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Home My WebLink AboutMP12-096 �C �J �9 A" tbutiuma W 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 April 11,2022 Devesh Dayal&Seema Mathur 196 Country Ridge Drive Rye Brook,New York 10573 Re: 196 Country Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 129.82-1-34 This document certifies that the work done under Mechanical Permit#12-096 issued on 11/26/2012 for the installation of a gas fired water heater has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to Q�E BR��. cu � 1982 BUILDING DEPARTMENT tJ 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 :- l7 Ov JiT -< r y" DATE: f Z- PERMIT# ISSUED: DI Z SECT- BLOCK: LOT: LOCATION: �-5��1Tj �� C�'�L OCCUPANCY: r ❑ VIOLATION NOTED THE WORK IS... 0/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 Ch ni od qu E :t:: _Gm tn 9 E rA 0 g cu -,e w -E. a -.4 0 =(U to en v, E cd Q6 go 00 6'. 'SO o b 211 .4 ta. z 0 C's 00. Ln > 00 U,3 Z OE QOD 9z z 00 IOR. 10 18. =s z op WZ 0 r- gz E 0 3 W o oe � Y � � � OR Ln cd E VILLAGE OF RYE BROOK BUILDING DEPARTMENT kN ECE0`\n 938 KING STREET,RYE BROOK,NY 1057 V 'Fcf, jo (914)939-0668 FAX(914)939-5801 www. ebr 0V 2 0 20 22 APPLICATION TO INSTALL AND/OR TMGE OF RYE FUEL BURNER BOILER OR HOT WATE H1v9AnMRG D IPARBROOK Permit#: v' 9U Building Inspector: Fee Paid-�-1�j. Date of Approval: N J V 2 6 2012 (fees are non-refundable) 9r Fxxxx kxx7rxFxx>'cxF Y*xxicx xiic is icx>'cxxir irxKir>F>k*xxicxxa'c*xirz Xxir it irxzzicxicxxxxxxiirxic is icxic REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly Completed & Signed Application. 2. Copy of Licensed Contractor's Insurance including Liability& Workers Compensation naming the Village of Rye Brook as Certificate Holder. 3. Fees: $75 per unit. 4. Inspection by Building Department for removal and/or installation. 5. Certificate of Compliance will be provided when all requirements are fulfilled. 6. Any electrical work requires an Electrical Permit and Electrical Inspection. 7. Any gas/plumbing work requires a Plumbing Permit and Plumbing Inspection. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the installation and or removal of the equipment as listed below.The applicant,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. 1. Property Owner's Name: L�xq aA Phone#:914.q .9IQ� 2. Job Address: `Cho iAnle Nr.. Phone#: q Jy.qn •C Q7 3. Parcel I.D#: i A�'/p ?O -/-3 y Zone: 4. Contractor: Phone#: Q N (p.5, r • 5. Contractor Address: R��p��pd��•, �� Fax: R-AiS. , 3 6. Scope of Work: Install Remove c; -Fuel Burner _; Boiler E; Water eater ' 7. Type of Equipment& Fuel: p4 r P �oaRkmA q 8. Location of Equipment:�� X-4- _ . Signature of Applicant: Date: i • 1y• 1,�L Printed Name of Applicant: �iI+GI.s�� S�.S�p��Si Phone#:��y •9465 ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD,YYYY) 02/16/2012 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LUNIALI NAME: Pattie ZukOWskl PHO Rosol Agency ACNNo Ext: 914-368-1280 (Arc Nd;914.428.0118 625 Fifth Avenue ADDRESS: pz@meridianrisk.com Pelham, NY 10803 INSURER(S)AFFORDING COVERAGE NAIC Pattie Zukowski INSURER A: MERCHANTS INSURANCE GROUP 23329 INSURED BRUNI & CAMPISI PLUMBING & HEATING INC INSURER B: First Rehabilitation Life Ins 91434 199 Ridgewood Drive INSURERC: Ullico Casualty Group Inc. Elmsford, NY 10523 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12-13 Liab Master (da) 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. AUUL LTR TYPE OF INSURANCE IN SR yyyp I POLICY NUMBER MMfODIYYYY MhVDD/YYYY LIMBS GENERAL LIABILITY CMP915233002/16/2012 0211612113 EACHOCCURRENCE S 1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 100.00 CLAIMS-MADE I X J OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY 1 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO LOC $ JECT AUTOMOBILE LIABILITY CAP926738Z 02/16/2012 02/16/2013 Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A X ALL OWNED X SCHEDULED BODILY INJURY(Per accident) f AUTOS AUTOS NON-OWNED PHUPLH DAMAGES X HIRED AUTOS X AUTOS Per accident)_ $ X UMBRELLA LIAB X OCCUR CUP914343 02/16/2012 0216/2013 EACH OCCURRENCE S 5,000,00 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,00 DEC) I X I RETENTIONS 10,00 $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY T11 LIMITS ER YIN ANY PROPRIETO"ARTNER/EXECIJTIV� VFJ-310057-0009115/2011 09/15/2012 E.L.EACH ACCIDENT $ 1,000,00 C OFFICEPUMEMBER EXCLUDED? U N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 YS Disa i ity Beare its D27356 i02/16/2012 02/05/2013 Statutory As Required By g 'Liability Law New York State DESCRIPTION OF OPERATIONS/LOCATIONS,VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space is required) 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 DEPT. AUTHORIZED REPRESENTATIVE 938 KING STREET RYE BROOK, NY 10573 Joseph Solimine Sr. JLF 0 1 988-201 0 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and Address of Insured(Use street address only) lb. Business Telephone Number of insured Bruni And Campisi Plumbing And Heating Inc (914)946-5558 199 Ridgewood Drive Elmsford,NY 10523 lc. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of insured(Only required if coverage is specifically Id. Federal Employer Identification Number of Insured Limited to certain locations in New York State,i.e.a Wrap-Up Policy) 132999646 2. Name and Address of the Entity Requesting Proof of 3a. Name of insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) State Fund#455 Village of Ryebrook 3b. Policy Number of entity listed in box"la": 938 KING STREET RYE BROOK,NY 10573 22331243 3c. Policy effective period: 9/15/2012 to 5/1/2013 3d. The Proprietor,Partners or Executive Officers are: nIncluded. (Only check box if all partners/officers include) 1� all excluded or certain partnerstofficers excluded. This certifies that the insurance carrier indicated above in box"3"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"2". The Insurance Carrier will also notify the above certificate holder within 10 days/F a policy is canceled due to nonpayment of premiums or within 30 days/F 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 Cern'frcate is valid for a maximum of 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. Please Note:Upon the 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 or the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Keevily Spero Whitelaw,Inc. (Print name of authorized representative or licensed agent of insurance carrier) Approved by: September 21, 2012 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier.(914)381.551 l Please Note:Only insurance arriers and their licensed agents are authorized to issue Form C-105.2 Insurance brokers are NOT authorized to use it. C-105.2(9-07) Reverse New York State Insurance Fund Workers'Compensation A Disability Benefits Specialists Since 1914 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 Phone:(888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 132999646 KEEVILY,SPERO-WHITELAW INC. 500 MAMARONECK AVENUE HARRISON NY 10528 POLICYHOLDER CERTIFICATE HOLDER BRUNI AND CAMPISI PLUMBING AND VILLAGE OF RYEBROOK HEATING, INC. 938 KING STREET 199 RIDGEWOOD DRIVE RYE BROOK NY 10573 ELMSFORD NY 10523 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 2233 124-3 215820 09/1512012 TO 05/01/2013 9/20/2012 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2233124-3 UNTIL 05/01/2013, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 05/01/2013 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/certicertval.asp or by calling(888)875-5790 VALIDATION NUMBER:107529507 U-26.3