Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BP22-198
PERMIT # SECTION TYPE OF WORK JOB LOCATION CONTRACTOR EST. COST ., WBC6 #, .� 8 r PAIt> LdT ` /-9..L.� „ TCO # FEE DATE LNSPECTI N RECORD_ I DATE INSP F��TING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS 0 SPRINKLER L!� ELECTRIC LOW -VOLT CO ALARM ff AS BUILT CO FINAL -T-, oe7k cc ol�7yt- tea �Ao m (o 3�� �7ld- 391oS aG3 ����-soya ►���4�s t57pci11 Cons�cJc-�,otJ 1Dyl&life {r-ei-a on a3-(=) 35//vQ-�o"a/ OTHER APPROVALS ARB BOT PB ZBA OTHER c G 1-e+K�A �6 cz,�`e�74-1 SO Iu UJiO/�/YIP/l7a/ C�r17" of VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-068 Certificate of ®crupaucp This is to certify that�DLU?L !/Q� -1�1V/P* ay ' Lzuki (3/O /� T \�k of, k, /v y having duly filed an application on ?'-P bylil(.t` a Cps 20 o;2J5 requesting a Certificate of Occupancy for the premises known as, 5 �,5���7 A 10J� jy?--ee�7 , Rye Brook,NY, located in a �� Zoning District and shown on the most current Tax Map as Section: /L/J•a27 Block: Lot: 55 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. a011'�� , issued 9 20 aa, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: Construction: for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of*shal or i exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in he m e,n shall the building be moved from one location to another until a permit to accomplish such change e fro Building Inspector. Building Inspector,Village of Rye Brook: Date: MAY 3 0 2025 �yE Oct o` V VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.Eyebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE May 30,2025 Sound Federal Savings&Loan c/o M&T Bank 115 South Ridge Street Rye Brook,New York 10573 Re: 115 South Ridge Street,Rye Brook,New York 10573 Parcel ID#: 141.27-1-55 Mechanical Permit#22-168 issued on 11/8/2022 for Fire Sprinkler System Modifications This certifies that the fire sprinkler heads,installed under the above captioned permit,have been satisfactorily completed. Sincerely, %� 4 Steven E. Fews Building&Fire Inspector /to C QR k G/. '9 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 30,2025 Sound Federal Savings&Loan c/o M&T Bank 115 South Ridge Street Rye Brook,New York 10573 Re: 115 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.27-1-55 This document certifies that the work done under Mechanical Permit #24-035 issued on 3/18/2024 for the modifications to the existing HVAC system has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to D I� BUILDING DE-VARTNIENT For office use onl PERMIT# FEB —6 2025 VILLAGE OF RYE BROOK ISSUED: / - C- 938 KING STRE6T�RYE BROOK,NSW YORK 10573 DATE: - LO VILLAGE OF RYE BROOK (914)9 0668. FEE: PAID BUILDING DEPARTMENT www.rv&r.eoknv.gov 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 **........*.♦♦................*..........*..sf•tt• t......i•.fft••.e••••t••t•i•t•.t•...i•i••••t1............................• Address: 121-125 South Ridge Street Rye Brook, NY —7 Occupancy/Use: Bank Parcel ID#: /�1, s) / Zone: C Owner: M&T Bank Address: P.E./R.A- or Contractor: RW Dake Construction Address: 100 Bluff Drive, East Rochester, NY 14445 Person in responsible charge: Dan Pongonis Address: 1070 N Farms Rd., Wallingford, CT 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: Dan Pongonis being duly swom,deposes and says that he/she resides at 10780 N Farms Rd. (Print Name of Appl cant) (No and Street) in Wallingford ,in the County of New Haven in the State of CT ,that (City/Town/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 which may �,rn G Q) have been donated gratis was:$ 1 0 for the construction or alteration of: M&T Bank 121-125 South Ridge Street Rye Brook, NY Deponent further states that he/she has examined the approved plans of the structure/work 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-I O.A.of the Code of the Village of Rye Brook. Sworn to before me this 3rd Sworn to before me this day of February 2025 day of �e l r ,20 7 � Signature of Pro (Tuner Signature o Michael F. McKeon, VP/ M&T Bank 1 I'S Print Name of Property Owner rn ame of Applicant i ry �c ry rc MARIBEL JUAREZ r, 1 'W---4 Notary Public-State of New York N0.01J00021880 Qualified in Ulster County My Commission Expires Mar 7, 2028 QyE BRC��. O� 2m 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.org - - - - -- - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- ` 1 S DATE: -- PERMIT# ISSUED: JQ-19_Ti SECT: BLOCK: LOT: J..a LOCATION: �O J J -) OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Cf ACCEPTED EJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING , 5'e ❑ INSULATION ❑ NATURAL GAS L ❑ L.P. GAS ❑ FUEL TANK rr © FIRE SPRINKLER ❑ FINAL PLUMBING (� c y ❑ CROSS CONNECTION (- © FINAL ❑ OTHER �E BRcb F o 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.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : j 2-1 - I LS DATE: PERMIT# `l> ZL ISSUED: _SECT: BLOCK: LOT:U� LOCATION: L11 fT Pz�A IV K , OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ;L7 REJECTED/ REINSPECTION SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS t ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER + N rr" Le c �► c-Y YJ o 2�C W I N ScA L c l j.3 . 4 STEPS O��yE[3RC�k� � t cdw 1982 BUILDING DEPARTMENT Q 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 : I � l 1 �^.� l�{ 1 ,, � ! J DATE: PERMIT#y i Z 2- "'ISSUED: ! , SECT: l ( ! BLOCK: LOT: LOCATION: `� 1 —'� �' 1 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER f a f f 00 N w ON c QI � � • v o- � W = m o y FR M W r.f) f I� 00 v 0 17 N a tj v Q W 1-4 C o b Z0, H u, $ o a � tn O Q [�] N 0� N A Q N 4 , E = Q z M A oobv a cn aCN N O C -0 1 V} w n � yO Z . A w 80414 � � � W o v V U z oz 0-0 BUILDI I F RTMENT VrSE VILLA' E OF RYYIA i',OOK 938 KING STRtEE,r RYE BROO)14,NY I0573U ! 2 -( -0648� VILLAGE OF RYE BROOK www':irve roole:©re BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:. Approval Date: SEP 2 1 10 �1 Permit#: �U Application Fee: $ O Approval Signature: Permit Fees: S 'y_ �- Disapproved: Other:, Application dated: U-12z-�a is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address;1 I S k 9, S4 sec SBL: Ii , 1-? - 1 -S Zone: C' 2. Proposed Improvement. (Describe in detail): c �� ` ► ✓r:/ k,, n 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:-)(- Yes: If yes,indicate: TIER 1: TIER li: _TIER fli: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System, FM-200 System,Type I Hood,etc...) : No: _Z _Yes: (If yes,please submit a separate Automatic Fire Suppression System Pennit application&2 sets of detailed engineered plans) 5. Occupancy;(I Nm.,2 fam.,comm.,etc...)Prior to Construction;(_ter,.-AF,�;G After Construction: Co-"a rl a tc I) 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: /4,i T T&A I( Address: Q,,e MA i ft ata. ��}� {,C4 Ia. )y I q.;0_3 Phone# )01-7`12-t-11-109; Cell#_.�,01 -7a(.- .11-1iW email: ,-utl eo.4 0._4h-.4 8. Applicant:_ t I iaa Address: 1070 Al Fcr.tit S krl,$�.Y 3� t,./,-ff d CT (%cfj Phone#409-A 1'7. _Cell 4-?03-'!76-3 965' email: . h--, ,,Or..� 9, Architect SC k cW A rr-1 .'i r J c,,1 Address: ill Rf fj 01 Phone# Cell# 716 -597 -`d031_ email: Kmove.11i '1,Clne'!'J�ij:s a 0 t2 10. Engineer krr-k rgl Address: III 61,,,acA Aae, a,.+Ejal !��' IL) ]Oi Phone 471 C.- -f Cell #_716- 59 7 - 9 q'� I email:.5 I I ; d!0 sCL r;o1a,u, 11. General Contractor. A U Q,,I(t �n s t rh r_� un Address: L0 70 IJ Fw—(- Q,� �/ �� e fQr�l,Li G�iLj� Phone#-5 0 iK-a31- ILL Cell#203 7,77.n-,3 rf 4S email: 12. Estimated cost of construction '3"i( 7`i-�L (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed eyutpinem.professional fires.and material and labor which may iv donated gratis,) r � � 13. Job Timetable:Start: '0(32t% Finish:_ I I `7`I 2 (li 811 M021 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. Please note that application fees are non-refundable. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: ":ft ��CCS• _,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 6—f 0.2 ral C o,l LrG f, 'r 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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 13 Sworn to before me this day of S�iaTG�lC3�� ,20 ZZ-- day of ,)"kw , 20 Signaturco yowner Signature ofApplicant / } Michael F.McKeon.VP•'M&T Bank 0,+fh e�^✓ �Q C of!e- Print Name of Property Owner Print Name oaf Applicant 0/5 Notary Public Notary Public MARIA VICEVIC ROBERT OA CORTE NOTARY PUBLIC Notary Public Connection STATE OF NEW JERSEY My Commission Expires Feb 2a.2023 MY COMMISSION EXPIRES OCTOBER 20,2025 (4) 8/12/202 t r N N o w i N o cV a � W W � � w p w U O O • R. � W � W B N H 00 A v G hil O = A N _ rne Aft Q \ n U !. O C7 o Zola z z F � w Z ; M 0 z � � � ` V ►� M� � � (7 � � A A oo cn a< � A � Q V w N oD W . a � x A zw offp fl) w z z � g w z a 64x O V z A O - N z v , a CIO z w a o°c �I as a OKI ml w = d QQ QQ p ECENE BUILDING IyEPARTMENT DD DEC - 7 2022 VILLAGE OF RYE BROOK 938 KING STREET RYE BRoo k,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www a*ook.org ELECTRICAL PERMIT APPLICATION Westchester County Mastery Electricians License Required �� p� FOR OFFICE USE ONLY BP#: / EP#: / !! Approval Date: DEC - 8 202 Permit Fee: $ /SO /- Approval Signature: v Other: Application dated, le, 7-ZU'L Z 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. 1.Address: /Z`//2S SOe,7r1 S7 �YE/�iPOO f SBL: Ay�Z7- /- SS Zone: 2.Property Owner: > 7 S Address: /T/- /Z S` Phone#: ZD/- AIZ- 1f l/Q3 Cell#: email: 3.Master Electrician: Address: �Z/gel-Z Z S7 11514 -e qq iOS�r Lic.#:/ gS- Phone#: 61Z0-y6`)�ell#: email: /ZZ71,4,�1/Y57/19yLLCG'7�/ � Company Name: �ZW 71iU,i'ir/AOV' Z-L�7'721t/t' Address: a/zIl/e,CIO., 4.Proposed Electrical WorkTixture Count: ZZ - ZAG' 17S _ 3e ZYi22'e egl�v - C 5.31 Party Electrical Inspection Agency: /. 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 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 me this 14n day of ,20 day of 7- ,20_7Z- Signature of Property Owner Signature of Applicant Print Name of Property Owner Name of Applic t Notary Public otary Public SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County 6/23/2022 Commission Expires January 29,202C, STATEWIDE • Service Willi litlegrity 1:1 Main Street,Fishkill, NY 12524 1 email:• • . • SWIS JOB APPLICATION ;. 1 914.219.1062 SWISNY.com • • Office Use Elect.Permit# / - Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot rI Owner Name/Address(if different than above) Contact Number ❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑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 1P 3P #Meters #Disconnect ❑underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information /D 21,J�, ;U���-C ✓, r !iv/ 7/9 C 7-61 ti/ i�i [E D] DEC - 7 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SVAS.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 audwized 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 t; Date Signature Address City/State Zip Code License# Phone# ED State Wide Inspection Services EAPR - 24 1080 Main Street 6 Fishkill, NY 12524 SIV"K U _j 845 202-7224 Phone 5STATE WIDE INSVFC710NSERVICES VILLAGE OF RYE BROOK 914-219-1062 Fax BUILDING DEPARTMENT Email: office(cbswisny.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: Platinum Pro Electric Sound Federal Savings &Loan C/O Brian W. Detlefsen 121-125 South Ridge Street 42 Front Street Rye Brook, NY 10573 Mahopac, NY 10541 Located at: 121-125 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-296 141.27 � 55 Certificate Number: 2023-3482 Building Permit Number: BP 22-198 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 121-125 South Ridge Street, Rye Brook, NY 10573 The Basement, First Floor& 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 151h Day of May 2023. Name Quantity Rating Circuit Type Luminaires 45 Receptacles 40 Data Jacks 16 Switches 12 Panel Replacement 01 200AMP 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. Ln it W CIO ICI , oo 9) w ao r+. z a r Z o p� Q N n C A 0 �: .� a t w w >I LO � , z � � � CQ � � W) a° p4 c H ., Ln as � in � z o z r" \ r w 00 x a i 0 o Z CA Cl) Z Wz W Z cn M �"+ W O , w p 4 , Z AZ C H • 1-1 F1 CN \ U w A co o'< N V A w z o6 p`� o x o z r W 04 o Z zLn � a H 0 2 U z a ZN zW � zA o � w �I a a z M w = < yE- aRC�uk BUIL E IMENT OCT 19 2023 VIL� E OF RYE OK 938 KIN ET RYE.B ,NY 10573 VILLAGE OF RYE BROOK 4� ` 4 ; BUILDING DEPARTMENT wtiv�v Edo or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required _ FOR OFFICE USE ONLY BP#: �/=� — 9 V F.P#: `� C Approval Date: Permit Fee: S Approval Signature: Other: Application dated, September 28,2023 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 performed will be in conformance with all applicable Federal,State,County and Local Codes. I.Address: 115 S.Ridge Street SBL:_ /' /, Q�7 Zone: �. 2.Property Owner: Sound Federal Savings&Loan C/O M&T Bank _Address: One M&T Plaza,345 Main Street,Buffalo,NY 14203 Phone#: 716-559-3266 Cell#: email:_tsutton@mtb.com 3.Master Electric ian.fLicensed Installer: National Fire 8 Safety Solutions,Inc Address:211 Knickerbocker Avenue,Bohemia,NY 11716 Lic 412000269647Phone 4: 631-234-5656 Cell#: 516-805-7287 email: chdsct97nfssi corn Company Name: National Fire&Safety Solutions Inc Address: 211 Knickerbocker Avenue,Bohemia,NY 11716 4.Proposed Electrical Work/Fixture Count: Installation of a new fire alarm system throughout including manual pull stations,smoke detection, duct smoke detectors carbon monoxide detection fire sprinkler monitodnq and occupant notification with supervising station Signal transmission to central station is by UL listed fire cellular radio. 5.3rd Party Electrical Inspection Agency: State wide Inspection Services STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Christopher R Cassidy CET ,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 Licensed Installer for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) 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 ofte Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to b ore e his Sworn to fore me this day of is 20 day of 20 ,23 Si ttu roperly Owner Signature of"Applicant Christopher R Cassidy CET Print N of Pruprrty O�� r Print Name of Ap licant No Public )Mary Public ALEX SANTOS JOELLE M FENTY NOTARY PUBLIC STATE OF NEW YORK Notary Public,State of New York N+E C.001 TER rim No.01 FE6294288 3/312023 UC.I01 COMM.EXP. Qualified in Suffolk County Commission Expires Dec. 16,20-� STATE WIDE INSPECTION SERVICES, INC., Service Willi Integrity 080 • • SWIS JOB APPLICATIONr. • • Office Use Elect. Permit# ��� _ �3 Date Bldg Permit# — ` 9 Scl Ft Plumbing Permit# Final Certificate# City/Village �(��.` ' Zip Building Dept. County Address v I Cross Street Section Block Lot � 'C Owner Name/Addrf!. (If different thad bov - ' I�r Cow umber <,r•- V tl l ebov�,, ( K ! \i N•� . �y Zb -2, -71�v b�e Basement [11st Fl. 2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair F, ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation k1 S�-r�\�c�� \�►� 6 n��J ��t \ter titS��r L t � Ct�( \�I OCT 19 2M 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 anytime 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. Email Address ISL r �« Name License# I q y Date U LL Signature Address hX U(— flu City/State (Ja1 lull1 C� Zip Code Company �} 1G1 4 �7l v C 61 LILS L L Phone# A_ J D�F C E v E� State Wide Inspection Services CAD 1080 Main Street APR 1 7 2024 Fishkill, NY 12524 a 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE Nr DEPARTMENT BROOK Email: office(&swisny.com 8UR--- - 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: National Fire&Safety Solutions Inc. Sound Federal Savings&Loan Christopher R Cassidy c/o M &T Bank 211 Knickerbocker Avenue, Suite 1 121-125 South Ridge Street(AKA 115) Bohemia, NY 11716 Rye Brook, NY 10573 Located at: 121-125 South Ridge Street,AKA 115, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-235 141.27 1 55 Certificate Number:2023-9067 Building Permit Number: BP 22-198 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 121-125 South Ridge Street, AKA 115, Rye Brook, NY 10573 The Basement&First Floor 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 15th Day of December 2023. Name Quantity Rating Circuit Type Smoke Detectors 13 C/O Detectors 02 Fire Panel 01 Pull Stations 02 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. 4 W 7 p•l N t� � 'u F 00 ■ N N N � � � L N a Qr (30 6 Gz7 126. F...I ✓ 00IT r�°J o Lsy. r1 cl U) 1�1 aG G i a w Z O W y C y ca O oc) H a Q O Q3o � ° wE V Z W ~" M W W o � W) S � a °°o z O N W s rT �3 � em -6CN 0-4 � (, oo N y to U W L W w x z A it a a N O w V HS .. N z N z w < ; w oA r E Gy L A O U A a J a y. t REVISED Q E �, �L APPLICATIONNOV — S 2o22 OCT 1 y 2022 BUILDAG DEPARTMENT - VILLAGE OF RyEilkOOK VILLAGE OF RYL BROOK 938 KINGR 10573 �I , _ ._ _.. ......E_ .'_.R. , EN__ UIL3. V _ wwwxy ook ore. APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OE F IM — 1011— _ _( �� Approval Bate:_ 1� 'VIP#: — — & Application Fee:$ - Approval Signature: W I f Permit Fees:$ 2 Disapproved: Other: Application dated: 10/11/2022 is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: M&T Bank- I IS South Ridge St Rye Brook,NY 10573 2. Parcel I.D.:�_ i c�' '/ 'SS _ Zone: 3. Proposed Work(Describe system in detail including suppression agent): Relocating 6 sprinkler heads 4. Number&Types of Fire Sprinkler Heads: 6 concealed 5. N.Y State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job:$ 4.000.00 (Value shall include all labor,materials,fixed cquipmcnt,professional fees,and materials and labor which may be donated gratis.) 7. Property Owner: M Ficn k Address: *,le /tI T &1 6n,lo. NY Phone# ;�yl-ZL -clqQ Cell# a0l-7�G,-a'Iff� email:r'Af-Ic e.or-1 Applicant: Lj 1-le Address: 1076 1j rg r rti s Q'j' 1;4,,40 Phone#3C3 -37G-3CtC5' Cell# 0'3 1j CM� 7G-311 9E5 email;BGAAMA 0 L/i)Am Ica.d � � Architect/Engineer: �cl eid A(Cl;; eclL'i 1 Address: tl( CI✓-1i�,,j eve, 1-3,(r,L.'AT It1 m Phone# 716 4-005� Cell# 71(-rj97- g ) i email: Sr-+or,11; QSC�r�JIA,A C.Oj^1 Sprinkler Contractor: C i i}e R;f e P%o�e r-1%,Q A (.( C Address: 1 5 S Q.,C)n e_T�_N; I LT Phone#�t�0.�39- �I�? Cell# (d( 0 3�i' � �a7 email: ':ae0t);�eA,, r,4c I,Oki IIc,G0,n� t 8/I2/2021 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. Please note that application fees are non-refundable. STA1�.OF NEW YORK COUNTY OF WESTCBESTER ) as: 2rc)( being duly sworn,deposes and states that he/she is the applicant above named, (pr)nt narne of in7�dual signing as the applicant) and er states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the )i-� r 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 setforth 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. Swom to before me this 12th Swom to before me this A V) day of Octobo 20 22 day of r ,20�c� sipwure-urprupeq Owner a of AppfAant Michael F. McKeon,VP-M&T Bank Prt am offproppe-rryyOwncr Pant Name o Applicant Notary Public Public PATRICIA LITSIS NOTARY PUBLIC SHANNON NELSON STATE OF NEW JERSEY NOTARY PUBLIC - �qY COMMl, , EXPIRES 9/5/2023 MY 001611t11SSI0N EVtAES JAN.St,2026 z • s Ln W = M � N N a M x ~ O 00 W. k" wy :d w h"q a0 w N2 v cn [ � ^ � Ac � cc c CnCO L z o v � ov .aC L „� Ln � L? Q N i O � Cdadaw e x b v a u O U �1 Lnw � w LL O F" oo C/) O 0 w v ° w c V M1 G1 wo M U Ud � oQ �, O A z z Q ° � V H E-+ A a z a �o E w p••l en 0 cN U O oo N a v c D c, Z z a U W `~ �-• W w x z W o O ' �° � P F p O GCl C $ � a,bu � w O v U z o N O () 28w° � .y � U U A4 a (n a" w o •• . O z � � BUILD. , -�\ TMENT Imo' VT �� OF RYE'�BR�OOK Di 938 KING$� ET RYE BRo(I1h',NY 10573 MAR 13 2024 :*4 -0 68- -a VILLAGE OF RYE BROOK BUILDING DEPARTMENT" I APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT i - FOR OFFICE USE ONLY: PERMIT#: 035- Approval Date: R 2 2024 Permit Fee: $ 350—P 6 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#C 105.2 or Form#U26.3 i 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, 04/28/2023 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. I. Address: 115 South Ridge Street, Rye Brook, NY, 10573 SBL: /'M e)74—SS Zone: C— il 2. Property Owner: Sound Federal Savings & Loan c/o M&T Bank Address: Phone#: (201) 742 4408 Cell#: email: 3. Contractor: ENCON Heating & AC Address: 1265 Woodend Road, Stratford, CT 06615 Phone#: (203) 375 4228 (Ext 7455) Cell#: (475) 225 5237 email: lgrayson@goencon.eom 4. Scope of Work: New Installation( )• Replacement( )•Removal ( )•Other()0: HVAC - Modification to existing/ 5. List Equipment:No new equipment/modification of existing HVAC ducted branch runs, registers and diffusers only. (Reference Building Permit BP 22-198) 6. Location of Equipment: Ground floor renovated space only (Reference Building Permit BP 22-198) 7. Method of Installation/Removal (list all equipment needed to perform job): Fabricated sheet metal ductwork &flexible ductwork New RGD's (Reference Building Permit BP 22-198) 3 1 '_023 • STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Lee Grayson ,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 Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. 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 confortnance 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 `I m Sworn to before me this 1 day of a ,20.23 day of M arc1h ,20 2� *, �6-'/ Signature of Property Owner tg atu a of Applicant Michael F.McKeon,Vice President M&T Bank Senior Construction Manager LEE C"Z�-j Print Name ofProperty Owner r Name of Applica Notary Public Notary Public ROBERTOACORTE SHARI MELILLO Wooly Publlo Notary Public,State of New York caweethA No.01ME6160063 My Commission Egim:Feb 20,2= Qualified In Westchester County "ntnmission Expires January 29,202- 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. z 3/3/2023 -D ECE-HE DD MAR 18 2025 CI IMUIF.FLOW LLC VILLAGE OF RYE BROOK r TESTING 8 BALANCING BUILDING DEPARTMENT 489A Old Hartford Road Colchester, CT 06415 Office: (860) 531-9398 www.TrueflowCT.com O]E M & T Bank DATE: January 28, 2023 ADDRESS: Rye, NY \0,2\C e r t tf lcar/ a� o� d — 4 Scott W Boothroyd Truellow Testing&Balancing.LLC TABB Supervisor #TB996865S Not Valid Unkss Signed E.p—06302024 e"t",ed C00"2c`' TABB Technician: Josh LaPointe 1 &(OOTRIUEFLOW M &T Bank January 28, 2023 FAN DATA FAN NUMBER: RTU I MANUFACTURER: CARRIER MODEL NUMBER: 40RM-012 SERIAL NUMBER: 360109546 DESIGN ACTUAL Total CFM 3000-5000 2694 Connected Load 2170 Return Air ---- 2185 Outside Air ---- 509 Fan RPM ---- 793 Motor Horsepower ---- ---- Voltage ---- 460 Operating Amperage 5.15/5.20/5.17 Suction Static Pressure -.87" Discharge Static Pressure .14" Total Static Pressure ---- 1.01 Static Pressure Setpoint NONE Min. O.A. Position POTENTIOMETER Motor Manufacturer: GE Fan Sheave: AK84 X 1.0 Frame: 56Y Motor Sheave: 4.5 X 5/8 Motor Horsepower: ---- Belts: 41-410 Motor RPM: 1725 Sheave Position: OPEN Voltage: 230/460 Full Load Amperage: 5.2/2.6 NOTE: UNIT OPERATING AT NAME PLATE AMPERAGE TRUEFLOW Testing&Balancing,LLC 2 TRUEFLOW M &T Bank January 28, 2023 AIRFLOW DISTRIBUTION DATA FAN NUMBER: ROOM DESIGN FIRST FINAL FINAL NUMBER # SIZE A.K. CFM TEST FPM CFM NOTE PRIVATE OFFICE 105 1 24X24 1.0 120 126 127 127 PRIVATE OFFICE 104 2 24X24 1.0 120 102 121 121 PRIVATE OFFICE 103 3 24X24 1.0 120 120 130 130 SOUTH VEST. 100 4 24X24 1.0 60 47 65 65 PRINT/COPY 102 5 24X24 1.0 80 57 75 75 WEST VEST. 106 6 24X24 1.0 60 74 66 66 LOBBY 101 7 24X24 1.0 120 172 127 127 LOBBY 101 8 24X24 1.0 120 173 125 125 LOBBY 101 9 24X24 1.0 120 123 123 123 LOBBY 101 10 24X24 1.0 120 216 128 128 LOBBY 101 11 24X24 1.0 120 182 126 126 LOBBY 101 12 24X24 1.0 120 161 123 123 TELLERS 13 24X24 1.0 120 143 129 129 TELLERS 14 24X24 1.0 120 106 130 130 WORK RM 110 15 24X24 1.0 100 95 108 108 WORK RM 110 16 24X24 1.0 100 91 105 105 WORK RM 110 17 24X24 1.0 100 75 92 92 RESTROOM 108 18 24X24 1.0 100 80 95 95 RESTROOM 109 19 24X24 1.0 100 75 92 92 BREAK ROOM 107 20 24X24 1.0 150 186 153 153 2170 2404 2240 BASEMENT 21 1OX12 .83 NO DESIGN 375 547 454 OA 38X14 3.69 NO DESIGN 509 138 509 3 TRUEFLOW Testing&Balancing, LLC rRUEFL0W M &T Bank January 28, 2023 INSTRUMENT CALIBRATION SUMMARY Instrument Date of Serial Model Number Application Calibration - Airdata Multimeter ADM-860 Air Flow& Pressure Measurements 2/14/2022 M06245 Tachometer Z3884et Rotating Equipment Speed Measurements 9/30/2022 Hydrodata Multimeter HDM-250 Water Flow& Pressure Measurements 6/23/2022 W17093 Cooper-Atkins Fluke 971 Temperature & Humidity Testing 2/3/2022 CP51430 All calibrated devices are NIST traceable. TRUEFLOW Testing&Balancing,LLC 4 E �V/ E F- 24 October 2022 NOV - 2 2023 LD VILLAGE OF RYE BROOK BUILDING DEPARTMENT ASBESTOS AIR SAMPLING and PROJECT MONITORING REPORT M & TBank 115 South Ridge St. Rye Brook, NY 10573 UNYSE Project: 22-1014DJA PREPARED FOR: RW Drake Construction 1070 North Farms Rd. Suite 3 Wallingford, CT 06492 UNYSE 346 AUSTIN STREET. BUFFALO. NY 14207 I UNYSEENVIRONMENTAL CONSULTANTS unyse.net 24 October 2022 Blaze Graham RW Drake Construction 1070 North Farms Rd, Suite 3 Wallingford, CT 06492 Re: Asbestos Air Sampling & Project Monitoring Report M & T Bank 115 South Ridge St. Rye Brook, NY 10573 UNYSE Project: 22-1014DJA Dear Mr. Graham, I am pleased to present our asbestos air sampling & project monitoring report for an asbestos abatement project conducted at the address referenced above. Enclosed, please find our project summary, AASPM records, and relevant staff, firm, and laboratory certifications and accreditations. Please do not hesitate to contact our offices should we be of further assistance. Sincerely, Andrew J. McLellan President SLK/AJM file, 22-1014DJA ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 2 TABLE OF CONTENTS ASBESTOS AIR SAMPLING & PROJECT MONITORING REPORT PART 1: PROJECT SUMMARY....................................................................................4 PART 2: ANALYTICAL RESULTS................................................................................. 5 PART 3: SAMPLE CHAINS OF CUSTODY................................................................... 6 PART 4: SITE DRAWINGS ........................................................................................... 8 PART 5: SITE CHECKLISTS ...................................................................................... 10 PART6: DAILY LOGS ................................................................................................ 13 PART 7: PROJECT MONITOR VISUAL INSPECTION CHECKLISTS........................ 15 PART 8: FIRM, STAFF & LABORATORY CERTIFICATIONS..................................... 16 ENVIRONMENTAL CONSULTANTS 877-466-4429 346AUSTIN STREET BUFFALO NEW YORK 14207 3 PART 1 : PROJECT SUMMARY M & T Bank 115 South Ridge St. Rye Brook, NY 10573 UNYSE Project: 22-1014DJA UNYSE conducted asbestos abatement on-site air sampling and visual inspection activities on 10/14/22 and 10/15/22. The project-monitor performed pre and post abatement air sampling and conducted a final visual inspection of the work area. A daily summary of activities is enclosed. A total of sixteen (16) samples were collected during that period. Air samples were collected in accordance with New York State CFR 56-4 requirements and forwarded to an accredited laboratory where they were analyzed by phase contrast microscopy (PCM). Our review of this analysis indicates satisfactory results. Further details are available in Part 2. Asbestos project monitor visual inspection for completeness of abatement and completeness of cleanup is conducted prior to clearance air sampling per NYCRR56 and the current ASTM Standard E1368 "Standard Practice for Visual Inspection of Asbestos Abatement Projects." A visual inspection was conducted on 10/15/22 and the work area was deemed satisfactory. Further details are available in Part 7. Our New York State licensed site representative was Daniel Janish. Analysis was conducted at AmeriSci Manhattan. ENVIRONMENTAL CONSULTANTS 877-466-4429 346AUSTIN STREET BUFFALO NEW YORK 14207 4 PART 2: ANALYTICAL RESULTS 2 . \ } }/ , _ - � )- \ \S \2 }¥ {§ ) : I{F \ \§(\2 0 CD §) ■\ { §k\} E# 43 )icc Lli ! }f)� : \ } \ - - - - r) � 3 #� . .� 14 ENVIRONMENTAL CONSULTANTS 877 466-4429 #BAU s aSTREET BUFFALO N EVV YO 7 *207 5 / , . . 22 ° - � / )/ ; : : 2 1 , , j : 8 8 8 3 /j ;. ;; \ ) § G @ § @ {ja\)/ u$|\2 2 } � ;;!■! { kS n� E !!,�! § $ - - - ` • § / , \ ` c § aLu { 2j;; $ ` - - z \ ƒjtk![ ENVIRONMENTAL CONSULT ANTS 877 466-4429 a+AUSTINs RFC BUFFALO NEW YORK,&& 8 PART 3: SAMPLE CHAINS OF CUSTODY � I � � Tj--?�T � ► jig + � � � I o�� � ► � � , I � ; III J I i �� nk(✓INNN� s r—' N a ` IW.121 � w � PIN NI ti N N I N IN l n c m 'LL Y n m N i n E E E d U .� �N • ~ F- ~ y H 'cW O -IU-V (-� - n iL a �- O O O O a f3 t m N on ICJ =O w O M _ I v i Y N y 6 � II ,11 4ix Ci• �� m ` P m F W Q o wi z � ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 7 r I 0 o l cV 'v a � � � � 0�000;00 "• � � s n � o NJ 3 s� NN n1N � �ttam S E LL bwlo $ € I J � f 1 NE, a w a InlNNON N CL Y L I 1 ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 8 PART 4: SITE DRAWINGS Drawn By Daniel Janish Address 115 S. Ridge St. Rye Brook, NY 10573 Date 10/14/22 Floor M & T Bank North Drawn I I I Backgrounds KEY Sample -' Location � � I ot 1-4 ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 9 Drawn By Daniel Janish Address 115 S. Ridge St. Rye Brook, NY 10573 Date 10/14/22 Floor M & T Bank North Drawn I I Final Clearance KEY 18,4 Sample Location i f 10 _ f ENVIRONMENTAL CONSULTANTS 877-466-4429 346AUSTIN STREET BUFFALO NEW YORK 14207 10 PART 5: SITE CHECKLISTS Air Monitoring Checklist Project Address. 115 South Ridge St. Rye Brook, NY 10573 Date. Work Area Designation: Protect Size. 10114?2022 Front storage closet Small Project Project Number: Technician: Project Phase 221014DJA Daniel Jan sh 1 B Background Sampling Project Address: Abatement Contractor: 115 South Ridge St. Rye Brook.NY Empire Building Diagnostics 10573 o 1B-Background sampling 26-Sampling during abatement 1.(3)inside work area 0 1.If needed per variance 2.(3)Outside work area 2C-Post abatement sampling 3.Additonal Samples 0 1.(3)Inside work area 4.Samples placed random 0 2.Outside work area 2A-Work area preparation 0 3.Additional sample 1.If needed per variance 4.Samples placed random 5.Pre-sample agitation 6.Continuous agitation °`sisA" N(`37t Quad' k`{ i t{ v'"` Q 1.Certified ar techlproj.mn 0 4.Accredited lab 0 7.Samples placed unobstructed 0 2.Third party 0 5.Proper turnaround time 0 S.Samples at 45 downward ang. 0 3.Pumps calibrated pre&post 0 6.Post company license Notes Signature: ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 11 Air Monitoring Checklist Project Address: 115 South Ridge St. Rye Brook,NY 10573 Date: Work Area Designation: Project Size: 10/15/2022 Front storage closet Small Project Project Number: Technician: Project Phase 221014DJA Daniel Janish 2C Post Abatement Sampling Project Address: Abatement Contractor: 115 South Ridge St.Rye Brook, NY Empire Building Diagnostics 10573 1 B-Background sampling 2B-Sampling during abatement O 1.(3)inside work area O 1.If needed per variance O 2.(3)Outside work area 2C-Pcs:abatement sampling O 3.Additonal Samples 0 1.(3)Inside work area O 4.Samples placed random 2.Outside work area 2A-Work area preparation 0 3.Additional sample O 1.If needed per variance 4.Samples placed random Q 5.Pre-sample agitation 6.Continuous agitation r-, Q 1.Certified air techlproj.mn Q 4.Accredited lab Q 7.Samples placed unobstructed 2.Third party Q 5.Proper turnaround time 8.Samples at 45 downward ang. 0 3.Pumps calibrated pre&post 6.Post company license Notes Signature: ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 12 PART 6: DAILY LOGS I Daily Project Log Project Address 115 South Ridge St.Rye Brook,NY 10573 Dab Work Area Designation 10/14/2022 Front storage closet Nall Project i Abatement Contractor 221014DJA Project Address 115 South Ridge St.Rye Brook,NY 10573 Technician Daniel Janish Calibration Info Calibration Device ID: Last Calibration Date: 6/9122 Phase 16 Work performed today: Arrived on site to run background air samples on a small project.They:rill be removing a drye.all avail on the front storage closet which is adjacent to the main bank room.Joint compound is ACM.Pumps are pre calibrated to 10 LPM.Pumps pre and post calibrated. Persons entering site: 2 workers,air monitor,GC rep. Quantity material abated: 60112 Equipment Check(24hr) New Time New Time New Time New Time New Time New Tlme New Time 05:28 PM 06:00 PM 06:45 PM 07:37 PM Summary Weather O Chain of Custody PRE-Calibration 0 Sketch i] POST-Calibration ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 13 Daily Project Log Project Address 115 South Ridge St.Rye Brook,NY 10573 Dap Work Area Designation 10i15i2022 Front storage closet wall Project A Abatement Contractor 221014DJA Project Address 115 South Ridge St.Rye Brook,NY 10573 Technician Daniel Janish Calibration Info Calibration Device to: Last Calibration Dap: 6/9,'22 Phase 2C Work performed today: Arrived on site and conducted visua'inspection.No visible ACM at time of inspection.Set up pumps for final air samples.3 in and 3 out.In addition,in case of failures,set up a set of samples using Ahera TEM cassettes yo be read if PCM results in failure.5 inside and 3 outside.Pumps are pre calibrated.Bank is closed and no one in the areas.Post ca'ibrate pumps.Collect and take to AmeriSci Manhattan. Persons entering site: Monitor. Quantity material abated: 60 ft2 Equipment Check(24hr) New Time New Time New Time New Time New Time New Time New Time 08:00 AM C8: 5 AM C9:15 AM t 0:CO AM Summary Weather O Chain of Custody O PRE-Calibration O Sketch O POST-Calibration ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 14 PART 7: PROJECT MONITOR VISUAL INSPECTION CHECKLISTS Asbo. Project Monitor Visual Inspection Project Address 115 south Ridge Rye Brook.NY Date Work Area Designation Abatement Contractor 10/15/2022 Front storage closet,,vall EBD Project A Project Monitor Abatement Supervisor 221014DJA Daniel Janish Brian Project Address ACM Abated(from survey) 115 south Ridge Rye Brook. NY Joint compound.60ft 2 of associated drywall An appropriate'y`.rained and certified project monitor,contracted by the buildinglstructure ovMer,independent of the asbestos abatement contractor,shall complete the visual inspection.The project monitor visual inspection for completeness of abatement and completeness of cleanup shall be performed as per`.he provisions of the current ASTM standard El368"Standard Practice for Visual Inspection of Asbestos Abatement Projects" Completeness of Abatement-per ASTM Dust Waste Removed E1368-14 0 Yes 0 Yes Pass (:) No 0 No Removal Complete Location/Notes: Location/Notes: a Yes 0 No Debris LocationlNotes: 0 Yes 0 No Location/Notes: Completeness of Cleanup-per ASTM E1368.14 Pass -Signs, barrier tape and postings in place -Work area surfaces dry -Isolation barriers in place -Contractors'equipment cleaned -Critical barriers in place -All permanent fixtures examined -Decontamination facilities -Cloth/glove test completed PM Signature Cart Number: 0814211 ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 15 PART 8: FIRM, STAFF & LABORATORY CERTIFICATIONS New York State—Department of Labor Division of Safety and Health License and Certificate Unit State Campus,Budding 12 Albany,NY 12240 ASBESTOS HANDLING LICENSE UNYSE,LLC FILE NUMBER: 17-100402 LICENSE NUMBER 100402 346 Austin Street LICENSE CLASS. RESTRICTED DATE OF ISSUE 03/29/2022 Buffalo,NY 14207 EXPIRATION DATE 04/30/2023 Duly Authorized Representative—Andrew Mclellan: This license has been issued to accordance with applicable provisions of.Article 30 of the Labor Lass of Nesv York State and of the New York State Codes.Rules a nd Regulations(1'NYCRR Pitt-;6) It is subject to suspension or revocation for a(1) serious viotation of state.federal or local lases with regard to the conduct of an asbestos project.or(2)demonstrated lack of responsibility in the conduct of any job involving asbestos or asbestos material This license is valid only for the contractor named above arid this license or a photocopy must be prominently displayed at the asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York State have been issued an Asbestos Certificate.appropriate for the type of work they perform,by the New York-State Department of Labor. 4/v Amy'Phillips,Director SH 432(8112) For the Comnussioner of Labor LL ENVIRONMENTAL CONSULTANTS 877-466-4429 346 AUSTIN STREET BUFFALO NEW YORK 14207 16 STATE OF NEW VORK-DEPARTWNT Of LASOR A5WT0S CERT"CA'E DAHIEL J JANISH CU1SS(EXPIRFS) C AtFC(10t23) D INSP(10123) H PM (I(M23) 1 ID (10123) MUST BE CARRIED()N ASBESTOS PROJECTS `` "am6mi.■ Q I r rtllnm RiTUFd TO � iTiE 7at0 MT lDOI. - LLC UI11! _ RAM "o p m 161A an Lojw. 1: * im 6 Do* XTAYY OVVICT CA[PM 6R ALA MT IR 1226C a� ENVIRONMENTAL CONSULTANTS 877-466-4428 346 AUSTIN STREET BUFFALO NEW YORK 14207 17 NEW YORK STATE DEPARTMENT OF HEALTH WADSWORTH CENTER Expires 12:01 AM April 01,2023 Issued April 01,2022 r , CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance wath and pursuant to section 502 Public Health Law of New York State MR.PAUL J.MUCHA NY Lab Id No 11480 AMERICA SCIENCE TEAM NEW YORK,INC 117 EAST 30TH ST NEW YORK,NY 10016 is hereby APPROVED as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES AIR AND EMISSIONS All approved subcategories and/or analytes are listed below: Miscellaneous Asbestos 40 CFR 763 APX A No.III YAMATE.AGARWAL GIBS NIOSH 7402 Fibers NIOSH 7400 A RULES Serial No.:64684 Property of the Maw Ybrk Stake Departn"m of t eMttn Certa�akes are vaMo Dory M tK Medress stoN must ba wnspOtld*pgaMd,and are prtnied on sea"paper.Corgrued socredltatlon depends on successhA ongv 00Q*0j t In ttke Program.Consumers are urged to call(518)485-5570 w randy the Ieb—IWs aCCred6bl status. Page t of 7 mr-- ENVIRONMENTAL CONSULTANTS 877-466-4429 346AUSTIN STREET BUFFALO NEW YORK 14207 18 D VILLAGE OF RYE BROOK BUILDING DEPARTMENT Submittal: NEW FIRE ALARM SYSTEM Project Location: M&T BANK #3817 115 S. RIDGE STREET YE BROOK, NEW YORK 10573 Contractor: NATIONAL FIRE & SAFETY SOLUTIONS INC. 211 KNICKERBOCKER AVENUE BOHEMIA, NEW YORK 11716 (631) 234-5656 Vendor: NATIONAL FIRE PRODUCTS 211 KNICKERBOCKER AVENUE BOHEMIA, NEW YORK 11716 (631) 851-8900 I PA-1 00 E) PO ( TTER Fire Alarm Control Panel g The Symbol of Protection Features • 127 addresses available on this analog addressable system P sE"e�Fo • Additional system capacity achieved via multi-point SLC modules • 99 software zones y THE�So • NFPA 72 Compliant Smoke Sensitivity Test Built-In • System Operates as Class A or Class B for SLC,P-Link and NACs • 5 Amp Power Supply,Expandable to 310 amps • 2 NAGS,Regulated,Rated at 3 Amps each,expandable to 188 • 2 Input/Output(1/0)Circuits for system flexibility rated at 1 Amp each, ideal for manual release and abort • Strobe Synchronization and System Wide Sync for Potter/AMSECOO, Gentex®,Cooper Wheelock('and System Sensor®strobes • Dedicated Alarm,Supervisory and Trouble Relays • 4,000 Event History Buffer • Cabinet will house up to 18 AH batteries • Optional two line DACT with UD-2000 that can report General,Zone or Point Information • Built in IP Communicator • Ethernet Port for Programming and Network Connectivity • E-Mail System Status,Reports and Event Information NYC Fire Dept. FM UL • Product includes 5 year warranty Certificate of Approval ` • UUKL Listed for Smoke Control 6266 APPROVED .• LISTED Description Technical Specifications The IPA-100 is an analog/addressable releasing fire alarm system with a Dimensions 16"W x 17H x 3;4"D total system capacity of 127 addresses.Additional capacity on the system 3.0 Amps @ 120 VAC 50/60 HZ is achieved using multi-point SLC modules. The control panel utilizes AC Mains 2 0 Amps @ 240 VAC 50/60 HZ the exclusive Potter protocol that includes a complete line of sensors and modules. Each SLC may be comprised of any combination of smoke 16 gauge cold rolled steel with removable sensor,heat detectors or modules and allows for a total of 50 ohms of Enclosure locked door with Lexan viewing window impedance and may use any wire compliant with the National Electrical Standby Current-130 mA Code(NEC). Alarm Current-200 mA The IPA-100 has a 5 Amp power supply with two Notification Appliance 5 Amps power for NACs,1/O,and P-Link Circuits(NACs)and two Input/Output(1/0)circuits.The NACs are rated at Battery 3 Amps per NAC,regulated 3 Amps each and the 1/0s are rated at I Amp each.Each output is regulated 1 Amp per 1/0 circuit,regulated and power limited.In addition,each output is uniquely programmable and Battery Charger range 8-55 Ah may be configured for steady signal, strobe synchronization, constant Battery Charger voltage 27.3 VDC power, door holder power, or releasing. The strobe synchronization P-Link maximum current of 1 Amp includes Potter/AMSECO,Gentex,System Sensor and Cooper/Wheelock Temperature and 32'to 1200(0°C to 49°C)with a maximum and with the exclusive Quadrasync each output may have a unique brand Humidity Range humidity of 93%non-condensing. and all strobes will flash together.The I/Os are designed for inputs such as NFPA 12, 12A, 13, 15, 16, 17, 17A,70, manual release stations and abort switches that will not require polling and 72,92,750,and 2001 react nearly instantaneously. ANSI/UL 864-Local(L),Remote Station The IPA-100 is listed for releasing of fire suppression systems. The (RS),Central Station(CS),Propriety software allows cross zones,counting zones,and timers for suppression. (PPU),Auxiliary(AUX).Type of Service: The system is capable of multiple release outputs across multiple hazards. Standards Automatic(A),Manual(M),Water flow WF Sprinkler Supervisory SS Type of In addition,the PSN-1000 may be used to extend releasing capability. ( ) P � P rY( ) YP The NACs may be expanded using the PSN-1000 series intelligent power Signaling:Digital Alarm Communicator supplies. Each PSN-1000 adds another 10 Amps of power,2 additional (DAC),March Time(March),Non Coded input circuits and the IPA-100 will support up to 31 power supplies.The (NC),Reverse Polarity(Rev Pol),Other system will synchronize the strobes system wide.In addition,the PSN- Technologies(OT) 1000E has space to allow the installation of up to six loop expansion cards. IBC(International Building Code) The cards mount on a stacker bracket that allows access to all SLC circuit connections. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830101-REV H 2/22 PAGE 1 OF 5 (E) POTTER IPA-100 The Symbol of Protection Fire Alarm Control Panel SLC Loop Accessories The control panel may be connected with up to 127 addressable devices or modules in any combination.The SLC is not restricted by any special wire requirements and may be wired with any wire that complies with the NEC. SLC Loop Devices Device Description PAD200-PD Analog Photoelectric Smoke Detector is a smoke detector with a listed obscuration of 1.0 to 3.70/o/foot.UL 268 7th Edition. PAD200-PHD Combination Analog Photoelectric Smoke/Heat Detector—a smoke detector with a listed obscuration of 1.0 to 3.5°/c/foot obscuration and a fixed temperature range of 135°F to 185°F heat detector.Smoke detection compliant with UL 268 7th Edition. PAD200-PCD Combination Photoelectric Smoke/Carbon Monoxide Detector. Smoke detection compliant with UL 268 7th Edition. Carbon Monoxide detection compliant with UL 2075. Combination Photoelectric Smoke/Heat/Carbon Monoxide Detector. Smoke detection compliant with UL 268 7th Edition. Heat PAD200-PCHD detection with a fixed temperature range of 135'to 185'F and is UL 268 and UL 521 7th Edition compliant. Carbon Monoxide detection compliant with UL 2075. PAD 100-HD Analog Fixed Temperature(135'-185°F)or Rate-of-Rise Heat Detector(software selectable). PAD200-DUCTR Addressable Duct Smoke Detector with Form C Relay rate at 1 OAmps @ 250/120VAC or 8 Amps at 30VDC. PAD200-DUCT Addressable Duct Smoke Detector. PAD100-6B 6"round base that is mounted to an electrical box and wired for connection of one of the above sensors. PAD100-413 4"round base that may be mounted to an electrical box and wired for connection to the above sensors. PAD100-IB Isolator base that interrupts a short in a SLC and prevents the short from affecting protected devices on the loop. PAD100-RB Addressable Relay Base that contains one relay controlled by the SLC.Relay is rated at rated at 2 amps at 30 VDC or 0.5A at 125VAC. PAD 100-SB Addressable Sounder Base that contains an addressable sounder module that may be configured for local,group and all call. PAD100-CD Addressable CO gas detector. PAD100-DD Addressable photoelectric smoke detector for use in DUCT/DUCTR enclosure. PAD100-LFSB Addressable Low Frequency Sounder Base that contains an addressable sounder module that may be configured for local,group and all call. The LFSB complies with the Low Frequency Signal Requirements(520 Hz) PAD100-SPKB Speaker base is a wall or ceiling mount speaker capable of 25 or 70.7 VRMS and is field selectable from 1/8W to 4W. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830101-REV H 2/22 PAGE 2 OF 5 (E) POTTER I PA-1 00 The Symbol of Protection Fire Alarm Control Panel Modules Device Description PAD100-MIM Micro Input Module provides a small foot print contact module for mounting inside an enclosure. PAD 100-PSSA Single Action Addressable Pull Station. PAD 100-PSDA Dual Action Addressable Pull Station. PAD 100-SIM Single Input Module is a standard contact module with an LED that mounts into a 4"square electrical box. PAD 100-DIM Dual Input Module is a device that can monitor two distinct inputs with a single device or in a Class A mode. PAD 100-TRTI Two Relay Two Input module provides two form C relays that are individually controlled by the control panel.Each relay is rated for 2 amps at 30VDC or 0.5 amps at 125VAC.Also provides two contact inputs. PAD 100-NAC Notification Appliance Circuit module is an addressable remote appliance circuit controlled by the panel. PADI00-ZM Zone Module is used to connect conventional 2-wire smoke detectors to the system. PAD 100-IM Isolater Module interrupts a short on the SLC and prevents the short from affecting protected devices on the loop. PAD100-RM Relay Module that provides one form C relay controlled by the control panel.Relay is rated for 2 amps at 30VDC or 0.5 amps at 125VAC. PAD100-LED Module provides a single addressable LED that is controlled by the control panel. PAD 100-SM Speaker Module provides switching for two audio channels. PAD 100-LEDK Addressable LED and key switch that mounts in a single gang box. PAD 100-DRTS DUCTR Remote Test Switch that mounts in a single gang box and optionally supervised. PAD 100-OROI One Relay One Input Module provides one form C relay and one input.The relay is rated at 2 amps at 30VDC or 0.5 amps at 125VAC. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignaLcom 8830101-REV H 2/22 PAGE 3 OF 5 (E) POTTER IPA-100 The Symbol of Protection Fire Alarm Control Panel SLC Features RA-6500R(F)-4 x 40 LCD annunciator with a key pad in a locked The Potter protocol is a digital protocol with a proven design for metal enclosure.Flush mount version available. reliability and noise immunity.The system does not require special LED-16(F)—16 LED annunciator with common indicators in a cable or conductors for connection of the Signaling Line Circuit locked metal enclosure.Flush mount version available. as long as the cable is compliant with NFPA 70 and NFPA 72. PSN-1000(E)—10 amp,remote intelligent power supply with The system allows for Class A or Class B installations as well as 6 NACs,2 Inputs and a P-Link repeater.This panel is listed in "T Taps",with a max wiring distance of 10,000 Ft. conjunction with the IPA-100 as releasing circuits. CA-6075—Class A convertor that converts the SLC,NACs and Sensor Features P-Link connection The sensors through the fire alarm control panel provide a real UD-2000—UL listed,Dual line telephone alarm communicator time status as to the condition of the system.The smoke detector DRV-50—LED driver expander,used to connect up to 50 LEDs in a sensitivity,heat detector temperature level and drift compensation graphic display are all programmable options.The system also allows for a day/night -mode where the panel automatically adjusts the sensitivity depending thee Eth00 ernet communication bridge,provides remote mounting o on the time of day.To assist in the reduction of false alarms,the FIB-of the Etheernet connection smoke detectors also have a maintenance warning that sends a trouble ode 000—Fiber interface module,used to extend P-Link to multi- smoke signal when a detector is dirty to the point that it can no longer mode fiber(2 required) maintain the programmed sensitivity. RLY 5—Relay module,provides 5 form C relay contacts rated at 3.0 amps 24VDC/125AC User Interface SPG-1000—Serial parallel gateway,allows for the connection to a The fire alarm control panel has a 2 x 16 LCD display to provide serial or parallel printer information to the system status.The keypad has navigation keys The FIB-1000,FCB-1000 and the SPG-1000 may be installed in the to allow manipulation of the Menu on board the panel.The panel is stacker bracket or ordered with the optional rack mount enclosure. shipped standard with the following LEDs: MC-1000 Multi-Connect allows up to sixty-three IPA series panels to • AC Power-Green share a single reporting technology. • Alarm-Red IDC-6—Initiating device circuit provides 6 programmable inputs • Earth Fault-Amber AE-2—Two card expansion cabinet • Supervisory-Amber AE-8—Eight card expansion cabinet AE-14—Fourteen card expansion cabinet • Silenced-Amber • Trouble-Amber Ethernet/I.P. Connection • Pre-Release-Amber The IPA-100 is shipped standard with an Ethernet connection. This connection is the programming port and may be connected • Release-Red to a building Wide Area Network(WAN)or Local Area Network The common buttons include a Silence,Reset,Acknowledge,and (LAN).Once connected to the Internet,the panel may be selectively Drill.All of the buttons are accessible once the locked door is programmed to e-mail alarm conditions,trouble conditions, opened. supervisory conditions,test,Event History and detector status.An e-mail may be sent to the panel and the panel will e-mail the event P-Link history,detector status,configuration file or server status to an The IPA-100 has a proprietary communication protocol that authorized E-mail account.In addition,reminders may be set to send communicates through a RS-485 connection to field devices.Up an e-mail for service,testing or other conditions. to 64 devices may be connected to a single P-Link connection.The In addition,the Ethernet connection is UL listed as an IP P-Link includes the communication terminals and regulated 24 VDC communicator.The IP communicator is listed to report to the UL connection for the field devices.The field devices may be any of the listed Sur-Gard III IP receiver.The IP communicator replaces the following: traditional less reliable alarm communicator transmitter that utilized RA-6075R—2 x 16 LCD annunciator with a key pad in a locked telephone lines.The IP communicator is an active method of metal enclosure. connection and communication to the monitoring station. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830101-REV H 2/22 PAGE 4 OF 5 (E) POTTER I PA-1 00 The Symbol of Protection Fire Alarm Control Panel Dimensions TOP DEPTH=3.75" e o DOOR= 16.07" BACKBOX=15.77" DEPTH=3.84" © I • • �o • 0 0 cc OY pV a m LEFT SIDE RIGHT SIDE BOTTOM DWG b911 Compatible Releasing Devices Note: For releasing applications please order the Potter EOLD (3005012)for circuits connected to a releasing solenoid or actuator. Brand Description Skinner 73218BN4LTNLVNOC I 12CZ 73212BN4TNLVNOC322C2 Ordering Information Victaulic 753-E Series Model Description Stock No. Mini Max MX123 &MX200 w/8876677& 889323 IPA-100 Fire Alarm Releasing Control Panel 3992715 Viking 11591, 11601, 11602, 13843,& 13844 Replacement Board IPA-100 3992739 TLX PA0036 Potter Electric Signal Company. LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830101-REV H 2/22 PAGE 5 OF 5 E d0 I good 61/9 . G Awl-9b10E88 woo leuS[saauodmmm 500£-ZLS-998 :aainaaq aawojsno/ [IZI-9S6-998 :jioddnS goal OW`stnoZ*IS 0'I'I Siuedwo0[eu$tS ol [3 aajjod 'm&Bl ao JMd 9Z al Plnogs wajsAs auogd aqj of•_)V(j agj Sutpaumo siojonpuo0 anm ags•sjinoalo aagjo woa3 jlnpuoo ajeaedas g ul uni aq pings pug aSejloA gSlq On sauil auogd sql L17•0 igSiaM 8utddtgS aug auogd agj ozlas m a amsuo of juowdmba aagjo Sue aao3aq pollgjsui ped,Sai[putgag dOb'3 uI suondp Suijunolp oq jsnw •I,OyQ aiLL •uopipsunf SuTAeq r,4potpnv agj Aq pawaap (Slnsuapu00-uou) aSuell Cj�ptwnl{Suijeaad0 jualenmbo ao auil(S.LOd)aoiAaas ouogdalaj plo ute[d a uo pollgjsui (3a98)Oo0£@%£6-°/u0[ oq jsnw jt `Claadold�liom of,I DVG aqj iO3 aapao uI •spaoo 917f d omj (3o0Z1-doZ£)Oo6b-3o0 salnlgindula[ Suijeaadp pus autl auogd goea ao3 spolq Ieuiuual gjim pop!Aoad sl j.DV(j aq,I• [ *HA s M..b suoisuawid do Sueq ll!m•I jV(j agj`ajaldwoo sl uoljeolunulwoo agj aouo•aaAiaoat ajowaa a gjiM j3auu03 pue auil ayj aztas of A3[lEge [ lauud aad s000Z-Qfl XeW agj suq pug aSgjloA ao aull auogd g3ea saoj!uow Alleougwojne VWU imunD uuRjv IDV(j agj `polgeua uagM slo3oloid Ql pnuo0 oowapy ao SM dw91 waunj XgpuelS -VIS agj Sulsn someo►unwwoo 000Z-(M oiLL •uo►lels Suuolluow e 01 uoueo�ununuoo ao; saui[ auogd (Z) omj of do to3 sap!noad AO bZ-0 ZZ aSgjloA Suueaad0 (LOVG) jou!tusuwL immunwwoD uuel`d Imigicl 000Z-Qfl oql suoi;eoi;loads leolu43a1, uopdiaosaa 031sli spaoo auogd Sbf2I(Z)omj sapnloul I ssaappu of Alleuaalut Jos st ssaippe aoiAaQ lo3laeaq aoelaajul aas fl eIA Auldst QO j laued mew putgaq asea pm sllejsul P LOt+Q 3o uopwodo ojeoipm sQg-I snjgjS [awed IRU01 anuo0 b90b-O,gd e PUB slated alqussQIPPV sauas 3,dV Pue`Oj'`ddI pm osn aog sl000joad(II joejuo0 ooulapy ao SOQ-VIS Smsn sajeolunwwo0 uoljgjs SuuojluoW of uoljeolunwwoo 103 smolld . .. sawn;eat J0jDJlunu.auoj u.t. DIV I DI!bia u0go910Jd JO logw/fo alll 000z-a n ?13110d d (DPOTTER uD-2000 The Symbol of Protection Digital Alarm Communicator RJ31 X Phone Jack to UD-2000 Plain Old Telephone (POTS) lines Tip(Brown) Ring(Grey) Out to Premises Phones Out to Premises Phones Ring(Grey) Ti (Brown) Ll 1 8 I-Grey 2-Tan z 73-Black 4-Red 5-Green 3 6 6-Yellow a 7-Blue 4 5 8-Brown 4 5 Ring(Red) Tip(Green) Line In From Telco Tip(Green) Ring(Red) Line In From Telco Tel one 2 Te hone I Ti g Ring T Rg Ring UD-2000 Communicator Telco Tip=Red Telco Ring=Green Phone Tip=Brown Phone Ring=Grey Install in accordance with compatible fire alarm control panel installation manual Installation The UD-2000 DACT is connected to the control panel using the provided four-wire cable connection(P/N 5210514)between P4 and UD-2000 Pl.The connection is power limited and supervised. I. Power system down. 2. Slide the UD-2000 into the card guides located under the User Interface bracket. 3. Secure the UD-2000 to the User Interface bracket using the provided#6-32x3/8"screw 4. Install the provided four-wire conductor jumper between UD-2000 P1 and P4. Potter Electric Signal Company,LLC St. Louis, MO Tech Support: 866-956-1211 /Customer Service: 866-572-3005 • www.pottersignal.com 8830146-REV B • 6/19 PAGE 2 OF 3 (E) POTTER U D-2000 ® The Symbol of Protection Digital Alarm Communicator UD-2000 DACT Installation on UD-2000 DACT Installation on Small Platform Panel Large Platform Panel Fig I Fig 2 ° e o0 _ °® p aoo p in ®®® O O ®oo B p e e O F r= p o 0 0 1° e RC] R O ppF o Screw I1 I RE R QSlides in quides under main board. I O Q sl O DWG r593-32A O O eC D °®C- ID pp C- 0 to as P Connector on small platform R❑ control panel Q o p` ®® Qp P Connector ®®M ZZ on main board P Q O Ordering Information Model Description Stock No. UD-2000 Digital Alarm Communicator 3992769 Potter Electric Signal Company, LLC St. Louis, MO • Tech Support: 866-956-1211 /Customer Service: 866-572-3005 www.pottersignal.com 8810146-REV B • 6 19 PAGE 3 OF 3 tarnire Commercial Fire Alarm Cellular Wor IP COMMERCIAL FIRE CELLULAR& IP Fire Alarm LTE Communicators • Universal full event sole&dual path cellular&/or IP UL and NFPA 72 Fire Code-Compliant,the StarLink commercial fire alarm reporting from any panel brand, Series Wireless Commercial Fire Alarm Sole Path&Dual virtually anywhere Path Communicators provide universal support for any brand 12V to 24V fire alarm control panel,reporting in • Code-compliant, replaces 2POTs lines per FACP saves Contact ID and 4/2. With broadest Verizon LTE coverage thousands of dollars per year over the leased landlines footprint available,via most extensively deployed LTE CAT1, • Supports 12V-24 control panels and FACPs that using proven StarLink circuitry,they are also available communicate using Contact ID and 4/2(such as on legacy in mercantile locking metal models.All provide the most panels),as primary or backup economical solution for easy,versatile installation.Also regional compliances,i.e.,CSFM,NYCFD,LAFD and more. • Full data Reporting to any Central Station nationwide, Easy,Universal Installation at Every Applications Panel- via Verizon®LTE Network,"The Nations largest and most reliable LTE network. Rated#1 overall network, proven to Powered Technology TM'.StarLink Fire Communications are easily connected to any panel or Fire Alarm Control Panel deliver consistently fast speeds ad i more places than any other network'$ (FACP)standardly operating between 12V and 24V.Flexible in any application,StarLink Fire also comes in standard,or • Communicate critical life and safety alarm reports on Mercantile Models in metal housings,with code-compliant LTE(Long Term Evolution)10+year life,cyber-protected supervision,and choice of power options,Panel-Powered multi-billion dollar cellular network,for maximum life Technology"(powered by the panel),or direct-connect safety&liability protection 120VAC models.Signal Boost circuitry&dual diversity antennae for maximum signal acquisition&null avoidance, • Easiest installation, powered by panel, NO extra power receiving signals simultaneously on both antennae. supply, NO conduit,self supervised on 4 wires Flexible Performance&Reporting Options.StarLink • Over-the-Air Upgradeable Communicator Firmware. Fire provides full data reporting,in sole and dual path,as Remote ability for critical/mandatory updates,without a a primary or backup,to any central station of your choice, truck-roll without requiring any special equipment on premises. Ultra-affordable plans are available to meet various codes • Cost-saving models and plans for any code requirement. and requirements,with supervisory check-ins from 200 Substantial savings over monthly dedicated landline charges. seconds,to 5 minutes,to an hour.The units are very easily And,$100 saving incentive for system upgrades from old activated,plans and options are selected,and 24/7 account radios(all makes)and old POTS landlines,as well as new management is provided all through www.napcocomnet.com. installations connected by Napco Starl-ink Universal Fire Alarm verizoW Communicators - Sole Path Cellular and Dual Path Cellular&/or IP Models - Choice of plans(varies by model)-check-ins from 200 --� seconds,to 5-minutes to 1 hour,Verizon LTE Network • Patented Signal BoostTm andDual Diversity Antennae for maximum signal acquisition&null avoidance, receiving signals simultaneously on both antennae - Money-saving Tradeup incentive credit - Bonus:Full High-Speed Napco Panel remote uploading/downloading • COMPLIANCES:NFPA72 Editions:2016,2013,2010, 2007;UL 864,9th Ed.,UL1610,UL985,UL1023, NYCFD; CSFM;LAFD StarUnk� NFPA 1R� Code-compliant standard or mercantile metal models(right and left,respectively). tar .in Commercial Fire Alarm Cellular Wor IP COMMERCIAL FIRE CELLULAR & IP Fire Alarm Communicators StarLink Fire Specifications Ordering Information STANDARD MODELS: COMMERCIAL FIRE SOLE PATH CELLULAR& • Advanced LTE Dual Diversity Antennae for optimized DUAL PATH CELLULAR&/OR IP("I"MODELS):* performance SLE-LTEVI-FIRE Dual Path Communicator,Cellular&/or IP, • Durable ABS plastic housing includes three keyhole slots for connected by Verizon LTE",ABS. Low current draw, panel- mounting(for commercial application,aligns with triple gang powered technology"(powered by control panel) boxes) SLE-LTEV-FIRE as above, but sole path cellular model • Panel Powered Technology"(powered by panel),Low current SLELTEVI-CFB Commercial Fire Dual Path Mercantile model draw,71 mA standby,200mA transmit in red metal housing on LTE,Verizon LTE Network, powered • Dimensions:5-3/8"x 7-7/8"x 1-7/8"(HxWxD) directly from control panel • Weight: 13.5 oz SLETEVI-CFB-PS Commercial Fire Dual Path Mercantile model • 3 LED Indicators-Green,Signal Strength;Amber-Busy/ in red metal housing, LTE,Verizon LTE Network. Direct 120VAC Activation;Red-Trouble Powered(w/provisions for backup battery/charger).Or, • Patented Signal Boost1m signal amplification circuit and high- Optional TRF12 plug-in transformer may be used,where codes gain performance antennae permit • Operating Environment:0 to 490 C(32-1200F),up to 93% ACCESSORIES: humidity(non-condensing) Free Commercial Fire Tradeup Trifold • 12V-24V Universal FACP Support,auto-current sensing. Brochures/Mailers/Stuffers(A720)for new Support all brands communicating in Contact ID and 4/2 and existing fire accounts IN SLE-ANTEXT75 Optional extended antenna with MERCANTILE MODELS(similar to above,with): 75'cable(new conical shape) sue.-•- • Locking Metal Enclosure with Hinged door& 2 key-slots for SLE-ANTEXT50 As above,with 50'cable wall mounting(LED indicators,inside) SLE-ANTEXT30 As above,with 30'cable • Dimensions: 9-5/8"x 11-3/4"x 3-3/8"D(HxWxD) SLE-DLEXT Optional,as above,for downloading,extends distance • Weight:8 Ibs(max.,power supply models) to Napco panel up to 100' • Electrical Ratings for 120VAC,60Hz TRF12 Optional Plug in AC Transformer, 16.5V/20VA(use is • For Models with Power Supply: subject to local code compliance) • Input Voltage: 120VAC Nominal SLE-DLCBL Optional High-Speed Napco Panel Up/download cable • Input Current:400mA maximum • Maximum Charging Current: 200mA • Electrical Ratings for+12V New! FireLink- Integrated Fire Alarm Control • For Models without Power Supply: Panel w/ StarLink Fire LTE Built In • Input Voltage: 11-15VDC(power-limited output from listed Award Winning FL-FACP-LTEVS control panel) « Firewolf 8 Zone 24V Conventional • Input Current:71 mA with peak RF transmission current of '°'° Commercial Fire Alarm Control P P ' Panel with onboard StarLink Fire 200mA Sole Path,Verizon LTE Cellular • Electrical Ratings for the IN 1 Burg/Fire Input: Alarm Communicator and integral menu-driven LCD annunciator,w/ • Input Voltage:9-15VDC 4amp,24V power supply.Optionally • Maximum Input Current:U to 2mA from FACP NAC circuit expandable up to ss points/zones via P P commercial addressable,wireless or • Electrical Ratings for IN 2 and IN 3: conventional fire devices(2 onboard NACs providing up to 4A notification • Maximum Loop Voltage:15VDC power).Locking,mercantile red • Maximum Loop Current: 1.2mA enclosure,(surface or flush mount') P removable 16"xl7"door with • Electrical Ratings for 3 PGM Outputs: 14.25"xl6"base.Houses 16Ah battery backup • Open Collector Outputs: Maximum voltage 3V when active; 15V maximum when not active • Maximum PGM Sink Current:50mA mount StarLink Fire. • Operating Environment 0 to 490 C(32-1200F),up to 93% NAPCO 0 humidity(non-condensing) COMMERCIAL FIRE CELLULAR& IP [#70 333 Bayview Ave.,Amityville,NY 11701 USA • 12V-24V Universal FACP Support,auto-current sensing. 1-800-645-9445 •Fax:1-631-789-9292 NFPA Support all brands communicating in Contact ID and 4/2 www.napcosecurity.com Sca Unk StarUnk Rre,Rrel-ink SignalBoost PaneMo%wed Technology,Gemini&Gemini Commer3al are Uademarks of Napco.Ver¢on,LTE,etc are trademarks of their respective companies.'Shrunk offers full data co*rage in US from ertualyal panel brands reporting in Contact ID or 4/2. ForkideAonOStadnkoadergince MseeorineorderhupJAwwv.napmsea .=Vstariak/star Mgupgrade/Promowb)edtodtangew/opnanotice.LTEkl Wdamsarebasedonthoseoforrie,s SVerLon*rankings based onU1eRoodv*WUSNauticalRoo6core Report1N2017. ®NAPCO,NAFYOSecurity Technologies Inc.(NASDAQ:NSSC) A7342018.9 (DPOTTER RA-6500 The Symbol of Protection LCD Annunciator Features • Industry leading 4 line by 40 Character LCD • Common buttons for navigation • Common LEDs for status indication • 31 annunciator per panel • Maximum wire length of 6,500 feet • Available in 4 colors • Product includes a 5 year warranty ® ate • ■ ■ r ©DER • e • U ` LISTED Description Technical Specifications The RA-6500 is a LCD remote annunciator for the PFC-6000 series Standby Current 20 mA fire control panels. The RA-6500 communicates using a RS-485 connection to the main panel providing common indication of Alarms, Alarm Current 25 mA Supervisory,Trouble and other system status and control functions. Operating Temperature 0°C-49°C(32°F-120°F) The RA-6500 features a 4x40 LCD display with LED's for Power, 101/6-93%@ 30°C(86°F)non Alarm, Supervisory, Trouble, and Silenced conditions. It can be Operating Humidity Range condensing humidity mounted on a single gang electrical box or a four square electrical box. Maximum Wire Length 6500 ft. The annunciator is enclosed in a sheet metal enclosure and has a Potter lock securing the keypad. Maximum Annunciators 31 Size(WxHxD) 10"x 7-7/8"x 1-5/8" Wire Gauge 14 AWG-22 AWG Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830113-REV B 1/21 PAGE I OF 4 (E) POTTER RA-6500 ® The Symbol of Protection LCD Annunciator Installation The RA-6500 is connected to the PFC-6000 series fire control panels using a four wire RS-485 connection. The connection is power limited and supervised. Up to thirty-one Q 1)RA-6500 LCD annunciators can be connected using Class B or Class A wiring.Class A wiring requires an optional Class A Expander. RA-6500 Class B Wning Example RA-6500 Class A Wning Example Fig 1 Fig 2 To the next device Class A + + + + Expander Connection + m PUNK } a m + A B + a + + + + , Panel + + Connection + Expansion Panel + U Devi Cxpansion orrection + Device Qm Sa O + 0 Expansion Device O Expansion Device Address Settings The RA-6500 address is set by dip switch S1 located on the back of the RA-6500.The address must be set in the range of l to 31 to be recognized by the control panel. IL4-6500 Remote(Panel View) RA-6500 Enclosure Fig 3 Fig 4 00 O O 0 .M i 0 �� swnO 0 p Do o O O O O ° O ® O ® e ° O O o DWG.W77-] Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830113-REV B 1/21 PAGE 2 OF 4 (E) POTTER RA-6500 ® The Symbol of Protection LCD Annunciator Dimensions O O o 0 0 I� M N n � I N M O Q O 4.91 1.66(2) 6.10(2) 1/2"ELECTRICAL KNOCK OUT.87"DIAMETER 2 PLACES o + « o � 4.85 -- { 9.82 Potter Flectric Signal Company, LLC fit. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830113-REV B 1/21 PAGE 3 OF 4 (E) POTTER RA-6500 ® The Symbol of Protection LCD Annunciator Dip Switch Settings Refer to the table below for dip switch settings per Annunciator Address. Annunciator Dip Switch Settings Annunciator Dip Switch Settings Address SW-1 SW-2 SW-3 SW-4 SW-5 Address SW-1 SW-2 SW-3 SW-4 SW-5 1 On Off Off Off Off 17 On Off Off Off On 2 Off On Off Off Off 18 Off On Off Off On 3 On On Off Off Off 19 On On Off Off On 4 Off Off On Off Off 20 Off Off On Off On 5 On Off On Off Off 21 On Off On Off On 6 Off On On Off Off 22 Off On On Off On 7 On On On Off Off 23 On On On Off On 8 Off Off Off On Off 24 Off Off Off On On 9 On Off Off On Off 25 On Off Off On On 10 Off On Off On Off 26 Off On Off On On 11 On On Off On Off 27 On On Off On On 12 Off Off On On Off 28 Off Off On On On 13 On Off On On Off 29 On Off On On On 14 Off On On On Off 30 Off On On On On 15 On On On On Off 31 On On On On I On 16 Off Off Off Off On Ordering Information Model Description Stock No. RA-6500 LCD Annunciator-RED 3992660 RA-6500 LCD Annunciator-BLACK 3992744 RA-6500 LCD Annunciator-GRAY 3992745 RA-6500 I LCD Annunciator-LIGHT GRAY 13992746 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830113-REV B 1/21 PAGE 4 OF 4 (E) POTTER PAD300-PD The Symbol of Protection Photoelectric Smoke Detector Features • Low profile,less than 2 inches with the base =° • Wide selectable sensitivity range of 1.1 to 3.5°/m/foot • Detector communicates sensitivity to control panel • UL listed smoke calibration and sensitivity • Optional locking tab to prevent unwanted removal • Simple DIP switch address setting,no programming tool required • Magnetic test switch • LED alarm indicator • Product includes 5-year warranty • UUKL Listed for Smoke Control • UL268 7th edition compliant �L Description Technical Specifications The Photoelectric Smoke Detector is a listed Analog Addressable smoke detector compatible with fire alarm control panels that utilize Operating Voltage 24 VDC the Potter Addressable Device(PAD)protocol.The PAD300-PD is a low profile smoke detector with a wide sensitivity range.The detector Detector Current Draw 300 µA and base are made of a durable plastic in an off-white color to blend in with the ceiling. Alarm Indicator 1 LED The PAD300-PD has a sensitivity range of 1.1 to 3.5%per foot and is Alarm Set-point Range 1.1 to 3.50/o/ft(3.6 to l 1°/u/m) UL listed.The PAD300-PD features drift compensation and has built in dirty detector warning as well. The PAD300-PD and the control Installation Temperature Range 32 to 120°F(0 to 49°C) panel communicate over a proven and robust digital communication path and the system analyzes the information at the particular device. Operating Relative Humidity 0%to 93%(Non-condensing) The total polling speed is less than five(5)seconds,well under the UL range requirements. Start-up Time Max. 1 sec. The detector is compatible with any of the PAD300 series detector bases and simply twists on.The PAD300-PD is addressed using DIP Maximum Number of Addresses 127 switches in the rear of the detector and can be easily programmed in Per Loop the field without special tools. Maximum Number of Lighted Indicators in Alarm Per Loop 30 Setting the Address Each addressable device on the SLC loop must have a unique address Color Eggshell White from 1 to 127 to function properly. The address is set using DIP switches. Weight(without base) 9 1 g(3.2oz) Before connecting a device to the SLC loop, take the following Dimensions(without base) Height: 1.42 in(36mm) precautions to prevent potential damage to SLC or device.Verify the Diameter:3.93 in(100 mm) following: 1.Power to the device is removed. 2.Field wiring is correctly installed. 3.Field wiring has no open or short circuits. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830216-REV A 10/22 PAGE 1 OF 2 (E,) POTTER PAD300-PD The Symbol of Protection Photoelectric Smoke Detector Air Velocity Ratings The PAD300-PD has an Open Area of Protection air velocity rating of 0 to 300 feet per minute. The system has a maximum of 30 LEDs that can be turned on simultaneously.If the system already has 30 LEDs on,the PAD300-PD will operate even though the LED may not illuminate. Operation The PAD300-PD is an analog addressable detector that uses one address on the Signaling Line Circuit(SLC)of a compatible fire alarm control panel. The unit communicates with the control panel as it is polled.The LEDs flash every time the unit is polled and they will flash at a fast rate if the unit is in an active status.The polling LED can be turned off if desired for less conspicuous operation. The PAD300-PD with the PAD3004DB or PAD300-61313 has a low profile of less than two(2)inches to blend into the surrounding environment.The detector includes an insect screen to prevent foreign objects from reaching the chamber and can be cleaned to restore operation of a dirty detector. Detector Sensitivity The PAD300-PD and the compatible control panel work in tandem to keep the sensitivity consistent.As the detector is installed over time,the detector compensates for the dirt in the unit until it is out of range.At that time,the panel will indicate a dirty detector.The detector will then have to be cleaned or replaced. The PAD300-PD can be programmed to provide a maintenance alert prior to reaching the dirty detector level which will allow for intervention prior to the detector going into trouble. This allows for detector replacement or cleaning prior to a nuisance trouble occurs. NOTE.As required by NFPA, do not install the detectors until all construction is complete and the work area has been thoroughly cleaned. If the detectors have been installed in a construction environment,they should be cleaned or replaced before the system is placed into service. Spacing The PAD300-PD is UL listed with a recommended maximum spacing of 30 feet.Refer to NFPA 72 for specific information regarding detector spacing, placement and special applications. Compatible Bases All bases will mount on a single gang,3-1/2"octagon,3-1/2"square,double gang,4"octagon,4"square,50mm c/c,60mm c/c and 70mm c/c boxes. Device Description Stock No. PAD300-4DB 4"Detector Base 3992781 PAD300-6DB 6"Detector Base 3992782 PAD300-IB 6"base with an isolator module included 3992783 PAD300-RB 6"base with one Form-C relay contact. 2A C 30VDC,0.5A a) 125VAC 3992784 PAD300-SB 6"base with sounder module included.Sound pattern is provided from external source 3992785 PAD300-LFSB 6"base with 520Hz sounder module included.Sound pattern is provided from external source 3992786 Ordering Information Model Description Stock No. PAD300-PD Photoelectric Smoke Detector 13992775 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830216-REV A 10/22 PAGE 2 OF 2 (DPOTTER PAD300-PCD The Symbol of Protection Photoelectric Smoke/CO Detector Features • Photoelectric Smoke Detection compliant with UL 268 7th Edition • Carbon Monoxide(CO)detection compliant with UL 2075 • 10 year Carbon Monoxide detection lifespan with built in end of life indication • Walk Test mode allows for fast easy validation of CO sensor operation • Low profile,less than 2 inches with the base • Wide selectable sensitivity range of 1.1 to 3.50/a/foot • Detector communicates sensitivity to control panel ` • Optional locking tab to prevent unwanted removal • Simple DIP switch address setting,no programming too] required • LED Alarm Indicator • Product includes 5-year warranty • UUKL Listed for Smoke Control • Magnetic Test Switch u Description Technical Specifications The Photoelectric Smoke detectorand the Carbon Monoxide(CO)detector Voltage Range 24 VDC are both listed Analog Addressable detectors compatible with fire alarm Standby Current 300 µA control panels that utilize the Potter Addressable Device(PAD)protocol. The CO sensing portion utilizes a proven electrochemical sensor for Alarm Set-point Range 1.1 to 3.50/o/ft(3.6 to 11%/m) accurate detection of CO gas for life safety applications.The photoelectric Alarm indicator Current 1.4 mA detector complies with UL 268 7th edition enhanced smoke sensitivity CO Alarm Rating 70 ppm, 150 ppm,400 ppm tests.It has a wide sensitivity range of 1.1 to 3.5%per foot,and features drift compensation with built in dirty detector warning. Installation Temperature Range 327 to 120°F(0°C to 49°C) The detector and the control panel communicate over a proven and robust Operating Humidity Range <93%(Non-condensing) digital communication path and the system analyzes the information at Dimensions 3.93 in(100 mm) the particular device.The total polling speed is less than five(5)seconds, Weight 92 g(3.25 oz) well under the UL requirements. Height 1.42 in(36 nun) The detector is compatible with any of the PAD300 series detector bases and simply twists on.The PAD300-PCD is addressed using DIP switches in the rear of the detector and can be easily programmed in the field without special tools. Setting the Address Each addressable device on the SLC loop must have a unique address from 1 to 127 to function properly.The address is set using DIP switches. Before connecting a device to the SLC loop, take the following precautions to prevent potential damage to SLC or device.Verify the following: 1. Power to the device is removed. 2. Field wiring is correctly installed. 3. Field wiring has no open or short circuits. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com PRINTED IN USA 8830214-REV A • 10/22 PAGE 1 OF 2 E( ) POTTER PAD300-PCD e The Symbol of Protection Photoelectric Smoke/CO Detector Air Velocity Rating The PAD300-PCD has an Open Area of Protection air velocity rating of 0 to 300 feet per minute. The system has a maximum of 30 LEDs that can be turned on simultaneously.If the system already has 30 LEDs on,the PAD300-PCD will operate even though the LED may not illuminate. Operation The PAD300-PCD is an analog addressable detector that uses one address on the Signaling Line Circuit(SLC)of a compatible fire alarm control panel. The unit communicates with the control panel as it is polled.The LED flashes every time the unit is polled and they will flash at a fast rate if the unit is in an active status.The polling LED can be turned off if desired for less conspicuous operation. The PAD300-PCD with the PAD3004DB or PAD300-6DB has a low profile of less than two(2)inches to blend into the surrounding environment. Detector Sensitivity The PAD300-PCD and the compatible control panel work in tandem to keep the sensitivity consistent.As the detector is installed over time,the detector compensates for the dirt in the unit until it is out of range.At that time,the panel will indicate a ditty detector.The detector will then have to be cleaned or replaced. The PAD300-PCD can be programmed to provide a maintenance alert prior to reaching the dirty detector level which will allow for intervention prior to the detector going into trouble.This allows for detector replacement or cleaning prior to a nuisance trouble occurs. The PAD300-PCD will provide CO alarm reports at 70 ppm, 150 ppm,and 400 ppm. Note: As required by NFPA,do not install the detectors until all construction is complete and the work area has been thoroughly cleaned.If the detectors have been installed in a construction environment,they should be cleaned or replaced before the system is placed into service. Compatible Bases All bases will mount on a single gang,3-1/2"octagon,3-1/2"square,double gang,4"octagon,4"square.50mm c/c.60mm c/c and 70mm c/c boxes. Device Description Stock No. PAD300-4DB 4"Detector Base 3992781 PAD300-6DB 6"Detector Base 3992782 PAD300-IB 6"base with an isolator module included 3992783 PAD300-RB 6"base with one Form-C relay contact. 2A @ 30VDC,0.5A @ 125VAC 3992784 PAD300-SB 6"base with sounder module included. Sound pattern is provided from external source 3992785 PAD300-LFSB 6"base wih 520Ha sounder module included.Sound pattern is provided from external source 3992786 Ordering Information Model Description Stock No. PAD300-PCD Photoelectric Smoke/CO Detector 13992779 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com PRINTED IN USA 8830214-REV A • 10/22 PAGE 2 OF 2 E) P( OTTER PAD300-S B The Symbol of Protection Addressable Sounder Base Features • Integrated Sounder in base • UL464 and UL268 Listed • Sounder independent of detector,allows for a single station, grouped or all-call • May be mapped to any device connected to the control panel • Terminals accept 22 to 12 AWG wire sizes • Supports Class A,Class X and Class B wiring • Does not require SLC Loop address - • UUKL Listed for Smoke Control Description Technical Specifications The Addressable Sounder Base 6"(PAD300-SB)is a sounder base that may be utilized in a variety of applications. The base has a locking SLC Voltage 24 VDC feature for the detector that may be used or removed in the field.Once the detector is removed,the sounder is accessible in the bottom of the SLC Standby Current 300 µA unit. The base has an independent sounder module that may be programmed PWR Voltage 16-33 VDC as a single station, zone or all call sounder. The PAD300-SB passes PWR Active Current 42mA through the sound pattern sent to the sounder, therefore it may reproduce in any pattern the power supply provides. Alarm LED Current 1.4 mA The panel will support any combination of detectors or modules on the SLC.The PAD300-SB does not consume an address on the loop Sound Pressure 75dB @ 1 OR per UL 85dB @ 1 Oft per UL268 68 and is fully programmable to operate with any input. Once activated the sounder will also follow the input from the power source and de- Installation Temperature Range 32 to 150°F(0°C to 66°C) activate accordingly. Operating Humidity Range <93%(Non-condensing) Dimension 6.4 in(163 mm) Weight 199 g(7.40 oz) Height 1.57 in(40 mm) Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830221-REV A 10/22 PAGE 1 OF 2 (E) POTTER PAD300-SB The Symbol of Protection Addressable Sounder Base Detector Base Mounting Removing of Detector Head from Base 2.To remove the detector from the base once the locking feature has PAD300-SB should be mounted directly on the electrical box. The been activated, insert a small screwdriver into the slot on the base to mounting holes are configured for a single gang, 3-1/2" octagon, push the plastic tab while simultaneously turning the detector head 3-1/2"square, double gang,4" octagon,4"square, 50mm c/c.60mm counter-clockwise. See Fig.3. c/c and 70mm c/c boxes.See Fig. 1 Fig.3 Fig. I Inset small screwdriver into slot to remove detector from base. Alignment Features Mounting Screws Using the included screw, r, attach the detector base to Q detector bracket. 3.To remove the base cover from the lower enclosure once the locking Mount the detector feature has been activated, insert a small screwdriver into the slot bracket toountin box wing the g on the base to push the plastic tab while simultaneously turning the ®® QO screws. detector head counter-clockwise. Locking Feature Eliminate the Locking Feature PAD300-SB include a locking feature that prevents removal of the detector and removal of the base cover without using a tool. 1.To enable this feature,break off the locking tab and then install the detector.See Fig.2. Fig.2 a Qom 0°0 0 0 0 0 0°0 Break offtab(gray area) °°o°o°o'fl.p in image to enable locking 000, feature. Ordering Information Model Description Stock No. PAD300-SB Addressable Sounder Base 3992785 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830221-REV A 10/22 PAGE 2 OF 2 E) P( OTTER PAD300-HD The Symbol of Protection Heat Detector Features • Selectable Rate of Rise and/or Fixed Heat Detector • Low Profile • Reliable Detection Technology • LED Alarm Indicator • Ambient Temperature Listing of 32°F to 150°F • Simple DIP Switch Address Setting,No Programming Tool Required • Magnetic Test Switch • Product includes 5-year warranty • UUKL Listed for Smoke Control Description Technical Specifications The PAD300-HD is a listed analog addressable rate of rise and/or Operating Voltage 24 VDC fixed temperature heat detector compatible with any fire alarm control panel that has the Potter Addressable Device(PAD)protocol.The heat Detector Current Draw 300 µA sensing portion utilizes a proven thermistor for accurate and reliable Alarm Indicator 1 LED heat detection. The detector and base (not included) are made of a Alarm Set-point Range 135°F to 185°F(57°C to 85°C) durable plastic in an off-white to blend in with the ceiling. Rate of Rise Detection 15°F/min. 8.3°C/min. The PAD300-HD is UL listed with a selectable fixed temperature (Selectable Option) ( ) point from 135° to 185° Fahrenheit and can be used for rate of rise applications. See detector spacing limitations below. This flexibility Installation Temperature Range 32°F to 150°F(0°C to 66°C) allows the installer to cover a wide variety of applications with a single unit. Operating Relative Humidity 0%to 93%(Non-condensing) The PAD300-HD and the control panel communicate over a proven Range and robust digital communication path and the system analyzes the Start-up Time Max. 1 sec. information at the particular device.The total polling speed is less than Maximum Number of Addresses five(5)seconds,well under the UL requirements. Per Loop 127 The detector is compatible with any of the PAD300 series detector bases and simply twists on.The PAD300-HD is addressed using DIP Maximum Number of Lighted 30 switches in the rear of the detector and can be easily programmed in Indicators in Alarm Per Loop the field without special tools. Color Eggshell White Setting the Address Weight(Without Base) 68 g(2.4 oz) Each addressable device on the SLC loop must have a unique address Height: 1.5 in(38 mm) from I to 127 to function properly. The address is set using DIP Dimensions(Without Base) Diameter3.93 in(I00mm) switches. Before connecting a device to the SLC loop, take the following precautions to prevent potential damage to SLC or device.Verify the following: 1. Power to the device is removed. 2. Field wiring is correctly installed. 3. Field wiring has no open or short circuits. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830210-REV A 10/22 PAGE 1 OF 2 (E) POTTER PAD300-HD The Symbol of Protection Heat Detector Operation The PAD300-HD is an analog addressable detector that uses one address on the Signaling Line Circuit(SLC)of a compatible fire alarm control panel. The unit communicates with the control panel as it is polled.The LED flashes every time the unit is polled and it will flash at a fast rate if the unit is in an active status.The polling LED can be turned off if desired for less conspicuous operation. The PAD300-HD with the PAD300-4DB or PAD300-6DB has a low profile to blend into the surrounding environment.The system has a maximum of 30 LEDs that can be turned on simultaneously.If the system already has 30 LEDs on,the PAD300-HD will operate even though the LED will not illuminate. Spacing The ANSI/IJL listed spacing limitations of PAD300-HD smooth ceiling are dependent on alarm set point. Alarm Set-Point Rate of Rise Spacing Fixed Temperature Spacing 1357 to 185°F (57°C to 85°C) Max. 70 tt. Max.70 ft. Compatible Bases All bases will mount on a single gang,3-1/2"octagon,3-1/2"square,double gang,4"octagon,4"square,50mm c/c.60mm c/c and 70mm c/c boxes. Device Description Stock No. PAD300-4DB 4"Detector Base 3992781 PAD300-6DB 6"Detector Base 3992782 PAD300-IB 6"Base with an Isolator Module Included 3992783 PAD300-RB 6"Base with One Form-C Relay Contact 2A n 30VDC,0.5A C 125VAC 3992784 PAD300-SB 6"Base with sounder module included. Sound pattern is provided from external source 3992785 PAD300-LFSB 6"Base with 520Hz sounder module included.Sound pattern is provided from external source 3992786 Ordering Information Model Description Stock No. PAD300-HD Heat Detector 13993776 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830210-REV A 10/22 PAGE 2 OF 2 (E) POTTER PAD300-4DB/6DB The Symbol of Protection 4"/6"Detector Base Features • Terminals marked with polarity to assist with installation • Duplicate Terminals for In-and-out SLC Wiring • Terminals accept 22 to 12 AWG wire sizes • Installs on Single Gang,Double Gang,Octagon or 4"Square Box " • Locking tab prevents unauthorized detector removal • Product includes 5-year warranty . t .• • 6"mounting base comes with trim plate cover - t Application Technical Specifications The Potter PAD300-61)B and PAD300-4DB detector bases are used Installation Temp Range 320F to 150OF(0°C to 66°C) to install PAD300 series detectors.The PAD300-6DB will mount on Operating Humidity Range 0%to 93%(Non-condensing) a single gang, double gang, octagon, 4" square, 50mm, 60mm, and PAD300-4DB:3.93 in/100 mm 70mm electrical box. Dimension PAD300-6DB:6.3 in/160 mm Description Weight PAD300-41313: 1.34 oz/38 g The PAD300-6DB and PAD300-4DB are low-profile,surface-mount PAD300-6DB:3.03 oz/86 g bases used with Potter's addressable detectors.The base uses screw Height 0.76 in/20 mm clamp terminals that accept wire ranging from 22 to 12 AWG. Acceptable Wire Gauge 22 to 12AWG When installed on recessed electrical boxes, the PAD300-6DB is Single Gang wide enough to completely cover the back box and the immediate surrounding area. The base is equipped with a locking tab to deter Double Gang unauthorized removal of the attached detector. 3-1/2"Octagon Box Mounting Options 4"Octagon Box 4"Square with Plaster Ring 50mm c/c Box 60mm c/c Box 70mm c/c Box Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com PRINTED IN USA 8830203-REV A 10/22 PAGE 1 OF 2 (DPOTTER PAD300-4DB/6DB The Symbol of Protection 4"/6"Detector Base Locking Feature Wiring Diagrams The PAD300-613B and PAD300-413B include a locking feature that Fig.3 prevents removal of the detector without using a tool. 1)Class B Wiring: 1.To enable this feature,break off the locking tab(See Figure 1),and then install the detector. W - a g 2 s- 2 S- a w Fig. 1 LL w m a 1 S+ 1 S+ a 0 o + 1 2 S- Op 1 S+ 1 Break off tab(gray area)in image to enable locking feature. 2)Class A Wiring: cr ZW — Q a cr g -- a 2 s- 2 s- w Ir LL 2.To remove the detector from the base when the locking feature has w Co been enabled, insert a small screwdriver into the slot on the base to a push the plastic tab while simultaneously turning the detector head o 1 S+ 1 s+ counter-clockwise. J - D + Fig.2 3)Class X Wiring: Insert small + IB screwdriver into w _ « IM slot to remove a detector from base. 5 2 s- 2 s- W La Q a 2 1 s+ 1 S+ U IB IB J D + Of Of IM IM Ordering Information Model Description Stock No. PAD300-4DB 4"Detector Base 3992781 PAD300-6DB 6"Detector Base 3992782 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com PRINTED IN USA 8830203-REV A • 10/22 PAGE 2 OF 2 (E) POTTER PAD300-DD The Symbol of Protection Photoelectric Duct Detector Features • Low Profile • Reliable Detection Technology • LED Alarm Indicator • Magnetic Test Switch • Product includes 5-year warranty • UUKL Listed for Smoke Control • Approved for in-duct plenum mounted application Description Technical Specifications The PAD300-DD is an analog addressable photoelectric duct smoke Operating Range 24VDC detector(in duct) or mounted in the PAD300-DUCT or PAD300- DUCTR with sampling tubes extending into or traversing a duct.This Standby Current 300 µA detector is compatible with any fire alarm control panel that has the Potter Addressable Device(PAD)protocol. Alarm Indicator Current 1.4 mA The PAD300-DD is listed to comply with the requirements of UL 268 Alarm Set Point 2.51%/ft(81/6/m) A. The detector and the control panel communicate over a proven and robust digital communication path and the system analyzes the Installation Temperature Range 32°F to 120OF(0°C to 49°C) information at the device.The total polling speed is less than five(5) seconds,well under the UL requirements. Operating Humidity Range 0%to 93%(Non-condensing) The detector is compatible with any of the PAD300 series detector Air Velocity 0 to 3000 fpm bases and simply twists on.The PAD300-DD is addressed using DIP switches in the rear of the detector and can be easily programmed in Dimension 3.93 in(100 mm) the field without special tools. Setting the Address Weight 91 g(3.20 oz) Each addressable device on the SLC loop must have a unique address Height 1.42 in(36 mm) from 1 to 127 to function properly. The address is set using DIP switches. Before connecting a device to the SLC loop, take the following precautions to prevent potential damage to SLC or device.Verify the following: 1. Power to the device is removed. 2. Field wiring is correctly installed. 3. Field wiring has no open or short circuits. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com PRINTED IN USA 8830207-REV A • 10/22 PAGE 1 OF 2 (DPOTTER PAD300-DD The Symbol of Protection Photoelectric Duct Detector Operation The PAD300-DD is an analog addressable detector that uses one address on the Signaling Line Circuit(SLC)of a compatible fire alarm control panel. The unit communicates with the control panel as it is polled.The LED flashes every time the unit is polled and it will flash at a fast rate if the unit is in an active status.The polling LED can be turned off if desired for less conspicuous operation. The PAD300-DD with the PAD300-4DB or PAD300-613B has a low profile of less than two(2)inches to blend into the surrounding environment. Compatible Bases All bases will mount on a single gang,double gang,octagon,4"square with plaster ring electrical box. Device Description Stock No. PAD300-4DB 4"Detector Base 3992781 PAD300-6DB 6"Detector Base 3992782 Ordering Information Model Description Stock No. PAD300-DD Photoelectric Duct Detector 3992797 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com PRINTED IN USA 8830207-REV A • 10/22 PAGE 2 OF 2 (P) POTTER PAD1 00-LED The Symbol of Protection Addressable LED Module Features • Single addressable red LED indicator ' • Mounts in a standard 4"or double gang box • SLC Class A,Class X&Class B • Wiring terminals accessible when mounted in box • All wiring terminals accept 22 to 12 AWG y • Product includes a 5 year warranty • UUKL Listed for Smoke Control (®NT APPROVED Description Technical Specifications The PAD 100-LED uses one(1) SLC loop address when used as an Operating Voltage 24.OV addressable indicator. The module mounts on either a 4" square or double gang box.The PAD 100-LED includes one red LED to indicate Max SLC Standby 240µA the modules status. In normal condition, the LED flashes when the Current device is being polled by the control panel.When activated,the LED Max SLC Alarm 240µA will flash at a fast rate. Current Operating Temperature 32°F-120°F(0°-49°C) Application Range The PAD100-LED is compatible with Potter's IPA and AFC/ARC Ra g ting Humidity Oto93%(non-condensing) series addressable fire alarm control panels.The PAD100-LED is an Max no.of Module Per addressable LED module used to provide indication of a variety of Loop127 units system conditions. Dimensions 4.1 T'(I06mm)L x 4.17" Setting the Address (I06mm)W x 1.14"(29mm)D Each addressable SLC device must be assigned an address.The address Mounting Options Standard 4"Square or is set using the DIP switch located on the PAD 100-LED. Double Gang Box Before connecting a device to the SLC loop, take the following Shipping Weight 0.6lbs precautions to prevent potential damage to the panel or device: l. Power to the device is removed. 2. Field wiring is correctly installed. 3. Field wiring has no open or short circuits. Potter Electric Signal Company, LLC St. Louis, MO Phone: 866-956-0988 www.pottersignal.com 8830089-REV D 12/18 PAGE 1 OF 2 (E) POTTER PAD1 00-LED The Symbol of Protection Addressable LED Module Installation Using Compatible Electrical Box Fig I O 0 0 0 n� 0 Wiring Diagram PADI00-LED SLC Wiring Fig 2 FROM FACP OR 0 A16111ye PREVIOUS MODULE ® is TO NEXT MODULE 0 0 0 0 0 0 0 0 ®POTIFlt ('�D PAD100{ID _ © a Ordering Information Model I Description Stock No. PAD100-LED I LED Module 13992710 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830089-REV D 12/18 PAGE 2 OF 2 (DPOTTER S-24 & HS-24 The Symbol of Protection Selectable Candela Strobe&Horn/Strobes Features PhSEMB��o • 24VDC units have field selectable candela options of 15,30,60, , 75& 110 " • Super-Slide®Bracket-Ease of Supervision Testing THE v • Checkmate®-Instant Voltage Verification • Synchronize strobe and/or horn with AVSM Control Module - • Prewire entire system,install mounting bracket,then install — signals • Documented lower installation and operating costs • Switch selection for high or low dBA • Switch for chime,whoop,mechanical and 2400Hz tone • Tamperproof re-entrant style grill • Switch for continuous or temporal 3 tone(not available on whoop tone) • Silence audible while visual appliance will remain flashing(for use in accepted jurisdictions) • Faceplate available in red or off-white U� LISTED S3247 Description Technical Specifications The S-24/HS-24 Series is a low profile strobe and horn/ strobe combination that offers dependable audible and visual Single or Double gang,4" alarms and the absolute lowest current available.The S-24 Mounting Options square box,and AVBB surface &HS-24 Series 24VDC offers tamperproof field selectable mount back box candela options of 15,30,60,75,and 110 candela.The Terminals Screw-Clamp Type Strobe and Horn/Strobe offers a continuous or sync temporal Wire Gauge 18-12 AWG three in 2400Hz and mechanical tone,a chime and whoop tone.All tones are easy for the professional to change in the Operating Temp 32°F-120°F(0°-49°C) field by the use of switches. The S-24&HS-24 Series has a Height-5" minimal operating current and has a minimum flash rate of Dimensions Width-4.5" 1 Hz regardless of input voltage. Depth-2.5" This Series is shipped with a standard 4"metal mounting I Shipping Weight 1.05 lbs plate which incorporates the popular Super-Slide®feature that allows the installer to easily test for supervision.The product also features a locking mechanism which secures the product to the bracket without any screws showing. The S-24/HS-24 also features the patented Checkmate®- Instant Voltage Verification feature which allows the installer to check the voltage drop draw and match it to the blueprint. The S-24&HS-24 Series appliances are ANSI/UL 464 and ANSI/UL 1971, listed for use with fire protective systems and are warranted for three years from date of purchase. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830054-REV C 6/17 PAGE 1 OF 4 (DPOTTER S-24 & HS-24 The Symbol of Protection Selectable Candela Strobe &Horn/Strobes Switch Locations TONE SWITCH POSITION 3 4 5 Mechanical Temporal 3 ON ON ON Mechanical Continuous OFF ON ON n 2400 Hz Temporal 3 ON OFF ON 2400 Hz Continuous OFF OFF ON Chime Temporal 3 ON ON OFF Chime Continuous OFF ON OFF Y' ON i • Whoop ON OFF OFF Whoop OFF OFF OFF ��a YOTE: 1 2 3 4 5 6 • Switch Positions ]The and 2 in the OFF position to select isolated horn and strobe power inputs • Switch Position 6 ON=HIGH dBA • Switch Position 6 OFF=LOW dBA Candela Selection Checkmate TM -Instant Voltage Verification Candela selection slider switch. Depress center and slide switch to S¢ desired brightness level. $� Break off pin and insert into ® ! hole at the bottom of the ; m F1- selector to lock candela w setting. Signal must be removed from bracket and ; pin pushed forward from backside out of hole to The access holes are provided in the back of the terminal change candela. block to allow the voltage to be measured directly without removing the device.Typically this would be done at the end of the line to confirm design criteria.Most measure- ments will be taken using the S+and S-locations although access is provided to other locations.NOTE:Care should be taken to not short the test probes. Super Slide®Mounting Bracket To remove bezel, Allows the installer to pre-wire the system,test for system grip both sides of supervision,remove the signal head until occupancy,switch bezel and pull in out signals without changing mounting brackets and has a downward and locking edge connector for snap-in-place installation. outward motion. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830054-REV C 6/17 PAGE 2 OF 4 (E) POTTER S-24 & H S-24 ® The Symbol of Protection Selectable Candela Strobe &Horn/Strobes S-24 24 VDC Selectable Candela, Low Profile Evacuation Strobe Model Part Number Nominal Candela(ANSI/UL Number Voltage 1971) S-24WR 4890010 24 VDC 15, 30,60,75, 110 S-24WW 4890011 24 VDC 15,30,60, 75, 110 HS-24 24 VDC Selectable Candela, Low Profile Evacuation Strobe Model Number Part Number Nominal Voltage Candela(ANSI/ Reverberant dBA at 10 In Anechoic Room at UL 1971) ft,per ANSI/UL 464 10 ft HS-24WR 4890030 24 VDC 15,30,60,75, 110 62-82 100 HS-24WW 4890031 24 VDC 15, 30, 60, 75, 110 62-82 100 S-24 & HS 24 Strobe Current Ratings 24 VDC (16 - 33 Volts) Model Designations: Candela 24 VDC UL Max W=Wall mount 15 cd 30 mA 42 mA R=Red Faceplate W=White Faceplate 30 cd 35 mA 58 mA All units are available in plain(no lettering) 60 cd 66 mA 97 mA Plain units are non-returnable. 75 cd 80 mA 116 mA "ALERT"bezel available for order. 110 cd 103 mA 161 mA "AGENT"bezel available for order. S-24 & HS-24 Horn Ratings Horn Decibel Levels Horn Current Ratings Horn Mode Minimum SPL at 10 ft,per Minimum SPL at 10 ft, Regulated 24 VDC Max ANSI/UL 464(HIGH) per ANSI/UL 464(LOW) Operating @ High Setting(mA) Temp 3 (2400 Hz) 78 dBA 71* dBA 28 mA Temp 3 (Mechanical) 76 dBA 70* dBA 25 mA Temp 3 (Chime) 70* dBA 66* dBA 15 mA Continuous(2400 Hz) 81 dBA 74* dBA 28 mA Continuous(Mechanical) 80 dBA 72* dBA 25 mA Continuous(Chime) 70* dBA 66* dBA 15 mA Whoop 82 dBA 69* dBA 56 mA 107T:S: • For nominal and peak current across ANSI/UL regulated voltage range for filtered DC power and unfiltered(FWR [Full Wave Rectified])power see installation manual. •Potter does not recommend using a coded or pulsing signaling circuit with any of our strobe products. •The sound output for the temporal 3 tone is rated lower since the time the horn is off is averaged into the sound output rating. While the horn is producing a tone in the temporal 3 mode its sound pressure is the same as the continuous mode. * Operating the horn in this mode at this voltage will result in not meeting the minimum ANSI/UL 464 reverberant sound level required for public mode fire protection service.These settings are acceptable only for private mode fire alarm use.Use the high dBA setting for public mode application(not applicable when using the chime tone.The chime tone is always private mode). Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 9830054-REV C 6/17 -_ PAGE 3 OF 4 (DPOTTER S-24 & HS-24 The Symbol of Protection Selectable Candela Strobe &Horn/Strobes S-24 & HS-24 Series Wiring Diagram UL Listed UL Listed Control al Control Panel Signal So' Panel Signal sgnai S+ S+ S- H+ H- S+ S+ S- H+ H- S+ S+ S- H+ H- S+ S+ S- H+ H- Supervised Supervised Is C B B Signal Circuit Signal Circuit \ + \ + END END OF LNE RESISTOR RESISTOR END OF LINE RESISTOR All strobes are designed to flash as specified with continuous applied voltage.Strobes should not be used on coded or pulsing signaling circuits. However,use of the Potter AVSM control module or Gentex synchronization protocol is permitted to synchronize the strobe,horn,and/or mute the hom. •FOR SYNCHRONIZATION WIRING INFORMATION,REFERENCE AVSM CONTROL MODULE DATA SHEET(8830050)AND/OR AVSM CONTROL MODULE MANUAL FOR SYNCHRONIZATION MODULE WIRING DIAGRAMS.AVSM CONTROL MODULE DATA SHEET AND MANUAL CAN BE OBTAINED AT http://pottersignal.com OR CALL POTTER ELECTRIC TECHNICAL SUPPORT AT 1-866-956-1211 Architect & Engineering Specifications The audible and/or visible signal shall be Potter S-24 strobe and Potter HS-24 horn/strobe Series or approved equal and shall be listed by Underwriters Laboratories, Inc. per ANSI/UL 1971 and/or ANSI/UL 464.The notification appliance shall also be listed with Factory Mutual Listing Service(FM)and the California State Fire Marshal(CSFM). The notification appliance(combination audible/visible)shall produce a peak sound output of 100dBA or greater at 24VDC as measured in an anechoic chamber. The signaling appliance shall also have the capability to silence the audible signal while leaving the visible signal energized with the use of a single pair of power wires.Additionally,the user shall be able to select either continuous or temporal tone output with the temporal signal having the ability to be synchronized. Unit shall be capable of being installed so that any unauthorized attempt to change the candela setting will result in a trouble signal at the fire alarm control panel. The audible/visible and visible signaling appliance shall also maintain a minimum flash rate of 1 Hz or up to 2Hz regardless of power input voltage.The strobe appliance shall have an operating current of 42mA or less at 24VDC for the 15Cd strobe circuit. The appliance shall be polarized to allow for electrical supervision of the system wiring.The unit shall be provided with a mounting bracket with terminals and barriers for input/output wiring and be able to mount to a single gang or double gang box or double workbox without the use of an adapter plate.The unit shall have an input voltage range of 16-33 volts with either direct current or full wave rectified power for 24VDC models. The appliance shall be capable of testing supervision without disconnecting wires,verify voltage without removing unit and be capable of mounting to a surface back box. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830054-REV C 6/17 — PAGE 4 OF 4 CS/CHS PPOTTER SELECTABLE CANDELA ® The Symbol of Protection CEILING MOUNT Features • Nominal voltage 24 VDC • Tamperproof field selectable candela options 15,30,75,95, 115, & 150 • Super-Slide®Bracket-Ease of Supervision Testing • Checkmate®-Instant Voltage Verification • Synchronize strobe and/or horn with Gentex AV SM Control Module • Prewire entire system,install mounting bracket,then install ` signals • Documented lower installation and operating costs Input Terminals 12 to 18 AWG 111 — Switch Selection for High or Low dBA Switch Selection for 2400Hz or mechanical Tone • Switch Selection for Continuous or Temporal 3 • Tamperproof re-entrant grill • Surface mount with the CLNGBB(Ceiling Surface Mount Back Box) • Silence audible while visual appliance will remain flashing(for use in accepted jurisdictions) • Faceplate available in red or off-white Operating Temperature: U` 320F to 120OF(0°C to 49°C).The CS Series is not listed for outdoor use. LISTED Unit Dimensions S 1 247 Product includes a S year warranty 6"(15.24 cm)x 2.6"(6.604 cm) Description The Potter CS/CHS Series is a ceiling mount strobe or horn/strobe The Ceiling Mount Series comes standard with the 4"mounting plate combination that offers dependable audible and visual alarms and the which incorporates the popular Super-Slide® feature that allows the lowest current consumption. installer to easily test for supervision. The product also features a locking mechanism which secures the product to the bracket without The CS/CHS offers tamperproof field selectable candela options of 15, any screws showing. 30,75,95, 115 and 150 candela. The CS/CHS also features the patented Checkmate®-Instant Voltage The CHS horn offers a continuous or synchable temporal three in Verification feature which allows the installer to check the voltage drop 2400Hz and mechanical tone.All tones are easy for the professional to draw without removing the signal. change in the field by using switches.The models are shipped from the factory in the temporal three alarm mode. The CS Series appliances are ANSI/UL 464 and ANSI/UL 1971 listed for use with fire protective systems. The CS Series has a very minimal operating current and has a minimum flash rate of 1Hz regardless of input voltage. Potter Electric SignalCompany,LLC•St.Louis,MO 63042 USA-Cust Service:866-572-3005•Tech Support:866-956-0988•Canada 888-882-1833•www.pottersignal.com PRINTED IN USA MFG.#8830051-REV A PAGE 1 OF 4 06/13 CS/CHS (E) POTTER SELECTABLE CANDELA ® The Symbol of Protection CEILING MOUNT Mounting Super-Slide® 3.Snap Cover Over Assembly 2.Insert Locking Screw r 9 6 1.Slide Onto Bracket Checkmate*Instant Voltage Verification Switch Locations 12345 DO NOT PMNF o o S(�� +S+ 15 O° S_�? 0 The access holes are provided in the back of the terminal block to Switch positions 1 and 2 in the down position to select isolated horn allow the voltage to be measured directly without removing the and strobe power inputs.Switch 3 selects between temporal or non- device.Typically this would be done at the end of the line to confirm temporal tone.Up is temporal.Switch 4 selects between mechanical or design criteria.Most measurements will be taken using the S+and high frequency tone.Up is mechanical. Switch 5 selects between high S-locations although access is provided to other locations.NOTICE: or low dBA.Up is high dBA. CARE SHOULD BE TAKEN TO NOT SHORT THE TEST PROBES. Potter Electric Signal Company,LLC•St.Louis,MO 63042 USA-CustService:866-572-3005•Tech Support:866-956-0988•Canada888-882-1833•www.pottersignal.com PRINTED IN USA MFG.#18830051-REV A PAGE 2 OF 4 06/13 CS/CHS (E) POTTER SELECTABLE CANDELA The Symbol of Protection CEILING MOUNT CS Series 24 Volt Ceiling Mount Selectable Strobe Model Part Nominal Number Number Voltage Candela CS-24R 4890020 24 VDC 15,30.75,95. 115, 150 CS-24W 4890021 24 VDC 15,30,75,951. 115. 150 CS-24PR 4890022 24 VDC 15,30,75,95, 115, 150 CS-24PW 4890023 24 VDC 15,30,75,95, 115. 150 CHS Series 24 Volt Ceiling Mount Selectable Horn/Strobe Model Part Nominal Reverberant dBA @ In Anechoic Room Number Number Voltage Candela 10 ft.per ANSI/UL 464 dBA @ 10 ft. CHS-24R 4890040 24 VDC 15,30,75,95, 115, 150 81-86 90 CHS-24W 4890041 24 VDC 15,30,75,95, 115, 150 81-86 90 CHS-24PR 4890042 24 VDC 15,30,75,95, 115, 150 81-86 90 CHS-24PW 4890043 24 VDC 15,30,75,95, 115, 150 81-86 90 Model Designations: C=Ceiling Mount S=Strobe HS=Horn/Strobe R=Red Faceplate W=White Faceplate All units are available in plain(no lettering). Plain units are non-returnable. CS24 Product Strobe Current Ratings(mA) Candela 15 cd 30 cd 75 cd 95 cd 115 cd 150 cd 24 VDC 24VDC 72 mA 101 mA 167 mA 200 mA 214 mA 286 mA (16-33 Volts) UL Max' 120 mA 120 mA 1200 mA 1 220 mA 1 290 mA 321 mA CHS24 Product Horn Decibel and Current Ratings(mA) Horn Minimum dBA @ 10 ft. Minimum dBA @ 1011. Regulated 24 VDC Mode per ANSI/UL 464 per ANSI/UL 464 Max.Operating (HIGH) (LOW) @ High Setting(mA) Temp 3 2400Hz 83 75 23 Temp 3 Mechanical 81 73* 22 Continuous2400Hz 86 78 23 Continuous Mechanical 84 76 22 NOTES: • The sound output for the temporal 3 tone is rated lower since the time the horn is off is averaged into the sound output rating.While the horn is producing a tone in the temporal 3 mode its sound pressure is the same as the continuous mode. • For nominal and peak current across UL regulated voltage range for filtered DC power and unfiltered(FWR[Full Wave Rectified])power, see installation manual. • Potter does not recommend using a coded or pulsing signaling circuit with any of our strobe products. • Operating the horn in this mode at this voltage will result in not meeting the minimum ANSI/UL 464 reverberant sound level required for public mode fire protection service.These settings are acceptable only for private mode fire alarm use.Use the high dBA setting for public mode application(not applicable when using the chime tone.The chime tone is always private mode). • RMS current ratings are per UL average RMS method.UL max current rating is the maximum RMS current within the listed voltage range (16-33VDC for 24VDC units).For strobes the UL max current is usually at the minimum listed voltage(16VDC for 24VDC units).For audibles the max current is usually at the maximum listed voltage.For unfiltered FWR ratings,see installation manual. PotterElectticSignalCompany,LLC•St.l ouis,MO 63042 USA-CustService:866-572-3005-Tech Support:866-956-0988•Canada 888-882-1833•www.ponmignal.com PRINTED IN USA MFG.#8830051-REV A PAGE 3 OF 4 06/13 CS/CHS (DPOTTER SELECTABLE CANDELA The Symbol of Protection CEILING MOUNT Architect& Engineering Specifications The visible and audible/visible signal shall be Gentex model GCS or GCC or approved equal and shall be listed by Underwriters Laboratories Inc.per ANSI/UL 1971 for the GCS and ANSI/UL 464 for the GCC.The notification appliance shall also be listed with the California State Fire Marshal(CSFM). The notification appliance(combination audible/visible units and audible units only)shall produce a peak sound output of 90dBA or greater as measured at 24VDC in an anechoic chamber.The signaling appliance shall also have the capability to silence the audible signal while leaving the visible signal energized with the use of a single pair of power wires.Additionally,the user shall be able to select either continuous or temporal tone output with the temporal signal having the ability to be synchronized. The audible/visible and visible signaling appliance shall also maintain a minimum flash rate of IHz or up to 2Hz regardless of power input voltage.The appliance shall have an operating current of 72mA or less at 24VDC for the 15 candela strobe circuit. The appliance shall be polarized to allow for electrical supervision of the system wiring.The unit shall be provided with a mounting bracket with terminals with barriers for input/output wiring and be able to mount to a single gang or double gang box or double workbox with the use of an adapter plate.The unit shall have an input voltage range of 16-33 volts with either direct current or full wave rectified power. The appliance shall be capable of test supervision without disconnecting wires,verify voltage without removing unit and be capable of mounting to a surface back box. Conventional CS/CHS Series Wiring Diagrams UL Listed UL Listed Control Sprat Signal Control Signal Signal Panel S+ S+ S- H+ H- S+ S+ S- H+ H- Panel S• S+ S- H+ H- S. S+ S- H+ H- Supervised Superv:t_ B a B B Signal Circuk LJ Signal it END IS LINE END OF LINE RESISTOR RESISTOR \ + END OF LINE RESISTOR NOTES: • All strobes are designed to flash as specified with continuous applied voltage.Strobes should not be used on coded or pulsing signaling circuits.However,use of the Gentex AVSM control module or Gentex synchronization protocol is permitted to synchronize the strobe,horn and/or mute the horn. • FOR SYNCHRONIZATION WIRING INFORMATION,REFERENCE AVSM CONTROL MODULE DATA SHEET(8830050) AND/OR AVSM CONTROL MODULE MANUAL FOR SYNCHRONIZATION MODULE WIRING DIAGRAMS.AVSM CONTROL MODULE DATA SHEET AND MANUAL CAN BE OBTAINED AT htto://www. otp tersignal.com OR CALL POTTER ELECTRIC AT 1-800-325-3936. Potter Electric Signal Company,LLC•St.Louis,MO 63042 USA-Cust Service:866-572-3005•Tech Support:866-956-0988•Canada 888-882-1833•www.pottersignal.com PRINTED IN USA MFG.#8830051-REV A PAGE 4 OF 4 06/13 CS/CHS-WP Series @POTTER Outdoor Colored Lens Strobes and The Symbol of Protection Horn/Strobes Features • Fixed 75cd strobe • Available in surface-mount(standard)and Low Profile(LP) versions ' • WPBB/LP made of clear Lexan®-provides maximum visibility and reliability,allowing full 75cd output `! • Lens colors available in amber,blue,green,and red • Super-Slide®Bracket—Ease of supervision testinglilt �- • Checkmate®-Instant voltage verification ` • Synchronize strobe and/or horn with AVSM module LP Version Standard • Switch selection for high/low dBA • Switch for chime,whoop,mechanical,and 2400Hz tone • Input terminals accept 18 to 12 AWG • Switch for continuous or temporal 3 tone(not available on whoop) • Tamperproof re-entrant grill • 5 year warranty siwarr� LEM 00 7135-0328:0213 7135-0328:0212 Application The CS/CHS-WP Series devices are available in two different versions. The CS/CHS-WP Series Outdoor Colored Lens Signals are wall The standard version comes with a surface-mount back box(WPBB) mount, low profile strobes and horn/strobes that offer dependable to install directly on a wall. The Low Profile(LP)versions come with audible and visual alarms for warning and emergency notification in a low profile back box(WPLPBB)designed to be installed on a flush- outdoor locations. Applications include emergency communication, mounted electrical box. severe weather,emergency response and many more. Product Listings • ANSI/UL 464 and 1638 Description CSFM 7135-0328:0212(CHS-WP Series) The CS/CHS-WP Series Outdoor Colored Lens Signals are 24VDC CSFM 7135-0328:0213(CS-WP Series) units available in lens colors of amber,blue,green and red. The Series has a fixed 75 candela strobe. They have a minimal operating current Technical Specifications and a minimum flash rate of IHz regardless of input voltage. The weatherproof enclosure is made of clear Lexan® which provides Operating Voltage Nominal 24VDC(16-33VDC) maximum visibility and reliability for effective visible signaling, Operating allowing full 75cd output. The strobes can be synced using a Gentex Temperature -31°F- 150°F(-35°-66°C) sync protocol or the AVSM Sync Module. LP Version-5.75"H x 4.75"W x 3.25"D Dimensions The Colored Lens Series is shipped with a die cast universal 4" Standard-5.75"H x 4.75"W x 4.18"D mounting bracket which incorporates the popular Super-Slidev Wiring Connections Terminals accept 18- 12 AWG feature that allows the installer to easily pre-wire the system and test LP Version—Single gang,double gang,or for supervision.The product also features a locking mechanism that Monti 4"square back box secures the signal to the bracket without showing any screws. The ung Standard Version-Surface mount back box Colored Lens Series also features the Checkmate®- Instant Voltage included Verification Feature which allows the installer to check the voltage Shipping Weight 2.05 lbs. drop,current draw,and match against the blue print. Potter Electric Signal Company,LLC • St.Louis,MO • Tech Support:866-956-1211 /Customer Service: 866-572-3005 • www.podmignal.com 8830058-REV B • 1/15 PAGE 1 OF 4 CS/CHS-WP Series (E) POTTER Outdoor Colored Lens Strobes and The Symbol of Protection Horn/Strobes CS Series Outdoor Colored Lens Strobe,75 Candela UL Max Strobe Current Ratings(24VDC Regulated) Model Number Stock Lens Color Body Candela Amber Lens Blue.Green,and Number Color Red Lens CS-24WAR-WP 4890140 Amber Red 75cd 170mA 164mA CS-24WAW-WP 4890141 Amber Off-White For unfiltered FWR ratings,see installation manual. CS-24WBR-WP 4890142 Blue Red Horn Decibel and Current Ratings CS-24WBW-WP 4890143 Blue Off-White Minimum Minimum Regulated 24VDC CS-24WGR-WP 4890144 Green Red dBA at 10', dBA at 10'. Max.Operating Horn Setting h Per UL 464 Per UL 464 Current,at Hi CS-24WGW-WP 4890I45 Green Off-White g CS-24WRR-WP 4890146 Red Red (HIGH) (LOW) Setting(mA) CS-24WRW-WP 4890147 Red Off-White Temporal 3 2400Hz 78 71* 28 CSLP-24WAR-WP 4890148 Amber Red Temporal 3 Mechanical 76 70* 25 CSLP-24WAW-WP 4890149 Amber Off-White Temporal 3 Chime 70* 66* 15 CSLP-24WBR-WP 4890150 Blue Red Continuous 2400Hz 81 74* 28 CSLP-24WBW-WP 4890151 Blue Off-White Continuous Mechanical 80 72* 25 CSLP-24WGR-WP 4890152 Green Red Continuous Chime 70* 66* 15 CSLP-24WGW-WP 4890153 Green Off-White Whoop 82 69* 56 CSLP-24W RR-W P 4890155 Red Red *Operating the horn in this mode at this voltage will result in not meeting CSLP-24WRW-WP 4890156 Red Off-White the minimum ANSI/UL 464 reverberant sound level required for public mode fire protection service. These settings are acceptable only for \'07Y::Models with LP include the LP version enclosure. private mode fire alarm use.Use the high dBA setting for public mode application(not applicable when using the chime tone.The chime tone is always private mode). CHS Series Colored Lens Strobe,75 Candela Model Number Stock Number Lens Color Body Color Reverberant dBA at 10`,per ANSI/UL 464 In Anechoic Room dBA at 10' CHS-24AR-WP 4890160 Amber Red 70-82 100 CHS-24AW-WP 4890161 Amber Off-White 70-82 100 CHS-24BR-WP 4890162 Blue Red 70-82 100 CHS-24BW-WP 4890163 Blue Off-White 70-82 100 CHS-24GR-WP 4890164 Green Red 70-82 100 CHS-24GW-WP 4890165 Green Off-White 70-82 100 CHS-24RR-WP 4890166 Red Red 70-82 100 CHS-24RW-WP 4890167 Red Off-White 70-82 100 CHSLP-24AR-WP 4890168 Amber Red 70-82 100 CHSLP-24AW-WP 4890169 Amber Off-White 70-82 100 CHSLP-24BR-WP 4890170 Blue Red 70-82 100 CHSLP-24BW-WP 4890171 Blue Off-White 70-82 100 CHSLP-24GR-WP 4890172 Green Red 70-82 100 CHSLP-24GW-WP 4890173 Green Off-White 70-82 100 CHSLP-24RR-WP 4890174 Red Red 1 70-82 1 100 CHSLP-24RW-WP 4890175 Red Off-White 70-82 100 NO7'F_:Models with LP include the LP version enclosure. Potter Electric Signal Company,LLC • St. Louis,MO • Tech Support: 866-956-1211 /Customer Service: 866-572-3005 www.pottersignal.com 8830058-REV B • 1/15 PAGE 2 OF 4 CS/CHS-WP Series (E) POTTER Outdoor Colored Lens Strobes and The Symbol of Protection Horn/Strobes Tone Switch Locations ■ ®o Switch Position Z - Tone N® 3 4 5 Mechanical Temporal 3 ON ON ON w= Im Mechanical-Continuous OFF ON ON c:E S¢ 2400Hz-Temporal 3 ON OFF ON S¢ 2400Hz-Continuous OFF OFF ON u, .S- s, Chime-Temporal3 ON ON OFF DD H+ Y Chime-Continuous OFF ON OFF ® fl- D Whoop ON I OFF OFF Whoop OFF I OFF OFF NOTES. • Switch Positions 1 and 2 in the OFF position to select isolated horn and strobe power inputs • Switch Position 6 ON=HIGH dBA • Switch Position 6 OFF=LOW dBA Checkmate®Instant Voltage Verification It is often necessary to confirm the voltage Super Slide®Mounting Bracket drop along the line of devices.The access holes are provided in the back of the Allows the installer to pre-wire the system, test for system - terminal block to allow the voltage to supervision,remove the signal head until occupancy, switch be measured directly without removing out signals without changing mounting brackets and has the device.Typically,this would be done locking edge connector for snap-in-place installation. at the end of the line to confirm design criteria.Most measurements will be taken using the S+ and S- locations although access is provided to other locations. NOTE: Care should be taken to not short the test probes. Mounting Outdoor Enclosure Super Slide®Mounting Plate: Super Slide®Mounting Plate: Mounts to WPBB Outdoor Enclosure Mounts to WLPBB Outdoor Enclosure 44 Potter Electric Signal Company,LLC St.Louis,MO Tech Support: 866-956-1211 /Customer Service: 866-572-3005 www.ponmignal.com 8830058-REV B • 1/15 PAGE 3 OF 4 CS/CHS-WP Series (DPOTTER Outdoor Colored Lens Strobes nd The Symbol of Protection HornlStrobes Wiring Diagrams UL Listed UL Listed Control SO* sgna� Control PanelSow Panel S+ S+ S- H+ F4 S+ S+ S- H+ FF Panel S+ S` S- H+ FI- S+ S+ S- H+ FF Supervs Supervised B B B 0 Signal Cied it Signal Circuit \ + \ + END OF END OF LINE RE86TORdA RESOTOR \ + END OF 11NE RE98TOR `O71.). • All strobes are designed to flash as specified with continuous applied voltage. Strobes should not be used on coded or pulsing signaling circuits. However,use of the AVSM control module or Gentex synchronization protocol is permitted to synchronize the strobe,horn and/or mute the horn. • FOR SYNCHRONIZATION WIRING INFORMATION,REFERENCE AVSM CONTROL MODULE DATA SHEET(8830050)AND/OR AVSM CONTROL MODULE MANUAL FOR SYNCHRONIZATION MODULE WIRING DIAGRAMS.AVSM CONTROL MODULE DATA SHEET AND MANUAL CAN BE OBTAINED AT http://pottersignal.com OR CALL POTTER ELECTRIC AT 1-800-325-3936. Architect and Engineering Specifications The audible and/or visible signal shall be Potter Outdoor Colored Lens Commander Series or approved equal and shall be listed by Underwriters Laboratories Inc.per ANSI/UL 1638 and/or ANSI/UL 464.The notification appliance shall also be listed with the California State Fire Marshal(CSFM). The notification appliance(combination audible/visible)shall produce a peak sound output of 100dBA or greater at as measured in an anechoic chamber. The signaling appliance shall also have the capability to silence the audible signal while leaving the visible signal energized with the use of a single pair of power wires.Additionally,the user shall be able to select either continuous or temporal tone output with the temporal signal having the ability to be synchronized. The audible/visible and visible signaling appliance shall also maintain a minimum flash rate of 1Hz or up to 2 Hz regardless of power input voltage. The appliance shall have an operating current of 112mA or less for the 75Cd strobe circuit.The appliance shall also be capable of meeting the candela requirements of the ADA(75cd). The appliance shall be polarized to allow for electrical supervision of the system wiring.The unit shall be provided with a mounting bracket with terminals with barriers for input/output wiling and be able to mount to a single gang or double gang box or double workbox without the use of an adapter plate.The unit shall have an input voltage range of 16-33 volts with either direct current of full wave rectified power for 24 volt models. The appliance shall be capable of testing supervision without disconnecting wires.Also the appliance shall be capable of mounting to a surface back box. The unit shall also be able to verify voltage at the unit without removing unit. The appliance has extended temperature range of-31'to 150°F(-35°to 66'C).The appliance shall satisfy virtually all outdoor and severe environment applications.The WPBB enclosure is includes a gasket that must be inserted between the box and mounting bracket.There are drain holes in the back box to allow for drainage,the seal on the WPLPBB enclosure is not water tight. The WPLPBB enclosure includes a weather seal for mounting to wall and intended for use with universal electrical box.To allow for drainage,bottom edge of enclosure is not water tight. Potter Electric Signal Company, LLC St. Louis, MO Tech Support: 866-956-1211 /Customer Service: 866-572-3005 • www.pottersignal.com 150 eaot:zoos DESIGNING,MANUFACTURING, I8 DISTRIBUTING QUALITY SYSTEMS 8830058-REV B 1/15 PAGE 4 OF 4 (E) POTTER PAD1 00-OROI The Symbol of Protection One Relay One Input Module Features QySEMeIFo • One(1)Class B monitoring input ' • One(1)Form C relay contact •�4, P• • SLC Class A,Class X&Class B THE • Mounts in a standard 4"or double gang box • Wiring terminals accessible when mounted in box • All wiring terminals accept 22 to 12 AWG ®� i • Product includes a 5 year warranty ,.,.r'a"•%"••^ • UUKL Listed for Smoke Control NOTE.This addressable module does not support 2-wire smoke detectors. APPROVED Description Technical Specifications The PAD 100-OROI uses one(1)SLC loop address when monitoring Operating Voltage 24.OV one(1) Class B circuit and providing one(1) Form C relay contact. The module mounts on either a 4" square or double gang box. The Max SLC Standby 240µA module is capable of monitoring one(1)Class B circuit.The PAD]00- Current OROI includes one red LED to indicate the module's status.In normal Max SLC Alarm 240µA condition, the LED flashes when the device is being polled by the Current control panel. When a the input is activated, the LED will flash at a Relay Contacts 2A @30VDC,0.5A @125VAC fast rate. Max Wiring Resistance 100 S2 of IDC Application Max Wiring IµF ThePAD100-OROI is compatible with Potter's IPA and AFC/ARC Capacitance of IDC series addressable fire alarm control panels.The PAD100-OROI is an EOL Resistor 5.1K 52 interface module used to monitor dry contact devices such as sprinkler Operating Temperature waterflow, valve tamper switches, or conventional pull stations. The Range 32 to 120°F(0 to 49°C) module is capable of monitoring one Class B circuit. The PAD100- Operating Humidity u OROI also provides one(1)form C relay contact. Range 0 to 93/o(non-condensing) Setting the Address Max Loop of Module Per 127 units Each addressable SLC device must be assigned an address.The 4.17"(106mm)L x 4.IT' address is set usingthe DIP switch located on the PAD100-OROI. Dimensions (106mm)W X 1.14"(29mm)D When the PAD100-OROI is used to monitor one Class B circuit Standard 4"Square or a single device address is assigned,the input and relay are then Mounting Options Double Gang Box identified as a sub-point of the module address.For example,if the address number is assigned as"8",the RLYI relay will be"8.1"and Shipping Weight 0.6 lbs the IN I input will be"8.2". Before connecting a device to the SLC loop, take the following precautions to prevent potential damage to the panel or device: I. Power to the device is removed. 2. Field wiring is correctly installed. 3. Field wiring has no open or short circuits. Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830081-REV D 12/18 PAGE 1 OF 2 (E) POTTER PAD 1 00-OROI ® The Symbol of Protection One Relay One Input Module Installation Using Compatible Electrical Box Fig 1 O O 00 O Wiring Diagram PAD100-OR01 With One Class B Circuit Fig 2 VN70 O FROM FACP OR PREVIOUS MODULE ® ® ONE(1)FORM C ® +-I RLYt C ® RELAY CONTACT INt ® -j 0 0 0 0 0 ®IPOTIER END-OF-LINE RESISTOR PADI060R01 5.1KOHM 1/2W Part#3005013 0 It is possible that the internal relay in the PAD100-OR0I may be shipped in the non-normal/activated state.To ensure that the internal relay is set to the normal state,connect the module to the SLC loop and reset the control panel before terminating the wiring to the modules output. Ordering Information Model Description Stock No. PAD100-OR0I One Relay One Input Input Module 3992702 Potter Electric Signal Company, LLC St. Louis, MO Phone: 800-325-3936 www.pottersignal.com 8830081-REV D 12/18 PAGE 2 OF 2 18-2 Unshielded tE Re ee Plenum WIRE&CABLE d ETL listed for guaranteed performance Engineered With Yo Made in the USA Part No.: 760180 Applications: Jacket This document establishes the specifications of a Insulatio plenum rated two conductor twisted, unshielded cable used for fire protective signaling applications. Conductor Construction Details: Number of Conductors: 2/C Conductor: 18AWG Solid Bare Copper Standards: Insulation Material: Remguard Plenum Polymer Nominal Insulation Thickness: 0.010 in. NEC Article 760 Nominal Insulation Diameter: 0.060 in. . UL Subject 1424, Type FPLP Color Code: Black, Red Jacket Material: Remguard Plenum Polymer Jacket Color: Red or Per Customer Requirement Nominal Jacket Thickness: 0.015 in. Nominal Diameter:0.150 in. Codes & Listings: Surface Print: 3122598 FPLP 18AWG (ETL)US + (ETL)US Sequential Footage Marking Electricals: Preparation for Shipment: Suggested Working Voltage: 300 Volts, rms. The cable shall be packaged to preclude the Direct Current Resistance: 6.39 Ohms/1000'@20°C inducement of damage due to handling and transportation, and shall be in accordance Technical Details: with the best commercial practices available. Temperature Rating Shipping containers shall be constructed as to eliminate any possible damage to the Operation: -20C to +60°C cables due to shipment. Nominal Weight: 17 lbs./ 1,000 Feet MADE IN THE USA (q1ST101US Issue Date:04/16 All warranty information can be viewed at WWW.REMEE.COM. Revision:3 This product is RoHS compliant to directive 2002/95/EC . 1751 State RTE. 17A STE#1 Florida,NY 10921 Customer Service: 800-431-3864 Fax: 845-651-4160 Website: www.remee.com Page I of 2 ��- e �J9 16-2 Unshielded Remee Plenum WIRE&CABLE ETL listed for guaranteed performance With Yoe�r M�rd Made in the USA Engineered W Part No.: 760160 Applications: Jacket This document establishes the specifications for a lnsulatio plenum rated two conductor twisted, unshielded Conductor cable used for fire protective signaling circuit applications. Construction Details: Number of Conductors: 2/C Standards: Conductor: 16AWG Solid Bare Copper Insulation Material: Remguard Plenum Polymer NEC Article 760 Nominal Insulation Thickness: 0.010 in. . UL Subject 1424, Type FPLP Nominal Insulation Diameter: 0.070 in. Color Code: Black, Red Jacket Material: Remguard Plenum Polymer Jacket Color: Red or Per Customer Requirement Nominal Jacket Thickness: 0.015 in. Codes & Listings: Nominal Diameter:0.175 in. (ETL)US Surface Print: 3122598 FPLP 16AWG (ETL)US + Sequential Footage Marking Electricals: Preparation for Shipment: Suggested Working Voltage: 300 Volts, rms. The cable shall be packaged to preclude the Nominal Capacitance: 38.2 pF/FT Cond-Cond inducement of damage due to handling and Direct Current Resistance:4.02 Ohms/1000'@20°C transportation, and shall be in accordance with the best commercial practices available. Shipping containers shall be constructed as Technical Details: to eliminate any possible damage to the Temperature Rating cables due to shipment. Operation: -20C to +60°C (5i'aTto *10474 us Nominal Weight: 23 lbs./ 1,000 Feet g MADE IN THE USA Issue Date:04/16 All warranty information can be viewed at WWW.REMEE.COM. Revision:3 This product is RoHS compliant to directive 2002/95/EC . 1751 State RTE. 17A STE#1 Florida,NY 10921 Customer Service: 800-431-3864 Fax: 845-651-4160 Website: www.remee.com Page 1 of 2 t set"- 18-4 Unshielded Remee Plenum WIRE&CABLE d ETL listed for guaranteed performance = ���M�r Made in the USA Engineered W1th Yo Part No.: 760184 Applications: O This document establishes the specifications of a Jacket plenum rated four conductor unshielded cable Insulatio used for fire protective signaling circuit applications. conductor Construction Details: Number of Conductors:4/C Standards: Conductor: 18AWG Solid Bare Copper Insulation Material: Remguard Plenum Polymer • NEC Article 760 Nominal Insulation Thickness: 0.010 in. 0 UL Subject 1424, Type FPLP Nominal Insulation Diameter: 0.060 in. Color Code: Red, Black, Green, White Jacket Material: Remguard Plenum Polymer Jacket Color: Red or Per Customer Requirement Nominal Jacket Thickness: 0.015 in. Codes & Listings: Nominal Diameter: 0.175 in. (ETL)US Surface Print: 3122598 FPLP 18AWG (ETL)US + Sequential Footage Marking Electricals: Preparation for Shipment: Suggested Working Voltage: 300 Volts, rms. The cable shall be packaged to preclude the inducement of damage due to handling and transportation, and shall be in accordance Technical Details: with the best commercial practices available. Temperature Rating Shipping containers shall be constructed as to eliminate any possible damage to the Operation: -20C to +60°C cables due to shipment. Nominal Weight: 30 lbs./ 1,000 Feet NIE== ' MADE IN THE USA ,,.i us Issue Date:06/15 All warranty information can be viewed at WWW.REMEE.COM. Revision:3 This product is RoHS compliant to directive 2002/95/EC . 1751 State RTE. 17A STE#I Florida,NY 10921 Customer Service: 800-431-3864 Fax: 845-651-4160 Website: www.remee.com Page 1 of 2 (E)POTTER Project Name: M&T#3417 Standby Hours: 24 The Symbol of Protection 115 5 RIDGE STREET,RYE BROOK,NY Alarm Mins: 5 IPA-100 Installed By: NATIONAL FIRE Efficiency Factor: 20% Battery&Voltage Drop Designed By: NATIONAL FIRE SLC Type: CII ass B Calculations Date: 10/18/2023 NAC Source voltage: 20.4 Model p: IPA-100 Max Panel Current(amps): 5 Panel ID: .� User assumes all responsibility to ensure the quantities and current draw Location: BASEMENT ELECTRICAL ROOM values in this worksheet are accurate prior to submittal. Addressable Fire Panel Standby(amps) Alarm(amps) • Description 1 IPA-100 Analog Addressable FACP 0.130 0.130 0.220 0.220 Panel Standby: 0.130 Papal Alarm: 0.220 P-LINK(RS-48S) Standby Alarm 1 UD-2000/UD-1000 DACT Card 0.016 0.016 0.023 0.023 RA-6075/R LCD Annunciator 0.020 0.025 1 RA-6500(R/F) Flush Mount LCD Annunciator 0.020 0.020 0.050 0.050 LED-16(F) Flush Mount LED Annunciator 0.025 0.025 LED-16(F)' LED Annunciator LED Power' 0.015 0.210 CA-6075 Class A Module 0.012 0.044 IPSN-1000(E) Power Expander 0.015 0.015 PAD100-SLCE-127 SLC Expander 0.060 0.060 NOHMI-SLCE-127" SLC Expander 0.060 0.060 IDC-6 Initating Zone Expander 0.020 0.020 IDC-6 Initating Zone Expander Power' 0.030 0.270 RLY-5 Relay Expander 0.025 0.035 RLY-5 Relay Expander Power' 0.010 0.135 DRV-50 LED Driver Module 0.025 0.025 DRV-50 LED Driver Module LED Power' 0.010 0.215 FCB-1000 Fire Communications Bridge 0.025 0.025 FIB-1000 Fiber Interface Board 0.030 0.030 MC-1000 Multi-Connect Expander 0.010 0.010 SPG-1000 Serial Parallel Gateway 0.040 0.040 NCE-1000 Network Card Ethernet 0.050 0.050 L_�NCF-1000 Network Card Fiber 0.095 0.095 "REQUIRED IF USING NOHMI PROTOCOL SLC DEVICES (Maximum current draw on P-Link limited to 1 Amp) PLINK Standby: 0.036 PLINK Alarm: 0.073 'Only enter quantity y PUNK power Is being used to power devices SUC Devices Stand by Alarm AFC/ARC/IPA Series-PAD100/200 PAD-PD Analog Photo Smoke 0.000300 0.000300 PAD-PHD Analog Photo Smoke/Heat 0.000300 0,000300 PAD-HD Analog Fixed Temp Heat 0.000300 0,000300 PAD-CD Analog Carbon Monoxide Detector 0.000300 0.000300 _ PAD-PCD Analog Smoke/Carbon Monoxide Detector 0.000300 0.000300 PAD-PHCD Analog Smoke/Heat/Carbon Detector 0.000300 0.000300 PAD100-DRTS Duct Remote Test Switch 0,010000 0.015000 2 PAD-DUCT Addressable Duct Detector 0.000300 0.000600 0.000300 0.000600 PAD-DUCTR' Addressable Duct Detector w/Relay 0.000500 0.000500 _3 PAD100-PSSA/PSDA Addressable Pull Station Single/Dual Action 0.0002DO 0.000600 0.000200 0.000600 i PAD100-MIM Micro Input Module 0.000200 0.000200 4 PAD100-SIM Single Input Module 0.000240 0.000960 0.000240 0.000960 PAD100-DIM Dual Input Module 0.000240 0.000240 3 PAD100-RM Relay Module 0.000240 0.000720 0,000240 0.000720 _ _PAD300-OROI One Relay One Input Module 0.000240 0.000240 PAD100-TRTI Two Relay Two Input Module 0.000240 0,000240 PADI00-ZM' Conventional Zone Module 0.000240 0.000240 _PAD100-NAC' Notification Appliance Circuit 0.000200 0.000200 iPAD100-SM Speaker Module 0,000200 0000200 ___1PAD100-IM Isolator Module 0.000150 0,000150 f 2 PAD100-LED LED Module 0.000240 0.000480 0.000240 0.000480 L�PAD100-LEDK Addressable LED w/Key Switch 0,000200 0,000200 PAD100-SB" Addressable Sounder Base 0.000200 0.000200 lPAD100-LFSB"' Addressable Low Frequency Sounder Base 0.000200 0.000200 IPAD100-RB' Addressable Relay Base 0.000200 0.000200 PAD100-IB Addressable Isolator Base 0,000150 0,000150 Potter Electric Signal(CI2022 1 of 3 IPA-100 Battery and Voltage Drop Calculation AFC/ARC/IPA Series-PAD300 13 PAD300-PD Analog Photo Smoke 0.000300 0.003900 0,000300 0.003900 PAD300-PD-1 Analog Photo Smoke W/Isolator 0,000300 0.000300 -PAD300-PHD Analog Photo Smoke/Heat 0,000300 0.000300 PAD300-PHD-1 Analog Photo Smoke/Heat/Isolater 0.000300 0.000300 PAD300-1-11) Analog Fixed Temp Heat 0.000300 0.000300 :PAD300-HD-1 Analog Fixed Temp Heat W/Isolator 0.000300 0,000300 PAD300-CD Analog CO2 Detector 0.000300 0.000300 PAD300-CD-1 Analog CO2 Detector W/Isolater 0.000300 0.000300 PAD300-PCD-1 Analog Smoke/CO2 Detector 0.000300 0.000300 2- PAD300-PCD Analog Smoke/CO2 Detector W/Isolater 0.000300 0.000600 0.000300 0.000600 PAD300-PHCD Analog Smoke/Heat/CO2 Detector 0.000300 0.000300 PAD300-PHCD-1 Analog Smoke/Heat/CO2 Detector W/Isolater 0.000300 0.000300 ,PAD30C-DD Addressable Duct Detector 0.000300 0,000300 ',PAD300-SB"• Addressable Sounder Base 0.000200 0,000200 PAD300-LFSB* Addressable Low Frequency Sounder Base 0.000200 0,000200 IPAD300-RB' Addressable Relay Base 0.000200 0,000200 PAD300-18 Addressable Isolator Base 0.000150 0.000150 PFC-6000/P Series PSA Analog Photo Smoke 0,000325 0,000325 1 PSHA Analog Photo Smoke/Heat 0.000325 0.000325 RHA Analog Rate of Rise Heat 0,000325 0.000325 FHA Analog Fixed Temp Heat 0.000325 0.000325 'DDA Addressable Duct Detector 0.000325 0.000325 TAPS-SA/APS-CA Addressable Pull Station Single/Dual Action 0.000325 0.000325 IMCM Mini Contact Input Module 0.000325 0.000325 SCM-4 Single Contact Input Module 0.000325 0.001000 DCM-4 Dual Contact Input Module 0.000325 0.001000 TRMA Twin Relay Output Module 0.000325 0.001000 CIZM-4" Conventional Zone Input Mod 0.000325 0.001000 I MOM-4' Monitored Output Module 0.000325 0.001000 ARB Detector Base w/Relay 0.000325 0.000325 ASB' Detector Base w/Sounder 0.000325 0.000325 SCI" Short Circuit Isolator(Class A) 0.000325 0.002340 AIB" Detector Base w/Isolator(Class A) 0.000_325 0.002340 IM/IB/SCl/AIB Class B'• Current Draw from Install Manual SLC Loop Alarm LED Current 0.000000 0.000000 0.036000 0.036000 ' Requires Aux Power(Configure Below) SLC Standby: 0.007860 SLC Alarm: 0.043860 See the installation manual for special considerations when installing IM,18,AIB,SCI devices on Class B loops. "• Requires Aux Sounder Base Power(Configure Below) DescriptionNAC Circuits(See NAC Configuration below) Standby(amps) Alarm(amps) Ckt Use 1 Notification First Floor 0.00000 0.79800 2 Notification Second Floor 0.00000 0.30700 NAC Standby: 0.00000 NAC Alarm: 1.105W a •Configuration below) Standby(amps) Alarm(amps) DescriptionCkt Use 1 Aux Power Fire Cellular Power 0.00700 0.02000 2 0.00000 _ 0.00000 1/O Standby: 0.00700 I/O Alarm: 0.02000 Battery Calculation Summary Standby(amps) Alarm(amps) Panel Current: 0.13000 0.22000 P-link Current: 0.03600 0.07300 SLC Device Current: 0.00786 0.04386 NAC Circuit Current: 0.00000 1.10500 1/0 Circuit Current: 0.00700 0.02000 SLC Loop Type: Class B Total Standby: ® Total Alarm: Device Addresses Used � Standby Hours: 24 Alarm Mins: 5 Device Addresses Available: 127 AH Required: 4.35 AH Required: 0.13 Total Combined Standby&Alarm AmpHours Required: 4.48 Efficiency Factor: 20% Required Battery AmpHours: 5.38 Battery AmpHours Provided: 8� Note:The cabinet will house two 8 AH or IS AH batteries. The charging circuit 8 rated for up to two 55 AH batteries. Potter Electric Signal(g2022 2 of 3 IPA-100 Sat"and Volfaae Drop Calculation ©po-rTE NAC Circuit Configuration&Voltage Drop M&T#3417 1011812023 NAC I MAX Circuit Current Eanips): 3 Source Voltago Used • 1 Usage:Notification Description: First Floor Wire Type • ter Ohms Max Load Volts • Volts#16 1 5.08 165 2.676 0. 19.06 l Circuit Devices Standby(amps) Alarm(amps) Qty Lookup Type Description Each Total Each Total 4 Strobes _ Potter S-24 Stro 15c U.000000 0.042000 0.168000 2 Horn Strobes Potter CHS-24.95td,Hi db 0.000DD0 0.000000 0.243000 0.486000 1 Horn Strobes Potter HS-24,75cd,Hi db 0.000000 0.000000 0.144000 0.144000 User an add devices on the fly to these bottom 5 rows (No lookup function) Total Standby: Total Alarm: �NAC2 MAX Circuit Current(amps): 3 Source Vokage Used(VDQ: 20.4 Usage: Notification Description: Second Floor Wire Type Ohms/100011 Length I-Way Actual Ohms Max Load lamps) #16 Solid 5.08 80 0.813 0.30 Volts 20.1 •16 DevicesCircuit City Lookup Type Description Each Total Each Total 2 :Strobes Potter S-24 Strobe,15co O.UU00w 0. 0.042000 0.084000I 1 Horn Strobes Potter CHS-24,75cd,Hi db 0.000000 0.000000 0.223000 0.2230D0 User can add devices on the fly _ to these bottom 5 rows (No lookup function) Total Standby: Total Alarm: VO Circuit Configuration&Voltage Drop M&T#3417 1011812023 1/01 MAX Circuit Current(anilp,) 1 --Source Voltage Used(VDC) 204 Usage:Aux Power Desviptton: Fire Cellular Power Wire Type • trr Ohms Max Load(amps) Volts @ EOL Min #16 So i 5.08 10 0.102 0.020 20.40 Volts16 DevicesCircuit MY Lookup Type Description Each I otal Each Total t User an add devices on the fly - - -- - to these bottom rows 1 Fire_Cellular Radio Fire Cellular Radio_ 0.007000 0.007000 0020066 0.020000 Total Standby: Total Alarm: 1/02 MAx arcult Current(amps); 1 Source Voltage Used(VDC): 20.4 Usage:[ Description: Wire Type Ohms/1000fit Length I-Way Actual Ohms Max Load(amps) Volts @ EDE Min Volts Req'd #12 Solid 2.01 0.000 0.000 20.40 1 16 DevicesCircuit City Lookup Type Description Each Total Each Total User an add devices on the fly to these bottom rows 1 - - (No lookupfuncdon� -- Total Standby: Total Alarm: Potter Electric Signal(C)2022 3 of 3 IPA-100 Battery and Voltage Drop Calculation (E) POTTER ELK SERIES ® The Symbol of Protection BATTERIES i UL Recognized Features • 24 month free replacement • Long service life • Maintenance free • High power-to-weight ratio • Wide operating temperature rating • Ease of shipment • No leakage -- sealed lead acid Stock Model Volts AH Length Width Height Weight Number Number 5130080 BT 6 6 5.0 2.75 1.85 4.17 1.98 5130095 BT 10 12 1.2 3.82 1.77 2.24 1.28 5130092 BT-40 12 4.5 3.50 2.75 4.17 3.75 5130084 BT 80 12 8.0 5.94 2.56 3.98 6.25 5130090 BT 120 12 12.0 5.94 3.90 3.94 8.82 5130086 BT-180 12 18.0 7.12 2.99 6.57 13.67 5130097 BT 260 12 26.0 6.53 6.89 4.96 20.06 Potter Electric Signal Co.,LLC•St.Louis,MO•Cust Service:866-240-1870•Tech Support:866-956-1211• Canada 888-882-1833•www.pottersignal.com PRINTED IN USA MKT#8910100-REV B PAGE I OF 2 12/09 (E) POTTER ELK SERIES ® The Symbol of Protection BATTERIES Specifications BT64 BT 120 Constant voltage use at 20°C Constant voltage use at 20°C Standby use: Standby use: Voltage regulation: 6.75V — 6.90V Voltage regulation: 13.50V— 13.80V Initial current: < 1.5A Initial current: < 3.6A Cyclic use: Cyclic use: Voltage regulation: 7.2V— 7.50V Voltage regulation: 14.40V— 15.OV Initial current: < 1.5A Initial current: < 3.6A BT 10 BT 180 Constant voltage use at 20°C Constant voltage use at 20°C Standby use: Standby use: Voltage regulation: 13.50V — 13.80V Voltage regulation: 13.50V — 13.80V Initial current: < .39A Initial current: < 5.4A Cyclic use: Cyclic use: Voltage regulation: 14.40V— 15.OV Voltage regulation: 14.40V -- 15.OV Initial current: < .39A Initial current: < 5.4A BT 40 BT 260 Constant voltage use at 200C Constant voltage use at 20°C Standby use: Standby use: Voltage regulation: 13.50V — 13.80V Voltage regulation: 13.50V — 13.80V Initial current: < 1.2A Initial current: < 7.8A Cyclic use: Cyclic use: Voltage regulation: 14.40V — 15.OV Voltage regulation: 14.40V — 15.OV Initial current: < 1.2A Initial current: < 7.8A BT 80 Constant voltage use at 20°C Standby use: Voltage regulation: 13.50V — 13.80V Initial current: <2.3A Cyclic use: Voltage regulation: 14.40V— 15.OV Initial current: < 3.6A PRINTED IN USA MKT.#8910100-REV B PAGE 2 OF 2 12/09 Building Pernut Check List &Zoning Analysis OB & C ONLY Address: -TZ LDKF I S 1 SBL: t LA Zone: C- Use: Cont.Type: Other. Submittal Date: Z Z Z Revision Submittal Dates: Applicant M_LL ::MAC k- Nature of Work W Fjl_c 9 ti Reviews:ZBA: SEP 2 1 2022 PB: BP: Other. VEOK ( ) FEES:Filing. Z.S�BP: eq, _ � C/O: Legalization: APP.: Date Stamped: Properly Signed: SBL Verified:' Cross Connection: F.O.G.: ( ) ( ) 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: ( ) (Jf LANS:Date Stamped: Sealed ✓ Copies: Z Electronic Other. ( ( License: Workers Comp: Liability Tmp.Waiver. Other. ( ) ( ) Code 753#: Dated N/A: (L-Y ( ) HIGH-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other. (� ( ) LOW-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other. FIRE ALARM/SMOKE DETECTORS:Plan: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit: Nat. Gas: LP Gas: Grease Trap: Other. FIRE SUPPRESSION:Plan: Permit: N/A: Other. (� ( ) H V.A.C.: Plan: Permit: N/A Other. ( ) ( ) FUEL TANK Plan: Permit FUEL TYPE: Other. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plan: 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: REQUIRED EXISTING PROPOSED NOTES APPROVED Ama nata. SEP 2 1 1022 l - F.A.R.: QPen Space notes: I w1 "' � � ' I ( ' a rb x CR m3 jG c� .o cc °° c 0110 I l c 40) L Lo p 1 a diGe '� w 0 0 cc Ty 'ww � 1 � ll � �.. O •'� .��'L-i x V f o 1 cc w CA f�a o W 0.0 � T F a O c � 0 in m m letw 1 �1 w d Q cl Aeu W OF Gi 1 cm ,,. m � � — 1 . Laura Petersen From: Laura Petersen Sent: Monday, October 3, 2022 11:52 AM To: mmckeon@mtb.com Cc: bgraham@rwdake.com Subject: Building Permit Application - 11 S South Ridge Street - M &T Bank Attachments: Fire Suppression Full 9.2021.pdf; Operating Permit Full 8.2021.pdf Good morning, The building permit application has been approved by the Building Inspector. Before I can issue the buildingpermit the following items must be submitted to our office; General contractor's contact name. �. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) V4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $8,794.00 (due once permit is issued and ready for pick-up) ./5. Fire sprinkler application & fee ($250.00 application fee and permit fee $25.00 per $1,000.00 or a minimum of$275.00) (See attached) A6. Fire sprinkler contractor's liability insurance (the Village Of Rye Brook must be the certificate holder) ✓7. Fire sprinkler contractor's workers compensation on a NY State Board form (C 105-2 or U26.3) 8. Fire Inspection / Operating Permit Application & fee (See attached) Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Ipetersen(&ryebrook.orp 1 TE ACC)R" CERTIFICATE OF LIABILITY INSURANCE FDA 3;2,/zo2a"' 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 NAME: CliCT ent Service Team Arthur J. Gallagher Risk Management Services, LLC P A HO No Ext: 800-716-8314 ac No:855 595 4605 285 Delaware Avenue,Suite 4000 E-MAIL Buffalo NY 14202 ADDRESS: GGB.BU2.CL.Srv@ajg.com INSURER S)AFFORDING COVERAGE NAIC a INSURER A:New Hampshire Ins Co 23841 INSURED RWDAKEO-01 INSURER B: Merchants Mutual Ins Co 23329 R.W. Dake&Co., Inc. dba RW Dake Construction INSURER C: National Union Fire Insurance Company of Pittsburg19445 100 Bluff Drive INSURER D:Westchester Surplus Lines Insurance Co 10172 East Rochester NY 14445 INSURER E:Pennsylvania Manufacturers Indemnity Co 41424 INSURER F: COVERAGES CERTIFICATE NUMBER:1854309223 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. ILTR TYPE OF INSURANCE ADDL BR POLICY NUMBER MM/DDPOLICYIYYYY MWDD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY Y Y GL5268131 4/1/2024 4/1/2025 EACH OCCURRENCE $2,000,000 F_�7 DAMAGE TO R CLAIMS-MADE OCCUR PREMISES Ea occurrence S 500,000 X $0 Deductible MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $4,000,000 POLICY T JECT PRO-- FX LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y Y CA4489622 4/1/2024 4/1/2025 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ I Hired Physical Damage $150,000 B UMBRELLA LIAB X OCCUR Y Y CUP0001983 4/1/2024 4/1/2025 EACH OCCURRENCE $5.000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$in nnn $ A WORKERS COMPENSATION Y WC015893619 4/1/2024 4/1/2025 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE [ NIA E.L.EACH ACCIDENT $2,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 D Pollution Liability Y G24380099012 4/1/2024 4/1/2025 Per Occurrence $5,000.000 E Excess Umbrella 6024019207531 4/1/2024 4/1/2025 General UmbAggregcur/Agg $5,000,000 $3,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) To the extent covered by the following form(s): Business Auto #74445(10/99)Primary Insurance for Additional Insureds when required by agreement #87950(9/14) Blanket Additional Insured where required by contract or agreement #62897(6/95)Waiver of Transfer of Rights of Recovery Against Others to us where required by contract or agreement General Liability #CG2001 Primary and Noncontributory when required by written contract #CG2010 Blanket Additional Insured-Owners,Lessees or Contractors when required by contract or agreement See Attached... 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 AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD rORK workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured R.W.Dake&Co.,Inc. 100 Bluff Drive 585-381-2500 East Rochester,NY 14445 1 c.NYS Unemployment Insurance Employer Registration Number of 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 160B42044 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Ins Co Village of Rye Brook Rye King Street 3b.Policy Number of Entity Listed in Box"la" Rye Brook,NY 10573 Y ty WC015893619 3c.Policy effective period 04/01/2024 to 04/01/2025 3d.The Proprietor,Partners or Executive Officers are X] included.(Only check box if all partners/officers included) N� all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 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 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: Arthur J.Gallagher Risk Management Services,LLC (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 1, 3rz7/2024 (Signature) (Date) Area President Title: Telephone Number of authorized representative or licensed agent of insurance carrier: 800-716-8314 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 ,4coRo� CERTIFICATE OF LIABILITY INSURANCE FDATE(MM.DD VYVV) 10/11/2022 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 M &T Insurance Agency, Inc NAME: Tricia Haenle 9 Y. PHONE FAX 3 City Center i No.E : 585-258-8278 (A/c No:855-595-4609 E-MAIL 180 South Clinton Ave., Suite 700 ADDRESS:.CLService@mtb.com Rochester NY 14604 INSURERS AFFORDING COVERAGE INSURER A:New Hampshire Ins Co 23841 INSURED RWDAKEO-01 INSURER B:Merchants Mutual Ins CO 23329 R.W. Dake&Co., Inc. dba RW Dake Construction INsuRERc:Westchester Surplus Lines Ins 10172 100 Bluff Drive INSURER D;National Union Fire Ins of Pittsburgh PA 19445 East Rochester NY 14445 INSURER E:Westchester Fire Ins Co 10030 INSURER F: COVERAGES CERTIFICATE NUMBER:1014400692 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. ILTR TYPE OF INSURANCE �DDL SUBR POLICY NUMBER MM DD/YYYY MM/D/YYY LIMITS D X COMMERCIAL GENERAL LIABILITY Y Y GL5268131 4/1/2022 4/1/2023 EACH OCCURRENCE _ __$_1,_00.0,00.0_ _ CLAIMS-MADE X OCCUR DAMAGE TO RENTED ' PREMISES�a_occurrenceI $500,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY _$1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$2,000,000 POLICY X PE I X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ D AUTOMOBILE LIABILITY Y Y CA4489622 4/1/2022 4/1/2023 COMBINED SINGLE LIMIT $2,000.000 iY(Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident)_ $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident)_ _ _ _ Hired Physical Damage $100,000 B UMBRELLA LIAB X OCCUR Y Y CUP0001983 4/1/2022 4/1/2023 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS MADE, AGGREGATE $5,000,000 DED X RETENTION$Inorin $ A WORKERS COMPENSATION Y WC015893619 4/1/2022 4/1/2023 ''X PER OTH- AND EMPLOYERS'LIABILITY Y/N - STATUTE _ ER ANYPROPRIETOR,PARTNER'EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER,MEMBEREXCLUC NIA —. - - ---- -- -- ---- ---- - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes.describe under —— - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability Y G24380099 009 4/1/2022 4/1/2023 Per Occurrence $5.000,000 E N10792228001 4/1/2022 4/1/2023 General Aggregate $5,000,000 Excess Umbrella Y Y XS Umbrella Occur/Agg $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) To the extent covered by the following form(s): Business Auto #74445(10/99)Primary Insurance for Additional Insureds when required by agreement #87950(9/14) Blanket Additional Insured where required by contract or agreement #62897(6/95)Waiver of Transfer of Rights of Recovery Against Others to us where required by contract or agreement General Liability #CG2001 Primary and Noncontributory when required by written contract #CG2037 Blanket Additional Insured-Owners, Lessees or Contractors when required by contract or agreement See Attached 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016 03) The ACORD name and logo are registered marks of ACORD f"'NEW Workers' CERTIFICATE OF STATE 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 R.W. Dake&Co.,Inc. 585-381-2500 100 Bluff Drive East Rochester,NY 14445 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 16-0842044 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Ins Co Village of Rye Brook 3b. Policy Number of Entity Listed in Box"1 a" 938 King St WC015893619 Rye Brook,NY 10573 3c. Policy effective period 04/01/2022 to 04/01/2023 3d.The Proprietor, Partners or Executive Officers are �✓ included.(Only check box if all partners/officers included) ❑ 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: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) Approved by: October 12, 2022 (Signature) (Date) C.E.O. North America Title: Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 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 ACOR�� CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIVYVY) 1 0/1 11202 2 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 NAME: Insurance Solutions of America PHONE FAX 407 332-0033 925 West State Road 434, Ste 201 (A/C,No.ExQ: (A/c,No):407-332-0030 E-MAIL Winter Springs FL 32708 ADDREss: certs@isolutionsfl.com INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A:Hudson Excess Insurance Com an 14484 INSURED ELITFIR-04 INSURERS:An1GUARD Insurance Company 42390 Elite Fire Protection LLC 150 Courtney Dr INSURERC:Wesco Insurance Company 25011 Rocky Hill CT 06067 INSURER0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1840713704 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. WTSRR TYPE OF INSURANCE INSD ADDL�SUBR. POLICY NUMBER MM/DD/YYYN MM/DD/YYri LIMITS A X COMMERCIAL GENERAL LIABILITY FSL000287-03 1111/2022 1/11/2023 EACH OCCURRENCE i '- $1,000,000 � DAMAGE RENTED CLAIMS-MADE OCCUR PREMISESTO Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 7 POLICY R T El LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LLABILITY I ELAU353623 4/6/2022 4/6/2023 COMBINED SINGLE LIMIT Ea accident $1,0G0.000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident _$ $ X UMBRELLA LIAB X OCCUR FSL0000138-03 1/11/2022 i 1/11/2023 EACH OCCURRENCE _ $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ WORKERS COMPENSATION WWC3580944 4/4/2022 1 4/4/2023 X7 SPER TATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1.000,000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Certificate is subject to all policy limits,conditions and exclusions. 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD YORK NEW Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): OTHER:Fire Sprinkler Elite Fire Protection LLC 150 Courtney Dr From: Village of Rye Brook Rocky Hill,CT 06067-2051 PHONE:860-539-2127 FEIN:XXXXX5850 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The out-of-state entity has no NYS employees and/or NYS subcontractors AND ALL work related to the permit, license or contract is done outside of NYS; OR ALL employees are direct employees of a government entity outside of New York. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Joseph L.Brooker,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN I Signature• Date: HERE (��!? / a A Exemption Certificate Number Received 2022-069460 October 11, 2022 ta NYS Workers' Compensation Board CE-200 01/2018 CIJRO� DATE(MM/DDNYYY) A CERTIFICATE OF LIABILITY INSURANCE /1/2024 4/27/2023 .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). CONTACT PRODUCER Lockton Companies NAME: 444 W.47th Street,Suite 900 PHONE FAX A/C No): Kansas City MO 641 1 2-1 906 E-MAIL (816)960-90M ADDRESS: kcasu@lockton.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Greenwich Insurance Company 22322 INSURED ENVIRONMENTAL CONTROL,LLC INSURER B:Allied World National Assurance Company 10690 1304803 1265 WOODEND ROAD INSURER C:XL Insurance America Inc. 24554 STRATFORD CT 06615 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15274014 REVISION NUMBER: XXXXXXX 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 SUER POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY N N RGD300147504 4/l/2023 4/1/2024 EACH OCCURRENCE $ 2 D00 OW CLAIMS MADE __X__ OCCUR PREMISES Ea occurrence $ 500 OW MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4 000 0W POLICY JET LOC PRODUCTS-COMP/OP AGG $ 41000,000 OTHER: $ A AUTOMOBILE LIABILITY N N RAD943796404 4/1/2023 4/l/2024 COMBINED SINGLE LIMIT $ Ea acddent 5 000 000 I X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ )Cy AUTOS ONLY AUTOS $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per acddent $ XXXXXXX B X UMBRELLA LIAR X OCCUR N N 0313-7473 4/1/2023 4/1/2024 EACH OCCURRENCE $ 5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ $0 $ XXXXXXX WORKERS COMPENSATION PER OTH- C AND EMPLOYERS'LIABILITY N RWD300147604 4/1/2023 4/1/2024 X STATUTE ER C Y/N STOP GAP:ND,OH,WA,WY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 OOO 000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I OOO 000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. WORKERS COMPENSATION COVERAGE EXTENDS TO NEW YORK STATE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 15274014 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING STREET RYE BROOK NY 10573 AUTHORIZED REPRESENTATIV O 1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r"t" Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name 8 Address of Insured(use street address only) 1 b Business Telephone Number of Insured Environmental Control,LLC (203)375-5228 DBA Encon,LLC 1 c NYS Unemployment Insurance Employer Registration Number 1265 Woodend Road oflnsured 4609688-9 Stratford,CT 06615 1d Federal Employer Identification Number of Insured or Social Work Location of Insured(Only required if coverage is specifically limited Security Number to certain locations in New York State,i.e.,a Wrap-Up Policy) 06-0855856 3a Name of Insurance Carder 2.Name and Address of Entity Requesting Proof of XL Insurance America,Inc. Coverage(Entity Being Listed as the Certificate Holder) 3b Policy Number of Entity Listed in Box"I a" Village of Rye Brook RWD3001476-04 938 King Street Rye Brook,NY 10573 3c Policy effective period 04/01/2023 to 04/01/2024 3d Proprietor,Partners or Executive Officers are [X] included.(Only check box if all partners/officers included) [ ] 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: Joseph Tocco (Pri�thorizedentative or licensed agent of insurance carrier) Approved by: 04/28/2023 (Signature) (Date) Title: Chief Executive Officer Telephone Number of authorized representative or licensed agent of insurance carrier: 212-915-6815 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 NATIO-2 OP ID: AH ,aco CERTIFICATE OF L DATE(M3/20 YYV) LIABILITY INSURANCE 10/0 /2023 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). 877-242-9600 coNTACT Central Insurance Agency PRODUCER NAME' Central Insurance Agency,Inc. PHONE 877-242-9600 FAX 877-243-8995 PO Box 1047 (A/C,No,Ext): A/C,No): Smithtown,NY 11787 ADDR AIE :Certl ICateS CI81r1SUreS.COm George Gavaris INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peleus Insurance Company 34118 I SIJRED INSURER B,Allstate Ins.Co. 19232 t�atlonal Fire&Safety SOlut s Inc. INSURERC:North American Capacity Ins.Co 25038 lOn 211 Knickerbocker Ave Suite 1 INSURER D:Hartford Undewriters Ins Co_ 30104 Bohemia, NY 11716 —-- 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 TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,000 CLAIMS-MADE X] OCCUR X X GLV0000349 03124/2023 03/24/2024 DAMAGE TO.EoNTED $ 300,000 X Extended PD MED EXP(Any oneperson) $ 10,000 X Contractual Liab. PERSONAL&ADV INJURY $ 1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a JERe LOC PRODUCTS-COMP/OP AGG $ 2+000+000 Prof/E&O $1 M/$2M OTHER: COMBINEDE tSINGLE LIMIT $ 1,000,000 B AUTOMOBILE LIABILITY - ANY AUTO X X 648955867 03/24/2023 03/24/2024 BODILY INJURY Per rson $ OWNED rx SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOSX HIRED NON-OWNED PROPER DAMAGE $ AUTOS ONLY AUTOS ONLY A UMBRELLA LIAR X OCCUR EACH OCCURRENCE 5+000+000 $ X EXCESS LIAB CLAIMS-MADE X X UMV0000119 03/24/2023 03/24/2024 AGGREGATE $ _ 5,000,000 DED X I RETENTION$ 10,000 ProflE&O 51000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY TAT TE Y/N ANY PROPRIETOWPARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT C Cyber Liability C-4LSA-233844-CYBER-2022 08119/2023 08/19/2024 Occ/Agg $2mi75,00 l D Property 91 SBA AU1E4H 09/09/2023 09/09/2024 BPP 75,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as an additional insured under the general liability with respect to the liability created by the negligent acts, errors and omissions of the named insured herein as required by written contract.The General Liability includes a waiver of subrogation as required by written contract. CERTIFICATE HOLDER CANCELLATION VILGRYE 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 Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �E Workers' f s' 4 Y£3M C"••""•"..,STATE C0111penSatiOn CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured ADP TotalSouce CO XXI,Inc. 6312345656 5800 windward Parkway Alpharetta,GA30005 1c.NYS Unemployment Insurance Employer UC/F: Registration Number of Insured National Fire&Safety Solutions Inc 07-70030 4 211 Knickerbocker Ave Bohemia,NY 11716 1d. Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e., a Wrap-Up Policy) 113480586 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Insurance Co. Village of Rye Brook 3b.Policy Number of Entity Listed in Box 1 a" 938 King Street WC 034298546 NY Rye Brook,NY 10573 All worksite employees working for National Fire&Safety Solutions Inc paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. 3c. Policy effective period 07/01/2023 to 07/01/2024 3d.The Proprietor, Partners or Executive Officers are 2 included.(Only check box if all partners/officers included) ❑ 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"la"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 Carver or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. 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"30,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: David McElroy (Print name 3of�authhorrii�zed representative or licensed agent of insurance carrier) Approved by: 10/03/2023 (Signature) (Date) Title: CEO North America Telephone Number of authorized representative or licensed agent of insurance carrier: 800-743-8130 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) Certificate Number: www.wcb.ny.gov