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HomeMy WebLinkAboutMP24-059 �yE BR(��
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. 19
VILLAGE OF RYE BROOK
MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A.Klein (914)939-0668 Christopher J.Bradbury
www.ryebrookny go
TRUSTEES BUILDING&FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M.Heiser
Salvatore W.Morlino
CERTIFICATE OF COMPLIANCE
October 4,2024
Austin Ringer&Juliette Ringer
90 Windsor Road
Rye Brook,New York 10573
Re: 90 Windsor Road,Rye Brook,New York 10573
Parcel ID#: 135.52-3-50
This document certifies that the work done under Mechanical Permit #24-059 issued on 5/6/2024 for the
installation of two new condensers and five new mini split units have been satisfactorily completed.
Sincerely,
Steven E.Fews
Building&Fire Inspector
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N5
1982 BUILDING DEPARTMENT
❑BYILDING INSPECTOR
E 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.or>;
- - - - - - - - - - - - - - - — - - — — INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : 0 UV C\r DATE: i - - <�
PERMIT# 1'\R ISSUED:S•c�lt SECT: % - BLOCK: LOT: -50
LOCATION• CCPC t./\ c,C4 `} 7- i L1'' OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... �! ACCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS �. /'� . ► [ J ��/U'f'(�V C`�I
❑ L.P. GAS n
❑ FUEL TANK ~�! to ! ST C 1 N
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
OTHER H.V.�, C
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BUILD ' - ,�cRTMENT
Vl<LOF RYOOK
938 KING te' ET RYE BR66k,NY 10573 MAY - 3 2024
+ 4
` 8 VILLAGE OF RYE BROOK
org BUILDING DEPARTMENT
APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING VENTILATION AND/OR AIR CONDITIONING EQUIPMENT
FOR OFFICE USE ONLY: PERMIT#: _ /� _
Approval Date: < Permit Fee: $ 30o
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSLLD 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$750.00
REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE:
1. Properly completed& Signed Application.
2. Site/Staging Plan if Required by the Building Inspector.
3. Copy of Licensed Contractor's Liability Insurance. (Village of R),e Brook must be listed as certificate holder)& Workers
Compensation Insurance on a NYS Board form (Porn,4 C 105.2 or Farm# U20.3 '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.
Application dated, 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: 90 Windsor Rd SBL: 1J5;5 4 3_75aone:
2. Property Owner: Austin Ringer / ,,J`„)jXHe �Z ' Address: 90 Windsor Rd, Rye Brook, NY 1057:
Phone#: (914)715-3416 Cell#: email: austinringer@gmail.com
3. Contractor: Structure Home and Small Business Solutions LLC Address: 21 Goffredo Ct, Middletown NY 10940
Phone#: 845-649-4959 Cell#: email: StrueturaNY@gl-lail.com
4. Scope of Work:New Installation X)• Replacement( )-Removal( )-Other( ):
5. List Equipment: 2 x Mitsubishi M-Seroes H_i Condensers on exterior, and 5 x Mitsubishi wall mount ail
handlers on interior.
6. Location of Equipment: Outdoor unit locations: Both condensers on rear of hous,
Indoor unit locations: Dining Room, Bedroom, Office, Living Room, and Master Bedroom
7. Method of Installation/Removal(list all equipment needed to perform job): Connect indoor units to outdoor condensers with
communication wire for power and copper lineset to exchange refrigerant. Drain piping will also be installed for
all indoor units.
t
10/30/2023
STATE OF NEW YO UNTY OF WESTCHESTER ) as:
, , being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states that(s)he is the 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 be ore me thisl Sworn to befor me this 2�a
day of ,20—a-q _ day of ,200
S' nature of Property Owner Signature of Applicant
i 1011T
Print Na e f Prop Owner Print Na Appl' t
Not- Public Not Public
:Pub'.11c
ESQUIVEL
Notarytate of New York r MICHAEL ESQUIVEL
6442359 ;4ctar!,0abitc-State of New York
Qualiftchester County .:©.0iEa6442359
My compires Oct 11,2026 Qu•"'Sed in.Westchester County
M% Cc mission Expires Oct 11,2026
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
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BUIL E MENT U
VIL E OF RYE OK
938 KIN , ET RYE B ,NY 10573 MAY 1 4 2�24
VILLAGE OF . BROOK
.or BUIL,r)iNG DEPARTMENT
ELECTRICAL PERMIT APPLICATION _
Westchester County Master Electricians License Required FOR OFFICE USE ONLY �R -//`� ( — EP#: cD �/—0 9 /G�
Approval Date: Permit Fee: $ bD—
Approval Signature: Other:
i
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$750.00
Application dated, 2 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 electricalequipment,wiring, fixtures,or to perform other high or low voltage electrical work as per
the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work
performed will be in conformance with all applicable Federal,State,County and Local Codes.
1.Address: -1 O W io(A b SBL: 3 S• 5 Z - 3- S n Zone: R -3
2.Property Owner:_ R V 5Ti N (Z1NGt 1t �L 1 tNt' Ql�'6 ddress: q D W i0�9500, RID,, RYF 8"01.0 P V, 1057 3
Phone#: 9 I W I 1 S 3 W lI L Cell#: email: (-1 USTi Nt�l r�tt�[�K►4i �.�or1
3.Master Electrician/Licensed Installer: f'(R YLi O S i t, J1, Address: 121 (o_MCC et4unefi 57' P�7e-ti
Lic.#:�(�Phone#: Q 1 4 �(d 3'�4 1 Cell#: 1 Li 1-03 �9151 email:__�(G i t_I/W E pIA aa1 Gw L (�K/�IG+Pod)
Company Name: �14 PLi D Si I ✓A� 1-,&PT) CffL TkAddress: III �1-ACC CNIIItCIt 5%. ID4'_,C'H07fK�
4.Proposed Electrical Work/Fixture Count:
W NQ A) G ro o P�n.�-sS o o er-0-e P 2 z ✓
5.31 Party Electrical Inspection Agency: W
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
being duly sworn,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 wF._L,�
i
performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in thi
application and in any accompanying approved plans and specifications,as well as in accordance with the New York State UniformPrevention&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 th'
day of ,20 da of ,20cc
h
t7 ONO to x
Signature of Property Owner Signature of Applicant a 0 3
/} z d y
Print Name of Property Owner Print Na plicant a E
o o
,Z O U
LA RAKL
Notary Public Nota
1 /3 20 3
STATE WIDE INSPECTION SERVICES, INC.
0•0 • •
aswis • : APPLICATION tel 845.202.7224 1 fax 914.219.10621 •
Office Use Elect. Permit# 4/— O Date 9
� Z
Bldg Permit# _ l( — 0 S C Scl Ft r
Plumbing Permit#
Final Certificate#
City/Village f'A, Zip Building Dept. County ko! C
Address Q w Cross Street Section �•5� Block Lot �v
Owner Name/Address(If different than above ? Contact Number14
Basement ❑ 1st FI. ❑ 2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑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 # 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
�v G (1v�11�0"t-SSo 0-f P
p E- ENE
ID
MAY 14 2024
VILLAGE OF OE BROOK
I BUILDING DEPARTMENT
This application is valid for one(1)year from the date received by SWIS.This application Is Intended to cover the above listed items to be inspected,if at 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 s t L J A E L C C'N vk C 6� L 7W!L— • �©� Name ��{� v � i (�
License# Date j It 2 Signature `
k ` 'L
Address , C� e R e� 5 City/State&4T �0,1- � �� Zip Code 1
Company L/ S ` ✓ t �-t 611At('A O n Phone# 9 LJ 0 IT S
iState Wide Inspection Services
1080 Main Street
MAY 2 8 2024 Fishkill, NY 12524
as%V U
S 845 202-7224 Phone
VILLAGE OF RYE BROOK 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT _ Email: office@swisnv.com
--- �"'—�'-- Website: www.swisny.com
Service With Integrity
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
Mario Silva Electrical, Inc. Austin&Juliette Ringer
Mario Silva 90 Windsor Road
121 Grace Church Street Rye Brook, NY 10573
Port Chester,NY 10573
Located at: 90 Windsor Road, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP24-099
135.52 3 50
Certificate Number:2024-3372 Building Permit Number: MP24-059
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: 90 Windsor Road, Rye Brook, NY 10573
The Basement& Exterior were inspected in accordance with the NYS and NFPA 70-2017 and the detail
of the installation, as set forth below,was found to be in compliance on the 24th Day of May 2024.
Name Quantity Rating Circuit Type
A/C Compressors 02 40 Amp
Officer: Frank 1. Farina
This certificate may not be altered in any way and is validated only by the presence of a seal at the location
indicated.This certificate is valid for work performed on the date of inspection only.
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I
MITSUBISHI
Aff1k ELECTRIC Submittal D. _. _.
Heating and Cooling Multi-Split Cold Climate Air Source Heat Pump System
Job Name: Location:
Purchaser: Submitted By:
Submitted To: Reference: Approval: Construction:
Engineer: Date: Application:
AW •Variable speed INVERTER-driven compressor
•M-NET connection optional through outdoor unit(Part q listed below)
•Quiet outdoor unit operation as low as 54 dB(A)
•High pressure switch for additional protection
•Built-in base pan heater
_ R Images provided for reference purposes only
Performance: Non-Ducted Mixed Ducted
Rated Capacity Btu/h 22,000 22,800 23,600
Capacity Range Btu/h 12,600-23,600 12,600-23,600 12,600-23,600
Rated Power Input W 1,630 1,995 2,360
Cooling at 95°F Power Input Range W 530-3,770 530-3,770 530-3,770
Moisture Removal nts/h NA NA NA
Sensible Heat Factor NA NA NA
Rated Capacity Btu/h 25,000 24,800 24,600
Heating at 47°Fz Capacity Range Btu/h 11,400-30,600 11,400-30,600 11,400-30,600
Rated Power Input W 1,725 1,789 1,871
Power Input Range W 850-4,540 850-4,540 850-4,540
Maximum Capacity Btu/h 25,000 24,800 24,600
Rated Capacity Btu/h 14,000 14,000 14,000
3 Capacity Range Btu/h 13,600-25,000 13,550-24,800 13,500-24,600
Heating at 17°F Maximum Power Input W 3,557 3,676 3,795
Rated Power Input W 1,622 1,629 1,635
Power Input Range W 1,410-3,557 1,530-3,671 1,650-3,795
a Maximum Capacity Btu/h 25,000 24,800 24,600
Heating at 5°F Maximum Power Input W 3,760 3,980 4,200
Maximum Capacity Btu/h 22,500 23,350 22,200
Heating at-13°F Maximum Power Input W 4,050 4,220 4,400
DuctedEfficiency: Non-Ducted Mixed
SEER2 19.00 16.70 14.40
EER2 13.50 11.75 10.00
HSPF2(IV)/(V) 10.0/8.20 8.95/7.40 7.90/6.60
COP at 47°F Rated Capacity 4.25 3.97 3.70
COP at 17°F IMaximum Capacity 2.06 1.95 1.90
COP at 5°F°/-13°F Maximum Capacity 1.95/1.63 1.80 1.55 1,72 1.48
Outdoor Operating
Cooling Operation Air Temp(Maximum/Minimum)* (Comfort cooling only applications) I °F °C *115 to 14 (46to-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-13 (18 to-25)
Heating Operation Thermal Lock-out/Re-start Temperatures °F °C -18/-14 (-28/-26)
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)801(26.6°C)DB,67°F(19.4°C)WB//95°F(35°C)DB,75°F(23.9°C)WB
2Heating 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,607(15.6°C)WB//5°F(-15°C)DB,4°F(-15.6°C)WB
5Heating 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.
©2023 Mitsubishi Electric Sales Canada Inc. Form No.SB MXZ-3C24NAHZ4-U1 202401
SubmittalMITSUBISHI
Arlk ELECTRIC Data: MXZ-3C24NAHZ3-U1
CoolingHeating and
Power Supply 208/23OV,1Ph,60Hz
Voltage:Indoor-Outdoor,S1-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 40
Recommended Wire Size(Indoor-Outdoor) AWG 14
• .•. Unit Specifications:
MCA A 31.5
MOCP A 40
Fan Motor Output W NA
Airflow Rate (Cooling/Heating) CFM 2,150/2,550
Sound Pressure Level,Coolingl dB(A) 54
Sound Pressure Level,Heating2 dB(A) 58
Refrigerant Control LEV
Compressor Oil Type/Refrigerant Charge FV50S/8 lbs.13 oz.(4.0 kg)
External Finish Color Munsell 3.OY 7.8/1.1
Unit Weight Lbs.[kg] 189[86]
W:In.[mm] 37-13/32[950]
Unit Dimensions D:In.[mm] 13[330]
H:In.[mm] 41-11/32[1,0481
Gas Pipe Size O.D.(Flared) In.[mm] A:1/2;B,C:3/8[A:12.72;B,C:9.521
Liquid Pipe Size O.D.(Flared) In.[mm] A,B,C:1/4[A,B,C:6.351
Total Piping Length Ft.[m] 230[70]
Maximum Height Difference,ODU above IOU Ft.[m] 49[15]
Maximum Height Difference,ODU below IDU Ft.[m] 49[15]
Farthest Piping Length from ODU to IDU Ft.[m] 82[25]
Maximum Number of Bends for IDU 70
Model No. Description:(Optional
CM-S-FR-NKMU Front Windscreen
WRE2 Rear Windscreen
WSD2 Side Windscreen
PAC-IF01MNT-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-5G76RJ-E JOINT PIPE(3/8->5/8)
Notes: SVZ Connections Rules:
Minimum of two Indoor units must be connected lOnly 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(PAC,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 syatcn should be required.check the local code. Be sure to attach each screw to its correspondent terminal when
Use a ring tongue terminal in order to connect a ground wire to terminal securing the cord andlor the wire to the terminal block.
®-®(MXZ-2C)
INDOOR UNIT ®-®(MXZ-3C) CONNECTING WIRES AND CONNECTING GROUND WIRE
sie In. Use solid conductor Mrn.AWG14 or stranded conductor Min.AVVG 14
1-3/8 in. (15 mm) Use double Insulated copper wire with 600 V insulation
TermiulbbU TsrmnY bbdt� ( mm) Use copper conductors only.
1 I 1 J Follow local electrical code.
POWER SUPPLY CABLE
n Ong ise solid of stranded conductor Min_AWG8
' terminal'
U LY [A-- -4. Use copper conduclois only.
2081230 V AC Lead wire
i I fi Power supply Follow local electrical code.
t phase 6o Hz D�� I 20Br230 V AC GROUND WIRE
switch• 1 phase 2w�6600 Hz Grounding ;se solid or sliw)ded conductor'An_AWG8
I-se copper conductors
9 terrrtlrial• Fo low local electrical code.
Ztemwvw**
R _ _i - WARNING:
• Use the indoor/outdoor unit connecting wire that meets the Stand-
1 1 L1 — =Ground ards to connect the indoor and outdoor units and fix the wire to
Tem.tnl block Te Inn block T-1,W11 bloat i the terminal block securely so that no external force is conveyed
te-®(MXZ-2C) to the connecting section of the terminal block.An incomplete
IN-©(MXZ-3C) connection or fixing of the wire could result in a fire.
OUTDOOR UNIT For future servicing,give extra length to the connecting wires.
• Turn on the main power when the ambient temperature 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.MitsubishiElectric.ca Page 2 of 3 Specifications are subject to change without notice.
0 2023 Mitsubishi Electric Sales Canada Inc. Form No.SB MXZ-3C24NAHZ4-U1 202401
SubmittalMITSUBISHI
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Changes for the Better
www.MitsubishiElectric.ca Intertek Specifications are subject to change without notice.
m 2023 Mitsubishi Electric Sales Canada Inc. Form No.SB MXZ-3C24NAHZ4-U1 202401
Mini King Installations
21 Goffredo Ct.
Middletown NY 10940
structurany@gmail.com
www.Minikinainstailations.com
Austin Ringer
90 Windsor Rd
Rye Brook, NY, 10573
Reference: Ductless air heating and air conditioning system
Proposed equipment to be installed
Condenser 1 24000 BTU M-Series H2i MXZ-3C24NAHZ4-U1
Dining Air Handler 12,000 BTU Wall MSZ-FS12NA
BR1 Air Handler 6,000 BTU Wall MSZ-FS06NA
Office Air Handler 9,000 BTU Wall MSZ-FS09NA
Condenser 2 30000 BTU M-Series 1-12i MXZ-3C30NAHZ4-U1
Living Air Handler 12,000 BTU Wall MSZ-FS12NA
Master Air Handler 9,000 BTU Wall MSZ-FS09NA
5x Mitsubishi Electric PAC-USWHS002-WF-2 Wifi Interface Uses Kumo Cloud
2x Mitsubishi Wireless Programmable Red LINK Thermostat& Receiver Kit MHK2
Other
Electrical Labor and Material Not Included
Electrical Permits Not Included
Equipment Pen-nit Not Included
Total Project Cost $25,312.70
Coned Rebate for decomission $10,000.00
Final out of pocket cost for all material, labor and application submission $15,312.70
Due at Signing $10,718.89
Due Upon Completion $4,593.81
A;w
Apr 23 2024
Customer Signature *By signing this proposal,you approve and agree the installation of your project
Apr 23 2024
Contractor signature
Terms and Conditions
SUBMITTALS:All systems shall be AHRI-matched,as evidenced by the appropriate AHRI rating sheet,to be submitted to the
program administered to the program administration by the distributor.All submitted certificates must be active in the AHRI
directory.
PAYMENT: Shall be as follows: $15,313 paid in installments as per the benchmarks above.
ESTIMATED TIME SCHEDULE:Mini King shall commence work after this contract is signed and deposit is received,Materials
shall be ordered and customer shall be notified accordingly.
CHANGES IN WORK:Any deviations from the specifications or modifications of the terms contract and any extra or incidental
work or reductions in work shall be set forth in writing and signed by both parties prior to the making of such change or doing said
extra or incidental work.Any increase or decrease in the contract price resulting from such change shall be included in such writing.
TERMINATION OF CONTRACT:You,the buyer,may cancel this transaction at any time prior to midnight of the third business
day after the date of this transaction.The company reserves the right to terminate this agreement at any time in the event of a failure
to make payments when due and/or in the event that a dispute under the terms of this contract arises and is not resolved within five
(5)working days of written notice by the company to you of the existence of a dispute and the need to resolve it.
INSURANCE:The Company will provide and pay for workman's compensation insurance covering our employees and public
liability and property damage insurance protecting themselves.The company also assumes responsibility for the collection and
payment for social security and federal and state unemployment taxes as applicable.
ACCESS AND WORK BY OTHERS:the company shall be provided with suitable access to the work area and adequate working
space.If the company's work is dependent upon or must be undertaken in conjunction with the work of others,such work shall be
so performed and completed as to permit the company to perform its work hereunder in a normal uninterrupted single-shift
operation.Unless otherwise agreed upon,price is based on completing the job in one mobilization of equipment.If it is necessary
for the company to remove its equipment and return to the site,there will be an additional charge.
ORAL REPRESENTATIONS OR WARRANTEES:No oral representations or warrantees are authorized to be made by any of the
company's employees,representatives or agents.
WARRANTEES:All materials,parts and equipment are warranted by the manufacturers or suppliers written warranty.All labor
performed by the above named companies is warranted for 12 months.
The above companies make no other warranties,express or implied,and it's agents or technicians are not authorized to make any
such warranties on behalf of the above named company.
)kfXOdO Sign Audit Trail
by apryse
Document Details
Title 90 Windsor Rd-Ductless Heat Pump Proposal
File Name 90 Windsor Rd-Contract.pdf
Document ID cdc47fe25e7d420aae6ade87e666f56d
Fingerprint 972a01b392788cabOd04cb5cd445275b
Status
Document History
Document Created Document Created by Vincent Drago(structurany@gmail.com) Apr 19 2024
Fingerprint 6cica83I331d'�60�(�65'b4809far;11r;13 03:11AM UTC
Document Sent Document Sent to Austin Ringer(austinringer@gmail.com) Apr 19 2024
03:11 AM UTC
Document Viewed Document Viewed by Austin Ringer(austinringer@gmail.com) Apr 23 2024
IP: 172.56.160.112 12:02PM UTC
Document Signed by Austin Ringer(austinringer@gmail.com)
IP: 172.56.160.112
Document Signed Apr 23 2024 A;w 12:05PM UTC
Document Sent Document Sent to Vincent Drago(structurany@gmail.com) Apr 23 2024
12:05PM UTC
Document Viewed Document Viewed by Vincent Drago(structurany@gmail.com) Apr 23 2024
IP:47.230.143.121 03:04PM UTC
Document Signed by Vincent Drago(structurany@gmail.com)
IP:47.230.143.121
Apr 23 2024
Document Signed 1 twzx� Dya�O 03:04PM UTC
Document This document has been completed. Apr 23 2024
Completed Fingerprint:972a01 b392788cabOd04cb5cd445275b 03:04PM UTC
Processed by XOdO sign
CoolingMITSUBISHI
ArW ELECTRIC Submittal Data: MSZ-FS12NA-Ul
Heating and Indoor
Job Name: Location:
Purchaser: Submitted By:
Submitted To: Reference: Approval: Construction: ❑
Engineer: Date: Application:
•Wireless Handheld Remote Control
•3D i-See Sensor
•Dual Barrier Coating
•Double Vanes
_ •Triple Filter System
•CN24 Auxiliary Heat Control
Images provided for reference purposes only
Rated Capacity:
Coolin Btu/h 12,000
Heat at 47°F Btu/h 12,300
Indoor
Power Supply 208/230V,1Ph,60Hz
MCA A 1.00
Blower Motor Full Load Amperage A 0.65
Blower Motor Output W 40
Airflow Rate at Cooling,Dry CFM 137-167-221-304-424
Airflow Rate at Cooling,Wet CFM 117-143-190-261-364
Airflow Rate at Heating,Dry CFM 155-226-282-367-454
Sound Pressure Level(Cooling) dB(A) 21-24-29-36-44
Sound Pressure Level(Heating) dB(A) 21-28-32-38-43
Drain Pipe Size In.(mm) 5/8 (15.88)
External Finish Color White(Munsell 1.OY 9.2/0.2)
W:In.(mm) 36-7/16 (925)
Unit Dimensions D:In.(mm) 9-3/16 (234)
H:In.(mm) 12(+11/16) (305(+17))
Unit Weight Lbs.(kg) 29 (13.5)
Gas Pipe Size O.D.(Flared) In.(mm) 3/8 (9.52)
Liquid Pipe Size O.D.(Flared) In.(mm) 1/4 (6.35)
Moisture Removal pints/h 1.9
Model No. D• (Optional
MELCO-RETAIL-MINI Building Automated System DDC Interface
PAC-US444CN-1 ISimple thermostat Interface
PAR-40MAAU lWired Wall Mounted Remote Control
PAR-CTO1MAU-SB ❑ITouch Screen Wired Wall Mounted Control
PAC-YT53CRAU-1 ❑I Basic Wired Wall Mounted Control
MAC-1710RA-U ❑ External Heat Control Adapter
PAM-4 ❑ Heater control relay
RMF-CA200-V1 ❑ Deluxe Thermostat Interface
MAC-3341F-E ❑ System Control Interface
MAC-497 ❑ PAR Control Interface
(OptionalModel No. Description:
M21EAA307 ❑ Wired Remote Sensor
MAC-233OFT ❑ Anti-Allergy Enzyme Filter(Electro static)
MAC-308OFT ❑ Platinum Deodorizing Filter
CN24RELAYKITCM3 ❑ CN24 Relay Kit
AHRI Rated Conditions(Rated data is determined at a fixed compressor speed)
'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,437(6.1°C)WB
For data on specific Indoor units(all ducted,all non-ducted,and both ducted and non-ducted)combinations,see MXZ Technical and Service Manuals.
Applications should be restricted to comfort cooling only;equipment cooling applications are not recommended for low ambient temperature conditions.
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.
www.MitsubishiElectric.ca Page 1 of 2 Specifications are subject to change without notice.
©2021 Mitsubishi Electric Sales Canada Inc. Form No.SB MSZ-F512NA-U1 For MXZ SYS 202107
SubmittalMITSUBISHI
ArW ELECTRIC
Heating . Cooling
Dimensions:Indoor Unit Outline and
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' �MITSUBISHI
c us ELECTRIC
0 Changes for the Better
Intertek
www.MitsubishiElectric.ca Specifications are subject to change without notice.
0 2021 Mitsubishi Electric Sales Canada Inc. Form No.SB MSZ-FSI2NA-U1 For MXZ SYS 202107
(ool (alc
Project Name: Austin
Address: 90 Windsor 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: 0i Elevation(Ft):
LOAD CALCULATION TOTALS
HVAC System:Home
Heated square footage: ®i Heating BTUH:
Cooled square footage: ®i Cooling BTUH:
Heated volume(above grade CF): Wro I CFM: ®i
Cooled volume(above grade CF): I ff,WITINSensible cooling:
Exposed wall area(SF): Latent cooling:
SHR:
Load Calculation
Cooling
Heating
0 20,000 40,000 60,000
BTUH
Approved ACCA MJ8 Calculations
Calculations are based on the ACCA Manual J 8th Edition and are approved by ACCA.
All computed calculations are estimates on building use, weather data, and inputted
values such a R-Values, window types, duct loss, etc. Equipment selections should
meet both the latent and sensible gain as well as building heat loss.
HEATING AND COOLING LOADS
HEATING LOADS Heating Loads
aboveGradeWalls
SECTION •
aboveGradeWalls 1.510.2 8.496 ceilings
windows
ceilings 969.8 2,137
37.8°�•
doors
doors 48 1,308 2.6,
floors 970.9 6,444 floors
infiltration 0 13,026 12.81'0
infiltration
skylights 0 0
25.8"b
windows 378 19,074
Totals 50,487
COOLING LOADS Cooling Loads
aboveGradeWalls
SECTION AREA SENSIBLE LATENT
AEDExcursion 0 0 0 appliances
aboveGradeWalls 1,510.2 2,798 0
windows
—+ ceilings
appliances 0 2.400 0 —
ceilings 969.8 1,290 0 infiltration
doors 48 474 0 plants 132'
floors 970.9 1,088 0
----- -- occupants
infiltration 0 1,217 2,069
occupants 0 920 800
plants 0 0 300
skylights 0 0 0
windows 378 11,630 0
Totals 21,818 3,169
FENESTRATION LOADS
AED Graph(mid-summer)
20,000
2
10,000
m
0
8 9 10 11 12 13 14 15 16 17 18 19
— BTUH — Average — Average*1.3
This graph represents hourly aggregrate fenestration loads in mid-summer.
AED graph(fall)
15,000
= 10,000
m
5,000
0
8 9 10 11 12 13 14 15 16 17 18 19
— BTUH —Average — Average*1.3
This graph represents hourly aggregrate fenestration loads in October.
COMPONENT LOADS
ABOVE GRADE WALLS
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: N Heating BTUH: 891
insulation,Stucco or Siding. U Value: 0.097 Area: 158.3 Cooling BTUH: 293
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 1213-0s w Exposure: E Heating BTUH: 1,164
insulation,Stucco or Siding. U Value: 0.097 Area: 206.9 Cooling BTUH: 383
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 128-Os w Exposure: S Heating BTUH: 891
insulation,Stucco or Siding. U Value: 0.097 Area: 158.4 Cooling BTUH: 293
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 126-0s w Exposure: W Heating BTUH: 1,142
insulation,Stucco or Siding. U Value: 0.097 Area: 202.9 Cooling BTUH: 376
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 1213-0s w Exposure: N Heating BTUH: 736
insulation, Stucco or Siding. U Value: 0.097 Area: 130.8 Cooling BTUH: 242
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: N Heating BTUH: 141
insulation,Stuccoor Siding. U Value: 0.097 Area: 25 Cooling BTUH: 46
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 1213-0s w Exposure: E Heating BTUH: 248
insulation, Stucco or Siding. U value: 0.097 Area: 44.1 Cooling BTUH: 82
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: E Heating BTUH: 1,044
insulation,Stucco or Siding. U Value: 0.097 Area: 185.6 Cooling BTUH. 344
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 12B-Os w Exposure: S Heating BTUH: 904
insulation,Stucco or Siding. U Value: 0.097 Area: 160.6 Cooling BTUH: 298
Map trace wall
Frame Wall,Wood framing, R-11 cavity Construction nr: 1213-0s w Exposure: W Heating BTUH: 1,337
insulation, Stucco or Siding. U Value: 0.097 Area: 237.6 Cooling BTUH: 440
BELOW •
There are no components for this section.
Default small windows for wall id 7184896 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: 195
Default medium windows for wall id 7184896 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,211
Window, NFRC rated,Clear glass. E posure: N4 SHGC: 0.67 Cooling BTUH: 389
Default small windows for wall id 7184897 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. E posure: E2 SHGC: 0.67 Cooling BTUH: 398
Default large windows for wall id 7184897 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,817
Window, NFRC rated,Clear glass. Exposure: E6 SHGC: 0.67 Cooling BTUH: 1,193
Default small windows for wall id 7184898 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 303
Window, NFRC rated,Clear glass. Exposure: 6 SHGC: 0.67 Cooling BTUH: 189
Default medium windows for wall id 7194898 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,817
Window, NFRC rated,Clear glass. Exposure: S6 SHGC: 0.67 Cooling BTUH: 1,154
Default small windows for wall id 7184899 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. Exposure: yy SHGC: 0.67 Cooling BTUH: 453
Default large windows for wall id 7184899 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,817
Window, NFRC rated,Clear glass. Exposure: w SHGC: 0.67 Cooling BTUH: 1,358
Default small windows for wall id 7184905 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. Exposure:
N2 SHGC: 0.67 Cooling BTUH: 195
Default medium windows for wall id 7184905 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,211
Window, NFRC rated,Clear glass. Exposure: N4 SHGC: 0.67 Cooling BTUH: 389
Default small windows for wall id 7184907 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 303
Window, NFRC rated,Clear glass. Area:posure: N SHGC: 0.67 Cooling BTUH: 97
Default small windows for wall id 7194906 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. Exposure: E2 SHGC: 0.67 Cooling BTUH: 398
Default small windows for wall id 7184908 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. E posure: E2 SHGC: 0.67 Cooling BTUH: 398
Default large windows for wall id 7184908 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,817
Window, NFRC rated,Clear glass. Exposure: E6 SHGC: 0.67 Cooling BTUH: 1,193
Default small windows for wall id 7184909 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 303
Window, NFRC rated,Clear glass. Area:
S SHGC: 0.67 Cooling BTUH: 195
Default medium windows for wall id 7184909 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,817
Window, NFRC rated,Clear glass. Exposure: S6 SHGC: 0.67 Cooling BTUH: 1,172
Default small windows for wall id 7184910 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. Exposure: W SHGC: 0.67 Cooling BTUH: 453
Default medium windows for wall id 7194910 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 606
Window, NFRC rated,Clear glass. Area:
W SHGC: 0.67 Cooling BTUH: 453
Default large windows for wall id 7184910 Construction nr: 1 G
U Value: 0.87 Heating BTUH: 1,817
Window, NFRC rated,Clear glass. Area: 36
Exposure: w SHGC: 0.67 Cooling BTUH: 1,358
Window cooling BTUHs shown here are daily average values.See AED graphs for details of fenestration loads during the day.
CEILINGS
Map trace generated ceiling
Ceiling under attic or attic knee wall,Asphalt Construction nr: 16C-25 al Heating BTUH: 1,718
shingles, Light, R-25. U Value: 0.038 Area: 779.4 Cooling BTUH: 1,037
Map trace generated ceiling
Ceiling under attic or attic knee wall,Asphalt Construction nr: 16C-25 at Heating BTUH: 420
shingles, Light, R-25.
U Value: 0.038 Area: 190.4 Cooling BTUH: 253
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.
Default doors for wall id 7184908
Construction nr: 11 Area: 24 Heating BTUH: 654
Wood Door, Hollow Core. U Value: 0.47 Exposure: E Cooling BTUH: 237
Default doors for wall id 7184910
Construction nr: 11 Area: 24 Heating BTUH: 654
Wood Door, Hollow Core. U Value: 0.47 Exposure: W Cooling BTUH: 237
Map trace generated floor
Floor over enclosed unconditioned crawl space Heating BTUH: 6,444
Construction nr: 19A-Ocp Heating U Value:0.295 Cooling BTUH: 1,088
or basement, no floor insulation, Carpet or Area: 970.9 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
NCFM Heatin 207 Heating BTUH: 13,026
Leakage Category: Semi-Loose NCFM Cooling: 93 Sensible BTUH: 1,217
Latent BTUH: 2,069
BLOWER • •-
There are no components for this section.
HUMIDIFICATIONWINTER
There are no components for this section.
OCCUPANTS
Nr.Occupants: 4 Sensible BTUH: 920 Latent BTUH: 800
APPLIANCES
Standard kitchen and utility room,lighting:2,400 BTUH Quantity: Sensible BTUH: 2,400
Latent BTUH:
Plant Size: small Quantity: 5 Latent BTUH: 50
Plant Size: medium Quantity: 5 Latent BTUH: 100
Plant Size: large Quantity: 5 Latent BTUH: 150
ROOM DETAIL
Room name:Second Floor
Heated square footage: Total Cooling BTUH: 111117110111111
Cooled square footage: Total Heating BTUH:
Heated volume(above grade CF): CFM:
Cooled volume(above grade CF):
Exposed wall area(SF):
Load Calculation
Cooling
Heating
0 5,000 10,000 15,000 20,000 25,000
BTUH
AED Graph(mid-summer)
7,500
= 5,000
00
2,500
0
8 9 10 11 12 13 14 15 16 17 18 19
— BTUH — Average --- Average*1.3
AED graph(fall)
6,000
= 4,000
ti
m
2,000
0
8 9 10 11 12 13 14 15 16 17 18 19
— BTUH —Average — Average*1.3
ROOM DETAIL
Room name:First Floor High
Heated square footage: Total Cooling BTUH:
Cooled square footage: Total Heating BTUH:
Heated volume(above grade CF): CFM:
Cooled volume(above grade CF):
Exposed wall area(SF):
Load Calculation
Cooling
Heating
0 10,000 20,000 30,000
BTUH
AED Graph(mid-summer)
10,000
2
5,000
00
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
DO
2,500
0
8 9 10 11 12 13 14 15 16 17 18 19
— BTUH — Average — Average"1.3
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'4C CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
12/05/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Geoff A McCarthy
GRBM, Inc. raoNN , (845)878-9293 A/c No): (845)878-3769
39 Old Doansbur9 Road E-MAIL ADDRESS: @g Geoff rbminc.com
INSURERS AFFORDING COVERAGE NAIC#
Brewster NY 10509 INSURERA: Obsidian Specialty Insurance Company 16871
INSURED INSURER B:
Structura Home and Small Business Solutions LLC INSURERC:
21 Goffredo Ct. INSURER D: Progressive Casualty Insurance Company 24260
INSURER E:
Middletown NY 10940 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DD MM/DDNYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR DAMAGE TORN D
PREMISES Ea occurrence)
ccurrence $ 100,000
MED EXP(Any one person) $ 5,000
A SCB-GLM-000031367 06/11/2023 06/11/2024 PERSONAL SADVINJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY 0 PRO-
JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident 1,000,000
ANY AUTO BODILY INJURY(Per person) $
D OWNED SCHEDULED
AUTOS ONLY AUTOS 962026793 09/28/2023 09/28/2024 BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE
AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under --
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Village of Rye Brook as certificate holder and additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS.
938 King St AUTHORIZED REPRESENTATIVE
Rye Brook,NY 10573
r
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
INYSIF
New York State Insurance Fund PO Box 66699,Albany, NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
0. .M
°AAAAA 834516432
GRBM INC
T Nt
39 OLD DOANSBURG RD Y? y
BREWSTER NY 10509
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
STRUCTURA HOME AND SMALL BUSINESS VILLAGE OF RYE BROOK
SOLUTIONS LLC 938 KING ST
21 GOFFREDO CT RYE BROOK NY 10573
MIDDLETOWN NY 10940
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2515 851-0 24860 06/11/2023 TO 06/11/2024 12/5/2023
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2515 851-0, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR
WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS,
OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW
YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS.
THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STAT SUR NCE FUND
T4 �V
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 1005921281
1 I_Or q