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MP22-133
JPERMIT # DATE: �9 -� E7(P6 SECTION / BLOCK / LOT, TYPE OF WORK `' j JOB LOCATION... OWNER //1 Qe O zi I-r. -zi— I - - EST. COSj� O # Cat FEE OLLD- L62 TCO # FEE DATE INSPECTION REC0312 DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING L RGH PLUMBING GAS ( SPRINKLER ELECTRIC LOW -VOLT O ALARM 0 AS BUILT L7 FINAL 1 jj&�5 9y3 3 6 c so�a°c) _ a yq / C �'010C LO6/ec OTHER APPROVALS ARB BOT P8 ZBA - OTHER tt� 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 January 4,2023 Kin Yee Chow& Kar Loc Carl Leung 2 Charles Lane Rye Brook,New York 10573 Re: 2 Charles Lane,Rye Brook,New York 10573 Parcel ID#: 135.41-1-39 Mechanical Permit#22-133 issued 8/29/2022 to Replace Existing LP Gas Generator This certifies that the new LP gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, , 7�-- I Michael J. Izzo Building&Fire Inspector /to D E C E �� 1,ot•office use onh: DDBUILDING DEPARTMENT PEluvtl•r DEC 2 0 2022 VILLA OF RYE�B �OK ISSUED: )38 KING STRFFT' ` YE BROOK,NVW YORK 10573 DATE:/r1� VILLAGE OF RYE BROOK (914)939-0668 I'I:E: y4f //O-- PAID,IS BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL, INSPECTION rrrrrrrrwwewrrrrrwrwwwrwwrrrww►•rrrrrrrr►r•wrrrrrrrrr•r«wrrww.rwrrrwrrr.rrrrrrrrrrwrrrrrrrrrrwrrrr.rrrr.rrrrrr«rrrrrrrrrwrrrr Address: 6 Charles Lane Occupancy/Usel Fam. Residential Parcel ID 4: 135.41-1-39 Zone: R-15 Owner: Kar Lok Carl Leung Address: 6 Charles Ln, Rye Brook. NY 10573 P.E./R.A. or Contractor: Pristine Construction Address: 5 Colt PI, Old Westbury, NY 11558 Person in responsible charge: Kar Lok Carl Leunq Address: 6 Charles Ln, Rye Brook, NY 10573 Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: Fnuad Peuyafar being duly sworn,deposes and says that he/she resides at 5 Colt PI (Print Name of Apl licani) (No and Street) in Old Westbury in the County of Nassau in the State of NY_-_,that (Cityrrownf village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work, including all site improvements. labor,materials,scaffolding,fixed equipment, professional fees,and including the monetary value of any materials and labor% hich may have been donated gratis was:S 16,355 for the construction or alteration of: Installation of an 18kW Standby generator on liquid propane with an automatic _ _transfer switch mounted on a concrete pad. Deponent further states that he/she has examined the approved plans of the structureiwork herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me dies 12 day of AJ4�;}— , 20 �'�` day o.___ , 20 22 Signa ner Signatu f App ant Kar Lok Carl Leunq Fouad Pouvafar Print Name of'Property Owner Print Name of Applicant NowiYllubhc r Notary Public --- r BEV'+EW Y 041LEY' a BITAJAVAHERI NO"PO,.i'r ?tatty ,;v4 N yrt Notary Public,State Of New York -o6'i6 No.01JA6418652 Go rnv _I Qualified in Nassau County My Gcr:vn y.:rw ntar�l :9,20 a-S1 _,i _ Commission Expires June 14,2025 �yE BRC��. 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 - - - - - - - - - - - - - - - - - - - - clr'onk t �l ADDRESS :— � � `Q � DATE. { 1`2 cQ 3 )-2-S I 1� PERMIT# ` ` ISSUED: ECT: �LOCK: LOT: 25 LOCATION: 1 n OCCUPANCY: - kz ❑ 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 ❑ FIN L PLUMBING ❑ SS CONNECTION FINAL ❑ OTHER �E BRC�v�• '9a2 BUILDING DEPARTMENT ❑PUILDING 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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: (✓ c— , f Q DATE: 1 r�- ` f 21 PERMIT# ` v� `� ISSUED: r �S BLOCK: LOT: LOCATION: ` �T OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE s ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS Qr L.P. GAS ,, J ;r v� V� , ���^ ( ❑ FUEL TANK fc ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ���� P�M�7717a1��7m���1M1�7X! !�� 1���`W■��1�� �ml R�m�lll�ll�IM1114r� �■������11�M m x z m i ! z m N T r l = a N N ; tea M`I s 0 00 \ ■ 00 y ! x �Z �j -b s FG ►� y�~ � � Q � ��+ O ■ Ifs O O O uZ � F—� w M F � � ,r � p-' v1-4 w ' oD 0 3 r cL14 � O : 1 d �� m CC Ir 00 W U O vj W r� y S zO - v MCI 0-4 "� x Moo rs M..� M ~ W a oZj � vU � ' G1 �' r � a � o CY Ile v � � mu v c° •° o H o a y � w p p HS ° � � �au BUILDING DEPARTMENT E 1VILLAGE OF RYE B ", OK938 KING STI T Rvr B1to NY 10573AUG 2 2 2U22'014) 939-066 �1v��Vti'.x ;t GE OF RYE BROOK ING DEPARTMENT FOR OFFICE USE ONI_V: Approval Date: mit P Application # Approval Signature: T ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee:` Permit Fees: �'� Ur APPLICATION TO INSTALL A PERMANENT STANDBY BACKUP GENERATOR Application dated: 08/15/22 is hereby made to the Building Inspector of the Village of Rye Brook for the issuance of Permit to install a permanent standby backup generator in accordance with§2504.1.of the Code of the Village of Rye Brook,as per detailed statement described below. Please note that electrical and plumbing permit applications must be filed separately by those licensed professionals,and that separate permits are required for the installation of any related fuel tanks. Further note that all applications for commercial use will require a site plan approval from the Village Planning Board prior to the issuance of any permit. I. Job Address: 6 Charles Lane 2. Parcel 1D#: 135.41-1-39 Zone: R-15 3. N.Y. State Construction Classification: Frame N.Y. State Use Classification: Residential 4. Proposed Generator&FueI Type(Describe in detail): In place replacement of generator with a 18kW liquid propane operated with an automatic transfer switch mounted on a concrete pad. 5. Property Owner: Kar Lok Carl Leung Address: 6 Charles Ln. Phone# Cell# (716) 465-9433 email: klcleung@gmail.com Applicant: Address: 5 Colt P1, ld Westbury, NY 11568 Phone 4 Cell #(,516) 476-6222 email: -fouad@pristinedt.com Architect or Engineer(if applicable): N/A Address: Phone# Cell# email: General Contractor: Fouad Pouyafar of Pristine Construction LL C Address: 5 ,olt PI Did West; NY 11568 Phone# Cell# (516) 476-6222 email: fouad@pristinedt.com 8/12/2021 6. Give exact dimensions from proposed generator to lot lines: front yard: rear yard: 90' right side yard: 65' left side yard: 7. If building is located on a corner lot, which street does it front on: N/A 8. Will the proposed project disturb 400 sq.ft.or more of land,requiring a Stormwater Management Control Permit from the Village Engineer as per Chapter 217 of the Code of the Village of Rye Brook? Yes: No: XX 9. Will the proposed project require a Site Plan Review by the Village Planning Board as per Chapter 209 of the Code of the Village of Rye Brook? Yes: NO: XX (provide detailed drawings as per Chapter 209) 10. Will the proposed project require a Steep Slopes Permit as per Chapter 213 of the Code of the Village of Rye Brook? Yes: No: XX (provide a detailed topographical survey) 11, Is the lot or any portion thereof located in a Wetland as per chapter 245 of the Code of the Village of Rye Brook? Yes: No: XX (provide a detailed survey indicating the Wetland& Buffer Zone) 12. Is the lot or any portion thereof located in a Flood Zone as per the FEMA Flood Insurance Rate Map#36119CO279 dated 9/28/07? Yes: No: XX 13. Will the proposed project require a Tree Removal Permit as per Chapter 235 of the Code of the Village of Rye Brook? Yes: No: XX (a tree replanting schedule may be required) 14. Does the proposed project involve a Home-Occupation as per Chapter 250-38 of the Code of the Village of Rye Brook? Yes: No: XX If so, indicate: TIER L TIER 11: TIER III: 15. What is the total estimated cost of construction: $ 16,355 (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis) 16. Estimated date of completion: OCL 2022 STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: Fouad Pouyafar , being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the Contractor 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 `f h Sworn to before me this day of , 20 da � , 20 Signature of Property Owner Signatur a p ican Kar Lok Carl Leun PQ afar Print to of Property Owner BEVERLY BAILEY )f'Applicant NaWr Public, SW%of Now YA J No.01BA6056W8uel c•[ C� lfieei In Klrvs Csur>t otary Public a MY COrhn ExOme Mimh II0,9D tary Public tZfr..C. : This application must be properly completed in its entirety and must inch Z s 1&, y�e(s)of the legal owner(s) of the subject property, and the applicant of record in the s $� 01 application not property completed in its entirety and/or not properly signed shall be deem1w�� n V1lestchsli�alttilll�be returned to the applicant. Please note that application fees aCSrflMWgAcFxplres January 29,2�;t 2 8/1212021 ■ a a s a � a ■ N N N N ns s ■ a W n � � ae Mir OG v o oPLO 00 CA J H ^ V LO 000 Q 41 CZ w " z � aE 00.0 w O Q w ` c a � Z I� V j cn ? c►nr �j 3 ( h H .A M ai O z f4 A z � ,� ° ,� °� o •., M F .� 1 } it ? ' wrA Za C V z z W :7 C. c oa cn Q,' � °j a d ►n H o ►� x V W z L; BUILDING DEPARTMENT OCT 17 2022 1 ID VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT wwvv.ry&ook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY /33 EP#: Q'D-a 9 Approval Date: KT 18 29P Permit Fee: $ `—/-'n 6 Approval Signature: Other: Application dated, is her by 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. 1.Address: (p (✓ /f(L. � SBL: �y� /�� ,/—J / Zone: , 2.Property Owner:�LIfJ EC C.t-{pllj Address: L Ci Afllfd'� LIA?JC Phone#:-'Ib L(A5 —`1� 33 Cell#: email: 3.Master Electrician: �C zN (� �� Address: CN 1 N Lie.#: Phone#: ( ZW) -7-4 Cell#: 1 L email: i` iTc Company Name: Ag CiAotcp 1�"ddress: 4.Proposed Electrical Work/Fixture Count: 5.31 Party Electrical Inspection Agency: ********************************************************************************************************* STATE OF NEW YQRK,COUNTY OF WESTCHESTER ) as: IE—M&}hji,� M IN ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name individual signing as the applicant) \ state that(s))he is the legal owner of the property to which this application pertains,or that she is the �\ C�1a�/_y/k_F' 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 regulations. Sworn to before me this Sworn to before 4ne this day of ,20 day 20 Signature of Property Owner ature of Applicant �IN47' )OC� { / Print Name of Property Owner Name of AppI' t Notary Public S11A"FA16 Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20L3 6/23/2022 STATEWIDE • 181 Main Street, Fishkill, NY 12524 1 emoil:office@swisny.com SWIS JOBAPPLICATION tel845.202.72241 fax914.219.1062 SWISNY.corn SWISTraining.com Office Use Elect. Permit# /_. _ 9 n Date� Bldg Permit# / Utility I # Final Certificate# City/Village Zip Township D County - f Address Cross Street Section Block Lot Owner Nameb dr ss(44iffer"Mhana 1 tJ ^ / Contact Numbe Z ❑Basement ❑1st FI. ❑2nd FI. ❑3rWFl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside esidential ❑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 - _2_00 ^M RCC [BE � V F, 0 OCT 17 2022 VILLAGE OF RYE 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 of authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector ll Date Finalized Inspector# Company Name 1 ._t Date Signature, Address ` — City/State _&VTWrocre License# Phone# Z� State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 a 845 202-7224 Phone TO 914-219-1062 Fax STATEWIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Your Choice Electric LLC Kin Yee Chow& Kar Lok Carl Leng 16 Greenhaven Road 6 Charles Lane Poughquag, NY 12570 Rye Brook, NY 10573 Located at:6 Charles Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-249 Certificate Number: 2022-7231 Building Permit Number: MP22-133 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: 6 Charles Lane, Rye Brook, NY 10573 The Basement and Exterior was 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 315t Day of October 2022. Name quantity Rating Circuit Type Generator 01 18KW Automatic Transfer Switch 01 200 Amp �J_ 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. N N tt W C O 0G C U x y 4 W aG CIO W4 Lei z Ln $ ` r rT p z , wzP2Mz � �4 Mo 00 \ � r z it W 00 04 H ^ 4 N W _.. z z ° n Na W ' R � i E'y cw.� w R ` t3Rnv BUIL j'NG ICE' k MENT D D VIL E OF RYE OK 938 K N , ET RYE BR . ,NY 10573EEBUILDING.IDE 16 2022 � -0 F RYE BROOK w or PARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY aP�/7/OZ__ ►% a3 PP#: �CDCD/Q !1 Approval Date: Permit Fee: $ 7 D —/- Approval Signature: Other: Disapproved: (fees are non-refundable) #kckck*ck*ck*k****kk*Icccckckckckckckklcck**:k*********** #*�c*�cic##klc##*#*##***kk*k**#kdcckkck#�c**kk�e;!c***kckckckkckk+k##ckk Application dated, !3 I aOl ,-2— 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 Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal, State, County and Local Codes. 1.Address: 6 Charles Lane Rye Brook SBL: /3, 1-1/-1-39 Zone: 2.Proposed Work: reconnect generator 3.Property Owner: Leung Address: 6 Charles Lane Phone#: 716-465-9433 Cell#: email: 4.Master Plumber: Kevin M Brady Address: PO Box 1076 Rye NY 10580 468 914-934-0809 914-774-9215 kevin brad lumin Lic.#: Phone#: Cell#: email: @ YP 9•net Company Name: Kevin M Brady Plumbing & Heating Co)Mress: PO Box 1076 Rye NY 10580 INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 3rd Floor 4"Floor 5`h Floor Exterior 1 LP 5.* List Other Equipment/Provide Details: generator connection - appliance valve to gener (Notarized Signatures Required Next 2 Pages) 8/12/2021 BUILD,INd'DgkRTMENT O VILLA' E F,RYi�JI4OOK 938 KING ' ET RYE BROOK,NY 10573 a 4 ******************************************************************************************************* AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, KW zoK. OA?,,L LEUt 167 , residing at, (�CXat�21�s ZA; kYc� NY/ D�� (Print name) (Address�vlicre you live) being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; CfIAkCES 4/J , Rye Brook, NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property Owner(s)) eve 1-vK c4KL L_Ebr, , (Print Name of Property Owner(s)) Sworn to before me this 11r_4 day of , 20 (Notary Public)" ✓�»»•-�` --� WVERLY BAILEY NOWY P, i Yo QuWftd in LNV Cares Yiiah -3 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Kevin M Brady ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the contractor 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 L31A Sworn to befo e me this day of ,20 2?i day of Signature of Property Owner Signa a of Applicant ,�� AR t✓oK CL c-EUt J� � A Print Name of Property Owner Print Name of� Applicant Notary Public BEVERLY BAILEY ine Coell r Ooiblry PU C, ftle of New Yqt cotar y Pubs i c � � No•01BA80W% ' S001D 6205102k QuislMed In KirW CourMyl2 Qualified in Ib cam EZ4 bN 1M�d►2r,90 I Westchester County This application must b comp e m its entire sand must include the notariz d sl ature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications 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 GENERAC 10/14/18 kW GUARDIANR SERIES _ Residential Standby Generators Air-Cooled Gas Engine INCLUDES: Standby Power Rating G007171-0,G007172-0(Aluminum-Bisque)—10 kW 60 Hz • True Power" Electrical Technology G007223-0.G007224-0,G007225-0(Aluminum-Bisque)—14 kW 60 Hz • Two-line multilingual digital LCD Evolution'" controller G007226-0,G007228-0(Aluminum-Bisque)—18 kW 60 Hz (English/Spanish/French/Portuguese) • Two transfer switch options available: 100 amp 16 circuit switch or 200 G� amp service rated smart switch • Electronic governor • Standard Wi-FO'connectivity • System status&maintenance interval LED indicators _„- • Sound attenuated enclosure • Flexible fuel line connector n GENERAC • Natural gas or LP gas operation -- • 5 Year limited warranty • Listed and labeled by the Southwest Research Institute allowing installation as close as 18 in (457 mm) to a structure.* ®� *Must be located away from doors, windows,and fresh air or E�I FISTED QU, n � intakes and in accordance with focal codes. https:llassets.swii.or,qllibraryIDirectofyOfUstedProductsl Note.CHI.or CUL certification only applies to unbundled units and units packaged with limited Constructionlndustryl973_DoC_204 13204-01-0 1 PM.pdf circuit switches.Units packaged with the Smart Switch are ETL or UL ce0ied in the USA only. 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One reason for this confidence is the GENERAC SYSTEM TORSIONAL TESTED MOTOR STARTING ABILITY product line is offered with its own transfer systems and controls for total system compatibility. MOBILE LINK WI-FI CONNECTIVITY: FREE with select Guardian Series home standby generators, Mobile Link Wi-Fi allows users to monitor the status of the generator from anywhere in the world using a smartphone, tablet, or PC. Easily access information such as the current operating status and maintenance alerts. Users can connect an account to an authorized service dealer for fast,friendly,and proactive service.With Mobile Link, users are taken care of before the next power outage. `PROMISE ® ��� GENERAC° 10/14/18 kW Features and Benefits Engine • Generac G-Force design Maximizes engine"breathing"for increased fuel efficiency.Plateau honed cylinder walls and plasma moly rings help the engine run cooler,reducing oil consumption and resulting in longer engine life. • "Spiny-lok"cast iron cylinder walls Rigid construction and added durability provide long engine life. • Electronic ignition/spark advance These features combine to assure smooth,quick starting every time. • Full pressure lubrication system Pressurized lubrication to all vital bearings means better performance, less maintenance and longer engine life.Now featuring up to a 2 year/200 hour oil change interval. • Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil. • High temperature shutdown Prevents damage due to overheating. Generator • Revolving field Allows for a smaller, light weight unit that operates 25% more efficiently than a revolving armature generator. • Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. • Displaced phase excitation Maximizes motor starting capability. • Automatic voltage regulation Regulating output voltage to=1%prevents damaging voltage spikes. • UL 2200 listed For your safety. Transfer Switch (if applicable) • Fully automatic Transfers vital electrical loads to the energized source of power. • NEMA 313 Can be installed inside or outside for maximum flexibility. • Remote mounting Mounts near an existing distribution panel for simple,low-cost installation. Evolution" Controls • AUTO/MANUAL/OFF illuminated buttons Select the operating mode and provide easy,at-a-glance status indication in any condition. • Two-line multilingual LCD Provides homeowners easily visible logs of history,maintenance,and events up to 50 occurrences. • Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations. • Utility voltage sensing Constantly monitors utility voltage,setpoints 65%dropout,80%pick-up,of standard voltage. • Generator voltage sensing Constantly monitors generator voltage to verify the cleanest power is delivered to the home. • Utility interrupt delay Prevents nuisance startups of the engine,adjustable 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer. • Engine warm-up Verifies engine is ready to assume the load.Setpoint approximately 5 seconds. • Engine cool-down Allows engine to cool prior to shutdown.Setpoint approximately 1 minute. • Programmable exercise Operates engine to prevent oil seal drying and damage between power outages by running the generator for 5 minutes every other week. Offers a selectable setting for weekly or monthly operation, providing flexibility and potentially lower fuel costs to the owner. • Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature. Compatible with lead acid and AGM-style batteries. • Main line circuit breaker Protects generator from overload. • Electronic governor Maintains constant 60 Hz frequency. Unit • SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature,withstanding winds up to 150 mph(241 km/h).Hinged key locking roof panel for security.Lift-out front for easy access to all routine maintenance items.Electrostatically applied textured epoxy paint for added durability. • Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries. • Small,compact,attractive Makes for an easy,eye appealing installation,as close as 18 in(457 mm)away from a structure. GENERAC 10/14/18 kW Features and Benefits Installation System • 14 in(35.6 cm)flexible fuel line connector Listed ANSI Z21.75/CSA 6.27 outdoor appliance connector for the required connection to the gas supply piping. • Integral sediment trap Meets IFGC and NFPA 54 installation requirements. Connectivity • Ability to view generator status Monitor your generator with a smartphone,tablet,or computer at any time via the Mobile Link application for complete peace of mind. • Ability to view generator Exercise/Run and Total Hours Review the generator's complete protection profile for exercise hours and total hours. • Ability to view generator maintenance information Provides maintenance information for your specific model generator when scheduled maintenance Is due. • Monthly report with previous month's activity Detailed monthly reports provide historical generator information. • Ability to view generator battery information Built in battery diagnostics displaying current state of the battery. • Weather information Provides detailed local ambient weather conditions for generator location. GENERAC.; 10/14/18 kW Specifications Generator Model G007171.0,G007172-0 G007223-0,G007224.0, G007226-0,G007228.0 (10 kW) G007225.0(14 kW) (18 kW) Rated maximum continuous power capacity(LP) 10,000 Watts' 14,000 Watts' 18,000 Watts- Rated maximum continuous power capacity(NG) 9,000'A'afts- 14.000 Watts' 17.000'Natts' Rated voltage 240 Rated maximum continuous load current—240 volts(LP/NG) 41 7/37 5 58.3!58 3 75 0 70 8 Total Harmonic Distortion Less than 5% r Main line circuit breaker 45 Amp 60 Amp 80 Amp Phase 1 Number of rotor poles 2 Rated AC frequency 60 Hz Power factor 10 Battery requirement(not included) 12 Volts,Group 26B 540 CCA Minimum or Group 35AGM 650 CCA Minimum Unit weight Oo kg) 338/153 385/175 420,191 Dimensions(LxWxH)in/cm 48 x 25 x 29/121.9 x 63.5 x 73.7 Sound output in dB(A)at 23 ft(7 m)with generator operating at normal load" 61 65 65 Sound output in dB(A)at 23 ft(7 m)with generator in Quiet-Test"low-speed exercise mode" 57 55 55 Exercise duration 5 min Engine Engine type GENERAC G-Force 400 Series GENERAC G-Force 800 Series Number of cylinders 1 2 Displacement 460 cc 816 cc Cylinder block Aluminum w/cast iron sleeve 1,alve arrangement Overhead valve Lifter type Solid Hydraulic Ignition system Solid-state w'magneto Governor system Electronic Compression ratio 9,5 1 Starter 12 UDC Oil capacity including filter Approx l 1 qt/to L Approx 2 2 gt/2 1 L Operating rpm 3,600 Fuel consumption Natural Gas ft'/hr(m%hr) 1/2 Load 101(2.86) 195(5.52) 169(4.79) Full Load 127(3.60) 2511 247(6.99) Liquid Propane ft/hr(gal/hr)[L/hr1 1/2 Load 36(0.97)[3.661 65(1.81)[6.871 62(1.70)[6.451 Full Load 54(1 48)[5.621 112(3.07)[11.611 110(3,02)[11,441 Note Fuel pipe must be sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3 5-7 0 in water column(0.87-1.74 Wa)for NG,10-12 in water column(2.49-2.99 kPa)for LP gas For BTU content nutiply ft'hr<2500(LP;or ft';hr x 1,000 MG) For hAegajoule content,multiply m'/hr x 93.15(LP)or m'hrx 37 26(NG). Two-line plain text multilingual LCD Simple user interface for ease of operation. Mode buttons AUTO Automatic start on utility failure Weekly,Bi-Weekly,or Monthly selectable exerciser MANUAL Start with starter control,unit stays on.If utilityfails,transfer to load takes place. OFF Stops unit.Power is removed Control and charger still operate Ready to RuNMandenance messages Standard Engine run hours indication Standard Programmable start delay between 2-1500 seconds Standard(programmable by dealer only) Utility voltage loss Return to utility adjustable(brownout setting) From 140-171 V;190-216 V Future set capable exerciser/Exercise set error warning Standard Run Alarm,Maintenance logs 50 events each Engine start sequence Cyclic cranking:16 sec on,7 sec rest(90 sec maximum duration). Starter lock-out Starter cannot re-engage until 5 sec after engine has stopped Smart Battery Charger Standard Charger Fault,'Missing AD Warning Standard Low Baftery(Battery Problem Protection and Battery Condition Indication Standard Automatic Voltage Regulation with Over and Under Voltage Protection Standard Under-Frequency/Overload/Stepper Overcurrent Protection Standard Safety Fused,%Fuse Problem Protection Standard Automatic Low Oil Pressure/High Oil Temperature Shutdown Standard Overcrank'Overspeed(1'72 Hz)rpm Sense Loss Shutdown Standard High Engine Temperature Shutdown Standard Internal Faultln correct'Vviring Protection Standard Common External Fault Capability Standard Field Upgradable Firmware Standard Rating definitions—Optional Standby:Applicable for supplying backup power for the duration of the utility power outage with correct maintenance performed.No overload capability is available for this rating.(All ratings in accordance with BS5514,IS03046,UL2200,and DIN6271). 'Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU/Megajoule content,ambient temperature,attitude,engine power and condition,etc.Maximum power decreases approximately 3.5%for each 1,000 ft(304.8 m)above sea level and approximately 1%for each 10'F(6°C)above 60*F(16`C).'"Sound levels are taken from the front of the generator.Sound levels taken from other sides of the generator may be higher depending on installation parameters. GENERAC' 10/14/18 W Switch Options Limited Circuits Switch Features Model G007172-0 0007224.0 (10 kW) (14 kW) • 16 space,24 circuit.Breakers not Included. No.of poles 2 • Electrically operated,mechanically-held contacts for fast,positive connections. Current rating(amps) 100 ♦ Rated for all classes of load,100%equipment rated,both inductive and Voltage rating(VAC) 120/240,10 resistive. Utility voltage monitor(fixed)* • 2-pole,250 VAC contactors. -Pick-up 80% • 30 millisecond transfer time. -Dropout 65% • Dual coil design. Return tout'rlfty* Approx.15see ♦ Rated for both copper and aluminum conductors. Exercises bi-weekly for 5 minutes' Standard • Main contacts are silver plated or silver alloy to resist welding and sticking. ETL or UG Listed Standard • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor Total circuits available 24 mounting flexibility. Tandem breaker capabilities 8tandems • Multi listed for use with 1 in standard,tandem,GFCI,and AFCI breakers from - Siemens,Murray,Eaton,and Square D for the most flexible and cost effective Circuit breaker protected install. Available RMS Symmetrical 10,000 Fault Current 250 Volts Dimensions *Function of Evolution controller Exercise can be set to weekly or monthly Height Width - �,---, H1 H2 W1 W2 Depth in 26.75 30.1 10.5 13.5 6.91 [ 1 cm 67,94 76.43 26.67 34.18 17.54 j Wire Ranges I Conductor Lug Neutral Lug Ground Lug 2/0-#14 2/0-#14 2/0-#14 I �--._ L.J. L.oearH" `---xs.--- Service Rated Smart Switch Features Model G007226-0 G007228-0 ( 4 ) • Includes Smart A/C Management(SACM)module standard, of pole3 wAl'r( rws o,s� W) , • Intelligently manages up to four air conditioner loads with no additional hardware. Current rating(amps) 200 120/240,1t�"`} • Up to eight large(240 VAC)loads can be managed with Smart Management Voltage rating(VAC) Modules(SMMs). Utility voltage monitor(fixed)' • Electrically operated,mechanically-held contacts for fast,clean connections. -Pick-up 80% • Rated for all classes of load,100%equipment rated,both inductive and -Dropout 65% resistive. Retum to uttifty* t5-sec • 2-pole,250 VAC contactors. Exercises bi-weekly for 5 minutes' Standard • Service equipment rated,dual coil design. EX or UL Listed Standard` • Rated for both aluminum and copper conductors. Enclosure type NEMA/UL 3R • Main contacts are silver plated or silver alloy to resist welding and sticking. Gircult breaker protected 22,000 • NEMA/UL 311 aluminum outdoor enclosure allows for indoor or outdoor Lug range 250 MCM-#6 mounting flexibility. *Function of Evolution Controller Dimensions Exercise can be set to weekly or monthly 200 Amps 120/240,to Open Transition Service Rated Height Width H1 H2 Wt W2 Depth in 26.75 30.1 10.5 13.5 6.3 Cm 67.94 76.45 26.67 34.3 16.01 f I Wire Ranges Conductor Lug Neutral Lug Ground Lug - L — ----' 400 MGM-#4 350 MCM-#6 2/0-#14 GENERACa 10/14/18 kW Available Accessories Model# Product Description G005819 0 26R Wet Cell Battery Every standby generator requires a battery to start the system.Gene rac�offers the recommended 26R wet cell bat- tery for use with all air-cooled standby product(excluding PowerPaco- 6007101-0 Battery Pad Warmer The pad warmer rests under the battery.Recommended for use if the temperature regularly falls below 0 IF(-18 °C).(Not necessary for use with AGM-style batteries). 1 1 1 G007102-0 Oil Warmer Oil warmer slips directly over the oil filter.Recommended for use if the temperature regularlyfalls below 0 IF(-18 IC). 6007103-1 Breather Warmer The breather warmer is for use in extreme cold weather applications.For use with Evolution controllers only in climates where heavy icing occurs. 6005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical bad you may Contact Kit not need.Not compatible with 50 amp pre-wired switches. The fascia base wrap snaps together around the bottom of the new air cooled generators.This offers a sleek,con- G007027-0-Bisque Fascia Base Wrap Kit toured appearance as well as offering protection from rodents and insects by covering the lifting holes located in the base. If the generator enclosure is scratched or damaged,it is important to touch up the paint to protect from future G005703-0-Bisque Touch-Up Paint Kit corrosion.The touch-up paint kit includes the necessary paint to correctly maintain or touch up a generator en- closure. G006482.0—10 kW Scheduled Maintenance Kit Generac's scheduled maintenance kits provide all the items necessary to perform complete routine maintenance 6007216-0—14/18 kW on a Generac automatic standby generator(oil not included). The Wi-Fi enabled LP fuel level monitor provides constant monitoring of the connected LP fuel tank.Monitoring G007005-0 Wi-Fi LP Fuel Level Monitor the LP tank's fuel level is an important step in verifying the generator is ready to run during an unexpected power failure.Status alerts are available through a free application to notify users when the LP tank is in need of a refill. G007000-0(50 amps) Smart Management Modules (SMM)are used to optimize the performance of a standby generator. It manages G007006-0(100 amps) Smart Management Module large electrical loads upon startup and sheds them to aid in recovery when overloaded.In many cases,using SMM's can reduce the overall size and cost of the system. G007169-0(4G LTE) The Mobile Link family of Cellular Accessories allow users to monitor the status of the generator from anywhere. G007170-0(Wi-FVEther- Mobile Linkl Cellular in the world,using a smartphone,tablet,or PC.Easily access information such as the current operating status and net) Accessories maintenance alerts.Users can connect an account with an authorized service dealer for fast,friendly,and proac- tive service.With Mobile Link,users are taken care of before the next power outage. Dimensions & PCs 121e mm 85).8 mm [a 0 h] [2S.1 inj Model UPC G007171-0 696471074680 G007172-0 696471074673 G007223-0 696471082548 2 mm to 5 In) G007224-0 696471082555 G007225-0 696471082562 G007226-0 696471082579 0 0 G007228-0 696471082586 MFT SIDE VIEW FRONT VIEW Dimensions shown are approximate.See installation manual for exact dimensions.DO NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES. GENE RAC" Generac Power Systems,Inc. • S45 W29290 HWY.59,Waukesha,WI 53189• generac,com c 2020 Generac Povver Systems,Inc.All rights reserved. All specifications are subject to change without notice. Part No.A0000973374 Rev.A 10/22/2020 Building Permit Check List&Zoning Analysis Address: 4+ Zone: 1 1 Use: Z f O Const.Type: Other. Submittal Date: e> Z Revisions Submittal Dates: Applicant: _V G Nature of Work: ��T� 1� F x�S l "4 Reviews:ZBA PB: BOT: Other. OK � ( ( ) FEES:Filing.f AD--�' BP: Z� C/O: Flood Plane: Legalization: ( ) (eAPP: Dated: a/Notarized ✓SBL: ✓Truss I.D. Cross Connection: H.O A ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) (-SURVEY:Dated Current: Archival: Sealed Unacceptable ( ) ),PLANS:Date Stamped Seale Copies: Electronic Other. ( ) (. License ✓ Workers Comp: ✓✓ Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. (� ( ) PLUMBING Plans: Permit Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval;- notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval;- notes: REOLUED EXLSTING PROPOSED NOTES AVVHUVEL) Area M Circle: 2 5 2022 FronWr Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft H Sb: Sd.H Sb: GFA Tag Ft�Inmp Paz Height/Stories: notes: `t 1 7 a ° N \ tV s WL w ` io O us u U o A err J CG Vj " 4.. s.. .� �2. z w a'�e a Leh rz > 4. 0 z folo C4 y M •X. i H A 7 yyrf U. YOR 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 Pristine Construction LLC 516-476-6222 5 Colt Place 1c.NYS Unemployment Insurance Employer Registration Number of Old Westbury,NY 11568 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 474724177 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Insurance Fund Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1a" 938 King Street H2422554-2 Rye Brook,NY 10573 3c.Policy effective period 08.10.2022 to 08.10.2023 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"l 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". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? YES ENO 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: James Berliner (Print name of authorized representative or licensed agent of Insurance carrier) Approved by: .1 .1 — 8.15.2022 0 (Signature) (Date) Title: Licensed Agent of Record Telephone Number of authorized representative or licensed agent of insurance carrier: 203-367-7704 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 (9-15) www.wcb.ny.gov TE ,acoRO CERTIFICATE OF LIABILITY INSURANCE DA08/151202a2YY) 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(les)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($). PRODUCER NAME CT James Berliner BERLINER-GELFAND&CO INC PHONE. , (203)367-7704 ac No): (203)333-0710 188 Main Street-Suite A ADDREss: Jim@Beriinednsurance.com INSURER(S)AFFORDING COVERAGE NAIC 0 Monroe CT 06468 INSURERA: Merchants Mutual Insurance Co 30104 INSURED INSURER B: Merchants Mutual Insurance Co Pristine Construction,LLC INSURER C: INSURER D: 5 Colt Place INSURER E: Old Westbury NY 11568 INSURER F: COVERAGES CERTIFICATE NUMBER: 2022-2023-Constr 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. �TRR TYPE OF INSURANCE IN O WVD POLICY NUMBER MM/D Y YY MM/DD EXP LIMITS COMMERCWL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEIT CLAIMS-MADE © OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A BOPI103580 05/01/2022 05/01/2023 PERSONAL&ADV INJURY $ included GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY❑PRO OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acrid M ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S X UMBRELLALIAR OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAS CLAIMS-MADE CUP1002276 05/01/2022 05/01/2023 AGGREGATE $ 5,000,000 DIED I X RETENTION $ 10,000 $ WORKERS COMPENSATION P_FS7A T OTH- AND EMPLOYER8'LIABILITY ER y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street. AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD t -- j Lai Q. > o u cV L�J U LOi w t"y uz) V W C {' a $' w in acc LU � � W 0 0 J I f �W ref J �o � _ W v r- E > • i W 0 1 c get �Yw W p.Y 1 3 ~ f ; � g � � W 00•g9=6 ,g=y f I t � I >o N O - N N sECL � o E �o 1 9°c° c - c \� o g D f o E CL O-Z I r- Filed Map 12212 Lot 13 c ° — L CL a $ E� c� ! .� 521 L ! Igsl Of 214.65 E — $ c S 01.05'50" E / • � / •r } E! a LA- CL / � I o ILL: E-4 yt N / A cZ / I �. / I 0o 0 W � o� I