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HomeMy WebLinkAboutBP23-021PQ3_0c/9l�is7o�e G OTHER PERMIT # c��� o�i DATE J 3 fir' SECTION J` /J_ - BLOCK LOT 9 / Q TYPE OF WORK T O� � r0ke� e�OVQ � �7 ��a �/����00/LI /�E'/70✓Q�7G/7 A 108 LOCATI IV _ OWNER/»P CONTRACTOR COST `� CO at s r/ V� vv-vi i i io Tos���1 ac 1 c9/SOS 3 TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING Yr INSP RGH PLUMBING v GAS O SPRINKLER Col ELECTRIC LOW•VOLT Cl ALARM AS BUILT O FINAL VILLAGE OF RYE BROOK WESTCHEST4; COUNTY, NEw YORK NO. 24-020 Certif tcate of Occupancy y This is to certify that i/ / //rt 44- 1 �� of, Rq,,4YU D N Y, having duly filed an application on � C� { 20 cRq requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: / 5.7 Block: / Lot: and having fully complied �with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. �5-6li /, issued � �/ 290g3, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: /"--/Construction: for the following p oses: /y-1 r r �/� �Lf',/d I ho,-, Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in he hall be made,nor 1 th building be moved from one location to another until a permit to accomplish such change h `a4 bee�o from a Bu' in Inspector. Building Inspector,Village of Rye Brook: D MAR ate: 1 1 202� tty wo'�J V VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J.Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 11,2024 Amelia Irizarry 6 Lincoln Avenue Rye Brook,New York 10573 Re: 6 Lincoln Avenue,Rye Brook,New York 10573 Parcel ID#: 135.73-1-29 This document certifies that the work done under Mechanical Permit#23-130 issued on 8/29/2023 for the installation of a new Navien combination boiler/water heater has been satisfactorily completed. Sincerely, Steven E.Fews Building&Fire Inspector /to D E C I-MJ IE BUILDING DEPARTMENT For office use onIZ: PERMIT# MAR —6 2024 IDVILLAGE OF RYE BROOK ISSUED: 138 KING STREET4 RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914.)93P-0668 FEE:gg //U-- PAIDa' BUILDING DEPARTMENT wrwW,ry—ook org 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 sssrrsssessrsss/ssssesrssreserssrsstrsssrssrtrssesssrrsrserssrrerssrrsrssrrrrrrsrrrs:ssssrrrsrrsrrrsrrrsrrtrrss♦sssssrrsrrers Address: GAr0k Ige" Occupancy/Use: Parcel ID#: ��'�7, �3 —�aq Zone: 'e /o Owner: P!� rG/s�/Z/ // Address: �j /rICD�l7 iYyYj �,/ P.E./R.A. or Contractor:. elG ddress: Person m responsible charge: Address: 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: being duly swom,deposes and says that he/she resides at (Print Name of Applicant) 1No.and Street) in 6W29 ,in the County of ��� in the State of Wthat (Citc/Town/Village he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was: $ for the construction or alteration of: ,4121- haAro-" 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 erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building 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§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Swom to before me this day ofG� ,20q'-A day of ,20 caner Signature of Applicant S-We of Prop 1 / ire t me of Property Owner Print Name of Applicant i Notary blic Notary Public SHARI MELILLO Notary Public,State of New York No.O1ME6160063 &,12/2021 Q:jr_lified in Westchester County ».mission Expires January 29,20�� �E BRC�k cu � • �9a2 BUILDING DEPARTMENT ,❑BBUILDING INSPECTOR O 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 : (o L i ►.) C-l7 L � /'� �P DATE: PERMIT# -ISSUED:Z.' 2`/"2� SECT: 3 .7 I BLOCK: LOT: LOCATION: �� 4 2 V� y� OCCUPANCY: ❑ Violation Noted THE WORK IS... CJ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas i' ^'�`X ►S�, . - `� Z �a'L ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION O—FINAL ❑ OTHER �yE BRCb�_ ��• �9a2 �' BUILDING DEPARTMENT VBILDING INSPECTOR SISTANT 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 : lO L 1 '-j C O L DATE: PERMIT# i ` Z 3 oc 1 ISSUED: SECT: 13S. BLOCK:_LOT: Z f LOCATION: y , �e L` t 6A��-? OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas X �^��N I� ► �f �,9�, �0 �, �- ❑ L.P. Gas �� ,�� � � �n ��Qp�•., ❑ FUEL TANK ❑ E SPRINKLER 21 FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��. cu � �7 c ��• �9b2 �' BUILDING DEPARTMENT ❑��//BUILDING INSPECTOR VASSISTANT 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,\J C.Q L N j y r DATE:.' ' ". o z Y PERMIT# 1' `�, z ISSUED: 0' 711'2.3 SECT: BLOCK: LOT: LOCATION: se n J OCCUPANCY: ❑ Violation Noted THE WORK IS... 2 PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas T Q S if- E /Ij cf #�. O► (DA VIVL- ❑ L.P.Gas �et-� A ❑ FUEL TANK ^ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER �E BRC�,�. cu � 04 =- BUILDING DEPARTMENT BUILDING INSPECTOR /0 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 : 0 C_c)� r^� DATE: Y �GAq PERMIT# \ ,q `7� J"A ISSUED: SECT: BLOCK: LOT: A' r LOCATION: ,_�J UC \N \44?, OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING pINSULATION Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER i4RXtN O I'd 1. •'982 BUILDING DEPARTMENT UILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street - Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : � �\ � 1 DATE: PERMIT# I ISSUED: SECT: BLOCK: LOT: LOCATION: 'y `� �CA-7 OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ."EY ROUGH PLUMBING ❑ ROUGH FRAMING ` ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER e a a � s F+1 n1 N • � ~ � O O a x # Fy■'1 C!j s [-i W O Zi � � � W rn G. a 4 W V a & ,q C \ v Cq Q ■ Z w ~' • a og y H w O W FFB�II ` ° O H 0 Ri O ° o o -0 4i _ Q. w 0-4 ^ a cn W 0 eq 0 ~ w q w a oo v( O w 8 °' o x I, � V Z � A cd v ■ O M b v� � 0� V � oC G% o A �, Ox , � o W MSN w W fx v\� �a v V Q' vi O Ewa z a w o O � ' oo04 L of v d' � • p V •• 0. W W R R. GL a ■ BUILI)I��77 �FPARTMENT VIL�;A'c E OF Rvlt;BOOK FEB 16 2023 938 KING$t�ET RYE BRO ,NY 10573 ti VILLAGE OF RYE BROOK w f 02k,6rg BUlLD1NG DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: ,l� Approval Date: F F R Pen #: / ' Application Fee:S Approval Signature: Permit Fees: $ + Disapproved: Other: // er Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use, as per detailed statement described below. �J 1. Job Address: � , Ia1:r'`lv _ / G' �s VII- SBL:�� ,�"I�q Zone: J'� `/CJ 2. Proposed Improvement.(Describe in detail): 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:;9 Yes: If yes,indicate: TIER I: TIER II: TIER III: r� 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application R 2 sets of detailed engineered plans) 5. Occupancy; (1 fain.,2 fain.,comm.,etc...)Prior to Construction: J et;fl-A-7 After Construction: 6. NX State Construction Classification: N.Y. State Use Classification: 7. Property Owner: 'ate Address: Phone# Cell#�` email: 8. Applicant: Address: Phone# Cell.# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: / 11, General Contractor. G Phone# !J-- Cell# email: 12. Estimated cost of construction $ /'?/" (NOW I he !,tnttatcd cost shill ink ludc all labor.❑ri�l.ticafloldmg,fixed etimpment,professional fees,and material and labor which tna� he donated gratis.) 13. Job Timetable: Start: Finish: (1) 9/12/2021 BUILD MENT VIL E OF RY 'I�ROOK FEB 16 2023 938 KING LT RYF Bnoox,NY 10573 4 066$ VILLAGE OF RYE BROOK k.' BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VQ,LAGE CODE 4216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION . ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK,COUNTY OF WESTCBESTER ) as: / 31, w'/r ,residing at, /6 k-101- /'� /�c,�G �o� (Print name) (Address whe'TC you lire) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Zzzo; /ram , 'i ,Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (. nature of Prope wner(s)) ( � f (Print Name of Property Owner(s)) Sworn to before me this f day of V_ ,203 VWO-0 -( ) (Notary Pub ic) - R C.Lena idataNryaputiic sto of (2) Oualfled In Wes tc c,�n�yy��:yy�2,64 C,bMM W FraiTBS Feb.�" 8/1 212 02 1 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. ST=EOF W 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 a cant) 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. By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this I L Sworn to before me this day of IC��cr� , 20 )-3 day of , 20 afore of Property er Signature of Applicant ame of Property Owner Print Name of Applicant Notary Public Notary Public SNAFU MELILLO Votary Public,state of New York No.OIME6160063 Qualified in Westchester County :©mmission Expires January 29.20Z' (4) 3/2l/19 BUILDING DEPARTMENT D E C E� V E VILLAGE OF RYE BROOK AUG 15 2023 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.rN,ebrooLorg BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date:AUG 1 G 3 Per it oZ/ Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: / Amendment Fee:O/Q(T—P/1 6 Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an exis ing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. I. Job Address: �Q /)//J �fi� Ale Ag_ae / Existing Permit#: 2. Parcel ID#: �1�, .3���� Zone: Original Approval Date: 3. Proposed Amendment(Describe in detail): all 46� r 4. Property Owner: Address: Phone# Cell#� e-mail lllyAe�o/A i//�/ Applicant: Address: Phone# Cell # e-mail Arch itect/Engineer Address: Phone# Cell# e-mail 5. Occupancy;(I-Fam.,2-Fam.,Comm.,etc...)Prior to construction: After construction: — /'✓f 6. Will the proposed amendment require the installation of a new,or an extension/modification to an existing a matic fire suppression system?(Fire Sprinkler,ANSL System, FM-200 System,Type 1 Hood,etc...)Yes:_No:�yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.o mor of impervious coverage requiring a Storm water Management Control Permit as per`217 of Village Code?Yes:_NoArea: i sit 2/202 t 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No:)(if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No:�0(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No:'O(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No:�O (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No:_eLcefyes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No:"irRfyes,indicate: TIER I: TIER II: TIER III:_(if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendrn t r Milt in additional square footage to the building or subject structure, and if so,provide such additional footage here. (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y. State Construction Classification: A N.Y. State Use Classification: 17. Estimated date of completion: This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer&signed by those professionals where indicated. It must also 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. STATE OF NEW YORK,COUNTY OF WESTC1 ESTER ) 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 true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Swom to before me this day of ,20 day of ,20 Att;�4 �ature of Prop weer Signature of Applicant Ic ame of Property Owner Print Name of Applicant Notary Public SHARI MEULLO Notary Public Notary Public,State of New York 2 No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20LI 8/12/2021 co u Ow (A I—I M � Z logO + r- ~ ai Lti en 00 w , z a rA w N o Q ,� a v a! w w U z Az A > O o w V + z 3 �o z z , Ln z U z Wo WM w z "t 00 � ►-� c V A o• a O W U r Q 0.4 cc en • ►� w W x w � o F o ° '� z o A oLn 04 y x �l z z oe H w W. D ; RJ, ' D BUILI} NG_,DEPARTMENT AUG 3 0 2022 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 ICING.. ETRYE'BRogK,NY 10573 BUILDING DEPARTMENT �._, _ (914)91?9 9b6-X-5--rcd-1 j :�K4}939-5801 wvizw� or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: QJJ — OQ EP#: Approval Date: F FB 2 Application Fee. A)l * Approval Signature: Permit Fee: S Disapproved: 71 Other: (fees are non-refundable) Application dated, p is hereby made to Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. 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: 6, L I n l ,�C&) A YC U k�e- Q 62,00lc I SBL:/3,5/7,3—/ Zone:)I 2.Property Owner: Address: Phone#: —t� Cell#: d -SIy email ra; 'iv5�3 3.Master Electrician:, 6 V tj G(ZIEc?) Address: � (p�� �u Z/j"I Lic.#:F 53 ei Phone#:'(I`{-q3 r-a Y Z J_Cell Jj-�7Y25 email: I Ci q P I L-Cd oQ oC, CO rn Company Name:(A es.TMO (�.- I N.c tit c Address: 3U i R 0 Ad A f 0.03 4.Proposed Electrical Work/Fixture Count:(I,h AL m,,;t yv / 00 Uo 1 T S l;=tz Ic-e- TO 10[) 06L'+ Seaaul­e. � j, LA)0-1- L o /Di AwA55j ood STA ( OF NEW YOM COUNTY OF WESTCHESTER ) as: ng dui o ,dcpo�and'states that he/she is the applicant above named,and does further print name of individual signing as the ap cant) state that(s)he is the legal owner of tfie 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 architec ontracto)agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belie, t 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 o'19 l Swom to efore me this V day of ,HOr-vey 20 _ day o 20_9Q _ Sign a Tperty er Si a of Applicant Print Name of Property Owner Pr' ame of Applicant Notary Publi NMr u c,State of New York No.01ME6160063 DCMPAGE GAYA VITHANAGE Qualified In Westchester County 3 Notary Public-State of New York Commission Expires January 29,20 NO.01,V16424207 Qualified in Westchester County 1/5/16 My Commission Expires Oct 25, 2025 STATEWIDE • Service With birlegrit.v 1:1 Main Street,Fishkill, NY 12524 1 email. • • SWIS JOB APPLICATION ;. 1 914.219.1062 • SWISTraining.corn Ofi Elect. Permit# /�� L� Date Bldg Permit# n Utdity ID# Final Certificate# City/Village Zip Township County Address Nf al (K'NLAC Cross Street Section Block Lot Owner Name/Address(If different than above) I Contact Number ❑Basement 01st FI. 2nd FI. 3rd FI. ❑More Than 3 FI. ❑Garage Attic 0 Outside Residential Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps J Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent ) SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑underground New Reconnect ❑Overhead ❑Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information ha � U 1 n� -c 2vl-c To Oct IA a1 a(� U aL e U I �A Neu u�I - ID I t AUG 3 0 2022 � VILLAGE 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 UKs i G Date Signature r' Address + City/State Zip Code t �s License# �3�� Phone# C� 5 V / ID State Wide Inspection Services JAN 2 5 2024 1080 Main Street Fishkill, NY 12524 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECI10N$FRVII FG BUILDING DEPARTMENT Email: office swisn .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: Westmore Electric Amelia Irizarry 6 Sunset Road 6 Lincoln Avenue Rye Brook, NY 10573 Rye Brook, NY 10573 Located at: 6 Lincoln Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-048 135.73 1 29 Certificate Number: 2024-0440 Building Permit Number: BP 23-021 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 Lincoln Avenue,Rye Brook, NY 10573 The First Floor Kitchen &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 25" Day of January 2024. Name Quantity Rating Circuit Type Luminaires 07 Receptacles 06 Switches 05 AFCI 05 GFCI 03 Hood 01 Cook Top 01 Dishwasher 01 Refrigerator 01 Name Quantity Rating Circuit Type Service 01 100 Amp Meter 01 Panel 01 Disconnect 01 Grounding and Bonding of Service to Current Code. Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Page 2 7 J N 3 CV] N N v M V M d N o O P. v� � w � Z O � W o wAw H ~ wLn c < ip Z ~ ., w 3 z 0. A 00 H W S.. O 0 Z � cn z v z° .. w z oc " � •r (1i � a i G S • Z .j z CQ w z � t, s Q�lE- BRnv.� rR BUILDING DEPARTMENT VILLAGE OF RYE BROOK OCT - 2 2023 938 KING STRI-.I:'r RYI?BRom,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK ««vv.ryebrookoi a BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 23 ` O ZI EP#: C ) 1 y Approval Date: OCT U Z Permit Fee: $ Approval Signature: Other: ************************************************************************************************** Application dated, - — is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: i0 L�l n cr.(n AUGC . SBL: I�JS� . � 3 - 1 -2 �� Zone: 2.Property Owner: A M 't✓\t cA r, Za r 1 Address: A Cti V 1 1'�,J G Phone#: l(4t -9�0 SIq Cj Cell#: email: 3.Master Electrician/Licensed Installer: Cep i- 0) \j " t_U y-'-o Address: a5 Lic.#: _Phone#: 1163 Cell#: L 6 ) email: .2L( 7F60 i CA dv0, ,0�^'� . Company Name: M�P-E .,4 �f E7&C.F(C /"Z— Address: W It, +Y—' d M-Aarn vou g:y�j y(or }1 4.Proposed Electrical Work/Fixture Count: p +2, W t vi Ed 0 o A-e_N F t'N W� r�� -1�f Q�1 �h�iJv•✓t 5.31 Party Electrical Inspection Agency: STATE OF 1NJJEW YORK, COUNTY OF WESTCHESTER ) as: PQ / M V i 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) state that(s)he is u 1 for the legal owner and is duly authorized to make and file this application. (Master Electrician Licensed Installer) The undersigned further states that all statements contained herein are true to the best of hisiher 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 befo me this c1 day of 20 day of C, r ,20 _ Signature of Property Owner Signature of Applicant tM t�i W�(lcit Print Name of Property Owner Pr( ' Name of A`pplic� Notary Public No Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County, Commission Expires January 29,20� STATEWIDE • Set-vice With bilegi-ity 1:1 Main Street,Fishkill, NY 12524 1 email:office(• • SWIS JOB APPLICATION :• 1 914.219.1062 • • • Office Use Elect.Permit# /Q 1./ Date Bldg Permit# Utility ID# Final Certificate# City/Village R�r C `�� !" Zip ; ' Township County Address ' /1* Cross Street Section i 2�� 1 Block Lot -� Owner Name/Address(If different than above) !N` I'I c , Contact Number ❑Basement 0 1st FI. ®2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside 0 Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps �, 3r L� Range(s) Cocktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incanoescent Fluorescent SERVICE Amperage Voltage 1 P 13P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information J ' r OCT - 2 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by WAS.This application is intended to cover the above listed items to be Inspected,d at any time of inspection additional items leave 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 appikattons for the above address with any other Inspection company.The applicartt,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 / r<` City/State :t r Zip Code License# i l �, Phone# • a10 sa(YJ C� �� o � � c)(Y DState Wide Inspection Services 1080 Main Street MAR - 6 2024 Fishkill, NY 12524 Sw UA _ 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(c6swisny.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: IWIRE 24/7 Electric Inc Amelia Irizarry Cesar M. Vicuna 6 Lincoln Avenue 25 White Road Rye Brook, NY 10573 Putnam Valley, NY 10579 Located at: 6 Lincoln Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-214 135.73 1 29 Certificate Number: 2024-0949 Building Permit Number: BP23-021 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 Lincoln Avenue, Rye Brook, NY 10573 The Second Floor Bathroom 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 201' Day of February 2024. Name Quantity Rating Circuit Type Switches 03 Luminaires 02 Bathroom Fan 01 Boiler 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for%vork performed on the date of inspection only. r ON c 0 N • I \ \ M a, Q` i CV N N w 00 Ln a V) a o ►� Z F a _a � _ V) a /� v W U Z a zs. M C �" a � z S � d zo w = o - A z a 00 \ z U Z W z .� W z M p � �W V ,n " P'1 ice" � �/ w e� ►-� � � V 00 a, � ham+ M �� H� F -.> >- [w•� � � .� � i 1-1 r i zz o n z a Z *k u W Q w o Z z a o z o r Us a z Q z Q o < .. A o a � a ' r �I as a a a w = < n r • BR BUIL i L MENT VIL / E OF RYE OK AUG 2 9 2023 938 KIN( ET RYE B \ ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: �,3'� O / PP#: Approval Date: A1JG 3 U Permit Fee: $/ z5_ AL Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agrees that said plumbing work will be in conformance with all applicable Federal,State,County and Local /Loccal Codes. 1.Address: 1Q /�( �` �LC� GC- SBL: J,Sr• J 'J"d Zone:e—A 2.Proposed Work: At , J' 3 bathlmr'-2 s e r 3.Property Owner: 1 T rftj Address: Phone#: Cell#:ff 0 ,0,4 j�9 email: /Q, l'/ u,(�/ holm Va4.Master Plumber: Address: y C .S n r / Lic.#: Q�Phone#:�7�y>(�A�7 7 /71ell#: N SO- 3email: /eL Company Name: 1P Plt, mb n.$ f- �CG[.(�//�/ Address: Q,C f7 S( ' M e0% 1osa3 . INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor ' D 2nd Floor / I Aj CO % 3 d Floor 4`h Floor 5`h Floor Exterior 5.*List Other Equipment/Provide Details: lombi n / Q e_ bet—le/ t zeo—fef eater wMA dw Allavlen' iip c C -eto: - a - (- (Notarize Signatures Required Next 2 Page f�t -1- 8/12/2021 � Q kk fu,r�s l�-Q.. STATE OF TEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, not name of individual signing as the a cant) 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. Swom to before me this Sworn to before me this 3 0 day of ,202 _ day of ,20 �3 tgnature of Pr rty O r Signatur f Applicant Pancic Ca Peter Print Name of Property Owner Print Name of Applicant Notary Publi HARI MELILLO No c Notary Public,State of New'fork James A. Basulto No.0jME6160063 NOTARY PUBLIC,STATE OF NEW YORK Qualified In Westchester C:),imy No.01BA6198853 Commission Expires Januay 29. 20n Qualified in Westchester County This application must be properly completed in its entirety and must inc c missi n E; it s the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/12i2021 R BUILDING DEPARTMENT wC� DD VILLAGE OF RYE BROOK AUG 2 9 2023 938 KING STRIEET RYE BRom,NY 10573 .=39;!2k.-org 0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ******************************************************************************************************* AFFIDAVIT OF COMPLIANCE VILLAGE CODE §21 6) • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: ,residing at, �ji�CQ�!'J i� /�•��� ✓�� (Print name) (Address where you live) OF being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; r? �j1���/� /4�& / i✓ ?� ,Rye Brook,NY. (fob Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. gnature of Prope wner(s)) (Print Name of Property Owner(s)) Sworn to before me this day of otary Public) SHARI MEULLO votary Public,state of New York No.01ME6160063 Qualified in Westchester County -3- "ommisslon Expires January 29,2 8/12/2021 W N • o c 00 00 CA O apt W � W = tr/�z f- 4 o � a e o o o ON 00 C� z O m L o u V w � O O °� z .• ° �- � v � s � z o,� �r �' a � e �cc u U F.y ►.� CNz �I 00 M�1 r� Q a a N wo 2 E - 3 .. p W: KW7 ,..a M o F o o � W O 47 F z zCA 0 Z J a rn c Ei..l F W ° z � Q �� . _ � 9.2 P��1������i�i3� ������p������r�+i�.�i�i�i�i \!►�i l» � i�Z3 VILLAGP, OF RVE BROOK I D AUG 2 9 2023 BUILDOW; UEPAk*rmFN'f R I 938 KING STRXF r,Rr F. gk00k, NY 1073 VILLAGE OF RYE BROOK (914)939.0"816jIit ycbrook.or BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL MODI D REMOVE MECHANICAL,/ EQUtrI� OFFICE USE ONj�� i -� 7, >�0 Permit# j�� Building Inspector: Q M3 Application Fee: Date of Approval: ---- Permit Fee 41 Bldg/Use Class. Res. ( );Comm. ( ); ��►�+►�+►r<w�►R�ldwrr►*+er►*,t*rrw*��►*r�►r►r�►r***a*,taw*�►rr►r**,t*r►*rs*rtr►**�wsww****ws*r**a*t+�t*ts��• REQUIREMENTS FOR RELEASE OF PERMIT: I A CIA M)CA n.of COMPLIANCE IS REQUIRED TO CLr)RE OUT THIS PFRMrr) 1. Properly Completed& Signed Application. 2. Payment of Application Fee: Residential =$100 00, Commercial =S250 00(fees are eon-refiwdow 3.Site/Staging Plan as required by the Building Inspector. 4. Sealed Construction/Installation Documents&Specifications as required by the Building Inspector. 5.Copy of Licensed Contractor's Liability Insurance.(village of Rye Brook must be listed as certificate holder)dt Workers Compensation Insurance on a NYS Board form t Fomi#('10;'_or Form tt l!26 3 or NY State Workers('ompensation Waiver) 6. Payment of Permit Fee: Residential =$18.00/1000.00 of Construction/Materials Cost with a minimum fee of S 100,00. Commercial =$25.00/1000 00 of Construction/Materials Cost with a minimum fee of$275.00. 7. Inspection by Building Department for removal and/or installation. N86owno&vregrrre4 8. Any electrical work requires a separate Electrical Permit and Electrical Inspection. 9. Any gastplumbing work requires a separate Plumbing Permit and Plumbing Inspection. **1t�ekffler*firf*rt**,rk*tint**rr*A,t*fF*Sri***+k**Ie,t**r*+ti+tr#t,ti*i4rr,t#,r*r,r#rrAr,t*+t,r,►,tisf,ti#ii,tfr+t• Application dated, r4 is hereby made to the Building Inspector of the Village of Rye Brook,NY, for a permit for the installation,modification,and/or removal of the specific Mechanical Equipment as listed below The applicarn and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with the approved plans,and with all applicable Local,County,State&Federal laws,codes,rules and regulations. I Address �l�U�i�1 HMG A�/(_ agiJ1SDL SBL: L 1��� Zorn. 2. Property Owner AW-f rsweiv Address: Phone# Cell#.YAI--�- email: I r ,, l , 3.Contractor G� Address: - Phone# aZ -9 Cell#��/y�'�Sd`7y7QQ� email: % •CD�I1 4,Applicant: Ct Q �y Address: 3 j 3 1 Phone# Qry �y- 7 �7� Cel .y/y�ySO'7y9� email:mn � DIDAIUA�i/K121 ed,/i►/a'• Z'" Ll 5.Scope of Work. New Installation( )•Replacement W.Removal( )Q•Other( ) ,,,,�,, 'J \ 6."fype of Equipment N1 U1Pp C-01W ffb (/U6i1,0t 14J0, C/` 7. Location of Equipment 1 Ad flWf— _ 8.Cost of Equipment including Installation Cost S r:5,-100- ) EI1212021 STATT Of NEW YORK,COUNTY OF WESTCIII:STER ) as f _ being duly sworn,deposes and states that he/she is the applicant above rtraned. Irmo name of nxfin dual moninp as► 1wwiJ and further states that(s)hc is the legal owner of the property to which this application pertains,or that(s)he is the fix the legal owner aril is duly authorised to make and file this application (Mdrcate archdccl,c%"rarhw,ww,mit on,etc) That all statements contained Imrcin are true to the best of his/her knowledge and belief,and Ihm any work performed.or use wwnducted at the above captuaxd pmpertw will he in co rifrxinance with the details on set firth and contamed in this application and in an% aconmpam ing appmw wd plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Budding Code,the code of the Village of Itye 11rook and all other applicable laws,ordinances and regulations Swore to be&wre me this Sworn to before me this y Z) day of A V4 Vf.20 Z' _ day of 49JMJf .20 13'3 tgnaturc of rtw Owner Sipatrne rApplicant Print Name of Pmpem Owner Print Name oyf Applicant Notan bile ;zn-*,W.CRAIG Notary Ja A. Bas:FNE tlorty Attu t>R ttlwlr Yak NOTARY PUBLfC,STATE W YORK,!M NIX "C111/�06a7 No.01BQ1988COMMM NIXpi� 04MS V Qualified in WestchestntyCommission Expires Janu0 01 S This application must be properly completed in its entirety and must incluGe the notarizeu legal omner(s)of the subject property.and the applicant of record in the spaces provided. Any appiicabon not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be rettwited to the applicant 2 W1NJM1 r�-; � � r '�' A --� t �;, � ,. r � ��� Model 4 N avi e N NCB-250/150H,240/130H,240/110H, 190/O8OH,190/060H STEP 1 Before Installing �I II�II�III�I�� IIII QRead the Installation&Operation Manual before Installing. Location Requirements 27227 049 This product must be Installed and serviced by a licensed plumber, Select the best location on'Choosing an Installation'in the Installation&Operation a licensed gas fitter,or a professional service technician.Navlen Is not liable for any damages or defects resulting from Improper Manual. installation. _ Allowable minimum clearances When applicable,the Installation must conform with Manufactured Home Construction and Safety Standard,Title 24 CFR,Part 3280 QNysyipppy hlffa�ki>VOII and/or CAN/CSA Z240 MH Series,Mobile Homes. ToP 1 Top 91n(229 mm)minimum QWARNING Back OS in(13 mm)minimum Back �Side Front 41n(100 mm)minimum Follow all local codes and/or the most recent edition of the National Fuel Gas Code(ANSI � 2223.1(NF PA 54)In the USA,or the Natural Gas and Propane l nstallation Code in Canada Sides 31n(76 mm)minimum (CAN/CGA 8149.1). Bottom 12 in(300 mm)minimum Side From Safety DO NOT install the boiler in areas with excessively high humidity. I Bottom STEP 2 Installing p Unpacking p Checking the Rating Plate —�eawrw,.+ra+us+wa� This boilerthe ured conversion Natural Gas : -- � from the factory.If comrerslon to Propane Navien Combination Boller --- `""�%-•-•-_ Gas In required,the conversion kit supplied with the boiler must be used. ---- User's Information Manual, ___ Installation Operation Manual a Wall mourning bracket �c.�'__ '�•` Tapping screws and anchors ®B VentTerminatlonCaps Qj WARNING Wall flanges aoPropane Conversion Kit Before connecting the gas supply,determine the gas type and pressure for the boiler by ll•r'1 High All Conversion Kk referring to the rating plate.Use only the same gas Type indicated on the rating plate.Using a G79�J [Natural Gas Only) different gas type will result in abnormal combustion and malfunction of the boiler Gas ® -- supplies should be connected by a licensed professional only. • The appliance and its gas connection must be leak tested before placing the appliance in Spare Parts operation. This boiler cannot be converted from natural gas to propane or vice versa without a Navien gas 4� A® conversion kit.Do not attempt afield conversion of this boiler without a Navien gas conversion kit.Doing so will result in dangerous operating conditions and will void the warranty. Pressure Relief Valve(30PSO Navies Inc Is not liable for any property damage and/or personal In)ury resulting from improper corrverslons. ® Outdoor Temperature Sensor and Cable p Mounting on the Wail Removing the Front Cover CAUTION Do not Install the boiler on dry walls without proper reinforcement. ODrill in the supplied anchor twits after considering where the vent termination will be located. Unfasten the 4 latches (2 at the top and 2 at the bottom)to remove the front cover and gain access to the IIv\ internal components. 0 OSecure the mounting bracket to the wall Lift up the boiler,restthe unit on the hooks with the tapping screws and anchors. provided on the wall bracket on the wall. 0 p Gas Piping Connections Gas meter's capacity z Total gas capacity of connected appliances "Mupply GasRegulatorExample: n— A% Gas meter z Boiler + Furnace + Domestic gas stove 425 CFH 195 CFH 58.8 CFH 63.7CFH •1 CFH=1,020 Btuh Gas Inlet Ada ter The boiler Is recommended to be the p first appllanceto be connected to the 1/2"rigid pipe can be used;refer to the sizing tables in the Installation&Operation T gas supply line. Manual for limitations.Avoid using 1/2"corrugated connectors or tubing as noise may occur. Botmm View Water Piping Connections Space Heating System DHW System Water Piping Connections Auto Feeder Inlet (Make-up Water) Pressure ON Relief Valve Domestic Cold Condensate Outlet II/ Domestic Hot Space Heating Return I I 4a•Cold Water 5upp'iy O O 0 Pressure 0 Relief Valve r DHW Supply Install the Included 3/41n,maximum 30 psi pressure The DHW pressure relief valve is not supplied,but is required. relief valve on the space heating supply. span Heeding Install an approved 3/4 in,maximum 150 psi pressure retie'valve supply •C======• 'sr. An ASME approved HV pressure relief valve for space on the domestic hot heating system is supplied with the boiler. Filling the System Bullt-in Watts Fill Connectlon &mnal Water Fill Connection Before filling the boiler,open the pressure relief valve by lifting the The Navkn NCB-H boiler is equipped with an auto-feeding water lever on top,and loosen the air vent cap to allow the system to fill External water fill connection may be installed on the system piping properly.Close the pressure relief valve when the system is full. connection and motorized feeding valve.Therefore,installation of if it is required for specific applications.See the following figure for additional system water fill connection is not necessary in most an example of extemal water fill installation on the system piping. np cases.See the following figure for an example of a water fill / installation using the built-In connection. Pressure—� 1�1 Relief Valve G I - Air Vent Cap o r Make-up Water e 1 Backfiow Preventer Air Separator Pump CAUTION To System From Ensure that the pressure relief valve Is closed before testing or Make-up System operating the system. Water Expansion Tank 0 Condensate Drain Connection A condensate drain pipe must be connected to the 1/2"condensate outlet fitting at the The end of the 1/2"(NPT)plastic piping should drain into a laundry tub or into a Floor bottom ofthe unit and water must be poured Into the exhaust connection to fill the drain. condensate trap. Do not submerge the end of Syphon the pipe in water. Water III NPT 1/21n Condensate Outlet a - Ovat miheaterrW draft bye Floor drain +brie Wdyaro 7++� • r am rW6Yn btheYadya6 Wamndeesepnp 0 p Venting Vent Termination Options Concentric Vent Termination Horizontal vent termination Sidewall installation Interior view Exterior view nuil.a, W—G. x+ 1tls� Combustion Air Combustion Air Vent-* Maintain 12•min. clearance above 1•125 mm) in highest anticipated / snow level or grade. Roof installation Vertical vent termination Sidewall vent termination Vent aa'n00 mm)min ISmhfmm aq t °dbiOf°'ab0" Combustion p1 BdatMt''dy[ Air Maintain 12•min. 3 (18"min.for Canada) clearance above highest anticipated snow level maximum % of 24•above roof. Combustion Air 1' t vent .............................................................................................................................:............................................................................................................................. Venting Length Exhaust Vent Piping Materials 3'pipe venting yr pipe venting All Navien boilers are Category IV appliances- • The venting system should be approved for use with Category IV appliances(typically Type SH Special Gas Vent approved by UL 1738-S636). Maximum Length 150' Maximum Length 65' Venting requirements in the USA and Canada are different(see below). Navien recommended venting materials toCale Recommended Vent Materials 2-to-3-inch PVC/CPVC Schedule 40 or 80(Solid Core) USA UL1738 Certified PVC or CPVC Approved Polypropylene(PP) Maximum number Maximum number Approved Stainless Steel(SS) of elbows:8 of eibows:6 • Type SH Special Gas Vent Class IIA(PVQ Canada" Type BH Special Gas Vent Class IIB(CPVC) Type BH Special Gas Vent Class IIC(Polypropylene/Stainless Steep •For installation in Canada,field-supplied plastic vent piping must comply with CAN/CGA B149.1(latest edition)and be certified to the Standard For Type BH Gas Venting System;ULC-S636.Components of this listed system must not be Interchanged with other vent systems or unlisted pipes or fittings.All plastic • 90'elbow=5 linear feet of venting 90'elbow=8 linear feet of venting components and specified primers and glues of the certified vent system must be from a single system • 45'elbow=3linear feet of venting 45'elbow=4linear feet of venting manufacturer and must not be intermixed with another system manufacturers parts. The supplied vent connector and vent termination are certified as part of the boiler. p Electrical Connections External LWCO Connection(if required by local codes) Power Connection ® Refer to your local codes to ® determine if an LWCO device is CAUTION required for your system and ensure that the bulk-In device meets the Using abnormally high or low AC requirements. '��' voltage may cause abnormal gyp operation,thereby causing fire which reduces the life expectancy of this 0 s Product. 0 a 0 1 0 • usm 0 �11 r u� �� 1 E� ,.. 1� 120 VAC 60 Hz In.2 Amp current withpropergrounding 0 89t9mt9�0 0 _ nwmr Sol DO NOT touch the power cord DO NOT allow the boiler to be CAUTION with wet hands. exposed to excessive amounts of water. Disconnect the power to the boiler before Installing any wire connections on the main PCB. 0 STEP 3 After Installing 0 Opening All the Valves Gas Valve Space Heating System Valves DHW System Valves UI M NavieN ~ Navien,Inc. 20 Goodyear,Irvine,CA 92618 Tel:1-800-519-8794,Fax 1-949-420-0430 Shut-oRvalves www.Navienlnc.com Shut-off valves © Operating the Boiler PDWWoN FAd_JuftTanWaW. View Dealt Mataallea the B00W Space Heating Tem rpe ature QHW Temcerature --_-_ 1. In normal operation mode,rotate _ the Command dial(0)The space heating temperature(M is y 0 highlighted on the screen. 2. Rotate the Command dial(0)to 1 the right to select the DHW ® w temperature. LU 3. Press the Command dial(a to select the indirect DHW temperature 4*.The highlighted section will flash. To turn the boiler on,press the t. In normal operation mode,rotate the 1. Press the Menu button QVb,and If an error message appears during Power button(U). Command dial(0).The space 4. Rotate the Command dial(0)to boiler oration,reset the boiler to heating temperature(UM is the right or left to increase or then select'2.Status Pe When the power Is on,the boiler highlighted on the screen. decrease the temperature. Information' resolve the problem.Press the Back automatically enters normal 2. Rotate the Command dial(®)to button( D)on the front panel to operation mode,and the boiler's 2. Press the Command dial rat to select 5. Press the Command dial tur to Bch between the information reset the boiler. the space heating temperature.The confirm the new temperature. operating conditions are displayed highlighted section will flash. Items. If resettin does not on the screen. & Press the Back button(rj)to • 9 3. Rotate the Command dial(a)to the return to normal operation mode, o ily the problem, refer right or left to Increase or decrease or rotate the Command dial(a to g the temperature. to adjust other operation section of the User's conditions. 4. Press the Command dial Information Manual or ur to confirm the new temperature. contact the service 5. Press the Back button(*'.:))to return 40 DHW temperature higher center. than 180°F can cause to normal operation mode,or rotate the Command dial(a to adjust suiding. other operation conditions. © Measuring the Inlet Gas Pressure 0 O 0 ,� Open a hot water faucet.The boiler y should tum on and I the gas in the gas y V] y / -- supply line will be n Open Closed kili 1 purged. Shut off the manual gas valve. Leave the faucet on until the boiler shuts Unfasten the 4 latches(2 at the top and 2 at the Loosen the screw indicated In the figure and down due to a lack of gas supply,and then bottom)to remove the front cover and gain access to connect a manometer to the pressure port turn off the hot water faucet the internal components. Reset the manometer to zero before use. O Re-open the manual gas O Recommended Gas Pressure Settings: valve and check for leaks. M not Open multiple fixtures that V3.-5'-10.5'WChave high flow rates,such as ❑bathtub and shower faucets,to mramp the boileru.to its maximum firing rate. ♦ / 1 % Gas supply Open Adjust the inlet gas pressure with gas regulator. Check the inlet gas pressure reading on the manometer. CAUTION The boiler cannot function properly without sufficient inlet gas pressure.Measuring the Inlet gas pressure should be performed by a licensed professional only. 13 Installing the Front Cover © Ensure Maximum Water Flow After running the boiler for the first 10 minutes,turn it off and clean the cold water filter and the space heating return strainer to remove any trapped debris. Final Check A trial run should be performed in accordance with the Installation checklist listed in the boiler's Installation&Operation Manual. ANavieN NCB-H High-Efficiency Condensing Combination Boiler Engineering Specification 1. General Requirements a. Project scope i. Supply and install (Clty) high-efficiency condensing Combination Boiler(s), sealed combustion, modulating, and power vented that use either outside or inside air for combustion. b. Acceptable manufacturers I. The Combination Boiler shall be a Navien NCB-H as basis of design with an input rating of Btu/hr. and an output of Btu/hr. It shall be capable of operating on either natural gas (NG) or propane (LP) with the following performance: Navien Combination Boiler Other Specifications ' Space Heating Ratings Heating Input BTU/H Heating Rating Connection Size Water Model Number Capacity Water AFUE (%) Water Pressure (Supply,Return) Volume Min Max BTU/H BTU/H NCB-190/060 H 11,000 60,000 56,000 49,000 95.0 NCB-190/080H 11,000 80,000 74,000 64,000 95.0 NCB-240/110H 13,000 11,000 102,000 89,000 95.0 12-30psi 1"NPT 1.5gallons NCB-240/130H 13,000 130,000 120,000 104,000 95.0 NCB-250/150H 14,000 150,000 138,000 120,000 95.0 Navien Combination Boiler Other Specifications ' Domestic Hot Water Ratings Model Number Heating Input BTU/H Water Minimum Flow Rate 45OF DHW Inlet DHW Outlet Min Max Pressure Flow Rate (25°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 NCB-240/110H 13,300 199,900 15-150PSI 0.5 GPM(1.9 3/4" NPT 3/4''NPT L/m) 4.7 GPM(17.8 L/m) NCB-240/130H 13,300 199,900 NCB-250/150H 14,000 1 210,000 4.9 GPM(18.5 L.m) 20 Goodyear. Irvine, CA 92618 Q 949.420.0420 © 949.420.0430 © Navieninc.com Page 1 of 5 ii. The Combination Boiler shall have a DHW minimum 15 to 1 turndown ratio with the full modulation range between the maximum and the minimum output levels. iii. The Combination Boiler shall be capable of operating on natural gas (NG) or propane (LP) gas. The normal operation of the Combination Boiler with natural gas pressure shall be between 3.5 inches of W.C. and 10.5 inches of W.C. The normal operation of the Combination Boiler with propane gas pressure shall be between 8.0 inches of W.C. and 13.5 inches of W.C. c. Installation i. The Combination Boiler shall be installed according to Navien's installation and operation manual. 2. Required Certifications a. The boiler shall be certified and listed by C.S.A. International under the latest edition of the ANSI Z21.13 for the U.S. and CSA 4.9 for Canada. b. The boiler shall bear the ASME "H" stamp for 30 psi maximum working pressure and shall be National Board listed. c. The boiler's AFUE shall be verified by the Hydronics Institute of AHRI and listed in the AHRI Certification Directory. d. The boiler shall be certified for low NOx sub 14 ng/J or 20 PPM at 3% 02 and shall be listed in the South Coast Air Quality Management District directory. e. The boiler controls shall be certified by CSA, UL, or equivalent. f. The boiler shall have CRN registrations g. All electrical components shall be certified by CSA, UL, or equivalent. 3. Product Design a. Enclosure i. The enclosure shall be constructed of cold-rolled carbon steel, primed and painted on both sides. ii. The maximum Combination Boiler dimensions shall be: 17.3 in. (width) x 12.8 in. (depth) x 29.3 in. (height). iii. The maximum Combination Boiler weight shall be 96 Ibs (44 kg). 20 Goodyear, Irvine, CA 92618 © 949.420.0420 949.420.0430 © Navieninc.com Page 2 of 5 b. Heat exchanger and combustion components i. The primary and secondary heat exchangers shall be constructed of stainless steel material and engineered to attain the highest level of heat transfer in a compact design. To accomplish this, the heating water shall flow through a series of tubes (secondary heat exchanger) and finned tubes (primary heat exchanger), designed to maximize the heat transfer area. ii. The DHW flat plate heat exchanger installed inside the combination boiler shall be constructed of stainless steel material iii. The heat exchanger shall be able to operate with a 35% mixture of propylene glycol without significant loss of performance. iv. The burner shall be a premix design made with stainless steel and a woven metal fiber covering mesh to provide a wide range of modulating firing rates. The burner and flame observation port shall be provided for visual inspection during boiler operation. The burner flame shall be ignited by direct spark ignition and monitored by the flame sensor. v. The negative pressure regulating gas valve shall use the fan venturi effect to pull the gas through the valve in the correct ratio to inlet air. vi. The boiler shall be equipped with a variable speed blower capable of modulating the boiler firing rate from 100% down to 20% and providing smooth operation throughout the entire operating range. c. Built-in DHW (Domestic Hot Water Module) shall include the following: i. Integrated pump with maximum hot water output 4.9 GPM at 77 deg F delta T ii. Flow adjustment valve iii. Mixing valve iv. 3-way valve with easy access from the front of the unit with motor attached using a clip for tool-less removal v. Stainless steel flat plate heat exchanger d. Venting and combustion air configurations i. The boiler shall be capable of using either outside air (direct vent system) or inside air (non-direct vent system using single pipe) for combustion. Inlet and outlet of the vent system shall be connected to either through- the-roof or sidewall terminations and shall be tested for unbalanced (different pressure zones) locations. ii. Air intake acceptable venting materials include PVC, CPVC, PP, and SS. Total equivalent vent length shall be up to 65 ft. using 2" pipe and up to 150 ft. using 3" pipe. 20 Goodyear, Irvine, CA 92618 0 949.420.0420 0 949.420.0430 © Navieninc.com Paae 3 of 5 iii. Exhaust (flue gases) shall be vented using PVC Schedule 40 (solid core), CPVC Schedule 40 or 80 (solid core), SS and approved polypropylene as referenced in the boiler installation manual. Total equivalent vent length shall be up to 65 ft. using 2" pipe and up to 150 ft. using 3" pipe. iv. Common venting flue gases shall use Category IV approved materials. Maximum of eight (8) units including one (1) NCB-H Combination Boiler and seven (7) NPE tankless water heaters can be connected to a common vent with the use of the Common Vent Backflow Damper Collar Kit. e. Electrical i. The main power supply shall be 110-120 VAC, 60 Hz, three phase and shall not exceed 15 Amps. The Combination Boiler shall be supplied with a factory-installed 3-pronged (grounded) plug. ii. The Combination Boiler terminal strip shall be equipped with 120 VAC power for 3 zone pumps, 24 VAC power for 3 zone valves, 3 thermostats, LWCO, Navien SmartZone zone pump controller, universal supply/return temperature sensors, outdoor air temperature sensor, alarm contacts, DHW tank, air handler interrupt, and cascading control for up to 16 Units (1 Combination Boiler and up to 15 NPE tankless water heaters). f. Controls shall be certified and furnished with the following features: i. Backlit Control panel with LCD type display, clear language text, Select Mode buttons and Command Dial to select and view information ii. Operating temperature limit with 194 deg F maximum Combination Boiler water temperature set point iii. High temperature limit control preset at 200 deg F and equipped with manual reset iv. Low water cut off(LWCO) with manual reset v. ASME certified pressure relief valve set to 30 PSIG provided as standard vi. Flue gas, supply and return water temperature sensors vii. Built-in freeze protection viii. Warm Weather Shutdown ix. 4 pump contacts (Combination Boiler, zone1/DHW, zone2 and zone 3/system) x. Fully customizable outdoor temperature reset curve provided along with an outdoor temperature sensor for field installation xi. One (1) Combination Boiler and up to fifteen (15) NPE tankless water heaters system including lead/lag cascading capability and main Combination Boiler rotation functionality 20 Goodyear, Irvine, CA 92618 949.420.0420 0 949.420.0430 © Navieninc.com Palle 4 of 5 xii. Alarm contacts indicating manual reset lockouts on flame failure, high temperature limits, high pressure limits, low water cut off limits and air pressure limits xiii. Flame sensor rod xiv. Alarms, errors and operating status xv. Control capability to communicate with Navil-ink to control temperatures remotely, access usage data and receive diagnostic notifications 4. Warranty a. The heat exchanger shall have ten (10) year limited warranty for residential applications. b. All other parts of the boiler shall have five (5) year warranty for residential applications covering defects in materials and workmanship. c. The labor warranty shall be one (1) year. d. The warranty period shall be based on the date of manufacture or the date of installation (whichever period is longer). 5. Manuals a. Complete set of documents including product brochure, installation manual, user manual, wiring diagrams, piping diagrams, controls sequences, engineering specification, submittals and warranties shall be submitted for approval at least seven days before the bid date. 20 Goodyear, Irvine, CA 92618 949.420.0420 © 949.420.0430 © Navieninc.com Page 5 of 5 / Building Permit Check List&Zoning Analysis Address: n C-5�1� SBL• 13 Zone:. Use: 21 Const.Type: y 0> Other. Submittal Date: Z Revisions Submittal Dates: Applicant Z`r —7`Z c-1 (— `--, / Nature of Work: !1 k-e—t k 0E \-C)VAC,�b Reviews:zBA EB 2 `L 2023 PB: BOT: other. NEED OK ( ) ( FEES:Filin BP: `� C/O: Flood Plane Legalization: ( ) (, /A P: Dated: Notarized t/SBL:-- Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed Unacceptable: ( ) ( ) PLANS:Date Stamped: Seal Copies: Electronic. Other. License: ✓Workers Comp: Liability: ✓Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: ( ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. PLUMBING Plans: Permit: Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: OPPROVED approval notes: REQUIRED EXISTING PROPOSED NOTES Date: f EB Am: E=W ' Front Front Sides: Bar Main Cov Accs,Cov Ft.HS : Sd.H/Sb: SEA: Tom: EL IMP: Radsiw- Hight/Stoaes notes: 'V .•} / r 1 `'• EmCD 12 = a O r O I. � y��OR; t O \� .ram �,�:i`F / ram. �•,bag ":.,o �' r<_:y-•�' �-0 0 Q Z U Qkotectiop ir- CO La .-.; ;. .'� LT. ' LI- %�: __•.."�I .1 D}yy U dam; :`•.r'_.A�, •/• � bV ICI u V] I �D 3-• �•1 V � c�' :ram'i' f.� > co �s r 1 scoiAp.;~.. o M %¢ ell )A! } t �i{''}fJl, J'1/{+{Illy �g �I 1�11\'i ,� - ({ fll'�;rf•.-. 9e � f ' 1'ci'Se xAe.:( -�s.�/�3' +yam 4. ^ A114�C RO CERTIFICATE OF LIABILITY INSURANCE Doz/14/""20 3n 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 ACT JEFFREY D. KAVOVIT PHONE -845-562-0701 Nc Ne:845-562-0852 FARM FAMILY CASUALTY INSURANCE CO. Acdmiss:JKAVOVIT@AMERICAN-NATIONALLDRI 88 OLD RT.9W STE#100 INSURER(s)APPORDe1G COVERAGE NA1C s NEW WINDSOR,NY 12553 ._ __ _ B1suRrRA.FARM FAMILY CASUALTY INS.CO. _ 13803 INSURED 03URERe:UNITED FARM FAMILY INS.CO. 29963 FRANKS CONTRACTING CORP MURERC: 361 N BROADWAY INSURER D. TARRYTOW N, NY 10591 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 TIIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR TYPE OF W1fURANCEL�SD WVID POLICY NUMBER POLICY EFF POLICYEXP LIMITS A X COMMERCIAL GENER��ALL7�LLIIABILm X 3101 X9740 05/01/22 05/01/23 FJ�OODURRENCE s _ 1,000.000 CLAIMS-MADE �= OCCUR IPREMISES(Ea omyyna) $ 100 NO X SELECT BUS PACKAGE MED EXP(Any one pan-i) _$ 5,000 PERSONAL a_ADV INJURY $ _1'000,000 OWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE L 2,000,000 X POLICY ❑JJERCT ❑LOC PRODUCTS-coMPIOPAGO s 2,000,000 OTHER _ _ $ B AUTOMOBILELJAaILITY 3101C4695 05/01/22 05/01/23 IF, BINEDSINGLELIMIT s 1,000,000 ANY AUTO BODILY INJURY(Pv pelaan) S OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY MlA1RV(Par accidalR) _ qX AUTOS ONLY _X AUTOS ONLY PROPERTY - S -.. S A X UMBRELLA UAe _OCCUR 3101 E3189 05/01/22 05/01/23 EACH OCCURRENCE S 1,000,000 ExcEss 11Ae AGGREGATE _ s 1,000,0_00 DED RETENTION S 10,000 _ SYORKFFS COMP®d6AT10N11- ANO EMPLOYSIW LUMMUTY YIN STAUTE ':T OER __... ANY PROPRIETOWPARTNERIEXE-CUTIVE EL EACH ACCIDENT $ OFFICER#AEMBER EXCLUDE07 ❑ NIA (MwxWory in NH) E L DISEASE-EA EMPLOYEE S II aeStnbe un)er -- OESCRIPT.ON OF OPERATIONS 1,1. E.L.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES WORD 1111,Addkw"Rrnaka S&a&4%my be atMoMd H am*apeta M to~ CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY. CEIRTIFICATF,HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF RYE BROOK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING STREET RYE BROOK, NY 10573 AUTHORIZED REPRESENTATIVE C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 4 \\ NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE m A^A A^A 823931705 LOVELL SAFETY MGMT CO, LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 %1 * SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FRANKS CONTRACTING CORP VILLAGE OF RYE BROOK 361 NO. BROADWAY 938 KING STREET SLEEPY HOLLOW NY 10591 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2442 768-4 795440 04/01/2022 TO 04/01/2023 2/14/2093 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2442 768-4, 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:I/WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. OWNER JOSEPH PACI ONE OF ONE OFFICER FRANK'S CONTRACTING CORP THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND 7 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 568210746 AC�® DATE(MMIDDIYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 08/08/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME: Courtney Potter _ McCarthy Insurance , No Ext: (914)769-0417 AIIC No): 378 Elwood Avenue E-MAIL courtne mccarth Insurance.net ADDRESS: y@ Y Hawthorne, NY 10532 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Selective Ins Company of America 12572_ INSURED INSURERS: Preffered Mutual PLP Plumbing & Heating LLC INSURERC: 133 E Main St INSURERD: Elmsford, NY 10523-3300 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 00009545-2841177 REVISION NUMBER: 1 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 UBR POLICY NUMBER MMIDD YYYY Y MM POLICY EFF POLICY EXP LTR IDD YYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y S 2021936 07/31/2023 07/31/2024 EACH OCCURRENCE $ 1.000000 DAMAGE TO RENTEU-- CLAIMS-MADE C OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY jE O LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ B AUTOMOBILE LIABILITY PCAO1OO716109 10/24/2022 10/24/2023 EaM�tdenll LE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Paraccdent $ A X UMBRELLA LIAB X OCCUR S 2021 936 07/31/2023 07/31/2024 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Plumbing Contractor Village of Rye Brook listed as Additional Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZER REPRES AI ` L �.` CPO ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CPO on 08/08/2023 at 11 34AM NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 1^^^^^ 208277769 378 ELWOOD AVE 4%A�J - MCCARTHYINSURANCEHAWTHORNE NY 10532 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PLP PLUMBING & HEATING LLC VILLAGE OF RYE BROOK 133 E MAIN ST 938 KING ST ELMSFORD NY 10523 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2382 037-6 188031 02/17/2023 TO 02/17/2024 8/8/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2382 037-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S7NCE FUND V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 133736053 x - Y O Z (Ll}- FILL O wxl r Q I� w Q m 0I �J >m !� - 0 � 7 96 rt� . w iV L 96 � 105 z^ r I ,�'" IV �-- � _ _ a .r— �_ - - �� � . -� ?�, �� i � .' /4 t- -. 1 ' � ': • � � �;` �.. S `\ l , • f