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HomeMy WebLinkAboutMP22-083 blame t1 J`� tc ca4yJ, �• . 1 4016 af'InUlF1L at* 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 June 13,2022 Chad Charney&Brittany Charney 2 Wilton Circle Rye Brook,New York 10573 Re: 2 Wilton Circle,Rye Brook,New York 10573 Parcel ID#: 135.66-1-45 This document certifies that the work done under Mechanical Permit #22-083 issued on 5/24/2022 for the installation of a new condenser and a new air handler has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �yE BRcb, '9a2 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 :— �' 1 l `-�� �� `�0� DATE: PERMIT# v� ISSUED:`+ SECT: Qk (C(CLOCK: % LOT: LOCATION: AAc 1 �WCOCCUPANCY: 7. c �z ❑ VIOLATION NOTED THE WORK IS... ACCEPTED U KEJECTED/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 �i-FINAL �❑ OTHER m i = M M y w a = h+•l � N Ln r, a�i GL U V 1 ■ a a �. pq CA ■ a W Ln .Tr y F+y m e a y n CZ O o F4 Ou LL x W n ° � ° [� _ cn s lyrCISCk � W h A v © 44 'O'L, 0 04% v s MCI G1 oQ O = a tia•a z � U � U CQ U •�"� c V A w aOC w w W ° y Vu z COD. 0� U � � � _ U W O a p o o I-d v o O v � � � W I o Z W A 0 � .~ BUILDING DEPARTMENT u �/ VILLAGE OF RYE BROOK 938 KING STUET RYE BRUox,NY 10573 MAY 2 3 2022 (914)9394668 VILLAGE OF RYE BROOK wwwxyebrook.-on BUILD I NG DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING E UIPMENI T FOR OFFICE USE ONLY: PERMIT#: �! dam'D© Approval Date: Permit Fee: $ Co—f b Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE 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 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,6't)3'c)4 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. ` f� Q 1. Address: \'� �\�' SBL:r� 1 Zone: t — 0 2. Property Owner: Address: ZW ''►` Phone#: I � — �]:�Cell#: email: 3. Contractor:`"1j'Ek `�o,r s s�' [��� ��-- Address: Phone#: — 3 S — 3 �1 Cell#: Cam` — ` �i'{� � email 4. Applicant: I Y:)V-%SA Address: Ifs Phone#: Cell#: email: 5. Scope of Work:New Installation'+Replacement( )•Removal( )•Other y( 6. List Equipment: _ \y1dy. u • 7. Location of Equipment: Al 8. Method of Installation/Removal(list aD,,equipmcntd needed job): 11 4 811=021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: HAD CrOr"C�y ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signifig as the applicant) and further states that(s)he is a legal owner of the property to which this application pertains,or that(s)he is the nt(t>-i 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. Sworn to before me this h Sworn to before me this A day of 20 �_Z day of iA4, 20 coo 01� Signature of Property OwAer gnature of Applicant Print Name perry Owder not Name of Applicant No Notary IAN S LANDSMAN LAN S LANDSMAN public of New York REGISTRATION OOJLA6428985 REGISTRATION NOILA6428985 COMMISSION EXPIRES 02/0712026 COMMISSION EXPIRES 02/07/2= 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 e Um LC \ �« m . � � � - . ©® � . ° • 2D X 2 Wilton C|[ Building ►#TRITEC H MECHANICAL 11C Proposal Date Proposal N 3/15/2022 17241 Tel : 203-359-3399 Name/Address E-mail Chad Charney Info@tritechmechanical.com 2 Wilton Circle Rye Brook Ny CT License#: 392970 Total The following proposal is for the installation of a complete two and half ton central ac system for the residence of 2 Wilton Circle, Rye Brook Scope of Work: •Install a 2.5 Ton Central AC system to serve the second floor and one drop to the kitchen. •Install the Air Handler and a complete supply and return ductwork system in the attic. -Suspend Air Handler from the roof rafters and install an emergency drain pan and shutoff switch. -Install all new supply and return registers, first floor ductwork will be run through the second-floor closet. -Install a completely new line set and drain line. Pressure test line set for 24 hours. Line set will run exposed on the outside wall with a proper wall sleeve to hide it. -Provide and install all necessary Line and low voltage wiring. -Install condensing unit on the front left side of the house. Set condensing unit on a prefab composite pad. -Install (1) new digital. Programmable thermostat -Provide a permit and all inspections. *Start and test. Equipment: 1)American Standard 14 Seer Condensing Unit M# 4A7A4030 •(1)American Standard Variable Speed Air Handler M#TEM4AOB30S3 I SA •(1) Honeywell F-100 Air Filter •(1) Honeywell M#Th8321 RI 001 Labor and Materals 12,350.00 price guaranteed for 30 days your signature and date indicates acceptance of contract and entitlement of a 3 Subtotal day right to rescind. Signature Date Sales Tax (6.35%) Tri Tech Rep Date Total Page 1 0TRzTECH....... Proposal Date Proposal# 3/15/2022 17241 Name/Address Tel : 203-359-3399 E-mail : Chad Charney Info@tritechmechanical.com 2 Wilton Circle Rye Brook Ny CT License#: 392970 Total Breakdown: Labor and Material Cost$11,900.00 Permit Fee $450.00 Total Labor and Material. $12,350.00 Optional Work: Install a set of aluminum insulated attic pull downstairs in the hallway. Cost for labor and material $ 1,200.00 Note: Painting by others. your signature and date indicates acceptance of contract and entitlement of a 3 Subtotal $12,350.00 day right to rescind. Signature Date Sales Tax (6.35%) $0.00 Tri Tech Rep Date Total $12,350.00 Page 2 shtodard HEATING & AIR CONDITIONING Submittal Split System Cooling 4A7A4030L1000A/B I IIII ]]llllllllll �iiii([[[[[[[[[[ IIII [[[fff[[[[[[[[ 11111111111111J1 1111111111J1 I�� JlJlJ1111111111 ]JJIJIIJJIIIJIJI,, Note:"Graphics in this document are for representation only.Actual model may differ in appearance." January2022 4A7A4030L-SUB-1 G-EN AAW?40 NShuidmpid HLA1 ING & AIR CON[) [ 110^: i ♦G B I C SERVICE PANEL ELECTRICAL AND REFRIGERANT COMPONENT CLEARANCES PER PREVAILING CODES. TOP DISCHARGE AREA SHOULD BE UNRESTRICTED FOR AT LEAST 1524 IS FEET) ABOVE UNIT. UNIT SHOULD BE PLACED SO ROOF RUN-OFF WATER DOES NOT POUR DIRECTLY ON UNIT, AND SHOULD BE AT LEAST 305 (12') FROM WALL AND ALL SURROUNDING SHRUBBERY ON TWO SIDES. OTHER TWO SIDES UNRESTRICTED. DIE ELECTRICAL SERVICE PANEL K 25 111 A 22.2 I7/81 DIA. HOLE LOW VOLTAGE 28.6 11-1/BI DIA. N.O. WITH 22.2 17/8) DIA. HOLE IN CONTROL BOY BOTTOM FOR ELECTRICAL POWER SUPPLY H F N,O. FOR ALTERNATE 0 ELECTRICAL ROUTING L IOUID LINE SERVICE VALVE. 'E' I.D. FENALE BRAZE CONNECTION WITH 1//• SAE GAS LINE 1/4 TURN BALL SERVICE VALVE. 'D' FLARE PRESSURE TAP FITTINGS. I.D. FEMALE BRAZED CONNECTION WITH 1//• SAE FLARE PRESSURE TAP FITTING. Model Base A B C D E F G H ] K 4A7A4030L 3 730 829 756 3/4 3/8 127 76 197 60 508 (28-3/4) (32-5/8) (29-3/4) (5) (3) (7-3/4) (2-3/8) (20) SOUND POWER LEVEL Model A-Weighted Sound Full Octave Sound Power[dB] Power Level[dB(A)] 63 Hz* 125 Hz 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz::I: Hz 4A7A4030L 71 73 73 72 69 68 60 52 45 Note:Rated in accordance with AHRI Standard 270-2008*For reference only 2 4A7A4030L-SUB-1 G-E N HEATING & AIR CONDITIONING Product Specifications OUTDOOR UNIT(a)(b) 4A7A4030L1000A 4A7A4030L1000B POWER CONNS.—V/PH/HZ(c) 208/230/1/60 208/230/1/60 MIN.BIRCH.CIR.AMPACITY 17 14 BR.CIR.PROT.RTG.—MAX.(AMPS) 25 25 COMPRESSOR DURATIONTM-SCROLL DURATIONTM-SCROLL NO.USED—NO.STAGES 1 VOLTS/PH/HZ 208/230/1/60 208/230/1/60 R.L.AMPS(e)—L.R.AMPS 12.8—67.8 10.9—62.6 FACTORY INSTALLED START COMPONENTS(a) NO(Uses BAYKSKT263) NO(Uses BAYKSKT263) INSULATION/SOUND BLANKET NO NO COMPRESSOR HEAT NO NO OUTDOOR FAN PROPELLER PROPELLER DIA.(IN.)—NO.USED 23—1 23—1 TYPE DRIVE—NO.SPEEDS DIRECT—1 DIRECT—1 CFM @ 0.0 IN.W.G.(r) 2800 2800 NO.MOTORS—HP 1-1/8 1-1/8 MOTOR SPEED R.P.M. 825 825 VOLTS/PH/HZ 200/230/1/60 200/230/1/60 F.L.AMPS 0.77 0.77 OUTDOOR COIL—TYPE SPINE FINTM SPINE FINTM ROWS—F.P.I. 1-24 1-24 FACE AREA(SQ.FT.) 16.25 16.25 TUBE SIZE(IN.) 3/8 3/8 REFRIGERANT LBS.—R-410A(O.D.UNIT)(9) 4 LBS.,11 OZ 4 LBS.,11 OZ FACTORY SUPPLIED YES YES LINE SIZE—IN.O.D.GAS(h) 3/4 3/4 LINE SIZE—IN.O.D.LIQ. 3/8 3/8 CHARGING SPECIFICATIONS SUBCOOLING 10°F 10°F DIMENSIONS HXWXD HXWXD CRATED(IN.) 34 x 30.1 x 33 34 x 30.1 x 33 WEIGHT SHIPPING(LBS.) 183 183 NET(LBS.) 156 156 (a) Certified in accordance with the Air-Source Unitary Air-conditioner Equipment certification program,which is based on AHRI standard 210/240. (b) Rated in accordance with AHRI standard 270. (c) Calculated in accordance with Natl.Elec.Codes.Use only HACR circuit breakers or fuses. (d) This value shown for compressor RLA on the unit nameplate and on this specification sheet is used to compute minimum branch circuit ampacity and max. fuse size.The value shown is the branch circuit selection current. M Use start components only when compressor is found to enter locked rotor condition and will not start or when lights dim at compressor start.No means no start components.Yes means quick start kit components.PTC means positive temperature coefficient starter.Optional kit shown. M Standard Air—Dry Coil—Outdoor (9) This value approximate.For more precise value see unit nameplate. (h) Max.linear length 60 ft.;Max.lift—Suction 60 ft.;Max.lift—Liquid 60 ft.For greater length consult refrigerant piping software Pub.No.32-3312-0*(* denotes latest revision). 4A7 A4030L-SUB-1 G-E N 3 Aw�e4w S7itgd d,, HEATING & AIR CONDITIONING Mechanical Specification Options General Compressor The outdoor condensing units are factory charged with The compressor features internal over temperature and the system charge required for the outdoor condensing pressure protection.Other features include:Centrifugal unit,ten(10)feet of tested connecting line,and the oil pump and low vibration and noise. smallest rated indoor evaporative coil match.This unit Condenser Coil is designed to operate at outdoor ambient temperatures as high as 115°F.Cooling capacities are The outdoor coil provides low airflow resistance and matched with a wide selection of air handlers and efficient heat transfer.The coil is protected on all four furnace coils that are AHRI certified.The unit is certified sides by louvered panels. to UL 1995.Exterior is designed for outdoor Low Ambient Cooling application. As manufactured,this system has a cooling capacity to Casing 55°F.The addition of an evaporator defrost control Unit casing is constructed of heavy gauge,galvanized permits operation to 40°F.The addition of an steel and painted with a weather-resistant powder evaporator defrost control with TXV permits low paint finish.The corner panels are prepainted.All ambient cooling to 30°F. panels are subjected to our 1,000 hour salt spray test. The addition of the BAYLOAM107A low ambient kit Refrigerant Controls permits ambient cooling to 20°F. Refrigeration system controls include condenser fan, Thermostats—Cooling only and heat/cooling(manual compressor contactor and low and high pressure and automatic change over).Sub-base to match switches.A factory supplied,field installed liquid line thermostat and locking thermostat cover. drier is standard. 4 4A7A4030L-SUB-1 G-EN ,�ticericaM �S�da�-d. HEATING & AIR CONDITIONING About American Standard Heating and Air Conditioning American Standard has been creating comfortable and affordable living environments for more than a century. For more information,please visit www.americanstandardair.com. c@us LISTED The AHRI Certified mark indicates company participation in the AHRI Certification program.Far verification of individual certified products,go to ahridirectory.org. The manufacturer has a policy of continuous data improvement and it reserves the right to change design and specifications without notice.We are committed to using environmentally conscious print practices. 4A7A4030L-SUB-IG-EN 31 Jan 2022 Supersedes 4A7A4030L-SUB-IF-EN (April 2020) 02022 American Standard Heating and Air Conditioning Submittal 2-1 /2 Ton Convertible Air Handler TEM4AOB3OS31 SC a o . o March 2022 TEM4AOB30-SUB-1 E-EN Outline Drawing MINIMUM UNIT CLEARANCE TABLE I.10 12.13 7.11 I.N SERVICE CLEARANCE (RECOMMENDED) SIDES 2' FRONT 21' BACK 0' INLET DUCT 1' 9 C OUTLET DUCT NIA NOTE:THIS UNIT IS APPROVED FOR INSTALLATION CLEARANCES TO COMBUSTIBLE MATERIAL AS STATED ON THE UNIT RATING NAMEPLATE L Of $2.00 !.I2 2.12 � s.is Q Y LD f.N $2.00 $I.I! Y A $I.ss nr I.7) O O T 1{ O 2 IlC{ O H • Y f.lf 0 4.)2 I.)7 I 3.9 el I � � zls E F D L.E PRODUCT DIMENSIONS Air Handler Model A B C D E F H Flow Gas Line Control Braze TEM4AOB3OS31SC 45.02 18.50 16.50 16.75 4.68 7.33 18.34 TXV 3/4 All dimensions are in inches 2 TE M4AO B30-SUB-1 E-E N Product Specifications MODEL TEM4A0B30S31SC Coupling or Conn.Size— 3/8 RATED VOLTS/PH/HZ 208-230/1/60 in.Liq. RATINGSca) See O.D.Specifications DIMENSIONS H x W x D Crated(In.) 46 x 21 x 24 INDOOR COIL—Type Plate Fin Rows—F.P.I. 3-14 Uncrated 45-1/8 x 18-1/2 x 21-1/8 WEIGHT Face Area(sq.ft.) 4.37 Tube Size(in.) 3/8 Shipping(Lbs.)/Net(Lbs.) 116/110 0) These Air Handlers are A.H.R.I certified with various Split System Air Refrigerant Control TXV Conditioners and Heat Pumps(AHRI STANDARD 210/240).Refer to the Split System Outdoor Unit Product Data Guides for performance Drain Conn.Size(in.)(b) 3/4 NPT data. (b) 3/4"Male Plastic Pipe(Ref:ASTM 178S-76) DUCT CONNECTIONS See Outline Drawing (1) Remote filter required. INDOOR FAN—Type Centrifugal Minimum Airflow CFM Diameter-Width(In.) 11 X 8 - TEM4AOB3OS31SC No.Used 1 H Drive-No.Speeds Direct-3 eater Minimum Heat Speed Tap With Heat Without Heat CFM vs.in.w.g. See Fan Performance Table Pump Pump No.Motors—H.P. 1-1/3 BAYHTR1504BRK, Motor Speed R.P.M. 825 BAYHTR1504LUG, Low LowBAYHTR1505BRK, Volts/Ph/Hz 208-230/1/60 BAYHTR1505LUG BAYHTR1508BRK, F.L.Amps 2.0 BAYHTR1508LUG, BAYHTR1510BRK, Low Low FILTER BAYHTR1510LUG, Filter Furnished?(c) No BAYHTR351OLUG REFRIGERANT BAYHTR1517BRK High Low Med Low R-410A Ref.Line Connections Brazed BAYHTR3517LUG Coupling or Conn.Size— 3/4 in.Gas TE M4AOB30-SUB-1 E-E N 3 Heater Pressure Drop Table TEM Air Handler Models Number of Racks Heater Racks Airflow 1 2 3 4 Heater Model No.of Racks CFM Air Pressure Drop-Inches W.G. BAYHTR1504 1 1800 0.02 0.04 0.06 0.14 BAYHTR1505 1 1700 0.02 0.04 0.06 0.14 BAYHTR1508 2 1600 0.02 0.04 0.06 0.13 BAYHTR1510 2 1500 0.02 0.04 0.06 0.12 BAYHTR3510 3 1400 0.02 0.04 0.06 0.12 BAYHTR1517 3 1300 0.02 0.04 0.05 0.11 BAYHTR3517 3 1200 0.01 0.04 0.05 0.10 BAYHTR1523 4 1100 0.01 0.03 0.05 0.09 BAYHTR1525 4 1000 0.01 0.03 0.04 0.09 900 0.01 0.03 0.04 0.08 800 0.01 0.03 700 0.01 0.02 600 0.01 0.02 4 TE M4AOB30-SUB-1 E-F N Performance and Electrical Data 1. See Product Data or Air Handler nameplate for approved combinations of Air Handlers and Heaters. 2. Heater model numbers may have additional suffix digits. Table 1. Air Flow Performance TEM4AOB3OS31SC(a) EXTERNAL STATIC AIRFLOW (in w.g) Speed Taps—230 VOLTS Speed Taps—208 VOLTS High Med Low t High Med Low t 0.1 1391 1305 1059 1338 1146 902 0.2 1305 1231 1029 1257 1098 868 0.3 1203 1138 970 1159 1027 817 0.4 1083 1027 884 1044 935 753 0.5 948 899 769 913 823 664 0.6 795 752 626 766 692 0.7 626 587 603 542 1. Values are with wet coil,no filter,and no heaters 2. CFM Correction for dry coil=Add 3% 3. t=Factory setting W For the TEM4AOB30S31SC in downflow applications,airflow must not exceed 1200 cfm due to condensate blow off. TEM4A0B30-SUB-1 E-EN 5 Performance and Electrical Data Table 2. Electrical Data TEM4AOB3OS31SC 240 Volt 208 Volt No.of Heater Model No. Circuits/ Capacity Heater Minimum Maximum Capacity Heater Minimum Maximum Phases Amps per Circuit Overload Amps per Circuit Overload kW BTUH Circuit Ampacity Protection kW BTUH Circuit Ampacity Protection No Heater 2.0* 3 15 2.0* 3 15 BAYHTR1504BRK 1/1 3.84 13100 16.0 23 25 2.88 9800 13.8 20 20 BAYHTR1504LUG BAYHTR1505BRK 1/1 4.8 16400 20.0 28 30 3.6 12300 17.3 24 25 BAYHTR1505LUG BAYHTR1508BRK 1/1 7.68 26200 32.0 43 45 5.76 19700 27.7 37 40 BAYHTR1508LUG BAYHTR1510BRK 1/1 9.6 32800 40.0 53 60 7.2 24600 34.6 46 50 BAYHTR1510LUG BAYHTR1517BRK Circuit 1 cal 9,6 32800 40.0 53 60 7.2 24600 34.6 46 50 2/1 BAYHTR1517BRK- 4.8 16400 20.0 25 25 3.6 12300 17.3 22 25 Circuit 2 BAYHTR3510LUG 1/3 9.6 32800 23.1 31 35 7.2 24600 20.0 27 30 BAYHTR3517LUG 1/3 14.4 49200 34.6 45 3050 10.8 36900 30.0 40 40 BAYHTR1517BRK with single circuit 1/1 14.4 49200 60.0 83 90 10.8 36900 51.9 73 80 power source kit BAYSPEKT201A *=Motor Amps ta) MCA and MOP for circuit 1 contains the motor amps 6 TEM4A0B30-SUB-1 E-EN Features and Benefits • Painted metal cabinet with captured foil face • Draw Through Design insulation • Horizontal Drain pan • 2%or less air leakage • Fused 24V Power • R-4.2 Insulating Value • 3 year warranty • Multi-Position UP/Down Flow,Horizontal Left/Right . 10-year warranty registered • ALL Aluminum Coil • Optional extended warranty available • Electric Heaters with polarized plug connections (sold as accessory) Important:Condensate management kit is required for • R-410A Thermal Expansion Valve all 5 ton air handler models installed in • ECM Motor(3.5—5 Ton Models) downflow applications. • Low Voltage Pigtail Connections TE WA0 B30-SUB-1 E-E N 7 About Trane and American Standard Heating and Air Conditioning Trane and American Standard create comfortable,energy efficient indoor environments for residential applications. For more information,please visit www.trane.com or www.americanstandardair.com. C UL US LISTED The manufacturer has a policy of continuous data improvement and it reserves the right to change design and specifications without notice.We are committed to using environmentally conscious print practices. TEM4AOB30-SUB-1 E-EN OS Mar 2022 Supersedes TEM4AOB30-SUB-ID-EN (Apri12020) ©2022 1 � DATE(MM/DD/YYYY) ACORN CERTIFICATE OF LIABILITY INSURANCE �i 5/13/2022 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 John M. Glover Agency PHONE Sarah Gjidoda' FAX P.O. Box 700 •203-956-2458 Arc No:203-857-7848 Norwalk CT 06852 E oRess: sgiidodaj@jmA.com INSURER(S)AFFORDING COVERAGE NAIL0 INSURER A:Hartford Insurance Group 914 INSURED TRITECH-01 Tri Tech Mechanical LLC INSURER a:Ohio Casualty Insurance Company 24074 47 West Main Street INSURERC:Ohio Security Insurance Company 24082 Stamford, CT 06902 INSURER0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:464134206 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP ILTR POLICY NUMBER M/DD MMOD LIMITS C X COMMERCIAL GENERAL LIABILITY BKS60888711 3/19/2022 3/19/2023 EACH OCCURRENCE E 1,000,000 CLAIMS-MADE IJ OCCUR PREMISES T RENTED PREMISES Ea occurrence i 300,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000.000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I " I jE Q X LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE DMIT $ Ea accident ANY AUTO BODILY INJURY(Per parson) S OWNED SCHEDULED Peraocident AUTOS ONLY AUTOS BODILY INJURY( ) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ B X UMBRELLA LAB X OCCUR US060888711 3/19/2022 3/19/2023 EACH OCCURRENCE $2,0D0,000 REXCESS LIAB CLAIM4M SADE AGGREGATE $2,000,000 DED I X RETENTION$ $ A WORKERS COMPENSATION 31 WECAM4WE5 7/9/2021 7/9/2022 X I STATUTE ER CT&NY AND EMPLOYERS*LIABILITY Y r N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 Ries.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000.000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if 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 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE -�(wit n -Ink tcZ e— ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD INEWK Workers' CERTIFICATE OF ATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a. Legal Name&Address of Insured (use street address only) 1 b. Business Telephone Number of Insured Tri Tech Mechanical LLC (203) 359-3399 47 West Main St 1c. NYS Unemployment Insurance Employer Registration Number of Stamford, CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 02-0717079 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Hartford Insurance Group p Village of Rye Brook 938 King Street 3b. Policy Number of Entity Listed in Box"1 a" Rye Brook, NY 10573 31 WECAM4WE5 3c. Policy effective period 7/9/2021 to 7/9/2022 3d. The Proprietor,Partners or Executive Officers are ❑ included. (Only check box if all partners/officers included) Q 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: John M Gdover Agency (Print name of authhoo�rizzeed representative or licensed agent of insurance carrier) A roved b �? Jrru lust 05/13/2022 PP Y (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: (800) 275-2766 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