HomeMy WebLinkAboutMP21-193 VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
www.ryebrook.org
TRUSTEES BUILDING & FIRE INSPECTOR
Susan R. Epstein Michael J. Izzo
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
May 16,2022
Jeffrey Feist&Lauren Feist
18 Rocking Horse Trail
Rye Brook,New York 10573
Re: 18 Rocking Horse Trail, Rye Brook,New York 10573
Parcel ID#: 129.75-1-3
This document certifies that the work done under Mechanical Permit#21-193 issued on 12/14/2021 for the
installation of three new condensers and three new air handlers have been satisfactorily completed.
Sincerely,
Steven E. Fews
Assistant Building&Fire Inspector
/to
�(T)
/ 93 BUILDING DEPARTMENT
❑BXLDING INSPECTOR
0 ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
I`
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAx (914) 939-5801
www rygbrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : ` U(`� , (� Q DATE:
PERMIT# i 1 1.� 1^ , ISSUED: I SECT: L�- !-�BLOCK: t LOT:
LOCATION: �� 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
❑ OTHER
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BUIL MENT
VIL E OF RJ. ,00KDEC 13 2029
938 KING 'E r Ryt• ,NY 10573
`t -4 7.0 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT
FOR OFFICE USE ONLY: PERMIT
Approval Date: DEC 1 Permit Fee: $
Approval Signature: Other:
Disapproved:
(fees an:nun-rJundablc)
*#****#***#***************************at•kdc****y:A**9e**it•k****•h*i:***ak***##***#*#**Aat**},******1:*******k*****
REOUIREMENTS 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 he listed as certificate holder)&'Workers
Compensation Insurance on a NYS Board form(Form#C105.2 or Fonn#U26.3/or NY State Workers Compensation waiver)
4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit•COMMERCIAL—$350.00/unit.
5. Inspection by the Building Department for removal and/or installation. (48 hour notice required
6. Electrical work requires a separate Electrical Permit&Electrical Inspection.
7. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection.
Application dated,43�—I3—Qd is hereby trade to the Building Inspector of the Village of Rye Brook for a permit for the
installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document
agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws,
codes,rules and regulations. �Q /
1. Address: ' �� aca_ �AA t �— SBL:A:) ,75—/`3 Zone: I S
2. Property Owner: q� ,ft ��i 1 Address: 5A+4 .45 >�+ -1� —
Phone#: 'Z.0 J `�p$ t'3 Cell#: email:J44k-h9Aa,-r14 — M•r fy�c.0
3. Contractor: A 2,f l c_ r G4 Address: /y MA
Phone#: Q/y 9 3 VA 3 / Cell#: email: 51}iArr A S
4. Applicant: In P ,s-,-t- /}S 994., Address:
Phone#: Cell#: email:
5. Scope of Work:New Installlration : •Replacement( •Reemoval( )•/Other( ):
6. List Equipment: Z._ z y P�X I '"1�1�u1 l— Tl/J/Y — l7 r••� 'z—T D Z I /xa 3
l-1 Y,T2 so(Q o C r000/5
7. Location of Equipment: 1 �, / �ay� �•e 5 F✓ Sf g /ird�'�
,q
8. Method of lnstallation/Removal(list all equipment needed to perforn,job):
E
8i12/2021
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,contactor,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
a
C 20 day of 120
�Jj/
ZtName
r perty Owner Signature of Applicant
Pr erty O er Print Name of Applicant
Notary Public SHARI MELILLO Notary Public
Notary Public, State of New York
No. 01"`F61 t 0^63
0,li Ned in Westch,ster County
Commission EXDires January 29,20 J-
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
8/12/2021
HBXB-HW Series
Hydronic Air Handler, without Pump
Cooling or Heat Pump/ HW Heat
1.5 - 5 Tons, up to 131,700 BTUH Heating
The HBXB-HW air handler is designed for use with today's high ef-
ficiency split-system condensing units,heat pumps,hot water boilers,
and Tankless Water Heaters.
Boiler applications:The HBXB-HW can be directly wired to a boiler
without adding additional relays or related controls. Multiple air
-► handlers can be connected to a single boiler to provide comfortable,
efficient,whole house hydronic space heating.
Tankless Water Heater applications: For Tankless Water Heater
applications,install the optional high capacity flow control module
(#940-2CV)in the piping between the Tankless Water Heater and the
HBXB-HW air handler.
Cooling efficiencies are up to 15 SEER,depending on the outdoor
condensing unit or heat pump model. First Co's customer is
x ultimately responsible for confirming which fan coil models
O� f are compatible with selected outdoor unit(s)and which expan-
sion valves(if any)are required. To determine certified indoor/
outdoor combinations,go to www.firstco.com or contact the
factory.
Standard Features:
•Multi-function micro-processor circuit board with these
standard features:
•Blower Start Relay-Eliminates field installed boiler
relay,allowing direct wiring from the boiler to the air
handler
•Blower-on fan delay-(heating mode)-preheats
M. the HW coil for 45 seconds.
E - . -Blower-off fan delay-(heating and cooling
tfa models)- blower continues to operate for 45
seconds after thermostat is satisfied,for increased
•xr efficiency.
s t`? •120V or 24V zone valve control-The micro-pro-
cessor powers either 120V or 24V field supplied
motorized zone valves.
• Factory or field installed R-410A TXV(coding or heat pump operation)
(non-bleed type)
• Manual Air Vent on hot water coil
• Blower door shut-off switch(except 60HBXB-HW)
• Slide out hot water coil for easier service
• Copper tube heating and cooling coils
• Compatible with all major brands of split condensing units and
heat pumps
• Attractive baked-on powder coated cabinet
• Primary and secondary condensate drain connections
• Easily accessible 1"filter
Optional Accessories:(see p.2)
•Freeze Protector-Reduces the possibility of the water coil
freezing by switching the unit to the heating mode if the water
temperature is nearing freezing conditions.
•High capacity Flow Control Module for Tankless Water Heater
applications(#940-2CV)
•Counterflow conversion kits
FIRST CO.-P.O.Box 270969-Dallas,Texas 75227-Ph.(214)388-5751 -Fax(214)388-2255-www.firstco.com
HBXB-HW Series („/ MCXTILBIO
♦— C B
DX COOLING II 4 GPI I 3`-�I 14 H—►I
BOILER HEATING WATER —► ----____________OPENING f WATER _ _
OUT _ �' IN
HOT WATER COIL
---=------ --- 10-4--24VWIRING
0
�NT�tEt i ELECTRICAL
COMPARTMENT POWER SUPPLY
HORIZONTAL ' t i (K.O.(both sides) A
c� CONVERTIBLE i
DRAIN PAN :AIRFLOW
COOLING COIL DIRECT --
C u$ EXPANSION'R-22'T o
01
CISTE
d-
� f—FILTER
COIL
(ALL'SWEAT) 14 E—►I I�—F I .4 D
(See PA for Model Numbers) DRAIN
CONNECTINS 314 MPT
ACCESSORIES
BLDIMER DATA UPFLOW/HORIZONTAL ONLY DOWNFLOW ONLY MOTOR (field installed)
UNITMIN. MAX. MOTOR CFM va EXTERNAL STATIC PRESSURE
MODEL HP.AMPS CIR. C— SPEED
PROTECTION(120V) AMPACITY PROTEC CONK a06 at0 0.20 a30 a40 0.50 0.06 0.10 0.20 o.3o 0.35
NIGH 810 780 715 65D 580 500 T70 690 630 s70 540 FLOW CONTROL MODULES
1eHUfFMW 1i8-28 3.5 15 MED. 580 856 600 545 490 420 640 820 675 620 490
MED.LOW 53D sos 460 41s 3eo 29s 4eo aso 420 360 3sD PART NUMBER FOR
LOW 350 325 270 220 160 - 330 310 280 220 200
HIGH 950 920 855 790 720 645 760 730 1 040 620 590 940'3CV 18-48HBXB-HW
24HBXB-HW 1,5-S.1 6.38 15 MED. 860 835 785 = 050 580 720 690 840 590 550
LOW 780 755 705 650 590 510 6W 655 800 650 525
tiIGH 1120 1095 1045 09s 940 B80 1080 1D60 1010 950 920 940-2CV 60HBXB-HW
30HBXFHW 1/5-5.1 6.36 15 MED. B50 840 810 760 740 690 866 060 SW 8D0 77C
LOW 680 67D 655 525 505 510 730 720 690 660 W NOTE:
HIGH 1340 1310 1250 1t80 1120 1050 109c '070 1010 950 925
3$HBX044W ffi-&5 10.63 15 MED. 290 1280 1200 1140 1080 1000 108C 1030 990 920 990 Flow Control Modules are required
LOW 1200 1170 1120 1070 1010 940 1D20 WC 940 090 56C When connecting t0 individual gas
HIGH 1810 1780 1720 1680 t590 15so 15t0 1480 I430 1380 1950
4$HBXB-HW 3/4-10.7 13.38 1s MED. 1570 15s0 1510 7460 1400 /340 1270 1240 1130 1150 1120 water heaters.
LOW 1280 1260 I= 1180 .13D 1050 1005 98C 930 690 880
HIGH 2160 2125 2056 19W 1995 "10 WHBXB-HW�s nut approved la
SOHBXB-HW I-Its 1�38 15 NED, 1885 1840 178$ 171C 1820 1525 OOvn80w COnV41310n
LOW SW
1640 1490 1. 1565 1260 EXPANSION VALVE KITS
(Field Installed)(cooling only or heat pureg)
NOTES: PART NUMBER
1.All models are approved for installation with 0"clearance to combustible R22 FITS
materials.
2. For downflow applications,select air handler 1/2 ton larger than 9EVR22-4 18/24HBXB-HW
the outdoor unit in order to achieve nominal airflow. 9EVR22-5 30/36HBXB-HW
3.Use 48HBXB-HW for 3.5 ton applications and field-convert fan motor to 9EVR22-6 48/60HBXB-HW
medium speed.
R410a
9 E V R410-3 18/2 4 H BX B-H W
PHYSICAL DIMENSIONS 9EVR410-4 30/36HBXB-HW
UNIT 9EVR410-5 48/60HBXB-HW
MODEL A B C D E F G H FILTER
NOTES:
18HBXS-HW 1. Above expansion valve kits are approved for
24HBXB-HW 40 20 20 18 t/2 16 2 18 16 ,8 X 20 X 1 both cooling only(non heat pump)and heat
30HBXB-HW pump applications.
36HBXB-HW 42 23 20 21-1/2 16 2 18 19 20 X 22 X 1 2. Valves are non-bleed type. Field added.
Hard start kit may be required.
48HBXB-HW 48 28 21-1/4 26-1/4 17-1/4 2 18 24 20 X 25 X 1 3. Valves have screw-on connections.
60HBXB-HW 52 28 25-1/4 26-1/2 21-1/4 2 22 24 14 X 24 X 1
12 required)
COUNTERFLOW 10TS
KIT NUMBER FOR
919-11 18,24HBXB-HW
COIL CONNECTIONS 919-12 30,36HBXB-HW
UNIT LIQUID SUCTION FREEZE PROTECTOR 919-13 48HBXB-HW
SIZE
KIT NUMBER E FOR NOTES:
18/24 3/8 518 1. Counterflow,conversion not recommended
30/36 3/8 3/4 941-1 18 60HBXB-HW where the air handier is installed above a
48/60 1/2 1 7/8 finished ceiling.
2. No kit available for 60HBXB-HW.This
-2- model is not approved for counterflow
installation.
Model Numbers:
FACTORY INSTALLED TXV
MODEL SIZE MODEL MODEL
(BTU) (PISTON) (R-410A TXV)
18,000 18HBXB-HW 18HBXB-HW R410 TXV
24,000 24HBXB-HW 24HBXB-HW R410 TXV
30,000 30HBXB-HW 30HBXB-HW R410 TXV
36,000 36HBXB-HW 36HBXB-HW R410 TXV
42,000/48,000 48HBXB-HW 48HBXB-HW R410 TXV
60,000 60HBXB-HW 60HBXB-HW R410 TXV
All TXV's are approved for cooling only or heat pump operation (non-bleed type).
NOTE:
Expansion valve requirement depends on the selected outdoor unit.
Go to www.firstco.com or contact the factory for assistance.
PEWO MANCB DATA
MO MOTOR CFM P D BTUH(1000)AT
M.
HTG ENTERING
UNIT COOLING SPEED 0.3 GPM (FT. WATER TEMPERATURE
MODEL BTUH CONN. ESP ( .) WTR.) 140'F 160'F 180'F
3 1.13 24.6 31.6 38.7
HIGH 850 2 0.51 2.7 29.2 35.7
1 0.13 17.0 21.9 26.8
3 1.13 22.4 28.7 35.1
18HBXB-HW 18,000 MED. 550 2 1 0.51 20.7 26.6 32.5
1 0.13 15.8 20.4 24.9
3 1.13 18.9 24.3 29.7
MED.LOW 420 2 0.51 17.8 22.8 27.8
1 0.13 138 17.8 21.7
3 1.13 27.7 35.6 43.5
HIGH 800 2 0.51 25.4 32.7 39.9
1 0.13 19.0 24.5 29.9
3 1.13 26.3 33.8 41.3
24HBXB-HW 24,000 MED. 725 2 0.51 24.2 31.1 38.1
1 1 0.13 18.3 23.5 28.8
3 1.13 24.6 31.6 38.1
LOW 650 2 0.51 22.7 29.2 35.7
1 0.13 17.1 22.0 26.9
6 7.55 37.5 48.2 58.9
HIGH 1000 4 3.64 35.1 45.2 55.2
2 1.04 30.0 38.6 47.2
6 7.55 32.3 41.6 50.8
30HBXB-HW 30,000 MED. 780 4 &64 30.5 39.2 47.9
2 1 1.04 26.3 33.9 41.4
6 7.55 2&2 36.3 44.3
LOW 625 4 &64 2&7 34.3 40.9
2 1.04 23.5 1 30.2 36.9
6 7.55 41.5 53.4 65.2
HIGH 1200 4 164 3&7 49.8 60.8
2 1.04 32.8 42.2 51.5
6 7.56 40.3 61.8 63.4
38HBX"W 36.000 MED. 1140 4 &64 37.7 48.5 59.3
2 1 1.04 32.1 41.3 50.5
6 7.55 39.0 50.1 61.3
LOW 1070 4 3.64 36.5 47.0 57.4
2 1.04 31.3 40.2 49.1
6 2.90 6&6 85.6 104.7
HIGH 1660 4 1.40 61.7 79.4 97.0
2 0.41 48.0 61.8 75.5
6 2.90 62.3 80.1 97.9
48H8XB-HW 48,000 MED. 1460 4 1.40 57.4 73.8 90.2
2 0.41 4&0 57.8 70.7
6 2.90 %5 70.1 85.7
LOW 1180 4 1.40 50.6 65.0 79.5
0.41 40.1 51.6 63.0
9 5.15 83.8 107.8 131.7
HIGH 1980 7 3.33 80.0 102.9 125.8
5 1.86 74.5 95.8 117.1
9 5.15 76.8 98.7 120.E
60HBXWHW 80,000 MED. 1710 7 3.33 73.5 94.5 115.5
5 1.86 6&9 $8.5 108.2 In keeping with its policy of continuous
9 5.15 68.5 88.1 107.7 progress and product improvement,
LOW 1430 7 3.33 65.8 84,6 103.4 First Co.reserves the right t0 make
s 1.86 61.8 79.5 97.1 changes without notice. Maintenance
NOTES: for all First Co.products is available
(1) Heat BTU is at 65'Entering Air Temperature. under"Product Maintenance"at www.
(2) Units are shipped with motors connected to high speed for cooling and medium speed for firstco.com.
heating.
(3) 190'EWT would increase the 180'EWT heating capacities by 9.1%.200'EWT would
increase the 180'EWT heating capacities by 18.2%. -3-
APPLICATION GUIDELINES (for Boilers)
Zone Valves Install a motorized valve with each air handler to control flow to that zone as
required.
TYPICAL WIRING SCHEMATIC
FOR MULTIPLE ZONE CONNECTIONS
WITH ZONE VALVES
24 VOLT 4 CONDUCTOR 24 VOLT
CLASS 2 WIRING CLASS 2 WIRING CLASS 2 WIRING
-T t ---------------0-T -
1 ........ .........� . . ............
G G HBXB-HW T -0-------- ....... ........ ..........0--T - G G
HBXB-HW
W ............. W FAN COIL i i i i FAN COIL W ............. W
R R 24V ... ....a-24V
R ------------- R
24V 24V
T PIGTAIL LEADS FOR THERMOSTAT
iyi--- C
RN BRN
24V REMOTE
24V REMOTE
THERMOSTAT PIGTAIL LEADS FOR T T
MOTORMED VALVE MOTORIZED VALVE
-0- NOTE:CAP OFF NOTE:CAP OFF
CONDENSER BROWN IF NO I I BROWN IF NO CONDENSER
CONTACTOR CONDENSING UNIT / \.CONDENSING UNIT CONTACTOR
IS USED 24V MOTORIZED 24V MOTORIZE IS USED
ZONE VALVE ZONE VALVE
TYPICAL WIRING SCHEMATIC
FOR MULTIPLE ZONE CONNECTIONS TO
TACO SR-504/506 SWITCHING RELAY
24 VOLT 24 VOLT
CLASS 2 WIRING CLASS 2 WARING CLASS 2 WIRING
-T -W....... .........
......... ... ............. -
-----
G ...........
-T -W....... ...........0--T -
HBXB-HW HUS-14W
W .......... w FAN COIL FAN COIL W ----- -------------- W
R R 24V-
R ....... R
.4-24V C
Y C C
BRN BRN 24V REMOTE
24V REMOTE TA
THERMOSTAT 8RC0
W4 FX7-1 MF-11 11,1F.0"41 THERMOSTAT
101. RELAY 12L
, NOTE:CAP OFF NOTE:CAP OFF
CONDENSER BROWN IF NO BROWN IF NO CONDENSER
CONTACTOR \ CONDENSING UNIT CONDENSING UNIT CONTACTOR
COMECTIONS IS USED IS USED
T 4;
BOILER
-T -4
Catalog No.HBXB-HW714(Replaces HBXB-HW513) -4-
0 TRAME"
Product Data
Split System Cooling
4TTR4018L1000A
4TTR4024L1000B =
4TTR4025L1000B _ — —
4TTR4030L1000A
4TTR4031L1000A =_
4TTR4036L1000A
4T7R4037L1000A —
4TTR4042L1000A
4TTR4043L1000A
4TTR4048L1000A
4TTR406OL1000B
Note:"Graphics in this document are for representation
only.Actual model may differ in appearance.'
1n N April 2020 22-1904-1 M-EN C FS
TECHNOLOGIES'
0 TAME'
Product Specifications
Model No.W 4TTR40181_1000A 4TTR4024L1000B/ 4TTR4030L1000A/ 4TTR4036L1000A/
4TTR4025L1000B 4TTR40311_1000A 4TTR4037L1000A
POWER CONNS.—V/PH/HZ(o) 208/230/1/60 208/230/1/60 208/230/1/60 208/230/1/60
MIN.BRCH.CIR.AMPACITY 12 14 17 18
BR.CIR.PROT.RTG.—MAX.(AMPS) 20 20 25 30
COMPRESSOR CLIMATUFF®- CLIMATUFFO- CLIMATUFF®- CLIMATAUFF®-
SCROLL SCROLL SCROLL SCROLL
RL AMPS—LR AMPS 9—63 10.1—52 12.8—68 14.1—72
Outdoor Fan FL AMPS 0.60 0.90 0.77/.64 0.77/.64
Fan HP 1/15 1/8 1/8 1/8
Fan Dia(inches) 18.2 18.2 23.0 23.0
Coll SPINE FIN" SPINE FIN'" SPINE FINTM SPINE FIN"
Refrigerant R-410A 4 LBS.,2 OZ 4 LBS.,11 OZ/ 4 LBS.,11 OZ 5 LBS.,8 OZ/
4 LBS.,2 OZ 5 LBS.,3 OZ
LINE SIZE—IN.O.D.GAS(<) 3/4 3/4 3/4 3/4
LINE SIZE—IN.O.D.LIQ.(c) 3/8 3/8 3/8 3/8
Charge Spec.Subcooling 10OF 10OF 10OF 10°F/(8°F on 037)
Dimensions H x W X D Crated(IN.) 30.1 x 26.7 x 30 30.1 x 26.7 x 30 34 x 30.1 x 33 38 x 30.1 x 33
Weight—Shipping(lbs.) 153 153 183 183
Weight—Net(lbs.) 133 133 156 156
Optional Accessories:
Anti-short Cycle Timer TAYASCT501A TAYASCT501A TAYASCT501A TAYASCT501A
Evaporator Defrost Control AY26XO79 AY28XO79 AY28XO79 AY28XO79
Rubber Isolator Kit BAYISLT101 BAYISLT101 BAYISL7301 SAYISLT101
Extreme Condition Mount Kit BAYECMT023 BAYECMT023 BAYECMT023 BAYECMT023
Start Kit BAYKSKT263 — BAYKSKT263 BAYKSKT263
Crankcase Heater Kit BAYCCHT302 BAYCCHT302 BAYCCHT302 BAYCCHT302
Seacoast Kit BAYSEAC001 BAYSEAC001 BAYSEAC001 BAYSEAC001
Low Ambient Kit BAYLOAM 103 BAYLOAM 103 BAYLOAM 103 BAYLOAM 103
Service Valve Panel Cover TAYSVPAN- TAYSVPANL0022AA TAYSVPANL0032AA AAYSVPANL3343AA
L0022AA
Refrigerant Lineset ccl
W Certified in accordance with the Unitary Air-conditioner equipment certification program which is based on AHRI standard
210/240.
W Calculated in accordance with N.E.C.Only use HACR circuit breakers or fuses.
W Standard line lengths—60',Standard lift—60'Suction and Liquid line.For Greater lengths and lifts refer to refrigerant
piping software Pub#32-3312-0*(*denotes latest revision).
W 25,30,35 and 50 foot linesets available.For a complete listing of lineset options available from equipment or supply stores,
refer to the Trane Residential and Light Commercial Product Handbook.
2 22-1904-1 M-EN
TRAW
Product Specifications
Model No.(a; 47TR4042L1000A/ 4TTR40481_1000A 4TTR40601_10008
4TTR40431_1000A
POWER CONNS.—V/PH/HZ(b) 280/230/1/60 280/230/1/60 280/230/1/60
MIN.BRCH.CIR.AMPACITY 22 24 27
BR.CIR.PROT.RTG.—MAX.(AMPS) 35 40 45
COMPRESSOR CLIMATUFF9-SCROLL CLIMATUFF®-SCROLL CLIMATUFF@-SCROLL
RL AMPS—LR AMPS 16.7—109 18.5—124 20.8—127.1
Outdoor Fan FL AMPS 1.05 1.05 1.05
Fan HP 1/5 1/5 1/5
Fan Dia(inches) 27.5 27.5 27.5
Coil SPINE FIN`" SPINE FIN'" SPINE FIN'"
Refrigerant R-410A 6 LBS.,2 OZ/ 5 LBS.,3 OZ 7 LBS.,10 OZ
5 LBS.,5 OZ
LINE SIZE—IN.O.D.GAS W 7/8 7/8 7/8
LINE SIZE—IN.O.D.LIQ.<<i 3/8 3/8 3/8
Charge Spec.Subcooling 12°F 10OF 101F
Dimensions H x W X D Crated(IN.) 34.4 x 35.1 x 38.7 34.4 x 35.1 x 38.7 42.4 x 35.1 x 38.7
Weight—Shipping(lbs.) 216 212 246
Weight—Net(lbs.) 184 189 211
Optional Accessories:
Anti-short Cycle Timer TAYASCT501A TAYASCT501A TAYASCT501A
Evaporator Defrost Control AY28XO79 AY28XO79 AY28XO79
Rubber Isolator Kit BAYISLT101 BAYISLT101 BAYISLT101
Extreme Condition Mount Kit BAYECMT004 BAYECMT004 BAYECMT004
Start Kit BAYKSKT263 BAYKSKT263 SAYKSKT263
Crankcase Heater Kit BAYCCHT301 BAYCCHT301 BAYCCHT301
Seacoast Kit BAYSEAC001 BAYSEAC001 BAYSEAC001
Low Ambient Kit BAYLOAM103 BAYLOAM103 BAYLOAM103
Service Valve Panel Cover TAYSVPANL0044AA
Refrigerant Lineset(C)
(a) Certified in accordance with the Unitary Air-conditioner equipment certification program which is based on AHRI standard
210/240.
(b) Calculated in accordance with N.E.C.Only use HACR circuit breakers or fuses.
«i Standard line lengths—60',Standard lift—60'Suction and Liquid line.For Greater lengths and lifts refer to refrigerant
piping software Pub*32-3312-0•(`denotes latest revision).
<ai 25,30,35 and 50 foot I inesets available.For a complete listing of lineset options available from equipment or supply stores,
referto theTrane Residential and Light Commercial Product Handbook.
22-1904-1 M-EN 3
0 7XAA,E.
Product Specifications
Sound Power Level
Sound Power Level
A-Weighted
MODEL Sound Power Full Octave Sound Power(dB)
Level[dB(A)]
63 125 N65
500 1000 2000 4000 8000
Hz* HzHz Hz Hz Hz Hz
4TTR4018L1 71 74 7168 67 63 56 50
4TTR4024L1 71 74 7168 67 63 56 50
4TTR4025L1
4TTR403OLl 71 73 73 72 69 68 60 52 45
4TTR4031L1
4TTR4036L1 71 73 73 72 69 68 60 52 45
4TTR4037L1
471`1140421-1 71 81 72 69 69 66 60 57 54
4TTR4043L1
4TTR4048L1 1 71 81 72 69 69 66 60 57 54
4TTR406OL1 1 71 81 72 69 69 66 60 57 54
Note: Rated in accordance with AHRI Standard 270-2008*For Reference Only
4 22-1904-1 M-EN
0 rAWF
Accessory Description and Usage
Anti-Short Cycle Timer—Solid state timing device that prevents compressor recycling until
five(5)minutes have elapsed after satisfying call or power interruptions. Use in area with
questionable power delivery,commercial applications,long lineset,etc.
Evaporation Defrost Control — SPST Temperature actuated switch that cycles the condenser
off as indoor coil reaches freeze-up conditions. Used for low ambient cooling to 30°F with TXV.
Rubber Isolators — Five(5)large rubber donuts to isolate condensing unit from transmitting
energy into mounting frame or pad. Use on any application where sound transmission needs to
be minimized.
Hard Start Kit— Start capacitor and relay to assist compressor motor startup. Use in areas with
marginal power supply,on long linesets,low ambient conditions,etc.
Extreme Condition Mount Kit— Bracket kits to securely mount condensing unit to a frame or
pad without removing any panels. Use in areas with high winds,or on commercial roof tops,etc.
AHRI Standard Capacity Rating Conditions
AHRI Standard 210/240 Rating Conditions
1. Cooling 80eF DB,67°F WB air entering indoor coil,95°F DB air entering outdoor coil.
2. High Temperature Heating 47°F DB,43°F WB air entering outdoor coil,70°F DB air entering
indoor coil.
3. Low Temperature Heating 17°F DB air entering indoor coil.
4. Rated indoor airflow for heating is the same as for cooling.
AHRI Standard 270 Rating Conditions—(Noise rating numbers are determiend with the unit in
cooling operations.) Standard Noise Rating number is at 95°F outdoor air.
Model Nomenclature
Outdoor Units 1 2 3 4 5 6 7 8 9 10 1112 13 14 15
4 T W V 0 0 3 6 A 1 0 0 0 A A
Refrigerant Type
2=R-22
4=R-410A
TRANE
Product Type
W=Split Heat Pump
T=Split Cooling
Product Family
V=Variable Speed M or B=Basic
Z=Leadership—Two Stage A=Light Commercial
X=Leadership L=Side Discharge
R=Replacement/Retail
Family SEER
3=13 6=16 0=20
4=14 8=1a
5=15 9=19
Split System Connections 1.6 Tons
0=Brazed
Nominal Capacity In 000s of BTUs
Major Design Modifications
Power Supply
1=200-230N I60 or 206.23011160
3=200.23013I60
4=46013160
Secondary Function
Minor Design Modifications
Unit Parts Identifier
22-1904-1 M-EN 5
0 TAANF
Schematic Diagrams
Figure 1. 1.5-4.0 Ton Models
TO POWER SUPPLY PER UNIT NAMEPLATE AND LOCAL CODES
e I
' ----� FAN CAPACITOR
��� CN •IRECONNECTOR
_---START KIT ---__ CPR COIPRESS011
BAYKSNT263 � cR RUM CAPACITOR
J m CS , r CS STARTING CAPACITOR
ap CSR CAPACITOR SNITCHING RELAY
(-O�-------RD-------------L44 B I CSR-o��Q+--�-BK/BL------ NS-2 G INDOOR FA RELAY
1 R ___; HPCO HIGH PRESSURE CUTOUT SNITCH
/ L LPCO LOW PRESSURE CUTOUT SWITCH
CAPACITOR 1 B K B IOL INTERNAL OVERLOAD PROTECTOR
1 __
1 -—- SN SYSTEM OM-OFF SWITCH
OD B OP Z JR.O IM WS COMPRESSOR MOTOR CONTACTOR
MTRBK F C H R CPR I ODA OUTDOOR ANTICIPATOR
--PR OFT OUTPOOR FAN THERMOSTAT
THERMALLY R --- Lo ODS OUTDOOR TEMPERATURE SENSOR
PROTECTED I ODT OUTDOOR THERMOSTAT
INTERNALLY SC SWITCH OVER VALVE SOLENOID
TDL 013CHAROE LINE THERMOSTAT
__ THIS TRANSFORMER
HPCO LPco TYPICAL
TYPICAL I
AIR HANDLER I THERMOSTAT
IWARN I NG ®CAUT ION
HAZARDOUS VOLTAGE) USE COPPER CONDUCTORS ONLY[
DISCONNECT ALL ELECTRICAL UNIT TERMINALS ARE NOT DESIGNED
MS y I POWER INCLUDING REMOTE TO ACCEPT OTHER TTPES OF CONDUCTORS.
I , I ' DISCONNECTS BEFORE SERVICING. Failure to do so my taste d"a
BL Yo I to the egsip.nt.
I Failure to ditteseect power
NOTES Idi ' belare ,:;,,.act
coo cause
' I HEAT I I I senre Persoaol injury or
---ROPRENOT� -- W3 CONTROLS' I I death.
oDt- I X2 r
II- O-BK---}--'ice—�—j W2 ---,--i-a rtoLa+of WIRE
I'-------BK---�--'I I BK/BL
-—-J ' II , I I I "---COLOR OF WARREN
ODT-Ai i(OPTIONAL) (i-
BK-----AL) I I I BN :
LAC'
RD RFO OR ORANGE
BI BROWN IL YELLOW PR PURPLE
-------BK----------' I L_-_-_J I Pa PINK LTBL LIGHT BLUE
I
NOTES:
If ODT-B IS WHA T USED. ADD JUMPER BETWEEN
r2 d WS AT AIR NDLER. IF USED. OOT-B
' I MUST BE MOUNTED REMOTE OF CONTROL 501 IN
AN APPROVED WEATHER PROOF ENCLOSURE.
' 2. IF ODT-A IS NOT USED. ADD JUMPER BETWEEN
3, 2 LOW VOLTAGE 124 AT AIR DVR IFIELD WIRING MUST BE IN AVG MIN_
I
FOR CANADIAN INSTALLATIONS
POUR INSTALLATIONS CANADIENNES
BL IB TMS I 1 CAUTION: NOT SUITABLE FOR USE ON
2ev SYSTEMS EXCEEDING 15OV-TO-GROUND
ROO I ATTENTION:NE CONVIENT PAS AUX
INSTALLATIONS DE PLUS DE 150 V A
LA TERRE
TO POWER SUPPLY I _=EEy—_ I ' ,
PER LOCAL CODES ——— I —+ '
PRINTED FROM D157362P03 REVO
6 22-1904-1 M-EN
TRWE'
Schematic Diagrams
Figure 2. 5.0 Ton Models
TO POWER SUPPLY PER UNIT NAMEPLATE AND LOCAL CODES
1 SEE SERVICE iACTIl
�l o FOR 0►TIOSAL 1TAR7 EIT A L E G E N D
� ccERRnr J
m
Ca
�MS I ' B R L R-ICSR , NS m CF FAN CAPACITOR
�"��RD X �X_I- E-S 8K/BL—X CM WIRE CONNECTOR
1 �RD X -BK/BL CPR RUNPCAPAC I1
® CAPACITOR CR RUN CAPACITOR
OD BR OR�OR CS STARTING CAPACITOR
AAN CSR CAPACITOR SWITCHING RELAY
MTR BKPR LF C H CPR ODT OUTDOOR THERMOSTAT
_ TMQ T RD -—' Co HPCO HIGH PRESSURE CUTOUT SWITCH
PIM ECTED I LPCO LOW PRESSURE CUTOUT SWITCH
INTERMALLT MS COMPRESSOR MOTOR CONTACTOR
TNS TRANSFORMER
IOL INTERNAL OVERLOAD PROTECTOR
TYPICAL I I I �MOR of WIRE
TYPICAL
HPCO LPCO I BK/BL
AIR HANDLER I
7�...Q�TpS , THERMOSTAT I aLa a NAINER
' \ I I SE SI.KR RS�RED OF ONANE
In J J , SL SLUE NR SMITE SR KEEN
O I SR SRONN IL YELLON PR ps
YIr I PE PINK
S e Y I I Y i ----T-}-
«c��� I FOR CANADIAN INSTALLATIONS
BL I I YO -— I I POUR INSTALLATIONS CANADIENNES
I �
CAUTION: NOT SUITABLE FOR USE ON
NOTES laz HEAT I SYSTEMS EXCEEDING 15OV-TO-GROUND
tonALE CONTROLS i I ( ATTENTION:NE CONVIENT PAS AUX
INSTALLATIONS DE PLUS DE 150 V A
DDT g, X2 I I LA TERRE
r-EY��BK X —,� W2 ---�—�-+--- W2 I
ODT-A C�BK (OPTIONAL)
I
�V I
I
B
BLJ
B I
ziv , I
RD—O
�I I
TO POWER SUPPLY I—^
PER LOCAL CODES ---- '
' PRINTED FROM D160439POI REVA
I I _
22-1904-1 M-EN 7
TRWE-
Schematic Diagrams
Figure 3. 5.0 Ton Models
/ C LPCO RPCO BK OD
BN/BL 101 �� PR FAN
R �'--I -plt BR MTR
RD � � I nERwuT
FroTECTEI
NOTE: CPA INTERNALLY
0
I. IF COT-0 I[ROT USED. R ALB ED. ADD JUMPER OETEN 12 13 AT AIR NANDLEA. IF USED,ODT-
MWT DE MOUNTED AS/DTE a CONTAOI WX IN AN"AMID■EATKI PROOF ENCLONUIE. I ------------ - - -----------��
2. IF OCT-A IS ROT USED. ADD JUMFER BETKEM III A 12 AT AIR WAKEN.
1.LOW VOLTAGE 124 V7 FIELD■IRIK MIST 1E If An MINI".
4 IR. E COFFER COIDOCTON[ONLTI
LEGEND
I
24 Y FACTONY �I- RELAY CONTACT(1.0)
L. WI AIIB J-� LAPAC ITOR
RELAY CONTACT II.C> I }'/T'_�/
—— 21 Y FIELD
LINE MI III. MIAMI ADI N R�R
1 FIELD IASTALLED .�F TUN a Mllb GRIM x \ '
—x—llRE Yj FACTORY
NIRIM "7 �nyyYIa. I.E[SERVICE FAcr: BR
NASNETIC COIL � Rn I FOR OPTIONAL START
6 FR[IWIf KTMT[A F11TCM I SIT ACCE9SONY- - -
ORWND Ti TI
JIMCTION MM-—IATEI DR—1.IL-11 I vs�F CAPACI TON CM^'b 1DlDl 11r1w I j O BN BL I
WINE NOT OR
CONNECTOR Pa.IL rpNLf rWlr BL
p TEMIIK ®ANAL.;I.NAL[I
Pp rL1�NUE NDr Ir
IL AgF ®IF[wl[Tcr I1Au1 I i I
..
n tl1YFA
112 --ll<5 J
TERM UAL RLOC1 MAID
I '
---- —��BK I TL�flIIS�L/1
.----��BK 1 TL/RD
I FTIOMLI/
-—-11[MDTEI
IT-1
X BK BK J GR YL
———— X DDT-
QY X
pTI-1
X eK I I I I
I I I I
I I I
I LTO POKR SUPPLT PER
�'�--jUMIT RAW" A AID
LOCAL CODES
PAINTED FROM D16043SIP01 REVA
8 22-1904-1 WEN
0 rAWEA
Outline Drawing
B
III ,
0
SERVICE PANEL
ELECTRICAL AND REFRIGERANT
COMPONENT CLEARANCES
PER PREVAILING CODES.
lOP DISCHARGE AREA SHOULD BE
UNRESTRICTED FOR AT LEAST 1524 15 FEET$
ABOVE UNIT UNIT SHOULD BE PLACED SO ROOF
RUNOFF WATER DOS MOT POUR DIREC TLI ON UNIT.
AND SHOULD BE AT LEAST S05 112•U FROM MALL AND
ALL SURROUNDING SHRUBBERY ON TWO SIDES.
OTHER 790 SIDES UNRESTRICTED.
�_ _ _ _ _ - -
ELECTRICAL SERVICE
PANEL
K
25 11
A
22 2(7/BI OIA. HOLE
LOW VOLTAGE
21 S II"I/BI DIN N.O.WITH
22.2 17/3
M DMA. )a[ IR CONTROL
BOX BOIIOM FOR I ECIRICAL
POKER SUPPLY H
F
0 FOR ALTERNATE
0 ELECTRICAL ROUII NO
L IOUID MINE SERVICE VALVE.
fEWALE BRAZE
CONNECTION WITH I11' SAE GAS LINE I/4 TURN BALL SERVICE VALVE 'D'
FLARE PRESSURE TAP FITT I MG5 I.D. FEMALE BRAZED CONNECTION WITH 1/N'SAE
FLARE PRE33URE TAP FITTING
Model Base A B C D E F G H J K
4TTR4018L 2 730 724 651 3/4 3/8 127 57 194 38 457
(28-3/4) (28-1/2) (25-5/8) (5) (2-1/4) (7-5/8) (1-1/2) (18)
417R4024L 730 724 651 127 57 194 38 457
4TTR4025L 2 (28-3/4) (28-1/2) (25-5/8) 3/4 3/8 (5) (2-1/4) (7-5/8) (1-1/2) (18)
4TfR4030L 730 829 756 127 76 197 60 508
4TfR4031L 3 (28-3/4) (32-5/8) (29-3/4) 3/4 3/8 (5) (3) (7-3/4) (2-3/8) (20)
4TTR4036L 3 832 829 756 3/4 3/8 127 76 197 60 508
4TTR4037L (32-3/4) (32-5/8) (29-3/4) (5) (3) (7-3/4) (2-3/8) (20)
4TfR4042L 4 741 946 870 7/8 3/8 143 83 206 70 508
4TTR4043L (29-1/8) (37-1/4) (34-1/4) (5-5/8) (3-1-4) (8-1/8) (2-3/4) (20)
4TTR4048L 4 741 946 870 7/8 3/8 143 83 206 70 508
(29-1/8) (37-1/4) (34-1/4) (5-5/8) (3-1-4) (8-1/8) (2-3/4) (20)
4TfR4060L 4 943 946 870 7/8 3/8 152 98 219 86 508
(37-1/8) (37-1/4) (34-1/4) (6) (3-7/8) (8-5/8) (3-3/8) (20)
22-1904-1 M-EN 9
T j -� R•� *W•.✓' �\iN' :•T`6"I ��
��
��i Qr� �`�.C!iJ,✓'•Nl G�,y t't�, ''v4P ,O .(OF;
"o h > •-♦f k'R `
4 N i rlr ,11/1�1'1111�,M s ,�1111�le x _ 11�1'111. 1� �`'t111,1'il'1 '111; M 1111,/�/,'j.:? 1�1/111/1j1'��
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< / ,1 11 � � ,'/ 1 .� 53 1 1 �> lw`, ,•Ij1�1�. � ♦• @ tv • �a i ♦• � �$A3
?i •��• �y3a ..�♦ 4119 •♦ A A vyA Gy �ip> i A 1; r T y �Fi...•,
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.,
ACoRD CERTIFICATE OF LIABILITY INSURANCE 712/10i2=( YYn
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 POUCIES 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()es) 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 CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY -- --- -- --
HOME OFFICE: P.O.BOX 328 A CNNo Ext:888-3334949 Axc_No):507446-4664
OWATONNA,MN 55060 a�ESS:CLIENTCONTACTCENTERa7FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
_ INSURER A:FEDERATED MUTUAL INSURANCE COMPANY_ 13935
INSURED 286-4684 INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024
ARCTIC MECHANICAL INCORPORATED
INSURER C:
460 N MAIN ST -- — -----
PORT CHESTER, NY 10573-3310 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:90 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 DL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR AVID MM/DD/YYYY MMJDD/WYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR -7 PREMISES TOAGE RENTED
om,E. $1�'�
MED EXP(Any one person) EXCLUDED
A N N 9907993 01/18/2021 01/18/2022 PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY JECT LOC PRODUCTS-COMPIOP AGG $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
Ea acaden
X ANY AUTO BODILY INJURY(Per person)
OWNED AUTOS ONLY SCHEDULED
A AUTOS N N 9907993 01/18/2021 01/18/2022 BODILY INJURY(Per accident)
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
AUTOS ONLY (Per ac dent
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000
A EXCESS LIAB CLAIMS-MADE N N 9907994 01/18/2021 01/18/2022 AGGREGATE $5,000,000
DED I X (RETENTION
WORKERS COMPENSATION OER
AND EMPLOYERS'LIABILITY X PER STATUTE
ANY PROPRIETOR/PARTNER/EXECUTIVE �1 E.L EACH ACCIDENT $1 wU ow
B OFFICER/MEMBER EXCLUDED? JJ NIA N 9298530 01/18/2021 01/18/2022
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
It yes,desaibe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000
I -
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
CERTIFICATE HOLDER CANCELLATION
286-468-4 90 0
RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
VILLAGE OF
VILLAGE
KING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN I
RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 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) tb.Business Telephone Number of Insured
ARCTIC MECHANICAL INCORPORATED 914-934-8301
460 N MAIN ST
PORT CHESTER,NY 10573-3310 1c. NYS Unemployment Insurance Employer Registration Number of
Insured
Work Location of Insured(Only required if coverage is Specifically limited to I Federal Employer Identification Number of Insured or Social Security
certain locations in New York State,i.e.,a Wrap-Up Policy) Number
06-1596446
2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company
Village Of Rye Brook
938 King St 3b,Policy Number of Entity Listed in Box"ta"
Rye Brook,NY 10573-1226 9298530
3c.Policy effective period
01/18/2021 to 01/18/2022
3d.The Proprietor,Partners or Executive Officers are
QX 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"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: DANIELLE SACKETT
(Print name of authorized representative or licensed agent of insurance carrier)
Approved by: Xti1L�cum Z 12/10/2020
(Signature) (Cate)
Title AUTHORIZED REPRESENTATIVE
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