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BP23-074
PERMIT / 03 _ Q 7� DATE 3 SECTION Wit ei B C 00 L^• TYPE OF WORK Q JOB LOCATI U O OWNER�Q/YIPS EST. C �CO 0 Tco u FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING ❑ RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT Cl ALARM Cl BUILT FINAL DATE • 0 =F 1i 41 ° icy r/4 FEE DATE INSP QR� t 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 7,2024 James Luciano& Helen Luciano 14 Lyon Street Rye Brook,New York 10573 Re: 14 Lyon Street, Rye Brook,New York 10573 Parcel ID#: 141.28-1-1 Building Permit#23-074 issued on 6/5/2023 for a Rooftop Solar Array This certifies that the rooftop solar array,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D �� � �� � I 7T � R For officeD use only: BUII'D PERMIT# —�7y JAN 2 6 2024 VIL OF RYE K ISSUED: to-S—r 9 KING STREE E BROOK, PORK 10573 DATE: —a -a VILLAGE OF RYE BROOK (914)9 C -F 939-5801 FEE: S� PAM19 BUILDING DEPARTMENT o or 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 »»s»ssssssaw»»rrr»sssssswwssssrs•sssrs»s»sswssswwssrsssrsssssssrssssssssssswsssssssssssssssssssssss.ssswssrswsswwwrrr Address: 14 Lyon Street, Port Chester, NY 10573 Occupancy/Use: 1-Fam Res parcel D#: 141 .28-1-1 Zone: Re)—F Owner: Helen Luciano Address: 14 Lyon Street, Port Chester, NY 10573 P.E./R.A.or Contractor: Trinity Solar Address: 62 Leone Ln, Chester, NY 10918 Person in responsible charge: Trinity Solar Address: 62 Leone Ln, Chester, NY 10918 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 YOM COUNTY OF WESTCHESTER as: Trinity Solar being duly sworn,deposes and says that he/she resides at Holds Office at - 62 Leone Ln (Print Name of Applicant) (No.and Street) in Chester ,in the County of Orange in the state of NY that (City/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: $ 42,000.00 for the construction oralterationof Installation of a roof-mounted solar array system tied into existing electrical services. 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 belie£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 thereofhereafter created,erected,changed,converted or enlarged,wholly or partly, in its use or structure until a Certificate of Occupancy or Certificate ofCompliance shall have been duly issued bythe Building Inspector as per §250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this 1441-- Sworn to before me this Z day of NfternbtX- , 20Q day of , 201 4& , UTAJ� Signature of Property caner Signature of Applicant Helen Luciano /JU&lk -Zaka,r Print Name of Property 1Owner Print Na of Applicant i otary lic N ry Public Jacqueline D.Thomas Notary Public,State of New York TERESA ANGELICO Registration No.01TH5013606 Notary Public-State of New York Qualified in Westchester County No.01AN6430527 Commission Expires July 15,2027 Qualified in Orange County My Commission Expires 03/14/20-La- QyE BR(�� 1982 BUILDING DEPARTMENT ❑BBUILDING INSPECTOR eASSISTANT 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 : J/V S DATE: .__) - S 102- V PERMIT# '1>5) ISSUED: kIS 1�- 3 SECT: � y_BLOCK: / LOT: LOCATION: 'R(00 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 I J n ❑ Natural Gas le �O C'A +t>, ❑ L.P.Gas P 7-7 / Q ❑ FUEL TANK Z• ❑ FIRE SPRINKLER ❑ FINAL PLUMBING OSS CONNECTION INAL ❑ OTHER ' M N M Ncr W v xn IM4 ■ N O 0 Z ►n W \ ` c z � � s, '� O x O A � pq � = o � r , J•{ � � ��•• � O O '� (—xi � � � � a '5 rya ` ~ co N o z _ H 0 � N O clio u w (� . q SO o yU ~ 00 `n z O _ © © \ m a . M� A Z N ? A o 00'e (N V s Eat . °' - W o o 4OR 4-4 ti CY 0 ~ Rr V W C7 Z Z b U w o� O 0 �D -D;:, 0 y w Z H O 0 v o -� Z to w lul M �l o C, $ � 091-4 BUICD( OK ENT t � , VI 938 KINGNY 10573 MAR 17 2023(914) 9-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date:_ -_ ermi / ' ; Application#_AR9j.�'U._25 Approval Signature:_ y LVLJ ARCHITECTURAL REVIEW BOARD: Disapproved: n LV Date:r- F BOT Approval Date: Case# : ChairPB Approval Date: Case# : Secret ZBA Approval Date: Case# Other: Application Fee:4 Permit Fees: ��`/�(1 APPLICATION TO INSTALL PHOTOVOLTAIC SOLAR ARRAY Application dated: Mar 16, 2023 is hereby trade to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Pennit tur the installation of a Photovoltaic Solar Array as per detailed statement described below. 1. Job Address: 14 Lyon Stree¢ sp. I�, NY 10573 141.28-1-1 �,/��o SBL: Zone: 2 Type,kW&Location of Array,fuse additional sheets if n cessar}1; 10.4 kW DC; roof-mounted Modules:26 HANWHA 320(Q.PEAK DUO BLK-G5 320) rru� 3.Property Owner: Helen Luciano Address: 14 Lyon Street C NY 10573 Phone# (914}261-7539 Cell# e-mai{ ��}�— \� ►�� c JrQt1.�� 4.Applicant:Trinity Solar-Sydney Martinez Address: 62 Leone Ln, Chester, NY 10918 Phone# (845) 572-0060 x1713 Cell# e-mail teresa.angelico@trinity-solar.com 5.Design Engineer: Trinity Solar- Ihor Bojcun Address: 2211 Allenwood Road,Wall, NJ 07719 Phone# (732)780-3779 Cell# e-mail ihor.bojcun@trinity-solar.com 6.Solar Contractor:Trinity Solar Address: 62 Leone Ln, Chester, NY 10918 Phone# (845)572-0060 e-mail operations.upstateny@trinity-solar.com 7.Occupancy;(f-tam.2-ram.Commercial,etc t Pre-construction: 2-1=am Res Post-construction: 2-Fam Res 8.If building is located on a comer lot,which street does it front on: 9.N.Y.State Construction Classification: N.Y.State Use Classification: 10. Construction Type&Location:( )Typical Western Lumber Frame:( )Timber Frame[TC];()Wood Truss ITT]: ( )Pre-engineered wood[PW];Located;()Floor Framing[F];( )Roof Framing[RI:O Floor&Roof Framing[FRI;Other: 11. Number of stories: Roof Style:I hip shed mansard.etc... 12. Willa New Roof Be Installed: NP❑ Yes ❑ (a icparate roofing pen nit is reyrured to re-mofan existing hul dine) 13. Roofing Material&Number of LayersAsphalt- 1 Layer 1 3r21l19 14. Will the proposed project disturb 400 sq,ft,or more of land,or create 400 sq. ft.or more of impervious coverage requiring a Stormwater Management Control.Permit as per§217 of Village Code? No: e Yes: ❑ Area: 15. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? No: a Yes: ❑ (If yes.applicant must sulanit a Site Plan Application,&provide detailed drawings) 16. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?No: a Yes: ❑ (If yes,applicant must submit a Tree Removal Permit Application) 17. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? No: a Yes: ❑ Indicate:TIER I:_TIER II:_TIER III:_ (if yes,a Home Occupation Pennit Application is required) % 18. What is the total estimated cost of construction: S S 0 r d r'c) (Note:The estinvlted cost shall include all site improvements,labor,material,scaffolding.fixed equipment,professional fees,including any m erial and labor which may be donated gratis.If the final cost exceeds the estimated gist,an additional Ibe will be required prior to issuance of the CIO). 19. Start Date: Completion Date: This application must bear 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 YOM COUNTY OF WESTCHESTER ) as: I, Trinity Solar - Sydney Martinez ,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, Contractor/Agent for the legal owner and is duly authorized to make and file this application. (indicate architect.contractor,agent.attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of Fr ,20 day of ,20_ 5 Notary Public Xotary Public Signature of Property Owner ignat re of licant Helen Luciano Trinity Solar - Sydney Martinez Print Name of Property Owner Print Name of Applicant Eimer J, Baez TERESA ANGELICO Notary Public, State of New York Notary Public-State of New York Reg. No. 01BA6423254 t+o.OIAN6430527 Qualified In Westchester County 2 oualifed In Orange County Commission Expires 10/12/2025 MYC>�IttnissionEnpiras031i412U 3121/19 o o W y a y O qu � x z A H ° 0-4 N W g CX 04 V z ' it �-' F V W _ � 7 M �+ W W z °3 it G H W FW � u � u H $ a � � s w 00* o z CA S z o CA v w z a, x 0-0 oz '' �I a a z a]a w yE nv� BUIL BR E MED DD NT R J U N 2 9 2023 VIL E OF RYE OK 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK (914)9 939-5801 BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required )� FOR OFFICE USE ONLY BP#: �J —0 / � EP#: 03— 1 Approval Date: ,t1N 3 0 2023 Permit Fee:$ �C)` -nA Approval Signature: Other: Disapproved: (fees are non-refundable) ****************************************** ****************************************************** Application dated, Jun 22, 2023 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. 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. L Address: 14 LYON ST 5�2 r�r�p� NY, 10573 SBL: 141.28-1-1 Zone: 2.Property Owner: Heleno Luciano Address: 14 LYON ST �X� � NY, 10573 Phone#: (914)261-7539 Cell#: (914)261-7539 email: 3.Master Electrician: William Geiger Address: 62 Leone Ln, Chester, NY 10918 Lic.#: 599 Phone#: (845)572-0060 Cell#: email: bill.geiger@trinity-solar.com Company Name: Trinity Solar Address: 62 Leone Ln, Chester, NY 10918 4.Proposed Electrical Work/Fixture count: Installation of a 10.4 kW roof-mounted solar array system tied into existing electrical services. Modules: 26 HANWHA 400 (Q.PEAK DUO BLK ML-G10+400) STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Trinity Solar-William Geiger 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 legal owner of the property to which this application pertains,or that(s)he is the Contractor/Agent for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this .23 PC( Sworn to before me this Z-1 da of Tun 20�� day of, �20 Z Signature of Property Owner Signature of A li t Helen Luciano Trinity Solar-William Geiger int Name of Prop e O er Print N me of Applica r Yo&t Public Notary Public NOTARY PUBLIC,STATE OF NEW YORK Tristan Rondin OualzReg lstratlon No.01TH5013606 Notary Public of New York In Westchester 3 Bronj County Commisslon Expires July 15, I.D.OIR00009393 COMMISSION EXPIRES M09/2027 3'21/19 STATEWIDE • Service With lijilegri�y 1'1 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOB APPLICATION tel845.202.7224 fax 914.219.1062 SWISNY.com I SWISTraining.corn Office Use Elect. Permit#��� Date-lo N I_; a0 Bldg Permit# O 7 ' / Utility ID# Final Certificate# f y/ City< illage 8 ROOK Zip 73 ,T, Township t y County Address/ Cross Street _/ CSection/�//� Block Lot Owner Name/Address cif different than above) r I �� v�y Q Contact Number / ❑Basement ❑ 1 st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside VResidential [:]commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information ivSTft/1�9�oN OF /1 A00r— ROv�fA 5o%f /��Y 5�/51 7�� 1n 7T0 Z�Xi5_VA �ECTR�tr� SfA�/�'�fS ;� � � sys►�M s�Z� - ��° yew JUN 2 9 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,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 appikadons 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 • t 5 O I• �G� Date 49 as Signature Address of 4/15—: City/State E ;e v Zip Code v License# r I Phone# 7 D0 V L� V r�1 State Wide Inspection Services I I 1080 Main Street Q Fishkill, NY 12524 JUL 2 8 2023 845 202 7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@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: Trinity Solar James Luciano& Helen Luciano Bill Geiger 14 Lyon Street 62 Leone Lane Rye Brook, NY 10573 Chester, NY 10918 Located at: 14 Lyon Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-142 141.28 1 1 Certificate Number: 2023-5476 Building Permit Number: BP23-074 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: 14 Lyon Street, Rye Brook, NY 10573 The Photovoltaic System 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 28th day of July 2023. Name Quantity Rating Circuit Type PV Modules 13 Inverter 01 Disconnect 01 AC Disconnect 01 Production Meter 01 DC Disconnect 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 work performed on the date of inspection only. DDD ' SOLAR I nTr - n utyJl AN 2 6 20244 L.r._ Rye Brook Village, NY I VILLAGE OF RYE BROOK October 16, 2023 938 King Street BUILDING DEPARTMENT Rye Brook, NY 10573 Trinity Solar No. 14 Lyon Street 2022-09-762129 Port Chester, NY 10573 To the Building Official: I hereby certify that I am a Licensed Professional Engineer in the State of New York.The solar photo-voltaic(PV) system installed at the above-referenced location conforms to the manufacturers' requirements/specifications. The PV system complies with all applicable laws, codes and ordinances as specified by all applicable codes, including 2020 Residential Code of New York State and the 2018 IRC, and the provisions of ASCE7-16. Regards, Thor Bojcun, PE Structural Engineer-Trinity Solar pF NEIV yp Q- l\ 1 = �95675 R�FES S I ONP" NY License No.095875 Trinity Solar 162 Leone Lane I Chester,NY 1(845)572-0060 Laura Petersen From: Steven Fews Sent: Friday, May 5, 2023 11:15 AM To: Helen Luciano Cc: Laura Petersen Subject: RE: Solar panels and meeting Expires: Saturday, September 2, 2023 12:00 AM Good Morning, you spoke to me and Laura. The Architectural Review Board Meeting is schedule for May 17th 2023 here at the Village Hall.That meeting starts at 7:30pm. The last meeting was April 191h, we didn't have you or anyone from the solar company to represent the application so that it could be approved. Someone will need to be in attendance. We have all the material we need at this time. Thank You. Steven E. Fews Acting Building Inspector& Fire Inspector Office (914) 939-0668 From: Helen Luciano<hzluciano@gmail.com> Sent: Friday, May 5, 2023 10:32 AM To: Steven Fews<SteveFews@ rye brook.org> Subject: Solar panels and meeting H i, I received a phone call the other day and unfortunately did not get the name of the person I spoke to, but I was told I need to be at a meeting to discuss my plans to install solar panels on the roof of my home. I was told I would receive an email with the details of the meeting and as of yet have not received any information. I would appreciate it if you would please send me the day, time, and place of the meeting and what, if any information I need to provide. Thank you for your time. Helen Luciano 14 Lyon St Rye Brook 1 ' t Building Permit Check List&Zoning Analysis Address: n 1 �� c---, SBD Zone: 1C,'/Use: Const.Type: Other. Submittal Date: �\Z� Revisions Submittal Dates: Applicant: 4 Y1Ckr N e--Z Nature of Work Reviews:ZBA: FU 2 7 2023 BOT IM OKOther ED LYPEES:Filing. �i5 BP J�C�=�U�C/O Flood Plane: Legalization APP: Dated: Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone 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: ( ) (,�4P LANS:Date Stamped: ✓ Sealed: ✓ Copies7--- Electronic. ✓ Ocher: License:Z Workers Comp: LLiability Coomp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Ocher. ( ) ( ) 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: I�-a (-)-ARB mtg.date approval•- ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval notes: REQUIRED EXIMNG PROPOSED NOTESP Li Art _ Date:MA Y 2 2023--- Ckrcle: - - Fro Eont- Frorit: Si : RAW Main Cov Accs.C�v F S S .HS : CE& Tot, Im : F I : P kur Hgight/Stories notes: 0 Y)a r Y-VA)W- ok S -11 1 Q ko ck-- CJ-Q Residential Building Permit Fee Work Sheet Permit#: Date Issued: FnT Zone: Address: — Property Owner t iN Job Description:_ O For d ��I tions yin �..,.....��, u1t: ioiiowrng tee sch y Total Sq. Ft. (excluding basements Basement Sq. Ft. x $65.00 x $I S.0 f sys S?a- p, o -------------------------------------------------- l w reAd� u / 7, New Construction Sq.. t. • New Construction Cost • Building Pen-rit Fee Basement= sq.ft.x$65.00 = $ x $I5.00/$I,000.00= $ Attached Garage= sq.ft.x$300.00= $ x$I5.00/$I,000.00= $ I,Fl. = sq. ft.x$300.00= $ x$I5.00/$I,000.00= $ 2"d Fl. = sq.ft.x$300.00 = $ x$I5.00/$I,000.00 = $ 3rd Fl. — sq. ft.x $300.^^— °'T /d,�3 $ 41,Fl. = sq. ft.x$300. _ $ Total Sq.Ft.'= a�. sq. ft. Total C Q �0 _ $ :s 0Y@D $ / �l rs�l n /✓J �'I'/ jDnn emQ % � 4� /-?,0�7 W�A—/7 10 17 Date: AM, . BUILDS 1RTMENT D `J v VILLA E OF RYE°, OOK 3D ��= MAR 17 2023 938 KIN(: ST1E'r RYE BROOK,NY 10.573 (914)9 9 39-5801 VILLAGE OF RYE BROOK w o r BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANT This form must be completed and signed by the applicant of record and a copy shall b submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address:14 Lyon Street, Port Chester, NY 10 Date of Submission: Feb 23, 2023 Parcel ID#:141 .28-1-1 Zone: Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: Installation of a roof-mounted solar array MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building system tied into existing electrical services. Department by the applicant-no exceptions. 1. (®Completed Application 2. (®Two(2)sets of sealed plans. (one lull size;maxitmutn Property Owner: Helen Luciano allowable plan size 36"x 42 and one I l"x IT) Address: 14 Lyon Street, Port Chester, NY 1057" 3. (®Two(2)copies of the property survey. 4. (®Two(2)copies of the proposed site plan. Phone#(914) 261-7539 5. (®One electronic/disc copy of the complete application materials. Applicant appearing before the Board: 6. ®Filing Fee. Trinity Solar 7. (®Any supporting documentation. 62 Leone Ln, Chester, NY 10918 8. (a 110A approval letter. (fapplicable) Address: 9. ®Photographs. Phone#(845) 572-0060 10.(0) Samples of finishes/color chart. (a Sample board or Architect/Engineer: Trinity Solar - Ihor Bojeun model may be presented the night ofthe meeting) Phone#(732) 780-3779 By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects.The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this Sworn to before me this day of — 13 U , 20 of " , 20 Z 3 Signature of Property Owner Apat&e of licant r_ Helen Luciano Eimer J. Baez Trinit Solar - S dne Martinez Notary Public, State of New York Y Y Y Print Name of Property Owner Reg. No. 01 BA6423254 Print Name of Applicant Qualified in Westchester County "/ e Commission Expires 10/12/2025 Notary Pub tc tary PuUlic TERESA ANGELICO Notary Public-State of New York No.01AN6430527 Qualified in Orange County My Commission Expires 03014404LL NY Putnam County Home Improvement Contractor#PC6987 NY Putnam County Electrical License#R23713 NY Westchester County Home Improvement Contractor#WC-27944-1115 f NY Westchester County Electrical License#599 nn i NY Rockland CountyHome Improvement Contractor#H-12313-40 S _AR NY Rockland County Electrical License#402 NY Orange County Electrical License#198 NY Sullivan County Electrical License#442 NY Greene County Electrical License#502 NY,jurisdictions,license or registration information furnished upon request.For other jurisdictions,please visit: http://www.trinity-solar.com/about-us/locations-and-licenses Village of Rye Brook Building Department Rye King Street D , Rye Brook, NY 10573 T: (914)939-0668 Mar 16,2023 MAR 17 2023 VILLAGE OF RYE BROOK To Whom It May Concern, BUILDING DEPARTMENT On behalf of our customer named below,we wish to submit a Building Permit Application for the installation of a roof-mounted solar array system tied into existing electrical services: Name: Helen Luciano Address:14 Lyon Street, Port Chester, NY 10573 SBL: 141.28-1-1 Please find the attached documents for review: ■ Architectural Review Board Application ■ Building Permit Application ■ Homeowner's Consent Affidavit ■ WC HIC License • WC Electrical License ■ Insurances(Disability, Liability,Workers'Compensation) ■ (2)Stamped Plans, Engineer Letter and Spec Sheets • (2) Photos of Property and Surrounding Properties ■ (1) Electronic Submission - Flash Drive ■ Application Fee Check-$75.00 Please do not hesitate to contact me with any questions. Th nk you, 7"J ey artin Applications Specialist Trinity Solar—Hudson Valley (845)572-0060 x1713 sydney.martinez@trinity-solar.com Hudson Valley Office 1-877-SUN-SAVES 62 Leone Lane Ph:845-572-0060 Chester, New York 10918 Fax:845-576-0068 www.trinity-solar.com BRnv� Village of Rye Brook ML MR Agenda FB SE Architectural Review Board Meeting AC SF Q v ` Wednesday, May 17,2023 at 7:30 PM Village Hall,938 King Street JM 1. ITEMS: 1.1. ARB23-025 (Consent Agenda) James Luciano&Helen Luciano 14 Lyon Street Rooftop solar array. 1.2. ARB23-038 (Consent Agenda) Sanjoy Dey&Sanghita Debmukta 12 Lyon Street Rooftop solar array. 1.3. ARB23-039 (Consent Agenda) Thomas Bailey III&Sarah Bailey (on � 309 Betsy Brown Road Rooftop solar array. 1.4. ARB23-040 (Consent Agenda) (Amendment to Prior Approval) Joshua Adelson&Lindsay Adelson 6 Whippoorwill Road Change previously approved deck material color. Consent Agenda Approvals: Motion 1 Second (� —Abstention Aye; Nay; Adjournment; Notes }� 1.5. ARB23-041 Brian Cohen&Dayna Cohen 3 Hills Point Lane Expand pool patio,replace terrace stone floor and replace terrace railing. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 1 of 4 s . Architectural Review Board May 17,2023 1.6. ARB23-042 John Schueller&Nikki Schueller 1002 King Street Enclose side entry porch to create mudroom with storage area below. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB23-043 Mark Karasik&Danielle Perlman 11 Loch Lane Driveway parking court extension,deck extension,install hot tub and fencing. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB23-044 Joshua Rosen&Alison Rosen 6 Fairlawn Parkway New two-story single-family dwelling with finished basement. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.9. ARB23-045 Yuval Meron&Jana Meron 46 Winding Wood Road New deck,new patio,new window and doors in sunroom and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 4 Architectural Review Board May 17,2023 1.10. ARB23-046 Michael Segal&Debra Segal 996 King Street New deck,pergola and gazebo. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB23-047 Michele Wertheimer Fredman 11 Eagles Bluff New front entry and portico. Approvals: Motion Second Abstention Aye; Nay, Adjournment; Notes 1.12. ARB23-048 Salman Nir Messafi&Stephanie Messafi 26 Latonia Road Replace and expand existing patio. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB23-049 Fabricio Denadae&Luciana Chieus do Amaral 110 Brush Hollow Close New steps with handrail and new outdoor kitchen. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 3 of 4 Architectural Review Board May 17,2023 1.14. ARB23-050 Steven Berger&Debra Berger 3 Castle View Court Replace deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.15. ARB23-051 Junyi Xie&Yanjun Zhu 46 Bonwit Road Replace deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: June 21, 2023 Page 4 of 4 aR�ly� Village of Rye Brook NII, MR 1/ nd Architectural Reviewoard Meeting SE A two AC SF Wednesday,April 19,2023 at 7:30 PM �;�,�•� Village Hall,938 Ring Street JM i 1. ITEMS: 1.1. ARB23-025 (Consent Agenda) James Luciano&Helen Luciano 14 Lyon Street Rooftop solar array. 1.2. AR1323-026 (Consent Agenda) Karina Yapur 30 Tamarack Road Rooftop solar array. 1.3. ARB23-027 (Consent Agenda) Han-Hsuan Liu&Haoyun Feng 27 Mohegan Lane Rooftop solar array. 1.4. ARB23-028 (Consent Agenda) Victor Paterno&Annemarie Paterno 15 Old Orchard Road Replace front walk,entry steps,driveway retaining wall and re-pave driveway. 1.5. ARB23-029 (Consent Agenda) Christopher Davis&Lauren Davis 1 Whippoorwill Road Replace front walk, front steps,re-do concrete patio with pavers and install gas firepit. 1.6. ARB23-030 (Consent Agenda) Jonathan Fox&Alison Fox 1 Country Ridge Circle 6'&4'high white vinyl fence and gates. 1.7. ARB23-031 (Consent Agenda) Cape Eland LLC 12 Rock Ridge Drive 4'high welded wire fence and gates. 1.8. ARB23-032(Consent Agenda) Scott Stern&Bonnie Stern 79 Greenway Close 3'high split rail fence and gate. 1.9. ARB23-033 (Consent Agenda) Fabricio Denadae&Luciana Chieus do Amaral 110 Brush Hollow Close Replace decking on existing rear deck. Architectural Review Board April 19,2023 Consent Agenda Approvals: Motion (4— Second—�,� Abstention Aye; Nay;_ Adjournment; Notes 1.10. ARB23-034(Amendment to Prior Approval) Matan Dvir&Ilana Dvir 1 Dorchester Drive Dormer modifications. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB23-035 Eric Goldstein&Rebecca Kleban 5 Berkley Drive Rear covered porch,stone walkway and drainage. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB23-036 Scott Hirsch&Christine Staeger-Hirsch 1 Beacon Lane Remove rear door,install window.Remove side bay window,install sliding doors. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB23-037 (Amendment to Prior Approval) Win Ridge Realty LLC 166 South Ridge Street New store front"Amazing Lash Studio" Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: May 17,2023 rT-r), n I 1�/ SOLAR Rye Brook Village, NY February 21, 2023 938 King Street Rye Brook, NY 10573 Trinity Solar No. 14 Lyon Street 2022-09-762129 Port Chester,NY 10573 To the Building Official: The following information constitutes a summary of the relevant design criteria and recommendations for the support of a new photovoltaic [PV]system on the existing roof framing components at the above-referenced location. Criteria is as follows: 1. Existing roof framing: Conventional roof framing at R1 is 2x10 at 16 o.c.; existing rafter span= 14'6";(horizontal projection) 2. Roof Loading: • 3.Opsf dead load(pounds per square foot-PV panels, mounting rails&hardware) • 6.9psf-existing roof loads(2.9 psf-2x10 framing, 1.5psf roof sheathing, 2.5 psf shingles) • Ground Snow Load-30psf-per ASCE Hazard Tool • Wind criteria-Exposure Category B, 116 mph wind 3. Existing Roof modification-none required;existing roof framing is acceptable for PV installation. OThe installation,described above, is in general conformance with the manufacturers'specifications and complies with all applicable laws, codes,and ordinances as specified by applicable codes, including the 2020 Residential Code of New York State. The spacing of the mounting brackets cannot exceed a maximum of 48"o.c. between mounting brackets and will be fastened using 5/16" diameter corrosive-resistant steel lag bolts. In order to evenly distribute the load across the roof rafters,there shall be a minimum of 2 mounting brackets per rafter(4" long lag bolts required)and a minimum 2'/2"penetration(embedment)of all bracket lag bolts beyond the roofing materials;this is adequate to resist all stated live loads above—including wind shear. Per NDS Section 12.1.4, pilot holes not to exceed one-half the diameter of the shank need to be bored into the primary framing members for the full length of the threaded portion of the screw to avoid splitting of the framing member. Stainless steel lag bolts are required. Regards, Thor Bojcun, PE Structural Engineer-Trinity Solar OF NEh, eo y0'P A ✓�Z _r n W ZN � 095675 RCFESS IONP� NY License No.095675 Trinity Solar 162 Leone Lane I Chester,NY 1(845)572-0060 SOLAnTr ' n i L Rye Brook Village, NY February 21, 2023 938 King Street Rye Brook, NY 10573 Trinity Solar No. 14 Lyon Street 2023-02-825718 Port Chester,NY 10573 To the Building Official: The following information constitutes a summary of the relevant design criteria and recommendations for the support of a new photovoltaic [PV]system on the existing roof framing components at the above-referenced location. Criteria is as follows: 1. Existing roof framing: Conventional roof framing at R2 is 2x10 at 16 o.c.,existing rafter span= 14'6"; (horizontal projection) 2. Roof Loading: • 3.Opsf dead load(pounds per square foot-PV panels, mounting rails&hardware) • 6.9psf-existing roof loads(2.9 psf-2x10 framing, 1.5psf roof sheathing, 2.5 psf shingles) • Ground Snow Load-30psf-per ASCE Hazard Tool • Wind criteria-Exposure Category B, 116 mph wind 3. Existing Roof modification-none required; existing roof framing is acceptable for PV installation. OThe installation,described above, is in general conformance with the manufacturers'specifications and complies with all applicable laws, codes,and ordinances as specified by applicable codes, including the 2020 Residential Code of New York State. The spacing of the mounting brackets cannot exceed a maximum of 48"o.c. between mounting brackets and will be fastened using 5/16" diameter corrosive-resistant steel lag bolts. In order to evenly distribute the load across the roof rafters,there shall be a minimum of 2 mounting brackets per rafter(4"long lag bolts required)and a minimum 2%"penetration(embedment)of all bracket lag bolts beyond the roofing materials;this is adequate to resist all stated live loads above—including wind shear. Per NDS Section 12.1.4, pilot holes not to exceed one-half the diameter of the shank need to be bored into the primary framing members for the full length of the threaded portion of the screw to avoid splitting of the framing member. Stainless steel lag bolts are required. Regards, Thor Bojcun, PE Structural Engineer-Trinity Solar \CHAEt,9 YO o * ro A 7- LW Z� 2 095675 �OFESSIOtA NY License No.095675 Trinity Solar 162 Leone Lane 1 Chester,NY 1(845)572-0060 MATERIAL LIST (FOR INTERNAL USE ONLY) JOB NAME: LUCIANO, HELEN (COMBINED) 1% 4 ADDRESS: 14 Lyon Street SOLAR Port Chester, NY 10573 2211 Allenwood Road 877-786-7283 41.002146,-73.678964 Wall,New Jersey 07719 www.Trinity-Solar.com 58.16 ESTIMATED PERSONNEL HOURS 2.42 DAYS 1.82 DAYS 1.21 DAYS • 26 HANWHA 400's(10.4KW) (CREW OF 3) (CREW OF 4) (CREW OF 6) • 2 SEPARATE ARRAYS • 23'PEAK TO GROUND • 0 PORTRAIT&26 LANDSCAPED • 2 INVERTERS INSTALLED OUTSIDE • NO TRENCH ESTIMATED SENT TO JOB USED ❑ HANWHA400(Q.PEAK DUO BLK ML-G10+400) 26 ❑ 5440 SE OPTIMIZERS 26 ❑ SE5000H-USOOOBEi4 1 ❑ SE5000H-USOOOBEi4 1 El ❑ 60A OUTDOOR FUSED DISCONNECT W/(2)30A FUSES 2 ❑ SOLADECK BOX(ES)&HAYCO CONNECTOR(S) 2 ❑ PV LEAD WIRE 100' ❑ INSULATED BUG BITES(LINE TAPS) 2 ❑ CASE(S)OF BLACK SPRAY PAINT 1 ❑ CASE(S)OF TAR 1 ❑ ECOFASTEN 2012025 CF STD RAIL MLL AL 171.5 26 ❑ ECOFASTEN 2012013 CF RAIL SPLICE 17 ❑ ECOFASTEN 2099017 CF END CLAMP 32MM BLK 24 ❑ ECOFASTEN 2099022 CF MID CLAMP SHORT BLK 40 ❑ ECOFASTEN 4011011 MODULE JUMPER 4 ❑ GROUNDING LUG(NOT PROVIDED BY ECOFASTEN) 2 ❑ ECOFASTEN 2012022 CF UNIV L-FOOT MLL 3 96 ❑ ECOFASTEN 3012020 GF-1 FLASHING GLV BLK 8 x 10 96 ❑ ECOFASTEN 2012019 CF MLPE MOUNT 26 ❑ ECOFASTEN 2012020 CF WIRE MGMT CLIP 26 ❑ ECOFASTEN 2012024 CF END CAP 24 N i 1 §�s98R $7_R 47 i � Y • A W lil .q �V � ■ s i 4 � 8 S s jg t� F U a �--�.. � T a 9 9•� E �R �g �d y � g � S a U F t3 d$�n $➢e 9 R !g8 g$ lip YQ 3 41e a 'g 4�� o Hilll $ 8 N Das � s 0 g OI Fib so W ©Is. �n N ; R Jo y F g �m -oil LL 2 O cR s Z L _ t b o W � w ti 0 OV � f E Z E f 4 • o o . � 4 t w j E' IJ of ! 55a - s X. > 3e m LA 00 O n 44 SO n to • 1 u o `� c L OiD 3 u c CA I�.: ~ sit 3 i° �$ �• y. td %kft i o i , INVERTERS o p pp 0 3 � a (0 u Eo O o = • � • cm ' 9dd Ent N C L C L O O O =g ° E l ^ W L O L O 1i C N W V) C v� c cEGv s co 0 \W = O / H C) ^' w o'; V! w V1E vq N • • • • o = - Al > o v n " t/1 M . • • • • 3 " _" A o (a V S O C c d °„v " m W O O O 3 Bi o+ c Z i O O �, t E m c o v QJ ap O o E o c L.� w w o y ° o (�) T Q V) Vl a+ a4 r i a N �✓ i ,C Vl V) o an d E ZJ Z O O 1 - ► !E v ' Y • CDtD yy G � N Z /� 0 m r • • • • • V � vi vi 0 2 Fp 10 xS�ae It c3 PP a L ¢ � S I Ib 4� 3 z _ o o _ Q 5 l { 3 oilk= d LL z 'oo Z ? �&s $3dd }ss � eiaiase �1 POWER OPTIMIZER v r r ° L T E A ut m n E R E o o O E E a z — dq N 3 m E o a w a o p m V L p C W GJ F Z v _ N _ P N 5 LL E LL 2¢a O �N E o rn CL E O y O � ° Q c� 3 y 5 w a+ V c°i+ E L a c4; a g m a� `o c pp O -°'� E i Q O g — E g ? 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( ; « � G � 'c- _ !! � ; } 22 = k # LLI ) } \ � LL. �j►� i , + `r )1ci !� ��`�► �7F'�f It ; ` 1 O. a d• v�i a • o O N cM � F'• ?; ca as b � � r. cz .14 � ,• •ter a a � i ection pool 04 LO �- v 4. ti .� rJ a r E t sAV r,tip S7 � al QI N Q� (1 • / / N lie Jh. e .a / ' °, r ATE(MMIDD/YYYY) A,C"Ro CERTIFICATE OF LIABILITY INSURANCE �/ 5/13/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONACT NAME: Mark GraSela Arthur J Gallagher Risk Management Services. Inc. PHONE FAx 4000 Midlantic Drive Suite 200 (A/c,No •856-482-9900 Arc No:856-482-1888 Mount Laurel NJ 08054 A DARESS: CherryHill.BSD.CertM@AJG.com INSURER 8 AFFORDING COVERAGE NAIC A INSURERA:Gotham Insurance Company 25569 INSURED TRINHEA-03 INSURERB:National Union Fire Insurance Company of Pittsburg19445 Trinity Solar Inc. 62 Leone Lane INSURERC:Endurance American Speciafty Ins Co 41718 Chester NY 10918 INSURERD:Liberty Intemational Underwriters INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:231041841 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADL SU POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NQn wun POLICY NUMBER IMMIDDNYYYI IMIMIDD/YYYYJLIMITS A X COMMERCIAL GENERAL LIABILITY GL202100013378 6/1/2021 6/1/2023 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $100.000 MED EXP(Any one person) $5,000 PERSONAL SADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JET LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ .. AUTOMOBILELUUUU Y CA 2960145 6/1/2022 6/1/2023 COMBINED SINGLE LIMIT $2.000.000 Ea accident X ANY AUTO I BODILY INJURY(Per person) $ OWNED F SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ A UMBRELLALIAB X OCCUR EX202100001871 6/1/2021 6/1/2023 EACH OCCURRENCE $5,000,000 D X EXCESS LIAB ELD30006989101 6/1/2022 6/1/2023 CLAI, MS-MADE 1 1000231834-06 6/1/2022 6/1/2023 AGGREGATE 55,000,000 DED RETENTION SS Limit x of$5,000,000 $19,000,000 B WORKERS COMPENSATION WC 13588108 6/1/2022 6/1/2023 X PER H- AND EMPLOYERS'LIABILITY STAT TE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y— NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,D00 If yes describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S 1,000,000 B Automobile CA 2960145 6/1/2022 6/1/2023 All Other Units $250/500 Comp/Collusion Ded. Truck-Tractors and Semi-Trailers $250/500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King St Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Trinity Solar Inc. 631-319-7233 62 Leone Lane 1c.NYS Unemployment Insurance Employer Registration Number of Chester,NY 10918 Insured 49-230977 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 22-3292324 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) National Union Fire Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box 1a" 938 King Street Rye Brook,NY 10573 WC 013588108 3c.Policy effective period 6/1/2022 to 6/1/2023 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box 1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) Approved by: %% l /02.aCZ 611/2022 (Signature) (Date) Title: C.E.O.North America Telephone Number of authorized representative or licensed agent of insurance carrier: 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. 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