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HomeMy WebLinkAboutMP22-106V/ TCO N FEE DATE INSPECTION RECORD DATE INSF FOOTING FOUNDATION FRAMING RGN FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT O ALARM AS BUILT Q FINAL `c�, cj(� �9/y�83S-51o59 8/ila.7 Bo�sfo// ElPcfi %cal OTHER APPROVALS ARB SOT PB ZBA OTHER ,�/,Aga-/o7/�1a/sfesro%(�ci%nn Rio/et mCo.�lnc _Ck, 1e44-e-r qI /djzc/ BRnuk C t�4Ju JJ V G ur G�i 7. 193 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 10,2024 Gary Jacobs&Cynthia Jacobs 116 Country Ridge Drive Rye Brook,New York 10573 Re: 116 Country Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 129.66-1-11 Mechanical Permit#22-106 issued 7/1/2022 for a New Generator This certifies that the 30kw LP gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to BR(� tC 4°uJJ� G Ql� VLUC W�J 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.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 10,2024 Gary Jacobs&Cynthia Jacobs 116 Country Ridge Drive Rye Brook, New York 10573 Re: 116 Country Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 129.66-1-11 This document certifies that the work done under Mechanical Permit #22-107 issued on 7/1/2022 for the installation of one 500 gallon under-ground propane tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to F1 . i BUILDING DEPARTMENT PERMIT# "�� °1 t' /O SEP - 5 2023 ! 'i938 VILLAGE OF RYE BROOK ISSUED: '7—/—���- -! KING STREET,RYE BROOK,NEW PORK 10573 DATE: Q)L/ VILLAGE OF RYE BROOK (914)939-0668 FEE:A PAU4& BUILDING DEPARTMENT �►101��.nebrook.orl, 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 rrrrrwrr♦rrrwrrrr•rrrr•rrrrprr rr rrru rrrrrwrrrr aar r•rrrar rrr rrr rrrrrwrrrr rrrrwwr••rr►rrrrrrrrr rrr rr rr••rrrrrrrrrw•rwrrrru Address: Occupancy/Use: P reel ID#: — Zone: Own9r: _Address: P.E./R.A. or Contractor: 14 ,/7kk E .'7i,S7'2// 4f— IPC40 CA&ess: Person in responsible charge: C'.�� / dress: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction)'alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: .� eing duly sworn,deposes and says that her she resides at fo I\u aadS!w _ / in in the County of ��pT J�}C�p n �� in the State of Imo! that oµ I- VIIhg—I hershe htas.pe'rvised 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: for the construction or alteration of: _3Q_ k (.0 00 Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been crected/complcted in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed compl ies with the laws governing building construction.Deponent further understands that it shall beunlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this Li4k Sworn to before me this j4\ Y of AV USt , 202_L d of V 2023 t VA gnature of Prope ner S gnature of Applicant Print time of Pro erty Owner Print Name of Applica t Notary P Notary PubROSANNA G MART NOTARY PUBLIC-STATE OF NEW YORK No.01 MA6435613 NOTARY PUBLIC-STATE OF NEW YORK Qualified in Bronx County No.01 MA6435613 My Commission Expires 06-27-2026 Qualified in Bronx County My Commission Expires 06-27-2026 �yE BRC��, O� Zm b • �9a2 BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - -- - ADDRESS : 1 t DATE: `� I �C- � 1 PERMIT# ^ ` � `� ISSUED: �ICT: BLOCK: LOT: LOCATION: OCCUPANCY: _j ❑ Violation Noted THE WORK IS... Y PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION ma q 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 _ W ' u b v � N ■ CV N N p W� . . t (n s I-1 Q jJJC+yi .y. yy o�� V p _ G a 44 Ln 4.4bit cx = w Ln en 0 1�1 00 ° o F+ v w 4 '1 44 � O W O oag �, �/ va14 h� W d W ® ® a � a' V a V A � 0 w ,N y^ - V s ^ O w � � o �•••1 0 O o a w GON 00 OC o OW 00 Cc: W � G H n zap . O � U u � z •• � 4 iL V � � � a a � � n 14 GQ a W x z td M BUILDINGARTNIENT VILLA OF RYE �OOK 938 KING STR`'CT RYE BROII*,NY 10573 JUN 2 4 2022 WMA.:a Qk.ofP_ VILLAGE 0F RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: JUN 3 0 &Wmit# ��/ Application # Approval Signature: ARCHITECTURAL REV W BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee! Permit Fees: APPLICATION TO INSTALL A PERMANENT STANDBY BACKUP GENERATOR Application dated: bL1q is hereby made to the Building Inspector of the Village of Rye Brook for the issuance of a Permit to install a permanent standby backfip ge erator in accordance with§250-4.1.of the Code of the Village of Rye Brook,as per detailed statement described below. Please note that electrical and plumbing permit applications must be filed separately by those licensed professionals,and that separate permits are required for the installation of any related fuel tanks.Further note that all applications for commercial use will require a site plan approval from the Village Planning Board prior to the issuance of any permit. 1. Job Address: 1p 0 �7 2. Parcel ID#: I 2q . 4, (o — ] • ( 1 Zone: "f 3. N.Y.State Construction Classification: N.Y. State Use Classification: 4. Proposed Generator& Fuel Type(Describe in detail): 3d V_W IL O We d pf U acne_ 5. Property Owner: Address: Phone# A ell# /r• D email: �p Applicant: Address: 0 Phone# Cel{# �',-r�'3�d$� email: �m4a c1.Ee�J�'l 46MAi Architect or Engineer(if applicable): Address: Phone# A Cell# email: General Contractor: Address: 10 s Phone# ` 8 Sb ell# / OS email: (-#7)9IL t 811 212021 6. Give exact dimensions from proposed generator to lot lines: front yard: rear yard: right side yard: left side yard: 7. If building is located on a corner lot,which street does it front on: 8. Will the proposed project disturb 400 sq.ft.or more of land,requiring a Stormwater Management Control Permit from the Village Engineer as per Chapter 217 of the Code of the Village of Rye Brook? Yes: No: 9. Will the proposed project require a Site Plan Review by the Village Planning Board as per Chapter 209 of the Code of the Village of Rye Brook? Yes: No: (provide detailed drawings as per Chapter 209) 10. Will the proposed project require a Steep Slopes Permit as per Chapter 213 of the Code of the Village of Rye Brook? Yes: No: (provide a detailed topographical survey) 11. Is the lot or any portion thereof located in a Wetland as per chapter 245 of the Code of the Village of Rye Brook`? Yes: No: (provide a detailed survey indicating the Wetland&Buffer Zone) 12. Is the lot or any portion thereof located in a Flood Zone as per the FEMA Flood Insurance Rate Map#36119CO279 dated 9/28/07? Yes: No: 13. Will the proposed project require a Tree Removal Permit as per Chapter 235 of the Code of the Village of Rye Brook? Yes: No: (a tree replanting schedule may be required) 14. Does the proposed project involve a Home-Occupation as per Chapter 250-38 of the Code of the Village of Rye Brook? Yes: No: If so, indicate: TIER I: TIER II: TIER III: 15. What is the total estimated cost of construction: $ '7, eoc> (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis) 16. Estimated date of completion: STATE OFp NEW Y1ORK,COUNTY OF WESTCHESTER ) as: AL JD being duty 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 CAIkti061( 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,jthe Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this p' \ Sworn to before me this Z - day of �=J , 20 C�2, day of `4� 2A NIL yzia�_ Signature Property Owner Si gea"t'EnCot AppIica P ' AVame of Property caner NotaR Publ' ER 0ri@RN SHAR ELI110 �'pUbric,$tale of 1V a Public,state of New York ©Ualifie o,0113R615 Of N;%Applicant 1ME6164063 Cornmi din westc Notary Public qualified in Westchester County Z ion ekPires commission Expires January 29,20 3 20` This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. 2 si12/2021 00 Ln ~ N N Ln W OV N N \ M oG a 1 y \ -- GO 1 •�i W a` w > aS ■ V a �_ q Q u 'ti a N U a v) d F-o Lrn o fan, pUj W C A � w �' U o U Cz a n a ►� Ono s � � O �■� � M ti U 0 t7 � Zi ■ 4 z :L Q o < V V W z v x '" z ~ o `—' Q w z w x a � c z �vD LS V� t VnBUIL"I ;� I�E��R'TMENT DD VILLAGE OF RYE ]R E OOK J U N 2 4 2022 938 KING S'T*T RYE 131�OQK,NY 10573 ()[4 _066$ VILLAGE OF RYE BROOK www; &k.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY CU EP#: Approval Date: l \ Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ***************�/P*"_* **** *************************************************************************** Application dated,L_ c) r3 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or renlove electrical equipment, wiring, fixtures ,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal State,County and Local Codes. I.Address: ad L SBL: is 9.G 6 f — / Zone: .1k 2.Property Owner: Address: Phone#: Cell#: �� 3 email: C 3.Master Electrician: Address: Lic.#: leg Phone#: 5- bS Cell#: email: Company Name: AVAddress: . �M 4.Proposed Electrical Wor ixture Count: ********************************************************************************************************* /�1STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: J t ,N $et to l) being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) U4.^tee4 state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this CP i Sworn to�efo-repme this l " day of � "� ,20 71L Siga of Property Ownen �\ � Sigt of Appli nt � i Prin e of Pro r�L Print Name of!plicant Notary Public SHARI MELILLO t1RWGT rL1R J.BRADBURY Notary Public,State of New York Notary Public,State of New Yo No.O1ME6160063 No.01 BR6159985 Qualified In Westchester Coun" Qualified in Westchester County Commission Expires January 29,20� Commission Expires January 29,20 8/12/2021 STATEWIDE • Service With bitegrity 1080 • office@swisny.com SWIS JOB APPLICATION ;. 1 914.219.1062 • SWISTraining.corn Office Use Elect.Permit# 1_ \ \� Date 7 Bldg Permit# Utility ID# /t'I�� a - I �v Final Certificate# City/Village ocz Zip )! 3 Township C r .p Address Cross Street Section Block Lotto C C1,Vk h�(41 oc'. M I Owner Name/Address(if different than a ve) ry) ( `I �I Cabs Contact Number ❑Basement ❑1st Fl. ❑2nd FI. 7v❑� 3rd FI. ❑More Than 3 ❑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 13P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information 7kz �5k fle-Ace o f�i ) w k-o ( I e v CD Bo a vi Q g c c}✓ A lA �,eV1� U sS V, CCCFF WF D JUN 2 4 2022 1 ID VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWS.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 au1..d 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 , ,N r t `< ! Date Signature f ,� ✓ Address City/State ,� i K j Zip Code License# %j } Phone# 7 J .� State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 U S 845 202-7224 Phone 4 Va VW914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: -- L Alan Bonistall Electrical Contr, Inc. Jacobs Residence Alan Bonistall 116 Country Ridge Drive i 53 Purdy Street Rye Brook, NY 10573 N�V — 20222 j Harrison, NY 10528 VILLAGE OF RYE�BROOK BUILDING DEPARTMENT Located at: 116 Country Ridge Drive,Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-128 Certificate Number: 2022-4845 Building Permit Number: MP22-106 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 116 Country Ridge Drive, Rye Brook, NY 10573 The Garage and Exterior were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 14th day of October 2022. Name Quantity Rating Circuit Type Generator 01 30kW ATS 01 400AM P Officer: Frank!. 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%vork performed on the date of inspection only. 0 N N � W � � ►.� D a � o 01 ad � g 4 H M O W g y � w v " H 64 '= V� as w kn O z u � w 8 h..� CINoo zz y !^r_, w a < > T a V a E 'n as N W Uv $ CAa a o z o . < v� V V O D V gb § , " `►I i > � _� q U a � y a'u o �1 Z A Q a z r Zoe# I D JUN 2 6 202 R BUILD N „� MENT RIEviS S VIL Oli RY: OOK MAR - ?0 pIJ�N D• 8 KING Q E!?R. R -r ,NY 10573 VILLA of GE 11 pATE -� SUILp�NG pij Oye t3RODK Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: �/ ) O 7 JUN 3 2D22 ��, 'Ed Approval Date: Permit Fee: $ Approval Signature: �FL. 1-IZ�lZO� t�U � Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C 105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment, or Installation: $185.00 per Tank. 1G '04,$ ' #5. Dig Safely New York#(dial 811): 6. Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests& Reports (after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. ******************* ** ******************************************************************************* Application dated, 7 is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/ r install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and r ' s. Indicate Permit T : nstallat' ( • Removal( )•Abandonment( )/Above Ground ( ) Buried in�Groun 1. Address: COLX)�ry '��'064-C SBL: Zone: 2. Property Owner&Address: C �yy�-C <y 3e,CpbS ll(� Covnf�y � P ��D�l���y Q�IGGz( Phone#: Cell#: ylg- $aN-, 14f93 email: CRC08S(f-44&)P tY-(6M 3. Contractor&Address: J4 q(Sj-L-nr C;2 u."14 D.%. 4''f,T Kttc.,� K!j Phone#: I c{- 32,(>c Cell#: email: *J2:C!(P. 4. Applicant: Phone#: Cell#: email: 5. Indicate Fuel Type: Fuel Oil( )•L.P.Gas 66•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: I - Sc5-o Crrr+Clow j71to��.wucv yy.UK. G.;tU 6-;+0,eA"t,eva bfxi K> L )LCAIAVTf-CA; Q) lS V O�weti� - 7. Exact Location(s)of each Tank: l�i C",i-1 i `�i t z GK t 8/12/2021 STATE F NEW YORK COUNTY OF WESTCHESTER ) as: G m An being duly sworn,deposes and states that he/she is the applicant above named, (print name oflindividual 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 pulkyy�— 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. n Sworn to before me this Sworn to before me this day of U ,20 day of /1'�u^� 20 22 LORI HAPRIGAN �— NOTARY PUBLIC,STATE OF NEW YORK ignature of PropeAy Owner NO.01 HA6214953 Signature of ppli QUALIFIED IN NEST NESTER COUNTY \ S COMMISSION EXPIRES VECEhi BER 21,20 7 � Print a of Property Ow Print Na e of Ap licant ENot;ary JIENTHAI 164� te of New York 4748Notary Public EST COUNTY N Public YorkCoun res NOV 19 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 8/12/2021 VgJFAFJVJV Your Full ServiceProvider 6/28/22 Pam Jacobs 116 Country Ridge Rd Rye Brook NY 10973 To whom it may concern, The underground propane tank located at the above-mentioned address has been installed in accordance with NFPA 58 codes. The tank location was addressed as per Mike Izzo request due to evidence of ledge rock in the area originally proposed. The new location is approximately 19 deeper into the property still maintaining all required setbacks. In the new location,when excavating,no ledge rock was found. The tank was set into a sand bed and then backfilled with additional sand. If you have any further questions,please feel free to contact our office. Thank you, Jerry Ccdrone llalstead Quinn Manager 33 I lubbelis Dr. Mt.Kisco NY 10949 914-666-3200 X109 33 Hubbells Drive, Mount Kisco, New York 10549 Phone (914) 666-3200 Facsimile (914) 666-6743 Your Pull ScrvlcrArovidel- NALSTEAD-QUINN PETROLEUM CO„INC. 33 HUReeks DRIVE MOUNT KISCO.NY 10649 (014)669.3200 DATE: 1212l2021 Note;All plumbing and plumbing permltc dean by others.Halstead Quinn ACCT NO.: will make(ulal connection;alter so plumbing Inapectlonc are completed NAME: DeslgA Renovollon: ADDRESS: 116 Country Ridge Drive,Rye Brook EMAIL/FAX: HALSTBAD•QUINN 16 PLEASED TO SUBMIT THE FOLLOWING ESTIMATE FOR YOUR TANK INSTALLATION: (to euppert 18kw generator,400kbtult pool beater,and are ptl TANK& PART 1 PRICE/UN17�P OF UNITS PRICE l UNDERGROUND I 500•GALLON UNDERGROUND PROPANE TANK PSO/B ' $3,228.00 i I S3,YeB.001 �(•[�j o',./ l { I SACRIFICIAL MAGNESIUM ANODE BAG PS041 i $259,00 { 1 i $259.001 —� { 1 REMOTE READER I J �•�•r REMOTE READER SF306 F125.010i 1 � 5125A01 ANNUAL MONITORING CHARGE OF$79.00(BILLED VMEN MDNnoR 13ACTIVATEO j once yearj AND RECUR3 EVERY YEAR FROM ACTn/ATION onge) MATERIALS: , I TYPE"L"POLY COATED THICK WALL COPPER TUBING: ' I 3/8.10(PER FT.) NP282 i $3.9e1 Plurating( 10.00 1/2"ID(PER FT,) ,QSTIMATED/BILL ACTUAL FPPT NP2619 $4.60j dons by $0.001 3/d-ID(PER FT) $6.061 others $0.00j I ' FLEXIBLE CONNECTOR: j BRAIDED STAINLESS STEEL VIBRATION DAMPENING CONNECTOR NP293 I 585.95� 1 I F85.95I REGULATORS: { { 1ST STAGE REGULATOR(EA) R003 or R004 r $70.951 1 ! ! I i79.9,1 A006,R007, ' 2ND STAGE REGULATOR ROOK. Roos 1 $79.951 by others I $0.001 REMOTE VENT $79.001 by others; $aoo{ DANDIOLOCK FOR VERTICAL TANKS I { MOOIA $38.DOj I E0.00 bAN016LOCK FOR HORIZONTAL TANKS Moo10 I $50.001 $0.001 ADDITIONAL MATERIALS: I j METAL LOCATOR TAPE(PER FT) MP003 $0.381 waived $0,00 PIPE TRACING WIRE(PER FT) $0.301 I $0.001 I ! LABOR RATES: I I 1 DELIVER TANK TO SITE SLRT I $125.00; 1 I 1125.001 I II' I ONE MAN(price per nouh SLRT I $12$.001 2.5 $312.501 BASIC DISPATC14 CHARGE(price to arrive at jobelle) OF S55.001 $0.001 TWO MEN(price per pour) SLRT2 $260.00! $0,001 I PLUMBER TO RUN LINES AND SET PRESSURE TEST ON LINE $400.001 1 I $100.00 TOTAL EXCLUDING TAX: $4,696.40 The price above does not Include any applicable taxes,till led out upon completion.Farmit fees billed out separately Remote reader and monitoring fee 19 listed above and may not De Included In total.A remote reader is recommended on all generator links eo that they may be nceurately monitored. If you do not have a remote reader,we will not know when your generator Is In use urdeas you notify us. Inlhal delivery price per gallon Is: S 2.094 This,Is on estimate and may vary booed on actual work performed.This estimate will remain In affect for thirty(30)days from the data above. If you accept this estimate,please elfin below and raturn the estimate with a 90%deposit. Downpoyment of 60%le duo upon elgning of proDoael.Balance N due upon completion. Flnanou cilarg96 of 1.6%per month will be assessed for any balances considered Into by terms of this contract. customer shall pay any and all collection 1 Iroom and attorneys necessary to secure Into payments. Very truly yours, ¢g$eed and A d, Date: ��r 1cAlure Mork SchadwecMer Print`Neme `�Ll ` C-,0 OVERALL LEN FAIERALL I HEIGHT 1450 wy� AND op APPROXIMATE UNDERGROUND VESSEL DIMENSIONS AND SPECIFICATIONS WATER DIAMETER HEAD OVERALL OVERALL HEIGHT LEG** WEIGHT *':*QUANTIT)' CAPACITY (OD) TYPE LENGTH UGSR UGLR WIDTH (lbs,) FULL LOAD PER STACK Dimensions and specifications shown are approximate. Individual vessels may vary. ~Dual lifting lugs for 500and 100 wg.rtanurd tanks. ,^Leg widths and spacing may vary based vn mfg.location. Check with your salesperson for details. z20.zo\smwg.standard tanks'noholes m legs(one center hole nnrenuex). soo and zmmwg.standard tanks z holes zo''nncenter. 14sowa.and uvas shown above. ~~^Full load and stack quantities vary uv shipping location, Check with your salesperson for details. General Specifications Conforms to the latest edition of ASME Rules for Construction of Pressure Vessels,SectionVU|, Division 1. Complies with NFPAS8. Rated at2SOpskg from '2O^ FtolZ5^ F All vessels registered with National Board. Some standard vessels available with [RN (Canadian Registration Numbed. Vessels shipped with durable ready-to'burycoating. Vesse|s, dependingnn manufacturing location, are either powder coated with phenolic epoxy, painted with a single application urethane coating, or primed with liquid epoxy and coated with liquid epoxy top coat all providing a durable ready-to'burycoating. All vessels are shipped vacuum pre-purged to enable simplified first fill of the vessel. ' Green composite dome provides large working space and is resistant to the elements. Anode stud attached to riser pipe to enable ease of cathodic connection. Applicable federal,state,or local regulations mavcontamspocncmvu/rements for protective coatings and cathodic protection.The purchaser and installer aeespvn,m|emrmmp//anewu:aomuem(.otate,/no/anuwrpxmaustry regulations,including proper purging for first fill per wspxzs3-89(a).Cathodic protection required.Coating must be continuous and uninterrupted and must comply withan local,state or national code, KOHLER. Model: 30 R C LA Multi-Fuel Natural Gas/LPG 09001 Standard Features 4 WHUR • Kohler Co. provides one-source responsibility for the NATIONALLY REGISTERED generating system and accessories. • The generator set and its components are prototype-tested, factory-built, and production-tested. • The generator set accepts rated load in one step. • A standard five-year or 2000 hour limited warranty covers all systems and components. • Quick-ship (QS) models with selected features are available. See your Kohler distributor for details. • Meets 291 kph (181 mph) wind load rating. • GFCI service outlet installed on the junction box. • RDC2 Controller One digital controller manages both the generator set and transfer switch functions (with optional Model RXT transfer switch). o Designed for today's most sophisticated electronics. o Electronic speed control responds quickly to varying household demand. The Kohler", Advantage o Digital voltage regulation protects your valuable • High Quality Power electronics from harmonic distortion and unstable power Kohler home generators provide advanced voltage and quality. frequency regulation along with ultra-low levels of o Two-line, backlit LCD screen is easy to read in all lighting harmonic distortion for excellent generator power quality to conditions, including direct sunlight and low light. protect your valuable electronics. • Engine Features Powerful and reliable 2.2 L turbocharged liquid-cooled • Extraordinary Reliability engine Kohler is known for extraordinary reliability and o Electronic engine management system. performance and backs that up with a premium five-year or o Simple field conversion between natural gas and LPG 2000 hour limited warranty. fuels while maintaining emission certification. • Aluminum Enclosure III, Innovative Cooling System Attractive aluminum enclosure allows installation as close o Electronically controlled fan speeds minimize generator as 18 inches from your home or small business. set sound signature.• Certifications • Quiet Operation The 60 Hz generator set engine is certified by the Kohler home generators provide quiet, neighborhood- Environmental Protection Agency (EPA) to conform to the friendly performance. New Source Performance Standard (NSPS) for stationary spark-ignited emissions. o cUL/UL listing, CSA certification standard are available (60 Hz only). o Accepted by the Massachusetts Board of Registration of Plumbers and Gas Fitters. o Meets NFPA 37 requirements for 18 in, offset for installation. • Approved for stationary standby applications in locations Generator Set Ratings • served by a reliable utility source. Standby Ratings Natural Gas LPG Alternator Voltage Ph Hz kW/kVA Amps kW/kVA Amps 4E5.6 120/240 1 60 30130 125 30/30 125 120/240 1 60 30/30 125 30/30 125 120/208 3 60 30/38 106 30/38 106 4D8.3 127/220 3 60 30/38 100 30/38 100 120/240 3 60 30/38 92 30/38 92 277/480 3 60 30/38 46 30/38 46 * 50 Hz options available.Contact your Customer Service representative. RATINGS:All three-phase units are rated at 0.8 power factor.All single-phase units are rated at 1.0 power factor.Due to manufacturing vanations,the ratings tolerance is�5%. Standby Ratings:Standby ratings apply to installations served by a reliable utility source.The standby rating is applicable to varying bads with an average load factor of 80%for the duration of a power outage.No overload capacity is specked for this rating.Ratings are in accordance with ISO-3046/1.as 5514.AS 2789.and DIN 6271.GENERAL GUIDELINES FOR DERATING:Affitude Derate 1.3%per 100 m(328 ft.)elevation above 200 m(656 ft.).Temperature.:Derate 3.0%per 10'C(18'F)temperature above 25 C(77 F).Availability is subject to change without notice.The generator set manufacturer reserves the right to change the design or specifications without notice and without any obligation or liability whatsoever.Contact your local Kohler generator distributor for availability. G4-304 (30RCLA) 6/21 Alternator Specifications Specifications Alternator • NEMA MG1, IEEE, and ANSI standards compliance for Manufacturer Kohler temperature rise and motor starting. Exciter type Brushless,Wound-Field • Sustained short-circuit current of up to 300%of the rated Leads:quantity,type current for up to 10 seconds. 4E5.6 4, 120/240 4D8.3 12,Reconnectable • Sustained short-circuit current enabling downstream circuit Voltage regulator Solid State,volts/Hz breakers to trip without collapsing the alternator field. Insulation: • Self-ventilated and drip-proof construction. Material Class H Temperature rise 130°C,Standby • Windings are vacuum-impregnated with epoxy varnish for Bearing:quantity,type 1,Sealed dependability and long life. Coupling Flexible Disc Amortisseur windings Full • Superior voltage waveform from a two-thirds pitch stator and Voltage regulation,no-load to full-load .1.0%Maximum skewed rotor. Unbalanced load capability 100%of Rated Standby • Total harmonic distortion (THD)from no load to full load with Current a linear load is less than 5%. One-step load acceptance 100%of Rating Peak motor starting kVA: (35%dip for voltages below) 240 V 4E5.6(4 lead) 44 (60 Hz) 480 V,400 V 4D8.3(12 lead) 120 (60 Hz) 88(50 Hz) Application Data Engine Exhaust Engine Specifications 60 Hz 50 Hz Exhaust System 60 Hz 50 Hz Manufacturer Kohler Exhaust manifold type Dry Engine:model,type Residential Powertrain Exhaust temperature at rated kW,dry KG2204T,2.2 L,4-Cycle exhaust, °C(OF) 633(1171) Turbocharged Maximum allowable back pressure, Cylinder arrangement In-line 4 kPa(in.Hg) 7.5(2,2) Displacement,L(cu.in.) 2.2(134.25) Bore and stroke,mm(in.) 91 x 86(3.5 x 3.4) Fuel Compression ratio 10.5:1 Piston speed,m/min. (ft./min.) 310(1016) 258(847) Fuel System Main bearings:quantity,type 5,plain alloy steel Fuel type Natural Gas or LPG Rated rpm 1800 1500 Fuel supply line inlet 1 in. NPT Max.power at rated rpm,kW(HP) Natural gas fuel supply pressure,kPa (in.H2O) 5-11 LPG 47.8(64.1) NA 1.2-2.7( ) Natural Gas 47.6(63.9) NA LPG vapor withdrawal fuel supply Cylinder head material Cast Iron pressure,kPa(in.H2O) 1.2-2.7(5-11) Piston type and material High Silicon Aluminum Fuel Composition Limits* Nat.Gas LP Gas Crankshaft material Nodular Iron Methane,%by volume 90 min. — Valve(exhaust)material Forged Steel Ethane,%by volume 4.0 max. — Governor type Electronic Propane,%by volume 1.0 max. 85 min. Frequency regulation,no-load to Propene,%by volume 0.1 max. 5.0 max. full-load Isochronous C4 and higher,%by volume 0.3 max. 2.5 max. Frequency regulation,steady state -_1.0% Sulfur,ppm mass 25 max. Frequency Fixed Lower heating value, Air cleaner type Dry MJ/m3(Btu/ft ),min. 33.2(890) 84.2(2260) Engine Electrical Fuels with other compositions may be acceptable. If your fuel is outside the listed specifications,contact your local distributor for Engine Electrical System further analysis and advice. Ignition system Electronic Lubrication Battery charging alternator: Ground(negative/positive) Negative Lubricating System Volts(DC) 14 Type Full Pressure Ampere rating 90 Oil pan capacity,L(qt.)§ 4.2(4.4) Starter motor rated voltage(DC) 12 Oil added during oil change(on average), Battery,recommended rating for-18°C(0°F): L(qt.)§ 3.3(3.5) Qty.,cold cranking amps(CCA) One,630 Oil filter:quantity,type§ 1,Cartridge Battery voltage(DC) 12 Oil cooler Remote Battery group size P4 § Kohler recommends the use of Kohler Genuine oil and filters. G4304 (30RCLA) 6/21 Application Data Cooling RDC2 Controller Radiator System 60 Hz 50 Hz Ambient temperature, °C(°F) 45(113) Engine jacket water capacity,L(gal.) 2.65(0.7) Radiator system capacity,including VoL a. e24O S engine,L(gal.) 13.2(3.5) o Water pump type Centrifugal o Fan diameter,mm(in.) qty.3 @ 406(16) �®Q Fan power requirements(powered by IDv. .� .., engine battery charging alternator) 12VDC, 18 amps each Operation Requirements Air Requirements 60 Hz 50 Hz The RDC2 controller provides integrated control for the Radiator-cooled cooling air, generator set, Kohler8 Model RXT transfer switch, m3/min. (scfm)t 51 (1800) 51 (1800) programmable interface module (PIM),and load management. Combustion air,m3/min. (cfm) 1.6(57) 1.3(45) Air over engine,m3/min. (cfm) 25(900) 25(900) The RDC2 controller's 2-line LCD screen displays status t Air density=1.20 kg/m3(0.075 Ibm/ft3) messages and system settings that are clear and easy to read, Fuel Consumption* even in direct sunlight or low light. Natural Gas,m3/hr.(cfh)at%load 60 Hz 50 Hz RDC2 Controller Features 100% 12.0 (424) 10.0 (353) • Membrane keypad 50% 7.6 (268) 6.2 (222) o OFF,AUTO,and RUN push buttons 50% 7.6 (268) 6.3 (222) 25% 5.5 (196) 4.5 (159) o Select and arrow buttons for access to system Exercise 3.4 (121) 2.8 (99) configuration and adjustment menus LP Gas,m3/hr.(cfh)at%load 60 Hz 50 Hz • LED indicators for OFF,AUTO,and RUN modes 100% 4.7 (166) 3.9 (138) • LED indicators for utility power and generator set source 75% 3.7 (132) 3.0 (105) availability and ATS position (Model RXT transfer switch 50% 2.8 (100) 2.3 (81) required) 25% 1.9 (69) 1.6 (56) • LCD screen Exercise 1.2 (41) 1.0 (35) o Two lines x 16 characters per line 1 Nominal Fuel Rating: Natural gas,37 MJ/3m3(1000 Bt/ft3) o Backlit display with adjustable contrast for excellent LP Vapor,93 MJ/m (2500 Btu/ft ) visibility in all lighting conditions LP vapor conversion factors: 8.58 ft.3=1 lb. • Scrolling system status display 0.535 m3=1 kg. o Generator set status 36.39 ft.3=1 gal. o Voltage and frequency o Engine temperature Sound Enclosure Features o Oil pressure • Sound-attenuating enclosure uses acoustic insulation that o Battery voltage meets UL 94 HF1 flammability classification and repels o Engine runtime hours moisture absorption. • Date and time displays • Internally mounted critical silencer. • Smart engine cooldown senses engine temperature • Skid-mounted,aluminum construction with two removable • Digital isochronous governor to maintain steady-state speed access panels. at all loads • Fade-, scratch-, and corrosion-resistant Kohler®cashmere • Digital voltage regulation: ±1.0% RMS no-load to full-load powder-baked finish. • Automatic start with programmed cranking cycle Sound Data • Programmable exerciser can be set to start automatically on any future day and time,and to run every week or every two Model 30RCLA 8 point logarithmic average sound levels are weeks 53 dB(A) during weekly engine exercise and 61 dB(A) during • Exercise modes full-speed generator diagnostics and normal operation. For o Unloaded exercise with complete system diagnostics comparison to competitor ratings,the lowest point sound levels o Unloaded full-speed exercise are 52 dB(A) and 59 dB(A) respectively.* o Loaded full-speed exercise (Model RXT ATS required) All sound levels are measured at 7 meters with no load. • Front-access mini USB connector for SiteTech'" connection * Lowest of 8 points measured around the generator.Sound levels at other points • Integral Ethernet connector for Kohler®OnCue® Plus around generator may vary depending on installation parameters. g • Built-in 2.5 amp battery charger • Remote two-wire start/stop capability for optional connection of a Model RDT transfer switch See additional controller features on the next page. G4-304 (30RCLA) 6/21 KOHL KOHLER® Phone 9 CO.,Kohler,Wisconsin 9-164 USA Phone 920-457-4441,Fax 920-459-1646 For the nearest sales and service outlet in the US and Canada,phone 1-800-544-2444 KOHLERPower.com Additional RDC2 Controller Features Available Options, Continued • Diagnostic messages Starting Aids§ o Displays diagnostic messages for the engine, generator, ❑ Block Heater,120 V, 1 Ph Model RXT transfer switch, programmable interface ❑ Block Heater,240 V, 1 Ph module(PIM),and load management device ❑ Oil Pan Heater, 120 V,1 Ph o Over 70 diagnostic messages can be displayed ❑ Oil Pan Heater,240 V,1 Ph • Maintenance reminders § One block heater or oil pan heater is recommended for ambient • System settings temperatures below 0°C(32°F). At temperatures below-18°C(O'F), o System voltage,frequency,and phase installation of both heaters is recommended. Voltage adjustment Automatic Transfer Switches and Accessories o Measurement system, English or metric ❑ Model RDT Automatic Transfer Switch • ATS status (Model RXT ATS required) ❑ Model RXT Automatic Transfer Switch o Source availability ❑ Model RXT Automatic Transfer Switch with Combined o ATS position (normal/utility or emergency/generator) Interface/Load Management Board o Source voltage and frequency ❑ Load Shed Kit for RDT or RXT • ATS control (Model RXT ATS required) ❑ Power Relay Modules(use up to 4 relay modules for each o Source voltage and frequency settings load management device) o Engine start time delay Maintenance o Transfer time delays ❑ Maintenance kit(includes air filter,oil,oil filter,and spark plugs) o Fixed pickup and dropout settings Miscellaneous • Voltage calibration ❑ Rated Power Factor Testing • Programmable interface module(PIM) status displays Literature Input status (active/inactive) ❑ General Maintenance Literature Kit o Output status (active/inactive) ❑ Overhaul Literature Kit • Load control menus ❑ Production Literature Kit o Load status Warranty o Test function ❑ Extended 5-Year/2000 Hour Comprehensive Limited Warranty Generator Set Standard Features ❑ Extended 10-Year/2000 Hour Comprehensive Limited Warranty • Aluminum sound enclosure with enclosed silencer • Battery rack and cables Dimensions and Weights • cLIL/US listed, CSA certified Overall Size,L x W x H,mm(in.): 1880 x 836 x 1169 • Electronic, isochronous governor (74 x 32.9 x 46.0) • Flexible fuel line Shipping Weight,wet,kg(lb.): 599(1320) • Gas fuel system (includes fuel mixer,electronic secondary Weight includes generator set with engine fluids, sound enclosure, gas regulator,two gas solenoid valves,and flexible fuel line silencer,and packaging. between the engine and the skid-mounted fuel system components) • GFCI service outlet, 120/240 V for customer connection • Integral vibration isolation T : • Line circuit breaker H • NEC prime mover shutdown switch • Oil drain extension — • OnCueO Plus Generator Management System • Operation and installation literature f'-- W L • RDC2 controller with built-in battery charger NOTE:This drawing is provided for reference only and should not be • Standard five-year or 2000 hour limited warranty used for planning installation.Contact your local distributor for more detailed information. Available Options DISTRIBUTED BY: Controller Accessories Lockable Emergency Stop(lockout/tagout) Programmable Interface Module(PIM) (provides 2 digital inputs and 6 relay outputs) Electrical System ,❑ Battery ❑ Battery Heater ❑ OnCue8 Plus Wireless Radio Kit ®2021 Kohler Co.All rights reserved. G4-304 (30RCLA) 6/21 Laura Petersen From: Bonistall Electric <bonistallelectric@gmail.com> Sent: Friday,July 1, 2022 7:33 AM To: Laura Petersen Subject: Re: Generator Permit Application - 116 Country Ridge Drive Hi Laura, The cost is $5,800. Thank you, Doreen On Thu,Jun 30, 2022 at 2:32 PM Laura Petersen<LPetersen@ryebrook.ors>wrote: Good afternoon, At your earliest convenience, please provide the estimated cost of construction for the generator permit application for 116 Country Ridge Drive. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 i Fax(914)939-5801 ( IoetersenCa)rvebrook.org ALAN BONISTALL ELECTRICAL CONTRACTING, INC. 53 Purdy Street Harrison, NY 10528 PH: (914) 835-5659 i Laura Petersen From: Steven Fews Sent: Tuesday, July 12, 2022 3:42 PM To: JERRY CEDRONE Cc: Laura Petersen Subject: RE: Halstead Quinn Expires: Wednesday, November 9, 2022 12:00 AM Fantastic! Thank You. Steven E. Fews Assistant Building& Fire Inspector Office (914) 939-0668 Fax (914) 939-5801 From:JERRY CEDRONE <jerry1075hq@live.com> Sent:Tuesday,July 12, 2022 11:58 AM To: Steven Fews<Steve Fews@ rye b rook.o rg> Subject: Re: Halstead Quinn Hello Steven, The excavator got back to me today the dig# is 06202-002-191 Thank you, Jerry Cedrone Service Manager Halstead Quinn 33 Hubbells Dr. Mt. Kisco NY 10549 914-666-3200 x 109 From:JERRY CEDRONE<jerry1075hg@live.com> Sent: Wednesday,July 6, 2022 6:26 PM To: Steven Fews<SteveFews@ rye brook.org> Subject: Re: Halstead Quinn Hello Steven, Thank you for getting back to me. I will follow up with the excavator to obtain the dig number. Thank you, i Jerry Cedrone Service Manager Halstead Quinn 33 Hubbells Dr. Mt. Kisco NY 10549 914-666-3200 x 109 From:Steven Fews<SteveFews@ryebrook.org> Sent: Wednesday,July 6, 2022 4:05 PM To:JERRY CEDRONE<JERRY1075HQ@live.com> Cc: Laura Petersen <LPetersen@rvebrook.org> Subject: RE: Halstead Quinn Good Day Jerry, The permit was processed, but we have yet to get a dig number for that work to add it to the file Thank You. Steven E. Fews Assistant Building & Fire Inspector Office (914) 939-0668 Fax (914) 939-5801 From:JERRY CEDRONE <JERRY1075HQ@live.com> Sent: Wednesday,July 6, 2022 3:27 PM To: Steven Fews<SteveFews@ryebrook.org> Subject: Halstead Quinn Hello Steve, Hope you had a good 4th. Just wanted to follow up on the permit issue for: Jacobs 116 Country Ridge Rd Rye Thank you, Jerry Cedrone Service Manager Halstead Quinn 33 Hubbells Dr. Mt. Kisco NY 10549 914-666-3200 x 109 2 A ® DATE(MM/DD/YYY1) /`l CERTIFICATE OF LIABILITY INSURANCE 06/16/2022 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 Sheyla Molina NAME: BNC Insurance Agency PH CONEo Ext: F'AX No(914)937-1230 (914)937-1124 A/ N 90 S Ridge St Ste UL-2 E-MAIL smolina@bncagency.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Rye Brook NY 10573-2836 INSURERA: Selective Insurance Company of South Carolina 19259 INSURED INSURER 8 ALAN BONISTALL ELECTRICAL CONTRACTOR INC INSURER C: 53 PURDY ST INSURER D INSURER E: HARRISON NY 10528-3705 INSURER F: COVERAGES CERTIFICATE NUMBER: CL222904712 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 SR ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7X OCCUR PREMISES Ea occurrence g 500,000 MED EXP(Any one person) $ 15,000 A Y S 2380251 03/08/2022 03/08/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ❑PRO ❑ 3,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S 2380251 03/08/2022 03/08/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2380251 03/08/2022 03/08/2023 AGGREGATE $ 5,000,000 DED I X1 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 $ tf 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) Village of Rye Brook is included as an additional insured when required under written Contract or Agreement. 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 ©1988-220�155 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NEw Workers' Yo YORK STATE Compensation P CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (914)835-5659 Alan Bonistall Electrical Contractor Inc. 53 Purdy Street lc.NYS Unemployment Insurance Employer Harrison,NY 10528 Registration Number of Insured Work Location of Insured(Only required if coverage is specifically ld.Federal Employer Identification Number of Insured limited to certain locations in New York,i.e.,a Wrap-Up Policy) or Social Security Number 133249559 2.Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Selective Insurance Company of New York 3b.Policy Number of entity listed in boa"la" VILLAGE OF RYE BROOK WC 9083329 938 KING STREET 3c.Policy effective period RYE BROOK, NY 10573 10/9/2021 to 10/9/2022 3d.The Proprietor,Partner or Executive Officer are ❑ included.(only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"Y insures the business referenced above in box 1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Paul Sohigian (Print name of authorized representative or licensed agent of insurance company) Approved by: 6/16/2022 (Signature) (Date) Title: Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: (914)937-1230 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 rK•s+�.�✓ �.i� rn. s � Ui r �4� ,,, .i4�',• 4^' �/ r � .!_> �'Qb—� -.'a.;` � � •�r'p�; .. ' '� ""�.,. •-'.., Ir�° �' ti'1i'• �-r w^ � •`'����• .ko- �ai r -�se,Y�6 • I,�. M .p,'t'.. �<\', - �h/►1i/i'� i Fin I►Iti'i1�'�` 1 IR z a f .- i '�• ' y BGair»y7 — t{Aj Irs))� TTF w- CO4. ,►r IR 0 i 77f ) a� z = _ op" LLJ C.) WLU 0- W V/ r(Wi)co Z CD �` � ,, �1.'► — ` i� �1'♦��uy �'sue , C d W c) Q LLI -i / Z LO y- --. :� , CD co p Al, : .;r•� :it - =: �� I. r _ -:-T.�.r r;�_.t t ryv='�,r.�=�1•X�Y-3.Y"'Xy('r,�� "� /l - rA 7� ►11 ty 11/ t 1',1 1.1 It rt>l i Imp j� ALMEOIL-01 LKAZZI AcoRO CERTIFICATE OF LIABILITY INSURANCE DAT/30/2DIY1 713012021 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 NCO AM EACT Lauren Kazzi -- — AssuredPartners New England,Inc. 850 Main Street PHONE o,Ext):(203)514-7876 (AID.Ne):(203)514-7876 Bridgeport,CT 06604 $ Lauren.Kazzi@AssuredPartners.com INSURER AFFORDING COVERAGE NAIC 9 INSURER A:New York Marine&General Ins.Co. 16608 INSURED INSURER B Halstead-Quinn Petroleum Co.,Inc. INSURERQ _ 33 Hubbells Drive INSURERD: Mount Kisco,NY 10549 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL BUBR POLICY NUMBER POLICY EFF POLI JMMI CY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PK201900018638 8/1/2021 8/1/2022 DAMAGE TO RENTED 100,000 _ PREMISES(Ea oc,ur 1$ MED EXP(Any onepersoN $ 5,000 _PERSONAL&ADV_INJURY 1,000,000 )00,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ X POLICY _ JECT LOC PRODUCTS_-COMP/OP AGG__$ 2,000,000 OTHER: COMBINED SINGLE LIMIT 11000,000 A AUTOMOBILE LIABILITY _(Ea acElden1) _._t—_. _ X ANY AUTO AU202000017114 8/1/2021 8/1/2022 -BODILY INJURY(Per person) _$ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) $ _ X HIRED X- NON-OpWNED PRROPERTY DAMAGE — AUTOS ONLY AUTO ONLY `(Peraccidenl is A X UMBRELLA LIAB X' OCCUR EACH OCCURRENCE 5,000,000 EXCESS LIAB F-I CLAIMS-MADE EX202000001337 8/1/2021 8/1/2022 AGGREGATE S 000'60O DIED 1 X I RETENTIONS 0 WORKERS COMPENSATION PSTATUT OTH- AND EMPLOYERS'LIABILITY -- _ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ QFF ICEWMEMBER EXCLUDED? N/A — Ma idatory In NH) E.L_DISEASE_EA_EMPLOYEE!__ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached If more space Is required) Certificate holder is included as Additional Insured where required by contract or agreement with regard to liability arising out of the Insured's operations per the terms and conditions of the referenced general liability,auto,and umbrella policies. Village of Rye Brook Is Included as Additional Insured where required by contract or agreement with regardto liability arising out of the Insured's operations per the terms and conditions of the referenced general Iiability,auto,and umbrella policies. 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 Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ✓"e✓�QOO ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund 199 CHURCH STREET, NEW YORK,N.Y. 10007-1100 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) Emu 510423602 ty,4 '• KEEVILY,SPERO-WHITELAW INC. � , , tY 500 MAMARONECK AVENUE HARRISON NY 10528 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER HALSTEAD-QUINN PETROLEUM CO, INC. VILLAGE OF RYE BROOK 33 HUBBELLS DRIVE BUILDING DEPARTMENT MOUNT KISCO NY 10549 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G2090 374-6 223333 05/01/2021 TO 05/01/2022 7/13/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2090 374-6, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/NMW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 INSURANCE FUND DI RECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 998907210 ��N30IS3-d a z SOODVI !I (ZD CY) Lc 0 LU Lil C1,14 CN W W < U-C) 0 IC 0 0 LLJ ce L>jf 4cu;�-)31, LU2! gLe - ----------D C) > A6 0 t - 0 .A. A 01 , '1'D,e00(b. lit gl tit Y !Ntj t kF 1 I I 1 � I , } i 1 t :x ,i 3 W Pr tz °= t WZ wm � � 4• N G ao Ic ----- eJ.r. JJJrr. ONOH gXlbl AWOOD