Loading...
HomeMy WebLinkAboutMP23-017 (-Q�l G GY�4vJV i G ��Yw WYi V��'WWV VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.iyebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 12,2023 Jonathan Seti&Rorie Katz 14 Terrace Court Rye Brook,New York 10573 Re: 14 Terrace Court,Rye Brook,New York 10573 Parcel ID#: 135.66-1-16 This document certifies that the work done under Mechanical Permit #23-017 issued on 2/13/2023 for the installation of a new Navien combo boiler and a new air handler has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRCb, .FO • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - -- - - - - - - ADDRESS : , \ ` �, <` ` DATE: PERMIT# \ ISSUED:�3�z'SECT: 1 BLOCK: _LOT: LOCATION: �J��y y � C� `�� OCCUPANCY: r ❑ Violation Noted THE WORK IS... 6 PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P.Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E 4RO ID4�''� F0 BUILDING DEPARTMENT .BUILDING INSPECTOR El 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 :— , ,e c co- DATE: PERMIT# ISSUED: SECT: BL LOT: J � LOCATION: ` �e �� � OCCUPANCY: ` ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED EJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE �- ❑ FOUNDATION C\ � ❑ UNDERGROUND PLUMBING 1VOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS c- ��• �i ❑ L.P. GAS C; \�.<"0o\ 1 J ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING � - ❑ CROSS CONNECTION ^ ❑ FINAL \ t4e ❑ OTHER fl s ry co � s M o o w ■ N � N ■ v � a ■ N M `� 0 Ey a ■ Iri 9 z „ °w r ■ H A a 0-4w ■ en Ch W w w °° w 04 o � Z z RT _ �+ • � � W N z r•. W W p �, � m co a (> w i v � `� � � �..] W � W x N cad ?•� O �1 ■ MCI '. pW� 04 O CHI) " Lo " ~ ° ► W N cu o Gp � =-aA ov zH C7 R av� � a' z o W R 0 � .- u Qj �I mi s w ) w1 z a' BUILD f MENT VIL OF RY OOK FEB 13 2023 938 KING ,ET Rytl, Biz ,NY 10573 VILLAGE OF RYE BROOK K BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#:,��'�s� �! 7 Approval Date: FEB 1 q 7 Permit Fee: S 8N Approval Signature: Other: Disapproved: i� v_ (fees are non-refundable) ,k:F*ir it*ir of*it srxirx ir*iris*irtirk***ir*ie ir****,kaF,k•kir*k**+k**********ir***ir it*****k it*ir sk it*ir*sk*ir is it it it*******ir************ir* REQUIREMENTS FOR RELEASE OF PERMIT toe 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 he listed as certificate holder)& Workers Compensation Insurance on a NYS Board form (Form P C 105.2 or Fonn#U26.3/or NY State Workers Compensation Wainer) 4. Payment ofFees/Unit: RES1Ul.NTIAI. = $100.00/unit• COMMERCIAL — $3 5 01 0 04111it. 5. Inspection by the Building Department for removal and/or installation. (48 hour notice required) 6. Electrical work requires a separate Electrical Permit&Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. it ie,tr it*ir ie ie ir�vk*ir it dr,k*,lr*,4*ir*$ir it ir,kir*ir it ie it ie k it Ir,t*ir**>M iTr**alr fi**tk*****ir it*ir it it#,r##*#***ir is**i<***ie*ie*ir it it it is><ir icx is it><i Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. �} ' I / -'1. Address: 81-`tx-p- C� ldti(l' 1 /V l ��"3 SBL: I351 Cob /—/6 Zone:,IO 2. Property Owner: 4`.�e �7� Address: N f 5 73 Phone#: Cell#: n email: r-I e a Wl 3. Contractor: Lo c, 0 yy&2 ,,l �ux /Address: 105 Phone#: Cell#:qiq: �f�9D email: GtQ U,12r /CO+►� 4. Applicant: Address: Phone#: Cell#: email: 5. Scope of Work: New Installation( )•Replacement tK)•Removal( )•Other( ): 6. List Equipment:NC.�1%n.,o I(1 I () t`�C -_r'1 S �I)a L/1, ��� � 0 V), c ce�T � der E .4 F: � a`•� G� �:j"4. r . 7. Location of Equipment: K ,&P_. VLl. n �(k�tjln C- �A 8. Method of Installation/Removal(list all equipment needed to perform job): �\jyw �00 \ 1 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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 trite 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 day f I S ,20 day of / Fe 20 r' Si afore of Property ner t Si a of Applicant Cl 1�' r t Name of Property Owner ame of Applicant Notary Public HARI MELILLO Notary $AELILL0 Notary Public,State of New York Notary Public,State of New York No.01ME6160063 No.01ME6160063 Qualified In Westchester County Qualified In Westchester County Commisaton Expires January 29,2022 COMmIssion Expires January 29,2u:-) 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 BY12/2021 A&A, PRODUCT DIMENSIONS & SPECIFICATIONS AFM SERIES HIGH EFFICIENCY X13 �1 MULTI-POSITION HYDRONIC HEAT DX COOL ZX_ � AIR HANDLERS Everything's Right HereT. STANDARD FEATURES APPLICATION VERSATILITY Upflow or horizontal right as shippped(field-convertible for down-flow or horizon- tal left applications).Can be AHRI certified with most brands of air conditioners or heat pumps. ETL listed for use with either R22 or R41 Oa when a proper metering device is used. MOTOR X13 speeds and torques are controlled by software embedded in the motor to maintain constant torque.Motors are pre-programmed at the factory. CABINET Sturdy, galvanized steel cabinet with painted front panels. Cabinet fully insu- lated with 1/2" faced insulation to prevent sweating and mold growth,to en- capsulate glass fibers,and to provide excellent R-value. Stick pins ensure insu- lation remains In place. Units ship with disposable filter in filter rack. BLOWER Direct drive variable-speed blowers circulate air quietly and efficiently. Vari- able speed motors allow for precise air volume selection. Motor speeds and torques programmed in the motor. Blowers mounted on rails so they can be easily removed for service. ELECTRONIC CONTROL BOARD An electronic board controls the functioning of the system reducing moving parts. The board provides for various hot water supply source connections Representative image only.Some models may vary in and the blower time delay to maximize heat/cool extraction.As an enhanced feature the pump circulates hot water every 6 hours to prevent coil freeze appearance.Due to continuous product improvement, during off cycle. specifications are subject to change without notice. MODULAR HYDRONIC HEAT KITS Heat kits available with either circuit breakers or terminal blocks.Available in 2, 3 &4 row, providing 16,000 to 59,000 BTU's of heat. Heat kits are easily in- stalled in the field using molex plugs or can be ordered factory-installed.Freeze stat is standard, wired into circulating pump control circuit. Controls are ac- cessible from the front for easy service. Electrical connections can be made from the top or left. Disconnect does not protrude through the wall panel. Fan time delay relay standard for increased efficiency. Heat kits are available with or without circulating pump and check valve. Units are provided with auxiliary relay for remote pump. Schrader ports are standard on water-out manifold, hose bib available as an option. DX COIL High efficiency rifled copper tubes/enhanced aluminum fins provide maximum heat transfer. All coils immersion tested at 500 psi then nitrogen pressur- ized and factory sealed for maximum reliability. Liquid-line Schrader allows pre-installation pressure testing Available with either orifice or TXV metering device. Field-installable bolt-on TXVs are also available. Rugged, UV safe, GLP drain pan holds minimal condensate while eliminating the possibility of corro- sion. Galvanized metal drain pan with bottom primary and secondary drain connections or alternate right side primary.All connections 3/4"FPT. Access door allows for coil cleaning. WARRANTY Five-year limited parts warranty. OPTIONS See options menu. Phone: 281.441.6500 FAEMW �, Toll Free: 800.423.9007 HARDI �� J END Fax: 281.441.6510 "`'L ..«�..�.. c��"/�us 4�R ir' USA www.aspenmfg.com _... A 'For complete warranty details visit www.aspenmfg.com. Reused 04i 02/14.In keeping with its policy of continuous progress and product improvomem Aspen reserves tho right to make changes without notice and incurnng obligation 2014 HEATING AND COOLING PERFORMANCE AND ELECTRICAL DATA PERFORMANCE DATA ELECTRICAL DATA HEATING CAPACI I Y BTU/HR at 3 GPM MAX MODEL HYDRON'C NOMINAL HEATING COIL MIN.CIR. FUSE HEAT KIT COOLING AMPACITY OR ENTERING WATER TEMP CIRCUIT ROWS SIZE 120" 140' 1 80i BREAKER AFM18.19 W-C/-T2SP/L 1,5 --------2-------- 17700.- ........25100.. ........40400 . ..... ----------------- ------- ....... WC/T3SP/L 3 22600 32000 51300 6.6 WC/T2SP/L 2 20100 28700 46100 AFIVI24,25 ------------------------ 2 ................. ................................................... WC/T3SP/L 3 26100 1 37000 59300 WC/T2SP/L 2 22100 31400 50600 ---------------------- ---------------­ 18"x12" ----------------------------------------­----­-- AFM30,31 WC/T3SP/L 2,5 3 2e700 40900 65500 ----------------------- ----------------- -------------- ----------- .............. WC/T4SP/L 4 32500 46100 74000 WC/T2SP/L 2 23600 33800 54300 9 1 20 .................. AFM36,37 W C/T3SP/L 3 3 31000 44000 ................. ------ W Q/T4SP/L 4 34900 49700 79700 VVC/T2LP/L 2 31000 44100 70700 ------------------------ ................ --------------- ............................... AFIV142,43 WC/T3LP/L 3.5 3 37800 53800 86300 ----------------------- ................. .............. ............................... WC/T4LP/L 4 42600 60600 97100 VVC/T2LP/L 2 32400 46000 73900 ....................­ ­--------------- ---------------- --------­------- ----------- AFM48, VVC/T3LP/L 4 3 22"x1 4.5" 39500 56200 90100 14.3 30 ....................... ----------------- ­---­--­---------------------------_-_----- WC/T4LP/L 4 44400 63200 101300 WC/T2LP/L 2 34100 48600 77900 ....................... ----------------- ---­------------------------- .............. AFM60,61 VVC/T3LP/L 5 3 41500 59100 94BOO ----------------------- ................. -------------------------------------------------- WC/T4LP/L 4 46600 66300 106400 BLOWER DATA MODEL SPEED MOTOR MOTOR MOTOR CFM V. EXTERNAL STATIC- TAP HP AMPS VOLTAGE Cl 1)0 0 30 0.4[) 0.50 TAP 5 900 853 797 738 673 ------------­- ----------­--------------------------------------------------------------------------------- TAP 4 670 646 613 592 553 --------------- ------­-----------------------­-­---------------------------------_--------­------­--- AFM 1B/19/24/25 TAP 3 1/3 500 476 452 421 400 .............. -------------------- ----------------------------------_--_-------------- TAP 2 400 360 339 312 ------- ..... ... ... ... TAP1 900 853 797 738 673 TAP 5 1150 1087 1030 975 910 --------------- --------........----------------------------------------­------------------------------- TAP 4 1080 1048 1010 960 895 --------------- -----------­----------------------------------_----------------------­---­---­---------- AFM 30/31/36/37 TAP 3 1/2 6.8 240 900 862 825 796 745 ............... ............................................................................................... TAP 2 700 663 632 600 552 ............... ---­-­----------------------­-----­----------------------------------------­------------- TAP1 500 473 449 421 395 TAP 5 1850 1806 1752 1700 1652 --------------- ------­­­-------------------------------------------­----------------------------------- TAP 4 1704 1656 1600 1532 1479 ---------­­ ...............---------------------------------------- -------------------------------------- AFM 42/43/48/60/61 TAP 3 1 10.9 1494 1461 1426 1400 1364 -------------- -------------- -------- --------------------------------------------------- TAP 2 1350 1310 1272 1229 1175 ....... --- ...TAP-1 1 -------676----------------652-------....... --------------600----- -------5-5-9------- 621 Dry coil AFM 18 G -001 Meter inodeyice 4=non-bleed A/C or H/P R410 TXV AFM=120V X13 Motor Nominal tonnage(MBTUH) B=20'o bleed A/C or H/P R22 TXV Option Code Multi-Position Air Handler F=Flo-rater G=R41 Oa Flo-rater X=non-bleed A/C or H/P R22 TXV HYDRONIC HEAT KIT NOMENCLATURE Interruption 2-2 Row Hydronic Coil Water heat C=Circuit Breaker 3-3 Row Hydronic Coil S= 18-37,Coil size-18 x 12 P=vv,/pump (hydronic) L=42 T=Terminal Block 4-4 Row Hydronic Coil $1,Coil size-22 x 14.5 L=less pump DIMENSIONS AND SPECIFICATIONS FILTER PISTON SHIP SKID MODEL A" B" C" LD E" F" G" SIZE SIZE WL S)T dTYAFM18 '19+W* 1 4y 1, 4 E ;3. .� 1 -1j 2 /-1, 4 0-1, 41bX20 0.055 99/ [53] [125] [48] ] [47] [18] [26] AFM24/25+W* 21 491/4 18-3/4 12 18-1/2 8-1/4 12-1/4 16X20 0.059 100 [53] [125] [48] [30] (47] (21] (31] AFM30/31+W* 21 491/4 18-3/4 12 18-1/2 8-1/4 14-1/4 16X20 0.068 118 4 [53] [125] [48] [30] [47] [21] [36] AFM36/37+W* 21 491/4 18-3/4 12 18-1/2 10-1/4 16-1/4 16X20 0.074 147 [53] [125] [48] [30] [47] [26] [41] AFM42/43+W* 24-1/2 57 22-1/4 14-3/4 22 11 16 20X20 0.080 153 3 [62] [145] [57] [37] [56] [28] [4 1] AFM48/49+W* 24-1/2 57 22-1/4 14-3/4 22 13 18 20X20 0.084 180 3 (62] [145] [57] [37] [56] [33] [46] AFM60/61+W* 24-1/2 57 22-1/4 14-3/4 22 15 20 [62] [145] [57] 11 (37] [56] (38] [51] F20X20 0.092 200 3 . -C 1, LINE VOLTAGE 00 LOW VOLTAGE 20 IQ M 0 4.000 B [10,21 rr HORUMAL DRAM! BOTH SIDES i G 3WLOW F ua I 1 Phone: 281.441.6500 -- RAIN 147.01 L----E ��y DRAIN ...�^"� Toll Free: 800.423.9007 MPEN ax: 281.441.6510 ,/ - � ! Fwm spenmfg.om Everything's Right HereT. • FdNavieN NCB-H High-Efficiency Condensing Combination Boiler Submittal Sheet ❑ Model NCB-1901060H(60,000 Btu/hr. space heating and 160,000 Btu/hr. DHW) ❑ Model NCB-1901080H(80,000 Btu/hr. space heating and 160,000 Btu/hr. DHW) Model NCB-240/110H(110,000 Btu/hr. space heating and 199,900 Btu/hr. DHW) ❑ Model NCB-2401130H(130,000 Btu/hr. space heating and 199,900 Btu/hr. DHW) ❑ Model NCB-2501150H(150,000 Btu/hr. space heating and 210,000 Btu/hr. DHW) Job Name: Location: Engineer: Wholesaler: Sales Rep: Contractor: Model: Gas Type (NG/LP): Notes: Boiler Standard Features Boller Optional Accessories Controls • SS Dual Heat Exchangers SS Primary Manifold Kit Smart Controls with LCD • Cold-rolled Carbon Steel Condensate Neutralizer Kit Display, Quick Dial Wheel and Casing Zone Controller Setup Wizard • 95%AFUE Universal Temperature Sensor Built-in 3 zone pumps and 3 • DHW 15:1 TDR NaviLink Control System zone valves powered • Heating up to 1 1:1 TDR Ready-Link Racking System connections • 30 PSI ASME Relief Valve NaviClean Magnetic Filter Manual Reset LWCO • Direct Spark Ignition NaviCirc for Recirculation Manual Reset High Limit • Variable Speed Blower HotButton and Wall Plate Freeze Protection • Dual Venturi Mixing System Outdoor Reset • Negative Pressure Gas Valve Venting Warm Weather Shutdown • Cascaded with up to 15 NPEs Direct Exhaust Sidewall or Air Handler Interface • Common Vented with up to 7 Roof Vent 4 Circulator Outputs NPEs Direct Exhaust Inside Air NaviLink Mobile Application • Wall Mounting Bracket Venting • High Altitude NG and LPG 2" PVC, CPVC, PP, SS up to Warranties Conversion Kits 65 ft. 10 yrs. Residential HX • Outlet & Inlet Temp Sensors 3" PVC, CPVC, PP, SS up to Warranty • Outdoor Temperature Sensor 150 ft. 5 yrs. Residential Parts • Flue gas Temperature Sensor Vent Termination Caps Warranty • Condensate Trap Wall Flanges 1 yr. Labor Warranty • Mixing and Water Adjustment Valves 20 Goodyear. Irvine, CA 92618 Q 949.420.0420 © 949.420,0430 © Navieninc.com 2 NCB-H High-Efficiency Condensing Combination Boiler—Submittal Sheet rMs Overhead View FBI I AT(364 mm) 0E E � C (o � N • E i 51015 6.T(170 mmICY CP i Supply Connections Li Supply Connections 01 b Q O O Dew fli;Uoe ----- Demeter I A Pressure Relief Valve Adapter 3i in • • B Air Intake 2 in C Eftust Gas Vent 2in 7!r D Heating Supply 1 in • • •• E Domestic Hot 3A in F Gas Connection %in G Domestic Cold 3A In 2.7'(68 mm) 3.5' i IT 2.9' 2.5' H Auto Feeder Inlet(Make-up Water) 14 in (08 mm) (85 mm) (74 mm) (63 mm) I Condensate Outlet 14 in J Heating Return 1 in 9.6'(244 mm) 17.3'(440 mm) Navien Combination Boiler Domestic Hot Water Ratings Other Specifications Heating input(BTU/H) Model Number Water Minimum Flow Rate 77OF DHW Supply DHW Return Min Max Pressure Flow Rate (43°C)Temp Rise Connection Size Connection Size NCB-190/060H 10,700 160,000 3.7 GPM(14.0 L/m) NCB-190/080H 10,700 160,000 0.5 GPM NCB-240/130H 13,320 19900 15-150 PSI (1.9 L/m) 4.7 GPM(17.8 L/m) 3/4"NPT 3/4"NPr B-240/130H 199,9NC ENCB-250/150HT 14,000 210,000 4.9 GPM 18.5 L/m Other Specfficadons Neat' 1 BTU/H.,,. .."eatim Net AHRI Water Model Number Capacity Rating Water AFUE(%) Water Pressure Connection Sze Water Min Max (MBH) (MBN) (Supply,Return) Volume NCB-190/060H 1 11 60 56 49 95.0 NCB-19WOODH 11 8o 74 64 95.0 NCB-240/110H 13 110 102 89 95.0 12-30 psi 1"NPT 1.5 gallons NCB-240/130H 13 1 130 120 104 1 95.0 NCB-250/150H 14 1 250 139 120 1 95.0 20 Goodyear, Irvine, CA 92618 © 949.420.0420 949.420.0430 © Navieninc.com DATE(MMIDDIYYYY) AC"RL® CERTIFICATE OF LIABILITY INSURANCE az/osizozs 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 Carlos Teixeira NAME BNC Insurance Agency PHONE (914)937-1230 FAX (914)937-1124 AIC No E AIC No 90 S Ridge St Ste UL-2 E-MAILADDRESS: cteixeira@bncagency.com INSURER(S)AFFORDING COVERAGE NAIC M Rye Brook NY 10573-2836 INSURERA: Merchants Insurance Company 23329 INSURED INSURER B Alpha Omega Heating&Cooling inc INSURER C: 43 MAYFAIR WAY INSURER D: INSURER E: WHITE PLAINS NY 10603-1026 INSURERF: COVERAGES CERTIFICATE NUMBER: CL232610278 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 ADUL 5U5R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIDDIYYYY MMIDDIYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR DAMAGE TO RENTEE5 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A Y CTRIO10587 02/06/2023 02/06/2024 PERSONAL&ADV I NJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL X AGGREGATE $ 2,000,000 ❑LOC PRODUCTS-COMP/OPAGG $POLICY ❑PEC 2,000,000 OTHER I I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CTRIO10587 02/06/2023 06/20/6202 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER LISTED AS ADDITIONAL INSURED AS PER WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Rye Brook Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE '� Rye Brook NY 10573 C0 1988--2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ANEW Workers' STATE Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name and address of Insured (use street address only) 1b. Business Telephone Number of Insured ALPHA OMEGA HEATING AND COOLING INC 43 MAYFAIR WAY (914) 804-4690 WHITE PLAINS NY 10603 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically 1 d. Federal Employer Identification Number of Insured or limited to certain locations in New York State, i.e. a Wrap-Up Policy) Social Security Number 47-2622849 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Sentinel Insurance Company Ltd. Rye Brook Building Department 11000 938 KING ST 3b. Policy Number of Entity Listed in Box 1a": PORT CHESTER NY 10573-1226 76 WEG AR7LZ4 3c. Policy effective period: 03/17/2022 to 03/17/2023 3d. The Proprietor, Partners or Executive Officers are �X Included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance 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 Worker's 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: Danielle Clausen ".� ( (print name �of authorized representative or licensed agent of insurance carrier) Approved by: � t�(trnjvlf_�,( 02/07/2023 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: (866) 225-7966 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-106.2 (9-17) Form WC 88 31 21 F Printed in U.S.A. www.wcb.ny.gov Page 1 of 2