper Kit ' 6, �^ cn,`'�� �`�� �� �°1 k ■ W-M S&10 Year Homeowner c� 4g t am2 ?� � .ram -°� c m '°a Protection P#an since ■ W-M Indirect-Fired Water Heaters wco-2RD 0.70 98 86 75 87.0 010 8X8 6 15 540 wGo-2 0.70 98 86 75 86.4 .010 8X8 6 15 540 WG0-3RD 0.80 112 98 85 87.0 .010 8X8 6 15 595 NOTES: wGo-3 0.95 133 115 100 85.3 .020 8X8 6 15 595 Add"P"for packaged boiler(WGO-2 WGo-4RD 1.00 140 123 107 87,0 010 8X8 6 15 645 through WGO-6 only).Add"A"for WGO-4 1.20 168 145 126 85.0 .010 8X8 6 15 645 boiler only(WGO-2 through WGO-9). • wco-5RD 120 168 148 129 87,0 .015 8X8 7 15 760 (1) No.2 fuel oil-Commercial Standard wG Specification CS75-56. Heating valueo-s 1.45 203 175 152 85.0 .015 8X8 7 15 760 of oil-140,000 BTU/Gal. woo-6RD 1.40 196 173 150 87.0 015 8X8 7 15 860 (2)Based on standard test procedures wGo-e 1.75 245 212 184 85"0 .015 8X8 7 15 860 prescribed by the United States WGO-7RD 1.60 224 197 171 87.0 015 8X8 8 15 930 Department of Energy at combustion wco-7 2.00 280 242 210 85.0 .015 8X8 8 1s 930 condition of 13 1/2%CO2 and -0.02" wG0-8 2.30 322 266 231 - .025 8X12 8 20 1030 W.C.draft. wGo-9 2.55 357 295 257 - .030 SX12 8 20 1135 (3)MBH refers to thousands of BTU *ENERGY STAR'compliant with Version 3.0 Boiler Specification of 87%AFUE only when installed at per hour. the reduced burner rate(R)and with the optional vent damper kit(D).Burners shipped with standard (4)Net AHRI ratings are based on net rate nozzle,reduced rates achieved through nozzle change-refer to burner instructions or boiler's installed radiation adequate for the rating label for correct selection. requirements of the building, In the interest of continual improvements in product and perform including a piping and pickupance.Weil-McLain reserves allowance Of 135-sufficient for normal the right Co change specifications without notice, cus conditions. Provide additional wM1410_BRO_018_WGO SP� DOE � allowance only for unusual piping and pick up loads. A�R" CERTIFICATE OF LIABILITY INSURANCE DATE(MvMMIDDM1001YYYY) 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 NAME: Tammle Pattanite Arthur J. Gallagher Risk Management Services, Inc. PHONE 888_273-8155 FAplC Np:856-273-3663 40Q0 MidlantiC Drive Suite 200 Mount Laurel NJ 08054 DREss: tammie attanite a' .com tNSURER S AFFORDING COVERAGE NAIC 0 License#:9R-724491 INSURER A:New York Marine And General Insurance Company 16608 INSURED SINGHOL-02 INSURER a: Singer Holding Corporation d/b/a Robison Oil One Gateway Plaza,4th Floor INSURER C: Port Chester NY 10573 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:945532112 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, INTR TYPE OF INSURANCE iwDn n POLICYNUMBER MMIODIYYYY MWN POLICY EFF POLICY exP LIMITS A X COMMERCIAL GENERAL LIABILITY PK202000020101 12/31f2020 12/31/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE T N EO PREMISES Ea occurrence) $100,000 MED EXP(Any one person) S 5,000 PERSONAL A ADV INJURY $1,000.000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.000 X POLICY JC O- FLO PRDUCT -COMPIOPAGG s2,000,000 OTHER: E $ A AUTOMOBILE LIABILITY AU202000017525 12131/2020 12/3112021 COMBINED SINGLE LIMIT $1,000,o00 Ea accdent X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident _ i A. UMBRELLA LIAR X OCCUR EX202000001405 12131/2020 1213MO21 EACH OCCURRENCE S 5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE S 5,000,000 DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANYPROPRIETORIPARTNERIEXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT S OFFICERIMEMBEREXCLUDED7 (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ if desIO cnbe under ES DCRIPTN OF OPERATIONS below E-L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Addibonai Remarks Schedule,may be attached if more space is required) Village of Rye Brook Building Department is named as an additional insured with respect to the above General Liability Policy,if required by a written contract executed prior to services performed. CERTIFICATE HOLDER CANCELLATION 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 Building Department 938 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD r ` ZNTEW Workers' CERTIFICATE OF ATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured ADP TotalSource FL XVII,Inc. 9143455700 10200 Sunset Drive Miami,FL 33173 L/C/F 1 c.NYS Unemployment Insurance Employer Registration Number of Singer Holding Corporation DBA Robison Oil Insured 1 Gateway Plaza 4th Floor 45045108 Port Chester,NY 10573 Id.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 133121491 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Ins Co Village of Rye Brook Building Department 3b.Policy Number of Entity Listed in Box"1 a" 938 King Street WC 038381464 NY Rye Brook,NY 10573 II worksitee employees working for Singer Holding Corporation paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. 3c.Policy effective period 7/11 1 to 711/2022 3d.The Proprietor,Partners or Executive Officers are Zincluded.(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"Y'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"T'. 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 Nen fork State Workers'Compensation Law. l rider penalty of perjury,l certify that I am an authorized representative OF liee.sect agent of!he insuranee...._...__referenced above and that the named insured has the coverage as depicted on this form. Approved by: Adrlana Sanchez (Prim name of authonzed repr^� arrive or licensed a p )tlnsruance camery Approved by: 6/30/2021 Title: Account Specialist II Telephone Number of authorized representative 800-743-8130 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized 10 issue it.