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HomeMy WebLinkAboutMP21-195 �yE.08 O` �ii 1►V�� Y cc�.u`�vyir VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J. Bradbun- www.tyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E.Fews Stephanie J.Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE October 3,2024 760-800 Owner LLC PO Box 349 White Plains,New York 10605 Re: 760 Westchester Avenue,Rye Brook,New York 10573 Parcel ID#: 135.82-1-2.1 This document certifies that the work done under Mechanical Permit#21-195 issued on 12/14/2021 for the modifications to the existing HVAC system has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE BRC�v� o`` tim 1932 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 : (� jts T(H� r DATE: PERMIT# 7 ISSUED: Z'�V_z SECT: Z3!� V BLOCK: LOT:2 LOCATION: f_ L e �C �t I� O�)— ¢ L��uP.�G 46-L /COJ I OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... [Q ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION - ❑ NATURAL GAS 7 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL w .E"THER H V.1q.�' , _ ■ _ L ■ ■ M O N ■ ,� 43 ' ■ 10, y0 4 W o � a� ar W ■ O O o0 © Cc) v �+ ■ ea` or� oa40. Ca cm co 00 W � WWWO � �'Z O g w A oz � o > � ° � �' ■ u A c,1 � � rA U 0-4 f■+�I W (s+ QWE. Q o w a o o w 1h+�11 �y rl p t!7 cz r/ � •• � C � �i+ Y�I G� fY w F °' aai y V E■■y - s 14 � Q V1 � Z p pow �y ,a .a Q � Q Md9 o�, :� ?: o a U U > >, o � .= d' a .• W a`C ;7Q.. > > H Ho Q U w bo o oo as a° a a w x40 � l BUILD.1,NG-1464RTMENT ECEMED V LI,L ACE OF RY�RttOt)h DEC - 3 2021 938 KINc �.T�:1'sT RYE BRO,(lk, NY 1057 (914)93 -468 (9Y9?9'39-580I VILLAGE OF RYE BROOK wvitWi _ r�iWor BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VEN-ILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE IJSE ONLY: PERMT h- DEC - 7 2021 Permit �ce:APPnaval Date: .em --00�-- -- Approval Signature: Other: - Disapproved, (k s are non-refundable) REOUIR MENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: I. 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 h;listed m eeniticate hokkr)& Workers Compensation Insurance on a NYS Board forth(Forth 4(105.2 or Form s U26.3 l or NY State Workers Compensation 1%'airrr) 4. Payment of Fees/Unit: RESMENTIAL=$100.00/unil •CONIMERC CAL =$350.00/unit. 5. Inspection by the Building Department for removal and/or installation.(48 hour rro/ic>.required) 5. It +ri:al.work requir0-a separate Electrical Permil & Electrical Inspection 7. P!unbirig.'Gas work requires a separate PlumLing Permit F, Plumbing i:ts1wetion. Application dated, 1113Lo'?f is hereby made to the Building Inspector of the Village ol•Ryc Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local.County,State& Federal laws,codes,rules and regulations. I. Address: 7 e4� tTti�zS��- lt�k,'�[-- - - ---SBL: �� 2 �l '"Z. Zone._(�'[?,z-1_ 2. Property Owner:_ R�4.j (, ------Address: .---_L0 c •'-, c&aau ----- -_----- Phone h:At 1- ��i�- 17oo ---_...Cell I/: --- email: 3. Contractor: F tf�s.- .r =iti�. - -- ----Address: _..-.� _ •ih Sk. _ 1u.. u� r C Y 0 ts"rc. Phone it:_20 i - 26%- G 2.7� Cell 9: 2-0"�,--3113•- 15 b' —_email: LA ruvr�L_si eAd4en hv_.c_•���� 4. Applicant:- av+u V`uv a7,.,4 _ _Address: J 66 sfi� f{a"rs �7 06 4 L Phone N: 2,33- •263 -6 7e _ Cell ll: 203 3ri3_453 email: �( ��k u�si �r�yF_r(cF •��tuzL.[t+v► i- Scope of Work:New Installation O•Replacement( )• Removal(V{f)•Outer 6. List Equipment: ekti� avJ i f S4a�y ��,g_.•_��Z✓ vti5 + R ,1$_It D_51_:__fl�`so iv�5�i�s� _tzr-„,.,-mac e a •:fit=_lnr�c�� .ern,_•- 7. Location or Equipment:�ff T�ncr i'.ru:nr-�}w �e it\ _ -�v•.�#{• ua �_- sl- 41i�.� am,-r r ]Vj 9 J i MW 5��q[t,.lric roots — 8. Method of Installation/Removal(list all cquipmeni needed it)pCribmi p,h): _LS:, Iet J(" w,0 �4- u5-C A �4 t 3/21/19 STATE OF Nt:W YORK,COUNTY OF WESTCI[ESTER '_` being duly sworn,deposes and slate;that he!sbe is the applicant above named. (print name ot'ndieiduJl signing as tln: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 L for the legal owner and is duly authorized to make and rile this application. (indicate archincct,ccnrractor,agent.attorney,etc.) 'chat 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 delails ai set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordauce with(lie New York State Uniform Fire Prevention cec Building Code,the Code of the Village ol'Ryc Brook and all other applicable laws,ordinances and regulations, Sworn to before me this ( Sworn to before me this clay of_ klNe- - - 20 (� day orOVQ.W�lX-�^ ,20 a 1- --- Sign0j, ,f1Pr5opertty, Owner Sign Lire of Applicant � L'� #' Print Name of Property Own r Oola�, i Name of�ppfiCant No Public Public ELIZABETH RTOLVE Notary Public,State of New York No.01T06129900 Qualified in Westchester COURA S Coromi*lion Expires July 05,20.+ This application must be properly completed in its entirety and nulst include the notarized signalure(s) ofthe legal 04vncr(s) of'thc subject property. and the: applicant ol'rccord in the spaces provided. Any application not propery. completed in its entirety and/or not properly si'-ned shall be deemed mull and void and ""ill be returned to the applicant. 2 3121119 .�. . EDGERTON, INC. THE COMPANY OF PROFESSIONALS - EST. 1956 vunicipality Job Name: 760 Wesic1 si,,r Ave, Start Date ljlz2 Z( Job Description `fie-mcvc a,ne Yisl rw w 0.v��I L( -}Wo vvew i,n (is PICKct 7\�Sa 1r`5`k11.6� 0. -�xv, .4o 5e (per Public Act 91-95) This Letter authorizes L- ju,,,ya,,, - - To sign the PERMIT as an agent for the above mentioned JOB and Municipality Applicable Licensee S-1 0302765 P-1 E-1 PO Box 304 • 786 Main St. - Monroe, CT 06468 • Phone: (203) 268-6279 • Fax: (203) 268-9970 • www.edgertonhvac.com DATE(MM/DD/YYYY) A�ORO CERTIFICATE OF LIABILITY INSURANCE 08/122021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER HOME OFFICE: P.O. BOX 328 AICCNNo Ext:888-333-4949 n/c No):507-446-4664 OWATONNA, MN 55060 E-MAIL ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC/t INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 358-951-2 INSURER B: EDGERTON INC INSURER C: PO BOX 304 MONROE,CT 06468-0304 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 540 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN WVD MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $100 OOO PREMISES Ea ocarrence MED EXP(Any one person) $5 000 A N N 9385634 04/01/2021 04/01/2022 PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2 000 000 PRO- X POLICY _ JECT ❑LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: AUTOMOBILE L:ABILITv COMBINED LIMIT Ea acciden $1,000,000 X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED A AUTOS N N 9385634 04/01/2021 04/01/2022 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per acciden X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAB CLAIMS-MADE N N 9385636 04/01/2021 04/01/2022 AGGREGATE $5,000,000 DED I RETENTION WORKERS COMPENSATION PER STATUTE OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE It 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 if more space is required) CERTIFICATE HOLDER CANCELLATION 358-951-2 540 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD N RK W Workers' STATE 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 MI XXX, Inc. 2032686279 10200 Sunset Drive Miami, FL 33173 UC/F 1 c.NYS Unemployment Insurance Employer Registration Number of Edgerton, Inc Insured 786 MainStreet 69221580 Monroe,CT 06468 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) 060777087 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 3b.Policy Number of Entity Listed in Box 1 a" 938 King Street WC 038383067 NY Rye Brook,NY 10573 II worksite employees working for Edgerton,Inc paid under ADP TOTALSOURCE,INC's payroll,are overed under the above staled 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. Under penalty of perjury,1 certify that I am an authorized representative referenced above and that the named insured has the coverage as depicted on this form. Approved by: Adriana Sanchez (Print name of authorized repr Wto,licensed of insurance carrier) Approved by: )AMP8/13/2021 (Signature) (Date) Tide: 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. C-105.2 (9-17) Certificate Number. 46664 www.wcb.ny.gov w..::..:i_...a,,,, :,.,� ss�.�.":........,..�....,,.._.,..vaiw..u...:....arv..e..:;.,......d......:.:_�.. _..,.......:�..... u..i "�.eu:. .:...:..D.....D.......�dkNW.... _ .._.._ _.._ .:...:. gg �� �� -yy.. ..: ii. _ ,...,.,,»....�... .a_ ...:�. LJ lJ �_3 -0 toy N N O N O m m 5 aa) yo memo) mro o 0 o ti vo E OD co wz za_ z z z r 6� .0a) dg ��° �ro r > r Q ++ z > m ¢� �mro om z z z O - N T` F L G } z O LLJ n 3 0£ a C.:) o N ° Z 2 W -10 i0 O a� i° a s 9 9 S r E o n U) U r Q off° 3a O Z ,.. � R N ■�■ a) N U N .L.. 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