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HomeMy WebLinkAboutMP21-177 i J WA anniUBJLJ aW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.iyebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 13,2022 Mary Ann T. Dona Irrevocable Trust 10 Bayberry Lane Rye Brook,New York 10573 Re: 10 Bayberry Lane, Rye Brook,New York 10573 Parcel ID#: 129.76-1-154 This document certifies that the work done under Mechanical Permit#21-177 issued on 11/15/2021 for the installation of a new oil fared boiler has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �E BRC��. , cu � �7 19F32 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 : vo A DATE: L' (_ �1-/- PERMIT# ISSUED: SECT: 1-2-5 BLOCK: LOT: LOCATION: � ) OIL= I� �z�J l C�F/l- OJ �`Iet� 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 ^ II ❑ L.P. GAS �511����Z�C 1, ❑ FUEL TANK ❑ FIRE SPRINKLERF_-- ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER -�U t,(, a C� a a N N iail V N O a � N c „ �., •� 3 N Q N o u 10, U oc o � -•; o � w � *" o gQ3 � � 3 ° EGG F~ ■ 00 wL _ G � o � aa •`3co h oc O N GOB O p O V ICI C7 H w O Uc/� o -fl � Ecen w z rA a blD.tea Q r o4 K � � a 4■ z x oo �, � a c Fri E ` © � o $ � - v V� or- pq � O x � � o �" °'�s� •� V E" � [r � Z 4 u, •v v v Q 3 z c oo12 U U 5E A d a W a > > O O GOO Ogg ® BUILD// _ MENT VILL�R7 RY OK NOV 12 2U2 y 938 KING STREET RYE 13Rc6 NY 10573 VILLAGE OF RYE BROOK (914)939-0668„ 9 39-5801 BUILDING DEPARTMENT www o rEr APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING EQUIPMENT/ FOR OFFICE USE ONLY: PERMIT/ t 7 Approval Date: NOV 1 vp Permit Fee:$ Approval Signature: Other: Disapproved: (fees are non-refundable) 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 RNe 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 N'ai%er) 4. Payment of Fees/Unit: RESIDL'NTIAI. =S I00.00/unit •COMMERCIAL =S350.004init. 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, 11/9/2021 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. A I. Address: 10 Bayberry Lane SBL: 129.76-1-154 Zone:P�rD 2. Property Owner: Maryann Doria Address: Same Phone#: 914-835-3600 Cell C email: Robison Oil One Gateway Plaza, Floor 3. Contractor: Address: Port Chester, IVY 10573 Phone#: 914-847-0286 Cell#: email: aolmstead@robisonoil.com 4. Applicant: Same as above Address: Phone#: Cell#: email: 5. Scope of Work:New InstallatioA )•Replacement()§•Removal( )•Other( ): 6. List Equipment: Replacement of oil fired boiler. 7. Location of Equipment: Basement 8. Method of Installation/Removal(list ail equipment needed to perform job): well McLain#WTGO-3 1 6/l/18 STA E Y RK COUNTY OF WESTCHESTER ) as: 4 i�j .being duly sworn,deposes and states that he/she is the applicant above named, (prin name of individual signing as the applicant) and furth ' states t at(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C f for the legal owner and is duly authorized to make and file this application. (indicate a c is c titteect,contractor,agent,anomey,etc.) That all statements contained herein are true to the best of his/her knowledge and belief:and that any work perforated,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�tr 0 th Sworn to before me this Sworn to before me this day of (? ,20—aL day of 20 AL S ignaturVoKproperty Owner a ure of Appli nt PriZNP rty Owner rint Name of icantamanda K olmstead amatir K Olmstead ot NOTARY PUBLIC,STATE OF NEW YORK TATE of NEW YORK Registration No.0IOL6411632 Registration No.01OL6417632 Quatified in WESTCHESTER County Qualified in WF.STCHESTER County Commission Expires 0813012025 t:(gnn .M0n Expires 0R13012025 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 6/1/18 D � �/ .` �` �,. 1 �� r � � � 1 DIMENSIONS STANDARD EQUIPMENT: 20a t , ■ Factory Tested and Assembled Cast ""'N m 2" Iron Section Assembly(jacket and SuppbM 7 p. H �sup°r' collector hood are not assembled on TA Far 7,8 and 9 section blocks) p E 4 { ■ Tankless Heater(P-units)or Tankless Opening Cover Plate(A-units) .� e ■ Insulated Steel Jacket awe 1 ' nay 9 ■ Aluminized Steel Flue Collector Z , rr,. ��� „ ___I Hood with Flue Cap on Top Outlet (convertible to rear outlet) P-WTGO Front Side A-WTGO Front Back Intermediate ■ Swing-Away Burner Mounting Door yc�4e oy °4' ■ Refractory Blanket and Target Wall Q '0 m c`Q h in Combustion Area ■ Circulator(Taco 007)-When Ordered B, 1 1/2 Alternate return-"A"units only ■ Comb.Temp. Controls,LWCO& E3 1/2 Pressure/temperature gauge Circulator Relay(all P-units/A-units H 3/4 Drain valve ordered with tankless heater) L 3/4 High limit/circulator control ■ Electrical Junction Box with Wiring N 1/2 Piping to expansion tank or automatic air vent Harnesses R, 3/4 Relief valve ■ Junction Box Cover Plate with Service Switch Supply"C"(inches) Dimension finches Tankless Heater ■ Two Vent Pipe Brackets .' ■ Pressure/Temperature Gauge ., 0 �c °��c ■ 30 PSI ASME Relief Valve(boiler ag c� t° o �` a�; sections tested for 50 PSIG working 0 3' �' m�� aF _ dF i pressure) ■ Drain Valve WTGO-3 1 1/4(circulator flange) 11/2 11/2 13 1/2 16 7/8 WT-14 1/2 3/4 ■ Barometric Damper WTGO-3L 11/4(circulator flange) 11/2 11/2 10 1/2 13 3/4 WT-14 1/2 3/4 WTGO-4 11/4(circulator flange) 11/2 11/2 13 5/8 16 7/8 WT-14 1/2 3/4 WTGO-S 11/2(circulator flange) 11/2 11/2 167/8 20 WT-14 1/2 3/4 OPTIONAL EQUIPMENT: WTGO-6 1 1/2(circulator flange) 11/2 11/2 20 23 1/8 WT-14 1/2 3/4 ■ High-Efficiency Flame-Retention Oil Burner(Beckett AFG,Carlin WTGO-7 not applicable 11/2 11/2 23 1/8 26 1/4 WT-20 1/2 3/4 EZ or Riello). Specify 2-Stage Fuel WTGO-8 not applicable 11/2 1112 26 1/4 29 3/8 WT-20 1/2 3/4 Unit(optional) if Required WTGO-9 not applicable 11/2 11/2 29 3/8 32 1/2 WT-20 1/2 3/4 ■ Vent Damper Kit ■ W-M 5&10 Year Homeowner RATINGS Burner Protection Plan Input AHRI Certified Ratings Minimum Chimney Size ■ W-M Indirect-Fired Water Heaters Rating ,A A y ray NOTES: y� "A ( Add"ID"for packaged boiler WTGO-3 A through WTGO-6 Only). Add"A"for c Ar m� 0v eQ m o m 4J c e��3 �o 0 0 oc v,2 F c� 41 + 2 �'So o m Q Q• s Q 3 boiler only(WTGO-3 through WTGO-9). (1) No.2 fuel oil-Commercial Standard WTGO-3LR 0.70 98 86 75 86.4 3.25 .010 8x8 6 15 540 Specification CS75-56.Heating value of WTGO-31. 0.95 133 114 99 85.0 3.25 .010 8X8 6 15 540 oil-140,000 BTU/Gal. • WTGO-3RD 0.80 112 98 85 87.0 3.00 .010 8X8 6 15 595 (2)Based on standard test procedures WTGO-3 0.95 133 115 loo 85.3 3.00 .020 8X8 6 15 595 prescribed by the United States • WTGO-4RD 1.00 140 123 107 87.0 3.75 .010 8x8 6 15 645 Department of Energy at combustion WTGO-4 1.20 168 145 126 85.0 3.75 .010 8X8 6 15 645 condition of 13 1/2%CO2 and -0.02- • WTGO-SRD 1.20 168 148 129 87.0 4.00 .015 8X8 7 15 760 W.C.draft. WTGO-s 1.45 203 175 152 85.0 4.00 .015 8X8 7 15 760 (3)MBH refers to thousands of BTU per hour. • WTGO-6RD 1.40 196 173 150 87.0 4.25 .015 8X8 7 15 860 (4)AHRI gross Output. WTGO-6 1.75 245 212 184 85.0 4.25 .015 8X8 7 15 860 (5)Net AHRI ratings are based on net • WTGO-7RD 1.60 224 197 171 87.0 5.50 .015 8x8 8 1s 930 installed radiation adequate for the WTGO-7 2.00 280 242 210 85.0 5.50 .015 8x8 8 15 930 requirements of the building,including a WTGO-8 2.30 322 266 231(4) - 5.75 .025 8X12 8 20 1,030 piping and pickup allowance of WTGO-9 2.55 357 295 257(4) - 6.00 .030 8X12 8 20 1,135 1.15-sufficient for normal conditions. Provide additional allowance only for *ENERGY STAR'compliant with Version 3.0 Boiler Specification of 87`i AFUE only when installed at the unusual piping and pickup loads. reduced burner rate(R)and with the optional vent damper kit(D).Burners shipped with standard rate (6) Tankless heater rating is in gallons of nozzle,reduced rates achieved through nozzle change-refer to burner instructions or boiler's rating label water per minute,heated from'40°F for correct selection. to 140'F with 200'F boiler water In the interest of continual improvements in product and oo,fnrmance.Wed-McLar, - temperature-tested in accordance with the right to change specifications without notice. s0pus � I-W-H Testing and Rating Standard for WM1410_BRO016WTGO DOE �� Indirect Tankless Water Heaters Test . with Boilers. r.r>.yyJY If � _, / n>/ / t A �_.��is A t!•\ / -s�AJ '\ J/fA F A• � .ld� A� ' ' / A A A{ A' �'ry'�� �','i'G�.'�1,•I.tlrr5lrh 7 Y4 '}• i ti�i{�1y "i � ,SF� % (''fi Y� � -i' 'S.'.'. "`� S� Y1•—' � �N v.\ F. � gv f `fro• #�• io• p pv r x oor Sv rHr �gtf foir . vp s foh v � " 111,1'I,Illr -S:111(111I1'1 SsVs., IIIIIIIIII 1 ti .. YY �♦ 'may+�? z 4 t O •�+ N \�'.s�+. any, �.` e y 4-4 �aa. .►r N rs� ° + t5 ,_ _ •/ S� � Cn tie �;:�•tee �,.� � � � V Lu U D 30two to O "d > W4 edaa I D�1 W In a: dCU v .� I • - •� �s �• : Z � ` 1 V1U F � Ri .4 C m OD -� U C co z >3 L (\j lei ee o ,n v7 N �• <(6¢].IY)► v) ,....1. .1 .fl�=.,�4- .' 1/1,11/�11�111�III�Is ji � '!'Ij1/1�llljlt.( �111/�11111 `'1111/�11111t "ems=-:r"' 's,•.'•J 8.a(, .11.'• azl4 �/� �a� ,�/�,, D1�, �1�, 3} •/� ..flt+a �A�. �.1r ♦,1 �fUt.$..S^'1, t �d yt 3�^� tky�f{•�1�p tt l�^�., t� �♦ t�t^{. F.�'Lf3 3fSE, �(� �y 1�•�00s� i� F 7. � a. it• W``�r� �Q. ���I�p�;\L'� O " .�, ��y Q �'�i�lj��t '� � �a 1 �k �;✓'� •' .,.',yam:..•hYr y.y;;<.s -• vi��-' -G -;�ws��Li.:` .4�i..--�'S� ��2+.�:1��NS,�, ,f��se•S'.,�,� �j 1 DATE(MM/DDIVYYY) CERTIFICATE OF LIABILITY INSURANCE 1/4/2021 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: Tammie Pattanite Arthur J. Gallagher Risk Management Services, Inc. PHONE ggg_273-8155 FAX No):856-273-3663 4000 Midlantic Drive Suite 200 E-IC.MAIL Mount Laurel NJ 08054 ADDREss: tammie_paftanite@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# License#:BR-724491 INSURER A:New York Marine And General Insurance Company 16608 INSURED SINGHOL-02 INSURER B: Singer Holding Corporation d/b/a Robison Oil One Gateway Plaza,4th Floor INSURER C Port Chester NY 10573 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:945532112 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PK202000020101 12/31/2020 12/31/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE FxI OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO-MLOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AU202000017525 12/31/2020 12/31/2021 COMBINEDINGLELIMIT Ea accidents $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per $ AUTOS ONLY acciden tt A UMBRELLA LIAB X OCCUR EX202000001405 12/31/2020 12/31/2021 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DIED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook Building Department is named as an additional insured with respect to the above General Liability Policy,if required by a written contract executed prior to services performed. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook Building Department 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW Workers' RK sTA E Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ADP TotalSource FL XVII,Inc. 9143455700 10200 Sunset Drive Miami,FL 33173 L/C/F 1 c.NYS Unemployment Insurance Employer Registration Number of Singer Holding Corporation DBA Robison Oil Insured 1 Gateway Plaza 4th Floor 45045108 Port Chester,NY 10573 1 d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 133121491 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Ins Co Village of Rye Brook Building Department 3b.Policy Number of Entity Listed in Box"1 a" 938 King Street WC 038381464 NY Rye Brook,NY 10573 II worksite employees working for Singer Holding Corporation paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. 3c.Policy effective period 7/1/2021 to 7/1/2022 3d.The Proprietor,Partners or Executive Officers are ®included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"Y'insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box "30,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. t1nder penalty of perjury,I certify that 1 am an authorized representative OF licensed agent of!he insu-onee earriee-referenced above and that the named insured has the coverage as depicted on this form. Approved by: Adriana Sanchez (Print name of authorized repr tative or licensed a, f insurance carrier) Approved by: 6/30/2021 (Signature) (Date) Title: Account Specialist II Telephone Number of authorized representative 800-743-8130 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it.