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MP23-020
((QyE DR �. L�wV Vu� . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J. Bradbury ,A-ww.ryebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 13,2023 Kathleen Riley 6 Lee Lane Rye Brook,New York 10573 Re: 6 Lee Lane, Rye Brook,New York 10573 Parcel ID#: 135.66-1-25 This document certifies that the work done under Mechanical Permit#23-020 issued on 2/16/2023 for the installation of a new condenser and a new air handler has been satisfactorily completed. Sincerely, "-"I Steven E. Fews Acting Building&Fire Inspector /to QyE BRO t7 1932 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 :_ y ��J`L , DATE: 1 I PERMIT# �\ - / ? y Z�� ISSUED: 11�, ECT: , BLOCK:LOT: 1 5 -� t LOCATION: "l C «&D�gf. � I�T� � CCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/RuNSPECTION ❑ 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 a s s a N w° � m M C N W F. N N N Ln a \1 Za` CIS 0-4 _ 1 &0-4 C. v� d4 W U � �n W � H hl a n v pvp t C � W E) F-1 NZ 00 y C oq CJ L M W M to ° > Z ►- W � v0 'o. � Qa o 40 M r� W � "� o t� ,^ 0 ■ L W A CU 4w W � �4 a � x W ° vo � � •� � CO ' ONO 0 1 2 ON A4 C;N CC ° c00 � � w W W '' u �' 11��•.11 -� w A 2 � CA v rL -a a v u or U o v W cn H o z z ,� Q z p W A Off :~ - A ° g C �1 A a z a w 0 .0 a D � � V C r BUILD, tv MENT FEB 15 2023 VIL E OF RY OOK 938 KING PT RYE BR NY 110573 VILLAGE OF RYE BROOK 4 -0644j BUILDING DEPARTME1 JT o k APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: 40Q-3-0ac Approval Date: F 202 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ****,a*w***,rt*t***,c*,r*****:�*#*,t**�*�r�*�** **,►*,r*********�**t*****,t*,r*******,t,t+t*****,t***,r*,t*,t*********** REfLIREMENTS 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#U26.31 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, 2 2 3 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. l. Address: L e C ` SBL: 1?)S.lo(n- l- 2S Zone: k_L© 2. Property Owner: Address: (o L r t. ��n Phone#: '�l q -`-111 - y?_3 Co Cell#: email: K4���eT m 3. Contractor: Ma Rio c n, Address: I t) 0 roS.S�tic-)�S 12 Phone#: 91,-1-SSO---7 09 3 Cell#: email: PeeiN� d hcv eat•.�1�c.Cocr 4. Applicant: Address: Phone#: Cell#: email: 5. Scope of Work:New Installation O•Replacement( )•Removal( )•Other( ): 6. List Equipment: (� ti��,hlsh', �tca�-{J�r.,r� Cocl� nser a���`521e 7. Location of Equipment: `Cnfe C t 4 _ a t x 4 + oJm V., 8. Method of Installation/Removal(lief all equipment needed to perform job): t an2rzo21 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Mo- tti, ,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 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 Swom to before me this `{ day of Fe ,20 "L'3 day of F c.O c-uar Y ,20 l3 ignature of pe Own `�Signa pplicant .I�,a�,�ee�, iZ1 j Ma��U �ry� Print Name of Property Owner Print Name of Applicant Notary Public Notary Public DIANE M KEMPTER DIANE M KEMPTER Notary Public •State of New York Notary Public-State of New York NO.alKE6391666 NO.01KE6391666 Qualified in Westchester County Qualified in Westchester County i My Commission Expires May 13. 2023 My Commission Expires May 13, 2023 Thi mpleted in its entirety and znu (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 sn2no21 s Ln N fNV N M Sn M z w n ■ N _� .Z, : lx� Q MM N Q ►-� o F Lr) ■ � � �~ � � z z N w � , MM N r. � m .. N IS Lnin w F O �.' . O w 00' O M - w O o ` R, z r o z W "� z 1+�1z 0 In _ i V L - , r. A arj [ x `J 0-4 r ►-i �"' d z 0 FBI �! W ■ w H F W w V w a F z � �+ i W V a o n i / \ �tl O U r+�l i-1 z oe z o � Q W z x aCIO � a Angelo Zaccagnino R [E D.O.B: 12l11f1968 Company: BUILDITI .G DEPARTMENT MAR - 3 2023 Zaccagnino Electric 81 Maple Avenue VILLAGE OF RYE$ROOK VILLAGE OF RYE BROOK Rye,NY 10580 938 KING,`9AxEET RYE BROOK,NY 105731 BUILDING DEPARTMENT License No. 755 yi*w. �d org Expires on:12I31/2023 Peter Borducci_LECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: !" 'P (� ` U Q EP#: Approval Date: Permit Fee: $ Approval Signature: Other: ************************************************ ********************************************* Application dated, 3 is hereby made to the uilding 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: !ze Lc, SBL:I-(�6- - I - al�� Zone: 2.Property Owner: Address: ('j Zee Z-0 Phone#: 03AJ Cell#: email: 3.Master Electrician: ('4gyl;yt0 Address: fl 144qpfe 4 e, Z 1� Lic.#: 5 S Phone#: q)q Cell#: email: " d�✓Ie Company Name: :�_ �G��r;��-�� Address: 4.Proposed Electrical Work/Fix e Count: 0o C 5.3rd Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Judo �A.v ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (pri t n me of individual sign ng as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn t of me this Sworn to 1 this d 3 day of 20 Sign re Property er *ame lic Print me of op , Ow er �l Printpplicant STEVf ON Notary P&ftj No. 0 00238 NOTARY PUBLIC- ATE OF EW YORK Qualified i estchester Co nt No, A6 My Commisslon Expires October 14, Y0 /�J Qualifie stchester COUnQ [ 'y� My Commisslon Expires October 14, �/: ) 2 STATEWIDE • Service With lntegri�y 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION ;. 1 914.219.1062 • • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1 st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information YD L � ��� ( MAR - AGE 3 2023 t VILL OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional Items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# 3D State Wide Inspection Services MAR - 9 2023 1080 Main Street Fishkill, NY 12524 4 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT 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: Zaccagnino Electric Kathleen Riley Angelo P. Zaccagnino 6 Lee Lane 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 6 Lee Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-058 135.66 � 25 Certificate Number: 2023-1604 Mechanical Permit Number: MP 23-020 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: 6 Lee Lane, 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 loth day of March 2023. Name Quantity Rating Circuit Type HVAC Systems 02 Officer: Frank 1. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. 2/14/23,3:33 PM Westchester County GIS::Tax Parcel Maps Tax Parcel Maps Address: 6 Lee Ln Print Key: 135.66-1-25 SBL: 13506600010250000000 2 5 Terrace Ct 135.66-1-20 6 Lee Ln 25 !W66-1-25 6 C - C O C 1� 100 00 88 95 Ip 5 Terrace t ' 35.06-' -'�� r t https://giswww.westchestergov.com/taxmaps/layout.aspx?r--RYK123721 112 (ool (alc Project Name: riley Address: 6 Lee Lane, Rye Brook, NY OUTDOOR DESIGN CONDITIONS Weather station:White Plains,Westchester Co.AP Summer Outdoor F: Summer Indoor F: ® Design Grains: ® Daily Range: MIMI Winter Outdoor F: ® Winter Indoor F: Cooling RH: llllllfflllllll Elevation (Ft): 1111011111 LOAD CALCULATION TOTALS HVAC System: Daikin Heated square footage: Heating BTUH: Cooled square footage: 1111111-TITIN Cooling BTUH: ®i Heated volume(above grade CF): � CFM: Cooled volume(above grade CF): � Sensible cooling: Exposed wall area(SF): Latent cooling: SHR: Load Calculation Cooling Heating 0 10,000 20.000 30,000 40,000 50,000 BTUH Approved ACCA MJ8 Calculations Calculations are based on the ACCA Manual J 8th Edition and are approved by ACCA. All computed calculations are estimates on building use, weather data, and inputted values such a R-Values, window types, duct loss, etc. Equipment selections should Owl meet both the latent and sensible gain as well as building heat loss. HEATING AND COOLING LOADS HEATING LOADS Heating Loads SECTIONAREA HEAT LOSSaboveGradeWalls aboveGradeWalls 1,493.5 8,402 ceilings 1.021.6 2.252 windows ceilings ducts 0 4.250 ducts floors 999 6,631 infiltration 0 7.003 floors skylights 0 0 infiltration 14 , windows 360 18,166 Totals 46,703 COOLING LOADS Cooling Loads appliances SECTION AREA -- SENSIBLE LATENT10.2% AEDExcursion 0 239 0 ceilings aboveGradeWalls 1,493.5 1,115 0 windows 7.4% appliances 0 2.400 0 1-t 11 ducts ceilings 1,021.6 1,747 0 10.5% plants floors ducts 0 2,260 217 1.3 , 4.8% floors 999 1,120 0 occupants - inflltmdw infiltration 0 753 1,281 7 8.6% occupants 0 920 800 plants 0 0 300 skylights 0 0 0 windows 360 10.378 0 Totals 20,933 2.598 FENESTRATION LOADS Warning (0): This application has glass areas that produced relatively large cooling loads for part of the day. Zoning may be required to overcome spikes in solar load for one or more rooms.A zoned system may be required, or some rooms may require zone control (provided by individual, motorized, thermostatically controlled dampers). AED Graph (mid-summer) 15,000 = 10.000 m 5,000 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH — Average — Average' 1.3 This graph represents hourly aggregrate fenestration loads in mid-summer. AED graph(fall) 15,000 = 10,000 ti m 5,000 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH — Average -- Average 1.3 This graph represents hourly aggregrate fenestration loads in October. COMPONENT LOADS ABOVE Map trace wall Frame Wall, Wood framing, R-11 cavity Construction nr 12EI-0b w Exposure N Heating BTUH 888 insulation, Brick Veneer. U Value: 0.097 Area 1578 Cooling BTUH: 118 Map trace wall Frame Wall.Wood framing, R-11 cavity Construction nr: 126-0b w Exposure: NE Heating BTUH' 1,427 insulation. Brick Veneer. U Value: 0.097 Area: 253.7 Coding BTUH: 189 Map trace wall Frame Wall, Wood framing. R-11 cavity Construction nr: 12B-Ob w Exposure: S Heating BTUH: 946 insulation, Brick Veneer. U Value: 0.097 Area: 168.1 Cooling BTUH: 126 Map trace wall Frame Wall. Wood framing, R-11 cavity Construction nr: 1213-0b w Exposure: w Heating BTUH 1,382 insulation. Brick Veneer. U Value: 0.097 Area: 245.7 Coding BTUH: 184 Map trace wall Frame Wall, Wood framing, R-11 cavity Construction nr 12B-Ob w Exposure N Healing BTUH 913 insulation. Brick Veneer. U Value. 0.097 Area 162.3 Coding BTUH: 121 Map trace wall Frame Wall. Wood framing, R-11 cavity Construction nr: 1213-0b w Exposure E Heating BTUH 966 insulation, Brick Veneer. U Value 0.097 Area 171.7 Coding BTUH: 128 Map trace wall Frame Wall, Wood framing. R-11 cavity Construction nr: 126-0b w Exposure: S Heating BTUH: 946 insulation. Brick Veneer. U Value: 0.097 Area: 168.1 Coding BTUH: 126 Map trace wall Frame Wall.Wood framing, R-11 cavity Construction nr: 12B-Ob w Exposure: W Heating BTUH 934 insulation, Brick Veneer. U Value: 0.097 Area: 166.1 Coding BTUH: 124 BELOW There are no components for this section. ra • Default small windows for wall id 3890532 ".unstnshon nl 1 G U Value: 0.87 Heating BTUH. 606 Window. NFRC rated. Clear glass. Area: 12 SHGC 0.67 Coding BTUH 195 Exposure: N Default medium windows for wall id 3890532 Construction nr: I U Value: 0.67 Heating BTUH 1.211 Window, NFRC rated. Clear glass. E posure: N 24 SHGC: 0.67 Coding BTUH: 389 Default small windows for wall id 3890533 Construction nr: 1G U Value: 0.87 Healing BTUH. 606 Window. NFRC rated. Clear glass Area: 12 Exposure' NE SHGC: 0.67 Coding BTUH: 252 Default medium windows for wall id 3890533 Construction nr: 113 U Value: 0.87 Heating BTUH. 606 Window. NFRC rated. Clear glass Area 12 Exposure: NE SHGC: 0.67 Coding BTUH: 252 Default large windows for wall id 3890533 Construction nr: 1G U Value: 0.87 Heating BTUH. 1.817 Window, NFRC rated. Clear glass Area: 36 Exposure: NE SHGC 0.67 Coding BTUH: 755 Default small windows for wall id 3890534 Construction nr: 1 G U Value 0.87 Heating BTUH 303 Window, NFRC rated. Clear glass E posure: 6 SHGC: 0.67 Coding BTUH: 195 Default medium windows for wall id 3890534 Construction nr: 1 G U Value: 0.87 Heating BTUH. 1.817 Window, NFRC rated. Clear glass. Area, 36 Exposure: S SHGC 0.67 Cooling BTUH: 1.172 Default small windows for wall id 3890535 Construction or 1 G U Value: 0.87 Heating BTUH. 606 Window, NFRC rated. Clear glass. Exposure: 1 SHGC: 0.67 Coding BTUH: 453 Default medium windows for wall id 3890535 Construction nr: 1 G U Value: 0.87 Heating BTUH. 606 Window, NFRC rated. Clear glass. Exposure W SHGC: 0.67 Cooling BTUH: 453 Default large windows for wall Id 3890535 Construction nr: 1 G U Value: 0.87 Heating BTUH. 1.817 Window, NFRC rated. Clear glass. Exposure: 3y SHGC 0.67 Cooling BTUH 1,358 Default small windows for wall id 3890540 Construction nr: 1G U Value: 0.87 Heating BTUH. 606 Window, NFRC rated. Clear glass. Exposure:rea 1 SHGC: 0.67 Cooling BTUH: 195 Default medium windows for wall id 3890540 Construction or 1G U Value: 0.87 Heating BTUH. 1.211 Window, NFRC rated. Clear glass. Exposure: 2 SHGC 0.67 Cooling BTUH: 389 Default small windows for wall id 3890595 Construction nr: 1 G U Value: 0.87 Heating BTUH- 303 Window, NFRC rated. Clear glass Area, 6 Exposure: E SHGC: 0.67 Cooling BTUH: 199 Default medium windows for wall id 3890595 Construction nr: 1 G U Value: 0.87 Heating BTUH. 1.817 Window, NFRC rated. Clear glass. Exposure: E6 SHGC: 0.67 Cooling BTUH: 1,193 Default small windows for wall id 3890596 Construction nr: 1 G U Value: 0.87 Heating BTUH. 303 Window, NFRC rated. Clear glass. Arposure: S SHGC: 0.67 Cooling BTUH: 189 Default medium windows for wall Id 3890596 Construction nr. 1 G U Value: 0.87 Heating BTUH. 1,817 Window, NFRC rated. Clear glass. Area: 36 SHGC: 0.67 Cooling BTUH: 1,154 Exposure: S Default small windows for wall id 3890597 Construction nr: 1 G U Value: 0.87 Heating BTUH. 303 Window, NFRC rated, Clear glass. Exposure: 6 SHGC: 0.67 Cooling BTUH: 226 Default medium windows for wall id 3890597 Construction nr: 1 G U Value: 0.87 Heating BTUH. 1.817 Window, NFRC rated. Clear glass. Exposure w SHGC: 0.67 Cooling BTUH: 1,358 Window cooling BTUHs shown here are daily average values. See AED graphs for details of fenestration loads during the day. Map trace generated ceiling Ceiling under attic or attic knee wall. Asphalt Construction or: 16B-25 ad Area: 240 Heating BTUH 529 shingles, Dark, R-25. U Value: 0.038 Cooling BTUH 410 Map trace generated ceiling Ceiling under attic or attic knee wall,Asphalt Construction nr: 166-25 ad Area 92.5 Heating BTUH 204 shingles, Dark. R-25. U Value: 0.038 Coding BTUH: 158 Map trace generated ceiling Ceiling under attic or attic knee wall. Asphalt Construction nr. 166-25 ad Area: 689.1 Heating BTUH. 1,519 shingles, Dark, R-25. U value: 0.038 Coding BTUH: 1.178 There are no components for this section Skylight cooling BTUHs shown here are daily average values. See AED graphs for details of fenestration loads during the day. Map trace generated floor Floor over enclosed unconditioned crawl space Heating BTUH 6.631 Construction nr: 19A-Ocp Heating U Value:0.295 or basement, no floor insulation, Carpet or Area: 999 Cooling U Value:0.295 Coding BTUH: 1,120 F Value: 1,1 hardwood. VENTILATION There are no components for this section. HOT WATER PIPING There are no components for this section. System generated ducts(above conditioned space) cHLF 0.1 Heating BTUH: 4,250 Attic- Radial FSC.F 0.123 Sensible BTUH: 2,260 217 Latent BTUH: 217 INFILTRATION NCFM Heating: 111 Heating BTUH: 7,003 Leakage Category: Average NCFM Cooling: 58 Sensible BTUH T53 Latent BTUH: 1,281 BLOWER • •- There are no components for this section. HUMIDIFICATIONWINTER There are no components for this section. OCCUPANTS Nr.Occupants 4 Sensible BTUH: 920 Latent BTUH t;00 APPLIANCES Standard kitchen and utility room.lighting:2,400 BTUH Quantity: Sensible BTUH. 2.400 Latent BTUH: Plant Size small Quantity: 5 Latent BTUH: 50 Plant Size medium Quantity: 5 Latent BTUH: 100 Plant Size large Quantity: 5 Latent BTUH 150 ROOM DETAIL Room name: 1st floor Heated square footage: ••• Total Cooling BTUH: .: Cooled square footage: ••• Total Heating BTUH: Heated volume(above grade CF): SKMOM CFM: Cooled volume(above grade CF): Exposed wall area(SF): Efflum Load Calculation Cooling Heating 0 10,000 20,000 30.000 BTUH AED Graph(mid-summer) 10.000 2 5,000 m 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH — Average — Average` 1.3 AED graph(fall) 10,000 2 5,000 ao 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH — Average — Average 1.3 ROOM DETAIL Room name:2nd floor Heated square footage: .:• Total Cooling BTUH: Cooled square footage: .:• Total Heating BTUH: Heated volume(above grade CF): CFM: Cooled volume(above grade CF): Exposed wall area(SF): Load Calculation Cooling Heating 0 5,000 10,000 15,000 20,000 BTUH AED Graph(mid-summer) 7,500 = 5,000 m 2,500 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH — Average — Average' 1.3 AED graph(fall) 6,000 = 4,000 ti ca 2,000 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH — Average — Average' 1.3 i + MUZ-FS18NAH ill : DELUXE WALL MOUNT AAk ELECTF11C 18,000 BTU/H HYPER-HEATING OUTDOOR UNIT W/BASE PAN HEATER Job Name: System Reference: Date: Indoor Unit................................................................._..--__MSZ-FS18NA Outdoor Unit MUZ-FS18NAH ......................................................................... A �.w INDOOR UNIT FEATURES • Slim wall-mounted indoor units provide zone comfort control • Dual Barrier Coating applied to the heat exchanger,vanes and fan to prevent hydrophilic and hydrophobic dirt build-up • Multiple fan speed options:Quiet.Low,Medium,High,Super-high,Auto • 3D i-see Sensor'enables advance features: o Indirect or Direct Airflow for personalized comfort o Absence Detection for energy-saving mode • Double Vane features: o Separates airflow to deliver air across a large area o Simultaneously deliver to air separate sections of a room o Generates more comfortable natural airflow pattern • Multiple control options available: o Back-lit screen handheld remote controller(provided with unit) o kumo cloud`smart device app for remote access o Third-party interface options o Wired or wireless controllers • Triple-action Filtration:Nano Platinum Filter,Deodorizing Filter,&Electrostatic Anti-Allergy Enzyme Filter • Hot-Start Technology:no cold air rush at equipment startup or when restarting after Defrost Cycle • Quiet operation • The outdoor unit powers the indoor unit,and should a power outage occur,the system is automatically restarted when power returns OUTDOOR UNIT FEATURES • INVERTER-driven compressor and LEV provide high efficiency and comfort while using only the energy needed to maintain maximum performance • H2i plus-`"performance offers 100%heating capacity at-5°and 70%to 81%heating capacity at-13'F • Blue Fin anti-corrosion treatment applied to the outdoor unit heat exchanger for increased coil protection and longer life • Built-in base pan heater Specifications are subject to change without notice. 0 2021 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. SPECIFICATIONS: MSZ-FS1 8NA& MUZ-FS1 8NAH _Maximurn Capacityr 6Tum 21,000,.. Rated Capacity BTUM 17,200 Minimum Capacity ...................... BTU/H 6,450 Cooling at 95*F' Maximum Power Input W .............. 2,220 Rated Power Input W 1,375 Moisture Removal Pints I/.h ....... ...... 4.8 ........—-------- Sensible Heat Factor .............. Power Factor .................................... 0.69 % 98.0/98.0 Maximum Capacity ....... BTU/H 30000 Rated Capacity BTU/H 19000 Heating at 47*F� Minimum Capacity ..............__._........_._......... BTU/H ..................... ........ 5150 Maximum Power Input .._............. W 4000 Rated Power Input ........................ W ........................... 1,610 Power Factor ................ % 98.0/98.0 Maximum Capacity BTU/H 27,000 ............. Heating at 17*F' Rated Capacity BTU/H 12,800 ............ Maximum Power Input W 3,820 Rated Power Input Capacity Heating at 58F4 Maximum BZU/H 23,1,280 000 Max mum Power Input W .......... ............... 3,250 ...........................- ............. ............................. Heating at-5'Fl Maximum Capacity .................... BTUIH 19.000 Heating at-13*Fl Maximum Capacity .............. BTU/H .......................... —...._...._..---------- Heating 17100 SEER .... 21.0. ..................... ..................................... EER' 12.5 HSPF[IV] 12.0 COP at 47'F' 3,46 Efficiency COP at 17'F at Maximum Capacity' 207 COP at 5*F at Maximum Capacity' 2.07 COP at-WIF at Maximum Capacity' 1.91 COP at-13*F at Maximum Capacity' 1,91 jj ENERGY Certified ..................................................................... Yes .............--—---------- Voltage,Phase,Frequency 2081230,1,60 Guaranteed Voltage Range VAC 187-253 ........... Voltage Indoor-Outdoor,S 1-S2 VAC 208/230 Electrical Voltage Indoor-Outdoor,S2-S3 V DC_ 24 Short-circuit Current Rating[SCCR] kA 5 Recommended Fuse/Breaker Size(Oudoor) A 20 ....................... _..—.--'---`------------- Recommended Wre Size(Indoor-Outdoor] ..................AAG 14 .. ............................ -------------------.............. MCA A 1.0 Fan Motor Full Load Amperage ............... .............A__..... 0.65 Fan Motor Output W 40 ........... Airflow Rate at Cooling,Dry CF M 225-262-304-355-437 Airflow Rate at Cooling,Wet CFhM1 194-225--261405-376 Airflow Rate at Heating,Dry CIFM 201-272-350-410-514 Sound Pressure Level[Cooling] d" 27-31-35-39-44 Indoor Unit Sound Pressure Level[Heating] _—AA 25-31-37-40-46 ......... ......... Drain Pipe Size ...... SM .............. Coating on Heat Exchanger ................................ .............................. Dual Barrier coating External Finish Color Munsell 1.OY 9.2/0.2 ..............._ Unit Dimensions W x D x H:In.[mm] 30-7/16 x 9-3/16 x 12(-11/16)[925 x 234 x 305(+17)] Package Dimensions ...........-- .................. Wx D x H In.[mm] 39 x 12-1/4 x 15-1/2[990 x 310 x 4001 Unit Weight Lbs.(kg] 29[115] .......... Package Weight Lbs.(kg] 34[15A] Indoor Unit Operating Temperature Cooling Intake Air Temp[Maximum Midmium]* .... -F 90DB 73WB/67DB, 57 WB ................. Range Heating Intake Air Terrip[Maximum Minimum] 'F 80 DB 170 DB ........... ........................................... NOTES: AHRI Rated Conditions 'Cooling(Indoor//Outdoor) -F 80 DB 67 M 95 DB,75 WB (Rated data is determined at a fixed compressor speed) 'Heating at 47*F(indoor fl Outdoor) *F 70 DB 60 WB Il47 DB,43 WB 'Heating at 17°F(indoor H Outdoor) 'F 70 DB,60 W3 H 17 DB,15 W3 Conditions 'Heating at 5'F(Indoor//Outdoor) 'F 70 DB,60 WB//5 DB,4 WB 'Heating at-4°F(Indoor H Outdoor) 'F 70 DB,60 WB/14 DB,-5 WB 'Heating at-5°F(Indoor//Outdoor) 'F 70 DB,60 WB -5 DB,-6 WB 'Heating at-1 3'F(Indoor//Outdoor) *F 70 DB 60 W3 -13 DB,-14 W3 *Outdoor Unit Operating Temperature Range(Cooling Air Temp(Maximum/Minimum)): •Applications should be restricted to comfort cooling only;equipment cooling applications are not recommended for low ambient temperature conditions. •For P-Series only: Wnd baffles required to operate below 23'F DB in cooling mode. • Cooling-only system with wind baffle.-40*F-115'F. Heat pump system with wind baffle.O*F-115'F. Refer to wind baffle documentation for further Information. -Outdoor Unit Operating Temperature Range(Cooling Thermal Lock-out/Re-start Temperatures,Heating Thermal Lock-out I Re-start Temperatures): *System cuts out in heating mode to avoid thermistor error and automatically restarts at these temperatures. SEACOAST PROTECTION(ONLY APPLIES TO P-SERIES-BS MODELS) •External Outer Panel:Phosphate coating-Acrylic-Enamel coating •Fan Motor Support:Epoxy resin coating(at edge fare) •Separator Assembly Valve Bed:Epoxy resin coating(at edge face) •Blue Fin treatment is an anti-corrosion treatment that is applied to the condenser coil to protect it against aitome contaminants. Specifications are subject to change without notice. 0 2021 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. SPECIFICATIONS: MCA A 18.0 _.._..._-.._-..._............_---- --.._._._.... .- __.__ :.._.__ .__............... MOCP A 20 ...................................._—.............................._...... .............._. ...................,................................................... __ Fan Motor Full Load Amperage _ A 0.93 Fan Motor Output W 50 Airflow Rate L __ CFM _ 1801/1949 Refrigerant Control LEV Defrost Method _ Reverse Cycle Costing on Heat Exchanger Blue Fin Coating Sound Pressure Level,Cooling' - dB(A) 52 - - -.. ...............—�-- _........-_._._.._.........._ Sound Pressure Level,Heating2 - dB(A) 55 Outdoor Unit Compressor Type Twin Rotary . ................__...._._._...._.. ..............._-.--....___.._................._..----. ..___. ..._...._......._......__.........._......_.., Compressor Model SNB172FOKMT Compressor Rated Load Amps A .__ 17.0 i Compressor Locked Rotor Amps A 13.6 i Compressor Oil Type//Charge oz. FV50S//0,40 External Finish Color Munsell 3Y 7.8/1/1 Base Pan Heater Built-in Unit Dimensions W x D x H,In.[mm) _ 33-1/16 x 13 x 34-5/8[840 x 330 x 8801 Package Dimensions W x D x H.In.[mm] 38-3/4 x 16-314 x 39[980 x 420 x 990] j ____..._..__..... -........ - ___..._.. _.___. ................ Unit Weight Lbs.[kg] 118[53.5j _—.._..... ....__— .._...........__.... ..._....... t....' ._............_. ...._..; Package Weight Lips.(kg] 135 61 _..... ..- Cooling Air Temp[Maximum/Minimum]* °F 115 DB/14 DB _.----..___----- Outdoor Unit Operating Temperature Cooling Thermal Lockout/Re-start Temperatures" °F -4/0 Range Heating Air Tamp[Maximum I Minimum] °F 75 DB,65 WB/-13 DB,-14 WB Heating Thermal Lock-out/Re-start Temperatures" °F -18/-14 _........... --_..........................._-----------= Type R410A ' .............. _.____. .....__._.-.. ... ... - .. . Charge Lbs,oz 3,7 i Refrigerant ---...._—__.._........_._._.- _---------........------------ Changeless Piping Length Ft.(m] _ --_- 25[7.Sj ' Additional Refrigerant Charge Per Additional Piping Length oz./Ft.[g/m] 0.216(20] ........_. .....__. -. -.. _.. .._....._._.__ --- --._....,__... _ ...i Gas Pipe Size O.D.[Flared] In.[mm] ...................... 112[12.7] ,_.._._._.._..._.._....._._. _. _....... ...__. ....... ....j Liquid Pipe Size O.D.(Flared) In.[mm] -_ 114[6.35] - Piping Maximum Piping Length FL[m] 100[30] Maximum Height Difference Ft[m] .I __ 50[15) Bends Mandmum Number of Bds 10 j NOTES: AHRI Rated Conditions 'Coding(Indoor/!Outdoor) -F 80 DB,67 WB//95 DB,75 WB (Rated data is determined at a fixed compressor speed) 'Heating at 47'F(Indoor//Outdoor) °F 70 OB,60 WB//47 DB,43 WB 'Heating at 17'F(Indoor I/Outdoor) 'F 70 OB,60 WB//17 DB,15 WB Conditions 'Heating at 5°F(Indoor//Outdoor) 'F 70 DB,60 WB//5 DB,4 WB 'Heating at-4°F(Indoor//Outdoor) -F 70 DB,60 WI3//A OB,-5 WB 'Heating at-5'F(Indoor//Outdoor) °F 70 IDS.60 WB H 5 DB,-6 WB 7Heating at-13°F(Indoor//Outdoor) 'F 70 DB,60 WB//-13 DB,-14 WB 'Outdoor Unit Operating Temperature Range(Cooling Air Temp(Maximum/Minimum)): •Applications should be restricted to comfort cooling only.equipment cooling applications are not recommended for low ambient temperature conditions. •For P-Series only: > Wind baffles required to operate below 23'F OB in cooling mode. Cooling-only system with wind baffle:-40°F-115'F. > Heat pump system with wind baffle.0°F-115'F. Refer to wind baffle documentation for further information. "Outdoor Unit Operating Temperature Range(Cooling Thermal Lock-out/Re-start Temperatures,Heating Thermal Lockout/Re-start Temperatures). •System cuts out in heating mode to avoid thermistor error and automatically restarts at these temperatures. SEACOAST PROTECTION(ONLY APPLIES TO P-SERIES-BS MODELS) External Outer Panel:Phosphate coating+Acrylic-Enamel coating •Fan Motor Support:Epoxy resin coating(at edge face) •Separator Assembly Valve Bed:Epoxy resin coating(at edge face) •Blue Fin treatment is an anti-corrosion treatment that is applied to the condenser coil to protect it against airt ome contaminants. Specifications are subject to change without notice. 0 2021 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. INDOOR UNIT ACCESSORIES: 8NA CN24 Relay Kit ❑ CN24RELAY-KIT-CM3 System Control Interface ❑ MAC334IF-E BACnet,and Modbus Interface ❑ PAC-UKPRC001-CN-1 Control Interface Thermostat Interface ElPAC-US444CN-1 Wireless Interface for kumo cloud` ❑ PAC-USWHS002-VVF-2 kumo station'for kumo cloud' ❑ PAC-WHS0IHC-E IT Extender ❑ PACWHS011E-E Lockdown bracket for remote controller ❑ RCMKPICB Remote Sensor Wired Remote Sensor ❑ M21 EAA307 Wireless temperature and humility sensor for kumo cloud' ❑ PAC-USWriS003-TH-1 _ Simple MA Remote ControllerT ❑ PAC-YT53CRAU-J ..._._.... ............... _....... ......__....._ ................ Wired Remote Controller Deluxe Wired MA Remote Controller ❑ PAR40MAAU ....... Touch MA Controller' � PAR- S CTOIMAUB ._.............................._......._...................-_—..__......_.----._.__............ _.---__ .._..........._... Wreless Remote Controller kumo touch-RedLINK'Wireless Controller n MHK2 Blue Diamond Sensor Extension Cable—15 Ft. a C13-103 ......... ._......-._..__. ............................_... ........ .._..... _..._ ..._.... Blue Diamond Alarm Extension Cable-6.5 Ft. ❑ C13-192 .-..--"---........---._.._._ .......__. Blue Diamond MultiTank—collection tank for use with multiple pumps ❑ C21-014 ! Condensate Sauermann Condensate Pump ❑ S130-230 Drain Pan Level Sensor/Control _ ❑ SS610E Fascia Kit for MicroBlue Pump,mounts the MicroBlue and sensordfK*bwm@M klAOor Wt ❑ T18-016 ....---..----"------- --__...............-----._._. Blue Diamond(MicroBlue)Mini Condensate Pump(110/208/230V)1p11*1e,0 BTUM ❑ X85-00I —..._ .._. 00 __ .... .... —._. Disconnect Switch (30A/600VAJL)[fits 2•X 4"utility box]-Black ❑ TAZ-MS3 03 - , (30A/600V/UL)[fits 2"X 4"utility box]-White ❑ TAZ-1dS303yy j ......_—_._............_.._...__.__.........__ _ _....k Filter Electro StaticAnti-allergy Enzyme Filter ❑ MAC-2330FT-E ! _........ .--. .__...._---.._—.. .................... _. ___....... Platinum Deodorizing Filter ❑ MAC3000FT-E 15'x 1/4'x 15'/12•Uneset(Twin-Tube Insulation) ❑ MLS141212T-15 I 30 x 1/4"x 30'/12"Lineset(Twin-Tube Insulation) ❑ MLS141212T30 ! Lineset 50'x 1/4"x 50'112•Lineset(Twin-Tube Insulation) ❑ MLS141212T50 65'x 114"x 66I 12'Lineset(Twin-Tube Insulation) ❑ MLS141212T-65 NOTES 'Requires MAC-3341F-E •MSenes EZ FIT'Recessed Ceiling Cassette,Floor-mount and Wall-mourt Allows indoor units to connect to an MA Controller Deluxe MA Remote Controller Simple MA Controller Touch MA Controller -PAC-SF40RM-E(Unable to use with wireless remote controller) •MSenes Ceiling Cassette,Ceiling Suspended,Honzontal-ducted and Multi-position Air Handler •PSenes Ceiling Cassette,Ceiling Suspended,Honzontal-ducted and Multi-position Air Handler Specifications are subject to change without notice. ®2021 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. OUTDOOR UNIT ACCESSORIES: Condensate Drain Socket - - ❑ MAC-871DS Hail Guards Hail Guard ❑ HG-A7 ..................... 14 Gauge,4 wire MiniSplit Cable-250 ft.roll ❑ S144-250 14 Gauge,4 wire MiniSplit Cable-50 ft.roll - ❑ S144-50 Mini-Split Wire 16 Gauge,4 wire MiniSplit Cable-250 ft.roll ❑ 5164-250 16 Gauge,4 wire MiniSplit Cable-50 ft.roll ❑ S164-50 Outdoor Unit 3-1/4 inch Mounting Base(Pair)-Plastic ❑ DSD-400P Mounting Pad Condensing Unit Mounting Pad:16"x 36"x 3" ❑ ULTRILITEI Outdoor Unit Stand—12"High ❑ OSMS1201 M 18"Single Fan Stand ❑ QSMS1801M Stand 24'Single Fan Stand _ - - - ❑ QSMS2401M ...................._....... __. Condenser Wall Bracket ❑ QSW82000M-1 _.... ..._.........._ ............................. ....._._. ..._............. . .........._..---_-..................... . Condenser Wall Bracket Stairdess Steel Finish n QSWBSS Specifications are subject to change without notice. 0 2021 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. INDOOR UNIT DIMENSIONS: : Unit: inch 7/16 x 1.1/16 Oblon hole 7/I x I /I6 Oblon hole 1113101101011 D10fe 4-1/16 8-7/8 8-7/8 4-1/16 36-7/16 e e 35.5/8 3/8 0 "1 oD I -1 " o 71 8 I/8 73/ M Indoor nit 2 5/8 15.9116 14-11/16 3-9116 9-3/16 Air in Noll hole 03 3/16 Insfaltalion D10ft m m N Pi in a`O 2 I 19/16 \ 2 — Drain nose n 2 3/8 21 II/16 6 5/I6 4 2 2-32-3// 11/16 Air out 4-5/8 I 5-3/16 CO N 2 Sl8 2-11/16 (06/09/12 KBTU/H) (15/18 KBTU/H) r Insulalion #1.1116 0.0 — Insulation 01.7/16 O.D Liquid line 11/4 19-11/16 (Flared connection /1/4) o Li uid lint 11/4 19-11/I6 (Flared connection 4114) Gas line 03/8 16-15116 (Flared connection #318) Gas line 13/8 16.15/16 (Flared connection 4112) Drain hose lInsulislion 11-1/8 Connecled porl 1518 0.9 Drain hose IlAsulalion 11-1/8 Connecled porf 05/8 O.D Specifications are subject to change without notice. ®2021 Mftsubishi Electric Trane HVAC US LLC.All rights reserved. OUTDOOR UNIT DIMENSIONS: Unit: inch REQUIRED SPACE 0 Pik. o��ow �000� 4In OR MORE I n�n OR MORE 16-7/16 AIR IN DRAIN HOLE e1-21/32 0 z x� vn 20 in OR MORE a A AIR It tN OPENTWO SIDES OF RIGHT din OR MORE. m? OR REAR SIDE AIR OUT 1-9/16 OVAL HOLES 2+3/6.13/16 HANDLE J 9132 SERVICE PANEL LIQUID REFRIGERANT PIPE JOINT VALVE VER a 6 6-7/6 19-11116 SERVICE POR 711116 GAS REFRIGERANT - 33-1/16 3-3/16 PIPE JOINT REFR TMT LIA,O RERRERART PFE FLARED e6.36 1/<' PPE ANT GAS IEFREERMIT PPE FLARED e12.7(1/2') 1340 Satellite Boulevard Suwanee,GA 30024 Toll Free:800-433-4822 www.mehvac.com FORM#MSZ-FS18NA-U1&MUZ-FS18NAH-U1-202101 0. Intertek Specifications are subject to change without notice. 0 2021 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. ,ii7i*{, ji'l,'t:`•`•A fp5'T',:o•,;1Ytly�:a J^l ORION•l�. d•.:i•..,;c �. ipy tiV" fia? 1R`.:., cr'^ /,;,R,4t � ,.4i:,,, �a' \ :.:.do;ss:3•.1ACI� ;i :�;.r-tic;.�,:,.GA 1Ix. .,'!%C:+-�:d"' ,,,.,•,.>:,f'`' ft.�v�`:;% ��rf?�, "0���� >.y�a ':,ui�;Sfi � SsY. :�•'!•i!}: ";Vk.A!< ;;I :�:;;,, � �. ;r. (� t,,: _ ,•"T �l n 1�.: � ,H n.>.{_:i:,br.7 �."��n,.>. e�� ry1''%" �Y'�`?+^ `^'��� �, Y: � .i,r' �. •','`R S. t�" •� T^•.,• •� en :SrR, �?h,.��i,•.�.�r:y{ll tr+•h�A % Y 't t .,,h! `�;\ �;- - r .'Y.. t. � r.i � ,ty.;••�,.,;. 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Yr�'g ,�",'�+�`` A`III DATED/YYYYj CERTIFICATE OF LIABILITY INSURANCE 11/13/1/13/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT _NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX HOME OFFICE: P.O.BOX 328 A/c No Ert:888-333-4949 Ayc No):5074464664 OWATONNA, MN 55060 E-MAIL ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC IJ INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 287-972-4 INSURER B: BRUNI AND CAMPISI PLUMBING AND HEATING, INC. INSURER C: 100 GRASSLANDS RD - - ELMSFORD, NY 10523-1110 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:37 REVISION NUMBER:0 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 DL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR NSR WVD MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAM ACE TO RENTED $100,000 PREMISES Ea cu ocrrence MED EXP(Any one person( $5,000 A Y N 6119957 01/01/2023 01/01/2024 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 �OTHER PR ❑LOC PRODUCTS-COMPIOP AGG $2,000,000 POLICY El: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) A OWNED AUTOS ONLY AUTOSULED N N 6119957 01/01/2023 01/01/2024 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 A 7EXCESS LIAB CLAIMS-MADE N N 6119958 01/01/2023 01/01/2024 AGGREGATE $5,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION PER STATUTE OTH. AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT DED?OFFICERIMEMBER EXCLU NIA _- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS be'!ow E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional RemarKs Schedule,may be attached it more space is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 287-972-4 37 0 VILLAGE OF RYEBROOK SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:DCB22B4E-5D9E-4960-BFA3-D7C23886CCED NTW Workers' CERTIFICATE OF 5TATC Compensation NYS WORKERS` COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured BRUNT AND I PLUMBING AND HEATING, 100 Grasslandsds Rd 1c.NYS Unemployment Insurance Employer Registration Number of Rd ELMSFORD,NY10523 Insured Work Location of insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York Slate,i.e.,a Wrap-Up Policy) Number 132999646 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Co.of North America VILLAGE OF RYE BROOK 938 KING STREET 31p.Policy Number of Entity Listed in Box"Ila" RYE BROOK,NY 10573 C51623769 3c.Policy effective period 10/1/2022 to 10/01 i2023 3d,The Proprietor,Partners or Executive Officers are included.(Only check box If all partners/officers included) ❑ all excluded or certain partnerslofficers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Lex Smith lDoous{�dtarume of authorized representative or licensed agent of insurance carrier) Approved by: � �_ - 9/12/2022 (Signature) (Date) Title: A si,stantProcjraLm Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 214-721-6248 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) AcctR:2809046 www.wcb,ny.gov