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HomeMy WebLinkAboutMP22-066 . 19 406 afU'I.IUQII aW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.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 11,2022 VRT Rye Brook LLC 1200 King Street Rye Brook,New York 10573 Re: 1200 King Street,Rye Brook, New York 10573 Parcel ID#: 124.73-1-1 This document certifies that the work done under Mechanical Permit #22-066 issued on 4/22/2022 for the installation of two new hot water heaters have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �yE BRC�uk ,,/�' 19132•��O 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: t' l r-)4 Q--, . DATE: S 11 1-,7Z_ PERMIT# Y `�2 !/ 0 � ISSUED:� 22 � VSECT:I'Zql 7-3 BLOCK: � LOT: t LOCATION: y 00-r rf- R-S / �- �"L OCCUPANCY: + Z` ❑ 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 ❑ ROSS CONNECTION [] FINAL OTHER N N v ■ s N N C v N N N w s t \ y x r� CL V VJ ■ � LV�]1 � y v ,b � y cul E ■ F4 k U "' C � : 1 A o � o `3 4,, O N MM ` O © en O A ° o - t Q 9 L 6J b, � O`er a C d CAe r j1:4 Iwo (� N N v o `C °�,. p, p■�I _ /� Q QJ � � rl � A Q,' .b pa� Pam• W �''. v 3zv � 4,b CO r'�1 w O Fed CIN z t��i O ® I iij w �" 00 0 i H W U � u -0 ." r MCI ■ 0 -0 h� 0001 G1 d' cn 5 -0 � ro Z �, U N a A v m mow OC 14 ON W i U v Z o V►j � � U U � o lam+ u. P4 0OvvvyU Q Z °z Owl r� w O a � r-+ 0 �ilmi *41 a 1.41 Volx � - BUILDING DEPARTMENT R IE C IE`" �IE VILLAGE OF RYE BROOK APR 2 0 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK MM.ryablook,org BUILDI14G DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: OC6 Approval Date: APR 2 2 10 Permit Fee: $ �0�� Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLUNCE: I Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 0 Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#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, Z41 ZLis hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. (' I. Address: k aA J-� SBL: 1 r 3 `f Zone: ress: 2. Property Owner: r C I f S Add I 'rR (� i Phone#: J ILI o'��, (� -q 0 0 Cell#: email: L 3. Contractor: CV0 PlVobml Address: S C K 5�- Noftiwo:: (I) 0764 Phone#: a01- 660" - - N _ Cell#: email:T� C-k D(f�) W- Qo Plumb"�Com 4. Applicant: Address: �3 i 8 i rc� (_M rc-, Phone#: K Cell#: mLi- �Mq- email: See' Oa}xo C,.rt) 5. Scope of Work:New Installation{ ) 'Replacement •Removal{ )•Other--------------- ( ): 6. List Equipment: c �4rr � Icx }ten ks /e C rU 0 Gas 7. Location of Equipment: Ln L2r Oz n 8. Method of Installation/Removal(list all equipment needed to perform job): l 8/12no21 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 5 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signor the applicant) and further states that a 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 arc ect,contractor,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 efore a this � Sworn to before me this day of (► ,20 2 7i day of 'r 20 Sign a of Property 97er Signature of Applicant Print Name of Pro erty er Print Nam of Applicant otary Public rotary Pub c boW%SStdA 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 ,aco CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/VYYY) �./ 04/20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ROBERT T.KIRKWOOD,INC. PHONE (914)769-9070 FAx (914)769-4706 91 Washington Avenue E-MAIL Ext AIC,No): g ADDRESS: certificates@kirkwoodinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Pleasantville NY 10570 INSURERA: Harleysville Insurance Company 23582 INSURED INSURER B: Wesco Insurance Co. 25011 Delpo Plumbing&Heating Corp. INSURER c: 75 Oak Street INSURER D: Unit 101 INSURER E Norwood NJ 07648 INSURER F COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 AUUL15UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE OCCUR DAMAGE TO RENTE17-PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A SPP0000004088AN 07/01/2021 07/01/2022 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2`000,000 X POLICY PRO PRODUCTS-COMP/OP AGG $ JECT ❑LOC 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED BA0000003964AN-1 07/01/2021 07/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ X UMBRELLA LIAR I X OCCUR tAG! H OCCURRENCE $ 5,000.000 A EXCESS LIAB CLAIMS-MADE CMB0000004087AN 07/01/2021 07/01/2022 REGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? B �Y N/A KWC1253993 07/01/2021 07/01/2022 E.LEACHACCIDENT $ (Mandatory In NMI If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Rye Brook Building Department is additional insured with respects to permits and licenses. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Rye Brook Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r • NW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Delpo Plumbing & Heating Corp. 201-660-7743 75 Oak Street Unit 101 1 c.NYS Unemployment Insurance Employer Registration Number of Norwood NJ 07648 Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e., a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 264306662 2. Name and Address of Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Wesco Insurance Co. Rye Brook Building Department 3b.Policy Number of Entity Listed in Box 1a" 938 King Street KWC1253993 Rye Brook NY 10573 3c. Policy effective period 07/01/2021 to 07/01/2022 3d.The Proprietor, Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) N 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 1a"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: Robert Kirkwood (Print name of authorized representative or licensed agent of insurance carrier) Approved by: it &0�/( 04/20/2022 (Signature) (Date) Title: Principal Telephone Number of authorized representative or licensed agent of insurance carrier: 914-769-9070 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