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BP22-219
PERMIT #�/ - Q I LDATE, !�(P: SECTION BLOCK TYPE OF W 0 R m/e,r% i/ g .+� P/i i/vll�7�d� f j f4h14"'Z v! 10B LOCATION �"�f d �S/�OAIOJ�Si�007 SO OWNER r_nnlTRn�TnR S ��dVC17�7_D : C -- L��'�ry'�7� bid % ��3l1 EST. CO VcO #� TCO # FEE DATE _ FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT 0 INSPECTION RECORD DATE 1NSP W �N,3�0/g A v A olf Aj Pe a�h /7 / cz:pf /69 woo 3� 9/� Elie c ;c (f 0120 OTHER APPROVALS ARB ZBA BOT _ PB _ _ OTHER CoP� \A J/ lio q/ fe? & G 1 e� VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK N(): 213-0%1 Certificate of ®ccupeucp This is to certify that 6&1')j Ri'Clae A'eo /& &C1 of, ra , having duly filed an application on ADKI 20 requesting a Certificate of Occupancy for the premises known as, Q J e , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: / Block: 4� Lot: f� and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No., , issued 20, 1, 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:&MIYS, Construction: for the following purposes: Y C 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 the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shal a made,nor shall the lAilding a moved from one location to another until a permit to accomplish such change has been tai ed fro Building I s tor. Acting Building Inspector, Village of Rye Brook: Date: `i w�jJJ 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.tyebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 8,2023 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: Amazing Lash Studio,166 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.35-2-36 Mechanical Permit#22-169 issued on 11/9/2022 for Modifications to Existing Sprinkler System This certifies that the fire sprinkler heads on the existing system,relocated under the above captioned permit, have been satisfactorily completed. Sincerely, Steven E. Fews Acting Building&Fire Inspector /to QyE DR 4' 19 c�` �c e ti�o�Vy VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.r�-ebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE May 8,2023 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: Amazing Lash Studio,166 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.35-2-36 This document certifies that the work done under Mechanical Permit #23-049 issued on 4/18/2023 for the installation of a new heat pump and ductless unit has been satisfactorily completed. Sincerely, At Steven E. Fews Acting Building&Fire Inspector /to RD E CL'E__" W rl�_' APR 12 2023 1A.•' � > For office u•t•Holy: VILLAGE OF RYE BROOK 13UILUING I�A�R`TMEN7' BUILDING DEPARTMENT VILlL�A A OF RYE H.JJ OK ltitit,l,,,; 938 KInG STREFi &N'E BROOK,Y 6%'PORK 10573 DA I I•:: r`(��a)939.0666cj, Fla:: ' — Pw)� �Al�bltirin0l oFL 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 ......................................................................•.........................0.0..#....................... Address: A� i'S, d6e 64 ��MOK//i I\)•f 10& ')3 J Occupancy/Use: IS Parcel ID a: ���35 —c—�W Zone: Owner: N�� t Address: Z �� i_� P.E./R.A.or Contractor: 'Acf&ress: ,, n Person in responsible charge• Address: 1 V Application is hereby made and submitted tot a Building Inspector of the Village of Rye B ok for the issuance of a Certificate of Occupancy/Certificate ofCompliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW Y JO�RK,COUNTY OF WESTCHESTER as: ma. — ;4U O r1'1 Q,being duly swom,deposes and says that he'she resides at �T3 ti' n b r i y r, ( nnl Name M A phrani) 1,' (No Strect) in `f ► p f aLmsi in the County of W es LC he-S+r—r in the State of •that (01% loan'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 have been donated gratis was-S LDS/O G for the const tion or alteration o 17Of' Deponent further states that he has examined the approved plans of the struclure/work herein referred to for which a Cenificate 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/compleled 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 orpremises or part thereof hereafter created,erected.changed,convened or enlarged,wholly or partly,in its use or structure until a Cenificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. -` Sworn to before me � `this A-1 Sworn to before me this 3(X4 day of \ ,20 Z 3 day of A\M ,_'0�3_ r n e of rope bluwna •W�'V 4%1l LLC Sisoal uc ul Appl"aot 1 J �L( I'nn1�of Prorwrt 14w1R* {J;N tt Yar`^O`tq L"AvFTMnQ1•e I'm aJoAptilcan, �� �_ NOII►tcY PUIt:3G t.'i!E�': ,•cW YORK No.r-wo?°IIl1a Nolan 1' tccount Noun Puhht Quollll�d to i P'��Mail: 17.1 M11 Comm Ak L QZ L,1 .�. �E BRC�k. • 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 :— � � DATE: O23 PERMIT# i ISSUED: l` �`�� SECT: � ) BLOCK:'?- LOT: LOCATION: ( � �`l J i'1 OCCUPANCY: ❑ Violation Noted ' TH WORK IS... [� PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION W '�1�C C !^y, / 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 �yE 4RCb�. O� Zm • 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 - - - - - - - - - - - - - - - - - - - - r ADDRESS : 1 G �� A DATE: 5)—2 1-1y PERMIT# �� ISSUED:�SECT: I. 7 1 BLOCK: OT: J� LOCATION: ,`�' 1� ,V�P ( � �t � OCCUPANCY: �y ❑ Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ .FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION r ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK f ❑ FIRE SPRINKLER (3 ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL �1 �t�` C4Pci ❑ OTHER \ Csu EEC AY �'� C`���I C 5 <o GLQ-J'�r cal(SS I r?c, l �E BRC�v�, cu � BUILDING DEPARTMENT P$UILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— DATE• PERMIT# r( ISSUED: SECT: BLOCK: LOT: LOCATION: '-11 1. OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED 0 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 LQ E 4RO, o`` tim ,,,[[ '932 BUILDING DEPARTMENT ❑`XUILDING INSPECTOR r]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:— (n DATE: PERMIT# ISSUED: ,. : LOCK:LOT: LOCATION: ' u OCCUPANCY: `1 , r. ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION / REQUIRED ❑ FOOTING `�G�k \�\ ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑,/.ROUGH PLUMBING , _L r� \ , J� ROUGH FRAMING u ' Qv" ��� iV Q4 �P Cr J V C( 1NC� S N�(1 S I(V� WILD JZ.6 ❑' INSULATION ❑ NATURAL GAS _ 1N X--<A{v V ❑ L.P. GAS �`. 07, ❑ FUEL TANKls� u "'�P ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL (L� ❑ OTHER tIl _ A � z IT N � A p � � � •+ �°V W o � w i A coo ei 1 u 0l C7 �o o x y b W W a � c � Ile. co 0 Or- O CIAA w G.y ►� o © W � 0 ,10 z w z ° P-+ ON Z a� V • M J W Vl V) " u = Cc, .5 4 v o o � 0 u U My Vz O o qC q �CR o W w � v � � U ° HO z U W o ° (i ,d � U C!J H v Q j W y O a4 �H •• A 0. F. Ili v : _ OAT 3 1 2a22 'BUILD �DEPAIt MENT CENED VIL E OF RY OOK pLAN D e 8 KING 1ET YE BR � ,NY 10573 AUG 3 0 2022 pNTE VILLAGE OF [RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: f te; NOV 1 ' ttit �/ Application Fee:$Approval Da Approval Signature: Permit Fees:$ ,::) e �0C Disapproved: Other: Application dated: c4ZVQs hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1, Job Address: 166 S RIDGE STREET SBL: 141,35-2-36 Zone. 2. Proposed Improvement.(Describe in detail):TENANT FINISH REMODEL FOR SALON CONCEPT IN EXISTING PRIOR-USE SPACE. MECHANICAL:EXISTING HVAC UNIT TO REMAIN,NEW DISTRIBUTION.PLUMBING:EXISTING WATER AND WASTE SUPPLY TO REMAIN,NEW RESTROOM,AND KITCHENETTE. ELECTRICAL: EXISTING ELECTRICAL_ GEAR TO REMAIN, NEW CIRCUITING THROUGHOUT. STRUCTURAL: NEW NON-STRUCTURAL WALLS AND FINISHES THROUGHOUT. 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: If yes, indicate: TIER L• TIER II: TIER III: 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: Yes: X (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: DRY CLEANER After Construction: SALON 6. N.Y State Construction Classification: II N.Y. State Use Classification: B 7. Property Owner: Win Ridge Shopping Center Address: 166 S Ridge St, Port Chester, NY 10573 Phone# Cell# email: 8. Applicant: Address: Phone# Cell# email: 9. Architect: JEFFREY BAKER Address: 6373 SILVER STREAM LN, FRISCO,TX 75036 Phone# Cell# 303-257-6029 email: jeffrey.baker@ design parameters.com 10. Engineer: JOHN TINSLEY Address: 19600 E PARKER SQ DR, PARKER,CO 80134 Phone# Cell# 720-263-6013 emnil• inhnfa)kvar^ncjdtina not 11. General Con-apt, ,f0.,J -S /��/7U�l/Gt� .fJ� Address. 76 7, 14, e e ti ru,?X A)7 I DY&7 t Phone# 917 94)7-&37 ;7 !? email: 12. Estimated cost of construction $ /©d, 000 (NOTE:The estimated cost shall include all labor,meter(l,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: 07/15/2022 Finish: 10/01/2022 (I) 8/12/2021 a a a N N N P� •� a�y+� _ O to A, ts,W rn W F� N V O cn a K.� N414 w � 'd qp w (� U Ak O v ^ U 140 O O 1 �+ F-i A °u p v V a 00 O O � 00 �'® v ' 4 O w W \ �Q 4 o o © ' "Z Cn �Q O 4 b a -o a �+ _ P-4 w r° ao W WCo � �3 oa � � Cl 00 z 0� o � � � © l O W O O ° A A �' b y L7 o O W + z , a z wz1 ° w cnfl �Q a w2t � O � o 7 o o - A z (� a o .. v U A ugo � � `� wai [� � H w 0 •� v � V Vr C7 A z O w i z w rn ti A.•� Cl) C7 �" w d 'Y u a a A W 0. z Ls; O U o .d cu a QED OCT 3 1 M 'BUILD � � MENT [) Q 1 �vl VIL OF RYE OOK 8 KING ET RYE BR( ,NY 10573 AUG 3 O 2022 p�T eo; Q _14 9 . 046� _ VILLAGE OF [RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: NOV it C Application Fee:$ DCL_ Approval Signature: AKTPermit Fees:$ OC?"— Disapproved: Other: Application dated:Cal�3o/�Qs hereby made to the Building Inspectorof 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: 166 S RIDGE STREET SBL: 141.35-2-36 Zone: 2. Proposed Improvement.(Describe in detail):TENANT FINISH REMODEL FOR SALON CONCEPT IN EXISTING PRIOR-USE SPACE. MECHANICAL EXISTING HVAC UNIT TO REMAIN,NEW DISTRIBUTION.PLUMBING:EXISTING WATER AND WASTE SUPPLY TO REMAIN,NEW RESTROOM,AND KITCHENETTE. ELECTRICAL: EXISTING ELECTRICAL_ GEAR TO REMAIN, NEW CIRCUITING THROUGHOUT. STRUCTURAL: NEW NON-STRUCTURAL WALLS AND FINISHES THROUGHOUT. 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: If yes, indicate: TIER I: TIER I1: TIER III: 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: Yes: X (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: DRY CLEANER After Construction: SALON 6. N.Y State Construction Classification: II N.Y.State Use Classification: B 7. Property Owner: Win Ridge Shopping Center Address: 166 S Ridge St, Port Chester, NY 10573 Phone# Cell# email: 8. Applicant: Address: Phone# Cell# email: 9. Architect: JEFFREY BAKER Address: 6373 SILVER STREAM LN, FRISCO,TX 75036 Phone# Cell# 303-257-6029 email: Jeffrey.baker@designparameters.com 10. Engineer: JOHN TINSLEY Address: 19600 E PARKER SQ DR, PARKER,CO 80134 Phone# Cell# 720-263-6013 email: John@kvaconsulting.net 11. General Contractor: Only One Construction Address: 1000 Simpson St Apt 6B Bronx, NY 10459 Phone# > Cell# email: ! 12. Estimated cost of construction $_ 0®, 00 (NOTE:The estimated cost shall include all labor,matey al,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis,) 13. Job Timetable: Start: 07/15/2022 Finish: 10/01/2022 (I) 8n 2/2021 BUILD MENT FE:AUG F U L/ VIL E Off' RY OOK 938 KING T 'ET RYE BRo' ,NY 10573 202� 4) 066 VILLAF RYE BROOK BUILDDEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE V16 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: T, E.�JL-r.US�t —, residing at, iD pf f- J24Ptne ', ZA,MF- �7t (Print name) (Address where you 91ve) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 166 S Ridge St, Port Chester, NY 10573 , Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (S(nature f Prupei _ 5)) (Print Name of Property(AwAaa40o,l) "�'� �L� �, � Sworn to before me this day of 20 22' (Notary P blie) 02!i uo"eW sl"dx3 uomstwutaD 1� U! PngiIt;ri(� (2) 'o AMON B�ICiivVS 4173N 8n2/2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owners) 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: CARLOS SOSA STRESER , 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 AGENT 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 Sworn to before me this day of .14t, yx 0 20_22 day of , 20� igoa re of Prope ty.d+wa.c Signa re f Applicant 1%6Qx:r Do, (o L.7sii-- mar-ad, r Print Name of Property O+MRcr _ Print Name of Applicant Notary Public Notary fublic KPLLY SAio KFI_LY 9 a�")I ER XER i`lr, an,, Publ:c. of Nlew York N'rtary P0hI;C, Sl; to of New York NC. 04�, C�.'i£d82 C, =„_r; Ir V._, I h�StEr Court, CualifiF-'d in Wf-s1 hestt=r Count COmMissior Expires March 9, 2i)_:� Commission Expires March 9, 20 U (4) 8/12/2021 O cxn w o o � CA � zo ■ W PLO OLn W N 1 O 14 W 7+ � W & -, W lF" O � '" o z co, 0 o o I � � a Z Z a z � ~ N aw � a Z W � c f z W ■ 00 0-4 O � W � W W W ~ � V ] W � a ; o a Q o a F a O M j...� �D A c7 A y `so a w BUIL© NC, I MENT FEB - 1 2023 VILILMA E OF'R.YE OK 938 KINci1ikmr T RYE B NY 10573 VILLAGE OF RYE BROOK �`�' BUILDING DEPARTMEPaT ELECTRICAL. PERMIT APPLICATION Westchester County Master Electricians License Required �1 FOR OFFICE USE ONLY BP#:�Q `c� ` EP#: Approval Date: n _ Permit Fee: $ Approval Signature: _ Other: Application dated, 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. fix!ures,oz 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: 166 South Ridge Street — __ _ SBL: 141.35-2-36 Zone:( /—/ 2.Property Owner: Win Ridge Realty LLC Address: 142 South Ridge Street Phone#: 914-701-4005 Cell#:_ ___ ___email: 3.Master Electrician: Steven Weinstein Address: Lie.#: E600 Phone#� 800-347-0909 Cell# _email: jwccp3@aol.com Company Name: Aardvark Electric Corp _Address: 94-24 88 Street, Ozone Park, NY 11416 4.Proposed Electrical Work/Fixture Count: Install lights.switches• outlets. telephune lines emergency lights &exit lights 5.3"'Party Electrical Inspection Agency: SWiS **r.****************************************ii*•t*x*14•***********c::P:e**1;':is:*�******t*********r•*A'*********ki:A STATE OF NEW PORK,COUNTY OF WEB.f'Ci'.ESTE R ) as: Steven Weinstein ,being duly sworn,dePoses ano states that he.,'she is the applicant above named,and does further (print name of indi�idual signing.,s the applicant) state that(s)he is the legal owner of the property to which lhi;a ililicatton pertains,or that(s)he is the Electrical Contractor for the legal owner and is duly authorized to make and file this applieatioi;. ('indicate architect,contractor,agent,attorney,elc.) The undersigned further state,that all statements contained h.-rt;a are true to the test of hia1her knowledge and belief,and that any work performed,or use conducted at the above captioned property•A ill be fn confc:mancc with the details as set forth and contained in this application and in any accompanying approved plat,and spec iGcations,a;well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Ry( 13r)ok and all other,,pplicable laws,ordinances,and regulations. Sworn to before me this Sworn to before me this 24 day of ,20 day of ,20 3 Signature of Property Owner Signature of Applicant _ Steven Weinstein Print Name of Property Owner Print Varue of AR L Gq O�.,�� Notary Public — - b E6145r� fi �►�'p1�1FtE�'.�y> �. Cl EENS Co,,,p k 2022 '�++111111���, STATE WIDE INSPECTION SERVICES, INC.; Service lVith Integrity CAO 0•• • • SWIS JOB APPLICATION • 0. • Office Use Elect. Permit# Date } > f Bldg Permit# Scl Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot 3 i4 Owner Name/Address(If different than 'above)',ltliv n ,, ,r, -i Contact Number — ,1 ,C �'F�t-ram; ,, .. t - , _ ... ❑Basement ❑ 1st FI. ❑2nd FI. 3rd A. ❑More Than 3 Fl. ❑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 ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation ��t51a�1 :X0 �IUAS , �Willt'rgfhcv 1i����� , —Vhont lii , D IEC CIE F� FEB 2a23 VILLAGE YE 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 ` ll{;! U. 1 Name License# Date Signature Address ;f:, City/State Zip Code Company Phone# ' D [EC (� �/7 State Wide Inspection Services `v' L� v � 1080 Main Street Fishkill, NY 12524 APR 19 2023 3D845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com BUILDING DEPARTMENT 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: Aardvark Electric Corp. Win Ridge Realty LLC 94-24 88th Street 166 South Ridge Street Ozone Park, NY 11416 Rye Brook, NY 10573 Located at: 166 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-029 141.35 � 36 Certificate Number: 2023-2763 Building Permit Number: BP 22-219 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: 166 South Ridge Street, Rye Brook, NY 10573 The First Floor Retail Space 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 19th day of April 2023. Name Quantity Rating Circuit Type Exit Lights 04 Emergency Light 01 Telephone Lines 04 Receptacles 36 Switches 16 Luminaires 40 Tat. +-_ Officer: Frank 1. 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. i' f 00 a, H w Q 0Ln en`-� �j z N N � - w -' 7 11 Z tiC Q r.. N O 00 O O r 00 C � A o g u z w L x ALn z uz PLO i F ,rn 00 � ►—� O W A F � z � � � � FBI •• �-1 w a A zZ N � 0 - � F E F rr � H z % O z r d 0-4 o a u W a � Q 3 z d N U og L^x y I l z w z A o � 0 C V � �I a w z z � BUILDING DEPARTMENT MAR 2 7 2023 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (9J4)939-0668 L BUILDING DEPARTMENT www.ryebrouk.urg ELECTRICAL PERMIT APPLICATION Westchester County Master lElectricians License Required FOR OFFICE USE ONLY BP#: �� / EP#: '—W APR 0 4 Approval Date:_ Permit Fee: Approval Signature: Other: ******************* ******** **** *************************************************************** Application dated, Z7 23 t. eby 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: J(o(o S. (Zwo6G-- ST 2yb'(ant ocK >.( i )S-)3 SBL:f y/,,3e—Q—_36 Zonc:k� 2.Property Owner: U%tv (LiNt,ts �A.t,-C-i Address: tt{'L Cs'. 4.0('14 S'r �/f ��( C44tis+-g- (00. Phone#: Ccu#: email: 3.Master Electrician/Licensed Installer: -= IF ;7 Address: Lic.#: Phone#: ZZ f Z.06 Cell#: email: NCA�uAk+I e S tAifU*gt" SN0-IMtZ7.c— Company Name: S(,,ty(LSflA�,te �tSt,uZc�t-t Address: ax (QC$3 4.Proposed Electrical Work/Fixture Count: 5.31 Party Electrical Inspection Agency: ***t*,t,r**+**,r*****t,e,r*t**,t**,t*,t***air*:rr*****t**t*,t******#*,t,►,et**,r*t,r:*:t,r<,t#****,r***,t*,t:***,tt�e*wt**,r*****,t STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named,and does further Apin, as the applicant) state that(s)he is the �iA��l� � for the legal owner and is duly authorized to make and file this application. (Master lilectrician 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 of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to before me this 4 1 day of 120 day A 20 'A,-Z- Signature of Property Owner Signature pl' Print Name of Property Owner P in ame of App tcanP t U__ Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County 3/3.!2023 Commission Expires January 29,20`;L� STATEWIDE • 1:1 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOB APPLICATION845.202.7224 fax 914.219.1062 • • • Office Use Elect.Permit# - Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Addr ss Cross Street Section Block Lot 1 Owner Name/Address(if different than above) Contact Number ❑Basement �1 st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑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 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information CEC EME ]D MAR 2 7 M3 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by AMS.This application is Intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name �_ Date - W `S Signature Address City/S14* IT zip CV5 License# 'Z Phone# i ; Arcuri Alarm Systems, Inc. PROPOSAL 81 Sterling Ave PROPOSAL No. 4854 Harrison, NY 10528 Proposal Date 10/04/22 914-906-9178 Fax Salesperson GUY License# 12000042641 Site Contact SHAWN FFRENCH Telephone Fax Number Prepared For Job Site AMAZING LASH AMAZING LASH 166 S. RODGE STREET 166 S. RODGE STREET RYE BROOK, NY 10573 RYE BROOK, NY 10573 Page 1 Overview FIRE ALARM PROPOSAL 4-PHOTOELECTRIC SMOKE DETECTORS. MAR 2 7 2023 2-PULL STATIONS. VILLAGE OF RYE BROOK 3-HORN STROBES.— 2� BUILD114G DEPARTMENT 10-STROBE LIGHTS, 1-NAC BOOSTER. FIRE ALARM PERMIT. TOTAL COST.....4500.00 ENGINEER PRINTS.....3000.00 TOTAL COST.....7500.00 ALL DEVICES WILL BE CONNECTED TO BUILDING FIRE CONTROL. IF EXPANDER MODULE IS NEEDED ADD 750.00 81 Sterling Ave Harrison NY 10528 Te1914-906-9178 Fax guya@arcurialarms.com www.arcurialarms.com Dj� �(a (� E State Wide Inspection Services l��J l� 1080 Main Street Fishkill, NY 12524 uts APR 2 7 2023 845 202-7224 Phone x0vK1 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com Service With Integrity BUILDING DEPARTMENT _ Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Scarsdale Security Systems Win Ridge Realty LLC Catrina Dimeglio 166 South Ridge Street 132 Montgomery Avenue Rye Brook, NY 10573 Scarsdale, NY 10583 Located at: 166 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-086 141.35 � 36 Certificate Number: 2023-2849 Building Permit Number: BP 22-219 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: 166 South Ridge Street, Rye Brook, NY 10573 The First Floor 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 25th day of April 2023. Name Quantity Rating Circuit Type Fire Alarm System Additions Smoke Detectors 04 Visual Inspection Only; Not Tested BY SWIS Pull Stations 02 Visual Inspection Only; Not Tested BY SWIS Horn Strobes 03 Visual Inspection Only; Not Tested BY SWIS Strobes 10 Visual Inspection Only; Not Tested BY SWIS Per the Building Inspector, Fire Alarm Systems NOT to be Tested by SWIS. L_ Jf- f Imo' 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. � Np � W .. wo " W � ON 2 Q � Z W z a o ? A " � cO A 1-1 1-11 7 1 M ~ � a w C4 ON of H W a v A N zz a c o w o z zz " a O .n o o cn cn `' V V $ a a z z o � .. �. a w p ECENE FAN 2 0 2023 BUILDING DEPARTMENT VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROQK,NY 10573 BUILDING DEPARTMENT (914)939-0669;, www.m oc i.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: 1 U Approval Date: F 1 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are son-refundable) ************************************************************************************************** Application dated, 5 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: SBL: � _�� 3(p Zone1U_� 2.Proposed Work: *-�I 1 '7eL,i oc —3 3.Property Owner: �q�� � r�rl�/) Address: r—ly t-q,h Phone#: Cell# emai 4.Master Plumber: la Address: ' Lic.#:%�7/ Phone#: S 13 do 2 well#: 9114 *5-13I&P 2- email: Ir 6 c v1vY►•� oL r Company Name:k0n r Address: I V � .� INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 1 2nd Floor 3'd Floor 4m Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: p4VI DNS USE-! _ ,being duly swom,deposes and states that hey"she is the applicant above named, (print name of individual sigtung 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 ,kyEN 7 I:b a 4WA/G'2 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor;agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations Sworn to before me this -C WK Sworn to before me this day of �i ' ,20 day of 20 �0 ure of Pro Arty Owee Signature of Applicant sa6w T PWiD &JArW tt" Print Name of Property 9wner Print Name of Applicant R Yew r kl�� NKGrkPublic KFLI Y SAMDL ER Notary York Notary Public Notary ! N . in County Cofnrnis.,ion Expires March 9, 20�2Lq 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 ofrecord in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and "ill be returned to the applicant. s>Er Leo iT �PcA77oti1 �,� /boo Srvr �D¢� sr,P£ -1 sn zrzo21 4 STAT Old NEW YO CO TY OF WESTCHESTER ) as: ✓ia I7 ,being duly swom,deposes and states that he/she is the applicant above named, (print name of individ signing as applicant) and states 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,con r,agent,attomey,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. Swom to before me this 2-10 Sworn to before me this ?,D day of 20 Ci 3 day of 202-3._ .4;�io,4vn �A� - Signature of Property Owner Siinature of Applicant �YO✓ Ot � Print Name of Propel+ end , ' cant � _ w 0"I _ ,a. Notary Publi = , d rn(V0 o c uN(10� 1S3HJ i �` a0 o31� N ; This application must completed in its entirety and must KJQd ® ed signature(s)of ��runnn the legal owner(s)of the subject property, and the applicant of record in the spaces provided.Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- gnv2021 p C C F� �W � BUI0_ 1�MENT FEB - 2 2023VILOOKVILLAGE OF RYE BROOK 938 KING ,NY 10573 BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE &216- STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZE❑ SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: ,'j, Z)#VID bw6u sH ,residing at, /o RYE W6,L% IU 240 RYE ,s32A0k-j A1Y _ t Print namt-) I-tddrrcS�Oww�ran I,,t,1 being duly sworn,deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 166 6607- I PUP61a 57��7 � ,2YE igluar', Aiy /OS73 ,Rye Brook, NY. Further that all statements contained herein are true,and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps,or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. D (ti final of ': ♦+r.w.« 1K�T 17D+Ktp. Et 6 L Qf— _ \attic of f'roperth i"'NOI Sworn to before me this day of GN ary l'uhfic) KFI IYSti'n' FR Notary I cw York t C"^14 : Count r� C ..omts.,tort Lxp res foaruh 9, 20 i r , i �+ ON Q w x �, v o tC 4 = Q 8 " L Q+ Ln en _ r., °° 00 4 00 V d 'o o a 2 7. � � � A � F 00 0 ,I iQ W V) ✓� o; W Q a. u e W W-1 U z < ° � O " U ' CN ►� aCY r FF+�II W a a N o �2 W w o 0 .°� � UU W U $ o ati u � a W oG o o r o Z o y Q W � V H � � '5 n U O U R. L � _ IND z W � r BUILD MENT L � �ff � { I VIL 1 E OF R OOK NOV - 3 2022 +� 938 KING ET WE BIt NY 10573 VILLAGE OF RYE BROOD BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION /FIRE SPRINKLER SYSTEM FOR OF IFICE USE ONLY: -'lppruva Date: NOV 9 P-: `l MP'U: C_-:�C)— Application Fee: S ZS 1 .lpprova Signature: Permit Fees: S 2'79- D > I hssppro[cd: Other: :*wwwwwww�:::;:w�:www:tt*wxww,.wwww�w:aww**w�:,�www*ww,t;r*wwww*,:+w*w:aww�:wwww**ww:�s;;w,rww*ww,:ww*wwxwww*w*x;::::rww,tww:�w�:i Applicatlion dated: It Ca is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to i stall or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: �' ' JCGe j1. e" /mac 2. Parcell.D.: Zone: G 3. Proposed Work(Describe system in detail including suppression agent): _ 7 /1 0 �t iu'->' ir' -1 c c. 7 (r n' 4. Number&Types of Fire Sprinkler Heads: 1 3 — K, : ; .14 f4o'4 t =i S. N.Y State Construction Classification: N.Y.State Use Classification: •F' 6. Estimated Value of Job:S 1 alue stall include all labtn-,materials.fired equipment,professional fees.and materials and labor which n►ar a deonated gratis.) 7. roperty Owner: ►� 6, St Address:_ 6 L \JU uA i ►U Q Phone# ql yW 7- 7-!3b Cell# email: Applicant: A tI iac K� sPt_. cL' .k,,�je. - I .vC Address:37S ,,..c Phone, �d 1 �3a S S� 1 3 Cell#ii y 4�S.3G-d email:) Qr.1 K�ti��aySd�l, .ri,cCDit/kC/r� c` Architect/Engineer: Address: Phone;r Cell# email: Sprinkler ContractonAtt tW,, �1LC .�')r��V ti-L _/,,C,Address:. S ►r,�— 14 Phone# Sd b Cell#9/y email:twoki, 1 8/12 2021 This a iication must be properly tar•,_ pia pope y completed In its entirety and must include the nat.dt l��fi 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. �I ki S- OF NEW; YORK �OUNTY OF WESTCHESTER ) as: k ,o rz- ,being duly sworn, deposes and states that heishe is the applicant above named, (print nami of indict/dual signing as the pplicaar) id further states than�(s)he is the legal owner of the property to which this application pertains, or that (s)be is the i r✓c for the legal owner and is duly authorized to make and file this application. (todtkere arcliitect,1Eon_ctor;agent,attoiney,etc.) That all statements contamed herein are true to the best of his/her knowledge and belief,and that any work performed,or use c onducted 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 Swom to before me this 03 day of 20 day of �Jo vernbi , 20 0,4- Signature of Property Owner Signature of Applicaa t _� C K, a Print flame f property Owner Print N f Applicant Notary Pub* Notary public SERANA f EDWARDS Notary Public-Stag of"'yob No,OIED6434559 Qualilled In W9stcho4wr county Ay Commission Expire Jun 6, 2026 i` t 2 t R/1�_'021 I of NEW , HYDRAULIC CALCULATIONS �P vJILLIgM � FOR r ALL SAFE FIRE SPRINKER n 0 _ � W 375 EXECUTIVE BLVD. ELMSFORD,NY 10523 059211 Rp , DATE: Oct. 20, 2022 JOB NAME: Amazing Lash 10 f� ! • w LOCATION: 1666 South Ridge Street (SPACE #7) - Rye Brook, NY 10573 JOB NUMBER: 2022-C-1245 DRAWING NUMBER: FP- 1 SYSTEM NUMBER: 1 OF 1 CALCULATED BY: Michael Koutsoftas CEILING HEIGHT: Varies -SYSTEM DESIGN DATA- CODE: N.F.P.A. #13 REVIEW AGENCY: Local Authority OCCUPANCY CLASSIFICATION: Light Hazard CONSTRUCTION TYPE: Non-Combustable - Steel & Concrete SYSTEM TYPE: Wet Tree DENSITY: .1 gpm/sq. ft. AREA OF APPLICATION: 950 sq. ft. COVERAGE PER SPRINKLER: 225 sq. ft. TYPE OF SPRINKLER CALCULATED: Make: Reliable Model: Pendent. K-FACTOR: 5.6 Size: 1/2" Thread Orifice: 1/2" NUMBER OF SPRINKLERS CALCULATED: 15 Temperture: 155 Degree -CALCULATION SUMMARY- INSIDE HOSE-STREAM DEMAND: N/A gpm OUTSIDE HOSE-STREAM DEAMAND: 100 gpm *IN-RACK SPRINKLER DEMAND: N/A gpm TOTAL WATER REQUIRED: 398.2 gpm FLOW and PRESSURE REQUIRED (CITY STREET MAIN) : 398.2 gpm @ 53.7 psi INTERIOR C-FACTOR: 120 UNDERGROUND C-FACTOR: 140 -WATER SUPPLY TEST INFORMATION- Source: City Supply Test Date: 9/15/16 Test Time: 1:15 PM Test By: Suez Location: South Ridge Street Static: 65 psi Residual: 50 psi Flow: 1126 gpm NOTES: Calculations preformed by: Fire Protection Design, Inc. _ LOCT 31 2022 VILLAGE OF RYE BROOK a BUILD N'G DLPARTM`:NT . 1 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 2 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH WATER SUPPLY ANALYSIS Static: 65.00 psi Resid: 50.00 psi Flow: 1126.0 gpm 80.0 70.0 LEGEND C 1 Available pressure 60.0 62.81 psi @ 398.2 gpm G A 2 Required pressure L 53.73 psi @ 398.2 gpm G 50. E •♦ •` Avail. OnSite Demand Press. •. 62.81 psi @ 298.2 gpm P 40.0 ♦ '. R ♦ �•� Req. OnSite Demand Press. E 53.73 psi @ 298.2 gpm S 30.0 � �• S A. Source Supply Curve U , B. System Demand Curve R 20.G C. Available at Source E � p 10.0 s i 0-0 „,,,,.,.,...,.,...,,,.,,,,,,,,,,,,,,,,,,.,,...,,.....,,..,,,,„,,,,,,,,,,,„,,,.. ......, .. ,,.., ,,,,,.,,,.,,,.. ,......,...,,.,. -14.7 400600 800 1000 1200 1400 1600 1800 2000 FLOW (GPM) Note: (1) Dashed Lines indicate extrapolated values from Test Results (2) On Site pressures are based on hose stream deduction at the source SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 3 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH NFPA WATER SUPPLY DATA SOURCE STATIC RESID. FLOW AVAIL. TOTAL REQ'D NODE PRESS. PRESS. @ PRESS. @ DEMAND PRESS. TAG (PSI) (PSI) (GPM) (PSI) (GPM) (PSI) SOURCE 65.0 50.0 1126.0 62.8 398.2 53.7 Available pressure is 9.1 psi (14%) greater than required pressure. AGGREGATE FLOW ANALYSIS: TOTAL FLOW AT SOURCE 398.2 GPM TOTAL HOSE STREAM ALLOWANCE AT SOURCE 100.0 GPM OTHER HOSE STREAM ALLOWANCES 0.0 GPM TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 298.2 GPM NODE ANALYSIS DATA DENSITY NODE TAG ELEVATION NODE TYPE PRESSURE DISCHARGE AREA REQ. ACT. NOTES (FT) (PSI) (GPM) (FT^2) (GPM/FT"2) Sl 24 .0 K= 5.60 10.7 18.3 130.0 0.100 0.141 S2 24 .0 K= 5.60 8.4 16.3 120.0 0.100 0.135 S3 24.0 K= 5.60 9.3 17.1 120.0 0.100 0.143 S4 24.0 K= 5.60 7.0 14.8 120.0 0.100 0.123 S5 24.0 K= 5.60 8.0 15.8 50.0 0.100 0.316 S6 24.0 K= 5.60 11.9 19.3 50.0 0.100 0.387 S8 24.0 K= 5.60 12.7 19.9 60.0 0.100 0.332 S9 24.0 K= 5.60 14.1 21.1 60.0 0.100 0.351 S10 24.0 K= 5.60 14.8 21.6 96.0 0.100 0.224 S11 24.0 K= 5.60 15.4 22.0 96.0 0.100 0.229 S12 24.0 K= 5.60 15.0 21.7 96.0 0.100 0.226 S13 24.0 K= 5.60 15.5 22.1 96.0 0.100 0.230 S14 24.0 K= 5.60 15.9 22.3 96.0 0.100 0.233 S15 24.0 K= 5.60 16.5 22.8 96.0 0.100 0.237 S16 24.0 K= 5.60 17.1 23.2 96.0 0.100 0.241 L1 24.0 - - - - 12.8 - - - - - - - - - - - - L2 24.0 - - - - 10.1 - - - - - - - - - - - - L3 24.0 - - - - 12.8 - - - - - - - - - - - - L4 24.0 - - - - 12.8 - - - - - - - - - - - - L5 24.0 - - - - 12.8 - - - - - - - - - - - - L6 24.0 - - - - 13.2 - - - - - - - - - - - - L8 24.0 - - - - 14.7 - - - - - - - - - - - - L9 24.0 - - - - 16.2 - - - - - - - - - - - - L10 24.0 - - - - 17.1 - - - - - - - - - - - - Lll 24.0 - - - - 17.1 - - - - - - - - - - - - L12 24.0 - - - - 17.3 - - - - - - - - - - - - L14 24.0 - - - - 18.0 - - - - - - - - - - - - L15 24.0 - - - - 18.3 - - - - - - - - - - - - L16 24 .0 - - - - 19.5 - - - - - - - - - - - - B1 24 .0 - - - - 26.9 - - - - - - - - - - - - B2 24 .0 - - - - 26.6 - - - - - - - - - - - - SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 4 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH NODE ANALYSIS DATA DENSITY NODE TAG ELEVATION NODE TYPE PRESSURE DISCHARGE AREA REQ. ACT. NOTES (FT) (PSI) (GPM) (FT^2) (GPM/FT^2) Al 22.0 - - - - 29.8 - - - - - - - - - - - - A2 22.0 - - - - 29.9 - - - - - - - - - - - - A3 22.0 - - - - 30.2 - - - - - - - - - - - - A4 22.0 - - - - 34.0 - - - - - - - - - - - - M1 5.0 - - - - 42.6 - - - - - - - - - - - - M2 5.0 - - - - 43.8 - - - - - - - - - - - - M3 3.0 - - - - 45.4 - - - - - - - - - - - - M4 3.0 - - - - 51.4 - - - - - - - - - - - - M5 3.0 - - - - 51.5 - - - - - - - - - - - - SOURCE 0.0 SOURCE 53.7 298.2 - - - - - - - - - SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 5 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH NFPA5 PIPE DATA Pipe Tag K-fac Add F1 Add Fl To Fit: L C (Pt) Frm Node El (ft) PT (q) Node/ Nom ID Eq.Ln. F (Pe) Notes To Node El (ft) PT Tot. (Q) Disch Act ID (ft. ) T Pf/ft. (Pf) Pipe: 1 5.60 18.3 Disch 8.00 120 2.1 L1 24.0 12.8 0.0 A1.000 3E: 6.0 11.00 -0.0 S1 24 .0 10.7 18.3 1.049 T: 5.0 19.00 0.110 2.1 Pipe: 2 0.0 0.0 1.00 120 0.0 L3 24.0 12.8 18.3 B2.000 ---- 0.00 -0.0 L1 24.0 12.8 18.3 2.157 1.00 0.003 0.0 Pipe: 4 0.0 33.4 L2 2.00 120 0.0 L5 24.0 12.8 18.3 L1 B2.000 ---- 0.00 -0.0 L3 24.0 12.8 51.7 2.157 2.00 0.022 0.0 Pipe: 6 0.0 51.7 L3 6.00 120 0.3 L6 24.0 13.2 30.6 B2.000 ---- 0.00 -0.0 L5 24.0 12.8 82.3 2.157 6.00 0.053 0.3 Pipe: 7 0.0 82.3 L5 20.00 120 1.6 L8 24.0 14.7 19.3 B2.000 ---- 0.00 -0.0 L6 24.0 13.2 101.6 2.157 20.00 0.079 1.6 Pipe: 8 0.0 101.6 L6 13.00 120 1.4 L9 24.0 16.2 19.9 B2.000 ---- 0.00 -0.0 L8 24 .0 14.7 121.6 2.157 13.00 0.110 1.4 Pipe: 9 0.0 121.6 L8 55.00 120 10.7 B1 24.0 26.9 21.1 B2.000 3E:18.0 18.00 -0.0 L9 24 .0 16.2 142.6 2.157 73.00 0.147 10.7 Pipe: 9A 0.0 0.0 2.00 120 2.9 Al 22.0 29.8 142.6 L9 B2.000 T:12.0 12.00 0.9 B1 24.0 26.9 142.6 2.157 14.00 0.147 2.1 Pipe: 10 0.0 0.0 6.00 120 0.0 A2 22.0 29.9 142.6 B1 B4 .000 ---- 0.00 -0.0 Al 22.0 29.8 142.6 4 .260 6.00 0.005 0.0 Pipe: 11 0.0 155.5 B2 15.00 120 0.3 A3 22.0 30.2 142.6 Al B4 .000 ---- 0.00 -0.0 A2 22.0 29.9 298.2 4 .260 15.00 0.021 0.3 Pipe: 12 0.0 0.0 168.00 120 3.8 A4 22.0 34.0 298.2 A2 B4 .000 E:13.0 13.00 -0.0 A3 22.0 30.2 298.2 4 .260 181.00 0.021 3.8 Pipe: 13 0.0 0.0 20.00 120 8.6 M1 5.0 42.6 298.2 A3 B4 .000 E:13.0 39.00 7.4 A4 22.0 34.0 298.2 4 .260 T:26.0 59.00 0.021 1.2 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 6 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH Pipe Tag K-fac Add F1 Add F1 To Fit: L C (Pt) Frm Node E1 (ft) PT (q) Node/ Nom ID Eq.Ln. F (Pe) Notes To Node El (ft) PT Tot. (Q) Disch Act ID (ft. ) T Pf/ft. (Pf) Pipe: 14 0.0 0.0 5.00 120 1.3 M2 5.0 43.8 298.2 A4 B4.000 T:26.0 55.00 -0.0 M1 5.0 42.6 298.2 4.260 C:29.0 60.00 0.021 1.3 Pipe: 15 0.0 0.0 2.00 120 1.5 M3 3.0 45.4 298.2 M1 A4 .000 T:20.0 22.00 0.9 M2 5.0 43.8 298.2 4 .026 G: 2.0 24.00 0.028 0.7 Pipe: 16 0.0 Fixed Pressure Loss Device M4 3.0 51.4 298.2 M2 6.0 psi, 298.2 gpm M3 3.0 45.4 298.2 Pipe: 17 0.0 0.0 6.00 120 0.1 M5 3.0 51.5 298.2 M3 A6.000 2E:28.0 31.00 -0.0 M4 3.0 51.4 298.2 6.065 G: 3.0 37.00 0.004 0.1 Pipe: 18 Source 0.0 2E:44 .0 300.00 140 2.2 SOURCE 0.0 53.7 298.2 M4 D6.000 T:47.0 96.00 1.3 M5 3.0 51.5 298.2 6.280 G: 5.0 396.00 0.002 0.9 Pipe: 19 5.60 16.3 Disch 12.00 120 1.7 L2 24.0 10.1 0.0 A1.000 E: 2.0 7.00 -0.0 S2 24.0 8.4 16.3 1.049 T: 5.0 19.00 0.089 1.7 Pipe: 20 5.60 17.1 Disch 1.00 120 0.8 L2 24.0 10.1 0.0 A1.000 E: 2.0 7.00 -0.0 S3 24.0 9.3 17.1 1.049 T: 5.0 8.00 0.097 0.8 Pipe: 20A 0.0 0.0 3.00 120 2.7 L3 24.0 12.8 33.4 A1.000 T: 5.0 5.00 -0.0 L2 24.0 10.1 33.4 1.049 8.00 0.335 2.7 Pipe: 21 5.60 14.8 Disch 11.00 120 1.0 S5 24.0 8.0 0.0 A1.000 E: 2.0 2.00 -0.0 S4 24 .0 7.0 14.8 1.049 13.00 0.075 1.0 Pipe: 22 5.60 15.8 Disch 8.00 120 4 .9 L5 24.0 12.8 14.8 A1.000 2E: 4.0 9.00 -0.0 S5 24.0 8.0 30.6 1.049 T: 5.0 17.00 0.286 4 .9 Pipe: 23 0.0 0.0 9.00 120 0.0 L5 24.0 12.8 0.0 A1.000 E: 2.0 7.00 -0.0 L4 24 .0 12.8 0.0 1.049 T: 5.0 16.00 0.000 0.0 Pipe: 24 5.60 19.3 Disch 1.00 120 1.2 L6 24.0 13.2 0.0 A1.000 2E: 4.0 9.00 -0.0 S6 24.0 11.9 19.3 1.049 T: 5.0 10.00 0.122 1.2 Pipe: 27 5.60 19.9 Disch 7.00 120 2.1 L8 24.0 14.7 0.0 A1.000 2E: 4 .0 9.00 -0.0 S8 24 .0 12.7 19.9 1 .049 T: 5.0 16.00 0.129 2.1 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 7 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH Pipe Tag K-fac Add Fl Add Fl To Fit: L C (Pt) Frm Node E1 (ft) PT (q) Node/ Nom ID Eq.Ln. F (Pe) Notes To Node El (ft) PT Tot. (Q) Disch Act ID (ft. ) T Pf/ft. (Pf) Pipe: 28 5.60 21.1 Disch 5.00 120 2.0 L9 24.0 16.2 0.0 A1.000 2E: 4.0 9.00 -0.0 S9 24.0 14.1 21.1 1.049 T: 5.0 14.00 0.143 2.0 Pipe: 29 5.60 21.6 Disch 6.00 120 2.2 L10 24 .0 17.1 0.0 A1.000 2E: 4.0 9.00 -0.0 S10 24 .0 14.8 21.6 1.049 T: 5.0 15.00 0.149 2.2 Pipe: 30 0.0 0.0 7.00 120 0.0 Lll 24.0 17.1 21.6 B2.000 ---- 0.00 -0.0 L10 24.0 17.1 21.6 2.157 7.00 0.004 0.0 Pipe: 31 0.0 21.6 L10 11.00 120 0.2 L12 24.0 17.3 22.0 B2.000 ---- 0.00 -0.0 Lll 24.0 17.1 43.5 2.157 11.00 0.016 0.2 Pipe: 32 0.0 43.5 Lll 12.00 120 0.7 L14 24.0 18.0 43.8 B2.000 ---- 0.00 -0.0 L12 24.0 17.3 87.3 2.157 12.00 0.059 0.7 Pipe: 33 0.0 87.3 L12 4.00 120 0.4 L15 24 .0 18.3 22.3 B2.000 ---- 0.00 -0.0 L14 24.0 18.0 109.6 2.157 4 .00 0.090 0.4 Pipe: 34 0.0 109.6 L14 9.00 120 1.2 L16 24.0 19.5 22.8 B2.000 ---- 0.00 -0.0 L15 24 .0 18.3 132.4 2.157 9.00 0.128 1.2 Pipe: 35 0.0 132.4 L15 35.00 120 7.1 B2 24 .0 26.6 23.2 B2.000 E: 6.0 6.00 -0.0 L16 24.0 19.5 155.5 2.157 41.00 0.173 7.1 Pipe: 37 0.0 0.0 2.00 120 3.3 A2 22.0 29.9 155.5 L16 B2.000 T:12.0 12.00 0.9 B2 24.0 26.6 155.5 2.157 14.00 0.173 2.4 Pipe: 38 5.60 22.0 Disch 2.00 120 1.7 Lll 24.0 17.1 0.0 A1.000 2E: 4.0 9.00 -0.0 Sll 24.0 15.4 22.0 1.049 T: 5.0 11.00 0.155 1.7 Pipe: 39 5.60 21.7 Disch 6.00 120 2.3 L12 24.0 17.3 0.0 A1.000 2E: 4.0 9.00 -0.0 S12 24.0 15.0 21.7 1.049 T: 5.0 15.00 0.151 2.3 Pipe: 40 5.60 22.1 Disch 2.00 120 1.7 L12 24.0 17.3 0.0 A1.000 2E: 4.0 9.00 -0.0 S13 24.0 15.5 22.1 1.049 T: 5.0 11.00 0.156 1.7 Pipe: 41 5.60 22.3 Disch 4.00 120 2.1 L14 24.0 18.0 0.0 A1.000 2E: 4.0 9.00 -0.0 S14 24.0 15.9 22.3 1.049 T: 5.0 13.00 0.160 2.1 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 8 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH Pipe Tag K-fac Add Fl Add F1 To Fit: L C (Pt) Frm Node E1 (ft) PT (q) Node/ Nom ID Eq.Ln. F (Pe) Notes To Node E1 (ft) PT Tot. (Q) Disch Act ID (ft. ) T Pf/ft. (Pf) Pipe: 42 5.60 22.8 Disch 2.00 120 1.8 L15 24.0 18.3 0.0 A1.000 2E: 4.0 9.00 -0.0 S15 24.0 16.5 22.8 1.049 T: 5.0 11.00 0.165 1.8 Pipe: 43 5.60 23.2 Disch 5.00 120 2.4 L16 24.0 19.5 0.0 A1.000 2E: 4.0 9.00 -0.0 S16 24.0 17.1 23.2 1.049 T: 5.0 14.00 0.171 2.4 NOTES (HASS) : (1) Calculations were performed by the HASS 2021 D computer program in accordance with NFPA13 (2022) under license no. 64621632 granted by HRS Systems, Inc. 208 Southside Square Petersburg, TN 37144 (931) 659-9760 (2) The system has been calculated to provide an average imbalance at each node of 0.003 gpm and a maximum imbalance at any node of 0.103 gpm. (3) Total pressure at each node is used in balancing the system. Maximum water velocity is 13.7 ft/sec at pipe 35. (4) Items listed in bold print on the cover sheet are automatically transferred from the calculation report. (5) Available pressure at source node SOURCE under full flow conditions is 62.44 psi with a flow of 432.88 gpm. (6) PIPE FITTINGS TABLE HASS Pipe Table Name: standard PAGE: A MATERIAL: S40 HWC: 120 Diameter Equivalent Fitting Lengths in Feet (in) E T L C B G A D N Ell Tee LngEll ChkVly BfyVly GatVly AlmChk DPVly NTee -------------------------------------------------------- F F45Ell 1.049 2.00 5.00 2.00 5.00 6.00 1.00 10.00 2.00 5.00 1.00 4.026 10.00 20.00 6.00 22.00 12.00 2.00 20.00 20.00 20.00 5.00 6.065 14.00 30.00 9.00 32.00 10.00 3.00 28.00 28.00 30.00 7.00 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 9 DATE: 10/20/2022 C:\HASS CALC\AMAZING LASH.SDF JOB TITLE: AMAZING LASH PAGE: B MATERIAL: THNWL HWC: 120 Diameter Equivalent Fitting Lengths in Feet (in) E T L C B G A D N Ell Tee LngEll ChkVly BfyVly GatVly A1mChk DPVly NPTee -------------------------------------------------------- F F45Ell 2.157 6.00 12.00 3.00 14.00 8.00 1.00 12.00 12.00 12.00 3.00 4.260 13.00 26.00 8.00 29.00 16.00 3.00 26.00 26.00 26.00 6.50 PAGE: D MATERIAL: DIRON HWC: 140 Diameter Equivalent Fitting Lengths in Feet (in) E T L C B G N F Ell Tee LngEll ChkVly BfyVly GatVly NPTee F45Ell 6.280 22.00 47.00 14.00 51.00 16.00 5.00 47.00 11.00 Wo G Za y a r•r PT a s y o s u b W E~ � z a > � oa .. w ,� L pal Q - ,� v O - w C'^ v9 � C z " O z M 04 0 h 6 3 u v w z 0-4 W a Mi1.4 P4 Z o H OCO O A V ,� � w � W w A a c c H � � 1 o O x1 .1 w A w A z 4 "0 ' o ^ W Q O W � W Q O A V 4 t � � V V ; • z z -1 z F u v m W a 0-4o a z HER A § A � U �t �3 G as zb- cnI"y u U w rA V A z U o [� p M 7 ' C Ca 6r 1�1 ° O c W .. f z w o z UCIO . so 3 s BUILDING: EPARTMENT D VILLAGE OF RYk':BROOK 938 KING TREET RYE BR©QK,NY 10573 APR 18 2023 4 -00$-, , rook,.6rg VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: J Approval Date: Permit Fee: $ Approval Signature: �T—�6 1UL3 Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. Site/Staging Plan if Required by the Building Inspector. 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/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, `� Zoe 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.r : // i 3 ,p 1. Address: R k Y, t('� FJ� FM , ��� '�p �SBL: /7/ ,S��-3/o Zone: 2. Property Owner: D."oLd �nG l`S In �,Ll;. �idfC�-c�a/ ddress: 10 Q-�Ae e16Lj�L Q NY ( � Phone#: Cell#: `i'f -70( o(OU5 email: C�k a%IL.r ty"r n,G J 3. Contractor: 10 end Address: I`'1 Lys 9Icue ;tit, 1Jet.1� NY SUSS? Phone#: ly G 1a1 I U`1 Cell#: IN y 9C(o -7`l 70 email: Yo(and Q yC,wI F l ,tom 4. Scope of Work:New Installation Replacement( )•Removal( )•Other( ): 5. List Equipment: M,�G ybt s h �J rt,�4,t- ftlQ - -� 1ZNtlt Z lvi -r un4 : 5UZ 'k1-P i'LlUA2 c,V&x ynk� 6. Location of Equipment: l,Kdc,�r jni� ��� �F Rr:..' .,� S�t�f"�,f Cv�t��( ant :s IodgFrd An rw4 Q. 7. Method of Installation/Removal(list all equipment needed to perform job): I`-'t hJ: , d tnrerJe� ``)- , 605 , �)ear✓l C l QS t 3/3/2023 SATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I e, r 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 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 k day of ,20 _ day of �;.� ,20:Z3 k*MtKke of Pro erty ignature of Applicant A61531i—I DPC60 F406uok q4ff h Print Name of Property w r Print Name of Applicant NIt4 Public otary Public KFLLY SA?I!pi_ER ALLEN F. CRIVELLO Notary Public, F�:,te o!' New York Notary Public,State of New York No. 01 SA-':-o:'.I 2 No. 01CR6099383 Ci eliflod in `1`!c hestor County Qualified in Nassau Co Commission Commission Expires March 9, 20' Commission Expires September 29,20— This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 3/3/2023 MLZ-KP12NA2 ; 000 OUTDOOR UNIT Job Name: System Reference: Date: Indoor Unit................................................................ MLZ-KP12NA2 Outdoor Unit..................................................................SUZ-KAl2NA2 I �`I�iIIIliHllllllllllllllll�Il��,��'E . �. IUIIII Jim 11IIIIlluIIIIII Ilrll. I�t'I�Illlllililllllllllllll����t►!fit! INDOOR UNIT FEATURES • Fits between 16"joists spacing • Stylish,square design panel • Built-in condensate lift mechanism(19.6") • Serviceable from the bottom(electrical and flare connections) • Adjustable fan speeds and vane directions • Washable antibacterial and deodorizing filter • Multiple control options available: Hand-held Remote Controller(provided with unit) kumo cloud"'smart device app for remote access Third-party interface options Wired or wireless controllers • Pocket inside the access panel for kumo cloud'Wireless Interface OUTDOOR UNIT FEATURES • Variable speed INVERTER-driven compressor • Innovative Joint Lap DC Motor leads to high efficiency and reliability • Pulse Amplitude Modulation technology • High-performance grooved piping for increased heat exchange efficiency Specifications are subject to change without notice. 0 2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. SPECIFICATIONS: MLZ-KP12NA2 & SUZ-KAl2NA2 Maximum Capacity BTU/H 12,000 Rated Capacity BTUfH 12,000 Minimum Capacity BTU1H 3,900 Cooling at 95'F' Maximum Power-input W 960 Rated Power Input W 960 Moisture Removal Pintath 2.8 Sensible_Heat Factor 0.74 Power Factor[208V 123OV) X 96.0/96.0 Maximum nCapacity BTLNH 17,000 Rated Capacity sfo_M 15,400 Heating at 47T, Minimum Capacity _BTUM 4,600 ............ Maximum Power Input W 1,700 Rated Power Input W 1,300 Power Factor[201) % 98.0/98.0 ................... Maximum Capacity BTUAI 10,900 Heating at 17'F' Rated Capacity BTLYH 9,900 Maximum Power I-nput 1,320 Rated Power Input. 1,020 Heating at 5*174 Maximum Capacity BTU/H 7.900 Maximum Power Input W 980 Heating,at-4*Fs Maximum Capacity BTUIH 5,900 SEER 19.8 EERI 12.5 HSPF[IV] 12.1 Efficisincy COP at 47*F2 3.4 COP at 17'F at Maximum Capacityll, 2.4 COP at 5T at Maximum Capacity' 2.3 ........--------- ......................... .................. ...... I ENERGY STAR*Certified yes Voltage,Phase,Frequency 208/230,1.60 Guaranteed-Voltage go Range VAC _187-253 Voltage:Indoor-Outdool S1-S2 VAC 2081230 Voltage:Indoor-Outdoor,S2-S3 VIDC Electrical 24 Short-circuit Current Rating[SCCR) ILA 5 Recommended FusetBreaker Size(Oudoor) A 15 Recommended Wine Size[indoor-Outdoor] AWG 14 ................ Power Supply Indoor unit Is powered by the Outdoor unit MCA A 1.0 Fan Motor Full Load Amperage A 0.68 Fan Motor Type DC Motor Airflow Rate at Cooling,Dry CFM 21-2-258-297-332 ----------------- Airflow Rate at Cooling,Wet CFM 180-219-252-282 Airflow Rate at Heating,Dry CIFM 212-272-311-350 Sound pressure Level[Cooling] dB[A] ................ 27�2-3&40 Sound Pressure Level[Heating] dB 26-32-36-40 Indoor Unit Drain Pipe Size j In.[T`i__ 1-1/4[32] Condensate Lift Mechanism,Maximum Distilince. In.[rnm] 19-11/16[5001 Coating on Heat Exchanger — External Finish Color Munsell 4.0GY 9.1t0.2 ............ Unit Dimensions W x ID x H:In.[mi 431,21118 x 14-3116 x 7-5116[1,102 x 360 x 185] Package Dimensions W x D x H:In.[MM] 4"116 x 15-3/4 x 11-1/8[1.177 X 400 x 284] Unit Weight Lbs.i[kg] 34[15.5] Package Weight 41[19.0] Indoor Until Operating Temperature Cooling Intake Air Temp[Maximum Miniffitin]• 90 DE,73 WB 67 DB,57 WB Range Heating Intake Air Temp[Maximumt Minimum] 'F 80 DB 70 DB NOTES: AHRI Rated Conditions 'Cooling(Indoor//Outdoor) 'F 80 DB,67 WB 95 DB,75 WB (Rated data Is determined at a fixed compressor speed) 'Heating at 47'F(indoor Outdoor) *F 70 DB,60 WB 47 D%43 WB 'Heating at 170F(Indoor Outdoor) -F 70 Di 60 WB 17 DB,15 WB Conditions 41-leating at 59F(Indoor//Outdoor) 'IF 70 DB,60 WB 5 DB,4 WB 'Heating at-4*F(Indoor//Outdoor) -F 70 DB,60 WB -4 DB,-5 WB 'Indoor/Outdoor Unit Operating Temperature Range(Cooling Air Temp[Maximum/Minimum]): Applications should be restricted to comfort cooling only;equipment cooling applications are not recommended for low ambient temperature conditions, **Outdoor Unit Operating Temperature Range(Cooling Thermal Lockout/Re-start Temperatures;Heating Thermal Lock-out/Re-start Temperatures): •System cuts out in heating mode to avoid thermistor error and automatically restarts at these temperatures. Specifications are subject to change without notice. 2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved MCA - - - - MOCIP A 18 .- Fan Motor Full Load Amperage A 0.5 -- — --- - ......VII ---- Fan Motor O ! 55 Airflow Rate[Cooling/Heating]- CFM 1229/1172 Refrigerant Control _ LE Defrost Method Reverse Cycle Coating on Heat Exchanger Blue Fin Coating Sound Pressure Level,Cooling' dB 54 Sound Pressure Level,Heating' dli(ij 55 Outdoor Unit Compressor Type - DC INVERTER-driven Twin Rotary Compressor Model SNB092FQAMT Compressor Rated Load Amps A Compressor Locked Rotor Amps A 8.2 Compressor Oil[Type//Charge]----_ r9e]_--_ a¢. FV50S//11.8 External Finish Color vary_Muneell 3Y 7.8/1.1 Base Pan Healer -- _-- -- ------ _Optional W Unit Dimensions --_- -— — x D x H_In.[mm] . 31-1/2 x 11-V4 x 21-5/8[800 x 285 x 5501 Package Dimensions W x D x H:In.[mm) 37 x 14-15/16 x 24-13/16[940 x 380 x 630) Unit Weight Lba.[kg] 81[37] Package Weight _ Lbs.[kgJ - 88[401 Cooling Air Temp[Maximum/Minimum]' °F 115 DB/14 DB Outdoor Unit Operating Temperature Cooling Thermal Lock-out/Re-start Temperatures" °F -1/3 _ _..._-........-'-------..__. Range Heating Air Temp[Maximum/Minimum) °F 75 OB,65 WB/-4 DB,-5 WB Healing Thermal Lock-out/Re-start Temperatures- 'F -14/-4 Type _ _ _ R410A Maximum Charge Quantity Lbs,oz 2.0,9 0 Refrigerant .__.__.------------ _._.... ..___._. Initial Charge Quantity Ft.[m] 25.0[7.5] Additional Refrigerant Charge PerAdditional Pipklg Length oz./Ft.[g/m] 0.216[20] Gas Pipe Size O.D.[Flared] In.[mm] 3/8[9.52] Liquid Pipe Size O.D.[Flared]- — — ---- In.[mm] 1/4[6.35] Piping Maximum Piping Length _ I Ft.[mJ 65[20] Maximum Height Difference ---.___..1_.._-_....Ft.[m] _...- _ ......_.__ -.._ -_ 40[12] - _ Maximum Number of Bends 10 NOTES: AHRI Rated Conditions 'Cooling(Indoor//Outdoor) 'F 80 DB,67 WB//95 DB,75 WB (Rated data is determined at a fixed compressor speed) 'Heating at 47'F(Indoor//Outdoor) 'F 70 DB,60 WB//47 DS,43 WB 'Heating at 170F(Indoor//Outdoor) 'F 70 DB,60 WB//17 DB,15 WB Conditions 4Heabng at 5'F(Indoor//Outdoor) -F 70 DB,60 WB//5 DB,4 WB 'Heating at-4°F(Indoor//Outdoor) 'F 70 DB,60 WB//r1 DB,-5 WB 'Indoor/Outdoor Unit Operating Temperature Range(Cooling Air Tamp[Maximum/Minimum]): •Applications should be restricted to comfort cooling only;equipment cooling applications are not recommended for low ambient temperature conditions. "Outdoor Unit Operating Temperature Range(Cooling Thermal Lock-out/Re-start Temperatures,Healing Thermal Lock-out/Re-start Temperatures): °System cuts out in heating mode to avoid thermistor error and automatically restarts at these temperatures. Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. INDOOR UNIT ACCESSORIES: MLZ-KP12NA2 -------------------- - ---------- ......--------- ------.......... BACr%W and Modbuse Interface ----------- 0 PAC-UKPRC001-CN-1 CN24 Relay Kit 0 CN24RELAY-KIT-CM3 IT Extender Ei PAC-WHSOIIE-E kumo stabon"'for kumo cloud' o PAG-WHS01HC-E Locicdown bracket for remote controller Control Interface C3 RCMKPICB System Control Interface ...... ............. . n MAC-334IF-E . Thermostat Interface 11 PAC-US444CN-1 Thermostat Interface 113 PAC-US445CN-1 USNAPAdapter 171 PAC-WHS01UP-E Wireless Interface for Iturno cloud* ........................................._................ Ei PAC-USWHS002-WF-2 Wired Remote Sensor Remote Sensor .......... ............................... 0 M21EAA307 Wireless temperature and humility sensor for kumo cloud* -0 PAC-,USWHS003-TH-1 Deluxe Wired MA Remote Controll n PAR-40MAAU Wired Remote Controller Simple MA Remote Controller' ci PAC-YT53CRAU-J Touch MA Controller' Li PAR-CT01MAU-SB Wireless Remote Controller kumo touch'RedLINK'Wireless Controller - - - - _ o MHK2 Blue Diamond(Advanced)Mini Condensate Pump md Reservoir&Sensor(208/23OV)[recommended] 11 X87-721 ............................ .................... Condensate Blue Diamond(MicroBlue)Mini Condensate Pump(110r2=30V)up to 18,000 BTLI/H Ei X86-003 Refoo Condensate Pump(100-240 VAC)up to 120,000 BTUIH 0 COMBI (30A/60OVIUL)[flts 2-X 4-utility box)-Black Disconnect Switch ...................... ......... .0 TAZ-MS303 (30A/60OV/UL)[fits 2-X 4-utility box)-White Ei TAZ-MS303W ...........................---------- Filter Anti-allergy Enzyme Fitter Li MAC-408FT-E --------------- Grille Grille(required) Ff MLP-444WU 15'x 1/4'x 15'/3118*Unesel(Twin-Tube Insulation) Ei MLS143812T-15 Lineset JXY x 1/4*x 30'1 31W Unseat(Tivin-Tube Insulation) Ei MILS143812T30 ineset(Twin-Tube Insulation) Li MLS143812T-50 [W x 1/4-x 65'/3111'Uneset(Twin-Tube Insulation) ii MLS1438M-65 ............... ......_._........... ............... NOTES, 'Requires MAC-334IF-E -M-Series EZ FIT*Recessed Ceiling Cassette,Floor-mount and Wall-mount Allows indoor units to connect to an MA Controller: Deluxe MA Remote Controller Simple MA Controller Touch MA Controller Specifications are subject to change without notice. C 2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. OUTDOOR UNIT ACCESSORIES: -�Control/Service &P-Series Maintenance Tool Cable Set a M21 EC0397 Control/Sece Tool —�.__._ ._.-- ---- --- -- USBNART Conversion Cabo(Required for all laptop connection) ❑ M21 EC1397 Hail Guards Hail GueM - ❑ HG-B4 -- 14 Gauge,4 wire MInISplit Cable-250 R roll ❑ S 144-250 14 Gauge,4 Wre MlniSplit Cable-250 fL roll - -_i ❑ S W 144-250 14 Gauge,4 wire MlniSplit Cable-50 ft.roll ❑ 5144-50 -- ! 14 Gauge,4 wire MiniSplit Cabo-50 ft roll i Mini-SpIR Wire ❑ SW144-W ff16G.uge,, ge,4 wire MiniSplR Cable-250 ft.roll - ❑ 5164-250 -- 4 wire MI Cable-250 ft roll - --—--- ---. ---.- --i ❑ SW164-250 16 Gauge 4 wire MlniSplit Cable-50 ft.roll ❑ S 164-50 16 Gauge 4 wire MInlSplit Cable-50 ft.roll ❑ S W I64-50 Mounting Pad Condensing- -Unit- - . Mounting. Pad.16° . _ ❑ ULTRILITEI_ x 36 x 3'- _.._. ... _ Outdoor Unit 3-1/4 Inch Mounting Base(Pair)--Plastic ❑ DSD-400P Port Adapter Adaptor.12'x 3/8'(required) MAC A455JP E 16"Single Fan Stand 111 QSMS1801M Stand 24°Single Fan Stand - -- ----- - --_-- -__�O QSMS2401M— y Condenser Wall Bracket Cl QSWB2000M-1 Outdoor Unit Stand-1 Y High ❑ QSMS1201 M Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. INDOOR UNIT DIMENSIONS: MLZ-KP12NA2 INDOOR UNIT OUTLINE DRAWING Unit: inch CENTER OF GELLING OPENING HXEISUSPENSUN REMOTE CONTROLLER (TOP VIEW) Bar PITCK'GRILLE IS THE SAW v, OUTLINE DRAWING FE N 2-3/8 3/4 1/16 — ------L --. 1/1 ®r o' m r; , � ---------- - I_ _____ J AN OUTLET ILHERSOE) CONNECTION PART OF (RIGHT SIDE VIEW) ELECTRIC BOX ATTACHING(:PAN HOSE 9/16 5/8 41-3/8 SLISPENSON BOLT RTCH 5/8 14-3/16 PPE CONNECTION Iws PPEI CONNECTION PART 09,12:0 3/8 (FRONT VIEW) DR�HOE cc) °° 18:01/2 43-3/8 ATTACHING CRAM HOSE DRAIN PIPE Lit U7 PPE CONNECTION CONNECTION Q.UOUD PPE) 37-13/16 3-1/16 (KID'V(PIPE) 71 10 v o 01/4 OD.01 Q6W 4-7/8 7-5/16 L 4-3/4 4-13/16 2-3/8 0 0 ELECTRIC BOX AN OUTLET AREA 1-7/8 Q� OAR (15/16) 57.3 S In OUTLET INLET 0 2-5/16 GRAN PAN THE BOTTOM OF CEUI AND CEILING SURFACE FIXING SECTION OF GRILLE MAY AND PPE COVER IS N THE SAW SURFACE RECEK%PART GRILLE OUTLINE DRAWING (MLP-444W) 38-1/16 MAX PROTRUSION 01MENSON OF FLAP KP09/12NA KP18NA 1-5/16 RECEPTIONa 47-1/4 15/16 1/2 LIOUID PIPE 01/4 6-13/16 CC EXTENSION OD. WE 6-9/16 OD PIPE 03/8 0112 3-5/16 10 10 LOAD PIPE ROARED[aNEGTDN 0 —� —.--. — CL CONNECTIONG 01/4 OF PIPE FLARED(ON ECT10N FLARED CONNECTION `o v GAS PIPE 03/8 0112 6-9/16 DRAIN HOSE HEAT01INUAIEROD. CO"CTION1D. E 8C BLENGtn 6-13/16 ^b CC) m m FOUR PPOSIN iALLATON DRAIN PPE CONNECTION REi10 PVC PIPE O.D.01(261n) Q- m m rn Q PLACES) C° C NOTEI.CUT THE ORAN HOSE IACCESSCRY)FOR USE.F NECESSARY. INDOOR UNIT DETAIL VIEW THE METHOD FOR STANDING (TOP VIEW) DRAIN FROM INDOOR UNIT CENTER OF(ELLNG OPENNG HOLE/SUSPENSON BOLT PITCW )1 CUT THE DRAIN HOSE (ACCESSORY) m GRILLE IS THE SAME FOR USE, IF NECESSARY. DRAIN PPE e -------------—----- -- ----------------i CONNECTION 'u I"PVC PPE Sy yN � OD.01126" Co ® MN VIDo i N , r------------�-------------i 10 I DOWNWARD SLOPE iI----- ___ ____________J ATTACH![ O GRAN HOSE m i AN OUTLET' l OUTLET IUNDERSI E) z 3-15/16 1 37-13/16 1 3-15/16 2-1/8 41-3/8 SUSPENSION BOLT PITH 2-1/8 7CELLNG SURFACE 13/16 45-11/16 CELLNGOPEHNGHOLE 13/16 47-1/4 OUTLINE OF EFILLE (FRONT VIEW) SIISPENSON BOLT W318 SUSPENSION BOLT W3/8 N � f� (EILLNG SURFACE GRILLE CEtLING SURFACE Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. OUTDOOR UNIT DIMENSIONS: Unit: inch(mm) REQUIRED SPACE '1 4 in. (100 mm)or more when front and sides of the unit are clear m a� U 4 00 �(1p0 A�n'o�t�°`g 15-3/4 j Air in Drain hole 01-21/32(KA09112115NA) ^ Drain hole 01-5/16(KA09M2115NAH) K. Air in + L o m •o 2a�g 21 lq 1-(3$� o N m C '2 When any 2 sides of left,right 1-9/16 and rear of the unit are clear Air out 2-holes 3/8x13/16 Service panel 7/8 11/16 Handle Liquid refrigerant pipe joint Refrigerant pipe (flared)a 1/4 r4 N ^ - Gas refrigerant pipe joint N N N Refrigerant pipe(flared)a 3/8(09/12 KBTU/H) N ' rn o 1/2 15 KBTU/H) rn n m 11-29/3 5-11/32 -15/1 19-11/16 6-23/32 Bolt pitch for installation 31-1/2 2-3/4 1340 Satellite Boulevard Suwanee,GA 30024 Toll Free:800-433-4822 www.mehvac.com c0. FORM#MLZ-KP12NA2 8 SUZ-KAl2NA2-202211 Intertek Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. Building Permit Check List & Zoning Analysis OB & C ONLY Address: (0 6 S 72 l7 t — SBL. I S J — 2- Zone: 1 Use: Const.Type: Other. Submittal Date: 'L Revisions Submittal Dates: Applicant: CAI t t.—t t'(' Nature of Work: I Wt9_rLl.0/L— GFL 'OEA-1 Reviews:ZBA: AUG 3 1 2022 PB: BP: Other. (EFA OK _ ( ( ) FEES:Filing. a BP: => 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 Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan. Other ( ) ( ) SURVEY:Dated Current: Archival:- Sealed: Unacceptable: ( ) (.� LANS:Date Stamped: &-**' Sealed:- '�-Copies: 7i Electronic Other. ( (rrLicense: Workers Comp: y�Liability: V Cornp.Waiver. Other. ( ) ( ) Code 753#: Dated: N/A: (Jf ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. FIRE ALARM/SMOKE DETECTORS.Plans: '� Permit: H.W.I.C.:_Battery:_Other. ( ( ) PLUMBING:Plans: Permit: Nat LP Gas: Grease Trap: Other. ( (1�FIRE SUPPRESSION:Plans: ✓ Permit: N/A: Other. (�( ) H V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK: Plans: Permit: FUEL TYPE: Other. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. _ ( ) ( ) Other. ( )ARB mtg.date. approval• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• _notes: Apmnlim Date: REQUIRED EXISTING PROPOSED NOTES Date: O U 1 v 77722 Am: Cir e: Fr n _ Front: Front: Sills: F.A.R.: Qpen Space: Stories: notes: ► �� �(L S�2�N�lsclL-"��at�S Laura Petersen From: Laura Petersen Sent: Wednesday, November 2, 2022 10:54 AM To: Marcia Hawthorne Cc: jeffrey.baker@designparameters.com'; john@kvaconsulting.net';Alena Hakanjin Subject: Interior Building Permit Application - 166 South Ridge Street "Amazing Lash" Attachments: Fire Suppression Full 9.2021.pdf Good morning, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office; 1. Fire sprinkler application & fee ($250.00 application fee and permit fee $25.00 per $1,000.00 or a minimum of$275.00) — Please see attached 2. Fire sprinkler contractor's liability insurance (the Village Of Rye Brook must be the certificate holder) 3. Fire sprinkler contractor's workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $3;7. 113-06-(due at the time of pick up) Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Ipetersenarvebrook.org 1 Laura Petersen From: Alena Hakanjin <ahakanjin@winridge.com> Sent: Friday, December 2, 2022 3:14 PM To: Laura Petersen; Marcia Hawthorne Cc: David English;Alena Hakanjin Subject: RE: Change of GC - 166 South Ridge Street "Amazing Lash" Hi Laura, We confirmed GC change (new GC - Vision 21 Inc.) with Marcia Hawthorne/Amazing Lash. Can you please revise permits to reflect change. Thank you, Alena Alena Hakanjin Property Manager WIN RIDGE REALTY, LLC 24 Rye Ridge Plaza Rye Brook, NY 10573 Tele: 914.701.4005 I Fax: 914.701.4009 E-mail: ahakanjin@winridge.com For information about Rye Ridge Shopping Center visit our website: www.ryeridgeshoppingeenter.com -----Original Message----- From: Laura Petersen <LPetersen@ryebrook.org> Sent: Tuesday, November 29, 2022 11:50 AM To: Marcia Hawthorne <mhgk7l@icloud.com> Cc: Alena Hakanjin <ahakanjin@winridge.com>; David English <denglish@winprop.com> Subject: RE: Change of GC - 166 South Ridge Street "Amazing Lash" [EXTERNAL] Good morning, Please provide a letter from the property owner stating the change in contractors for your building permits. Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street i Rye Brook, New York 10573 Phone (914) 939-0668 1 1petersen@ryebrook.org -----Original Message----- From: Marcia Hawthorne <mhgk71@icloud.com> Sent: Monday, November 28, 2022 2:28 PM To: Laura Petersen <LPetersen@ryebrook.org> Subject: Re: Change of GC Will do. Thank you. Sent from my iPhone > On Nov 28, 2022, at 1:09 PM, Laura Petersen <LPetersen@ryebrook.org> wrote: > Good afternoon and thank you for the email. Please provide the following items from your new contractor; > 1. General contractor's contact name & phone number. > 2. Copy of general contractor's valid Westchester County Home Improvement License. > 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) > 4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) > Thank you > Laura > Laura Petersen > Office Assistant > Village of Rye Brook > 938 King Street > Rye Brook, New York 10573 > Phone (914) 939-0668 1 1petersen@ryebrook.org > -----Original Message----- > From: Marcia Hawthorne <mhgk7l@icloud.com> > Sent: Monday, November 28, 2022 11:55 AM > To: Laura Petersen <LPetersen@ryebrook.org> > Subject: Change of GC > Good morning. We are changing our GC from Only one construction and would like to remove his information and furnish the new GC that we have hired. What do you need us to provide from the new co? > Sent from my iPhone 2 i D D , DEC - 1 2022 �--� Vision 21 inc. Fitzroy Golding VILLAGE OF RYE BROOK 963 East 101 Brooklyn BUILDING DEPARTMENT New York 11236 To the village of Rye brook This is to notify you that I am the new contractor that will be working on the project at 166 south ridge street rye brook New York.See a copy of my license,my liability,my insurance and workers compensation insurance.Thanks in advance. F.Golding i r f i mv 9 I�\ :,r -,r;,On.t,t.c�•Avtl��.,F(}4i��i\.. '�,:)k!`_4°-ti 4°e0``n`Se t p l.},��t a�,�9 AatlDr�,g lc.R,� l+ddl°eq/- ;'��.^etl�,��$�-+�4;"t'flt�'titr,r lexaJ{Jj�.jma�� 's.\.�.y^v�tl A-^�C.��.'�;-{{7'�r�'�'i4,rtiu4M1f`,f���'+rR�<'-}�:.3..^�V,$. ..y�'i�°u�A"y{E i te'it+41rk12P7},ti�¢�fi;M Zt, •�t•PJ B a-�,�+�'�•S=_y!�OfiTV`��t�`l fr;�'`^"1<''\y•,^�v � �/z ` hireq O� .�_A� nr� Co �5 •/! <cKi1)f�""�'`'"''-tl/p11t :•�;:^_.__-tllp44t� ♦':ti:.4lfplft,ie�r s:•rctfa911+�>:�' :4:a.t!li36°t`�_`=,•'a = al;:ttl/i°rit,'�c=t� � 4lZFi°9°lf�t»;9.. -rt� i y " t CIS Q Cal IN f rA n W CO V w m � �k �� G� r..i V � � o •° a 00 �gCtiOti : accR ►�/ •.\ ,�'.� 4� Z Cn U 6. !s o Cf N / a 14 'rA W 4-. O �M ` ic-y.,I 1. I 1 •off co m O '. E a ed Q e s' <(azae D <4cDD IN _ a < t�• � O U } rzm " d v N � •z as is N • tw; N W . Go Nip •`�+ a� ' O awn 4) U � e �:-, � .:: •er 6i 67 to U U_ U z�� ��r/ i 0 p.q { \ Itgxm '\ a 17°4pitt �Opltl`Yi:z° Fa.:at{f�pill li-01�11, 9s 46�it+ .t-*°' +J•r: i1,0{'{t"'•6 sp••_ ° !+l Od r 144004 t �OSft+ ,[,/ Y e 4 f' D! J ti $ 18447 $ 04r' ��4�e, nt GOtid.i 'C64s ��/ /IIi Fd° k _ k �gd 1' 4 gOdedt s • 1,;, 6• ,+ At 1f�:. ♦b i9 F4 0 60 + k AaA9'x` C,Li n; Av F of 3' .^ l I !-...,. tA•+R .A 't' r .A '`F' :.A '4" LR +' A 3' ryf�Y U E OV •A _�• \ { Molsad~ yN�✓.' Ye dry '1 Policy Number: RNYA302780-02 Date Entered: 03/09/2022 AC RU CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDONYYY) 11/29/2022 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 BARRY SUSSMAN N A.B.M. Brokerage Corp. --_ _ 9122 Flatlands Avenue PHONE (71B)272_6799 FAX Ne: (718)927-1277 E-MAIL ABt�KGEC�AOL.COM Brooklyn, NY 11236 ADDRESS: -INSURER(S)AFFORDING COVERAGE NAIC 0 _ NISURERA:ROCKINGHAM INSURANCE CO INSURED VISION 21 INC. INSURER B:ACE PROPERTY AND CASUALTY INS CO INSURERC: 963 EAST 101 STREET INSURERD: BROOKLYN, NY 11236 INSURERE: 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. NTR TYPEOFINSURANCE POLICY NUMBER PMW EFr P EXP LAIM A COMMERCIAL GENERAL LIABILITY �E =1,GOO,000 CiAIMSTNADE ® EAR OCCUR RNYA302780-02 5/15/2022 5/15/2023 REMES(Ea accv ca S MED EXP Wy one all $5,000 PERSONAL 6 ADN INJURY 3 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGATE $2,000,000 POLICY❑JERCCT LDC PRODUCTS-COrp/OP AGG $2,000,000 OTHER: AUTOMOBILE LWBRM CEOMB�I NNEED*SI E LIMIT s ANY AUTO OVNVED SCHEDULED BODILY INJURY(Per parson) S AUTOS ONLY AUTOS BODILY INJURY(Per accid") S HIRED NON-OVNVED tDAMAG =AUTOS ONLY AUTOS ONLY B UMBRELLA LIAR OCCUR EACH oNce $3,000,000 EXCESS LIAB HCLAIMS-MADE UMBIn'1638494—Al /16/2022 2/16/2023 AGGREGATE 53,000,000 DED I RETENTION S s WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER Y/N STATUTE E12 _ ANY PROPRIETORIPARTNERIE)TCUTNE =OFFICERIMEMBER EXCLUDED? ❑ N l A EL EACH ACCIDENT (Mandatory In NH) Iyes describe under yes, DISEASE-EA EMPLOYEE $ DESCRIPT70N OF OPERATIONS bebn E.L.DISEASE-POLICY LINK S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddRional Remarks Schedula,may be attached I more space Is ngrdnd) CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2015 ACORD CORPORATION. All rights reserved ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �. 4T A A A A A A 270709916 VISION 21 INC } 963 EAST 101 ST •• BROOKLYN NY 11236 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VISION 21 INC VILLAGE OF RYE BROOK 963 EAST 101 ST 938 KING STREET BROOKLYN NY 11236 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE K2473 594-6 556749 05/15/2022 TO 05115/2023 11/29/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2473 594-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT FITZROY GOLDING ONE OF ONE VISION 21 INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STAT SU NCE FUND /y/� �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:731212347 U-26.3 Laura Petersen From: Marcia Hawthorne <mhgk@live.com> Sent: Tuesday, December 20, 2022 3:12 PM To: Alena Hakanjin Cc: Mike Izzo; Shawn Ffrench; Steven Fews; Tara Orlando; Laura Petersen; David English Subject: Re: 166 South Ridge Street - "Amazing Lash"-Permit/GC Change My sincerely apologies. We were made aware of this GCs departure the same time as you. He is unprofessional and dishonest. We will look to pursue legal action against him. This is definitely a negative reflection on us and it's unfortunate because we do everything by the book. We have done eight Golden Krust restaurants throughout N.Y., in NJ and FL. We have never experienced anything like this ever. I am dumbfounded as you all are and we are reaching out to a few others that can take over our project. We can assure you that our job will continue without incident and we will open and will be a business that will be the heart and a part of this to the community that people will pleasantly welcome. My apologies again. Sent from my iPhone On Dec 20, 2022, at 2:12 PM, Alena Hakanjin <ahakanjin@winridge.com>wrote: Good afternoon, Inspector Izzo, Thank for providing that information. Best, Alena Alena Hakanjin Property Manager WIN RIDGE REALTY, LLC 24 Rye Ridge Plaza Rye Brook, NY 10573 Tele: 914.701.4005 Fax: 914.701.4009 E-mail: ahakanjin@winridge.com For information about Rye Ridge Shopping Center visit our website: www.rveridgeshoppingcenter.com From: Mike Izzo <Mlzzo@ryebrook.org> Sent:Tuesday, December 20, 2022 1:36 PM To:Alena Hakanjin <ahakanjin@winridge.com>; mhgk@live.com; Shawn Ffrench <shawn.ffrench@amazinglashstudio.com> Cc: Steven Fews<SteveFews@ryebrook.org>; Tara Orlando <torlando@ryebrook.org>; Laura Petersen <LPetersen@ryebrook.org>; David English <denglish@win pro p.com> Subject: RE: 166 South Ridge Street - "Amazing Lash"-Permit/GC Change 1 [EXTERNAL] FYI... /ffiGi a (/, IZZO Building & Fire Inspector Village of Rye Brook, NY (914) 939-0668 From: Alena Hakanjin <ahakaniin@winridge.com> Sent:Tuesday, December 20, 2022 1:33 PM To: mhgk@live.com; Shawn Ffrench<shawn.ffrench@amazinglashstudio.com> Cc: Mike Izzo <Mlzzo@ rye brook.org>; Steven Fews<SteveFews@rvebrook.org>;Tara Orlando <torlando@rvebrook.org>; Laura Petersen <LPetersen@ryebrook.org>; David English <denglish@winprop.com>; Alena Hakanjin <ahakaniin@winridge.com> Subject: 166 South Ridge Street- "Amazing Lash"-Permit/GC Change Marcia/Shawn: Please keep us all updated on this matter re GC change and permits. Thanks, alena Alena Hakanjin Property Manager WIN RIDGE REALTY, LLC 24 Rye Ridge Plaza Rye Brook, NY 10573 Tele: 914.701.4005 Fax: 914.701.4009 E-mail: ahakaniin@winridge.com For information about Rye Ridge Shopping Center visit our website: www.ryeridgeshoppingcenter.com 2 i�.+ x rsl O a ON Lo SWAM �w. 3 x O a O .e F• ece c ��� p i�: W � . ova �„� a Q, W � z c Y ' ItiiN� �tiii�iai�NenrE, �7 r� C � r�rw � Q V1 Qr � O � tF91N93Ar9Prl00m�'rM�16 a H ; O n o u- p1N1 W � WOOD iq��iwtb�+eD�.tlr W ' ♦ P„ sil?iGMr•ir9luf�Q" i � r- �_ N7i;6:s:a.IMgrw4a: 1nYll P` a ' W t1100t�MP�7itlDgQ92r%'Ftl:F. o 15 "— �ullullllill A � �J �� � - nm►�4� wREi 00 G ► +tl 0}riI0rpc 1 •7� 7 ijaeyaiGLv�� I� �.�� +l.l 4 ' Laura Petersen From: fitzroy Golding <fitzroy2165@gmail.com> Sent: Tuesday, December 20, 2022 7:21 AM To: Laura Petersen Good morning my name is Fitzroy with vision 21 inc I'm the contractor that was working at 166 South ridge street just want to inform the department that I'm no longer the contractor I would like my permit to remove from the property Effective immediately My telephone number 3474060958 if there's any question please give me a call thank you in advance i Laura Petersen From: Dawn McIntosh <dmcexpediting@yahoo.com> Sent: Wednesday, December 28, 2022 1:47 PM To: Laura Petersen Subject: 166 South Ridge Street Attachments: Village of Rye Brook INS.pdf Good afternoon Ms. Petersen, Permits#: BP 22-213 and BP-219 are being superseded by BJS Renovations. Inc as the new contractor. See requested insurances as discussed. Please Dawn @ 9178076347 or email me if there are any concerns. Please call or email when permits are ready for pick up. Thanking you in advance, Dawn McIntosh 1 a DATE(MM/DD/YYYY) A 652y CERTIFICATE OF LIABILITY INSURANCE 12/27/2022 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 endorsements. PRODUCER CTACT ON Geeta Punjabi FUTUREWISE INSURANCE BROKERAGE CORP PHONE 516 303-0089 Fc,(516)303-0098 244-04 JERICHO TURNPIKEE-MAIL AppgEss.geeta utureariseinsurance.nyc FLORAL PARR, NY 11001 INSURERS AFFORDING COVERAGE NAIC# INSURFRA NORTHFILED INSURANCE CO 27987 INSURED BJS RENOVATIONS, INC INSURERB. ATEGRITY INSURANCE COMPANY 16427 737 BURlIM AVZNUE INSUgEgC,NEW YORK STATE INSURANCE FUND 524210 BRONX, NY 10467 INSURER D.NATIONAL CONTINENTAL INSURANCE CO 10243 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. IN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSID INVID POLICYNUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE El OCCUR $ 100,000 WS490143 5/29/22 /29/23 MEDEXP An oneperson) $ 5 000 A Y Y I PERSONAL&ADV INJURY TO 000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE s 2,000,000 X POLICY El PEA E]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED D AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY e cci e UMBRELLA LIAB OCCUR EACH OCCURRENCE $ B EXCESS LIAB HCLAIMS-MADE AGGREGATE $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Ityes,describe undeDFSCRITION OF r PERATIONS below Fi ni,,FASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached rf more space is required) The certificate holder is named as additional insured Village of Rye Brook 939 King Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ PRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE N-so, ^^^^^^ 474466962 BJS RENOVATIONS, INC 757 BURKE AVE BRONX NY 10467 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER BJS RENOVATIONS, INC VILLAGE OF RYE BROOK 757 BURKE AVE 939 KING STREET BRONX NY 10467 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE X2375 452-6 652873 02/15/2022 TO 02/15/2023 12/28/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2375 452-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT BRANDO SPENCER BJS RENOVATIONS INC(1 OF 1) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND T 0/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:423747453 U-26.3 7DATE(MMIDDlYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE /10/2023 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). PRODUCER CONTACT Maryellen Longeill NAME: Avanti Associates PHONE (914)226-1348FAX A/C No Ext: A/C,No): (914)273-8050 201 Wolfs Lane E-MAIL ma ellen avantiassociates.com ADDRESS: ry INSURER(S)AFFORDING COVERAGE NAIC# Pelham NY 10803 INSURERA: Northfield Insurance Company INSURED INSURER B: Century Surety Company Y Yoland Construction and Metal Fabricators Inc. INSURER C: 74 Lyons Place INSURER D INSURER E: Mount Vernon NY 10553-1046 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2253113379 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,D00,000 CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A WS517027 05/30/2022 05/30/2023 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY JEC 2,000,000 ECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 3,000,000 B X EXCESS LAB CLAIMS-MADE CCP1062130 05/30/2022 05/30/2023 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re Permit CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ohl* NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^A^^^^ 133662129 AVANTI ASSOCIATES 4 - ': 201 WOLFS LN STE 1 ,+�.? PELHAM NY 10803 ❑4..4 L SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER YOLAND CONSTRUCTION AND VILLAGE OF RYE BROOK METAL FABRICATORS INC 938 KING STREET 74 LYONS PLACE RYE BROOK NY 10573 MOUNT VERNON NY 10553 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2335 819-5 194312 05/30/2022 TO 05/30/2023 4/10/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2335 819-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY, IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/IWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT PETER MITCHELL YOLAND CONSTRUCTION AND METAL FABRICATORS INC 1 OF 1 THIS CERTIFICATE DOES NOT APPLY TO THOSE JOB SITES WHICH ARE COVERED BY OTHER INSURANCE AND ARE SPECIFICALLY EXCLUDED BY ENDORSEMENT. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND 7 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 159871993 I I_9R z �� � � ` ' _ r�� \_ice• •� - _� _ �.,ice!/;i�;,���1;;�� �.i+,��• •: .,• 1��\ t����•`� ;•ice,, i Client#:2498 ALLSAF2 DATE(MMIDD/YYYY) ACORD,.., CERTIFICATE OF LIABILITY INSURANCE 1 10121/2022 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. lmpdkTFiNT:H the certMcate holder Is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED proWslons 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 any rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAB: Commercial support Edgewood Partners Ins. Center L( E 881.390-9700 X— 83 �380.9T80 No,Eaa: (AfC,Hop _ 40 Marcus Drive E4AAIL . NEConstructioncerts@epicbrokers.com 3rd Floor, - - - `— Melville,OY 11747 INSURER(S)AFFORDING COVERAGE NAIL a 8 Forster Specialty Insurance Co 44520 INSURED '..INSURERS:NorGUARD Insurance Company 31470 All Safe Fire Sprinkler Systems Inc -- - - FINsuREa c:Merchants Mutual Insurance Company 23329 375 Executive Blvd Elmsford,NY 10523 INSURERD: 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 CONTRACTOR 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. O _ --TYPE OF SUINSURANCE MR�ADDL SUBRi C TR INSURANCE POLICY NUMBER Yyw _ - _�.— ---. A X COMMERCIAL oeNERAL LIABILITY I GLOO90537 11191111112022 09111/202 EACH OCCURRENCE ;f 1.0w.000 CLAIMS-MADE X1 OCCUR �S IFaEOoau�aKe� .s SO,000-- X 81/PD DBd:5,000 MED EXP(Ann wie person) f 5i000 _ X Contractual Liab. PERSONAL aADVINJURY $1,000,000 :;FIrL AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE j S2,DOO,000 _ X PI?LICY_X.PR LOC PRODUCTS-COMPIOPAGG,32,000,000 -- OtHER. _ = C AUTOMOBILE LIABILITY —----- CAP920W1 09/IW20221MIG12023 eMBINEDMSINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) t ----- OWNED SCHEDULED AUTOS ONLY i X AUTOS I BODILY INJURY(Per accldeM) f HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY I nt Per accide - f -- -- - r—! -- ---- --� -— _ f -------- A UMBRELLALIAB '�(�(_-OCCUR I SE0120263 9/11/2022 09/1112021 EACH OCCURRENCE $1 1000MO X EXCESS U&S CLAIMS-MADE AGGREGATE t 1 OOO 000 DED RETENTION! __-_— B WORKERS COMPENSATION T-t- ALWC213191 9/16/2022 09/16 2012 3 X PER I oTH- --- ----- AND EMPLOYERS'LIABILITY YIN - .—....ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT f1,000,OOO OFFICER/MEMBER EXCLUDED? N NIA- - i (Mendalory M NMI i j E L DISEASE-EA EMPLOYEE 51,000,000 d yes dewibe under DESORPTION OF OPERATIONS', 000 OW _ - E.L.DISEASE-POLICY LIMIT f1 ' I DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Village Of Rye Brook Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S4346757/M4278743 CCA03 i-1 Workers CERTIFICATE OF S_ NEW . ..- I STATE Compensation 4 Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured All Safe Fine Sprinkler Systems,Inc. 914 773-7602 675 Executive Blvd (Elmsford, NY 10523 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 473975166 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carnef (Entity Being Listed as the Certificate Holder) NorGUARD Insurance Company illage of Rve Brook Building Department RyeKing Street 3b.Policy Number of Entity Listed in Box"la' Rye Brook, NY 10573 ALWC371889 3c.Policy effective period 09/16/2022 to 09/16/2023 3d The Proprietor.Panners or Executive Officers are C' included (Only check box if all panners/officers included i ❑ 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 of 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 Leonard Scioscia (Print name of authorized representative or licensed agent of insurance carrier) Approved by. 10;28/22 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier 631-390-9700 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