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MP21-131
PERMIT # or SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTOR1 EST. COST v/CO # �J TCO # _ l 3 ..,_ DATE: p(P:, 35 BLOCKLOT r. l FEE DATE INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS V SPRINKLER ELECTRIC f LOW -VOLT CJ ALARM AS BUILT 0 FINAL INSP r wAffirmidwhiml ar�7d oiJ�J��QCCayn/no CAL OTHER APPROVALS ARB BOT PS �ZBA OTHER �y lQ�d ail Co .fin c. �,dc,/-i,3./Ak� 4yr,t3R IV;Bawds a.!V l.4 w4 uv`Lf VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE January 5,2022 Marsha Arvoy 3 Rock Ridge Drive Rye Brook,New York 10573 Re: 3 Rock Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 135.35-1-46 This document certifies that the work done under Mechanical Permit #21-132 issued on 9/16/2021 for the installation of three 120 gallon above-ground propane tanks have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg t.Q-E B . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher]. Bradbury www,ry'ebrook.org TRUSTEES BUILDING & FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE January 5, 2022 Marsha Arvoy 3 Rock Ridge Drive Rye Brook,New York 10573 Re: 3 Rock Ridge Drive, Rye Brook,New York 10573 Parcel I D#: 135.35-1-46 Mechanical Permit#21-131 issued 9/16/2021 for a New Generator This certifies that the 24kw LP gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector tg For ` Q U BUIL4,14) R�"ENT PEtuvloffice # use and : DVILOF RYE OK ISSUED: I-/-a/3/ DEC 3 0 2021 938 KING STREE BROOK,, YORK 10573 DATE: 939-0660 FEE: FAIo]( VILLAGE OF RYE BROOK wi V'wx ,ebrook,6n! BUILDING DEPARTMENT 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 rs**•sssrsssrrsr*e*s****ass*ass**ss**ss*ssssssssss*ss''slsssassessarssass•rsssrsssrsrrssss*ts**sr*tr*tt*tttt**s*ts**st**t******* Address: Q ���y 00 _ NW . ( aS 7 3 Occupancy/Use: TS4m wt Parcel ID#: 3Sr 3 5-J'—�q ZP Zone: ` Owner: wa es h ct Pr f m a- Address: 3 d COX t/1-. e l; E"O P.E./R.A. or Contractor: }Jtt( Address: UW . C05CO6.U. C660 Person in responsible charge: �C)�7�'li3 Q�1 �U�1 l� Address: 209 O y Er Rp.RT. Q,0S C86.CT. �0 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 YOR K, COUNTY OF WESTCHESTER as: II ,,{ Cop hay t &)n �I being duly sworn,deposes and says that he/she resides at VOC— �1 U ae -D e ti ULG . in 6(Print Name of Applicant)p� ++ II '' CC r r-�p (No.and Strcet) ``� E P e-0 0 t< ,in the County of W Q J-+ 00E-5 TC e- in the State of I°� _! ,that (City/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 I`1<,5G o , d for the construction or alteration of: A( One- q e n e f-c to 1- !N kw . 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-IO.A.of the Code of the Village of Rye Brook. Sworn to ore me this 3 � Sworn to before me this day of , 20 day of , 202/1, Signature of Property Owner tgnatu of Applicant �r rho &Vd gmkd Print Name of ro Owner Z Applic t �� - _�: Notary blic My Commission Expires October 31,2023 MY Commission Expires ^ctober 31,2023 �E BRcb, w � Fo 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 ryebrook.org - - - - - - - - - - - - - - -- - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - y � ADDRESS : t 1�-- 1 ' DATE: 1 -2 - �1 (D � rERMIT, ISSUED. SECT: BLOCK: LOT: LOCATION: ` OCCUPANCY: �- 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 V S { S� p 1!A ❑ L.P. GAS ❑ FUEL TANK n ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ ROSS CONNECTION INAL / ❑ OTHER Bk '982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR XSSISTANT 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 : S ��� ! 'DATE: ` �� Z PERMIT# `L ISSUED: SECT: BLOCK: LOT: LOCATION: �� �� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... El ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION / REQUIRED ❑ FOOTING ` ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION Oojt� [INATURAL GAS qc- �s 11 L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER Qy�BRC�j�. 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.rxebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - -- - --- - - - - - ADDRESS : � � � � � DATE: �g ` L c)?/ PERMIT# �' . � ISSUED: iECT: BLOCK: LOT: LOCATION: f` OCCUPANCY• C ❑ VIOLATION NOTED HE WORK IS... ❑+ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING 4AU) ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ` i� D' L.P.GAS S ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER In Ln 1 N N ri O W O tn O ' o, c v ON IV rin ce p4 w W = w F W ,, w x A � � °v W w 00 " '"' w rI U W z U OW C a = U W W p e .7 Gr O $. Ell (3Rn�� VVILGE Bum DE14- MENTVEL `E OF RYE OOK2 2021 938 KIN ET RYE B NY 1057RYE BROOK (914)9 A� 939-5801PARTMENT w or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ^� FOR OFFICE USE ONLY EP#: O-1 r p1 55 Approval Date: Permit Fee: $ DCL Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, [��Z� is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an 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 frall applicable Federal, State,County and Local Codes. /� I 1.Address: eelc� I,Cl Cl � (J rl V r- SBL: 136-, 36-1—�/& Zone:/C—�`0i 2.Property O�wyner: /r 1 ,G Address: .Phone#: 7/ j 1b ^ Sr Cell#: errq►s^i1: y, 3.Master Electrician: /yV C v /�1 a V Address: � /P' 16 Ve •, Lic.#: F�Phoney#. a��7�� �Ce`tll t-!('9G�'"11 emait'� �v ZAC-r_!� #Da• ,---r Company Name: � �/at-' Address: — , 4.Proposed Electrical Work/Fixture Count: ( o/�-- xt9:*Yf*X'*:Y*Yt*#***ir*kir***lei:*-k lF is F*ic*:F:kk*:4 i['k**ft******F*��9:+ktYC4******�i k9r k it*ic*ie**ae:k*:4::Y*'}.F F•kT5'cxsP':'::'ry*;;.is r.ti:sF;.:**:4 kie STATE 17W YORK,COUNTY OF WESTCBESTER ) as: 6 ! eing duly sworn,deposes and states that he/she is the applicant above named,and does further (print n e findivt ual signing-, heappl..) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is thz!;:_C(� for the legal owner and is duly authorized to make and file this application_ (indicate archit ct.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 t efore me this I a Swo o befo a is AM of ft ,20�1 f)W__ Sign- of Property er Signature of Applicant Print aru 7 NON ' t eofA t NOTARY I L -�T F IdW VMK ARY l+Rlf.IG-!1 E MEW YORK * Notary PuNddc 01 A6 00 Notary Iled in ster County Qualified in Wet fief Count�t,° nay Commlown fxptres O t r ��1 Z•3 My Commission Exptrs;OCI*b#+ 14. 20_ - 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. � �" Phone: 914-347-3595 L,. DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North .awn Avenue `s fa�:1914-347 3596 Elmsford NY 10523 �_� BUILDING PERMIT NO. TEMP# V CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY t')r-U'4" mil'^+ STREET AND NO.OR ROAD _ /� POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME `f1; G "BUILDING OCCUPANCY l OWNFR'S NAME AND ADDRESS _ ,/' HOME TELIWONE NUMBER Imo' i U1i L- ��f 1 f CURRENT SUPPLIED BY FROM THEIR I 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 FLUORE Np. H.P.EACH NO. WATTS EACH INSPECTION I OUTSIDE BASEMENT I'FL. OCT 12 20 2-FL. 3-FL REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: F THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE fNSPECTED.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.WRE1S,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 p 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 OF COMPANY J f DATE OF APPLICATION 1*11RE OF APPLICANT STREET ADDpIIM TELEPHONE NO. CRY OR POST OFFICE '"L� ZIP CODE' / LICENSE NO.VINEN APPLICABLE I J (� WESTCHESTER ROCKLIND ELECTRICIL INSPECTION WRE15SERVICES,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: Zaccagnino Electric Marsha Arvoy 81 Maple Avenue NY, Rye 10580 Located at:3 Rock Ridge Dr Rye Brook, NY 10573 Certificate Number: 1031583 Section:135.35 Block:1 Lot:46 BDC: Permit Number: EP:21-255-BP:MP21- 131 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: 3 Rock Ridge Dr Rye Brook,NY 10573 Basement 1 st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NF'PA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 11/04/21 Name Type Quantity Generator Up to 25 KW ------- 1 Automatic Transfer Switch ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. /r"'/l�G This certificate may not be altered in any way. V ``,/ ��b 'f!' This certificate is valid for work performed before date of inspection only. n s m in ■ ' "'0 fy N N a M n AI O� O W s p C9 4 o 0. S . ' \ de k tA M Ix of co CM LPL] M A Z •n 4 O Q vi V� Q C7 ~ tn 4 c U 04 z =�Ono Q _ o ~ z Q Qo n 4 z Q V 3 a r ° g 4 a CZ rRFSEP � C BUILDING DEPARTMENT VILLAGE OF RYE BROOK 4 2021 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.aebroA.org BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY �P' /�' o�/- /3 1 PP #: p� Approval Date: SEP 16 Permit Fee: S / 75- job Approval Signature: Other: Disapproved: (fees are nan-refundable) #########*####### aksko##k####k#kk#ek##k####K##kk############*#########k#############k#+k##k#k######## Application dated, 7 1;:_2 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 Local Codes. 1.Address: ��OC.� P-+ SBL:/W.3�7—/— /cp Zone: 00`/Q 2.Proposed Work: TAJS i 1 3 - I a-U rt(1©AJ Ak)C Je (J r0 i+v f'.-, Pq VQ1 U-V 0 ct y 0' �q S live 4 s/g" Ye tic?+.v Gd 4+eJ C`0I2P(?r- 1 .0 Ck 'TF-P.v c,-\ 146"d w e. 3.Property Owner: M q r-S it a A nl©y Address: .3 Q G Ck P_i 6 9 e PC) gje_brtQK 1057 Phone#:y f I-� - ")1 ,5 ` 5 3(o Cell#: email: _ I q I'0. M q j'q c�c .CO 4.Master Plumber: 12 Av� tJ+CA f3+ Address: -?G1 8AA,\- 14p..t J Ave. b w' .V W,C k CG Lic.#: 13q5 Phone#:-ZQ 34(ol-39aO Cell#: Z03 .14,1(p_Isg 17 email: {D5 tt /jec t uel Company Name: 1.0 RAJ5 10i Aj C i Address: _`/0 w +A.'q..., Ave. 1-igo 1o.o., cC T o oSr�lz 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 I st Floor 2nd Floor 3'd Floor 4"Floor 5'h Floor Exterior I 5. * List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/122021 S ATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: pk1 1 Q ,being duly swom,deposes and states that he/she is the applicant above named, (p nt name U individual sig ng 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 ':�V for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomey,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 'IA day of �� �,20 a t day of ,20 WPP Signature of Property cr Si ture 17 Print Name of Property Own r Pri am f Applica t Notary Public N?40aty P u ic, State of New York LISA F. State o YNo.01ME6160063 NOTARY PUBLIC, State of New York No. OIGR6089461 Qualified in Westchester County � Oualifed in Westchester County Commission Expires January 29 20 � Commission Expires 31>4-1-3 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. 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. -Z- an 2no21 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 www.ryebrook.org AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, _, residing at, �� �p (,� t TT i tre (Print nan1r I.\4Jtlrt•.\N11CIC�uu Ir,o being duly sworn, deposes and states that (s)he is the applicant above named, and further states that(s)he is the legal owner of the property- to which this Affidavit of Compliance pertains at; K I d GP /,l�I ✓e -ka,' A mok , Rye Brook,NY. 1��a .�ticlress) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. 1Si4naliur of Properr, l itrilC101 r�h�t U � (Fli lilt N.unr of 111uperty UwnCrl' Sworn to before me this day of , 20 I`ular� Ptabli�I 1 USA F GRECO NOTARY Pl,f'1LIC. Si�I of New YuIK No' 01C'7,_ , ,61 iluaff Pd in V'�o�:l ��,e:�i�� Oouuty Commission Ehpiles -3- 3 ja�r�3 8/12/2021 i F *syY N MA E ro r < � e $ a � yti � . � t tn W� w g Y y V '_ L r� � f'� r _ as m � �i �.�► f a 'B ' V CA rn � ' to V � A M ty d r � = a a ONO 00 `'' N �/ W ?• rr t M 6 0 w e M > Z m u Q OG w u p '_ •• '� F E. z g c w `' fJy' W O i o � VC L+ v $ E -2 .8 con f V z C U w) > TE E il .. r 6. y U � � _ > > Gr G l0• !O t BUILD TMENT "rl VIL OF RY OOK 938 KING d ET RYE B[ j ,NY 10573 SEP 14 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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#: H/nt�/— 3 Approval Date: SEP 16 N2,04Permit Fee: S �"' I Approval Signature: AV Other: Disapproved: (fees arc non-refundable) *��e*****:r*,ate***�****,r�:+***x*�*:r:r*�:*****�x•:*;e�***xxx*�***�*:r,r:r***:v:**wve****re*********•x,r*te********r***** REOUI_RENIENTS 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: S 185.00 per Tank. 5. Dig Safely New York#(dial 81 1): 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. Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a 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 Tyne: Installation (✓)• Removal O •Abandonment( )/Above Ground ( )• Buried in Ground( ) 1. Address: iG. �i� VQ� r SBL: , -�ylpL�n : /�f 2. Property Owner&Address: M a r5Inot A(1\/0`J Phone#: CJ IL4'-? 15-%S3(a Cell#: email: Iq Jca nAar!;j &CtO1 -t" 3. Contractor&Address: New E�pIQ yd at ( 40 West PU+-,ugm Ave • t!>Wt/u)aLh cTbkb-:5 7 Phone#: 205-fkA-5$(pJ I.FCell#: ) ty- 1!o!7 email: RS (AA)f'O t 1 - A,e4 4. Applicant: fi`oLIA1 Ct CCLAi-_qA,;O " el•QPQ Ve M5tA)Q5 Pr- E-O I Phone#: Cell#: 20 3 -49(of -f (P f 7 email: p $ 6, A,1P£? t jA , 5. Indicate Fuel Type: Fuel Oil(J)!L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 3 -TAOK5 , Ll o Hos Per -MA. K 1' o Qc1I)eK)5 W• C Pzr +qNK. 5kc Shekk A±4CkC1,tp - 7. Exact Location(s)of each Tank: ao Prom 1.7 etieM+-d r- M ac rke ©AJ .S i V r-/ -e- t 8/l 2/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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 ,20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant 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. z 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Rc<L f Sc s eC Lt'l+oc- O ,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 for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor.agent.attorney,ctc.) 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. C Sworn to before me this l Sworn to before me this 1� day of a�'1(xr .20 a` t day of r vfd Signature of Property Dwner Signature of Applicant at4a Arav &"d 56cck 9 'u� Print me of Property Ow Name of Applican r f Notary Public 'NM& LISLI F GRECO Nota Public SHARI MELILLO NOTARY PUBLIC,St,i'e of New York '�' No 01GRUG "461 Notary Public, State of NewYork Qualifed in lh'es[Liie .i County No. 01 ME6160063 601T11Tlissloll ExP'ii6S 31 a `f/a3 Qualified in Westchester County This application must be properly completed in its entirety and muQttiWeKf@L° Ilt'1M*9rt#ary 29,202:� signature(s) of the legal owners)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. z 8/12/2021 Building_Permit Check List&Zoning Analysis Address 3 ��C� �� �- SBL 1 3 •3 - l - Zone: - Use: `L Const.Type-71-I� Other. Submittal Date: Z Z ( Revisions Submittal Dates: `i 2 Applicant: Nature of Work: [V°.�-M 1.G kl.,3 �- r► F ELF 1� Gi FNIF-0��(I-- Reviews:ZBA: N N H - 5 2021 PB: BOT: Other. N OK ( ( ) FEES:Filing. 00. a BP: ---C/O: Legalization: ( } O APP: Dated: Notarized. SBL: Truss I.D. Cross Connection: H.O.A.: ( } ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( } ( } ENVIRO:Long. Short: Fees: N/A.- SITE PLAN:Topo: Site Protection: S/W MgrnL: Tree Plan Other. ( } ( ) SURVEY:Dated: Current: Archival: Sealed: Unacceptable: ( } ( ) PLANS:Date Stamped: Sealed Copies: Electronic: Other. License: f Workers Comp: ✓ Liability: -/ 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.:_Batter}:_Other. ( (Jf PLUMBING:Plans: Permit:I/Nat.Gas: LP Gas: N/A/: Other: ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A Other. ( } W HVAC rm : Plans: Peit: N/ Other: FUEL TANK:Plans: Permit: ✓ Fuel Type: t-•7, G 4S Other. ( } ( } 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. C/O DENIAL LETTER: Other. ( ) ( ) Other: ( )ARB mtg. date: approval:- notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg. date: approval:- notes: APPROVED REQUIRED EXIST"ING PROPOSED NO= Area: Dole. SEP 1 6 2g! Cir Fron Sg: Front: Front Sim: R�r. Main Cov Accs.Cov Ft.H Sb: � S .HS —FA.• T imp: Ft.Img H6ght/Stories: tes f3-- 1l0 W N C V nJ r L 09/08/2021 I, Marsha Arvoy of 3 Rock Ridge Rd. in Rye Brook give New England Oil and Paul Scicchitano, Propane Manager at New England Oil authority to pull a g permit to install 3 propane tanks and a gas line to my generator. Sincerely, Marsha Arvoy i p'CA .� A •A� �/5t A � '-� A }ry\_:��•`r� aY A � :.��i�t! A i=` _ �•G� A �. ;� -�f A � � `, �� •t�..� ., ♦• a : y�'A�' . 'yam, '�<f �, fly, h """' rf. F �►,; � �'� �.• n� - - - - - - - -- - - y N a' l N O - Tl c �pr R O • O / V Uj O w, - IW- coo X cn Q`04 eClioll '14 f W „ w u LLJ / ►��; - Q U U d�Jieda� I k > Z O CIA as Q N O U FBIInci � . < vwi CA E co r • �t- OW z _ -L U 00 sf�. +\ U v U y N .... • . . . .. . . . . J «OH�"'„�' a��r 1/1 1),._9 • ••�r`,1+ 111 �aS �� ,1 M►, y-A• �,It 111 � a `r••,11 111 `.1 +11y-� * ._Ilrllt �, �� <(A)>� "'� 111/�i 111 111 r 11 � t,tl/1,1 1111N11 pp� II+Ir1�i '� ,1 111 _Tl,ll+rlll �- �{t � • w� r, rile w rii� yypp, i►� i /�/'►r �, �w � � riyr �tFw rf�ir w � �r4�1 p/': � �., rirar �w��� y �`-.-'�+ �,•' � �-`, \�.LO��'s/ -.._��. ��`M f/- .� �\°Llly�ri:.; .� �\•5•tiif�Ov�}'.'ri:a���`.'�''[%O��w'%i���� GREENWIC01 PMC IERNA CERTIFICATE OF LIABILITY INSURANCE DATE(M 3/26/202112021 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 C CT Patrick B.McKiernan Abercrombie,Bums,McKlernan&Company Ins.,Inc. PHONE FAx 484 Post Road rug,No,Ex,: 203 655-7468 ac,No: 203 656-0339 Darien,CT 06820 IM33.pmckiernan@abmck.com INSURERS AFFORDING COVERAGE NAIC A INSURER A:Selective Insurance 12572 INSURED INSURER B: Greenwich Power Systems,LLC INSURER C 209 River Road Extension INSURER D: Cos Cob,CT 06807 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCLALGENERALLIABILnY 1,000,000 EACH OCCURRENCE CLAIMS-MADE EK OCCUR S2093861 4/5/2021 4/512022 DAMAGE TO RCE,ENTEDISES occurrence) $ 500,000 MED EXP(Any oneperson) 15,000 PERSONAL 6 ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 POLICY FAI jP'T u LOC PRODUCTS-COMPIOPAGG 3,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1.000,000 ANY AUTO S2093861 4/5/2021 4/512022 BODILY INJURY Perperson) OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUOTNOSyy�ED X AUTOS ONLY X AUTO ONLY P OPERIY AMAGE are aoci nt A X UMBRELLALIAB X OCCUR EACH OCCURRENCE 1,000,000 EXCESS IJAB CLAIMS-MADE S2093861 415/2021 415/2022 AGGREGATE $ 1,000,000 DEC) RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UA BILn'Y YIN _ ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT AFICERIMEM9ER EXCLUDED? NIA andatory 3n NH) E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached B more space Is required) 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 g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE &--�?> ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured Greenwich Power Systems,LLC 209 River Road Extension 203-900-1122 Cos Cob,CT 06807 lc.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap-Up Policy) ld.Federal Employer Identification Number of Insured or Social Security Number 46-2283792 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Selective Insurance Company of South Carolina 3b.Policy Number of entity listed in box"Ia" WC 9080870 Village of Rye Brook 938 King Street 3c. Policy effective period Rye Brook,NY 10573 04/05/21—04/05/22 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/of tiers included) X 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"T'. The Insurance Carrier will also notify the above certificate holder within 10 days IFa 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 maybe sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved 8y the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. Please Note: Upon the 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: Patrick B.McKiernan (Print name of authorized representative or licensed agent of insurance carrier) Approved by: /°a&4- f 9. �lc/�ec,2rt�� 03/26/21 (Signature) (Date) Title: Secre Telephone Number of authorized representative or licensed agent of insurance carrier: 203-655-7468 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(9-07) www.wcb.state.ny.us ' � ' s -,w a"�'�� '�w�""a � ��r� �q2 ���� �> eat'""'�`"'�r5 �s-i�� .,,: �w, �„� '.r w} ��yc '• iV.>�, i�i'• �+� i� - � •Mi� �" �1 1, ►� ¢,� ~ � h 11 Ilfl 'i ►I .Ali ! "i ! \ii1�13�/ II 3yT a -' 'n 1 ! n tl/ � � C �7�•.,� ApY0. CL a cd N Cun W •tOD � o }, � N _ d U 41 GJ Ha car, V LLI co LU co o ff/ gQ 4 ''1 ��� }w�`✓ }y i+l J_ � � dJ tom,, Q G, � �'+ ,�'j ' } oil ILI zCo w Lurn o f iAVcoCis x 1} iu.La. U ,U Q 1 _ U l �11i7D) •==-- l��ll#r i*1 � - .EI���Ii14a-::-' �:�si�;lyi--- ' :-`Iti+lllfi�'+•*�'-r��- �,=al��i11'f+ih,--``�� .,'ti+l�++l�.�;-— �� .xf _ . Pi � '' '* 111 y9 '' 1111� �� �+Ij1+1✓ i ry1;1a• ,� n4 f� -� �1���,o }`�•*i+�r/� ��,� �- �. ��,y/�'v�—yr. Xl'++i�`i�' �e ,�� (:��� !�`�., ��'"' [�a�atSk� �— �N��vl;�,`���--� : y l �,��,o ti.�'+ / � �� �� �-,_ tip;;;`/. .. � ?l.��M1M1:�h.,.. �iv ,�.,� �x ,•v„ 5r� . ,4c Ro V® CERTIFICATE OF LIABILITY INSURANCE DATE05/20/2021 M, Y, 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 FEDERATED MUTUAL INSURANCE COMPANY NAME: HOME OFFICE: P.O. BOX 328 A C. . Exe:888-333A949 F CLIENT CONTACT CE.NTER PHONE Ac No);507-4464664 OWATONNA, MN 55060 E-MADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 263-933-4 INSURER B: NEW ENGLAND OIL CO INC INSURER C: 469 W PUTNAM AVE GREENWICH,CT 06830-6895 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:52 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTR INSR WVD MMIDDIYYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $100,000 EM SES Ea c ,.ce MED EXP(Any one person) $10,000 A N N 9414028 07/01/2021 07/01/2022 1 PERSONAL s ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 �OTHER JECT ❑LOC POLICY ❑ PRODUCTS-COMP/OP AGO $2,000,000 : AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 accident X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED AAUTOS N N 9414028 07/01/2021 07/01/2022 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON S N L PROPERTY DAMAGE Per AUTOS ONLY c,Z X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $4,000,000 A EXCESS LIAB 17 CLAIMS-MADE N N 9414031 07/01/2021 07/01/2022 AGGREGATE $4,000,000 DED I I RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER STATUTE O YIN ER TH- ANY PROPRIETORIPARTNERIEXECUTIVE E-L.EACH ACCIDENT $1,000,000 A OFFICERIMEMBER EXCLUDED? [:]NIA N 9414032 07/01/2021 07/01/2022 - (Mandalory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe elder DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 D DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES[ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 263-933-4 52 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured NEW ENGLAND OIL CO INC 203.869.5869 469 W PUTNAM AVE GREENWICH,CT 06830 1 c. NYS Unemployment Insurance Employer Registration Number of Insured 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 06-0670146 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 52 938 KING ST 3b. Policy Number of Entity Listed in Box"1 a" RYE BROOK NY 10573-1226 9414032 3c.Policy effective period 07/0 112 02 1 to 07/01 i2022 3d.The Proprietor, Partners or Executive Officers are 0 Included.(only check box if all partnersiofficers 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 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: Melissa Kopperud (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �Q 05/20/2021 (Signature) (Date) Title- Certificate Center Representative II 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 tx _ ....w.emn.2 R;•t.. n OF RYE apo(3 REVISE SEP 14 2021 'Iot''i 54.68 -- � Port of 17 ,' E-2.9 �x p°sa a a" Mos gad+ Aa O ,o �• B,gyp i_N �� '_� other V°"� 50.Noo4CIO $ Fort of t2 ` gas o other 5510 y � e�cQQ Part 'of Lot ona 19 r pa o , �l I � o �Hou Sj1 625 O � 4° ®4iA O r Lot ' 37 70 Part of t oa o �.' `� 4370 . . .D :! , IV" oeep, utnxy D=1fl4214 �;�� •� POM �- �`T `•' R AS A�pWN ON A G LINTY �0 5 G fa6ef 8, 2pp� StiRVEYED AS IN PI''` THE MUNSON c VWatlon i 89 MAIN $I PERMIT*/ e EdtCOtian Law.' WHITE PLAIN a d survey,,,,, ' AVgD l wlid copy." 1060j 5ccle i ? SEP 6 1 iSee J-107 2illage of Rye gr *.Ny inked or am FILE COPY GENERAC8 1 20 22 24 kW GUARDIAN® SERIES / Residential Standby Generators Air-Cooled Gas Engine Standby Power Rating r INCLUDES: G007038-1,0007039-1,G007038-3,G007039-3(Aluminum-Bisque)-20 kW 60 Hz 0 True Power" Electrical Technology G007042-2,G007043-2,G007042-3,G007043-3(Aluminum-Bisque)-22 kW 60 Hz G007209-0,G007210-1(Aluminum-Bisque)-24 kW 60 Hz • Two-line multilingual digital LCD Evolution" controller (English/Spanish/French/Portuguese) • 200 amp service rated transfer switch available • Electronic governor • Standard Wi-Fi®connectivity • System status&maintenance interval LED indicators • Sound attenuated enclosure • Flexible fuel line connector • Natural gas or LP gas operation GEN ERAS = • 5 Year limited warranty • Listed and labeled for installation as close as 18 in(457 mm)to a --------- structure.* *Must be located away from doors,windows,and fresh air intakes and in accordance with local codes. Xa.Qr C UL ususrEo QUIET-TEST Note:CETL or CUL certification only applies to unbundled units and units packaged with limited circuit switches.Units packaged with the Smart Switch are Ell or UL certified in the USA only. FEATURES O INNOVATIVE ENGINE DESIGN A RIGOROUS TESTING are at the heart of Gen- O SOLID-STATE, FREQUENCY COMPENSATED VOLTAGE REGULATION: This erac's success in providing the most reliable generators possible. Generac's G- state-of-the-art power maximizing regulation system is standard on all Generac mod- Force engine lineup offers added peace of mind and reliability for when it's needed els.It provides optimized FAST RESPONSE to changing load conditions and MAXI- the most.The G-Force series engines are purpose built and designed to handle the MUM MOTOR STARTING CAPABILITY by electronically torque-matching the surge rigors of extended run times in high temperatures and extreme operating conditions, loads to the engine.Digital voltage regulation at±1%. O TRUE POWER-ELECTRICAL TECHNOLOGY:Superior harmonics and sine wave O SINGLE SOURCE SERVICE RESPONSE from Generac's extensive dealer network form produce less than 5%Total Harmonic Distortion for utility quality power.This provides parts and service know-how for the entire unit,from the engine to the small- allows confident operation of sensitive electronic equipment and micro-chip based est electronic component. appliances,such as variable speed HVAC systems. O TEST CRITERIA: O GENERAC TRANSFER SWITCHES:Lang life and reliability are synonymous with ✓ PROTOTYPE TESTED f NEMA MG11-22 EVALUATION GENERAC POWER SYSTEMS.One reason for this confidence is that the GENERAC ✓ SYSTEM TORSIONAL TESTED ✓ MOTOR STARTING ABILITY product line is offered with its own transfer systems and controls for total system compatibility. O MOBILE LINK*CONNECTIVITY:FREE with select Guardian Series Home standby generators, Mobile Link Wi-Fi allows users to monitor generator status from any- where in the world using a smartphone,tablet,or PC.Easily access information such as the current operating status and maintenance alerts. Users can connect an account to an authorized service dealer for fast,friendly,and proactive service.With Mobile Link,users are taken care of before the next power outage. w GENERALQ@1,Mt��PROMISE O6 `� GENERAC® 20/22/24 kW Features and Benefits Engine • Generac G-Force design Maximizes engine"breathing'for increased fuel efficiency.Plateau honed cylinder walls and plasma moly rings help the engine run cooler,reducing oil consumption and 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 features combine to assure smooth,quick starting every time. • Full pressure lubrication system Pressurized lubrication to all vital bearings means better performance,less maintenance,and longer engine life,Now featuring 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 Regulating output voltage to±1%prevents damaging voltage spikes. • UL 2200 listed For your safety. Transfer Switch(if applicable) • Fully automatic Transfers vital electrical loads to the energized source of power. • NEMA 3R Can be installed inside or outside for maximum flexibility. • Integrated load management technology Capability to manage additional loads for efficient power management. • Remote mounting Mounts near an 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 multilingual LCD 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 verify 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 Verifies engine is ready to assume the load,setpoint approximately 5 seconds. • Engine cool-down Allows engine to cool prior to shutdown,setpoint approximately 1 minute. • 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 battery only when needed at varying rates depending on outdoor air temperature. Compatible with lead acid and AGM-style batteries. • 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(241 km/h).Hinged key locking roof panel for security.Lift-out front for easy access to all routine maintenance items.Electrostatically 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 in(457 mm)away from a structure. GENERACO 20/22/24 kW Features and Benefits Installation System • 14 in(35.6 cm)flexible fuel line connector Listed ANSI Z21.75/CSA 6.27 outdoor appliance connector for the required connection to the gas supply piping, • Integral sediment trap Meets IFGC and NFPA 54 installation requirements, Connectivity(WI-Fl equipped models only) • Ability to view generator status Monitor generator with a smariphone,tablet,or computer at any time via the Mobile Link application for ' complete peace of mind. • Ability to view generator Exercise/Run and Total Hours Review the generator's complete protection profile for exercise hours and total hours. • Ability to view generator maintenance information Provides maintenance information for the specific model generator when scheduled maintenance is due. • Monthly report with previous month's activity Detailed monthly reports provide historical generator information. • Ability to view generator battery information Built in battery diagnostics displaying current state of the battery. • Weather information Provides detailed local ambient weather conditions for generator location. GENERAC 20/22/24 kW Specifications Generator Model G007038-1 G007042-2 G007038-3 G007042-3 G007209-0 G007039-1 G007043-2 G007039-3 G007043-3 G007210-1 (20 kW) (22 kW) (20 kW) (22 kW) (24 kW) Rated maximum continuous power capacity(LP) 20,000 Watts' 22,900 Watts' 20,000 Watts` 22,000 Watts- 24,0W Watts' Rated maximum continuous power capacity(NG) 18,000 Watts' 19,500 Watts' 18,000 Watts" 19,500 Watts" 21.000 Watts` Rated voltage 240 Rated maximum continuous load current-240 volts(LP/NG) 83.3/75.0 91_7/81.3 83.3/75,0 91.7/81.3 100/87.5 Total Harmonic Distortion Less than 5% Main line circuit breaker 90 amp 100 amp 90 amp 100 amp 100 amp Phase 1 Number of rotor poles 2 Rated AC frequency 60 Hz Power factor 1.0 Battery requirement(not included) 12 Volts,Group 26R 540 CCA minimum or Group 35AGM 650 CCA minimum Unit weight(lb/kg) 448/203 466/211 436/198 4451202 455/206 Dimensions(L x W x H)in/cm 48 x 25 x 29/121.9 x 63.5 x 73.7 Sound output in dB(A)at 23 ft(7 m)with generator operating at normal load" 67 67 67 67 67 Sound output in dB(A)at 23 ft(7 m)with generator in Quiet-Test'low-speed exercise mode" 55 57 55 57 57 Exercise duration 5 min Engine Engine type GENERAC G-Farce 1000 Series Number of cylinders 2 Displacement 999 cc Cylinder block Aluminum w/cast iron sleeve Valve arrangement Overhead valve Ignition system Solid-state w/magneto Governor system Eleclronic Compression ratio 9.511 Starter 12 VDC Oil capacity including filter Approx.1.9 qt/1.8 L Operating rprr 3.600 Fuel consumption Natural gas 1113/1tr(m3/hr) 1/2 Load 204(5.78) 228(6.46) 164(4.64) 203(5.75) Full Load 301(8.52) 327(9.26) 287(8.13) 306(8.66) Liquid propane it3/hr(gal/hr)[Uhr) 1/2 Load 87(2.37)[8.99] 92(2.53)[9.57) 86(2.36)[8.95] 92(2.53)[9.57] Full Load 130(3.56)[13.48] 142(3.90)[14.771 136(3.74)114.15] 142(3.90)114.771 Note:Fuel pipe must be sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3.5-7 in water column(0.87-1.74 kPa)for NG,10-12 in water column(2.49-2.99 kPa)for LP gas.For BTU content,multiply ft3/hr x 2500(LP)or ON x 1000(NG).For Mega]oube content,multiply m3/hr x 93.15(LP)or m3/hr x 37.26(NG). Controls Two-line plain text multilingual LCD Simple user interface for ease of operation. Mode buttons:AUTO Automatic start art utility failure.Weekly,BI-weekly,or Monthly selectable exerciser. MANUAL Start with stoner control,unit stays on.It utility fails,transfer to load takes place. OFF Stops unit,Power is removed.Control and charger still operate. Ready to Run/Maintenance messages Standard Engine run hours indication Standard Programmable start delay between 2-1500 seconds Standard(programmable by dealer only) Utility Voltage Loss/Retum to Utility adjustable(brownout setting) From 1411-171 V/190-216 V Future Set Capable Exerciser/Exercise Set Error warning Standard Run/AIarm/Wintenance logs 50 events each Engine start sequence Cyclic cranking:16 sec on,7 rest(90 sec maximum duration). Starter lock-out Starter cannot re-engage until 5 sec after engine has stopped. Smart Battery Charger Standard Charger FauWissing AC warning Standard Low Battery/Battery Problem Protection and Battery Condition indication Standard Automatic Voltage Regulation with Over and Under Voltage Protection Standard Under-Frequency/Overload/Stepper Overcurrent Protection Standard Safety Fusett(Fose Problem Protection Standard Automatic Low Oil Pressure/High oil Temperature Shutdown Standard Overcrank/Overspeed(@ 72 Hz)/rpm Sense Loss Shutdown Standard High Engine Temperature Shutdown Standard Internal FaultAncorrect Wiring protection Standard Common external fault capability Standard Field upgradable firmware Standard "Sound levels are taken from the front of the generator.Sound levels taken from other sides of the generator may be higher depending on installation parameters.Rating definitions-Standby:Applicable for supplying emergency power for the duration of the utility power outage.No overload capability is available for this rating.(All ratings in accordance with BS5514,IS03046 and DIN6271)."Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU/megajoule content,ambient temperature,altitude,engine power and condition,etc.Maximum power decreases approximately 3.5%for each 1,000 ft(304.8 m)above sea level;and also will decrease approximately 1%for each 101(6°C)above 60°F(16°C). GENERAL' 20/22/24 kW Switch Options Service Rated Automatic Transfer Switch Features G007039-1,0007039-3(20 kW) • Intelligently manages up to four air conditioner loads with no additional hardware. Model G007043-2,9007043-3(22 kW) _ G007210-1(24 kw) • Up to eight additional large(240 VAC)loads can be managed when used in conjunction No,of poles 2 with Smart Management Modules(SMMs). Current rating(amps) 200 • Electrically operated,mechanically-held contacts for fast,clean connections. Voltage railing(VAC) 120/240,10 • Main breakers are rated for 80%continuous load. utility voltage monitor(fixed)' -Pick-up 80% r • 2-pole,250 VAC contactors. -Dropout 65% • Service equipment rated,dual coil design. Return to utility ApprmL 133ec • Efl.or UL listed Standard Rated for both aluminum and copper conductors. Enclosure type NEMAIUL 3R • Main contacts are silver plated or silver alloy to resist welding and sticking. Circuit breaker protected 22,000 • NEMA/UL 313 aluminum outdoor enclosure allows for indoor or outdoor mounting flexibility. U9 WW 250 MCM-#6 "Function of Evolution controller Dimensions Exercise can be set to weeky,bi-weekly,or monthly 200 Amps 120/240,1 e Open Transition Service Rated Height Width Depth H1 H2 W1 W2 in 26.8 30.1 %5 13.5 6.9 cm 67.95 76.43 26.67 34.18 17.5 Wire Ranges Conductor Lug Neutral Lug I Ground Lug 250 MCM-#6 350 MCM-#6 1 210-#14 orrrri �--w�J GENERAC` 20/22/24 kW Available Accessories Model# Produce Description G007101-0 Battery Pad Warmer Pad warmer rests under the battery.Recommended for use if temperature regularly falls below 0 IF(-18 IC).(Not nec- essary for use with AGM-style batteries). G007102-0 Oil Warmer Oil warmer slips directly over the oil filter.Recommended for use it temperature regularly falls below 0 IF(-18°C). 0007103-1 Breather Warmer Breather warmer is for use in extreme cold weather applications.For use with Evolution controllers only in climates where heavy icing occurs. G005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical load that may not be Contact Kit needed.Not compatible with 50 amp pre-wired switches. G007027-0-Bisque Fascia Base Wrap Kit The fascia base wrap snaps together around the bottom of the new air-cooled generators.This offers a sleek,contoured (Standard on 22/24 kW) appearance as well as offering protection from rodents and insects by covering the lifting holes located in the base. G005703-0-Bisque Touch-Up Paint Kit If the generator enclosure is scratched or damaged,it is important to touch up the paint to protect from future corrosion. The touch-up paint kit includes the necessary paint to correctly maintain or touch up a generator enclosure. G006485-0 Scheduled Maintenance Kit Generac's scheduled maintenance kit provides all the items necessary to perform complete routine maintenance on a Generac automatic standby generator(oil not included). G007005-0 Wi-Fi LP Tank Fuel Level The Wi-Fi enabled LP tank fuel level monitor provides constant monitoring of the connected LP fuel tank.Monitoring the Monitor LP tank's fuel level is an important step in verifying the generator is ready to run during an unexpected power failure.Sta- tus alerts are available through a free application to notify users when the LP tank is in need of a refill. G007000-0(50 amp) Smart Management Module Smart Management Modules(SMM)are used to optimize the performance of a standby generator.It manages large elec- G007006-0 trical loads upon startup and sheds them to aid in recovery when overloaded.In many cases,using SMM's can reduce (100 amp) the overall size and cost of the system. G007169-0-4G LTE Mobile Link'Cellular The Mobile Link family of Cellular Accessories allow users to monitor generator status from anywhere in the world.using G007170-0-Wj-Fi/ Accessories a smart phone,tablet,or PC.Easily access information such as the current operating status and maintenance alerts.Us- Ethernet ers can connect an account with an authorized service dealer for fast,friendly,and proactive service.With Mobile Link, users are taken care of before the next power outage. G007220-0-Bisque Base Plug Kit Base plugs snap into the lifting holes on the base of air-cooled home standby generators.This offers a sleek,contoured appearance,as well as offers protection from rodents and insects by covering the lifting holes located in the base. Kit contains four plugs,sufficient for use on a single air-cooled home standby generator. Dimensions & PCs Model UPC Bt1375.1 6-In m 1210— l rae.o w,] G007038-1 696471074185 G007038-3 696471074185 G007039-1 696471074192 G007039-3 696471074192 G007042-2 696471074208 126.e Ind G007042-3 696471074208 G007043-2 696471074215 G007043-3 696471074215 o O G007209-0 696471071511 G007210-1 696471084801 548 mm 1232 mm 125.5 Inl 148.5 Inl LEFT SIDE VIEW FRONT VIEW Dimensions shown are approximate,See installation manual for exact dimensions.DO NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES, GENERAC; Generac Power Systems, Inc. • S45 W29290 HWY. 59,Waukesha,WI 53189 • generac.com C2021 Generac Power Systems,Inc.Alf rights reserved. All specifications are subject to change without notice. Part No,A00 009 37 31 4 Rev.D 04/14/2021 ARCOSA 57 wg and 119 wg TANK .Wr Finished with ArcClad Superior Aboveground Coating T:ink Features.- • Taller collar to accommodate preferred regulator set-ups • Superior Coating • D.O.T 173.3150) permits A.S.M.E. containers to be filled for transportation • Heavy duty bottom foot ring • Re-certification not required as compared with D.O.T. 413W cylinders • #72 liquid level outage valve orifice Fabricated to A.S.M,E.code.Section Vill.Division t For more information Division 2 design avarlaUe Registered with the National Board 888.558.8265 Registered with CRN(Canadian Regtstratlan Number) ARCOSA TANK Vertical A.S.M . E. Tanks GENERAL SPECIFICATIONS V-FLOAT Conforms to the latest edition of the ASME code for GAUGE Pressure Vessels,Section VI II, Division 1. Complies 1114'-FILL with NFPA 58. 314'-SERVICE — VALVE Rated at 250 psig MAWP from-202 F. to 1259 F.All VALVE tanks may be evacuated to a full(14.7 psi)vacuum. Vessels are pre-purge with vacuum and conforms with National Propane Gas Association#133-89(a) 1'-RELIEF- Alternative Purge Process. VALVE Vessel Finish: Coated with Arc Zinc rich FITTINGS LAYOUT epoxy primer and super durable TGIC polyester topcoat. LID 15 9/16"OD LID COLLAR ———� 15 9/16"OD COLLAR x H to W w 30" M J _ 24" _i _j OUTSIDE DIAMETER C < w OUTSIDE DIAMETER i., w O 0 I 18.40" 24" I III FOOTRING FOOTRING------III 24"OD(57 WG) 30"OD(119 WG) Est weight: 268 lbs. Est.weight. 320 lbs. Quantity in Full Load: 208 Quantity in Full Load: 99 Cre December 14,2018 For more information 88�55>�8255