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HomeMy WebLinkAboutMP22-171 < C DRY towJJV .L'Ct�� . 190 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 BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 5,2024 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 116 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.27-1-6 This document certifies that the work done under Mechanical Permit#22-171 issued on 11/15/2022 for the installation of a two new rooftop HVAC units have been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to QyE BRC�v� cu � 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 : //6 S O U A R t j !�Q s 4 ,w DATE: 2 0 Z PERMIT# M !' - 22 - / 7/ ISSUED: '/.1'�12SECT:/V/. 2 7 BLOCK: LOT: LOCATION: _ Roo Ty / ! VA(f (2) OCCUPANCY: ❑ 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 / / ❑ Natural Gas �Y F C�P �00 o G/�U i t ❑ L.P. Gascl _ ( �! /� co"> ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING FFINAL ROSS CONNECTION ❑ OTHER Nt E DR(�� cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ;ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK u CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: ` �J DATE: PERMIT# S I ISSUED: ""SECT: BLOCK: LOT: LOCATION: Co' '"� , OCCUPANCY: 7 ` ❑ VIOLATION NOTED THE WORK IS... ,L1 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION r REQUIRED ❑ FOOTING V~' ❑ 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 r' N � a v b u, ■ rA z q o 0 • + W V `° 0. 0ie ,�r4. .�p 'A Ql� .> E� pH �, g a -� 4. 0 2 � _ n `' 10 � A4 > o2o va O Q W Z r"'+ M_ c � cu 10, Ln Y .� Ln 0 _ W V J O FBI O A (J A Uz ��' o ar • 11 CT f� ✓ �{ c o 'd r V N ^ �I �i o C 00 FBI \/ N 1 a" �/ r- V .5 V r� avy U O � '^ o .o � � v GG z w G c. a gv w O p; y W. a,, v 0 9 _ U ° H a '�u - p y z o � w 0 o V Z 0 A; W A 0 4 u « D MUDM1JIi�- BUILD NC". D MENT ' VIL E OFL E OOK NOV �°5.2022- 938 KING u'R ET 121RO` ,NY 10573 __14)966b41 VILLAGE OF RYE @RC1OK BUILDING DEPARTMEN APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Ir —/� 7 l r 0 2�27 Approval Date: Permit Fee: $ 1 Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form (Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit•COMMERCIAL=$350.00/unit. 5. Inspection by the Building Department for removal and/or installation.(48 hour notice required 6. Electrical work requires a separate Electrical Permit& Electrical Inspection, 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. Application dated, /I/S—c)ais hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. I. Address: 116 South Ridge St., Rye Brook, NY 10573 SBL: 141.27-1-6 Zone: C-1 P 2. Property Owner: Win Ridge Realty, LLC Address: 24 Rye Ridge Plaza, Rye Brook, Ny 10573 Phone#: 914.701.4005 Cell#: email: AHakanjin@winridge.com 3. Contractor: Bayside Refrigeration, Inc dba Airlogix Address: 24-26 46th Street, Astoria, NY 11103 Phone#: 718.947.1311 x214 Cell#: 347.865.6296 email: Stratos@Airlogix.co 4. Applicant: Address: Phone#: CelI C email: 5. Scope of Work:New Installation(X)•Replacement( )•Removal( )•Other( ): 6. List Equipment:RTU 1 and 2 replacement. ductwork. HVAC Controls 7. Location of Equipment: Rooftop, space interior & Method of Installation/Removal(list all equipment needed to perform job): Boom lift t r 811212021 STA,TE� OF NEW YQRK,CO,J1�ITY OF WESTCHESTER ) as: M'5IrtCA%'� (X44 101rIJ5 - ,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 C 0A r-t A-0 f^ 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 Sworn to before me this q4 day of ,20 day of;}r�� ,t 20 TZ Si n re of roperty A4ZOr Signature Hof Applicant 1� E;Ck4i 'O rl K7 Pr' t Name of Property Oaw= Print Na o c 'Miry Publi otary Pub is KFLLY S'^ nI Frl Nr,t,,iry p!'b�ir,, f_rr of �r@W York iJin V.. ",:hcst- County Expires March This application must be properly corrt-pleted 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. BRANDON H FLORES Notary Public-State of New Jersey My Commission Expires Jan 31, 2025 2 sn 2r2o21 w IL r z U OMIA ui , N U 00 a . J N r ummw � HIM o 0 z � In CO •6 • • x y • 10 • � i17t""1r GioiplK��••..��f �- A ( `,-.. a. a 0 a N N N ' I N Cs ON N W v Z w a Q w O x a N W W N WOO 0 x O 00* 1 W — ;n 2Ln Rr a C L O N < a f 41� 04 � � W � a U w o CA s z U W �"' O Q� O c� Li; = Z W U rA z U z Z W ZH � � Z � � � cn o � < re), N C� Q � ^ V a V o � o V z �-I W W P, Q , MM M W 1�1 h� Cn 4i 04 A N �C n zz W pC C7 � A w a ° f W A z Q ° � F" F a W 4 F U 08 aLn • e�'� Z � Q F < A p � A o a x �' �I a a z w z � a i BUILDING DEPARTMENT IE VILLAGE OF RYE BROOK D V 0 V I 938 KING STREET RYE BROOK,NY 10573 (914)939-0669 NOV 2 9 2022 www.ryebrook.org VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATION BUILDING DEPARTMENT Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP-#- /�/ c��� —� 1� EP#: aQ"-D(Q Nov 3 0 202 Approval Date: A 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, 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: t,» SBL: / T�i d 7 1—6 Zone:(f 2.Property Owner: t �-{ {��� Address: Phone#: Cell#: email: 3.Master Electrician: Nl I pty pm fz I.lr Toe'_l#e*4UAZf4Mkddress: rf Lic.#: y�Phone#: 9/y-37s--3Zr_3 Cell#: 1Y—V97-y6 S�0 email: HIA wA41.rt-EcD AOL-God Company Name: H I IL A41 T4_&e 7726L Address: V s3 y /— IUy 4.Proposed Electrical Work/Fixture Count: C S on e e__ I— A. c c!cerj..ef01 NN,E�r— 5.3rd Party Electrical Inspection Agency: V1J I S C r-tz �fL- //U.S PC f n t/V STA:'E OF NEW YORK,COUNTY OF WESTCHESTER ) as: loft LO 2 ,being duly sworn,deposes and states that he/she is the applicant above named,and does further ( "nt name of individual signing as the applicant) r state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the �y\. for the legal owner and is duly authorized to make and file this application. (indicate architecL contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn be ore me this xc 23 f 1p , ,20 Z" day f ,20 2Z 1 gna re of roperty gn ture of Applicant t � w t� .aUSN � c CEuaer Print Name of Property Ow nef Print Name of Ap lica Nota Ft161ic' JENNA TAMA ublic ry NOTARY PUBLIC,STATE OF NE Registration No.01TA641 3 Qualified in Westchester my Commission Eyplras November 23,2024 `""-" 6/23/2022 c STATE WIDE INSPECTION SERVICES, INC. Service With Integrity 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit It ,s )' / ! Sq Ft Plumbing Permit# Final Certificate# City/Village Zip �� Building Dept. County Address r, • Cross Street �v• Section Block Lot Owner Name/Address(If different than above) f]l Npp..,,j�ji Contact Number -+ ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1-1�—T # 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 Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ®`Safety Inspection ❑Consultation 612 RCC� C� OdC NOV 2 9 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(t)year from the date received by SWIS.This application is intended to cover the above listed items to he 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 �'A w A41fx 4L£L•4� p L Name License# 1 f�� Date b w.y.��3 . Signature VZ Address t�f�3 r�a�►� /� � � City/State Zip Code -? /rl�r t- t//1. ': Company kb Rj lf � �� Phone# ;= , _DC� � ��� JD State Wide Inspection Services DEC 2 1 2022 1080 Main Street Fishkill, NY 12524 a1 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Midway Electric Win Ridge Realty, LLC Richard Angelori 116 South Ridge Street 1453 Nepperhan Avenue Rye Brook, NY 10573 Yonkers, NY 10703 Located at: 116 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: 22-288 141.27 Certificate Number: 2022-8101 Building Permit Number: 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: 116 South Ridge Street, Rye Brook, NY 10573 The Exterior was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 8th day of December 2022. Name Quantity Rating Circuit Type HVAC Systems 02 officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. c ■ ■ ■ tl N �" tn O O N LL, ftl Ar O Z o w x OZoe A z Lin 00 CD 00 �.T.� v) �-" o ON °0 d Z c!) I V U A O z H V �40 CIS cr �, C7 A a x Z F F V IL c $ x u � w WoG O F c p �. ao z zz , w 2 w o x b e t.���i ��i�i��� •+�� ��� ••���li ��'�i�i'�IZ�����ii��������� ���F ������ V�ii J \Y MENT FNO 202 E T BUILPOR VILLAGE OF RYE BROOK OK BUILDING DEPART AIENT 938 KiNd, ET RYE B ql-,NY 10573 PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY Approval(late: Nov 2 "22 Permit Fee. $ Approval Signature: Other Disapproved: kfevc are nun-refmidable) Application dated, is hereby made to the Building Inspector ol'the Village of Rye Brook NY, for the issuance of a Permit to inst-01111 and or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that saiti plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. Y) V4 --) ')7--',,'o ULA n (-��, �q t �@U 'A� SBL: Zone< e 1.Address: 31 Ll-- - I k: W4-S Ap 2.proposed rq 7 A t 3.Property Owner: �,win Ridge Realty,LLC Address:K 224 Rye Ridge Plaza,Rye Brook,NY 10573 Phone#: 914-701-4005 Cell#: -1 email: -y ahakanjin@winridge.com 4.Master P Address: t/ y je, U Cell H: ON)qe- q �qtt 4, Lic. fl: Phone 4A t 4 - q 73 email:0*1' Vx arn, Address: ViX A I'Ll A41 y Company Name: I INDICATE FIXTURES& LINES TO BE4114STALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire I Sanitary Natural/ Other* Total Closers Fountains Tubs Tubs Service Service Sewer 1,11tins Basement I st Floor 2nd Floor 3 d Fluor 4'h Fluor 5111 Floor Exterior 5.* List C)jbcr Equipment/Provide I)Mitls. k.o w\-t 0 NA—� no AS n6 J (Notarized Signatures Required Next 2 Pageg) STATE OF NEW PORK,COUNTY OF WF.SMMSITR ) as: being duly sworn,deposes and states that he/she is the applicant about 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 y, contractor _ for the legal owner and is duly authorized to make and tile this application. (indicate architect,contractor,agent,attomey,etc.) chat all statetncnts contained herein are tnic 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 Sworn to before me this day oft 7.iS��t1 2021 day of Si tire of Pro erty Qxucr Signature of Applicant "50— Michael Ferro — Print Name of Property er Print Name of Applicant Z-2 Nota Public Maria Ferro Notary Pu is �"-I '" ^"�' -`� �lotary Public, State of New York Nr)tpev t` ,,-,'vYnrk No. OIFE4692612 ' —I in Westchester County C ��� � October 31, 20 � S� C �rl i_ 'flits application must be properly completed in its entirrl., :tt,d must trlTde the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/12/2021 BUILDIS4:1 TMENT NOV 2 9 2022 DI VILLAO OF Ry OOK 938 KING E;BR ,o1C,NV 10573 VILLAGE OF RYE BROOK EZUOAVIIl �,-0,,yg$;=Q' BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE.CODE. §216 - STORM SEWERS AND SANITARY SFWERS TRis AM DAVIT HDST ]SEAR TU NOTARIZED siGmTQRE or Tog LEGAL PROPERTY ONNER AND BE $QBIIITTED ALONG NITQ ANY 9DILDIMG OR PLumai EG PZRMIT APPLICATION. ANY BUILDING Olt PLUMBING PURNIT ANPLICATION 3VNMITTZD WITXOUT TRIS COMPLZTZD AND NOTAItIZZD TORM WILL = VXTVRNED TO TNR APPLICANT. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: David English , residing at, q 10 Rye Ridge Plaza,Suite 200 (Print name) (Address where you live{ being duly sworn,deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; o Rye Brook, NY. (Job Add . ) v Further that all statements contained herein arc true,and that to the best of his/her knowledge and belief,that 1 there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further 0/ 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. ( uroorPr David English,VP/Operations lf'rint Ntmne of Prolxrty 61 Ilerht}t Agent Sworn to before me this day of 20 2— (N ary blic) C�, IV 12/2021 Carrier SUBMITTAL Project 116 South Ridge Street Date Wednesday, September 28, 2022 Table Of Contents Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM RTU-2 .... ........ - - ...-..._........... ...... ------ -.._.-._...----- - -- -- -.._......._..._..._..._..... --..__...........3 Unit Report__ __ - ------------------------------------------..............................................................-..-......._..._...__._..._...-- —...........- __ ..._.._...- ----...-...-....... --- --4 CertifiedDrawing ....................------------------------------ - - ------------- ----- - - - - - - - ----------------------- - - ----.._...---- --- ---- -.5 PerformanceSummary...--------------------------------------------------------.....---•-----•--....--•-••-•-•-•--------------.-...-....._._..-•••-•••--•-_._..--•••-••.—._..._._- .......................................9 RT U-1 ---------- -- - --- -- --- ------ --------- ----------------------------•-•---------------............_..._....---...-.................-...--- - -.._..._..._..._..- - -............................................12 UnitReport..----------------------------.-------------------------- ----------------------- - - - - - ..................................-....-- - - -------- CertifiedDrawing -.................................-----------------------------------------------------------------------------------------------------------------------......................................---..........................14 PerformanceSummary.-- ..... . ..._.......- ...--•---------------......-...-.-----•----.-............_...._._..._..._....---------...----------------......._...-..._..._...-----------------..._..._...__ -...18 Packaged Rooftop Builder 1.69 Page 2 of 20 RTU-2 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM RTU-2 Tag Cover Sheet Unit Report Certified Drawing Performance Report Packaged Rooftop Builder 1.69 Page 3 of 20 U.,;,. R,.,t Fos RTU-2 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM Unit P.ramet.r. Dimension, (a. ) &Wight Unit Model _ ... ------ -...48TCED08A2A5-0A0G0 Unit Length: 7' 4.125" Unit Size: _.................._-_-------------.----.-.-----08 (7.5 Tons) Unit Width:_ 4' 11.5" Volts-Phase-Hertz:..........._.......-----------------------------------208-3-60 Unit Height: 3' 5.25'' Heating Type: - ---.._.......----------------------------------------._..G.. Tots, Operating Weight:_ 1103 lb Duct Cfg: . Vertical Supply I Vertical Return Medium Heat "' Weights and Dimensions are approximate. Weight does Round Tube Plate Fin Coils not include unit packaging Approximate dimensions are provided primarily for shipping purposes For exact dimensions and weights,refer to appropriate product data catalog. L,nend Filter, Gas Line Size: -----------...._.--.--..-----------------_.._.._ ._.._ 314 Condensate Drain Line Size:..... ............ 3/4 Return Air Filter Type:.._......._-........................_Throw.way Return Air Filter Quantity:__-.___. 4 Return Air Filter Size: ______ .-.__.............___ 16 . 20. 2 Selection include, construction throwaway filter into the base ran curve. This filter Is not MERV Rated. Unit Configuration Medium Static Option (Belt Drive) AI/Cu-AI/Cu Base Electromechanical Controls Standard Packaging 2-Speed indoor fan motor controlled by VFD Warranty Inrermation 1-Year parts(std.) 5-Year compressor parts(std.) 10-Year heat exchanger-Aluminized(std.) 15-Year heat exchanger-Stainless Steel(std.) No optional warranties were selected. NOTE: Pi.... see Warranty Catalog 500-089 for e:pia nation or poi ales and ordering methods. Ord.ring Inf. m tion Part N..mbe De ription Q ntity 48TCED08A2A5-OAOGO RooftopUnit a1 Base Unit Medium Static Option Belt Drive) Electromechanical control, No intake or exhaust option. 2 Speed Fan Controller VFD F..ld InstaIi.d Ac r CRRFCURB003A01 e, 14-inch Tall Roof Curb 1 CRDISKIT001A00 12 Speed VFD display kit 1 CRECOMZR069A01 JUltra LOW LEAK-Vertical EconoMi$er 1 Packaged Rooftop Builder 1.69 Page 4 of 20 _ 04\ 6Z z - © / ° CL §§ § ! 6 . . B � e<, '9— z :ig ■ 99 § k § 2a4:-7M. st � ♦ � . - | ° / -/�MOO. | y - ��_ ' § //. 7 j _ .. iz ;& ry � LH 2 �� � - \ � � � � ��2 f ` - \ eA ; a m zt - _¥ �i 2�! 2 --2;gne!. �! £ 7� - - ■ & ■ � � k A�§ ƒ ¥ � $ ƒ tzg ! \ 0 \ 0 7 = \ g can / \ cu a_ a_ a O N CD N d O N LO OD °a a) N 0 i W O 0O aa�t d i�n m v co 5�esi u, m aQ o V S y Z ��x N m v � � O o L y�y O Z O N O rT V 4 L✓ - o 2 A �$< c CL e_ o C n SSe O 0 IS a) Y O N U O d d 0 N N a O O N C, O O O � O d �2f w � � E m 1 E 1 E E�'E � a aSa�S m gz � m s a O O Ct) .. o 10 � -0 Of m N @ co Y O O V (D d d d CD N N N d C O 04 LO 00 0 0 J\ d \\ N '` d� �o 1■111 b � N* s 3 L be N L � ' I � A 0 hi kjca 7w a � � m " S �6$— bo' 0 0 co � -0 �j 1 � i w � � � Y O � U f0 as d Performance Summary For RTU-2 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06.57PM Part N�r„berA8TCED08A2A5-0A0G0 AR I E E R: ----------....-...................-----------......_...------ --------- 11.00 IE E R: ----.................................................. _.._ 12.8 B... Unit Di.a..,.1on. Unit Length:.................- --- ----------- - — -- -..._ 88.1 in Unit Width: ............................._..._..._..._............. . ........-59.5 in Unit Height: ____ _----—--- ---— ........ 41.3 in Opa--g W—ght BaseUnit Weight: .........................................................................- - ..............................._......................_.....................835 lb MediumHeat: ..............._......._.-_.-------------------------------------------------------------------- ..................15 lb Medium Static Option(Belt Drive): ---------•------------- - --------------------------------------- 2 Speed Fan Controller (VFD) - - -- --•--...-...................---------------------------------------- _.._..._._— - - - ......_...-----------20 lb A........., 14-inch Tall Roof Curb: ..--•---•----...---------------------------------------------------...... - - -...-...-.._........-..........--- -143 lb Ultra LOW LEAK-Vertical EconoMizer:.. TotalOperating Weight: _._..._................_................-............-.............-................-........-............................................ 1103 lb Unit Unit Voltage-Phase-Hertz: ..............................—...........................—....................................— ------------------_..208-3-60 AirDischarge: ...................................------—........................... ..........................................----------------------- V.r—ai FanDrive Type: ......----..................................................................................................................................... B., Actual Airflow:------------- CFM SiteAltitude:_.............--- - ....................--.............................................................................................. ..................._._._ 0 ft Coorng P.rf—.— CondenserEntering Air DB: ............-- --- ----- —..................................................—•--...-...-.......-...—----.....-95.0 F EvaporatorEntering Air DB:.--.......----_.........._.._............_............_...-....................—...-.............................-...........................78.0 F EvaporatorEntering Air WB._..---------••------------------•---------........................... — - ...................... ...-............-..................... 66.0 F Entering Air Enthalpy: _-.... .. ..-30.66 BTU/Ib EvaporatorLeaving Air DB: -....................................................................................................................................— 57.6 F EvaporatorLeaving Air WB:_ _ - - - - _ - —........................................................................................... 56.4 F Evaporator Leaving Air Enthalpy:..........._.____...__._..._......_........................................................ 24.01 BTU/Ib GrossCooling Capacity:.. -- - - .....-.......-...-.----------------------------------—..... -- --------......--•---. — .._..._... _---..._..._..88.38 MBH Gross Sensible Capacity: ..............._..._..........................._..._..._. ......................................... MBH Compressor Power Input: ------.......-----------------------.......... - - - —............................................................................ 6.38 kW CoilBypass Factor: ..- - - —.........................................................---........................................_................................0.094 Haat,ng Parrnr,nan�. Heating Airflow:_-----_..._..._..._................_......_..._................. ._2950 CFM EnteringAir Temp:------------------- - - - ------............................—........................................................... 70.0 F Leaving Air Temp:-,-,................................... Gas Heating Input Capacity:............. ............_......... .......120.0 1180.0 MBH Gas Heating Output Capacity:...................................... ..._. _._..-_....-98.0/148.0 MBH Temperature Rise: ---•— - --- - - - - - - --- -- - ---- - ------ - - ---- -- 46.5 F ThermalEfficiency(%): .---.................... _.._..—.................................................................................................._......._82.0 Supply Fan External Static Pressure----------- - ------ -----... ..............-...-........--...................................._.--......._..._.........................0.60 in wg Options/Accessories Static Pressure Economizer- -----------------..............................................-------------•-----------------.-. .0.10 in wg Total Application Static(ESP+Unit OptslAcc.):..................................................--........_.................__--------.--------------------0.70 in wg FanRPM:----------------------------. ....................._.......---......----------...---------------------.._........ -- ..................784 FanPower: ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1.75 BHP NOTE: _._. ......... _...............S.o.ot.d IFM RPM R.n..:733-949 Selection includes constriction throwaway filt.r into th. b... r.n cu —This filt.r is nut MERV R.—.. E�a�tr,�a� Data Packaged Rooftop Builder 1.69 Page 9 of 20 Voltage Range: .'-. ------' 87'253 Compressor#1RLA:-............................................................................ ....... -------------- 3.6 Compressor#1LRA ----------------------------------------------------------------------------__—' ----- ....... --------------------------------------------------------------83 Compressor#2 '_-- ---- ------- -..................................-----------------13.5 Compressor#2LRA ....................... _-__------ ----— ....... ..................... ---—_83 Indoor Fan Motor Typo� --------------- ................------------------................................. IVIED Indoor Fan Motor F -----_--------- 8.4 Combustion Fan Motor FLA ---'—'_----'_ PowerSupply MCA: _------------------------------------------------------------------------ _--------------------------------------------------------------------------------------------43 Power Supply M0CP(Fuse cv ..... --------------------------------'--_------------'5O Disconnect Size 5 DisconnectSize LRA:- ---------------- -----------___'_—_—_--..................... ....... ........ .......--------------------------------------------------- 227 Electrical Convenience _ -------------------- m... Outdoo Fan pQty/FLA ............... 2/ 1.5 C..~~. P.... 3CCR: S°ARNS.` R~°° 5,~~.,.... V..~°. A.~...... Sound Power Levels.db v: 1UE'12VVaus D..^~°. |.... O..°... 53Hz 984 95.5 858 125Hz 814 00.4 843 250Hz 782 737 80.5 500Hz 70.8 06.0 787 1000Hz 874 63.7 704 2000Hz 001 58V 727 4000Hz 87.4 582 683 8000Hz 708 57.8 051 A.VVeighn,d 79.0 74.8 82.0 Ad.....dA.~..°.. A°.....~ A........ P...~..~.. 1 Unit height above gmund� --------'_--------30.0 ft 2. Horizontal distance from unit m receiver: ---------------5nV ft 3. Receiver height above ground:_�-- -.-----5J ft 4. Height cxobstruction: V.O M 5. Horizontal distancefromobstructiontnmceker''V-O M 0. Horizontal distance from unit mobstruction:-........0.O M D.`.".^ o~~..".. |.~.~..~. Performance Summary For RTU-2 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM A 85.8 84.3 80.5 78.7 76.4 72.7 68.3 65.1 89.6 Lw B 59.668.271.975.576.473.969.3;31#.649.0 4LwA C 53.4 51.9 48.1 46.3 44.0 40.3 35.9 2 L D 27.2 35.8 39.5 43.1 44.0 41.5 36.9 LpA Legend A Sound Power Levels at Unit's Acoustic Center, Lw B A-Weighted Sound Power Levels at Unit's Acoustic Center, LwA C Sound Pressure Levels at Specific Distance from Unit, Lp D A-Weighted Sound Pressure Levels at Specific Distance from Unit, LpA Calculation methods used in this program are patterned after the ASHRAE Guide, other ASHRAE Publications and the AHRI Acoustical Standards. While a very significant effort has been made to insure the technical accuracy of this program, it is assumed that the user is knowledgeable in the art of system sound estimation and is aware of the tolerances involved in real world acoustical estimation. This program makes certain assumptions as to the dominant sound sources and sound paths which may not always be appropriate to the real system being estimated. Because of this, no assurances can be offered that this software will always generate an accurate sound prediction from user supplied input data. If in doubt about the estimation of expected sound levels in a space, an Acoustical Engineer or a person with sound prediction expertise should be consulted. Fan Curve 20 m� - 11oorFt 18 16 o,1a 3 7oaFM c U) 10 N a U CB i_J C/) C6 M 04 C2 1.90 TI Co CD 04 tB 12 16 20 24 28 32 �13 40 44 Aiflow(CFM-thot.sands) RPM=784 BHP=1.75 M<ixin=iRPM=14(X)Maximimi BHP=4.70 Note:Pleasecaltactapplicationcngi�forselectionsoutsidethe shadedregion. SC-SystcmCurve RP-RatedPoint Packaged Rooftop Builder 1.69 Page 11 of 20 RTU-1 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM RTU-1 Tag Cover Sheet Unit Report Certified Drawing Performance Report Packaged Rooftop Builder 1.69 Page 12 of 20 Unit Report For RTU-1 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM Unit Per .,,.ter. Dimen.ion. (n. in.)&Weight(ib.)••' Unit Model: _ -- _ -- _ 48TCED12A2A5-OAOGO Unit Length:.. ........... ____..._.._. sees.- .7' 4.125" Unit Size: _ _ ___12 (10 Ton.) Unit Width:... ._..._____._._____. _ _____4' 11.5" Volts-Phase-Hertz: --- -- __ 208-3-60 Unit Height:_ .----- --- _ _ _ 4' 1.375" Heating Type:_ ___ _ _ _ __. Ga. ... Totai Operating Weight: 1211 lb Duct Cfg:.________ Vertical Supply/Vertical Return Medium Heat "' Weights and Dimensions are approximate. Weight does Round Tube Plate Fin Coils not include unit packaging. Approximate dimensions are provided primarily for shipping purposes.For exact dimensions and weights,refer to appropriate product data catalog. Lines .na Filter. Gas Line Size:....-- --._. .. 3/4 Condensate Drain Line Size:_ _ __ ___ __3/4 Return Air Filter Type: - __ ___ __Throw.w.y Return Air Filter Quantity: _ _ ____ 4 Return Air Filter Size:.. ..s ee s._ __ _ 20. 20. 2 Selection includes construction throwaway filter into the be..fen curve.This filter is not MERV Rated. Unit Configuration Medium Static Option(Belt Drive) AI/Cu-AI/Cu Base Electromechanical Controls Standard Packaging 2-Speed indoor fan motor controlled by VFD Way Information 1rYear parts(std.) 5-Year compressor parts(std.) 10-Year heat exchanger-Aluminized(std.) 15-Year heat exchanger-Stainless Steel(std.) No optional warranties were selected. NOTE: Please see Warranty Catalog 500-089 for explanation of policies and ordering method.. Ordering Information Part Number Description Quantity 48TCED12A2A5-OAOGO RooftopUnit 1 Base Unit Medium Static Option Belt Drive Electromechanical control, No intake or exhaust option. 2 Speed Fan Controller VFD Field Installed Ac orl.. CRRFCURB003A01 14-inch Tall Roof Curb 1 CRDISKIT001A00 2 Speed VFD display kit 1 CRECOMZR069A01 Ultra LOW LEAK-Vertical EconoMi$er 1 Packaged Rooftop Builder 1.69 Page 13 of 20 % i 2 / tie a \ % 0 % � § ( izZZ / a E jam . 22kFS � | a « tg [� Bk ; f 2 ya $ 2 Ire � ' ' \\ � }�k � � � }99� � � � ♦ =9�© ¥ - ( ° \ slop" Ig ■ ` 43 y f § V r72 78 At J J � � � ■■ � � � .6t! 0 - o-1 ua g y y. , =2! "q2 ' Z4-Z:E72Z-V7 # � � � � � � � . & �. . ! ■ 2 ■ ! 273' a . �w 0 \ . § k - t § f = ® , 2 / e \ E = E \ > \ N \ - . . . . ... 0 \ \ ■� % g � _ R . . ,1§ \ E �§ 2 ■! _) � --- -ni ul �# # ` ] � » � , 8 — c } - --- ■ � �_- p , . - ! \ T 3■�il;�; CD \\/ k .\\j CD$ , o "' '`!■ & j a !! 0 \ .. ee!l:l;99 S f = ' 11 '0 (k;2& kIW / \ \ a_ 0- _ gi 2 \ \ \ CD / E rT �\ \ ! � .2 = k \ { p ± § ) ))ƒ�! !- = !«`. . v§§ L. ! $ ■ of^ I f_ I{�I _ } t / ■�! E EN 1E= E ° r ` | \ M. \|I { \ \ \ = 2 \ \ 0 _ .. c � - \ t \ 2 /ƒ \ N O N d N 00 -- - - - t- O O (0 at �7�GGz 6 C6Y r W w ds ry w m T �G ^V1 W � S v / 0 Al x$ D � m a lf CC 0 a) � a) m N Y O N U 0- a` a P°,^ N"~^..A8TCEO12A2A5'0A0GO AR| EER: llIN |EER 12.8 o... U.. o_...^~.. Unit Length: ......... 88] in Unit Width: ------ 59.5 in Unit Height: --- ---__ ............... 49.4 in 0,......° W..°^` Base Unit 9*0 |b MediumHeat-------------------------- ------------- -_-_----_----__-_-_-----_--'- 18 |b MediumStatic Option(BmkDhxe):... .................... ---------------------- '............................................................................................. 15 |b 2 Speed Fan Controller (/FD)- -------- ------------ --------------------------------------... ........ ............ ..................2O |b .......... 14inoh Tall Roof Curb: --' -143 |b Ultra LOW LEAK Vertical EconnMi$ec' ....................----------------------------------------------------------------------- 75 |b Total Operating Weight: ------...........---......................-------- --------- 1211 |b "~'` Unit Voltage-Phase-Hertz: .............. 2083-60 Air Discharge:-_ --- ---'---- «~~— Fan Drive B.° Actual Ai 3700 CRN Site Altitude:. . V M c.."." p^°..~.... Condenser Entering Air D8: 85.0 F Evaporator Entering Air D8: -uo.O F Evaporator Entering Air VVB:' 67.0 F Entering Air Envha|py: 1.44 BTU/lb Evaporator Leaving Air D8: - -569 F Evaporator Leaving Air VVB: 56.5 F Evaporator Leaving Air Enma 24.07 BTU8b Gross Cooling Capauty:-_----_--_'_-__---_---__-_-'----- - lZZ6h MBH GmooSensib|eCapooty- -- oz J§ MBH Compressor Power Input:.................................' ................. ............ ............ ................................._-' 88* kW Coil Bypass Factor: _..... ........... 0.041 *.~.." p..,~.~.... HeatingAirflow:-------...................................................................----------------------------------- ' 3700 CFM EnteringAir Temp:............--.... ......................... .............................. ............................... ... ............ ...................... 70.0 F Leaving Air Temp:------------- ............................................................---- - 116.0 F Gas Heating Input Capacity: -..... .......................................... ...................................................................18O.0/224.O MBH Gas Heating Output Capacity: ................. ....... .............................................................. ]47.O/ 184.0 M8H Temperature Rise: ------- _.--- --- --------'-__'........... 46.0 F ThermalEfficiency(96):....................................................................................................................................................... BzO 5.,~., F.. ExternalStatic Pressure............................................................................. ................................................................................. 030 inwg Options/Accessories Static Pressure Economizer: --------------------------------------------------------------------------- ............ ................. ............---.............................. ........-- 0.17 inwg Total Application Static(ESP~Unit OptsN\ccj:----------------------- '0.*7 inwn FanRPM: ........... ........... ..........................-------�857 FanPower --------------------------------------------------------------------------------------............--------------------.................................................................. .......- l.89 BHP NOTE:.'.-- - ---- - -- 8.1..` d IFM RPM R�.=.:O3B' lUa4 5~.~~°_. .....^~. ........~. `^.~~.~., °°.._ the base ran ......This °°.. . ..,xxERvR.., E...~.... Data Performance Summary For RTU-1 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06.-57PM VoltageRange:. ------------------------------------------------------- ------------------ 87 -253 Compressor#1 RLA:............-.................-....... ......................................................-...........-....................................................._ 15.6 Compressor#1 LRA: - --- -...................-............................................................---.....................--..................................110 Compressor#2 RLA:.....-...-•--..................-..................-.....................................................................................................15.9 Compressor#2 LRA:............. . .. ........•-•-•---.-........-.....----------.._...-...-.----...............-------•-•--•---......--•---...-........-.....------.......... 110 IndoorFan Motor Type:. .__.._ ------------------------------------------------ - ......-------------___....---•-----•------• Indoor Fan Motor FLA: _.._ ___- ....._-------------------------------------- - ......-...-...-.....................- ..10.6 --------...---------- ------------. Combustion Fan Motor FLA(ea): ............................................................................................................................0.48 PowerSupply MCA:...__ __.....__ . . . . ------------------------•-•----------------------------_50 PowerSupply MOCP(Fuse or HACR):--------..._...-........................................................-............-............-.......-...................--.60 DisconnectSize FLA........................-............-.......-................___...............................................-........-...-...-...-----•-----...........-........52 Disconnect Size LRA: - - ----------_- --- --- - - - - ----- - - - - - ---305 Electrical Convenience Outlet ................-................................................................................................................ on. Outdoor Fan[Qty/FLA(ea)]-............-....---.............................................................................................................._2/1.5 Control P.n.i SCCR: 5kA RMS.t R.t.d Sy-tric.l V.1t.q. A_uatic• Sound Power Levels,db re 10E-12 Wafts Di,charg. In1.t Outdoor 63 Hz 97.3 94.2 89.0 125 Hz 92.9 86.1 83.1 250 Hz 78.8 70.4 80.5 500 Hz 72.8 66.3 78.5 1000 Hz 68.4 63.7 75.5 2000 Hz 66.0 59.3 71.6 4000 Hz 69.1 59.1 69.6 8000 Hz 70.0 57.9 69.3 A-Weighted 80.4 73.9 82.0 Advancad Accu,tic, ks 4 7 Adwanc.d A--ti- Par .ter. 1. Unit height above ground:_..-........-.................--.......--__.30.0 ft 2. Horizontal distance from unit to receiver:_.............._50.0 ft 3. Receiver height above ground:_._ ____._ ..........._..- _5.7 ft 4. Height of obstruction: _.. . _ ____ 0.0 ft 5. Horizontal distance from obstruction to receiver:.. 0.0 ft 6. Horizontal distance from unit to obstruction:. 0.0 ft D.t.ii.d Acoustics Information O.t.- B.nd C.nt.r Fr.,. H. 1 63 1125 1250 1500 1 1. 1 2. 1 4. 1 8k IOv.r.1i Packaged Rooftop Builder 1.69 Page 19 of 20 Performance Summary For RTU-1 Project: 116 South Ridge Street 09/28/2022 Prepared By: 06:57PM A 89.083.1 80.578.575.571.669.669.391.0Lw B 62.867.071.975.375.572.870.668.281.1LwA C 56.6 50.7 48.1 46.1 43.1 39.2 37.2 36.9 58.6 L D 30.4 34.6 39.5 42.9 43.1 40.4 38.2 35.8 48.7 LpA Legend A Sound Power Levels at Unit's Acoustic Center, Lw B A-Weighted Sound Power Levels at Unit's Acoustic Center, LwA C Sound Pressure Levels at Specific Distance from Unit, Lp D A-Weighted Sound Pressure Levels at Specific Distance from Unit, LpA Calculation methods used in this program are patterned after the ASHRAE Guide, other ASHRAE Publications and the AHRI Acoustical Standards. While a very significant effort has been made to insure the technical accuracy of this program, it is assumed that the user is knowledgeable in the art of system sound estimation and is aware of the tolerances involved in real world acoustical estimation. This program makes certain assumptions as to the dominant sound sources and sound paths which may not always be appropriate to the real system being estimated. Because of this, no assurances can be offered that this software will always generate an accurate sound prediction from user supplied input data. If in doubt about the estimation of expected sound levels in a space, an Acoustical Engineer or a person with sound prediction expertise should be consulted. Fan Curve za _ — 17 ,$ K7 \ ,6 3,4 C �—12 7 U � U) \ 04 20DBFP 05pBF� 0. FP 1.0 -1508 v 0D 00 QB 12 1B 24 3D 36 42 4B 54 Aiflavv(CFM- IOL�) RPM=867 BHP=1.89 MaxinimiRPM=1400 MaximwI1BHP=4.70 Note:Pleasecontactapphai ioncnor eeringforselectiomontsidcthcshadcdirgion. SC-SystemCu ve RP-RatedPoint Packaged Rooftop Builder 1.69 Page 20 of 20 A�"�® DATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10127/2022 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 a. PRODUCER CONTACT NAME__ Kenn Vega y State Farm Kenneth M Vega Insurance Agency PHONE 718-413-0033 (F°x 718-502�479 IA1c F.t1' (_A/C,NoL 3920 Queens Blvd EAiA1L kenny@myagentvega.com *?We Sunnyside,NY, 11104 INSURERS)AFFORDING COVERAGE _ NAIC• INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER a: State Farm Fire and Casualty Company 25143 Baysice Refrigeration DBA Airlogix INSURER C: 0 24-26 46th Street INSURER D: __ 0 Astona,NY, 11103 INSURERE: INSURER IF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL'SU13R POLICY NUMBER POLICY EFF I MOLICOY T YEY% LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 DAMAGE TO �- RENTED CLAIMS-MADE X OCCUR I PREMISES Ea occurrence S 300,000 MED EXP(An ona person) S 5•DOO B X X 92C4P7813 05/01I2022 05/Dl/2023 PERSONAL d ADV INJURY $ 5.000.000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 10,000.000 X POLICY 19 JPERC n LOC PRODUCTS-COMP/OP AGG f 5,000,000 OTHER, $ AUTOMOBILE LIABILITY X X 2875497-E01-32 05/01/2022 05/01/2023 """Po SINGLE LIMIT S 1,000,000 X ANY Auro 32-127F-B29 05/01/2022 05/01/2023 8001LY INJURY(Per person) s A OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY A'JTOS HIRED NON-OWNED PROPERTY DAMAGE i AUTOS ONLY AUTOS ONLY of ac;p I 3 UMBRELLA LIAR X OCCUR EACH OCCURRENCE 3 5,000,000 B X EXCESS LIAO CLAIMS-MADe X X 192C4P7852 05/01/2022 1I 05/01/2023 AGGREGATE 3 5,000,000 DED RETENTION 3 S WORKERS COMPENSATION Pe R OTH- AND EMPLOYERS'LIABILITY STAT YIN LITE c ANY PROPRIETOR.'EXCLUDED? E/ExFCUTNE El NIA E.L.EACH ACCIDENT S OFF iCER/MEMBER EXCLUDED? (Mandatory In NH) 'E.L.DLSEASE-EA EMPLOYE $ H yyes,dw be order 0 SCR'PTION OF OPERATIONS bek— E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It mwe space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street 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 1001486 132849.13 04-22-2020 NiroR c Workers' CERTIFICATE OF sv►�I Coard mpensation Bo NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name Address of Insured(use street address only) 1b.Business Telephone Number of Insured FrankCrum 11,Inc.Labor Contractor,for leased workers to: (800) 277-1620 Bayside Refrigeration Inc dba:Airlogix 1c.NYS Unemployment Insurance Employer Registration Number of insured 2426 46th St Astoria,NY 11103 1d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to certain Number locations in New York State,i.e.,a Wrap-Up Policy) 112676236 2.Name and Address of Entity Requesting Proof of Coverage(Entity Being 3a.Name of Insurance Carrier Listed as the Certificate Holder) American Zurich Insurance Company Village of Rye Brook. Building Department 3b.Policy Number of Entity Listed in Box"1a" 938 King Street WC 50-23-139-01 3c.Policy effective period Rye Brook, NY 10573 6/1/2022 to 6/1/2023 3d.The Proprietor,Partners,or Executive Officers are included.(Only check box if all partners/officers inclued) X all excluded or certain partners/officers excluded. This certifies that the insurance carver indicated above in box"3 insures the business r ferenced above in box'I a'for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carver or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box 7. The insurance carrier must notify the above certificate holder and the Workers Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box 3c,whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,licese 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 refemced above and that the named insured has the coverage as depicted on this form. Approved by: Douglas Jones (Print name of authorized representative or licensed agent of insurance carrier) Approved bv: � i��✓ 10/27/2022 (Signature) (Date) Title: Vice President Telephone number of authorized representative or licensed agent of insurance carder: (480)951-4177 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) ww.vvcb.ny.gov