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HomeMy WebLinkAboutBP23-062PERMIT # J67 / %3 QCfJ c DATE: S/ o a3 sh 4) a 4.1 SECTION `�v PK//C!LOT _/' TYPE OF WORK,' OR /D�T e A 1X7� T��n JOB LOCATIO �7 L� OWNER <_Ef5 4 krl s� �S /c47 �y 21_ CONTRACTOR;,75 � �P/ r/S� - (y�L{VC!?ld1i`"�/ /790 INSPECTION "EC % DATE FOOTING - FOUNDATION FRAMING RGH FRAMING INSULATION b PLUMBING 32 RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT CJ ALARM 0 AS BUILT O FINAL INSP OuQ3_0&l1 cx r1uA4d��y 4 �!�j OTHER APPROVALS ARB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 23-134 Certificate of Occupaucp This is to certify that_Me ,4 of, AJV having duly filed an application on Jam. 44 a 3 20 o23 requesting a Certificate of Occupancy for the premises known as, ral lama �� Rwd , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: ) W. 7 Block: / Lot: 14 _ and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No , " , issued 20 c�-.93, 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: - C / Construction: for the following purposes: rel0 -ya 71/�/�7 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 height shall be made,nor s 11 the bui ding be moved from one location to another until a permit to accomplish such change h obtai in the ui d' nspector. Building Inspector,Village of Rye Brook: Date: AUG 2 2 2023 QyE DR � `1�4.jJJ V l`LV4 Vv� VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.rvebrook.org TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 22,2023 Merle Minks &Krishna Minks 42 Hillandale Road Rye Brook,New York 10573 Re: 42 Hillandale Road, Rye Brook,New York 10573 Parcel ID#: 130.77-1-4 This document certifies that the work done under Mechanical Permit #23-095 issued on 6/21/2023 for the installation of two heat pumps and ductless units have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D E C IEME -i���3�. For office use onI BUILDINdIJE?AATMENT PERMIT# JUL 2 8 2023 1 VILLAGE OF RYE BROOK ISSUED: -/C7- 938 KING STRECT,RYE BROOK,NEw YORK 10573 DATE: --//—a)3 VILLAGE OF RYE BROOK (914)939-0668 FEE: 0 QS— PA> AL BUILDING DEPARTMENT m2M,rygbrook.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 iiiititttt►►►►►tt►t►■tttnn►►►i►tiff►►i►iiitttitt►►iittttt►/♦■tttittl►■ftt►it/tff►f►iiit►itill/►■tt1►ftt►tfftttiffiiiiititt►►►tt► Address: 117— H; QXo,✓!C1/a G� � (Oadz< WY " C-29-7Z Occupancyl/Use: Parcel ID#: 77—/ -L/ Zone: as Owner: `l ,rlP� T .� S Address: :15( rcLS2 9- P.E./R.A. or Contractor: A,-A%oH o Address: '�s �,�,r�r[ Q, G� N k/ (o SI L Person in responsible charge: �rt�,yyt�. !;c rJ`uZ•p Address:3<- L-,6,,cyyj Iis�r ,� ,-%V j1c�S-t7 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 Y/ORK,COUNTY OF WESTCHESTER as: " /a"/, , f n U,4 being duly swom,deposes and says that he/she resides at M Z �f.J a t�c��� /��„ -3rr� IJ1� (Print Name of Applicant) l (No.and Street) \/ in k _ J&cj . ,in the County of jZ hhS c ' lr in the State of Rl T ,that ( ty/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:$j�1:7 o 0 n for the construction or alteration of: t-k ho vt j: 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 Sworn to before me this 2 F day of �-�-� ,20a3 day of , 20 23 Signature of Property Owner�/ Signature of Applicant ame of Property Owner e of Applicant 7 ' Notary Public No blic SHARI MEULLO Notary Public,State of New York SHARI MEULLO No.01ME6160063 Notary Public,State of New York s/t2/zort Qualified in Westchester Coun No.01ME6160063 Commission Expires January 29,2�� Qualified In Westchester County Commission Expires January 29,20?--7 ce_BR o tim 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 : oL-2 DATE: Z 1 PERMIT# —W2 ISSUED: 1�u1 SECT: BLOCK: 1 LOT: r PSS �V� t (1� c k— r i LOCATION: ' � � � 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 — _ r ❑ Natural Gas 1 J ❑ L.P.Gas >> f 1 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION J� FINAL /� OTHER �QyE[3Rlam O �7 O BUILDING DEPARTMENT n�LDING 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 :— L DATE: PERMIT# iTD(:��ISSUED: J `S �ZT: BLOCK: LOT: � LOCATION: �1 1 "- ' `� " 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 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER F ■ t ■ ■ ■ ■ � M N w a ■ Q � N ,b � ■ v ■ s N a ULn a -p ■ L x Qj w b (� `n v ., 0 A C) W a v Cl) W ►.. x a W © Z V �.y Qj ■ rF��{ r F-� 1:4 O ■ h+q F- W C� �Wr 06 o d a s [� I ea cn Ln CN.�.a 000 � O O w W O ° = WON � ■ ob pq �l uMi f�� `o' poovy � ■ 00 W , O O O w A p U V W � Z �' � � F' ° o � w � vw W Q ,. ■ ' W � y�� � a � ...i ■ O z z 0 00 z O y u ju W z w a 0 cc 9 U o a 5 _ O F o ° v v — U W ~ p © V 000 n Nu C O b N z w w o � � ° ■ �I AQ � � W � x � � �•� b BUILDING DEP�R MENT Q c LE ��`z VILLAGE OF ICY OOK APR 2 8 2023 938 KING STREET RYE BR ,NY 10573 (9�4) VILLAGE OF RYE BROOK l BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:A 3 Approval Date: #:&Q)3` 6 c APplicaiion Fee: $ ,r Approval Signature: Permit Fees: $ b Disapproved: Other: 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, 1. Job Address: 42 Hillandale Rd SBL: 130.77-1-4 Zone: R-25 2. Proposed Improvement. (Describe in detail): Existing kitchen to be renovated and partial removal of a non bearing wall existing bathroom to be modify as per new layout 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: If yes,indicate: TIER E TIER M TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an a IstTg automatic fire suppression system (Fire Sprinkler,ANSL System, FM-200 System,Type I Hood,etc...) :No:X Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application& 2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: one family After Construction: no change 6. N.Y State Construction Classification: type II B N.Y.State Use Classification: N/A 7. Property Owner: /y/e_ �/it�c5 Address: 47 ff;4Q..,,,��1�, �- - - /V / Phone# '2;0'9 !j!�r 763y Cell# AIX email: aNlr/ /s R •t, ,,.` Q,,,,AA 8. Applicant: Address: Phone# Cell# email: 9. Architect: Gabrielle Salman Architect Address: 467 BEDFORD ROAD,SUITE 169 PLEASANTVILLE, NY Phone# (914)773-1618 Cell# email: GSALMANAIAa@AOL.COM 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: AAo „z,'o Address: 3,� t-evA ,0011 -1. 6�mxh My MZ Phone# Cell# EU' S 31 17 5 a email: 12. Estimated cost of construction $ W) (NOTE The estimated cost shall include all labor,material,scaffoldin ,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: 5 ' 1 rj - Z 3 Finish: 7- I S ` 11 (1) 8n 2r2021 BUILDiNb DEPARTMENT D D D [�cr VILLAGE OF RYE BROOK 938 KING:�TREET RvE IB oa ,NY 10573 APR 2 8 2023 (9L� -oc, `� _-,__ VILLAGE OF RYE BROOK Ly BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • 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: l'�� rl� �IkS , residing at, I S' !IIIIC arm. Sf AW Y. Rye- PJ\1 7y�8�d rintllli III C) I Ajhll here,ouIi�eg 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; Z- t o or4-k' �✓ I , Rye Brook,NY. (.Ioh 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. (5ignalurcul I'roperl� (1��nerfs)I (Print Name of Property Omier(s)) Sworn to before me this day o C \ , 20 SHARI MELILLO Notary Public,State of New YorK No.OIME6160063 I �'utan a jlicl Qualified In Westchester County Commission Expires January 29, 20 2-7 12) Hrt2i2o21 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. STATE OF NEW YO,RK,COUNTY OF WESTCHESTER ) as: �il�f ,f, - W.4(i S , 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. Swom to before me this D Sworn to before me this day of , 20 day of 20 Signature of Property Owner Signature of Applicant int Name of Property Owner Print Name of Applicant ry Public Notary Public SHARI MEULLO Notary Public,state of New York No.01ME6160063 Qualified in westchester C29 It]�� ommission Expires January (4) s/1 z/2021 N o O N W � � ~j 1•y1 F. 96 H O a W U x N 6J M1 p00 cn w W z x rA z A H A ~' tx CA U Lia W Z W00 00 >t w 0 0 z y o w00 o H O z uZ o �, z W � x z W OR ° < O A z � x N W a v w MMGM !H w r V zz A a �I a z w T � EbRC� FFA�� L� U V L� BUILDING DEPARTMENT VILLAGE OF RYE BROOK JUN - 2 2023 938 KING STREET RYE BRooK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www& .org ELECTRICAL PERMIT APPLICATION Westchester County Master //Electricians License Required 2 1 FOR OFFICE USE ON)� N O 5 $ EP#: ��f J d— Approval Date: [ Permit Fee: $ Approval Signature: Other: Application dated,��^`�—�3 is hereby made to a 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. �-7--7 u 1.Address:�/7_ ,g N /(JL7 SBL:13 o t / / --�� / Zone: 2.Property Owner: G(L V- Address: Phone#: Cell#: 9p 73-$yS �7� 3�/ email: 3.Master Electrician/Licensed Installer: Address: 3 rv.3T' _AL- Lic.#: 3y----) Phone#: Cell#: Company Name: � �5 =/l {� Address: 3 .114_:_bS o,v 4.Proposed Electrical Work/Fixture Count: /-1—t� 5.3rd Party Electrical Inspection Agency: S *******rt,t***********tr,t**,t*s************rr,r****,r*****,r*«***,rw*****,t*«**+r,t***,r,t****+t*,t*,r**,t*,►**tnr,r******w**. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 the 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 his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn tq_before me this a day of ,20 day of J`� ,20 3 Signature of Property Owner Signature of Applicant /JiQwzS Print Name of Property Owner Name of Apphca Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.OIME6160063 3/3/2023 Qualified In Westchester County Commission Expires January 29,20Z1 STATE WIDE INSPECTION SERVICES, INC. Service With Integrity 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ; ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential [:]Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P it Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation r � C� JUN - 2 2023 VILLAGE OF RYE BROOK { BUILDING DEPARTMENT f 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 anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# Date Signature Address City/State Zip Code Company Phone# y DState Wide Inspection Services 1080 Main Street jD AUG 1 1 2023 Fishkill, NY 12524 a 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: offlce@swisny.com BUILDING DEPARTMENT 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: Carlos Electric Corp. Merle& Krishna Minks Carlos Rodrigues 42 Hillandale Road 3 Hudson Street Rye Brook, NY 10573 Tarrytown, NY 10591 Located at: 42 Hillandale Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-132 130.77 1 4 — Certificate Number: 2023-5798 Building Permit Number: BP 23-062 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: 42 Hillandale Road, Rye Brook, NY 10573 The First Floor and Second Floor 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 91' Day of August 2023. Name Quantity Rating Circuit Type Luminaires 20 Receptacles 18 Switches 11 GFCI 10 A/C Split Unit 02 Refrigerator 01 Hood 01 Bathroom Exhaust Fan 01 Electric Stove 01 Dishwasher 01 -X— 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. � M N N O 0 N \ a W M a, Z qT A a W o a CD z o Z w g 010 � o o00 � x oc z � o Ly Iv�l zW � f V A z M 14 M M ►--a O W Z � C7 A Q uo Z U t w CD o ° +�z o z o Ln VZ, ►.L4 _ o W 1 ' o � , BR__ � p [ECEM BUIL E NT VIL E OF RYE OK J U N - 6 2023 938 KIN T Ryl BI ' ,NY 10573 939-0669 VILLAGE OF RYE BROOK w�dar,rlrel�ruok.orm BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION / FOR OFFICE USE ONLY BP #: �'-Q (� PP #: �3--0 Approval Date: jUN Permit Fee: S ZC:: b Approval Signature: Other: Disapproved: (fees are non-refundable) *************** *** ***** *********#* *** *****##***************#******************************#* Application dated, '� �dJ is hereby m de o the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per det ed statement described below. The applicant&property owner,by signing this document agree that 'said `plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: LA�- t t� t�C�v► :�� Q D' SBL: 1 50 . 11 -1 -4 Zone:X �S! 2.Proposed Work: �2 t`o t�tih , 'A'V' 7 Vw on}1 t3 A "Ix^� �I rL . �O U Q Toy�e� A n U AooEn N(,j 47kow/Pr - 51n�K �o 51o�, . n 3.Property Owner: �L�N C `V' r,,N vw W W K 5 Address: Phone#: Cell#: ` Oci 50�S ��'3� email: 4.Master Plumber: M4A'l 4w �j CtA20V�Z�u Address: �-y qG�r s AV-C Q S S A'n� L ic.#: 6Lg_Phone#: Cell#:Q ty_ U 63►l email: e K P1 Lkv%,j% q"� '�C c7 b1 Company Name: C K [U vv� �`na E 4 i n` Address: `Ly y A4,e 5 NV,* 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 1 / 2nd Floor 1 1 3'd Floor 4d'Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: �ha-n�",( ►4,cv„7 0 `' k if hi, q"a� (Notarized Signatures Required Next 2 Pages) 3/3/2023 STATE � OF NEW YOM COUNTY OF WESTCHESTER ) as: Mr46w SCAA-0D-Z`, ,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 Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before�me this � Sworn to before me this . 6 — day of ZLYVI- ,20 l day of 2.1 n 20_:13 _ nel A�4 //t4/ Signature of Property Owner Si ature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public otaryilubliggGoRy M.RNERA SC-0-TT W.CRAIG Netary Public,State of New York No"Pubik of New York No.01 R16441398 REG NO. MR9390667 COMMISSION EXPIRES 04116@027 Qualified In Westchester County Commission Expires September 26,2 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. 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- 3/3/2023 BUILDING DEPARTMENT � VILLAGE OF RYE BROOK 3D 938 KING STREET RYE BROOK,NY 10573 J U N — 6 2023 (914)939-0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT xx****x*x**xxx�:xxxx>TxFxxxxxrx:�*xx:Yrx*x*xx-xr:xxxxxxx<:xx; x:*�x�;xx**xx****xxxx**,��**�x*xx*xxx*�xxx,�* AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • 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: A p 3l, residing at, �l 2 1.,fit a��/'o l��� Q P"z� N 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; (l Z H, &'JJ, 4 Rye Brook,NY. 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. -We rl Sworn to before me this t� day of ��/�t'�e , 20 h On W.CRAIG No/Mry Public of New York REG NO. 01gXPHM 0441161MT -3- 8/12/2021 Ln 1. y .1 I� w c.� b N �M a W 3 � x MEW it -CL C �-+ W s. O F-i 0 ' 'ram^ 1-1 .. � Q L ° gyp O v v C, A U M � W L C) 1, w °° v ' a rA 00 t C M 00 00 0011-1 " 0 '- - W M. I co et Y+ q ijjjj� 00 � W cn v� O � -4L400 Z �, o z z o..j � z, o a mow 00 MD N u W 7 o o ce BW" 1 � V o a V � � �, � � x w � o � a "1 > a0 cV z w o z 0 � .� � B b i' BUILDall ENT D E C E F Y IE VIL OK 938 KING ,NY 10573 JUN 2 1 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: J UN 2 0234 PERMIT 441ddJ "-0 /`J Approval Date: Permit Fee: $ /- D Approval Signature: Other: i Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: I. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (village of RNe Brook must be listed as certificate holder)& Workers Compensation Insurance On a NYS Board form (Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL = $100.00/unit• COMMERCIAL = $350.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice required) 7. Electrical work requires a separate Electrical Permit& Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. ` ��**\,�,�*,�********,�,���,�***,�*,�,�****,�**,���*����:�**���*�,�****,���xrxxxxxr*xxxx�xxrxrr Application dated, - —d3 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. I. Address: 42 Hillandale Road SBL: I30e77—/—q Zone: 2. Property Owner: Merle MinkS Address: 42 Hillandale Road Phone#: 808-895-7634 Cell#: 808-895-7634 email: merle.minks0-amail.eom 3. Contractor: Arctic Mechanical Address: 460 North Main Street, Port Chester, NY 10573 Phone#: 914-830-9318 Cell#: 914-830-9318 email:bravojr@arctic-mechanical.com 4. Scope of Work:New Installation •Replacement( )•Removal( )•Other( ): 5. List Equipment: Mitsubishi m#MXZ-2C20NA3-U1 heat pump, (2) Mitsubishi m#MSZ-GL09NA-U2 fan coil, Mitsubishi m#MXZ-3CNA3-U1 heat pump, Mitsubishi m#MFZ-KJ09NA-U1 floor fan coil, Mitsubishi m# MSZ-GL15NA-U2 fan coil, Mitsubishi m#MSZ-GL12NA-U2 fan coil. 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): 1 3/3/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Jhonny Bravo ,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 Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. 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 O Sworn to before me this day of `un-Q ,20 day of 7LJ OQ ,20 Signature of Property Owner Signature of Applicant ,7/�,G_c Manny 01^4VO t Name of roperty Owner Print Name of Applicant -t t --a AUAV—M&ft� o ry Public Nota Pub SHARI MEULLO GREGORY M.RIVERA Notary Public,State of New York Notary Public,State of New York No.01MEM0063 No.01 RIG441398 Qualified In Westchester County Qualified in Westchester County Commission Expires January 29,206L I Commission Expires September 26,20 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 3/3/2023 LEGEND Q------.TRENCH DRAIN -o—�-----VINYL FENCE —,—s-----STOCKADE FENCE PROPERTY LINE POB --POINT OF BEGINNING O HILLANDALE P O B---,, R= 310.00 z J >- W V) 3 O YARD YA ftJ YARD w N o YAR 000NC L w GARAGE f 26.9' RO FED UNDER STOOP L .4 t No. 42 a Z\\ N I` 1 STORY FRAME o �� `--�� FENCE ,_ Z `� D OKD FRAME Y I 0.2�W 1p C 29.E' 2 3 �� T OP -- " 13.4' 2p3, CONC A WEREA 3 RET WALL N Qv � i a oQ � Z n W ao W AREA= 19,929 Sq. Ft. Z c\ Q = 0.457 ACRE � Q: V N S O J h FENCE W 0.7 W WIZ o 1.6W �O a Q v W W 2UW a YARD 3 SubmittalMITSUBISHI 1 CoolingAWlk ELECTRIC Hewing and Job Name: Location: Purchaser: Submitted By: Submitted To: Reference: Approval: Construction: Engineer: Date: Application: •Variable speed INVERTER-driven compressor •M-NET connection optional through outdoor unit(Part q listed below) •Quiet outdoor unit operation as low as 50 dB(A) •High pressure switch for additional protection •Base pan heater optional(Part It listed below) images prmwee for reference purposes only Non-DuctedDucted Rated Capacity Btu/h 18,000 19,000 20,000 Capacity Range Btu/h 5,700-20,000 5,700-20,000 5,700-20,000 Rated Power Input W 1,417 1,709 2,000 Cooling at 95'F Power Input Range W 530-2,2245 530-2,2245 530-2,2245 Moisture Removal ints/h NA NA NA Sensible Heat Factor NA NA NA Rated Capacity Btu/h 22,000 22,000 22,000 Capacity Range Btu h 7,400-25,500 7,400-25,500 7,400-25,500 Heating at 47°F Rated Power Input W 1,641 1,706 1,771 Power Input Range W 670-2 455 670-2,455 670-2 455 Maximum Capacity Btu/h 15,500 15,000 14,500 Rated Capacity Btu/h 12,500 13,000 13,500 Capacity Range Btu/h 11,000-15,500 12,250-15,000 13,500-14,500 Heating at 17'F Maximum Power Input W 1,750 1,780 1,810 Rated Power Input W 1,300 1,325 1,350 Power Input Range W 1,200-1,750 1,275-1,780 1,350-1,810 Maximum Capacity Btu/h 11 100 11,000 10,900 Heating at 5'F Maximum Power Input W 1,600 1,650 1,700 Maximum Capacity Btu/h NA NA NA Heating at-13'Fs Maximum Power Input W NA NA NA Non-Ducted SEER 20.00 18.00 16.00 E ER 12.70 11.00 10.00 HSPF(IV) 10.00 9.65 9.30 COP at 47-F Rated Capacity 3.93 3.78 3.64 COP at 17°F Maximum Capacity 2.60 2.47 2.35 COP at 5'F IMaximum Cagacity 2.03 1.96 1.88 Outdoor Operating Cooling Operation Air Temp(Maximum/Minimum)' (Comfort cooling only applications) 'F 'C "115 to 14 (46 to-10) Cooling Operation Thermal Lock-out/Re-start Temperatures 'F °C 10.4/14 (-12/-10) Heating Operation Air Temp(Maximum/Minimum) 'F('C) 65 to 5 (18 to-I5) Hea-ting Operation Thermal Lock-out/Re-start Temperatures °F °C 1.4 5.0 -17/-15 AHRI Rated Conditions(Rated data is determined at a fixed compressor speed)('Windscreens required for cooling operations below 23'F(-S'C)) 1Cooling(Indoor//Outdoor)80'F(26.6'C)DB,67'F(19.4'C)WB//95'F(35'C)DB,75'F(23.9'C)WB ''Heating at 47'F(8.3'C)(Indoor//Outdoor)70'F(21.1'C)DB,60'F(15.6'C)WB//47'F(8.3°C)DB,43'F(6.1'C)WB 'Heating at 17'F(-8.3'C)(Indoor//Outdoor)70'F(21.1'C)DB,60'F(15.6°C)WB//17'F(-8.3'C)DB,15'F(-9.4'C)WB Rated conditions: Heating at S'F(-15'C)(Indoor//Outdoor)70'F(21.1'C)DB,60'F(15.6'C)WB//5'F(-15'C)DB,4'F(-15.6'C)WB SHeating at-13'F(25'C)(Indoor//Outdoor)70'F(21.1'C)DB,60'F(15.6'C)WB//-13'F(-25'C)DB,-15'F(-26.1'C)WB Note: 1.Mitsubishi Electric Sales Canada Inc.(MESCA)supports the use of only MESCA supplied and approved components and accessories for proper functioning of the unit(s).Use of non-MESCA supported components and accessories will affect warranty coverage.MESCA recommends(A)consideration of all applicable design and application parameters and requirements specific to any project. 2.Should any person change this document in any manner whatsoever without MESCA's written permission,the document shall be of no force and effect and any change shall be deemed to be a representation and warranty made by that person and not MESCA.That person,and not MESCA,shall assume full responsibility for the consequences of such changes.MESCA assumes no responsibility for any consequences in such cases. Notes: www.MitsubishiElectric.ca Page 1 of 3 Specifications are subject to change without notice. ©2022 Mitsubishi Electric Sales Canada Inc. Form No.SB_MXZ-2C20NA3-U1_202207 SubmittalMITSUBISHI ArW ELECTRIC 1 Heating and Cooling Power Supply 208/230V,1Ph,60Hz Voltage:Indoor-Outdoor,51-S2 VAC AC 208/230V Voltage:Indoor-Outdoor,S2-S3 V DC DC 12-24V Short-circuit Current Rating(SCCR) kA 5 Recommended Fuse/Breaker Size(Outdoor) A 20 Recommended Wire Size(Indoor-Outdoor) AWG 14 Outdoor MCA A 17.2 MOCP A 20 Fan Motor Output W NA Airflow Rate (Cooling/Heating) CFM 1,342/1,458 Sound Pressure Level,Coolingl dB(A) 50 Sound Pressure Level,Heating2 dB(A) 54 Refrigerant Control LEV Compressor Oil Type/Refrigerant Charge NE022/5 lbs.15 oz.(2.7 kg) External Finish Color Munsell 3.OY 7.8/1.1 Unit Weight Lbs.]kg] 126(57) W:In.[mm] 33-1/16[8401 Unit Dimensions D:In.[mm] 13(330] H:In.[mm] 27-15/16[710] Gas Pipe Size O.D.(Flared) In.[mm] A,B:3/8[A,B:9.52] Liquid Pipe Size O.D.(Flared) In.[mm] A,B:1/4[A,B:6.351 Total Piping Length Ft.[m] 1641501 Maximum Height Difference,ODU above IDU Ft.[m] 33[10] Maximum Height Difference,ODU below IDU Ft.[m] 491151 Farthest Pipin Len th from ODU to IDU Ft.[m] 82(25] Maximum Numbcr of Bends for IDU 50 Model No. Description:(Optional WFR1 CgFront Windscreen PAC-IF01MNT-E SYSTEM M-NET CONTROL INTERFACE MAC-A4S41P-E JOINT PIPE(3/8->1/2) MAC-A455JP-E JOINT PIPE(1/2->3/8) MAC-A456JP-E ❑JOINT PIPE(1/2->5/8) PAC-SG76RJ-E ❑JOINT PIPE(3/8->5/8) PAC-646BH-E Base Heater Notes: SVZ Connections Rules: Minimum of two Indoor units must be connected I Only 1 SVZ may be used on any system Minimum installed capacity cannot be less than 12,000 Btu/h When an SVZ is connected,total connected capacity must be less than 100% System can operate with only one Indoor unit turned on When an SVZ is connected,no P-Series Indoor units can be used(PCA,PLA,or PEAD) May connect to any style Indoor unit or combination Information provided at 208/230V Refer"MXZ Connection Rules"additional info available within TIC Rernir° rip tunque,ermmai m a Around to,ermnn Cormect wires to the matchingnumbers of terminals. • use a woer Io cormec, w.e • Be sure to attach each screw to its correspondent terminal when securing the cord andlor the wire to the terminal block. INDOOR UNIT CONNECTING WIRES AND CONNECTING GROUND WIRE sla n Use solid conductor Min AWG 14 or stranded conductor Min AWG 14 1-3/8 in (isram) Use double insulated copper wire with 600 V Insulation r.rrr.Ia� r...Ir_.r_uw* J l mm1 - Use copper conductors only - L_ Follow local electrical code. Grwnenq POWER SUPPLY CABLE terminal• Use sofid or stranded conductorMinM AWGS teae wr Use copper conductors only 200/230 v AC putt n,ppy ` Follow local electrical code. t phase ee Daconnec, 1081230 V AC \\y swath r phase 2 wires eo Hz ou se GROUND WIRE ,�--� Grndog U solid or stranded conductor Min AWG8 Grounamq i�_ tennlnar• Use copper conductors only te�me. Follow local electrical code. WARNING: Use the indoorloutdoor unit connecting wire that meets the Stand 1 I G and aids to connect the indoor and outdoor units and fix the wire to T«n.Ll einrs r.m.r eloa Tsn...+i,we the terminal block securely so that no external force Is conveyed to the connecting section of the terminal block.An incomplete © connection or fixing of the wire could result in a fire. OUTDOOR UNIT f a future servicing,give extra length to the connecbng wires • Turn on the main power who.the ambient temparatwe is-4'F (-20•C)or higher. • Under conditions of 4•F(-20•C).it needs at least 4hr stand by before the units operate in order to warm the electrical parts. www.Mitsubishi Electric.ca Page 2 of 3 Specifications are subject to change without notice. ©2022 Mitsubishi Electric Sales Canada Inc. Form No.SB_MXZ-2C20NA3-U1_202207 . j SubmittalMITSUBISHI Heating and Cooling Outdoor Unit Outline and Dimensions: N W C E C A O C C w N T t J` avow Jo .9Nll-6L w Ln C I' aiow Jo ,9L/Sl-E M N W U to Q \ 0 E V) b O .ZElet<Jl E Ln � W m U 0 st�erot a N st,5t tz ° .suu zr�Ez zEnt .stnt !) W ti sure V) T a � � � I 1 I N iO 4 a, .9t1Ebt �I IV f y •Z --- .T.En7. 2 C n � � h ���u�(�����p�q��NNm����'1/��,(�III'�npnnu(�11����u�„��pYm���'1((��gry((��IpI(j'p'�'gI(,,�,,•poll � r a llllll{ltlllllllWWIIUiII�'WiII('WI�II(Y�'I!I{(1IIWt I'WIIUjIfUII AW�'IW'II 1r • r5 UWWUoUWWUUUWU s aiow Jo ,96/6f-66 a E o O O N T ajow jo T G1 '� O W E \ U o U Q O zoCL E L O W rn O Ill ` N _ZflSZ•t � 0 m 'err .9t/SS .st,✓K LL s/t-et avow Jo .9l/lL-6L • Page 3 of 3 c US MITSUBISHI AAk ELECTRIC Changes for the Better Intertek www.MitsubishiElectric.ca Specifications are subject to change without notice. 0 2022 Mitsubishi Electric Sales Canada Inc. Form No.SB MXZ-2C20NA3-U1 202207 SubmittalMITSUBGHI 1 CoolingAWlk ELECTRIC Heating and Job Name: Location: Purchaser: Submitted By: Submitted To: Reference: EJ Approval: Construction: Engineer: Date: Application: •Variable speed INVERTER-driven compressor •M-NET connection optional through outdoor unit(Part If listed below) h •Quiet outdoor unit operation as low as 52 dB(A) 4 •High pressure switch for additional protection •Base pan heater optional(Part q listed below) Mnases provkW for reference purpose.only Non-Ducted Rated Capacity Btu/h 28,400 27,800 27,400 Capacity Range Btu/h 11,600-28,400 11,300-28,400 11,000-28,400 Rated Power Input W 2,680 2,760 2,840 Cooling at 95'F Power Input Range W 680-2,680 785-2,680 890-2,680 Moisture Removal ints h NA NA NA Sensible Heat Factor NA NA NA Rated Capacity Btu/h 28,600 28,000 27,600 Capacity Range Btu/h 18,100-36,000 18,300-36,000 18,500-36,000 Heating at 47°F Rated Power Input W 2,150 2,185 2,220 Power Input Range W 1 040-3,300 1,130-3,300 1,220-3,300 Maximum Capacity Btu/h 21,000 21,000 21,000 Rated Capacity Btu/h 17,800 15,500 17,800 Capacity Range Btu/h 15,700-21,000 15,100-21,000 14,500-21,000 Heating at 17'F' Maximum Power Input W 2,740 2,780 2,820 Rated Power Input W 1,760 1,830 1,900 Power Input Range W 1,420-2,740 1,440-2,780 1,470-2,820 • Maximum CapacityBtu/h 18,200 18,200 18,200 Heating at 5°F Maximum Power Input W 2,310 2,355 2,400 Maximum Capacity Btu h NA NA NA Heating at-13°Fs Maximum Power Input W NA NA NA Non-Ducted Mixed SEER 19.00 17.60 Ducted16.20 EER 10.60 10.30 10.00 HSPF(IV) 11.00 10.50 10.00 COP at 47°F Rated Capacity 3.90 3.77 3.65 COP at 17°F IMaximurn Capacity 2.25 2.22 2.18 COP at 5°F Maximum Capacinj 2.31 2.26 2.22 Outdoor Operating Cooling Operation Air Temp(Maximum/Minimum)' (Comfort cooling only applications) F °C) 1 115 to 14 (46 to-10) Cooling Operation Thermal Lock-out/Re-start Temperatures °F °C 10.4/14 (-12/-10) Heating Operation Air Temp(Maximum/Minimum) I °F °C 65 to 5 (18 to-15) Heating Operation Thermal Lock-out/Re-start Temperatures I °F °C 1.4/5.0 -17/-15 AHRI Rated Conditions(Rated data is determined at a fixed compressor speed)(*Windscreens required for cooling operations below 23°F(-5°C)) 'Cooling(Indoor//Outdoor)80°F(26.6°C)DB,67°F(19.4°C)WB//95°F(35'C)DB,75°F(23.9°C)WB ?Heating at 47°F(8.3°C)(Indoor//Outdoor)70°F(21.1°C)DB,60°F(15.6°C)WB//47°F(8.3°C)DB,43°F(6.1°C)WB 3Heating at 17°F(-8.3°C)(Indoor//Outdoor)70°F(21.1°C)DB,60°F(15.6°C)WB//17°F(-8.3°C)DB,15°F(-9.4°C)WB Rated conditions: °Heating at S°F(-15°C)(Indoor//Outdoor)70°F(21.1°C)DB,60°F(15.6°C)WB//S°F(-15°C)OB,4°F(-15.6°C)WB sHeating at-13°F(25°C)(Indoor//Outdoor)707(21.1°C)DB,60°F(15.6°C)WB//-13°F(-25°C)DB,-15°F(-26.1°C)WB Note: 1.Mitsubishi Electric Sales Canada Inc.(MESCA)supports the use of only MESCA supplied and approved components and accessories for proper functioning of the unit(s).Use of non-MESCA supported components and accessories will affect warranty coverage.MESCA recommends(A)consideration of all applicable design and application parameters and requirements specific to any project. 2.Should any person change this document in any manner whatsoever without MESCA's written permission,the document shall be of no force and effect and any change shall be deemed to be a representation and warranty made by that person and not MESCA.That person,and not MESCA,shall assume full responsibility for the consequences of such changes.MESCA assumes no responsibility for any consequences in such cases. Notes: www.MitsubishiEiectric.ca Page 1 of 3 Specifications are subject to change without notice. 0 2022 Mitsubishi Electric Sales Canada Inc. Form No.SB MXZ-3C30NA3-Ul 202207 SubmittalMITSUBISHI ArIk ELECTRIC 1 Heating and Cooling Power Supply 208/23OV,1Ph,60Hz Voltage:Indoor-Outdoor,S1-S2 VAC AC 208/230V Voltage:Indoor-Outdoor,52-S3 V DC DC 12-24V Short-circuit Current Rating(SCCR) kA 5 Recommended Fuse/Breaker Size(Outdoor) A 25 Recommended Wire Size Indoor-Outdoor�L AWG 14 Outdoor MCA A 22.1 MOCP A 25 Fan Motor Output W 2.43 Airflow Rate (Cooling/Heating) CFM 2,287/2,382 Sound Pressure Level,Coolingl dB(A) 52 Sound Pressure Level,Heating2 dB(A) 56 Refrigerant Control LEV Compressor Oil Type/Refrigerant Charge FV505/6 lbs.13 oz-(3.1 kg) External Finish Color Munsell 3.OY 7.8/1.1 Unit Weight Lbs.[kg] 1371621 W:In.[mm) 37-13/32(9501 Unit Dimensions D:In.[mm] 13[330] H:In.[mm] 31-11/32[7961 Gas Pipe Size O.D.(Flared) In.[mm] A:112;B,C:3/8[A:12.72;B,C:9.521 Liquid Pipe Size O.D.(Flared) In.fmm] A,B,C:1/4 fA,B,C:6.351 Total Piping Length Ft.[m] 230[701 Maximum Height Difference,ODU above IDU Ft.[m] 49[151 Maximum Height Difference,ODU below IDU Ft.[m] 49[151 Farthest Piping Length from ODU to IDU Ft.[m] 82[251 Maximum Number of Bends for IDU 70 Model No. Description:(Optional CM-S-FR-NKMU I Front Windscreen WRE3 Rear Windscreen WSD3 Side Windscreen PAC-IFOIMNT-E SYSTEM M-NET CONTROL INTERFACE MAC-A454JP-E ❑JOINT PIPE(3/8->1/2) MAC-A455JP-E JOINT PIPE(1/2->3/8) MAC-A456JP-E ❑ JOINT PIPE(1/2->5/8) PAC-SG76RJ-E JOINT PIPE 3/8->5/8) PAC-645BH-E Base Heater Notes- SVZ Connections Rules: Minimum of two Indoor units must be connected Only 1 SVZ may be used on any system Minimum installed capacity cannot be less than 12,000 Btu/h When an SVZ is connected,total connected capacity must be less than 100% System can operate with only one Indoor unit turned on When an SVZ is connected,no P-Series Indoor units can be used(PCA,PLA,or PEAD) May connect to any style Indoor unit or combination Information provided at 208/230V Refer"MXZ Connection Rules"additional info available within TIC Remark: Connect wires to the matching numbers of terminals. A disconnect switch should lie required.Check the local code Be sure to attach each screw to its correspondent terminal when Use a ring tongue tefnanal in order to connect a ground wke to terminal securing the cord andlor the wire to the terminal.block. INDOOR UNIT ®-®® t-M in i� i— 5181n.--- i -- mn) (t5mm) CONNECTING WIRES AND CONNECTING GROUND WIRE T.n.rw afloat l T.—al oirt o l Use solid conductor Min AWG14 or stranded conductor Min AWG 14 Use double insulated copper wire with 600 V insulation Use copper conductors only Ground tem.nal„ I Follow local electrical code. 2081230 VAC _4 �\,'i ply supply Lead wire POWER SUPPLY CABLE AND GROUND WIRE t phase 60 rtr� Disconnect 2O8r230 VAC Use solid of stranded conductor Min AWG 12 switch' t phase 2 wires 60 FU Use copper conductors only r-^ Grounding Follow local electrical code. Groundng � _ temknal'- terminal" [ ' " WARNING: �- - �--- ----- - - - -- Use the indoortoutdoor unit connecting wire that meets the Stand- ardsto connect the indoor and outdoor units and fix the wire to the r.�„n.i aoa r.fmtiirrora T.rmir,r ao�.f I Ground terminal block securely so that no external force is conveyed to the _ ®-®®!_—_—_ _--_J connecting section of the terminal block-An incomplete connection OUTDOOR Ui or fixing of the wire could result in a fire. D unit is for 4C36NA3 only For future servic ing,give extra length to the connecting wires www.MitsubishiElectric.ca Page 2 of 3 Specifications are subject to change without notice. 0 2022 Mitsubishi Electric Sales Canada Inc, Form No.SB MXZ-3C30NA3-U1 202207 SubmittalMITSUBISHI D. 1 + CoolingHeating and OutdoorOutline and Dimensions: w 0 QE g :Ir m ?a u N n m WOW Jo .9L/LL-6L w Ln V a I N C o ajow Jo m 4 8 W a as o Y o Q E n a i € o_ (n a o 0 0 E _ _E_ w M m 6 m l_1 to a .7_E/EL-9L m m 0 N H D§ (4old tpB) X m rn m D° .ZE/tL-LELn ry_ N IV E/EL.ZE/E m ry LL N m `o m .ZE/EL-L .Z PQ Yo F a O m o Wr■o m U f m m � N N .ZEA-% Zf c .9L/6-L f SOD ®®®® Q OOOOOp P avow jo ,9LlLL-6L a � o iry m aJOW Ja ,g/L-L N a y a w m 6 p L L Y I G T w g o g� a� E m u lo a o C E 0 o Nu my Ir N m m :o W 0 n v m ry Q 5jow jo ,9L/LL-6L W .ZE/S- .9LRL/L N ZE/6Z > W W .ZE/SL- .9/E-9 ,Z/L-7 QL L.L. Page 3 of 3 MITSUBISHI C us ELECTRIC 00""�° Changes for the Better www.MitsubishiElectric.ca Intertek Specifications are subject to change without notice. 0 2022 Mitsubishi Electric Sales Canada Inc. Form No.SB_MXZ-3C30NA3-Ul_202207 MITSUBISHI /IL ELECTRIC MmSERIES Changes for the Better SUBMITTALDATA: 0- • ttl BTUIH WALL-MOUNTED INDOOR UNIT FOR MXZ-C MULTI-ZONE HEAT PUMP SYSTEMS Job Name: Location: Date: Purchaser: Engineer: Submitted to: For []Reference []Approval []Construction System Designation: Schedule No.: SPECIFICATIONS: Capacity'Rated Cooling BluthiW 9,000 a»* Healing at 4r F2 BtA l W 10,900 --------- �._._.__ •'^ Ratng Corditions per AHM Standard: —_--- Indoc•Uni:MSZG�J9NA-U 1 Co.["I Indo ..80°F(2A Cp8/87•F(IR-CYWB;Outloor W F(35°C)DB I M F(24°CWM Fleaury at 47°F I Indoor.70•F(21•C)DS/8V F(/6•CrMB:Oue000r:47•F(8°C)DB;43•F(8•CIWB Fur data on specific indoor units(all ducted,a1 non-duc4ed.and both ducted and noncucted) comoriaeons.see ere MxZ Technical and Service Mane-al. Ylueless Remote Comroler Apolications should be restricted to comfort cooling only;equiomant cooling appkcaeo^s are not recomrne-ded for low ambient temperature conditions. Electrical Power V_ Requirements 1 2081230V,1-Phase,60 Hz ACCESSORIES: Minimum Circuit -- ---� I A 1.0 Indoor Unit Ampacity(MCA) Anti-Allergy Enzyme Filter(MAC408FT-E) wAll electrical work shall comply with National(CM and local Codes and hpYl tlo1M. • F.LA 0.76 )1Lm 1.5 Controls • w 30 -- - — Wireless Controller(MHK1) Wired Remote Controller PAR40MAA(Requires MAC-3341F-E) • • • • ldlmml 518(15) Thermostat Interface(PAG-US444GN-1) (QuietAirflow Rate DRY 145-170-237-321-399 Cooling j - — WET ! cFM 109-134-201-28&364 [Heating I DRY 145-17G-237-321-406 (QuietSciand Pressure Level Super Cooling 19-22-30-37-43 f Heating B(A) 19-22-30-37-43 External• �TI1-5/8 31-7/16 x 9-1/8 • 98 x 232)__ �--Lbs.(kg) 29(12) - Munsell 1.0Y 9.2/0.2 J Refrigerant Piping(Flared) Liquid(High Pressure) 1/4(6.35) h(mm) Gas(Low Pressure) 3/8(9.52) Should this document be altered or changed without MESCA's permission.it becomes null and void.MESCA assumes no responsibility for any consequences in such cases. Specifications are subject to change without notice ->2022 Mitsubishi Electric Sales Canada Inc. Page 1 of 2 Form 4 SB_MSZ-GL09NA-(U 1)(U2)_For_MXZ_SYS_202204 1 • 1 ' A Unit:in.(mm) 91/SI 6 81l 811-6 a0 M M O O O 2 2U N � _ C O 7 91/II Z $ o — � m m rn o� 0 a0 0 a C o �jJ� D C - �/ S O S J � L 91IS ¢ t0 o — 6wdld o C> 91IS1 £ x 8/£ 8 OI — o - o o o 0 o _ 7 Mill € U _ N v v co M o _ CM N a0 O Q U N >w ^I n 911£-Z /l - FEES, us MITSUBISHI E° /IM ELECTRIC Intertek Changes for the Better Form#SB MSZ-GL09NA-(U1 XU2)_For MXZ SYS_202204 Specifications are subject to change without notice. www.MilsubishiElectric-ca V 2022 Mitsubishi Electric Sales Canada Inc. Page 2 of 2 MITSUBISHI /\ ELECTRIC M -SERIES Changes for the Better SUBMITTAL DATA: 0. ill 8TU/H FLOOR-MOUNTED INDOOR U MXZ MULTI-ZONE HEAT PUMP SYSTEMS NIT FOR Job Name: Location: Date: Purchaser: Engineer: Submitted to: For Reference Approval Construction System Designation: Schedule No.: SPECIFICATIONS: i .. W Cooling' Blv.h I W 9,000 Heating at 47e F� RaN•y C—ditwos per AHRI Standard: _ - - Coofng l i-rior.NP F(27-C)DB,67-F(19'C)W8;0utd—95°F(35•C)DB 175-F124-C)WB 'Heatng at 47-F l lndooc 7o-F(21-C)DB r 6Cr F(16-C)WB:0u41�.4r F(B-C)DB i 43-F(6-C)WB Ix;ovr Urnit MFZ-KJ�9\A-�1 For data on spca`w ducted,indoo,units(al all ran-ducted,end bell,ducted and�o,-cursed) combnat—see ene MXZ Technical and Servae Manual. Wireless Remote Con"er Appktalions should be msidaled to Comfort coding only;equipment Cooling spot cabona arc nol recommended for low ambient temperature conditions. Electrical Power 208/230V,1-Phase,60 Hz ACCESSORIES: — _ Indoor Unit -- - Minimum Circuit ❑Anti-Allergy Enzyme Filter(MAC408FT-E) Ampacity(MCA) A1 1.0 ❑Platinum Catalyst Deodorizing Filter(MAC-308FT-E) All electrical work shall comply i•It11 National(CEC)and IOGI Codes and regulations. X ELA 0.62 z Controls w 30 - ❑Wireless Controller(MHK1) ❑Wired Remote Controller PAR-32MAA(Requires MAC-3331F-E) a - • Jai') 518(15) rr = Q Thermostat Interface(PAC-US444CN-1) - (QuietAirflow Rate DRY 138-173-208-251-275 lx S C �lrg WET CFM 117-147-177-213.234 a Heating DRY 138-159-180-219-343 I e (QuietSound Pressure Level E Cooling 21-25-30-34-38 A a dB(A) Hea9ng 21-24-27-32-41 -- y Unit• �(mm)��2�3-W8 x 29-17/32 x 8-15/32 7.9 a 0x750x215) Package Dimension 27,/4 x 32-314 x 12 a h(lttm) (693 x 816 x 275) Unit Lb") 33(15) _.---- € Package Lftft)J41(18.5) U Munsell 1.0Y 9.2/0.2 �­fnqeranl Piping(Flared) 3 Liquid(High Pressure) 1/4(6.35) m Gas(Low Presstxe) 318(9.52) — 3 v E 3 9 Specifications are subject to change without notice. N 7 2017 Mitsubishi Electric Sales Canada Inc. Page 1 of 2 Form#SB_MFZ-KJ09NA-U1_For_MXZ_SYS_201705 Z;o Z 86ed 'oul epeueo seleS oulo013!gs!gnslryy LLOZ* eo-ouloa13iyslgnsl!Vy-mm n 'ootiou lnoylum 96ueLio of loefgns e/e suogeogpedS aa»a9 ay).4o1 sa6Nagf 90LLOZ SAS ZXW /03 tn-VN60fN-Z3W SS#uuo3 JIH1J313 IHSI8f1SlIW sn o 22-7/16 4-59/64 g y. r 1-3/16 0 w y 0 p m • � N � ? W O �N N N 2-3/8 w w �n v_ a 41f LeM hb a0�hldbl N N N OD lP A w J 4 V p N J� O P lu N P WWJ � N 5-45/6 o v N N 23-5/B Vl ID �1 D 2/32 , D J 4 Y -� n� o V 9 o ,c O�O O 5 N O p ID q t 'p Ll r -n -n w m n �Z = O O O i oa M C r w W O 7 O O w N IUD 7 w m n 2 3/8 1-1132 ro ^' 4-59/64 o -n 6-1/2 a �•° O' • r ro i Q B-5/64 cl O Wo a �O ly] Zt fD-, o i2 � o o a a c o_ Ln � n a O N m O. f1 - 15-15/64 0o n_ 7 O O '7j P O � ID O o n O v 7 a p W w T ' v O Ln n n o rn a Cn N Q1D-'� �n w 00 N<-N NO v Eio�1D rD O � D;N� o 0 0o N I I N I C N 3 7 ^n V1 ' V 5-25/64 15-15/16 19/32 m-VN6or)i-zjw :SNOISN3wia MITSUBISHI /` ELECTRIC MmSERIES Changes for the Better DATA:SUBMITTAL rrtWALL-MOUNTED Job Name: Location: Date: Purchaser: Engineer: Submitted to: For Reference Approval Construction System Designation: Schedule No.: Electrical Power :.n. 208/230V.1-Phase,60 Hz Requirements Minimum Circuit Ampacity(MCA) P,4 .,' 1 Indoor'Outdoor(RBS) A 1/10 (15A-Recommended Breaker Size) VA*Ws Remote ConT°ller "- `�- *Ail electrical work shall comply with National(CEC)and local codes and regulations. ACCESSORIES: Blower Motor(ECM) FLA. 0.76 Blower Motor Output W 30 Indoor Unit SHE/Moisture Removal 0.80/2.7 pt./h Anti-Allergy Enzyme Filter(MAC-408FT-E) - --- Field Drainpipe Size O.D. ! In.mm) 5/8(15) Note:Mitsubishi Electric(MESCA) Outdoor Outdoor Unit supports the use of only MESCA supplied and approved Snow Guard/Wind Compressor DC INVERTER-driven Twin Rotary Windscreens(ME -FR-12-17) Deflectors i Windscreens and accessories - ----- ----- - ------- - --- for proper functioning of the unit(si.Use of Fan Motor(ECM) F,LA �-0.5 non-MESCA supported Snow Guard/Wind -- --- --" •" --- —---- ----- -- Deflectors/Windscreens and accessories (Quietow, Controls will affect warranty coverage. - lldtxx DRY 205-272-335-420-533 - 8 Wireless Controller(MHK2) (Coding) WET 170-237-300-385-498 Wired Remote Controller PAR-00MAA(Requires MAC-3341F-E) CFM Thermostat Interface(PAC-US444CN-1) Indoor DRY 205-247-304-367-463 s I SPECIFICATIONS: Outdoor 1,243/1,229 Rated • • (Quiet Conditions Coding' Fill4,000/1,080 Indoor Cooing 26-32-38-44-49 - - — - Heating 26 30 35 40-46 0 Heating at 47°P Bwm 1 w 18,000/1,600 - I----- -- Cooling I i 49 � Capacty,Range Minanum MaximumOutdoor -- _ Heating 51 4 ---- ---__ _� --- - ---- J u Cooling' Be,h 3,100 18,200 Heating at 47°P Bn.n 4,800 }20,900 — -- - 11-5/8 x 31-7/16 x 9-1/8 Heating at 17°Fe ewn - 16,400 Indoor(H x W x D) (295 x 798 x 232) Heating at 5°F• -8a m 13,700 J H - ..... l� 21-5/8 x 31-1/2 X 11-1/4 C-l". Indoor:W F(27°CpB/67°F 19°CMB:outdoor:95°F(35°C)DB/75°F(24°C)WB Outdoor( x W x D) 91 t (550 x 800 x 285) `Heabcg at♦7°F I Indor:o 7(°F(21°CpB 1 aC°F I ta°G)WB:Outdoor.{7•F(WC)DB 1 43°F(G CIYVB' •Heabrg,n 1"P F I kWa:o 70.F(21°C)DB/50°F(16°C)WB:ouiow.17•F(-6°CPO/15°F(-9°C)YIB' 'Hcabcg a;5°F I Indoor 70°F(21•C)OB/W F(16°C)WB:0,46":5°F(-15°C)DB 15°F(.15°Clive c Rabng Condtb—i perAHRI Standard. >_ 70ut�m 22(10) s 81 (37) g Coohny' 90°F(32°C)DB/67°F(19°C)DB Heating 80°F(27°C)DB/70°F(21°C)DB � Indoor Munsell 1.OY 9.2/0.2 - - - — - - -- Operating • Outdoor Munsell No.3Y 7.8/1.1 Coding` 115 F(46°C)DB/14°F(-10°C)DB - ---, -- R41 OA;21b.9 oz. Heating 75°F(24°C)DB/ 4°F(-20°C)DB - - _ - s 'AWicatwro Nw"d:,e reWlctW to cw*)l cooling only:aWi°ment oar kil;applications are not ri—nierwoo to.low ambient temporaWre condblow Refrigerant Liquid(High Pressure) F114 .35)AHRI Efficiency Ratings Gas(Low Pressure) 2.7) SEER(SEER2)I HSPF(HSPF2)/EER(EER2) 21.6(21.0)/10.8(9.7)113.0(13.0) Max.Total Refrigerant 40(12) a Pipe Length(Height Diff.) Ij COP at 47°F/17°F 3.3/3.0 FL(m) - - - Max.Total Refrigerant Yes Pipe Length(Length.) 165(20) t ENERGY STAR p,°di,=era th d-ua ty ce^.ified by an EPA-rew¢r°sd CedificaYm Body. Specifications are subject to Change Without notice C 2022 Mitsubishi Electric Sales Canada Inc. Page 1 of 2 Form#SB_MSZ GL75NA-(U1)(U2)_MUZ-GLI5NAH-U2_202210 DIMENSIONS: • ' Unit:in.(mm) 1/16%I Oblong hole 1/16X13/I6 Oblong hole Installotion late 3-118 8 7/8 8 1/8 1/8 31-7/16 L_ 30-15/16 114 o — 6 u8 6 1 r8 3/J 5l I6 9/16 2-118 9-1/8 Alf In 3i16 Indoor unit � all hole 02 9116 Installation plote --17[ J 1- !8 1-314 5/16 21-3/84-311(1 Dram hose 2 /l63/4 A l r ou • 3' - ll � e ( — — Fow el-318 O.D e1/4 19-11/16(Flared connection e1!4) e3/8 16-15/16 2.3116 1 15/16 (Flared arvielvon e318(GLK/IW12NA1 o`!2!GL15NA)) 1 3/16 Insuixim et-1:8 O.D Connected part e5/8 01) 5 4 REQUIRED SPACE Unit:in.(mni) 8 •1 4 in.(100 mm)or more when front and sides of the unit are clear ; 15-3/4 M In U DfM hole 01-21132(GL09/17/15NA) Drain hole It-5/161GL12/15NAN) v '01�/Opp A\eol�o n pre m/ b Air In y 1-9/16 e OO mml /4' N s Aralit 2_holes3/8x13/16 Service net ld`°le 2 °r/"Oe�„rJ € 7/8 11/16HOW a '2 When any 2 sides of left,right Liquid refrigerant pipe joint and rear of the unit are clear =° Refrigerant pipe(flared)a 1'4 i m h n Gas refrigerant pipe joint r N Refrigerant pipe(flared)0 3i8(GL09/12) m ^ ^ e 1i2(GL15) m t-29/9 -11/ E -t5/1 19-11/t6 6-23/32 Boll pifdt for in6tdlGNon - 3t-V2 2-3/4 ETA US ROOM. MITSUBISHI /\ ELECTRIC Intertek Changes for the Better Form#SCd MSZ-GLI5NA-(U1)(U2)_MUZ-GLI5NAH-U2_202210 Specifications are subject to change without notice. www.Mitsubish iElectric.ca c�i 2022 Mitsubishi Electric Sales Canada Inc. Page 2 of 2 4 MITSUBISHI /` ELECTRIC MmSERIES Changes for the Better SUBMITTAL DATA: MSZ-GL12NA-(U1)(U2) 12,000 BTU/H WALL-MOUNTED INDOOR UNIT FOR MXZ-C MULTI-ZONE HEAT PUMP SYSTEMS Job Name: Location: Date: Purchaser: Engineer: Submitted to: For ❑Reference ❑Approval Construction System Designation: Schedule No.: SPECIFICATIONS: 7H.WIr�C7 g' Btum/Y+ 12,000 ! F' sum w 14,400 Ratlrg Conditions per AHRI Standard: Indoor Uri:MSZG_'2^Y+-Jt 'Coo"I atdoor:W F(2T C)DB/6P F(19'C)WB:Outdoor 95•F(35°C)DB 175-F(24•C)WB Heawg at 4rF I Indoor Pr F(21•C)DB I W F(16'C)WB:Ouldocr 47°F(6°C)DB 143°F(6"CIWB For data on speciric irdoor units(al ducted,all non-ducted,and boll,ducted and nonM cted) rombinauun i.see Ina MXZ T- al and Sery Manual. Wireless Ren>a'.e C;:n:rgar Aoplcatane should be resuicted to comfort cooling only.equipment poling apply bons am rot rncu mo-ded for bw ambient temperature c 11tions. 208/23OV,1-Phase,60 Hz Requirements ACCESSORIES: Minimum Circuit A 1 Indoor Unit Anti-Allergy Enzyme Filter(MAC-408FT-E) `All electrical work shall comply with N&OMW(CEC)and loi Codes anti regudadeM. F.LA 0.76 r . • IIIIIII w 30 - - -- - Controls -� Moisture Removal ptrtl 2.5 I Wireless Controller(MHK1) Wired Remote Controller PAR40MAA(Requires MAC-3341F-E) . a . In.(mm) 5/g(15) J Thermostat Interface(PAC-US444CN-1) -(Quiet - Airflow Rate Cooling DRY 145-170-237-321-399 WET ICFM 109-134-201-286-364 Heating DRY 145 170 237-321-406 r Cooling 19-22-30-37-45 t18(A) - -- - -- Heating 1 19-22-3G-37-43 External Dimensions In(mm) 11-5/8 x 31-7/16 x 9-1/8 a (295 x 798 x 232) Lb.M 22(10) Munsell 1.OY 9.2/0.2 Relirigerant Piping(Flared) Liquid(High Pressure) 1/4(6.35) Gas(Low Pressure) 3/8(9.52) Should this document be altered or changed without MESCA's permission,d becomes null and void.MESCA assumes no responsibility for any consequences in such cabs. Specifications are subject to change without notice. O 2022 Mitsubishi Electric Sales Canada Inc. Page 1 of 2 Form#SB_MSZ-GLI2NA-(U1)(U2)_For_MXZ_SYS_202204 DIMENSIONS: Unit:in.(mm) 91/SI-6 0 8Il 8/I-6 M = m 91/S-8 m = o v o c o z � o � N m c _ 91/II Z $ o 0 c v m O ao m co O c mLL C M C V / O O C 1• O — N �/ 0 JV L C7 Q a 9 I/S c 6uldld j L � M 91IS1-£ 0 ^' AT f 8 x £ v W-1 815-1 — o °D a O g o — � — a f �o �o M � M N �Y O aD M 8rS 1i�I 91/11 1 Co ff ETA �S � MITSUBISHI Intertek AAk ELECTRIC Changes for the Better Form#SB_MSZ-GL12NA-(U1)(U2)_For_MXZ SYS_202204 Specifications are subject to change without notice. www.M its u bi sh i E lectri c.ca Co 2022 Mitsubishi Electric Sales Canada Inc. Page 2 of 2 (ool (alc Project Name: 42 Hillandale Road Address: 42 Hillandale Road,Rye Brook,NY OUTDOOR DESIGN CONDITIONS Weather station. White Plains,Westchester Co.AP Summer Outdoor F: Summer Indoor F: Design Grains: ® Daily Range: Winter Outdoor F: Winter Indoor F: Cooling RH: Elevation(Ft): LOAD CALCULATION TOTALS HVAC System:42 Hillandale Road Heated square footage: MWIT-TIR Heating BTUH: ®' Cooled square footage: spir,•1 Cooling BTUH: Heated volume(above grade CF): �l CFM: Cooled volume(above grade CF): � Sensible cooling: Exposed wall area(SF): ® Latent cooling: SHR: Load Calculation Cooling Heating 0 20,000 40.000 60,000 80,000 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 4!io values such a R-Values, window types, duct loss, etc. Equipment selections should meet both the latent and sensible gain as well as building heat loss. HEATING AND COOLING LOADS HEATING LOADS Heating Loads aboveGradeWalls aboveGradeWalls 1,908.9 10,739 windows ceilings ceilings 1.608.2 3,544 floors 1,608.2 10.674 floors Infiltration 0 18,633 skylights 0 0 windows 468 23.615 rfiltration Totals 67,206 COOLING LOADS Cooling Loads aboveGradeWalls AEDExcursion 0 0 appliances aboveGradeWalls 1,908.9 6,314 0 windows ; appliances 0 3,400 0 - ceilings ceilings 1,608.2 3.667 0 plants floors floors 1.608.2 5,361 0 infitraton 0 4,432 3,014 pCCUpants ___ infifiration occupants 0 920 800 plants 0 0 300 skylights 0 0 0 windows 468 20,630 0 Totals 44,724 4.114 FENESTRATION LOADS AED Graph(mid-summer) 30,000 = 20,000 m 10,000 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) 30,000 = 20,000 m 10,000 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 war Frame Wall,Wood framing, R-11 cavity Construction nr 12B-Os w FxpoSure N Heating BTUH 282 insulation, Stucco or Siding. U Value: 0.097 Area: 50.1 Cooling BTUH: 166 Map trace war Frame Wall,Wood framing, R-11 cavity Construction nr 12B-Os w Exposure: N Heating BTUH: 743 insulation, Stucco or Siding. U Value 0.091 Area 132 Coding BTUH 437 Map trace wall F rame Nall, Wood framing, R-11 cavity Construction nr 128-Os w Exposure N Heating BTUH 847 insulation,Stucco or Siding. U Value: 0.097 Area: 150.5 Coding BTUH: 498 Map trace wall Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: E Heating BTUH: 1,365 insulation. Stucco or Siding. U Value: 0.097 Area: 242.6 Coding BTUH: 802 Map trace war Frame Wall. Wood framing. R-11 cavity Construction nr. 12B-Os w Exposure: E Heating BTUH: 380 insulation, Stucco or Siding. U Value: 0.097 Area: 67.6 Coding BTUH: 224 Map trace war Frame Wall,Wood framing, R-11 cavity Construction nr 12B-Ds w Exposure: S Heating BTUH: 915 insulation,Stucco or Siding. U Value: 0.097 Area: 162.6 Coding BTUH: 538 Map trace war Frame Wall,Wood framing, R-11 cavity Construction nr: 128-Os w Exposure: S Heating BTUH: 594 insulation, Stucco or Siding. U Value: 0.097 Area: 105.5 Cooling BTUH: 349 Map trace war Frame Wall,Wood framing, R-11 cavity Construction nr 128-0s w Exposure' S Heating BTUH 419 insulation, Stucco or Siding. U Value: 0.097 Area: 74.4 Coaling BTUH: 246 Map trace war Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: W Heating BTUH: 1,230 insulation. Stucco or Siding. U Value: 0.097 Area: 218.7 Coding BTUH: 723 Map trace wall Frame Wall,Wood framing, R-11 cavity construction nr. 12B-Os w Exposure: W Healing BTUH: 174 insulation,Stucco or Siding. U Value: 0.097 Area: 30.9 Coding BTUH: 102 Map trans war Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: W Heating BTUH: 324 insulation, Stucco or Siding. U Value: 0.097 Area: 57.6 Coding BTUH: 191 Map trace wall Frame Wall,Wood framing, R-11 cavity Construction nr 128-Os w Exposure N Healing BTUH 904 insulation, Stucco or Siding. U Value: 0.097 Area: 160.6 Cooling BTUH: 531 Map trace war Frame Wall,Wood framing,R-11 cavity Construction nr. 12B-Os w Exposure: E Heating BTUH: 806 insulation,Stucco or Siding. U Value. 0.097 Area: 143.2 Cooling BTUH: 474 Map trace war Frame Wall,Wood framing, R-11 cavity Construction nr. 128-Os w Exposure. S Heating BTUH 902 insulation,Stucco or Siding. U Value: 0.097 Area: 160.4 Coding BTUH 531 ABOVE • Map trace wag Frame Wall, Wood framing, R-11 cavity Construction nr 12B-Os w Exposure: W Heating BTUH 856 insulation, Stucco or Siding. U Value: 0.097 Area: 152.2 Cooling BTUH: 503 BELOW • There are no components for this section. 11116171-31111111 Default small windows for wag id 4944930 Construction nr 1 G U Value: 0.87 Heating BTUH: 606 Window. NFRC rated.Clear glass. E posure: N SHGC 0.67 Cooling BTUH: 364 Default small windows for wall id 4944944 Construction nr 1G U Value. 0.87 Heating BTUH: 303 Window, NFRC rated, Clear glass. Exposure: N SHGC 0.67 Cooling BTUH: 182 Default medium windows for wall id 4944944 Construction nr 1 G U Value: 0.87 Heating BTUH, 1,211 Window, NFRC rated,Clear glass. Expo 24 sure: N SHGC 0.67 Cooling BTUH: 728 Default small windows for wag id 4944959 Construction nr 1 G Area: 12 U Value 0.87 Heating BTUH 606 Window, NFRC rated,Clear glass. Exposure: N SHGC 0.67 Cooling BTUH: 364 Default medium windows for wag id 4944959 Construction nr 1 G U Value: 0.87 Healing BTUH: 1,211 Window, NFRC rated,Clear glass. Area. N SHGC 0.67 Cooling BTUH 728 Default small windows for wag Id 4944960 Construction nr: 1 G U Value: 0.87 Heating BTUH 303 Window, NFRC rated,Clear glass. area 6 SHGC 0.67 cooling BTUH: 283 Exposure: E Default medium windows for wag Id 4944960 Construction nr 1 G U Value: 0.87 Heating BTUH 606 Window, NFRC rated,Clear glass. Exposure. E2 SHGC: 0.67 coding BTUH: 567 Default large windows for wall id 4944960 Construction nr 1 G U Value: 0.87 Heating BTUH: 1,817 Window, NFRC rated,Clear glass. Area 36 Exposure E SHGC 0.67 Cooling BTUH: 1,701 Default small windows for wall id 4944962 Construction nr 1 G U Value: 0.87 Heating BTUH: 303 Wllldov\,. Nr NU tilled, Cleaf glaSS. Expos ure: posure: E SHGC 0.67 Cooling BTUH: 283 Default medium windows for wall id 4944962 Construction nr 1G U Value: 0.87 Heating BTUH, 606 Window, NFRC fated,Clear glass. Area Exposure: E2 SHGC: 0.67 Cooling BTUH: 567 Default small windows for wall id 4944961 Construction nr 1G U Value: 0.87 Heating BTUH 303 Window, NFRC rated,Clear glass. Area: 6 Exposure: S SHGC: 0.67 Cooling BTUH: 280 Default medium windows for wall id 4944961 Construction nr 1G U Value: 0.87 Heating BTUH: 1,817 Window, NFRC rated,Clear glass. Area: 36 Exposure S SHGC 0.67 Coding BTUH: 1,679 Default small windows for wall id 4944963 Construction nr 1 G U Value: 0.87 Heating BTUH: 606 Window, NFRC rated,Clear glass. Exposure: S2 SHGC 0.67 Cooling BTUH: 560 Default medium windows for wall id 4944963 Construction nr iG U Value: 0.87 Heating BTUH: 606 Window, NFRC rated.Clear glass. Area 12 Exposure: S SHGC 0.67 Cooling BTUH: 560 Default small windows for wall id 4944965 Construction nr 1G U Value 0.87 Healing BTUH: 303 Window, NFRC rated,Clear glass. E posure: 6 SHGC 0.67 Cooling BTUH: 280 Default medium windows for wag Id 4944965 Construction nr 1 G U Value: 0.87 Healing BTUH. 606 Window, NFRC rated,Clear glass. E posure g2 SHGC 0.67 cooling BTUH: 560 Default small windows for wag id 4944953 Construction nr. 1 G U Value: 0.87 Heating BTUH, 303 Windnvv NFRC;rated. Cleardlas., Area: 6 Exposure: INSHGC 0.67 Cooling BTUH: 311 Default medium windows for wall id 4944953 Construction nr 1 G U Value: 0.87 Heating BTUH. 606 Window, NFRC rated,Clear glass. Exposure: W SHGC 0.67 Coding BTUH: 622 Default large windows for wall id 4944953 Construction nr: 1G U Value. 0.87 Healing BTUH 1,817 Window,NFRC rated,Clear glass. Area: 36 Exposure: W SHGC: 0.67 Cooling BTUH: 1,866 Default small windows for wall id 4944958 Construction nr: 1G U Value: 0.87 Heating BTUH: 606 Window, NFRC rated,Clear glass. Exposure: W SHGC: 0.67 Cooling BTUH: 622 Default small windows for wall id 4944964 Construction nr: 1G U Value: 0.87 Healing BTUH: 303 Window, NFRC rated,Clear glass. Area: 6 Exposure: W SHGC 0.67 Coding BTUH 311 Default medium windows for wall id 4944964 Construction nr: I U Value: 0.87 Heating BTUH: 606 Window. NFRC rated.Clear glass. Area w SHGC: 0.67 Cooling BTUH: 622 Default small windows for wall id 4944954 Construction nr 1 G lass u vane 0.87 Heating BTUH 606 Window, NFRC rated.Clear g Exposure: N SHGC 0.67 Coding BTUH: 364 Default medium windows for wall id 4944954 Construction nr lG Area: 24 U Value: 0.87 Heating BTUH: 1.211 Window, NFRC rated.Cla,, Exposure: N SHGC 0.67 Cooling BTUH: 728 Default small windows for wad id 4944955 Construction nr: 1 G U Value: 0.87 Heating BTUH: 606 Window, NFRC rated.Clear glass. Exposure: E2 SHGC 0.67 Coding BTUH: 567 Default medium windows for wall Id 4944955 Construction nr: 1 G U Value: 0.87 Heating BTUH: 1.211 Window, NFRC rated,Clear glass. Exposure: E4 SHGC. 0.67 Cooling BTUH: 1,134 Default small windows for wad id 4944956 Construction nr 1 G U Value: 0.87 Healing BTUH 303 Window, NFRC rated,Clear glass. Erxposure: S SHGC: 0.67 Cooling BTUH: 274 Default medium windows for wall id 4944956 Construction nr 1G U Value: 0.87 Heating BTUH: 1,817 Window, NFRC rated,Clear glas Area: 36 Exposure: S SHGC 0.67 Coding BTUH: 1.662 Default Small windows for wO ld 4944957 Construction nr. 1 G U Value: 0.87 Heating BTUH: 606 Window,NFRC rated,Clear glass. Area,osure: W SHGC 0.67 Coding BTUH: 622 Default medium windows for wall id 4944957 Construction nr 1G U Value: 0.87 Heating BTUH: 1.211 Window, NFRC rated,Clear glass. Exposr r W SHGC: 0.67 Cooling BTUH: 1.244 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 nr 16B-25 ad Area Heating BTUH. 2,548 shingles, Dark, R-25. U Value: 0.038 1,156.3 Coding BTUH: 2,636 Map trace generated ceiling Ceiling under attic or attic knee wall,Asphalt Construction nr 1613-25 ad Heating BTUH: 996 shingles, Dark,R-25. U Value 0.038 Area: 451.9 Cooling BTUH: 1,030 SKYLIGHTS 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. There are no components for this section. Map trace generated floor Floor over enclosed unconditioned crawl space Heating BTUH 10,674 Construction nr 19A-Ocp Heating U Value:0.295 Cooling BTUH: 5,361 or basement,no floor insulation, Carpet or Area: 1,608.2 Cooling U Value 0.295 F Value NIA hardwood. VENTILATION There are no components for this section. HOT WATER PIPING There are no components for this section. There are no components for this section. INFILTRATION NCF1 Neat ng 2gg Heating BTUH. 18,633 Leakage Category Loose NCFM Cooling: 6 Sensible BTUH, 4,432 Latent BTUH: 3,014 BLOWER • •' There are no components for this section. WINTER HUMIDIFICATION There are no components for this section. OCCUPANTS Nr.Occupants 4 Sensible BTUH 920 Latent BTUH 800 APPLIANCES Kitchen,utility room,additional fridge,lighting:3,400 BTUH Quantity Sensible BTUH 3,400 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 �t`�. '_� f`.�. r�rY G 1� � � q } i �.��{ .'tom .^3--:-�. �� x 4*.� �1*�. L-�;,.}'4fi "�� �a�����iJq't,`i::iYb1,i� _ - 'w` � °'�,�.�` .,��' 9�-: n :N ,� it; tis r , w r;`` ^q ROOM DETAIL Room name:First Floor Heated square footage: ®i. Total Cooling BTUH: Cooled square footage: Total Heating BTUH: Heated volume(above grade CF): JEMW CFM: Cooled volume(above grade CF): IBM Exposed wall area(SF): Load Calculation Cooling Heating 0 10,000 20,000 30,000 40,000 50,000 BTUH AED Graph(mid-summer) 20.000 ti 10,000 ca 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH —Average -- Average 1.3 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 ROOM DETAIL Room name:Second Floor Heated square footage: Total Coding BTUH: Cooled square footage: Total Heating BTUH: 111110,1111 Heated volume(above grade CF): CFM: imm 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) 10000 5,000 m 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH —Average Average 1.3 AED graph(fall) 7,500 = 5,000 ti ca 2,500 0 8 9 10 11 12 13 14 15 16 17 18 19 — BTUH —Average - Average'1.3 Building Permit Check List&Zoning Analysis Address: 2- �� 1 1 `C ��� SBL: 30 t Zone: --i.,5 Use: 2 Const.Type: Other. Submittal Date: 2- 2 Revisions Submittal Dates: Applicant: (--A V:_5 Nature of Work —1 S 1 O C vVCAAaC J UaA Reviews:ZBA: MAY r� 1Q13 PB: BOT: Other. NBFP OK ,)/FEES:Filing. BP: � C/O: Flood Plane: Legalization: VAPP: Dated: —Notarized. ./I cuss I.D. Cross Connection: " H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening ( ) ( ) ENVIRO:Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan. Other. ( ) ( ) SURVEY:Dated: Current Archival• Sealed. Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic Other. ( ) (, License: t—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. O O 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: approvaL• notes: REQUIRED EXISTING PROPOSED NOTES APMOVLU Cir : Fr a Front Erg Ste: $sar• Main Cov Accs.Cov Ft.H/Sb: Sd.H/Sb: SEA: : Ft.Imp Eaddng: Hight/Stories: notes: a CV N E p ar � � V . f L O y a t Qnl •u.r Lu U U) Q N = a 4� i.• O n ° w o�ection 0-1 i cl Z o�, .. Q f � Z O �' •�_ � c �_�. t� C w � c a • O w L, w. .N LL. ►- _ £+ c1r) o ~ O o z Cn a. o L 40 u o � u i N eta o y O 00 u a5 z N y U � a E, V e I \ ,�'a y ACORN CERTIFICATE OF LIABILITY INSURANCE °"05/03/2023" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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.Ifthe 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 ofthe policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Neu of such endorsement(s). PRODUCER CONTACT NAME: Michael S Friscia Michael S Friscia Agency,Inc PHONE FAX 128 Fisher Ave (A/C,NO,EXT):914-222-9215 (A/C,NO):914-819-5779 E-MAIL Eastchester NY 10709 ADDRESS: mfriscia@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIL A INSURED INSURER A: Utica First 15326 Stone Wall Enterprise LLCi, 10512 INSURER B: 35 Lockwood Rd INSURERC: INSURER D: Carmel,NY 10512 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 BYTHE 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 ADDTL SUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMBS P MERCUILGENERALLIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR DAMAGETORENTED PREMISES(Ea Occurrence) $ 50,00 MED EXP(Anyone person) $ 5,00 A I Y A6RT3000286870 03/23/2023 03/23/2024 PERSONAL&ADV INJURY f 1,000,00 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY I� PROJECT LOC PRODUCTS-COMP/OP AGG S 2,000,00 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANYAUTO BODILY INJURY(Per person) S OWNEDAUTOS SCHEDULED ONLY AUTOS BODILY INJURY(Per accident)$ HIREDAUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) S $ UMBRELLALIAB OCCUR EACHOCCURRENCE S EXCESS LIAB CLAIMS-MADE 'AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE OTHER S I ANYPROPRtETOR/PARTNER/ Y/N I E.L.EACH ACCIDENT s EXECUTIVE OFFICER/MEMBER N/A EXCLUDED?(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CERTIFICATE HOLDER CANCELLATION Village o ye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEU RED IN ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St AUTHORIZED REPRESENTATIV Rye Brook NY 10573 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks ofACORD INOK Workers' Certificate of Attestation of Exemption ATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party." The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Home Improvement Stone Wall Enterprise LLC 35 Lockwood Rd. From:Village of Rye Brook 938 King Street Carmel,NY 10512 PHONE:845-531-1790 FEIN:XXXXX1614 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,bon-owed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Anthony Scarduzio Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Anthony Scarduzio,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that 1 have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the a ve-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disabili and p family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Co n ion B I to the government entity listed above. SIGN HERE Si natur . Date: Exemption erti a Numb Received 1� , 2023-032153 May 4, 2023 NYS Workers'Compensation Board CE-200 01/2018 A yp »� ,r' j. ;��t iF'"_ %oJ •'Cyr, � `A. 4 �,A.Ae� ,p��W"-"�pQ .}.A1'i -.cA i..r t`��l •tiA�' 7 701 "M�';j A '?�"• •f�l A d' _ '1;�t A •sl'A i• "+P' �: v FT- If.. . +1L v �' n t�v� 1 ( 'i!t d�41a +/'/' 141 £��H,+ •fey,\♦+/)s + + J � /i0/1 , �;y�,4�+, CV ��•� �.�=��.ej���7+IJF.si�-ate .��%f fat e' .h1N1) �a�..�->i'f\y►IIJi _ :.��_.:.,+!!,1�, f -•-yss_!+,i.!'._..'E i4w1� z O y C = U tV era U w. / ��� •:; `off. o -v �;;,����"g';:�. cr uj L �.� a o v ' a Qto�ection • J I Ma Q Quj a ,E ce a� O = W o O o C' p: o r v • �e X in- cc L to •Ir cn o u vyi � J 3 «O)M �r+ � tic»)) ���. .. . ..�rr�•s -�s1-•��,"::*wr �F^a;.-T+�r'rr;�-,—,r.:s. � .. . . . ". ...a ;na-. r/11,1,1, s c..f.. 1+ ,1 L_ �':,e�'Ir 'I��s$ 1 ,+-, .*p ' s. � +++j1/it�1 3 I+r11+1+s� �p 'a, +i1/1Nt+ 111/+i+� +�f11►14r� j, ' �tt ,�• � i •♦ ly'�5� Ii/�/�l R�SSaTr 1�1�1� �4Fiw Y 1//ix ��� ,���/iTA� ' i. 'IC •�•�\ �i�����.'�' r \ °t3'�a"`�N" �� �i �x�w7�� �88 �''7�r:35�+•` �"'�^�' � � � t , ',��•0.'�," O� t�F(�'1�; +'�'W :���hr' .J •�k. i�v�h:ir -- '�d.. `d 55J'.. w\ q v? •`�+Y�.Sv� FYv - Iw r. ; " �.ram,.' "4.M.Y • �+• �. %4��j .�>• ./41�psy' +ram.. r ,•,L+I.. � H ..v�,�.: A�r CERTIFICATE OF LIABILITY INSURANCE DATE12115)2/152022,YYYYI 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 terns 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 NT NAME:CT CLIENT CONTACT CENTER _ FEDERATED MUTUAL INSURANCE COMPANY PHONE IA. HOME OFFICE: P.O.BOX 328 A;'.. Ent):8BB-333-4949 (ABC,No):507A46 4664 OWATONNA,MN 55060 EADMDRESS:CLIENTCONTACTCENTER FEDINS.COM _INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 286-468-4 INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 ARCTIC MECHANICAL INCORPORATED INSURER C: 460 N MAIN ST - — — - PORT CHESTER, NY 10573-3310 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:90 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 LTR INSR WVD MM/DD/YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE 17X OCCUR DAMAGE RENTED $100,000 PREMISES It. ocarrence MED EXP(Any one person) EXCLUDED A N N 9907993 01/18/2023 01/18/2024 PERSONAL&ADV INJURY $1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT 7 LOC PRODUCTS-COMPIOP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 a acciden X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED A AUTOS N N 9907993 01/18/2023 01/18/2024 BODILY INJURY(Per accidentl HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERdenTY DAMAGE P r tti X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAB CLAIMS-MADE N N 9907994 01/18/2023 01/18/2024 AGGREGATE $5,000,000 DIED I X I RETENTION$10,000 WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N X PER STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1 000 0M B OFFICER/MEMBER EXCLUDED? NIA N 9298530 01/18/2023 01/18/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,0W If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is requiredl CERTIFICATE HOLDER CANCELLATION 286-468-4 90 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V 4, © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD vORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured ARCTIC MECHANICAL INCORPORATED 914-934-8301 460 N MAIN ST PORT CHESTER,NY 10573-3310 1 c. NYS Unemployment Insurance Employer Registration Number of 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 State,i.e.,a Wrap-Up Policy) Number 06-1596446 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company 3b Policy Number of Entity Listed in Box"la" Village of Rye Brook #90 9298530 938 King St Rye Brook. NY 10573-1226 3c.Policy effective period 01/18/2023 to 01/18i2024 3d.The Proprietor, Partners or Executive Officers are o included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 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 Jean Newkirk (Print name of authorized representative or licensed agent of insurance carrier) Approved by (Signature) (bate) Title: AUTHORIZED REPRESENTATIVE Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov