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HomeMy WebLinkAboutSchool Building/Day Program Fire Inspection Certificate 2022-2023 CA F H a 00 0-4 ►'�"� � o x z a H w V W W W a p W H W ►� PLO W � [••� � A ° � o HA o wcc cn n ►--� .� W � pq z � � A A � z 117, oc V w H a o M A pwq O w U bv V 134 V b A O C A Z o CO) x a x �, A w Z a �yE BRC�uk 04 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 i - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - -- = - - - - - - - - ADDRESS:— DATE: PERMIT# ��` <<-�) d ISSUED: �� SECT: BLOCK: LQ LOCATION: " �. �J `' ter '^. OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECT'ION ❑ 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 0 FINAL / ❑ OTHER 1 a � BUI4,DDT1 ENT ' VILL ©UK ]nitial Ins ectio Daze: ❑ Pass MICHAEL J.IZZO 938 DING STEW YORK 10573 Fail 01 BUILDING&FIRE INSPECTOR (914)939-5801 Re-Inspection Date: ❑ Pass mizzo(iPrvebrook.orQ .w ❑ Fail FIRE INSPECTION REPORT, NOTICE OF VIOLATION & ORDER TO REMEDY SAME Site Address: �-1 C� Zone: SBL: Occupancy: '107_-p i, P < 1 )OO V'V� 4tate Use Classification: - Business Owner: \ ' 1 i Phone: Building Owner:,', /\� `• 1 Phone: I Emergency Contact: Phone: Building Representative in Attendance:- ------------------------------------------------------—-------------------------------------------------- ------------------------------ -------------------------- Take notice that the following violations of the New York State Uniform Fire-Prevention&Building Code and/or the Code of the Village of Rye rook Were found to exist at, 11 Sc 1�-` r 4 ,.in the Village of R " NY on, zo Ca Z 20 je pe on or ti served with this Order to Remedy must complete y cure s each violation escribed in this Order to Remedy by 3 1- -.,which is thirty(30)days after the date oYthis Order to Remedy. You are further directed to contact the Buildin -e artment during normal business hours to schedule a re-inspection of the premises to confirm full compliance with all applicable codes, laws,rules&regulations. BE ADVISED THAT YOUR FAILURE TO CORRECT ALL VIOLA I IONS IS A CRIME PUNISHABLE Bl'FINE,IMPRISONMENT OR BOTH. ---------------------------------------------------------------------- - --------------------------------------------------r---------------------------------------- f' No YES N/A 1.PORTABLE FIRE EXTINGUISHERS (PFE's) a. 906.1. Are PFE's installed throughout the space&on the premises as required by code. — b.906.3.1. Is the maximum travel distance to a PFE 75 feet or less. b — c.906.5.Are PFE's conspicuously located&readily accessible. •` C._ +-' _ d.906.6.Are PFE's unobstructed/unobscured from view. d._ �- e.906.7. Are PFE's properly mounted as per the manufacturers instructions. d- - e._ 7 — f.906.9. Are PFE's properly installed: <40 lbs. max. 5'above floor;>40 lbs.max.3.5' above floor. f. 2.FIRE ALARM SYSTEM&SMOKE DETECTORS a.901.6.1. Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72. a. b.907.4.2.1.Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b. c.907.4.2.2. Is the height of the pull station handle located between 42&48 inches above the floor. C. d.907.3.Is a fire alarm system provided in existing buildings as per section 907.3.1'&907.3.2. d. 3.FIRE SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS C a.901.6.1. Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. — b.901.6.1.Are the main valves secured against tampering in the open position, b. — c.901.6.1.Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C.— d.901.6.1. Is a supply of six spare heads&a wrench maintained on the premises. d.— — e.901.6.1.Are sprinkler heads&cover plates unfinished or of factory applied finish only. e._ L•- _ f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f._ — g.913.5. Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g._ - e_ h.507.5.2. Is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h._ i- — i.507.5.4.Are fire hydrants&fire protection equipment unobstructed. L j.507.5.5. Is a clear space of not less that 3 feet maintained around all hydrants. j. — k.901.8.Are all fire protection systems in place and maintained untampered. k.— T \ pnt INSPECTOR: j DATE: -1- ReviSed 011/2020 i No YEs N/A 4.STANDPIPE,CABINETS& FIRE DEPARTMENT CONNECTIONS a.901.6.1. Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. — b.901.6:1. Has the required flow test been performed within the past 5 years as per NFPA 25-14. b. — . — c.912.2.3 Are standpipe FDC threads compatible with fire department standards. C. �r— d. 905.7. Are cabinets containing fire fighting equipment unobstructed f unobscured. d. r.-- e.905.7.1. Are cabinets containing fire fighting equipment properly identified&labeled. e. ✓ _ f 912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g. 5.EXITS,MEANS OF EGRESS&OCCUPANCY a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. — b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b. — c. 1031.6. Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors, etc... C. _ d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. — / — e. 1010.1. Are egress doors provided and maintained as required by this section. e. — f. 1004.9. Are all spaces having an assembly occupancy posted with an approved occupant load sign. f g. 1013.1. Are exits marked by a properly located,approved&readily visible exit sign. g. — h. 1013.1. Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h. — i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1. provided as required by code. i. — j. 1013.3. Are all exit signs illuminated at all times. j. _ k.1008.1. Are the means of egress&exit discharge illuminated at all times the building is occupied. k. I. 1018.3. Are public aisles in group B &M occupancies maintained at least 36"wide where fixturesare placed on one side of the aisle&at 44"wide where fixtures are placed on both sides. m. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least M. 28"wide,or at least 36"wide where serving 50 or more people. 6.COMBUSTIBLE STORAGE&WASTE MATERIALS a.304.1. Is the building(s)and premises maintained free from accumulated combustible waste material. a. — b. 304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. — c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C. d. 315.3.Are combustible materials properly stored&separated from ignition sources. d. e.315.3.1. Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e.and 18"or more below sprinkler head deflectors in sprinklered buildings. f. 315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f. g. 315.3.3. Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g• — �f — h. 313.1. Is building maintained free from stored fueled equipment. (motorcycles, mopeds, mowers,etc...) h. 7.ELECTRICAL a.604.1. Is the building free from modified/damaged wiring,devices,appliances,equipment a. and maintained free from electrical hazards. -b.604.2.Are electrical service equipment areas properly illuminated. b. — c. 604.3.Are proper working space clearances provided& maintained for electrical service equipment. C. d.604.3.Are electrical service equipment working spaces free from any stored materials. d. — e. 604.3.1.Are all electrical control panel room doors, panel boards&disconnects properly labeled. e. v — f.604.4. Is the building free from unfused multi-plug electrical adapters. f. g. 604.5.Are electrical extension cords being used in a safe manner as per code. g. h. 604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h. i. 604.6. Is the building free from open-wiring spliced electrical connections. i. _✓ — j.604.8.Are electrical motors maintained free from accumulated oil, dirt&debris. k.915.1. Are Carbon Monoxide Detecwrs 'nstalled&maintained as required by this section and by 1103.9. k. t — — — INSPECTOR: DATE: -2- Revised 6/11l2020 No YEs N/A 8.ELEVATORS,DUMBWAITERS&ESCALATORS a. [PMl 603.1. Are elevators properly maintained,and is the current certificate of inspection on the premises. a. b. 606.3.Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b. _ .floors reading; IN FIRE EMERCENCY,DO NOT USE ELEVATOR,USE EMIT STAIRS c. 606.7. Are keys for elevator car doors& fire department service kept in an approved location. C. d.315.3.3. Are elevator machine rooms maintained free from stored combustible material. d. _ e. [Bl 3005.1.Are elevator machine room doors maintained unobstructed at all times. e. 9.COMMERCIAL KITCHENS a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a b.904.12.5, Is the fire protection equipment inspected,tested &maintained as per Section 901.6. b. c.904.12.5.2. Are automatic fire extinguishing systems serviced at least every 6 months&after system C. activation, and is the certificate of inspection forwarded to the code enforcement official. d. 904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d. _ 10.HEATING SYSTEMS a. [PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a. _ - b. [PMl 603.2. Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. c. [Pm]603.3.Are heating appliances maintained with proper clearances from combustible material. C. _ d. [PMl 603.4. Are safety controls for fuel-burning equipment maintained in effective operation. d. � _ e. [PMl 603.5. is the fuel-burning equipment provided with adequate combustion&ventilation air. e. 11.MOTOR FUEL-DISPENSING FACILITIES&REPAIR GARAGES a. 2303.2. Is an approved, labeled&readily accessible emergency disconnect switch provided a. in an approved location within 100' of,but not less than 20' from fuel dispensers. b. 2304.3.4. Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. c. 2304.2.4. Are fuel-dispensers unobstructed& in clear view of the attendant at all times. C. d. 2305.5. Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. 2-A:20-B:C provided& located not more than 75' from pumps,dispensers&fill-pipe openings. e. 2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e. f. 2305.7. Are weeds and other combustible materials kept at least 10' from fuel-handling equipment. f. g. 2306.4. Are above-ground tanks provided with vehicle impact protection. g. h. 2306.5. Are above-ground tanks provided with secondary spill containment. h. 12.HAZARDOVS MATERIALS(HAZ-MATS) e. 407.2.Are S.D.S. Sheets for all haz-mats readily available on the premises. a. d.407.3.Are spaces and individual containers containing haz-mats properly labeled& identified. b. e. 5004.2.Are stored haz-mats provided with approved secondary spill containment. c. d. 5003.7.1. Are proper NO SMOKING signs provided as per this section. d. 13.MISCELLANEOUS A.403.1. Is an approved fire safety&evacuation plan prepared& maintained for the building/occupancy. a. b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b. c.405.5.Are records of emergency evacuation drills kept& maintained on the premises. C. d. 505.1.Are approved address&building numbers properly placed&plainly visible from the street. d. e. 506.1. Are approved key boxes(knox boxes)provided,properly located &equipped with the proper keys. e. f. 703.1. Is all required fire-resistance rated construction properly maintained as per code. g. 703.1. Are openings through fire-resistance rated assemblies properly protected&maintained. g. h. 5303.5.Are compressed gas cylinders& systems secured &safeguarded against damage&access. h. _ v L 5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. i. .f 14.GENERAL HOUSEKEEPING a. Good b. Fair c. Inadequate d. Poor INSPECTOR: DATE: Z� , -3- Revised 611 112 02 0 ITEM NUMBER REMARKS -eS- o r• r7 � n r ea LA cx r- �< INSPECTOR: DATE: -4- Revised 6/11/2020 ,`�r��±I ►i R. .�y .��R��ri��I ! r•�±rT{<f�r �►mil��,`tom=< `=�I<- ►Ti•_y r.• r7-. ,<! l�lfi UlG.U�K V!.Rlt.�.`�lt.�.�!fi U�l f.�wlt. �lG.��lf�Ulfit�lt�`}lf�UltRU!{i t }!{�Ulf�Ulf�Jlt�UlfUlts�1}lf��}!� � � �► )<v. ► v. 1.�. 1 ��/.v�/amp/a�p1 ��►a��r �p1.;p1 �/.vn/ ��/ v�► us1' .tLti_Iu�i►�lal�•l4ti_a'ut .fuli_Lu3%[4t%tuf%tu ' <r► ♦,u Fire Alarm and Life Safety System ► �1� Inspection Certificate K� ► �4,' For it�4► S�r Cerebral Palsy of Westchester 1186 King Street & Lincoln • �;► Purchase, NY 10577 !a• Tested to NFPA 72 standards � ►��; • -1 i This Inspection was performed in accordance with applicable NFPA Standards. The subsequent pages ' of this report provide performance measurements, listed ranges of acceptable results, and complete IN +g nu► documentation of the inspection. Whenever discrepancies exist between acceptable performance u�`'1" �,4 standards and actual test results, notes and/or recommended solutions have been proposed or provided,*; for immediate review and approval. ►+ �4► `•'; Inspection Date Nov 10, 2021 �� • a.r. MR e, • ♦.0 1i�4► 1 �►� Building:Cerebral Palsy of Westchester Company:ADT Commercial LLC � �►� Contact:Dan Graham Contact:John Sterlaceu'•; �<4 Title: Manager Title:Technician 1%d F►� p a� ♦.4 ►• t4 1 r: * Fil ♦.4 s ►� MO� ; ul� 01+ 4/ •�r•<�2,19 - r.<�r•` T►.�>±riT��►-7�t�� �rlT=y r7:�►'�rat=�rf�!r7T��r7,T�!r � <�r<? '� `'�rI,`:�► `��r7�`�� �► ``�► ?r,`�r; '�,�UIf�U!�U!:�U4r�U4�UF�'�}!:\�lFf�u!�U!{�UIC�UF�UIC:�`►lt�`Jlf�U!�U!�U!`Ulf.�'JIf�U!�U!�Ulf��}!{�.Ulf�U!�Ul� Ivr.�pf► �nr ��/ �p1lav�►a��/`SUSl/+wpl ��))1 ��}1S�P1 vP1�.�s► �?► "r �?►�.v?►�.yS► ��I+.�n}1 v�f/��n►rjt�/ar�1 3`%'r �:r/1`j"/ �,[41�,t4�,t4��,i'a���a��j'4��,1a�,�41i_i4��luti,[�tv_fu��1�41�,�41��tal�•1'u����u���a�i�tal�,�al!•la�1��41��1'4��.!'4��.1a`+►�lal�a,14� Executive Summary Generated by:BuildingReports.com Building Information Building: Cerebral Palsy of Westchester Contact: Dan Graham Address: 1 186 King Street & Lincoln Phone: 914-384-4060 Address: Fax: City/State/Zip: Purchase, NY 10577 Mobile: Country: United States of America Email: Inspection Performed By Company:ADT Commercial LLC Inspector:John Sterlace Address: Red Hawk Fire &Security Phone: 914-351-6396 Address: 6 Skyline Dr. Fax: City/State/Zip: Hawthorne, NY 10532 Mobile: Country: United States of America Email:john.sterlace@redhawkus.com System Control Unit Manufacturer: Edwards Inspection Date: 1 1/10/2021 IDC Style: B Model Number: EST 3 Install Date: 01/31/2007 SLC Style: 4 Software Version: 4.0 Version Date: 05/16/2011 NAC Style: Y Location: 1 st FACP Control Room Current Protection: Breaker Monitoring Company:Statewide Phone: 888-388-6436 Account#: Central Station Si e Type: Digital Communicator Mfg: Silent Knight Model*: 5104 Test Tlme/Date: i 1/10/21 12:51:30 PM Restore Time: Note: ADT Commercial LLC 1 Download Date: 12/09/2021 Inspection Summary Category Total Items Serviced Passed Falled/Other MY % Qty % Qty % MY % Auxiliary 8 4.23% 8 100.00% 8 100,00% 0 0.00% Control 11 5.82% 11 100.00% 11 100.00% 0 0.00% Initiating 166 87.83% 166 100.00% 166 100.00% 0 0.00% Sound Test 1 0.53% 0 0.00% 0 0.00% 0 0.00% Supervisory 3 1.59% 3 100.00% 3 100.00% 0 0.00% Totals 189 100% 188 99A796 188 100.00% 0 0.00% Certification Company: ADT Commercial LLC Building: Cerebral Palsy of Westchester Inspector:John Sterlace Contact: Dan Graham Signed: Signed: ADT Commercial LLC 2 Download Date: 12/09/2021 Inspection & Testing Generated by:BuildingReports.com ui . tog:- Cerebral Palsy of Westc esfer. Control Panel l Edwards EST 3 The Inspection& Testing section lists all of the items inspected in your building. Items are grouped by Passed or Failed/Other.Items are listed by Category.Each item includes the services performed, and the time&date at which testing occurred. 7Auxi ation Senrke T me Date cPassed llaryy Releasing Device 1 st Corridor Next to Bathroom 3 Tested 12:53:05 PM 1 1/10/2021 Releasing Device 1 st Corridor Next to Bathroom 3 Tested 12:53:11 PM 1 1/10/2021 Releasing Device 1 st B Wing by A-1 Classroom Tested 12:54:31 PM 1 1/10/2021 Releasing Device 1 st 8 Wing by A-1 Classroom Tested 12:54:38 PM 1 1/10/2021 Releasing Device 1 st B Wing by Maintenance Offiice Tested 12:54:05 PM 1 1/10/2021 Releasing Device 1 st B Wing by Maintenance Off lice Tested 12:54:10 PM 1 1/10/2021 Releasing Device 1 st Corridor by Personal Care Room 2 Tested 12:53:29 PM 1 1/10/2021 Releasing Device 1 st Corridor by Personal Care Room 2 Tested 12:53:34 PM 1 1/10/2021 Control Battery 1 st A Wing Mechanical Room Tested 1:42:51 PM 1 1/10/2021 Battery 1 st A Wing Mechanical Room Tested 1:42:57 PM 11/10/2021 Battery 1 st Booster Panel Tested 1:18:33 PM 11/10/2021 Battery 1 st Booster Panel Tested 1:18:42 PM 11/10/2021 Battery 1 st Communication Panel Tested 1:42:33 PM 11/10/2021 Battery 1 st MAIN FACP Tested 1:33:41 PM 11/10/2021 Battery 1 st MAIN FACP Tested 1:34:17 PM 11/10/2021 Communicator 1 st Electric Room Tested 12:51:30 PM 11/10/2021 Control Panel 1 st FACP Control Room Tested 12:52:40 PM 1 1/10/2021 Expander Panel 1 st A Wing Inside Mechanical Room Tested 12:52:49 PM 1 1/10/2021 Power Supply 1 st Electrical Room Tested 10:27:04 AM 11/10/2021 Initiating Duct Detector 1 st A Wing Mechanical Room A/C 5 Tested/Cleaned 11:19:18 AM 1 1/10/2021 Duct Detector 1 st B Wing Mechanical Room Tested/Cleaned 11:18:47 AM 1 1/10/2021 Duct Detector 1 st C Wing Boiler Room Tested/Cleaned 11:20:1 2 AM 11/10/2021 Duct Detector 1 st C Wing Fan Room A/C 3 Gym Tested/Cleaned 11:18:30 AM 1 1 11 0/202 1 Duct Detector 1 st C Wing Fan Room A/C 4 Gym Tested/Cleaned 11:18:14 AM 11/10/2021 Heat Detector 1 st B Wing Classroom A 1 Visually Checked 1:03:01 PM 1 1/10/2021 Heat Detector 1 st B Wing Classroom S-4 Visually Checked 1:02:46 PM 1 1/10/2021 Heat Detector 1 st B Wing Electrical/ Fire Panel Room Visually Checked 1:01:20 PM 1 1/10/2021 Heat Detector 1 st B Wing Fire Panel Room Visually Checked 1:01:13 PM 1 1/10/2021 Heat Detector 1 st B Wing Front Reception Visually Checked 1:00:50 PM 11/10/2021 Heat Detector 1 st B Wing Janitors Closet/ Electrical Room Near Visually Checked 1:01:35 PM 1111012021 Exit Heat Detector 1 st B Wing Men's/Women's Bathroom Visually Checked 1:02:30 PM 1 1/10/2021 Heat Detector 1 st B Wing Mens Bathroom 13 Visually Checked 1:02:00 PM 11/10/2021 Heat Detector 1 st B Wing Women Bathroom 12 Visually Checked 1:02:16 PM 11/10/2021 Heat Detector 1 st B Wing boiler Room Visually Checked 1:01:28 PM 11/10/2021 ADT Commercial LLC 3 Download Date: 12/09/2021 Device Type Location service Time Date Passed Heat Detector 1 st B Wing Bathroom 1 1 Visually Checked 1:02 09 PM 1 1/1012021 Heat Detector 1 st B Wing Bathroom 14 Visually Checked 1:01:50 PM 1 1/10/2021 Heat Detector 1 st B Wing Janitors Closet Visually Checked 1:01:05 PM 1 1/10/2021 Heat Detector 1 st Bathroom WOMAN'S Visually Checked 1.00.01 PM 1 1/10/2021 Heat Detector 1 st Bathroom 15 MIENS Visually Checked 12:59:51 PM 1111012021 Heat Detector i st Bathroom 7 MEN Visually Checked 1:00:06 PM 1 1/10/2021 Heat Detector 1 st C Wing Bathroom 9 Visually Checked 12:58:44 PM 1111012021 Heat Detector 1 st C Wing Bathroom Women Visually Checked 12:58:36 PM 1 1/10/2021 Heat Detector I st C Wing Executive Office Visually Checked 1 2:58:58 PM 1 1/10/2021 Heat Detector 1 st C Wing Laundry Room Visually Checked 12:58:17 PM 11/10/2021 Heat Detector 1 st C Wing Men's Bathroom 2 Visually Checked 12:57:39 PM 11/10/2021 Heat Detector I st C Wing Men's Room Visually Checked 12:57:58 PM 1 1/10/2021 Heat Detector 1 st C Wing Recreation Room /Gym Closet Visually Checked 12:59:11 PM 1 1/10/2021 Heat Detector I st C Wing Vestiblue Door 4 Visually Checked 1 2:58:28 PM 1111012021 Heat Detector 1 st C Wing Women's Bathroom Visually Checked 12:58:08 PM 11/1012021 Heat Detector 1st C Wing Women's Bathroom 1 Visually Checked 12:57:45 PM 1111012021 Heat Detector 1 st C Wing Bathroom Visually Checked 12:58:50 PM 11/1 0/2021 Heat Detector 1 st C Wing Boiler Room Visually Checked 12:59:19 PM 1111012021 Heat Detector 1 st Conference Room Visually Checked 12:59.35 PM 1111012021 Pull Station 1 st A Wing Inside A 13 Tested 2:08:05 PM 1111012021 Pull Station 1 st A Wing Workshop Exit Tested 2:08:12 PM 1 1/10/2021 Pull Station 1 st B Wing Exit By Classroom 13 Tested 11:43:07 AM 1111012021 Pull Station 1 st B Wing Exit By Office Offices&Therapies Tested 10:28:32 AM 1 1/10/2021 Pull Station i st B Wing Exit By Water Electrical Room Tested 1 1:44:57 AM 1111012021 Pull Station 1 st B Wing Main Entry Office&Therapies Tested 1 1:25:04 AM 11/10/2021 Pull Station 1st B Wing Outside Bathroom 8 Tested 1 1:42:27 AM 1 1/10/2021 Pull Station 1 st B Wing office&therapy side exit Tested 1 1:25:32 AM 1111012021 Pull Station 1 st C Wing Gym Entrance Tested 1 1:22.50 AM 1 1/10/2021 Pull Station 1 st C Wing Gym Rear Exit Left Tested 1 1:23:19 AM 1111012021 Pull Station 1 st C Wing Gym Rear Exit Right Tested 1 1:23:53 AM 1 1/10/2021 Pull Station 1 st C Wing Gymnasium Entrance Tested 1 1:40:1 7 AM 1 1/10/2021 Pull Station I st C Wing Main entrance Tested 11:37:08 AM 11/10/2021 Pull Station 1 st C Wing Outside Care Room 3 Tested 2:06:05 PM 1111012021 Pull Station 1 st C Wing Outside Exploring Nature Office Tested 1 1:34:21 AM 1 1/10/2021 Pull Station 1 st C Wing Outside Supply Closet Tested 2:07:39 PM 11/10/2021 Pull Station 1 st Cleaner Storage Room Tested 2:07:58 PM 11/10/2021 Smoke Detector 1 st Gym storage 2 Tested/Cleaned 1 1140:26 AM 1 1/10/2021 Smoke Detector I st Gym storage 3 Tested/Cleaned 1 1:22:06 AM 1111012021 Smoke Detector I st A Wing Cafeteria Tested/Cleaned 1 1:38:55 AM 11/10/2021 Smoke Detector 1 st A Wing Corridor By Mechanical Room Tested/Cleaned 1 1:39:27 AM 11/1 012021 Smoke Detector 1 st A Wing Corridor By Room 17 Tested/Cleaned 1 1:39:35 AM 1111012021 Smoke Detector 1 st A Wing Corridor By School kitchen Tested/Cleaned 1 1:39:1 2 AM 1 1/10/2021 Smoke Detector 1 st A Wing Corridor Outside Bathroom 19 Tested/Cleaned 1 1:39:20 AM 1111012021 Smoke Detector 1 st A Wing Corridor Outside Room 18 Tested/Cleaned 11:39:42 AM 1 1 11 012021 Smoke Detector 1 st A Wing Inside Classroom 14 Tested/Cleaned 1 1:37:55 AM 1 1/10/2021 Smoke Detector 1 st A Wing Inside Classroom 15 Tested/Cleaned 1 1:38:34 AM 1111012021 Smoke Detector 1 st A Wing Inside Classroom 16 Tested/Cleaned 1 1:38:18 AM 1 1/10/2021 Smoke Detector 1 st A Wing Inside Classroom 17 Tested/Cleaned 1 1:38:1 1 AM 1 1/10/2021 Smoke Detector I st A Wing Inside Classroom 18 Tested/Cleaned 11:38:03 AM 1111012021 Smoke Detector 1 st A Wing Inside Tech Center Tested/Cleaned 1 1:39:04 AM 1 1/10/2021 ADT Commercial LLC 4 Download Date: 12/09/2021 Device Type Location Service Time Date Passed Smoke Detector I st A Wing Inside Workshop Area Tested/Cleaned 1 1:27:50 AM 1111012021 Smoke Detector 1 st A Wing Inside Workshop Area Tested/Cleaned 1 1:28:16 AM 1 1/10/2021 Smoke Detector 1 st A Wing Inside Workshop Area Tested/Cleaned 1 1:28:24 AM 1 1/10/2021 Smoke Detector 1 st A Wing Inside Workshop Area Tested/Cleaned 1 1:28:32 AM 1 1/10/2021 Smoke Detector 1 st A Wing Inside Workshop Area Cypress Room Tested/Cleaned 1 1:26:16 AM 1111012021 Smoke Detector 1 st A Wing Inside Workshop Area Cypress Room Tested/Cleaned 1:52:50 PM 1111012021 Smoke Detector 1 st A Wing Inside Workshop Area Near Exit Tested/Cleaned 1:52:59 PM 1 1/10/2021 Smoke Detector 1 st A Wing OT/PT Offiice Tested/Cleaned 1 1:27:11 AM 1111012021 Smoke Detector 1 st A Wing Recreation Office Tested/Cleaned 1 1:38:26 AM 1 1 11 01202 1 Smoke Detector 1 st A Wing ceiling hallway Corridor outside Tested/Cleaned 1:52:30 PM 1 1110/2021 bathroom 3 Smoke Detector 1 st B Wing Corridor By 13 Tested/Cleaned 1 1:43:26 AM 1111012021 Smoke Detector 1 st B Wing Corridor By Classroom 15 Tested/Cleaned 11:44A0 AM 1 1/10/2021 Smoke Detector 1 st B Wing Corridor By Daycare Room 5 Tested/Cleaned 10:26:39 AM 1111012021 Smoke Detector 1 st B Wing Corridor By Multi Purpose Room Tested/Cleaned 10:27:22 AM 1 1 11 0/202 1 Smoke Detector 1 st B Wing Corridor By Office 6 Tested/Cleaned 11:44:06 AM 1 1/10/2021 Smoke Detector 1 st B Wing Corridor By Room14 Tested/Cleaned 10:27:55 AM 1111012021 Smoke Detector 1 st B Wing Corridor Outside Maintenance Office Tested/Cleaned 11:42:35 AM 11/10/2021 Smoke Detector 1 st B Wing Corridor Outside Mechanical Room Tested/Cleaned 11:42.57 AM 1 1/10/2021 Smoke Detector 1 st B Wing Exit by Water Electric Room Tested/Cleaned 11:44:48 AM 1111012021 Smoke Detector 1 st B Wing Inside Mechanical Room Tested/Cleaned 11:19:01 AM 11/10/2021 Smoke Detector 1 st B Wing Inside 4 Tested/Cleaned 11.44.22 AM 1 1/10/2021 Smoke Detector 1 st B Wing Inside Classroom 16 Tested/Cleaned 10:26:50 AM 1111012021 Smoke Detector 1 st B Wing Inside Classroom 17 Tested/Cleaned 10:28:08 AM 1 1/10/2021 Smoke Detector 1 st B Wing Inside Classroom 18 Tested/Cleaned 10.28.19 AM 11/10/2021 Smoke Detector 1 st B Wing Inside Classroom S-4 Tested/Cleaned 1 1:44:13 AM 1111012021 Smoke Detector 1 st B Wing Inside Classroom S-5 Tested/Cleaned 11:43:34 AM 11/10/2021 Smoke Detector 1 st B Wing Inside Maintenance Office Tested/Cleaned 11:42:46 AM 11/10/2021 Smoke Detector 1st B Wing Inside Nurse Office 7 Tested/Cleaned 10:27:33 AM 11/1012021 Smoke Detector 1st B Wing Inside Speech Pathology Tested/Cleaned 1 1:43A 7 AM 1 1/10/2021 Smoke Detector 1 st B Wing Inside Sprinkler Room 19 Tested/Cleaned 10:29:12 AM 11/10/2021 Smoke Detector 1st B Wing Office I Tested/Cleaned 1 1:43:42 AM 1 1/10/2021 Smoke Detector 1 st B Wing Office 6 Tested/Cleaned 1 1:43:58 AM 1 1/10/2021 Smoke Detector i st B Wing Outside Offices&Therapies Tested/Cleaned 10:28:46 AM 1111012021 Smoke Detector 1st B Wing Social Workers Office 2 Tested/Cleaned 2:07:52 PM 1111012021 Smoke Detector 1 st B Wing Storage Room#6 Tested/Cleaned 11 A4:30 AM 1111012021 Smoke Detector 1st B Wing Storage Room 8 Tested/Cleaned 10:27:44 AM 11/10/2021 Smoke Detector 1st B Wing Therapy Room Tested/Cleaned 11:25:19 AM 1111012021 Smoke Detector 1st B Wing care Room 5 Tested/Cleaned 10:12:58 AM 1 1/10/2021 Smoke Detector 1 st C Wing By Main Entrance Tested/Cleaned 11:19:33 AM 1 1/10/2021 Smoke Detector 1 st C Wing Care Room 1 Tested/Cleaned 11:36:32 AM 1111012021 Smoke Detector 1 st C Wing Care Room 2 Tested/Cleaned 11:32:12 AM 1 1/10/2021 Smoke Detector 1 st C Wing Corridor Outside Classroom 1 Tested/Cleaned 1 1:36:49 AM 1 1/10/2021 Smoke Detector 1 st C Wing Corridor Outside Classroom 10 Tested/Cleaned 2:05:58 PM 1 1/10/2021 Smoke Detector I st C Wing Corridor Outside Classroom 12 Tested/Cleaned 2:07:25 PM 1111012021 Smoke Detector 1 st C Wing Corridor Outside Classroom 4 Tested/Cleaned 2:05:54 PM 1111012021 Smoke Detector 1 st C Wing Corridor Outside Classroom 5 Tested/Cleaned 1 1:31:43 AM 1 1/10/2021 Smoke Detector 1 st C Wing Corridor Reception Area Tested/Cleaned 1 1:37:44 AM 1111012021 Smoke Detector 1 st C Wing Directors Office Conference Room Tested/Cleaned 1 1:37:20 AM 1 1/1012021 Smoke Detector 1 st C Wing Inside Care Room 3 Tested/Cleaned 11:41.26 AM 1 1/10/2021 ADT Commercial LLC 5 Download Date: 12/09/2021 Part II: Nonpublic School Fire&�Building Safety Non-Conformance Report Sheet s School Name �- W �4�uildiu Name U U 0 0 CJ Z �j AU z4° AU z 42 c AU U U 08A-2 14A-2 20A-1 0813-2 1414-2 20B-1 08C-2 14C-2 20C-1 0813-2 14D-1 08E-2 14E-1 21 A-3 09A-2 15A-2 22A-3 0913-2 1513-1 2213-3 09C-1 15C-2 22C-3 09D-1 1513-2 ,L 15E-1 23A-1 09F-2 Vb 238-l 09G-2 16A-2 23C-1 16B-2 1 23D-2 1 OA-2 16C-2 l OB-2 1613-2 24A-3 IOC-1 l OD-1 17A-3 25A-1 1713-2 2513-l ll A-2 17C-2 25C-l 11B-1 1713-2 i 1C-2 17E-1 26A-3 11 D-2 17F-3 11E-1 17G-1 17H-2 12A-1 1� 17I-2 1213-3 171-1 12C-2 17K-I If any additional 1213-2 17L-1 non-conformances 12E-1 are observed,check item 12F-1 18A-2 26A-3 and list the Code section 12G-1 1813-2 below. 12H-1 18C-2 121-1 1813-2 12J-1 12K-1 X `b 1 19A-3 12L-1 1913-2 Inspector 12M-1 19C-1 The inspector has been 12N-1 1913-1 provided with a copy of the 120-2 19E-1 previous year's school fire 1917-1 safety report: 13A-2 19G-1 Yes No 13B-2 19H-2 5 Part III: NonPublic School Certifications All sections are re uired to be completed. Section III-A• III-B III-C& III-D Section III-A Fire Inspection Method Which method(s)did the school authorities use to complete the annual fire safety inspection for this building? Check appropriate box or boxes ❑ Inspection by the fire department of the city, town, village or fire district in which the building is located © Inspection by a fire corporation whose territory includes the school building Inspection by the county fire coordinator, or the officer performing the powers and duties of a county fire coordinator pursuant to a local law, of the county in which the building is located ❑ Inspection by a fire inspector Buildin Safe Ins ector or Code Enforcement Official who holds a valid certification For additional in ormation re a (ng these methods, lease see. h s:// senate. ov/le islatio,z/laws/EDN/807-A Section III-B-Fire Inspection by Local Fire Department,Fire District,Fire Corporation, County Fire Coordinator and/or Fire Inspector(Building Safety Inspector or Code Enforcement official)who holds a valid certification. The individual noted below inspected this building on (date)and the information in this Report represents,to the best of their knowledge and belief,an accurate description of the building and conditions they observed. The individual that performed this inspection has maintained their certification requirements pursuant to 19 NYCRR 1208-3.1. Inspector's Name: 2\ ve_w5 Title: -C\ r Signature: Date: Inspector's Organization: Inspector's Telephone#: Inspector's Email: 2'S0' re_L S Q"C W L Inspector's Code Enforcement Certification# `� {�11 ow 5 1-A-2). as assigned b 1,the NYS De artment of State Section III-C Contact info for the Authority-Having-Jurisdiction [AHJI Local Municipality,Town or Village Name of Local/Municipal Code Enfor ment Office : ; Address: V,�,n rOa Name of contact person : Title: 1 S`� 66 Telephone#: Email address: Section III-D School or Building Administrator,Director, or Headmaster The individual noted below certifies that this building was inspected as indicated in Section III-A above and hereby submits this fire inspection report on behalf of the Board of Trustees and certifies that: 1. Public notice of report availability has been published, and that 2• Any nonconformances noted as corrected on the Nonpublic School Fire Safety Non-Conformance Report Sheet portion of this report were corrected on the date indicated, and that 3. Violations which were not corrected immediately shall be corrected within an accepted period of time as approved by the Commissioner. Name: Title: Signature: Telephone #: Email: 6 RrFN=OV�2 F BUILD ► MENT 3 2021 VI E o[�.RY OK 938 KING ETRYE BRA NY 10573 VILLAGE OF RYE BROOK ftPalsy, hester BUILDING DEPARTME FIRE INSPECTION / OPERATING PERMIT APPLICATION FOR OFFICE USE ONLY: 22,�.,,A Fee Paid: $ _ � Inspection Date&Time: eC. a OJ/ -•304- N FEE SCHEDULE: Re-inspection Date&Time: Triennial&Private School Annual Inspection: =$450.00 Public Assembly Annual Inspection: <100 People=$525.00/>100 People=$775.00 wwwwwwwww,twwwwwww*w,rwwww**wwwwwww*ww*wwwwwwwwww*wwwwwwwwwwwwwww*wwwwwww*wwwww**wwwwww*w,rwwww*w*ww****wywwww Application,dated: is hereby trade to the Building Inspector of the Village of Rye Brook NY,requesting that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a permit to Operate the business, private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform Eire Prevention&Building Code,Title 19 NYCRR Part 1201, and all other applicable local, County, State&Federal laws, rules & regulations,as per detailed statement described below. 1. Address: 1186 King Street SBL: ,/��j1, 'j��—�—� Zone: 3 2. Business/Occupancy Name:/ Cerebral Palsy of �Sf��-fieI - NYS Use Class: 3. Property Owner: (fe/P&-a/ A/,$q Address: Phone# Cell# email: 5. Business Owner: Address: Phone# Cell# email: 6. Emergency Contact: Dan Graham Address: Phone# 914-937-3800 x407 Cell/# 914-384-4060 email: g1i'n1�.�'rQ�jq/y!(�C,QK�L2dI[ 7. Inspection Escort: bO 1j Gr'i41 Ad/" Title: '4 l7ae2C -' teV/S0— j O�g Phone#: Cell#: email: 8. Provide a brief description outlining the current and/or intended use of the property: School/Day Program 9. List all Hazardous Materials: 10. Occupant Load: Existing: Proposed: Other: 11. Date&Disposition of Previous Fire Inspection: 1/15/2021 P P C8 Pass ❑ Fail i un�i202 1186 King Street, Rye Brook, NY 10573 -T 914-937-3800 - F 914-937-3983 - www.cpwestchestcr.org Wjhqjj§aftivrrnust include the notarize ov the above mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK } COUNTY OF WESTCHESTER } as: Linda Kuck (print name of individual signing application) being duly sworn,deposes and states that he/she is the applicant above named, and further states that he/she is the legal owner of the property to which this application pertains,or that he/she is the Executive Director for the legal owner and is duly authorized to make and file this application. That all (indirwlw www1ort,husiinere owner,attorney,iaont,ote) statements contained herein are true to the best of his/her knowledge and belief,and that any work performed or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention &Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this / Sworn to before me this day of , 20c9- day of o-�-em K�'�/ ,20c�-1 Notary Public. otary Public x x Sig ature of Property Owner Signature of Applicant Linda Kuck Linda Kuck Print Name of Property Owner Print Name of Applicant STEPHANIE RUSSO-PASTILHA STEPHANIE RUSSO-PASTILHA Notary Public,State of New York Notary Public,State of New York No.01 RI;6136519 No.01 RL,16136519 Qualified in Westchester Countty,,f� Qualified in Westchester Count Commission Expires Nov.7,2Os A Commission Expires Nov.7,2t 2 8/12120i21 1186 King Street, Rye Brook,NY 10573 •T 914-937-3800• F 914-937-3983 • www.cpwestchester.org