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HomeMy WebLinkAboutPP24-057 �yE BR G 7. 19 VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher 1. Bradbury www.tyebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE September 30,2024 Richard Rosenberg&Laura Rosenberg 71 Hillandale Road Rye Brook,New York 10573 Re: 71 Hillandale Road, Rye Brook,New York 10573 Parcel ID#: 130.69-1-3 This document certifies that the work done under Plumbing Permit #24-057 issued on 4/23/2024 for the installation of a new gas fired water heater has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE 6Rcb 198,2. 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 - - - - - - - - - - - - - - - - - - - - 11 , ADDRESS : ' \ 1 1 ,�1�1 � DATE: N \ I PERMIT# ISSUED: ` "'SECT' BLOCK: LOT: LOCATION: OCCUPA?%Y: ` ❑ 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 ,Q FINAL ❑ OTHER : Ln O N N \ Cs N n ~ -tr M � N C�lj) 1-11 ywy U C� O W 914 pq a u �' O w n w W ti M pd w 1�1 �P�� 04 010 O W A W p w Z z oo p� �, w o - l' Wz cn en d V F� �a V U W OEM( 00 �, o QCA n A oo c� r� U W w O c Z z F� o ° 0 � C .. z 09 0 W 0 �I =1 a *41 al w x � L) F INR( ,, BUI NG Ok MENT APR 2 3 2024 i Z11LJ'W"dE'OF RYE OK _J 938 KIN ET RYE B -' ,NY 10573 VILLAGE OF RYE_ 6RI'OK 91 111-MNI.V71DEPARTIMENT rA" I�EE OF RYE ET RYE B WW i�VWQO Org dk�o org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP PP#: (7_-,)4_G -5 Approval Date: Permit Fee: $ Approval Signature: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A .PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.001 Application dated, L4, z-:Z,- is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. LAddress: -71 -SBL:/3(-), 7-1-3 Zone: 2.Proposed Work: V 3.Property Owner:lzlc�k Address: -71 Phone#: 91q Cell#: email: LTCUAR_A__GDAa)1 CNY� 4,Master Plumber: S ILA -Ie,L, A&--&Lab Address: Lic.#: jZ_1Z!:_5;' Phone#: email: C,A Pft,Wy\r\ Company Name: Address: 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 I st Floor 2nd Floor 3,d Floor 41h Floor 5'Floor Exterior 5.* List Other Equipment/Provide Details: 1A LUC- L.CD,:, A f- Wn-T' �,f (Notarized Signatures Required Next 2 Pages) -I- ST,AT46F NEW,Y,IO�R-K,COUNTY OF WESTCHESTER ) as: I* tlw & 01,0 „ 1eing duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as e�h applicant) and further s tes that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the S37,A-UA 1 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,a ent,attorney c.) 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 ^\ ,20G�A day of N-)f\\ 20 gnature of Property caner Signature of Applicant Print e of Prope ` Prmt e of Applican a a Bucci Aary lic Ngtary.Puplic-Conrr.ecttcut Amonda Bucci illy Cornniission Expires Notary Public-Connecticut �Fabruary2S.2026 MyCt�mrnla$ion Expires L Februiir 28,2025 This application must be properly completed in its entirety and must include the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any applicatiwn 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 10130/2023 BUILD MENT VnL, E OF RX\ oOK 938 KING ET RYE DR (f,NY 10573 Id 0� � 0 ff!lfRf\iHtfffMffffiffliflftffff•fit11\\1fff RffffffRflfiflf/flff\fff\itt/ffifflfflfiffffffffilfffftff AFFIDAVIT OF COMPLIANCE VILLAGE CODES§216 f 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: 316AU*71, S residing at, 7/ (Print wne) (Address where you lire) being duly sworn,deposes and states that s)he is the applicant above named,and further states that(s)he is the legal owner of the Jproperty to which this Affidavit of Compliance pertains at; / 7( N N! ( � I`�"X`� � /�� Rye Brook,NY. (Job Address) k.r 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 stonnwater 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. (. azure of Property Owner(s)) L,tz,vxI Pvo (Print Nome or Propertyo%mcgs)) ••^^���� Sworn to before me this ;C> day of_ Q`Ri`\ ,20 ► i 1.1//.Grifl/S- (Na ic) [ Amanda Buccl 3 Notary 17ublic-Conneclicut y Commission Ekplras February28,20L6 °71n021 m0 i Residential Gas SWater Heaters ProMaxe HIGH RECOVERY ATMOSPHERIC VENT 75 & 100 GALLON HIGHEST RECOVERIES ENHANCED-FLOW BRASS DRAIN • Capacity/input combinations up to 98 VALVE gallons/75,100 BTU's produce recoveries • Our residential water heaters have a up to 81 gallons per hour solid brass,tamper resistant,enhanced- S FULLY AUTOMATIC CONTROLS WITH flow,ball type,drain valve. SAFETY SHUTOFF • Uses a standard female hose fitting that allows for fast and easy draining • Accurate,dependable control system during maintenance. requires no electric connections.Fixed . Designed for easy operation,this valve automatic gas shutoff device for added includes an integral screwdriver slot safety. that features a 1/4 turn(open/close) GREEN CHOICE®GAS BURNER radius,which not only permits full • Patented eco-friendly burner design straight-through water flow but also a reduces NOx emissions by up to 33% quick and positive shut off and complies with Low-NOx emission CODE COMPLIANCE requirements of 40 ng/J. • Meets UBC,CEC and ICC National DYNACLEANTM DIFFUSER DIP TUBE Codes. • Reduces lime and sediment buildup and • Meets the thermal efficiency and maximizes hot water output.Made from standby loss requirements of the long-lasting PEX cross-linked polymer. U.S.Department of Energy and current COREGARD'"ANODE ROD edition ofASHRAE/IESNA 90.1. • Our anode rods have a stainless steel CSA CERTIFIED AND ASME RATED core that extends the life of the anode T&P RELIEF VALVE rod allowing superior tank protection far MAXIMUM HYDROSTATIC WORKING longer than standard anode rods. PRESSURE 150 PSI PUSH-BUTTON PIEZO IGNITOR DESIGN-LISTED BY CSA • Makes lighting the pilot fast and easy INTERNATIONAL with one-hand push-button spark ignition(Natural gas only). • Certified at 300 PSI test pressure and NIPPLES 150 PSI working pressure. • Factory-installed for faster installation. • Listed according to ANSI Z21.10.3 CSA 4.3 standards governing storage tank- BLUE DIAMOND®GLASS COATING type gas water heaters. • Provides superior corrosion resistance 6-YEAR LIMITED TANK AND PARTS compared to industry standard glass WARRANTY lining. • For complete information,consult GAS-FIRED written warranty or go to hotwater.com CIPUL 6 GrThe ice Co re r LISTED Gas-Fred Burner 02015 A.0.Smith Corporation.All rights reserved. Page 1 of 2 www.hotwater.com 1800-527-1953 Toll-Free USA I A.0.Smith Corporation 1500 Tennessee Waltz Parkway I Ashland City,TN 37015 AOSRG47002 mi Residential Gas SWater Heaters Recovery @ Dimensions in Inches Model Number Gallon BTU Input 907 Rise Approx.Shipping Capacity Natural Gas Gallon Per A B C D E F G H Draft Weight(Ibs) Hour Hood FCG-75 74 75,100 81 61 58-1/2 26-1/2 15-3/16 16 50-1/4 15-1/2 50-1/4 4 275 FCG-100 98 75,100 81 68-1/2 66-1/2 27-3/4 15-3/16 16 57-3/8 N/A N/A 4 350 Water connections-1"on FCG-75 and 1-1/4"on FCG-100 For 10-year tank and 6-year parts limited warranty,change"F"to'P'in model number(example:PCG-75). For optional side-mounted recirculating taps,add"L"to the suffix of the model number(example:FCG-75L). All models are certified from sea level to 7,700 ft.elevation. Dimensions and specifications subject to change without notice in accordance with our policy of continuous product improvement. HOT WATER TOP VIEW INLET COLD WATER INLET E T&P TEMPERATURE AND PRESSURE RELIEF VALVE DRAIN VALVE ~— X, HOT \ \ COLD F B H � 1 A 1 DRAIN VALVE ® ® 0 TD _ GAS INLET G FRONT VIEW For technical information call 800-527-1953.A.0.Smith Corporation reserves the right to make product changes or improvements without prior notice. Page 2 of 2 www.hotwater.com 1 800-527-1953 Toll-Free USA AOSRG47002 MR-11 11t James v L- O Gcorms Latgu--cr ivae -or,Cons mzerProteeftn CCL Dived Cow2iy Exaczr�&e U MM Bo pa r Frotv�floia H 01 SILL,SERVICES, LLC 900 FAST 8TH AVEINUE-SUF E=P'l 06 KJNG CF PRUSSLA,,PA-19406 Code and is ralid only upon Tjds license is issaed in accordance withA21icle XVI of the Westchester Coanty Consmner I ence ofthe official department seaL Proof of ci&zwhip or immigration statas is not reqpired for issunce of ffiis license. pres NOTFORFEDERALPT:WOM Date of E��iz�oa License N=ber ie.T j )8125/2020, WC-33093-H20 ;17f 1 ACb V CERTIFICATE OF LIABILITY INSURANCE D A23 TE(MM/12DoDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT The Graham Company PHONE John Kil arriff/Brett Nealis FAX The Graham Building •215-701-5291 A/c No: 1 Penn Square West E-MAIL KILGARRIFF UNIT rahamco.com Philadelphia PA 19102- INSURERS AFFORDING COVERAGE NAIC# INSURER A:Starr Indemnity&Liability Company 38318 INSURED SILAHEA-01 INSURER B:Travelers Property Casualty Insurance Company 36161 Slla Services, LLC DBA Astacio Plumbing and Heating INSURER c: Gotham Insurance Company 25569 70 Fort Point St INSURER D:Vantage Risk Specialty Insurance Company 16275 Norwalk CT 06855 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1197481594 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 ADDL SUBR POLICY EFF F POLICY EXP LTR TYPE OF INSURANCE IN.a WVD POLICY NUMBER MM/DD/YYYYI I(MM/DDNYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY Y 1000026061231 8/26/2023 8/26/2024 EACH OCCURRENCE $2,000,000 CLAIMS-MADE 1XI OCCUR DAMAGE TO RENTED PREMISES Ea oc rrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY JE� lxl LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY 1000673018231 8/26/2023 8/26/2024 Ee BINEDtSINGLE LIMIT $2.000,000 A1NY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY Per accident $ X e UMBRELLA LIAB X OCCUR CUP-1X56077A-23-NF 8/26/2023 8/26/2024 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5.000,000 DED I $ A WORKERS COMPENSATION 100 0005482 8/26/2023 8/26/2024 X STATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUC MN N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 C Excess Liability EX202300003951 8/26/2023 8/26/2024 Occurrence/Aggregate $5M/$5M D Excess Liability P03XC0000042070 8/26/2023 8/26/2024 Occurrence/Aggregate $4M/$4M DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Village of Rye Brook is additional insured on the above General Liability Policy if required by written contract. 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 Street Rye Brook NY 10573-1226 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD YO K 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 845-295-3887 Sila Services, LLC DBA Astacio Plumbing and Heating 1c.NYS Unemployment Insurance Employer Registration Number of 70 Fort Point St Insured Norwalk CT 06855 Work Location of Insured(Only required if coverage is specifically limited to id.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 85-1645781 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Starr Indemnity&Liability Company CERT HOLDER Village of Rye Brook 3b.Policy Number of Entity Listed in Box"l a" 938 King Street 1000005482 ADDRESS Rye Brook NY 10573-1226 y 3c.Policy effective period 8/26/2023 to 8/26/2024 3d.The Proprietor,Partners or Executive Officers are �X included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"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: Dylan Isadore (Print name of authorized representative or licensed agent of insurance carrier) Approved by: I ,A4_,L, 9/28/2023 (Signature) (Date) Title: Senior Underwriter Telephone Number of authorized representative or licensed agent of insurance carrier: 646-227-6300 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