HomeMy WebLinkAboutMP13-136 G Ct� v
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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 6,2022
Mark Tahmin&Arlene Tahmin
34 Hawthorne Avenue
Rye Brook,New York 10573
Re: 34 Hawthorne Avenue, Rye Brook,New York 10573
Parcel ID#: 135.75-1-78
This document certifies that the work done under Mechanical Permit#13-136 issued on 10/25/2013 for the
installation of a new stainless steel chimney liner has been satisfactorily completed.
Sincerely,
Michael J. Izzo
Building&Fire Inspector
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Qye Bkj�
1982 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.or
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : , W ' `� Y'� DATE:
PERMIT# SSU : SEC ' '�, BLOCK: LOT:
LOCATION: OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS/❑ ACCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION W� rYlGt REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS H �(�n� (�Q -4- �'1(� Q l c
❑ L.P. Gas 'N�.a�
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
,F.'O CROSS CONNECTION
FINAL
❑ OTHER
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VILL F BROOK ----- -__ - --,
BUI G DEP
938 KING T YE K,NY 10573 " !
(914)939-0668 F 1 www.ryebrook.or:r + OCT 2 20'3
APPLICATION FOR PERMIT TO INSTALL, MODIFY AND/OR
REMOVE MECHANICAL EQUIPMENT
Permit#: ,`� I — I Building Inspector:
Fee Paid: Date of Approval: OCT 2\�
Parcel ID#: Bldg/Use Class: Res. ( ; Comm.
***�'eie�kic*�F�cicsc�c****�F***�e�k�F*�FXic�c*xi'cic**k9ciric�rx9c�'cic*icicie�e*********icicixic*irkicicicic�cicic**xk* kkkkkk* klck
REQUIREMENTS FOR RELEASE OF PERMIT: (A CERTIFICATE OF COMPLIANCE is REQUIRED TO CLOSE OUT THIS PERMIT)
1. Properly Completed& Signed Application.
2. Payment of Application Fee: Residential =$75.00; Commercial=$175.00(fees are non-refundable)
3. Site/Staging Plan as required by the Building Inspector.
4. Sealed Construction/Installation Documents& Specifications as required by the Building Inspector.
5. Copy of Licensed Contractor's Insurance including Liability&Workers Compensation.
6. Payment of Permit Fee: Residential=$12.00/1000.00 of Construction/Materials Cost.
Commercial =$17.00/1000.00 of Construction/Materials Cost.
7. Inspection by Building Department for removal and/or installation. (48 hour notice required)
8. Any electrical work requires a separate Electrical Permit and Electrical Inspection.
9. Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection.
Application is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a permit
for the installation,modification,and/or removal of the specific Mechanical Equipment as listed below. The applicant,
by signing this document agrees that said equipment will be installed and/or removed in conformance with the
approved plans,and with all applicable Local,County, State&Federal laws,codes,rules and regulations.
l. Site Address: 84 H 1AZrh0-R QZ A TL jka 3 iZWg NY I O� 3
2. Property Owner& Phone: IM144,K---%'PrkiMjv3
3. Applicant Information:
4. Contractor name, address, contact phone: SflML�) 1T, HL1- LAC z'� CLopk tliiCtiTS Rp
—Y—ket M t-QR o CT b(,90,�; 20`3 - -7
5. Scope of Work: New Installation( ); Replacement( ); Removal ( ); Other(\t
6. Type of Equipment: S(L L L W t�kR FOR --j"R Q RCq Q-h t M 1 i.y
7. Specific Location of Equipment: C.► I Myz-,-( pry- r0CRZ C _}- HOc tS'�-
8. Applicant Signature: Date: 2G I.
1125113
�+00"","4rod James Ball llc
w�CERTIFIED 28 Cedar Heights Road
StamfordCT 06905
CHIMNENATIONAL11
SUIEEQ WE KICK ASH _pE.. 5=Y
Chimney Sweeping,Dryer Vent Cleaning _
JamesballchimneyLaul.com WC-8899-1-198 HIC0568337 CSIA#6310 C-DET#353 www.jamesballchimney.com
We recommend NFPA 211 level 2 inspection on all vents and chimney annually I Level Approved:2 1 Shown to Customer:Yes
Name:Mark Tahmin Invoice#V1117
Address:34 Hawthorne Ave C it :Rye Brook,State: NY Z�10573 Invoice Date: 10/8/2013
Tel:914-527-0528 Tel2: Te13:Email:Mtahmin@gmail.com Referred by:net
Comments
FINAL PRICE TO BE DETERMINED DURING INSTALLATION OF LINER AS LISTED.
7'boiler,gas 170,000 or 200,000 input btu's,3"40,000 btu input,=240,000 will fit in a 7"@ 30'will hold 279,000 Input btu's,7'x
36'top kit,re use cap,base tee and cap,7"Y,7"TO 3"wrap or Thermix Pour insulation.
Type of Work Amount
Oil flue cleaning and video scan 10/16/13 10"x 36' $0.00 I $350.00 1
Install a Ventinox SS Liner As per manufacturers instructions as per below$2800.00 I $0.00 I ?????
-3500.00
Permit Rye Brook $0.00 I $200.00
Transaction Date: 10/8/2013 Start Date:10/25/2013 Completion Date: 12/4/2013 $0.00 $550.00
Home Owner/ Sales Tax:7.37% $40.54
Representative's Signature
10/10/2013• Deposit Date Deposit
10/16/13 $1,000.00
Sales Person Signature
10/10/2013
You may cancel this transaction no later than midnight of: 10/10/2013 Balance Due Date Amount
Please ask or go our web page for more information,www.jamesbalichimney.com 11/5/13 -$409.46
I here by cancel this transaction Date
James Ball LLC company,has explained to me in writing and verbally,and I now fully understand the the apparent condition of my fireplace,appliance and vent
system at this time.The company has performed a visual inspection and is not responsible for concealed or hidden defects and has recommended corrective
actions both in writing and verbally. Since hidden defects and condition of use are beyond the control of the company, 1 understand that no Guarantee or
Warranty of,fire,health or structural safety of any fireplace,chimney or vent system is given or implied.The company is not responsible for any damage,existing,
caused or concealed due to cleaning,inspection or installations.This report is the property of James Ball LLC and maybe used or shared with any one at any time.
Home owner is responsible for any and all Building Permits that are needed as per state/local law for any installation or repair before work begins.Return Checks
$25 charge,Estimates are good for 30 days,Deposits on Liners,Glass Doors,Custom,Special orders are Non Refundable.
Home Owner/ Date: 10/10/2013
Representative's Signature _ _ 1
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ACOR4M CERTIFICATE OF LIABILITY INSURANCE FD /D
10/17/17/2013013
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 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 Col 1 ette Gri se
NAME:
FAX
Shoff Darby Companies, Inc. �N . 203.259.8308 LAIC .203.2S5.MS
100 Technology Drive, Ste 200 ADDRESS: griseirQshofflrlarby.cow
Trumbull , CT 06611 PROI7110ER 0 NS306
INSURER AFFORIDM COVERAGE NAIC S
INSURED DISURERA: Montpelier US Insurance Co
James Ball , LLC INWRER0: Travelers
28 Cedar Heights Rd INSURERC:
Stamford, CT 0690S INSURERD:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: Revised 12-13 master 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 DESCR13ED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE I POLICY NUMBER M/DD/YYYY1 fMM/DD/YYYY11 LIMA
GENERAL LIABILITY 14P000600101228 11/15/2012 11/15/2013 EACH OCCURRENCE $ 1,()00,000
X COMMERCIAL GENERAL LIABILITYDAMAGE TO RENTED $ 1OO
PREMISES Ea occurrence)
CLAIMS-MADE I-XI OCCUR MED EXP(Any me person) $ S,0001
A PERSONAL&ADV INJURY $ 11000,
GENERAL AGGREGATE $ 2,000.0
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,0
POLICY J 0- LOC $
A4 TOMONLE VASKM COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO
BODILY INJURY(Par person) $
ALL OWNED AUTOS BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per accident) _
NON-OWNED AUTOS $
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION 9899N44012 09/04/2013 09✓04M14 X WC STATUS OTI+
AND EMPLOYERS'LIABILITY CRY LM R
ANY PROPRIETOR/PARTNER/EXECUTIVE� N/A E.L.EACH ACCIDENT $ 1(0)0,0
B OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,0
R yes describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ SOO
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule.if more space is required)
E: Job Location-34 Hawthorne Ave.
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 AUTHORIZED REPRESENTATIVE
938 King St
Rye Brook, NY lOS73 Collette Grise/CG
�)1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
New York State Insurance Fund
Workers'Compensation&Disability Benefits Specialists Since 1914
105 CORPORATE PARK DRIVE SUITE 200,WHITE PLAINS,NEW YORK 10604-3814
Phone:(914)253-4871
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
A A A A A A 261487184
JAMES BALL LLC
28 CEDAR HEIGHTS RD
STAMFORD CT 069051102
POLICYHOLDER CERTIFICATE HOLDER
JAMES BALL LLC VILLAGE OF RYE BROOK
28 CEDAR HEIGHTS RD 938 KING ST
STAMFORD CT 069051102 RE:34 HAWTHORNE AVE
RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE
W 1439 316-9 814253 11/28/2012 TO 11/28/2014 10/16/2013
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 1439316-9 UNTIL 11/28/2014, 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 11/28/2014 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.
THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY.
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
�j ,
DIRECTOR,INSURANCE FUND UNDERWRITING
This certificate can be validated on our web site at https://www.nysit.com/cert/certval.asp or by calling(888)875-5790
VALIDATION NUMBER:445099595
U-26.3