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Home My WebLink AboutBP21-266PERMIT #46Y' %-�a� DATE: r O / Fxp: po SECTION _�.� O o1 BLOCK LOT :Owl i - — TYPE OF WORK JOB I.00ATiON _ OWNER�C CONTRACTOR B�EST. COST � '✓CO # ✓TCO # E ". n 0 r �flp .. 17vt e "t c©e.Ll FEE Y �/ I D-"l�Lo FEE4q 790�i�db INSPECTION RECORAD-,��,p ..�/ D TIE FOOTING -�- ZZ FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS Li SPRINKLER vi L��!,/ ELECTRIC Le LOW -VOLT ALARM AS BUILT FINAL a1- s he LLc �9Iy)700 a OTHER APPROVALS ARB ZBA OTHER 9 9/c%ft �477t i r17k��o u�-� 1c4 3)1gjaW i� -i��-' 1,5Ol>-/an9�rpS�ri %Z��-�/�/ic�h�v.�•� Sa�u7cn Sl9rv�cQs Ora fey v yE aRn� VILLAG E BROOK WESTCHES COU , NEW YORK ,Y NO: 22-035 Certificate of ®ccupaucp This is to certify that /00 moo o nic—r 1,_.,L---�C of, R�c ZLQC.?1C.I 1 V I having duly filed an application on P)OrLA Cc y\/ ) (S120 J-o- requesting a Certificate of Occupancy for the premises known as, O Ne,-34cha>4-cr A\/t,/ Ue., , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: ' Block: __L_ Lot: c2 and having fullyf complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. / -,=)LO//W, issued /0 20 02/, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: l� 4 " � J0 Construction: for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has beqn ob i omit 1) ' ding Inspector. Building Inspector,Village of Rye Brook: Date: MAR 1 4 2022 1 tt t.!uJ j u Ct6 + v l7 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J. 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 March 14,2022 760-800 Owner LLC / 800 Westchester Avenue LLC PO Box 349 White Plains,New York 10605 Re: 800 Westchester Avenue, Rye Brook, New York 10573 Parcel ID#: 135.82-1-2 Mechanical Permit#21-050 issued on 10/19/2021 for Modification to Existing Sprinkler System This certifies that the fire sprinkler heads on the existing system;4`h floor"Prager Meds", relocated under the above captioned permit, has been satisfactorily completed. Sincerely, Michael J. Izzo Building& Fire Inspector /tg 4R ty44.y3�y y VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.aebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE March 14,2022 760-800 Owner LLC / 800 Westchester Avenue LLC PO Box 349 White Plains, New York 10605 Re: 800 Westchester Avenue, Rye Brook,New York 10573 Parcel ID#: 135.82-1-2 This document certifies that the work done under Mechanical Permit #21-188 issued on 12/6/2021 for the modifications to the existing ,HVAC system; 4' floor "Prager Metis" has been satisfactorily completed. Sincerely,. Michael J. Izzo Building& Fire Inspector /tg VILLAGE OF R'" BROOK WESTCHESTER COU1V ', NEW YORK r' NO: 22-029 Zemporarp Certif irate of (9ccupaurp This is to certify that 7(0n ) [��VV n,f-,c LLC of, R B� 0 having duly filed an application on Fe b)'UO Y 1/r (b_ 20 aR requesting a Temporary Certificate of Occupancy for the premises known as,Sm 11Vesk' f-lef &n2Ue- , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: �5. c,;2 Block: _L_Lot: 02 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. oC �D�II, issued �� / 20 �, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the New York State Use Classification of , ,(,S)YlE'J',S' Y�u p - ,for the following purposes: 046 Subject to all the privileges, requirements, limitations and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the buildi or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height hall a made,nor shall the building be moved from one location to another until a permit to accomplish such change has be o ng Inspector. Da Building Inspector,Village of Rye Brook: te: F BB 2 8 2022 D E C IE ME 3BUILD TMENT For office�qsenFEB 16 2022 PERMIT# � VIL OF RYE$T}tti90K ISSUED: VILLAGE OF RYE BROOK 938 KING STREE YE 1ROOK,1�Of YoRK 10573 DATE:pD—/`O--D4 BUILDING DEPARTMENT (914)939�b�j -F 9; 9-5801 FEE: 4 WO— PAID Or w B APPLICATION FOR TEMPORARY CERTIFICATE OF OCCUPANCY 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 shall have been issued by the Building Inspector. g250-10.A.code of the village of Rye Brook Address: 800 Wtstcn��t_r RaIr - Occupancy/Use: Parcel ID#: 13 S . ). I —J. Zone: b Owner: 00 WSt(,he)ter AVf_. L_L( Address: PO h()A 3Vq, Wrltl OUIf)S',hl� N of Contractor: 5 U Fine jt rP.6 fW re. Address: R) gtg ,3qq V)hi f? 0 Din j A&� Person in responsible charge: R1 IG 1k1 C Address: 00 � X 3Llgf (tif;1 a Raa)S NY I Reason for temporary use: fi)trltud (Ub,06 VUiII n0f be dehAred Of) 71f1^U' QQer(1n6ii1S Estimated date of completion: {t- bru cw U��- Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Temporary Certificate of Occupancy for the structure herein mentioned in accordance with law: STATE OF NEW YOM COUNTY OF WESTCHESTER as:Ma(Vn(A W\a&Cj(JI being duly sworn,deposes and says that he/she resides at 20 6OX 34 (Print Name of Applicant (No.and Street) in Vv h j 1 tt, F(a i n ,in the County of W e S I C.I W?l r in the State of��,that ( own/Village) he/she has supervised the work performed to date at the location indicated above, for the construction, alteration or repair of: U0 W{S VCkieS1tr' F1Vt'nUt Deponent further states that he/she understands that a Certificate of Occupancy must be applied for and obtained upon completion of the above captioned project in accordance with law, and that a Temporary Certificate of Occupancy shall only be valid for a period not to exceed thirty(30)days. -t h Sworn to before me this 1 Sworn to before me this 1`"f day of , 20 ZZ day of T-2 bavc. , 20ZZ 2Z Si to of Pr Owner Signature of Applicant 4 �� d I Print Name of Property Owner Print Name of Applicant tary Public N ublic JANET A HERTEN JANET A HERTEN 1,10TARY PUBLIC-STATE OF NEW YORK NAnTARY PUBLIC-STATE OF N€W YORK No.01HE6085824 No.01HE6085824 Qualified in New York County Qualified in New York CoudW/19 My Commission Expires 01-06-2023 My Commission Expires 01-06-2023 �yE BRC�v� cu � '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q/ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK f❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.rygbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - ADDRESS : DATE' PERMIT# ' ISSUED: ECT:� LOCK: LOT LOCATION: ", "'�' ` C' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... d ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER E BR(�� O� 2m cu � 1982•'i�O BUILDING DEPARTMENT BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - -- - -------- ADDRESS: (,�J t�`�_ TIV�J DATE: — Z PERMIT#��-7 1 ISSUED: 10 ! SECT: 13S,3_—$LOCK: LOT: Z LOCATION: �(� �z �� ) q7L--" S OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... L1J ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION /� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL Q;'OTHER �� Qyre_BRC��_ 1982 BUILDING DEPARTMENT ❑$UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK l❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook.or¢ - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - --- - - - - - - - - - -- - - - � � Z G -,b 2 E ADDR SS. DATE: PERMIT# \ ISSUED: SECT: BLOCK: LOT: LOCATION: l`�1 (' (�L S OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL 1 ❑ OTHER `b\te e QyE BRCv�. BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - -- -- - - - - - - - - ADDRESS :— ' v DATE: vz�p PERMIT \ SECT: BL� � � ISSUED:� •CK' LOT: LOCATION: ' LlOC ► �(`. -> OCCUPANCY: \ ❑ VIOLATION NOTED THE WORK IS... 1J ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION _b��. REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE Cl FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ['r ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER IECE VW E B[TILD 1fE� j�j'r For office use only: PERMTI'# FEB 16 2022 VIL OF RYE K ISSUED: /Q--/9—�/ 9 8 KING STREE YE BROOK,N� YoRK 10573 DATE: O7�lti -c�3 VILLAGE OF RYE BROOK (914)9 6 939-5801 FEE:,Y& '710 PAID Z( BUILDING DEPARTMENT w". o 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 #ittt#frtrt#rtrtfrtiftitifkitft###k#iffitrtirtfrtif#f#k4fii#♦k#skits##i#irtrtftfikiiiki#f#i4it#tftrtrtrtfrtrtrtf#ikki#t#iiftfi#t#ftrt#rtrtrtfi#fi Address: 9W W NCh NU— Avenue Occupancy/Use: QffiC� Parcel lD#: Zone: OB - Owner: 90() W t,. f Cb S1tr AVt• L.LL Address: RO &A N 9, Whitt Palr)S, NylvOa P.E./R.A.or Contractor: '30 Pin?. S t rt�f L b r'Address: �(� g(�x �q 9� kh'r�Q11/1 Ny/040 Person in responsible charge: N i k)1Gf S/I C Address: PU P>(L( 3 V Gas h de C4910s. i!VT 1( 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 YORK,COUNTY OF WESTCHESTER as: (Y1u�-era mc\dnICk 1 being duly sworn,deposes and says that he/she resides at _ PO 60K 3 LIC/ (Print Name of Applicant)`` (No.and Street) in l i t I a I(- ) ,in the County of w S t c In e s to r in the State of—NY ,that (Cityfrown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost ofthe 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:$ 210 0 0 D U , for the construction or alteration of XO O yUg S t C hb r e r Ave n Ue, — P rQ a r m ri S 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 belies;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 ofany building or premises or part thereofhereafter 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. Sworn to before me this I wl(") Sworn to before me this I M day of 2�x , 20 day of CJ , 20 2Z Signa a operty Owner Signature of Applicant fj;` - Sti'l Molk-ty)o Mwin' (40 Print Name of Property Owner Print Name of Applicant Q tary P. lic No ublic JANET A HERTEN JANET A HERTEN 3/21/19 NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATE OF NEW YORK No.01HE6085824 No.01HE6085824 Qualified in New York County My Commission Expires 01-06-2023 Qualified in New York County My Commission Expires 01-06-2023 ■ O cn ... ■ O N a � U tA ■ �„ Lai U ■ ~ W O � ppi � � O a_ to wE- r kn a N_ v� A . O � 00 tn . _ z a z r h moo C� a; OW� z ; O V A a 0_ 0 c U w 4 • I•y F+y 00 � � � W ' '� C-� w a e 3 � •• � W� F J ,� O � .. E., � m � GL■ E- Lir • O 16 ' 00 z w u z Q co �EaRnu VF [Bum MENT v>T. Eo RYE ox 16 2021 938 KIN T RYE B K,NY 10573 1 ,- VILLAt_,_ _ BROOK '�c,ArZTMENT .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ? FOR OFFICE USE ONLY BP#: f Cf/ EP#: � Approval Date: Nov 1 7 1021 Permit Fee: $ / Approval Signature: Other: Disapproved: (fees are non-refundable) ********************//****************************************************************************** Application dated, //�V'c) 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: ROo Vy 5�'Ci�ti�f�/ ��p SBL: �3'Jr, 8a ��—� Zone:o a 2.Property Owner: R P W G x O U Address: Phone#: Iq I !d 2 k S /76 V Cell#: email: 3.Master Electrician: K 6 K A\b Cf , Address: 3�6� «�a/�h o l�l o` B Ss'►'1 ,1� /�{ Lic.#: 1 5 D Phone#: 1/ �1 7�a Cell#: email: Company Name: ko b 1 'e \ e Ct X(,C_ rp Address: 9-k G 4.Proposed Electrical Work/Fixture Count: e—uli STATE OF NEW YORK CO OF WESTCHESTER ) as: ing duly sworn,deposes and states that he/she is the applicant above named,and does farther (prfnt name of individual sigding 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 C Le+ CT�"r ! c , for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this 1 b day of ,20 day Signature of Property Owner Si nApplhicanA Print Name of Property Owner Notary Public Notary Public SHARI MELILLO Notary Public, State of New York No. 011,/iE-6160063 Qualified in Westchester County" Commission Expires January 29,204"- /1?J2021 • STATEWIDE INSPECTION cok) 1:1 Main Street,Fishkill, NY 12524 1 emoil: SWIS JOBAPPLICATION84 1 • I fax9l4.219.10621 • Office Use Elect.Permit# > Date �l Bldg Permit# I� ` / / Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number Basement ❑ 1st FI. 2nd FI. 3rd FI. More Than 3 Fl. Garage ❑Attic ❑Outside ❑Residential Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect Underground New Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information c��C1 ~�1' SA- - C' _ C-) RgAA./' TNOV 16 2021 L VILt BI is This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name k Q GA' % cI e C—EVI1 C 1-6 Date ) Signature---." ` Address j / / , ( �C I City/State ., .�tJf Zip Code License# ✓ 'v Phone# REV P� VState Wide Inspection Services FEB 1 1 2022 1080 Main Street DAT D. Fishkill, NY 12524 a 845 202-7224 Phone I VTLLPAUCE: OFF RYE BROM BUILDING DEPARTMENT 91;4-219-1062 Fax STATE WIDE INSPECTION SERVICES -- Email. office@swisny.com swisny.com Website: www.swisny.com Service With /ntegrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Rabadi Electric Corp Prager Metis 368 Illington Road, 800 Westchester Avenue Ossining, NY. 10562 Rye Brook, NY 10573 Located at:800 Westchester Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP21-301 135.82 Certificate Number: 2021-6709 Building Permit Number: BP21-266 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:800 Westchester Avenue, Rye Brook, NY 10573 The 4Th Floor Office Area was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 24th day of January 2022. Name Quantity Rating Circuit Type Electric Ceiling Luminaires 105 277V Receptacles 85 110V Switches 30 Sub Panel 01 Emergency Exit Light 08 Down Lights 14 110V Fire Alarm Installation Smoke Detectors 51 Horn/Strobes 08 Pull Stations 02 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. R D E C I E �VP `F� D State Wide Inspection Services i FEB 11 2022 1080 Main Street Fishkill, NY 12524 VILLAGE OF RYE BROOK 845 202-7224 Phone BUILDING !DEPARTMENT 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Rabadi Electric Corp 760-800 Owner LLC/800 Westchester Ave LLC 17 Kingman Terr. 800 Westchester Avenue Yonkers, NY 10701 Rye Brook, NY 10573 Located at: 800 Westchester Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP21-301 135.82 Certificate Number: 2021-6709 Building Permit Number: BP21-266 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:800 Westchester Avenue, Rye Brook, NY 10573 The 4th Floor Office Area was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 24th day of January 2022. Name Quantity Rating Circuit Type Electric Ceiling Luminaires 105 277V Receptacles 85 110V Switches 30 Sub Panel 01 Emergency Exit Light 08 Down Lights 14 110V Fire Alarm Installation Smoke Detectors 51 Horn/Strobes 08 Pull Stations 02 .N- Z. /, t r Officer: Frank). Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. N C c oN N � N W o c ,n - o F" Ln w o. Cn en �a t o � o v O be + w o (-+ + M 00 w Q Z Ln o A enW N z RO, 00 cn + v H oo `. �-+ ,� wj a O x •� a w < ca V ►� a a o U � � oZ � O W O � w cal ► W w x � m C7 H n a z $ canzo tn C z � t- 0.� 8 U 4 z a x � y z 00 04 W z a ° < .. a z dl � a a � • V i ? 1 LL '��'7 l_� U i BUILDING DEPARTMENT [—';- VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 BUILDING DEPARTMENT (914)939-0668 .`firs ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 1 FOR OFFICE USE ONLY BP#: EP#:• CDC)—O �j Approval Date: JAN 2 5 O 2 Permit Fee:$� Approval Signature: Other- Disapproved: (firs are non-refundable) Application dated, Z1 2Z- 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 conformancewith all applicable Federal,State,County and Local Codes. rr�� ,�� 1.Address: � 00 L.o e S 1 C -F! r�V-e SBL: 13 C> ` L�Z ~� °�` Zone:43 2.Property Owner: (-J Address:• 'F0 �0 t �y q,u k.ft e6jw (. AJ 10 60 5 Phone#: q 14-) r,-0C'C' - Cell#: email: rJ i i,c. 42 f--e LA)C-sow .CIO� r 3.Master Electrician: Address: 11 '' Lic_#: Phone#: ( Cell#: 4 I l-5 email: Lt:(�_c'o M Company Name:%Ii Lbrn�Y1 jlc t-��Of1 S P.rq\C.e s Address:l3� D A46ruX. ANA"1 ca S d '� 4.Proposed Electrical Work/Fixture Count: L-oW STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: n r j ��S ,being duly sworn,deposes and states that he/she is the applicant above named,and does further print name of indi%idual signing as the applic:iu: , state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Co n-Fruf w for the legal owner and is drily 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 m 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 bef me this Sworn to before me this day of ,20 Z Z- day of .20 7-t - r Sign9fdre of,Property Owner Signature o plicant P�6\.k J-t-c. �4 c Print N of Proper Owner Print Name PID pp jcan� No Public '� 1 Notary Public,State of New York N010 u l ,State of New York No.01T06129900 N0.01T06129900 Qualified in Westchester County Qualified in Westchester Coin Commission Expires July 05,20 ;/ Commission Expires July 05,20,_ 8/12/2021 Westchester Rockland Electrical Inspection Services, Inc. �` Phone 914 3a�s"95 60 NOT WRITE HERE-FOR OFFICE USE ONLY P.O. Box 208 L y Fax: 914-347-3596 Carmel NY 10512 i--)1 BUILDING PERMIT NO. TEMP# DATE III c-. CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY Q iL\ 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 INCADF-__ FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE _ i \\I�_ -.- _..., BASEMENT .`. 1"FL AN 2 1 2022 2-FL RYE :31- 3-FL BUILD INC' REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: Low `-eu Ck s THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS,INC.IS NOT LISTING,LABEUNG,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C UNDERGROUND AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATUR�OFAPPLIICANT STREET ADDRESS TELEPHONE NO, s a0d Cm OR POST 7Z ZIP CODE LICENSE NO.WHEN APPLICABLE DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 1/24/2022 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 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: Lynn Lladerman The Mechanic Group PHONE (845)735-0700 FAXCM,N,;(845)735-e383 One Blue Hill Plaza ACED L .11indermanemealbaaiogroup.oam Suite 530 INSURER(S)AFFORDINGCOVERAOE NAIC■ Pearl River NY 10965 INSURVIIA-Allied World Stuplus Lines 24319 INSURED mwRERB:The State insurance Fund 36102 Techcomm Solution Services LLC INSURERC• 1350 Avenue of the Americas INSURERD: _ 2nd Floor INSURERS: New York NY 10019 INSURERF: COVERAGES CERTIFICATE NUMBER:2021-2022 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 ADD SUBR POLICY EFF POLICY EXIP LIMBS LTR TYPE OF INSURANCE POLICY NUMBER M X COMMERCIAL GENERAL LUBLRY EACH OCCURRENCE $ 1,000,000 O RENTED A CWMS-MADE X OCCUR PREMISES Es occurrence S 100,000 X Zrrors 6 Omissions- 5200-0378-08 4/26/2021 4/26/2022 MEDEXp W7 one person S 10,000 PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X POLICY j� LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY eBINE It $ 1,000,000 (Eade ANY AUTO BODILY INJURY(Per person) S A ALL OWNED SCHEDULED AUTOS AUTOS 5200-0378-08 4/26/2021 4/26/2022 BODILY INJURY(Peraeekferk) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS S $ X UMBRELLALUB X OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS LJAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION S 5201-0413-06 4/26/2021 4/26/2022 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? El NIA R2336319-5 6/3/2021 6/3/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLO $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF-HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Steve Mechanic/LYNN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a a A Annn 743181260 MECHANIC GROUP INC ONE BLUE HILL PLAZA SUITE 530 ■ PO BOX 1646 PEARL RIVER NY 10965 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TECHCOMM SOLUTION SERVICES LLC VILLAGE OF RYE BROOK 1350 AVENUE OF AMERICAS 2ND FL 938 KING STREET NEW YORK NY 10019 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE M2336 319-5 363984 06/03/2021 TO 06/03/2022 1/24/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2336 319-5, 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:/IWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY AFFORDS COVERAGE TO THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. GREGORY LETT GRANT PACQUETTE HENRY RIVERS TECHCOMM SOULUTION SERVICES LLC 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 STAT SU NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 642557933 U-26.3 WESTCHESTER ROCKLAND 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: Techcomm Solution Services LLC 760-800 Owner LLC/800 Westchester Ave LLC 1350 Avenue of Americas NY, New York 10019 Located at:800 Westchester Ave Suite 400 Rye Brook, NY 10573 Certificate Number: 1033136 Section: 135.82 Block: 1 Lot:2 BDC: Permit Number: EP:22-012-BP:21-266 A visual inspection of the electrical system at this premise described as a Commercial occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at: 800 Westchester Ave Suite 400 Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside OtherAth Floor 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 02/15/22 Name Type Quantity Data Lines Drops/Points ------- 82 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. 01 01 � to �••� u logO m N U x ga a to a u z � « a° 00 �nto c` V U w > o00 m y Z e 3 N ° 8 6 >. oc z w z Q co S BUIenor,�Z' ENT DEC 14 2021 VIOK 938 KIN NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT PLUMBING PERMIT/APPLICATION / Q FOR OFFICE USE ONL) BP#: p� _ �f1(O PP Approval Date: DEC 1 5 02,^' Permit Fee:S ��5 Approval Signature: V" Other: Disapproved: (fees are non-refundable) Appl/cation dat S is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or renlove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will ibe in conformance with all applicable Federal,State,County and Local Codes. ;p 1.Address: 80o WQ j -c:�l cstcr V / SBL: gh3 s- ,g Z 1-2- Zone:Old 2.Proposed Work: -I-Vr\ s �7, i Gw. �1 Si ` 4 3.Property Owner: g`��1 l S �� Address: �( >(K�e �� Xr-cJ, NY Phone#: t I�J 7 OU Cell#: email: 4.Master Plumber: Address: %'^'Q-t— L-c,•-2 Lj�� Lic.#: //_V Phone#: rr Cell#:'J 1�-S 3 Z 1 Z Z email: P4-.,"r'/10 Company Name:C S v, h Address: 40¢s INDICATE FIXTURES&LIKIRN 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 31d Floor 4t°Floor % 5's Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 BUILD MENT D VIL A' E OF RY OOK DEC 14 2021 938 KING TREET RYE BR NY 10573 (914� -0 VILLAGE OF RYE BROOK ww t BUILDING )DFPARTMENT F*K>F*x+F k dr ai�r*i:k:lz;Fek*kir kxxk**fir a4*aY'raY**'r'e a4 eF 4#***iit i'r ak iir*iF*k eF*eF+iF*ir is k�r k��c�r it F 9r it it k kxaF******aF rr Fxxx:F*xk xk k F k*sY sck** 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: 3, plkd r r 1k ,residing at,Po Q ky- 341 r okh 6&t-f, W L06.6 (Print name) (Address(where you live) 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; 000 In)6 s�d'-oV , Rye Brook,NY. (Job Address) 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. ( nature�Owner(: I N Ik?�-VL (Print Name ol'Property Owner( Sworn to before me this day of Dee-IQ m`okt— ,20 :L _ Q, ( or ry Public) JANET A HERTEN NOTARY PUBLIC-STATE OF NEW YORK No.01 HE6085824 -3- Qualified in New York County My Commission Expires 01-06-2023 S/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: V 11\"(Aa -TV'C ,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 Qw09-r 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 14 Sworn to before me this day of bg!P_Yy�4r,20 day of Z)QC'e TM4bEr720 '�—( V Signa rop of P Signatur f plicant Print Name of Property Owner Print Name o Applicant Q N Public of Public JANET A HERTEN JANET A HERTEN NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATE OF NEW YORK No.01HE6085824 No.01HE6085824 Qualified in New York County Qualified in New York County i�atp�ki> iv�t tda eQ>i^aly completed in its entirety and must AY&BMOMftiA114WO�A"?) 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. -2- gn 2/2021 O � n H o 015 � x 3 `o IL E- o. (uh qe 3 ,. o Ontn E. m a ono � �� ri w w a F o vi 3 z22 o 0 ^ oo •� Ec 01% OEM z 00 wz a P wW Z o ►'� w N o `o w s O r� C O oC F-i ��Ey �" v�i t� Ey U aaH 61 O a o � &- F W � � � V � cg ,_`o •ls � � Q u y y E E a ° p a aw, w w ° � v = v, 4 Flo BUILDING DEPARTMENT D v �� VILLAGE OF RYE BROOK OCT 2 2021 938 KING SiWET RYE BRoai(,NY 10573 (914)93968 91�V939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Q ApprovalDate:OCT 1 3 202 #: Q/-a!& m,)4:�//,T0 Application Fee:$ 05,Q�'—/ 'b Approval Signature: Permit Fees: $ 0 /7J— Pb/ Disapproved: Other: Application dated: 10/12/2021 is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address. 800//Westchester Avenue, Rye Brook, NY Q 2. Parcel I.D.: 3Jr/ /�9a " Zone: 0 d1L 3. Proposed Work(Describe system in detail including suppression agent): Modify Existing Sprinkler System for new office alterations (Sprinkler Head Relocation) 4. Number&jypgs of Fire Sprinkler Heads• 66/ Reliable 05-56 Concealed Sprinlders 5. N.Y State Construction Classification: N.Y.State Use Classification: 6, Estimated Value of Job:$ 9,000.00 Value shall include all labor,materials,fixed equipment i (1 1 cil Icrs,wWd errt r ils and labor which mu be donated s�rau,. c Q� jo t� �/� � c Po �� 3 y9 W�,�Q�l4i�s,t��/ 7. Property Owner:7100p'C) 0J411?t-UC_ SfG(&4 AAddress: Phone# gf 4" c d S-17 Da Cell# email: /0&0S' Applicant: Hang Fire Sprinkler Co. LLC Address: 106 Dakota Drive, Hopewell Jct., NY, 12533 Phone# (845)475-2390 Cell# (845)475-2390 email: jeff.anjos@hangfire.cc Architect/Engineer: Fire Protection Design Address: 14 Denver Road,New City, NY, 109 Phone# (845)721-9835 Cell# email: mpfd(averision.net g=ral contractor RPW Group. Address: 800 Westchester Ave, Rye Brook, NY, 10573 Phone# (914)285-1700 Cell# email: nilli(cDrpwgroup.eom I 1/30/2020 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. Ibvfcl%ess ed STATE OF NEW YORK,COUNTY OF WC45ffiettEMR ) as: Jefferson Anjos ,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 Contractor for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomcy,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. Sworn to before me this Sworn to before me this /Z day of 120 day of loc&/bw-r , 20 2( 6e�z G Signature of Property Owner Si at of Applicant elsory Print Name of Properly Owner Print Name of ApplicanLbx�lv Notary Public Notary Iblic RYLEE GREENWELL Notary Public-State of New York NO.01GR6357822 Qualified in Dutchess County Qas My Commission Expires Apr 24, 2 1/30/2020 a OD JJ00 ii u O ' N N N `~ a � F. F L W e v v�i x 4 rA Fes d oZj . 0" Oda_ a O c � oE M O N g G ° 3 � � " V rn F�1 N s v v . ti cps W o N V $ < o � o � p O W O ` ^ en .a _ L a r ` ►� � C cn rr W �;, v 0 � 1 E� 0 0 � Q w as a O e 7, E (_ 00 O F w, o � � CvE W 3 N p 'r i UrE $ uE °.3 wcc V ■ � C7 � (� � .. � � arc ° � � r � 00 a C/j W v c-v 0 ; r 'y E 4 W W a zz 3a� u fo •• r ZCA Z 1■rl F O j p C .J o Crj • ,_, � V U � V c a � i = W rol Z "" O z < " � � •E rU Z~ Q EE V O z a Q � o A a w > �) OC � W O .< r .0. a r, QCi C61 04 m Lz, = rn F- P A r r r BUIqET MENT D c' �V� VILOF RY OOK 938 KING RYE BR ,NY 10573 DEC - 2 2021 4 -0668 ok.or2 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING E "PJ—)b QUIPMENT FOR OFFICE USE ONLY: PERMIT#: 6Approval Date: Permit Fee: $ a5 Approval Signature: Other: Disapproved: (fees are non-reftmdable) REQUIREMENTS FOR RELEASE OF PERMIT& CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder) &Workers Compensation Insurance on a NYS Board form(Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit• COMMERCIAL =$350.00/unit. 5. Inspection by the Building Department for removal and/or installation. (48 hour notice required 6. Electrical work requires a separate Electrical Permit&Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, LIAI-n is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County, State&Federal laws, codes,rules and regulations. q Q( SBY�e�t�s 1. Address: $Gp 4 &JlA6 *( JNK K� 'Rat Ta�C L: I SS.151-I.1 Zone: 2. Property Owner: NO- Sco bww U-46y vb.- - 1 Ij.LAddress: to 15by 3Nq %b Ijj NUJ Phone#: (dIM)US- 11W Cell#: email: 3. Contractor:0 Address: Vo 116W Z.S21 (ic;s Cd M %H bt 1 Phone#: Cell#: ZbS)WA-SbOS email: AL t;"a Cptwsna�.+dSl�,toh 4. Applicant: V% Address: Phone#: Cell email: *A 5. Scope of Work:New Installation()o•Replacement( )•Removal( )•Other( ): 6. List Equipment:*1ksk4 C\) T-Scorn A.'a\fm *—* riiC na. tT 9,00H :Sid rat Q � .{�a �,, t.>!• t ds l� �e pork �i�e..t' dive. OtW�1. t�.>t Ct u. d��uxa 7. Location of Equipment: firlof 4(\ftkkit. �ac it (Z4p1� 5d t �:u am Ica Arc �oc� 8. Method of Installation/Removal(list all equipment needed to perform job): 1Dytk%^3*& W*-Vk 44, :,PtI644 yZN 1 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: lcu*' C ,being duly sworn,deposes and states that he/she is the applicant above named, (print name ol 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 GO *"J*C 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 I St day of ,20 day of -D0ZJ6rA?y6F- ,20 z t q ff 0 •'pTAR C Signature of Property Owner ' O % S' a e of ApplicantO.ofCU6367294O QUALIFIED IN ' _ 0.01*`"D Print Name of Property Owner SUFFOLKCOUNTY: = Print N1me of plicant % S T P C, 4e Notary Public '�FrOFIIN Notary Pu is WA' COM(w 1l 13a(20Z5 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 Building Permit Check List&Zoning Analysis Address �D'J �S`�''�-rrS -�� Y/\�y SBL• 3�• `/�Z — l - Z_ Zone:013,-Z Use: Const.Typ Other. Submittal Date: _ Revisions Submittal Dates: Applicant: JeO v c- L I- G L ' Nature of Work: ►-j-VARlL t O�. D Ff1 c P—_ �G �r-� J �r - Ll L-0 9 2_ �ge, Z2 M EMI S " Reviews:ZBA PB: BOT: Other. OK ( ) FEES:Filing.—ZS?? '—a BP: —Cl Z S� C/O: Legalization: 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 Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current: Archival• Sealed: Unacceptable: ( ) (�PLANS:Date Stamped Sealed: ✓ Copies:,7-- Electronic Other. (1 (�License: Workers Comp: ✓ Liability: V" Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (•� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. (�( ) LOW-VOLTAGE ELECTRICAL Plans: Permit: N/A: Other. (� ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. PLUMBING Plans: Permit: Nat.Gas• LP Gas: N/A/: Other. (. (�FIRE SUPPRESSION:Plans: Penzmit �N/A: Other. H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: APPROVED REQUIRED EXISTING PROPOSED NOTES q Date:-_ OCT 1 3 /Q2' Cir Fr n Front: >rg= Sides: >3ar. Main Co Accs.Co Ft.H/Sb: Sd.H/Sb a&.. T !m : P Hdght/stories: notes: AC"RIDO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/11/2021 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: Brown&Brown of New York,Inc. PHONE (914)337-1833 FAX A/C No Ext: A/C,No): 1133 Westchester Avenue E-MAIL s: certificates@bbinsny.com ADDRE Suite N-136 INSURER(S)AFFORDING COVERAGE NAIC 0 White Plains NY 10604 INSURERA: The Cincinnati Insurance Company 10677 INSURED INSURER B: Federal Insurance Company 20281 RPW Group,Inc.,50 Pine Street Corp. INSURER c: The Travelers Indemnity Company 25658 PO BOX 349 INSURER D: INSURER E: White Plains NY 10605 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDLISUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7X OCCUR PREMISES Ea occurrence $ 500,000 X General Liability 10,000 MED EXP(Any one person) $ A Y EPP0589382 09/10/2020 09/10/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO PRODUCTS-COMP/OPAGG $ JECT ©LOC 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident IX ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AUTOS ONLY AUTOS 73599614 09/10/2021 09/10/2022 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C EXCESS LAB CLAIMS-MADE CUP-7S429260-21-NF 09/10/2021 09/10/2022 AGGREGATE $ 10,000,000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILrrY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In N If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B $15M Excess$10M Umbrella each Occurrence $15,000,000 7819-47-82 09/10/2021 09/10/2022 Aggregate $15,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Excess Umbrella Policy No.6072292085 Policy Term:09/10/2021-09/10/2022 Carrier:The Continental Insurance Company Policy Limits:$25,000,000 excess of$25,000,000 NAICS#54210 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. Building Department 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 @ 1988-20155 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD fi� NYSIF Now York State Insurance Fund 199 CHURCH STREET, NEW YORK.N.Y. 10007-1100 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a o ^^^^^^ 133772722 *t� ll THE FLANDERS GROUP300 LINDEN OAKSSUITE 210-1ST FLOOR ROCHESTER NY 14625 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 50 PINE STREET CORP VILLAGE OF RYE BROOK P O BOX 349 BUILDING DEPARTMENT WHITE PLAINS NY 10605 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2106 567-7 142431 01/01/2021 TO 01/01/2022 2/22/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2106 567-7, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/NVWW.NYSIF.COWCERT/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: 171138414 U-26.3 CARE&WA-01 �MGENOVESE DATI F!!!^,11)MYYYY) ' CERTIFICATE OF LIABILITY INSURANCE 9/3/2021 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 Meredith A.Genovese AssureclPartners New England,Inc. PHONE FAx 100 Beard Saw Mill Road (A/C,No,Ext):(203)514-7380 ac,No):(203)514-7380 Shelton,CT 06484 E-MAIL,ADDRESS;Meredith.Genovese@AssuredPartners.com .— -- INSURER(SI AFFORDING COVERAGE _ NAIC S INSURER A:Selective Insurance CompanV of NY 113730 INSURED INSURER B:GuldeOne National Insurance Companv 14167 Carey&Walsh,Inc. INSURER C:Selective Ins.Co.of So.Carolina 19259 P.O.Box 2529 INSURERD:Charter Oak Fire Insurance Company 25615 Briarcliff Manor,NY 10510-1511 — INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS PE OF INSURANCE R TYPE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 2,000,000 CLAIMS-MADE .XOCCUR X X S2509239 9/1I2021 9/112022 PHEMIS To RENTED s 500,000 X Contractual Liab ME EXP(Arry one persow $ 15,000 PERSONAL&ADV INJURY 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER-. GENERAL AGGREGATE S 2.000,000 POLICY 7 jECT F I LOC PRODUCTS-COMP/OP AGG S 4,000,000 OTHER: S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 Me Ix ANY AUTO X X S2509239 9/112021 911/2022 BODILY INJURY Per person OWNED AAUTODpS ONLY ALIT�.IO{S�yUyL.�ED BODILY INJURY Per accident S AUT�IJS ONLY X AUOTOS ONLDY P�20 RT�V DAMAGE S r s B UMBRELLA UAB X OCCUR EACH OCCURRENCE S 5,000,000 X EXCESS LIAB CLAIMS-MADE X X 99006921 9/112021 911/2022 AG REGATE _ t 5,000,000 DED RETENTIONS s C IORKERS ANDEMPLOYERS'NSATIOIN X PTRT T OTH- ANYPROPRIETOR/PARTNER/EXEcuTIVE YIN X C9084369 4Nl2021 4H12022 1,000,000 OFFICER/MEMBER EXCLUDED'! �N NIA E.L.EACH ACCIDENT $ )Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 it yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S D Leased/Rented 4T-660-8J123678-COF-21 9/1/2021 911/2022 from others 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) 'Workers Compensation Information" Insurer: Selective Casualty Insurance Company(NAIC 14376) Policy#WC9084368 (State of New Jersey) Effective Date: 411/2021 Expiration Date:4/112022 SEE ATTACHED ACORD 101 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 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TEW Workers' ORK ATE Compensation CERTIFICATE OF Bo NYS WORKERS' CONJPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured(use street address only) tb. Business Telephone Number of Insured Carey&Walsh,Inc. 914 762-9600 P.O.Box 2529 Briarcliff manor,N) 10510 1c. NYS Unemployment Insurance Employer Registration Number of Insured ork Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d. Federal Employer Identification Number of Insured or Social Security Number 132591740 2. Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Selective Insurance Company of South Carolina Village of Rye Brook 3b. Policy Number of Entity Listed in Box 1 a" 938 King Street Port Chester,NY 10573 WC9084369 3c. Policy effective period 3d. The Proprietor,Partners or Executive Officers are ®included.(Only check box if all partners/officers induced) []all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box "I a"for workers' 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". �Mdl the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if Fancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? ® YES ❑ NO This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, 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. Robert K Kesten (Print name of authorized representative or licensed agent of insurance carrier) Approved by: %ae, lX //f all 04/1/21 (Signature) (Date) Title: Executive Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: 203 427-8419 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-15) www.wcb.ny.gov ' AC"I?o' CERTIFICATE OF LIABILITY INSURANCE UAiE(MMIDDIYYYY) 110*� 5/24/2021 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 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: Cynthia Schmidt Allied Insurance Managers Inc. PHONE (248)853-0930 AIc No: (248)8s3-1s1z 1055 South Blvd. East F-MAIL ADDRESS cschmidt@alliedinsmgr.com Suite #110 INSURER(S) AFFORDING COVERAGE NAIC A Rochester Hills MI 48307 INSURERA:Clear Blue Specialty Insurance Company INSURED INSURER B:SeleCtiVe Of the Southeast 39926 Hang Fire Sprinkler Co., LLC INSURERC:Crum 6 Forster Specialty Ins. Co. 106 Dakota Drive INSURERD: INSURER E Hopewell Junction NY 12533 INSURERF: COVERAGES CERTIFICATE NUMBER:21/22 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 CONTRACTOR 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 AD L 1SUBR I POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 100,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ WCSE-CGL-0000691-01 5/22/2021 5/22/2022 MFD FXP(Any one person) $ Excluded PERSONAL 8 ACV INJURY $ 1,000,000 GENT AGGREGATE LIMRAPPLIES PER. GENERAL AGGREGATE S 2,000,000 JEO- ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY a OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED S 2491771 5/22/2021 5/22/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident) $ X WOS/Cont.d X SIM Addl Insured $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION S SEO-108483 5/22/2021 5/22/2022 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LLABLRY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 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 it 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 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Jayson Bass/CMS � iz�--- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 i2014;1; N Y S ' F New York state Insurance Fund 1 WATERVLIET AVENUE ALBANY,NEW YORK 12206-1649 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 FMI A A A A A A 833132921 HANG FIRE SPRINKLER CO LLC 106 DAKOTA DRIVE HOPEWELL JUNCTION NY 12533 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER HANG FIRE SPRINKLER CO LLC VILLAGE OF RYE BROOK 106 DAKOTA DRIVE 938 KING STREET HOPEWELL JUNCTION NY 12533 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2474 285-0 998793 05/23/2021 TO 05/23/2022 10/12/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2474 285-0, 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. 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.NYS IF.COMIC ERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY AFFORDS COVERAGE TO THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. JEFFERSON ANJOS MEMBER 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. 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X ern - s tic System "' P i N-S"OEC - .._- _ ! Dema rememmg dun to T dltruscr _ X ;i S ENg�h1TrY 6 0 ]ustm£D x -' 'R 6 0 I I is cra z0uff R'113BM Q5 ea i �- oo cFM@ 0 r _ g0 g truvk in ;�_ -i-- ' .�E$- g e COA13 iso G�'M 36x2d hallway 1 Q _- -.I�i,r OFF(GEt 1n 120(Et s,la - Y- j T -{ vD�f j b.la - �J - Al - 43 s ]alma om rj Zz= 0 ,, r i-- --- —— —— — i ta3zo OFF1�E#5 '__- pp ;AV S.#2 .: R004A -� ..._. t�._ 1 Ia -- /�L/ 4'E9 4 E8 L nN ii - J C�_ y 4022l -- - �1 - -• 7f-Ci7:0... W RECEPTION I CAq z N 10 6.0 e�nM - A7l - onlzo I I 3ocF. L. E7; EMPLOYEE .-_ LOUNGE i a I � __.._ 400 ._ 1406 t, ii __ .-. ,. - 75 CFM It _�..-__ j30 " _ - 310C�.M s VD :6 m W.g 11.3 _,._ .-'-" :_1. o' .. oxtd III�v a I� CF.M £1'x6 I I p �� XB _s m I SN E O a - -- - - yt - I.yA ' V1 let ._:.. o OFF �,.;-. 1.............®...�,bO C.F. '�,L.--��....-.d',_.Bxl o.-.._-_..._- ; �! �_ i '�.. I �� li, _ '. .._'BOO CF.HI-. i �I_. IX1CF 1 :. 4 � I za:i� 'I,OFFI E#3'.. � ) ---- � -;-- ---- '- - - I-- Cilo I om iVD-I. l oeDta AC 03 I m i SNARED -I-0 F10E#3 C 03 OFFICE Af10 { _._.-v -. ..._._._-_..-- -__ ._.._. _..-_-._._T... , .. ._ 6 9 a"00 C.F.MHslence I :_-._._-_.-..�__-i-- _421...._ -_ _. .._....._.,. -T-i-L.__- -.-_ ., i 0 o W.S.#5 wcrb x _F! I-P-�F Sk$4RE8 -:.. -- ;:, laoC.F. - -t- -- - -- - --'- ao7 13oc.F.n OFFICE# s^o ( COL LABOIIAT O - - -.. --onto- --1 _ - ---i- T-- -- W.S:#8. - '4`r✓}. ! AREg-s SHA 0 411C -_(aO GF.M OCFM�00 .M 70 C.F.M 1,- _AED�a .i• -_ _ 37A CFM _ .. .._ -- m oc.e. 8'x6' a i t•. i i 423 I 6�0 8 8"0 B -- -- - C' �� M - xisfrng { �- (ryp) s EI)�O)C NF `\\,Y sm I am 1 v, ,I ern UI I11 ° t U 7 Drawing Notes 1 71 --- and local.codesincludin but notlimitedtothe2020-NYSBuildin ,r .5 �,;-- �� --"" :I soc 'I -' _' T .. A e eeoe��.to"`- t-- 'k. `----- •#H 1)All work shall comply with all federal.state, g, . 9 a o `,c �, -� I, _I ytq Code,2020 NYS Mechanical Code,and the 2020 NYS Energy Conservation Code, O FICE#&''\ \ \' 1 s o to320 bED -"9 - 2FM ! ` �W 2zxlz r\ 0 08 _ __..e_ -. -- -- - y -- --I-- rD i 2)All new ductwork shall be fabricated with G60 galvanized iron and conform to latest SMACNA construction 4271 -i_ _ _.._._. 3� r (-- - - (}4- 1- 1 standards. \,'' \ / m - f 3 HVAC s stem shall be desi ned er ASHRAE Standards and shall be sized to maintain an indoor temperature of -- - Y 9 p t 75 degrees Fahrenheit during the cooling season and 68 degrees Fahrenheit during the heating season. \/ / �C Q48 is ecoF 8e WC0 4)Upon completion of project:contractor shall perform air balancing and submit a-balancing report demonstrating X ,; \ `.\ 8 6' e �� o :U_3.-I' J30CFM- } conformanee to within 10/of the design airflows. 6'0 5)Contractor shall furnish and install a control system that meets the building standard and capable of meeting the `� \ r`` `• T W S.#1 sequence of operation set forth below. 6)Architect to review and approve final thermostat locations. - { OFFICE#4 - zz:lz SVIARED i / ! 422 OFFICE 05 mng l SHAREQ Sequence of Operation OFFICE ------ ->---___- -4g9-_ - _-- -..._I m I OFF';10E#7 -- -.._ tree Existing.AC-36,AC-48,and Perimeter FCUs:Existing 480 -pipe fan coil units shall be controlled by a local Key Notes programmable thermostat.Thermostat shall be set to run the fan continuously during occupied hours of operation, Upon a call for cooling,space temperature rise above 75 degrees F(ADJ),the respective chilled water valve shall 1)Route%pumped condensate dram Ime to nearest slop s nk _I - - - 1 XEC. - - -BOLLABORAFiOrti I 3oc.F.n IL modulate open until space temperature is satis ied.Upon a call for heating,space temperature falls below 68 ___., _.FFlO€#8,,. , --I- _-_ ) 6 or floor drain. ( - O CE l AREA ` degrees F(ADJ),the respective hot water control valve shall modulate open until space temperature is satisfied. 424 I 41� 2 Pro osed location for I-TON air cooled condensin unit on I `---"--- -- ' GAV Box:CAV box damper shall modulate to deliver a constant volume of air to the space to meet minimum ) p B -- -. -..-�.-_- 0 1 -- o -- -- - --, ---t a^ 3rd floor roof.Coordinate final locationwith landlord. (�� ventilation requirements for the space. AC-1 I ACCU-1:New cooling only ductless split system serving the IT Room.A local controller with integral space temperature sensor shall control the air handling unit and its respective condensing unit.Upon rise in temperature t ADJ the air andler shall ener ze Its fan and roof mounted 00 cF _ above the set point of 75 degrees Fahrenhet( ), 9 ---60CF _ _._]4 0 �_ �o --_-__._ - __gmcF - �`I * u condensing unit to maintain set point. ae 1 1 ( b0 /yz"stnara ° OF1oE /` k°s nnwa \ FFIC ➢ale Ocnso i CFM 41 F IeE# i O/ I,AC 048 o j4,\ I _r� CRM PERMITi 6"m v % SBl# � �~� L 2 -- \ \: so COUNTY LICENSED \\ / - OATEAPPROVED \, X I.w 7 CTRICIAN \_\ \b \ *,�' �- saec F.MI OREM HUGDLE REC'UIREDTO FILE �� <" @ X fwJ v BUILDING INSPECT R III ye Brook,NY ! \ Ott D. \�C' Ur ILA / 413 DEC. D flat COPY ;•; y�.. �zoz� � VILLAGE OF RYE BROOK \m\. BUILDING DEPARTMENT I PROJECT NAME:Pra er Metis 4th Floor S ;` OFFICE#12 c��u�A�sxlNc g UPDATE', - 529 NORTH STATE RD 800 Westchester Ave,Rye Brook,NY 10573 4Y2 \ BRIARCLIFF MANOR IVY 10510 DRAWING TITLE:Duct Shop Drawing \ \cFm\ MECHANICAL CONTRACTORS DATE:Doc 1,2o2I JOB.#21-396 i CUSTOMER: SCALE:3116'=1' ARCHITECT: M pW ro 9 48 a a. 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