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HomeMy WebLinkAboutMP22-076 7 40" Q,rrnftwmaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www jyebrook.org TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE September 20,2022 Vinpin Thomas Kovoor&Merin Thomas Kovoor 32 Valley Terrace Rye Brook,New York 10573 Re: 32 Valley Terrace, Rye Brook,New York 10573 Parcel ID#: 135.59-1-65 This document certifies that the work done under Mechanical Permit #22-076 issued on 5/13/2022 for the installation of a new heat pump,air handler and associated ductwork has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �4�6 Bkj� O Zm 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 : DATE: PERMIT# l\ 0 \' ISSUED: SECT: I�J BLOCK: LOT6 LOCATION: ` " � OCCUPANCY: �V uo SQ� ❑ VIOLATION NOTED THE WORK IS..y-ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION `o 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 itld M y = Ln H PN~G y i H I-�1 ON vi en rn 1�/I F�•� w � � L : o tocO: o cn A � w1240 z a 04 W Z ti d+z ° w 0 ~ s ,c 7 W i z Uz „� .n a 0***4 CA Vol I v Q a ar Z = 1 ~ O AZy a 8 A c a �"1 M M '� W cn w a °� .0 .0 _ h+y ^ � vvaa I� x o � � �wo z2 . CD eq w A H w z � � O W o �2 BUILDm D' NT D [ECEMED VIL � E OF RY OOK 938 KINGri�ETRYEBR ,NY 10573 MAY 13 2011� 4 VILLAGE OF RYE BROOK • r BUILDING DEPARTMENT APPLICATION FOR PERM IT TO INSTALL AND/OR REMOVE HEATING,VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: mp i-o y Approval Date: MAY 1 Permit Fee: $ c2Mad Approval Signature: Other: Disapproved: i tees are non-rcfundabl,� **xxxxxxxxxx**,�***xxxxxxx:xxxxxxxxaxx*ttx*tt:xx7i:l� {elf#3�rt�kxatet�s'xxaxx**xxxx**xxxxxx**xx*x*******:c***:ct�t REQUIREMENTS FOR REUSE D� IZsRiMT{i'6 t"NCATE 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 Rve Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U263/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. PIumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. �x,�xxxxx:r*xxxaxx*xxxxxxxxxxxxxxx:txxxxxxxxxxxxxxxxxxxx*xxxxxxxx*xxx*xxx�*�*,�*,�:�:�**�***�:�**xxxxx�xx Application dated, \2 2c Q_ is 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. 1. Address: V,2- 4/ )fir rACC SBL:13�� , / "���QS Zone: 2. Property Owner: �/. pr�l eo Ito t- Address: �Z V A`I Ir 6-1 Phone#: I/L/- 42 D - 3(o fo`\ Cell#: email: �/j e i �., d,ro o t t,e• 3. Contractor: Yl/1 1'Y1-If C Address: I Zel O A 1L 'JA- PC Q i w7,73 Phone#: C{ l(^ (e 2 1 ^01 LI O 1 Cell#: C1 emaillM MVCh,�M ice,1 l,t.ra c t_!wJ iq ca 4. Applicant: Address: Phone#: Cell#: email: 5. Scope of Work:New Installation{,:I_•Replacement( )•Removal( )•Other( ): 6. List Equipment: C C C--a e--�- 0 V_ a U-C(I- j rlent, 0O"=? 7. Location of Equipment: 4 A,\a 1,_r i^' .4 ()AS /Var gi � (- /4c� Ce Method of Installation/Removal(list all equipment needed to perform job): aW tr ILE A-4 V`°`J2 �e�- ....,ca(1,.lc_ - I�,-t•� �-•�1 i e.s� �ni �4--�-i� /�h f- �v�� D ✓�-�/ t 9/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: V Its M, K o V 0 o(2, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) a,� er states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the �O'-'en n cr, for the legal owner and is duly authorized to make and file this application. (indicate architect,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. h Sworn to before me this f 0�' Sworn to before me this l day of ?" ,20 22 . day of ,20 �- /L/-V /" IAN S LANDSMAN _ Signattile of Property Owner Notary Public of New York Signature of licantN� REGISTRATION#f0/LA6428985 V T P E N 1�0 0 G 1? COMMISSION EXPIRES 02/07/2028 �j/ l/ r,4 2 t 3 Print Name of Property Owner Prli4 ame of Applicant 1 No tiblic DIANNE ROJAS No Public --kp Notary Public-State of New York No.01 R06127547 Qualified in Westchester County My Commission Expires May 23,2025 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 S/1 v2o21 E31 Specification 2/12 1. Nomenclature E OD A 18 H - 4860 1 2 3 4 5 6 Brand E: Ecoer Product Series OD: Outdoor Condensing Unit Model Letters A: 208/230V,1 phase,60Hz SEER 18: 18SEER Series Type H: Heat Pump(R410A) Capacity 2436: up to 3Ton; 4860: up to 5Ton. 2. Dimensions AIR DISCHARGE: ALLOW 60" MINIMUM CLEARANCE CZ Allow a minimum of Air inlets louvered 20 in.clearance on -,�; � > panels allow 20" one side of access minimum clearance panel to a wall and 24 in. on the other side of it. NOTE:APPEARANCE OF UNIT'MAY VARY. ModelDimensions(In.[mm]) . _ H W L 2436 24-15/16[633] 29-1/8[740] 29-1/8[740] 4860 33-3I:)I } 29`1/8[7401 29-1�8[74QJ Manufacturer reserves the right to change at any time for specifications or designs without notice and incurring obligations. 05.2018 ESI Specification 3/12 3. Product Specifications :., Combination Indoor Unit Model EAHATN-24 EAHATN-36 EAHATN-48 EAHATN-60 Capacity ' Cooling(BTU/h) 23400 34200 45000 54000 Heating(BTU/h) 24000 36000 47000 54000 Operation limit 2 Cooling operation range 20-122F 20-122F 20-122F 20-122F Heating operation range -3-86F -3-86F -3-86F -3-86F Compressor R LA 17.5 17.5 24.0 24.0 LRA 45 45 58.1 58.1 Condenser Fan Motor Horse power(HP) 1/3 1/3 1/3 1/3 F LA 2.5 2.5 2.5 2.5 Refrigeration System Refrigerant Line Size Liquid Line Size("O.D.) 3/8" 3/8" 3/8" 3/8" Suction Line Size("O.D.) 3/4" 3/4" 7/8" 7/8" Refirigerant Connection Size Liquid Line Size("O.D.) 3/8" 3/8" 3/8" 3/8" Suction Line Size("O.D.) 3/4" 3/4" 7/8" 7/8" Cooling Expansion Device (Indoor Side) TXV TXV TXV TXV Heating Expansion Device EEV EEV EEV EEV Maximum Line Length 10OFT 10OFT 100FT 100FT Maximum Elevation Difference 50FT 50FT 50FT 50FT Charging Specifications Refrigerant Charge(R-410A,oz) 113 113 165 165 Superheat at Service Valve 8°F(±2°F) 8-F(±2°F) 8-F(±2°F) 8°F(±2°F) Sub-cooling at Service Valve 10°F(±2°F) 10°F(±2°F) 8°F(±2°F) 8°F(±2°F) Electrical Data Voltage-Phase-Hz 208/230-1-60 208/230-1-60 208/230-1-60 208/230-1-60 Minimum Circuit Ampacity 24.4 24.4 32.5 32.5 Max. Over-current Protection 4 40 40 50 50 Volts Range 187-253 187-253 187-253 187-253 Decibels dB(A)5 61 61 63 63 Equipment Weight(lbs) 157 157 192 192 Ship Weight(lbs)6 187 187 225 225 Remarks. 1 Tested and Rated in accordance with AHRI Standard 210/240. 2 The heating operating range can lower down to -22F by field setting(n01). 3 Wire size should be determined in accordance with National Electrical Codes. 4 Must use time-delay fuses or HACR-type circuit breakers of the same size as noted. 5 It may vary based on the actual installation status 6 Weight shown includes packaging Manufacturer reserves the right to change at any time for specifications or designs without notice and incurring obligations- 05.2018 EAMATN Specifications 3/6 2. Dimensions NOTE: 25" MINIMUM CLEARANCE IN THE FRONT OF THE UNIT FOR FILTER AND COIL MAINTENANCE. SUPPLY AIR HIGH VOLTAGE CONNECTION 7i8'. FLANGES ARE PROVIDED ! 1-23/64", 1-23132'DIA KNOCK OUTS FOR FIELD INSTALLATION V D 5.9"(149) R3'(2ll 3.9"(99) 0.43'(265 0 83'(21) 1.9"(49) 0.75'(19) 6.0"(54) BREAKER SWITCH (ELECTRIC HEATER ONLY) VAPOR LINE COPPER LIQUID LINE COPPER \ H 3.Q"(75.5 i F 3 O'C75 SJ E 1 7'(43 5) 394`t 21 14'(355) lES' D 50) 075"Ic — C R&ET INLET (FRONT VIEW) (RIGHT SIDE VIEW) Model Dimensions Inch [mm] Size "Win.[mm] "W'in.[mm] "D"in.[mm] "A"in.[mm] "B"in.[mm] "C"in.[mm] 24 46-1/2"[1180] 21"[533] 21"[533] 19-1/4"[489] 13-7/8"[352] 16"[407] 36 46-1/2"[11801 21"[533] 21"[533] 19-1/4"[489] 13-7/8"[352] 16"[407] 48 56"[14221 24-1/2"[622] 21"[533] 22-3/4"[578] 15-1/4"[388] 16"[407] 60 56"[1422] 24-1/2"[622] 21"[533] 22-3/4"[578] 15-1/4"[388] T 16"[407] Manufacturer reserves the right to change at anytime fur specifications or designs without notice and incuriinK obligations. OS201 8 EAHATN Specifications 4/6 . 3.Product Speci ications Model . .0 Capacity 1 Nominal Cooling(BTU/h) 23400 34200 45000 54000 Nominal Heating(BTU/h) 24000 36000 47000 54000 Blower Diameter 10" 11" 11" 11" Width 8" 105/8" 105/8" 105/8" Fan Motor Horsepower(HP) 1/3 1/2 3/4 3/4 Full Load Ampacity 2.4 4.1 6.0 6.0 Refrigeration System Refrigerant Line Size Liquid Line Size(O.D.) 3/8" 3/8" 3/8" 3/8" Suction Line Size(O.D.) 3/4" 3/4" 7/8" 7/8" Refrigerant Connection Size Liquid Line Size(O.D.) 3/8" 3/8" 3/8" 3/8" Suction Line Size(O.D.) 3/4" 3/4" 7/8" 7/8" Expansion Device TXV TXV TXV TXV Heating Expansion Device (ODU side) EEV EEV EEV EEV Coil Drain Connection(FPT) 3/4" 3/4" 3/4" 3/4" Decibels dB(A) High Speed 60 63 67 67 Medium Speed 57 61 63 63 Low Speed 53 58 61 61 Electrical Data Voltage-Phase-Hz 208/230-1-60 208/230-1-60 208/230-1-60 208/230-1-60 Minimum Circuit Ampacity 2 3.0 5.2 7.5 7.5 Max. Over-current Protection 3 15 15 15 15 Volts Range 187-253 187-253 187-253 187--253 Air Filter Air Filter Size(in.) 20x19-1/2 20x19-1/2 23x20 23x20 Weight(lbs) Net Weight(lbs) 119 121 172 172 Ship Weight(lbs) 150 154 207 207 Remarks: 1.Tested and rated in accordance with AHRI Standard 210/240. 2.Wire size should be determined in accordance with National Electrical Codes. 3.Must use time-delay fuses or HACR-type circuit breakers of the same size as noted. Manufacturer reserves the right to change at any time fir specifications or designs without notice and incurring obligations. 05.2018 , s O N N W N W a M I H y LO > C- C', � ■, en L �7 ? en Ln a � • MM � � � A O W w � � +�„� A x w �L v �Oc� oZx � � A � z W Z z w en 04 MM� 00 oc 0-"4 C7 a x V z x oz Z �, w w a W o z w 5 H ►7'� U � U U � U g a ; a o ►n F 8 ►-� V O W z v s, � `� • s k �E��� R BUIL011 l�E�'AR'TMENT J U N - 1 2022 DD VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.yydgook.org ELECTRICAL PERMIT APPLICATION Westchester unty Master Electricians License Required FOR OFFICE USE ONLY � —0 EP#: '1 04 Approval Date: Permit Fee: $ /50�/"D Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, t, 112 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or emove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: ', Z c.Z SBL: Zone: ,e— 7 2.Property Owner: V , e—h k-o V o o r Address: Sci Y^L Phone#: Cell#: 3 6 6 1 email: 3.Master Electrician: V,T3�Address: Z t S Lic.#:/6�f Phone#: Z u;— g 6 0—14 yXell#:c?,o 3 J}—S 3 t'3 email: r q- u y\,lo& C CompanyName:F C-'1>4_ e e-CA-r'�c, (.�gAddress: /6 CT 0G1)0"1 4.Proposed Electrical Work/Fixture Count: 1A) 14;r /4.,J l t c—, V\J c v\S STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state 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,contractor,agent,attorney,etc.) The undersigned fittther states 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 Wore me this day of ,20 day of V ,20�_ Signature of Property Owner S j�aturre / C�— _ _ `�ucant r 2 J tk i`n r-n,A 0 C,-V\-A-Q Print Name of Property Owner Name of Applican� Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County Commission Expires January 29,20 Z 8/1 21202 1 Westchester Rockland Electrical Inspection Services, Inc. a Phone: 914-347-3595 DO NOT WRITE HERE—FOR OFFICE USE ONLY P.O. Box 208 F ' 1 -347-3596 Carmel NY 10512 TEMP a DATV t '®7 .- CITY OR VILLAGE ZIP CODE TOWNSHIP NTY C r-.- k- /G57 3 weSk CA,CS}.t� STREET AND NO.OR ROAD POLE NUMBER 3 Z Ja 11C --c rr0.ce- BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT NAME BUILDING OCCUPANCY k ? e �-- oVooT OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBE i'c0llUot 'r/y-- v--S667 CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER l LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT IN 1s'FL. Li Ll 2-FL. J U N 202 3 FL. BU LD_ItVG__ REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: — --�M�' a r �N e-�d ter w/ E le c,{ IYN. aw- ,�w A L t,Al\ -A,-\ j (, r. -F ,\ a th C / In+- /- THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS,INC.IS NOT LISTING.LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW L] ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SEFMCE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPUCATIO SIGNATUR OF APPLICANT -- STREET ADDRESS TELEPHONE NO. L.: -;'G w rv\ l ( C_j CRY Op 7ST OFFICE, J CA �� jJ0 9 7 O LICENSE NO.WHEN APPLICABLE /4 Z/ a 00 1 fN a W \ \ M 0 00 00 00a U hl i tc r. W M..a� �O N ^ ►ir x V a o4 H CA ,� o V v w X w Oc� rj) Uz ~ � ON V � a V z W V 9a x it oZ H r W � '4 E- � 3 w d a! Ln _o ° $ a a NV o w z v 601, z Q O z Ca ao � a w w a z f3Rnv� �---------� i ( I BUILDING bEPARTMENT � i LI !! VILLAGE OF RYE BROOK AI�G - 9 2Q72 1-01 938 KING STREET RYE BROOK,NY 10573 I VILLAGE OF RYE BROOK ,(914)939-0668 BUILDING [3EPARTMENT w*w&ftook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required J f FOR OFFICE USE ONLY BP-g- �`7/�� —(J'7 lO EP#: Approval Date: AUG:1 0 011 Permit Fee: $ 16 0 Approval Signature: Other: Application dated, Y'% — is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. p ' ^� 1.Address: SBL:� i�/—/�C[/ S Zone: 2.Property Owner:_ i p , Y\ o Address: Phone#: c- 3 - lL -1 Cell#: Lo'i - 9'0- L L i email: 3.Master Electrician: Address: /C Lic.#: /6`/`( Phone 910 - 1 L`-13 Cell#: -'-,3 -y y 3 - S;e 3 email: cv,, Company Name: I . C_ n e l c_�� Address: 4.Proposed Electrical Work/Fixture Count: w ►'ti In e-w 1 v, r-4" c 5.3'd Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Fe M c.,�cd o C-,o v,k4- being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state 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,contractor,agent,attorney,etc.) The undersigned further states 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 regulatio . Sworn to before me this Sworn to befo e me this day of ,20 day of - ,20 Z Signature of Property Owner Si ature of App icaant �vx-�e Print Name of Property Owner pn,'M-� Name of Applica Notary Public Notary W0i MELILLO Notary Public,State of New York No.01ME616OO63 Qualified in Westchester County /23/2022 G mmission Expires January 29,20 STATEWIDE INSPECTION SERVICES, INC. Service With haegrily 121 Main Street,Fishkill, NY 12524 1 email:I • SWIS JOBAPPLICATION8. 12.7224 I fax9l4.219.10621 • • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement ❑ 1 st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Q Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information LAU�.- 9 2n9 ! Ll VILLAGE OF RYc BROOK BUILDING DEPARTMENT This application Is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed you are authorized to make the Inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# / .il Phone# State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 � r 845 4-219 1 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: officeC&swisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: F. Conte Electric Corp Vipin Kovoor Ferdinando Conte 32 Valley Terrace 216 Saw Mill Road Rye Brook, NY 10573 Stamford,CT 06903 Located at:32 Valley Terrace, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-181 Certificate Number: 2022-4922 Building Permit Number: MP22-076 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:32 Valley Terrace, Rye Brook, NY 10573 The Attic and Exterior were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 24th day of August 2022. Name Quantity Rating Circuit Type HVAC System 01 I Ito Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. ACC DATE II CERTIFICATE OF LIABILITY INSURANCE 05/1 YYYY) �� osil v2ozz 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 NAME: Hiscox Inc. PHONE ($�)202 D7 AAX IC No: 5 Concourse Parkway E-MAILDRE Suite 2150 SS: contact@hiscox.com Atlanta GA,30328 INSURERS AFFORDING COVERAGE NAIC#_ INSURER A: Hiscox Insurance Company Inc 10200 INSURED P&M Mechanical, inc INSURER B: 129 Oak St INSURERC: Port Chester, NY 10573 INSURER D: INSURER E: 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 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 ADDL SUBR - - - LTR TYPE OF INSURANCE INSID WVD I POLICY NUMBER MMIDD/YYYYI fMM/DDIYYYYl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE �OCCUR DAMAGE TO ENTER PREMISES Ea occurrence $ 100,000 MED EXP(Any one ) $ 5,000 A N UDC-2333304-CGL-21 08/09/2021 08/09/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESSLIAB Id CLAIMS-MADE AGGREGATE $ _TIED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N A E ER _ ANYPROPRIETORlPARTNER/EXECUTIVE EL EACH ACCIDENT E OFFICER/MEMBEREXCLUDED7 ❑ NIA _ (Mandatory b NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) HVAC installation CERTIFICATE HOLDER CANCELLATION Village of rye Brook 938 King St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Rye brook 10573 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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 RK IONEW Workers' A E Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured (use street address only) 1 b. Business Telephone Number of Insured P AND M MECHANICAL INC (914)356-4311 129 OAK ST PORT CHESTER NY 10573A694 1c. NYS Unemployment Insurance Employer Registration Number of 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 45-3133874 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Hartford Accident and Indemnity Company Village of Rye Brook 22357 938 KING ST 3b. Policy Number of Entity Listed in Box 1a" PORT CHESTER NY 10573-1226 76 WEG AD9BHX 3c Policy effective period 10/25/2021 to 10/25/2022 3d. The Proprietor, Partners or Executive Officers are ❑ Included. (Only check box if all partners/officers included) X 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 frorn 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 Worker's 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 Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved by: , {i,n�nePr I/n�.,xr ' 05/12/2022 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: (877) 287-1312 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) Form WC 88 31 21 F Printed in U.S.A. www.wcb.ny.gov Page 1 of 2