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BP24-128
PERMIT # �/- d'7-" ��� DATE:, �� �y��CP SECTION � c��� %.3 BLOCK � _ LOT TYPE OF WORK e Q /% JOB LOCA I�ON� OWNER / X� l�l � O CONTRACTOR / �J�U4iPIC EST. COST � o�i� OOC� �CO # � ' TCO # S 0 FEES �as �� FEE DATE INSPECTION RECORD FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS Di SPRINKLER �/� ELECTRIC LOW -VOLT O ALARM 0 AS BUILT 0 FINAL DATE iNSP �0-2,9-2.� '�Ass2 F� =3 ��� �o�y/�-Lr �ci � /�)�5-53i 3 OTHER APPROVALS OTHER FINISHED BASEMENT NOT ', APPROVED FOR USE AS A �, SEPARATE APARTMENT OR DWELLING UNIT a�!-O9'1 r411 Scram �� 5���.�1�/ems Sys�e�r s —� C C /f�� /C� ��� �p � /��� �i�a�-/3/ /t��j�ia E/Pc��c LLc c,' e�a.��na.j `i�"(c VILLAGE 0-'`1�Y-E BROOK WESTCHESV� COU J. ' NEW YORK% NO: 24-135 Certtftcate of Occupancy This is to certify that of, Rve Alyjko / V ` having duly filed an application on )bPr Q25 20�requesting a Certificate of Occupancy for the premises known as, JP- / u,�� /P619d , Rye Brook,NY, located in a PU I) Zoning District and shown on the most current Tax Map as Section: 1' `7• Block: ' Lot: LAO 1 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. " , , issued 20 such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following s New York State Classifications, Use: �) Construction: -03 for the following purposes: LEW I aS' Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: FINISHED BASEMENT NOT APPROVED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement, whether by extending on any side or by increasing in height shall be rnade. nor shall the building be moved from one location to another until a permit to accomplish such change h e in f the Building Inspector. Building Inspector,Village of Rye Brook: Date: 0 C T 3 1 2024 4R(�k. (, 44 uu`3V 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.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 31,2024 David Lobel&Robin Lobel 46 BelleFair Road Rye Brook,New York 10573 Re: 46 BelleFair Road, Rye Brook,New York 10573 Parcel ID#: 124.73-1-69 Mechanical Permit#24-097 issued on 7/25/2024 to Install Fire Sprinkler Heads This certifies that the fire sprinkler heads,installed under the above captioned permit,have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to Qv BUILD R ENT For office use onl : 1 D PERMIT# —la VIL OF RYE OK ISSUED: —a —b1 OCT 2 5 2024 38 KING STRE YE BROOK, YORK 10573 DATE:/0 9 �06 O-c FEE: ., Q-S- PAIIAN VILLAGE OF RYE BROOK BUILDING DEPARTMENT � 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 r****s*s***/***s****rr*/**rsrr*r***s*sssssrr*rrr*rrrrrrsr*r*r******rss*ssss**s***s**ss*srssrrrs*s*srs*s*ss**rs*r**rsrrrrr*rr** Address: b G�(� ✓ �lve /O°' Occupancy/Use: Parcel ID#: 71 �3— /— ��1 / Zone: Lf/� Owner: �ct v; ( // Address: y� Belle A r Qa&4 P.E./R.A. or Contractor: 6eN 4j4 e:t Address: (S? / 'b 4-64 1Q9. Lei �Prg /�y to;V Person in responsible charge: A A ohY re e-c, Address: /2G 01,vs/ RJ, B��a/d Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW�YORK, COUNTY OF WESTCHESTER as: /� L Ahe h y [ _eelbeing duly sworn,deposes and says that he/she resides at Z 6/ (��'�c kl Re S (Print a of//Appli ant) / / (No.and Street) in e in the County of tVe 5-4 h l S T'-/ in the State of /YIP ,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:$ Z�DO D , for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. p Sworn to before me this Sworn to before me this t1:'-9 day of , 20 day of ��t7 , 20�� v Signature of Property Owner Si re of Applicant Print NamP Pmp Own Print Name of Applic t �HARON SPINA Notary PublicrState of No.01SP4912t Notary CARD(J. CASSERI Q Clualified in WeStChester blic Hot ry Public, State of New York 2025 Commission EsPires Nov.30, in "!-,v.1 MY 8/12/2021 Qualified in ':es'N,'af 'er Crr"m6'3 Commission Expires h�.arc�i 2, QyE BRC�uk, o`` tim • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET . RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : q b 1"o PC, ? � o" � DATE: IC) - Z Ci - Z 0 L't PERMIT# V 2_ L'- Z ISSUED: -Z Y-Z SECT:1 y•7.3 BLOCK: LOT: 6 Z LOCATION: 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 ( ,moo✓� ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �] FINAL ❑ OTHER �E BRC�v� o`` tim • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR dASSISTANT 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 : lJ �e L e 4(A 1 (l K oc- L DATE: D- 30 - Z 0LI PERMIT# /'/ ZI _7C'1 ISSUED: sECT: BLOCK: LOT: LOCATION: 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 GASH ❑ L.P. GAS ❑ FUEL TANK 0 FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION -t' ❑ FINAL ❑ OTHER 00 CA v `a A O D Q w O U7 PU z � � o O 04 w � a2 a " a o ° W oo "' d O ` a 0 1-4 x E o 'S Q. Avg ° ~ O Uz & ON o p W I- i a i� v� b v � :I EMA 1.4 F wx - fl cy �iO4 t � o �j z0 go A F' ►n � oo � „ W 1-4 " c� O ��Qjj O A w V A pC, U V o a d ~ : z Q ~ ■ zui F= M} I u /wj H 0 z v C s 2 M ti =3 J 3 Z (, LT.i p p 5 « y e l� rT� F O v tr 11 = vwi U. M°° + z paw u � v7 Eo °- �wm QQ A z C > � © Q W a z 3 . 0 � 050Z0�CL a , a�o - s x ° BUILD MENT C E VIL OF RY OOK R [ FEB -3 7073 938 KING ET RYE BR ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONL Approval Date: crmit#; Application Fee: $ Approval Signature: Permit Fees: $ Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a th e in le,as per detailed statement described below. jQ1. Job Address: CJ 11� qr a� / SBL: 107 V, -'�t09 Zone:- 2. Proposed Improvement. (Describe in detail): 9SCr'tPn f Q 4o'' 0 lic e,1v5 41 4C q 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:-2�_ Yes: If yes,indicate: TIER I: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) : No: "r Yes: (If yes,please submit a separate Automatic Fire Suppression System Pe it application&2 sets of detailed engineered plans) 5. Occupancy; (1 fam.,2 fam.,comm.,etc-.)Prior to Construction: I After Construction: 141, 6. N.Y State Constructio lassification: N.Y. State Use lasssificcation: 7. Property Owner: / �v; Address: ��/C 1'4�`'� 09 Phone# 11 Cell# 9/7-4EJ-37Z 9 email: P1, E' O 8. Applicant: �n f aJh Y i� 4 eC Address: M4 O 1(ve/ „0CJ. Q Sob Phone# Cell# 9/��S' 3I 3 email: t G► �, y c e. Co 9. Architect: off+ .5-C t �; -- e,S l .- e:5 4 SAddress: 2S73' �✓ -3� rq o, �G's Phone#q/'�-Po-771 Z Cell# email: � IHC sic �, Car 10. Engineer: Address: Phone# Cell# L semmail: 11. General Contractor:►'SG�,g l t� reA 4ic rT%,-p_Address: / Ai e L _n, /S Phone# f/ Cell# 4l"/z-sY 7 f 3 email: A 14o, ./e} �iy,C/r Ca.c 01 12. Estimated cost of construction $ -) Sd oG (NOTE:The estimated cost shall include all labor,mate ial,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: 7 i Z- Finish: 3 2Z (1) 8/1 212 02 1 BUILD MENT D E ffu VIL OF RY OOK 938 KING ET RYE BR ,NY 10573 FEB - 3 2023 `L 4 -0 -c VILLAGE OF RYE B-ZOOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NffEW YOR1 K, /COUNTY OF WESTCHESTER ) as: / /� Q ,Q d � bC' + residingat, �i ��{� lCoG '`t't !�r'o_ I- r (Print name) (Address where you live) being duly sworn, deposes and states that (s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Rye Brook, NY. (lob Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property Owner(s)) b a,�n-�\ (_bN4,\ (Print Name of Property Owner(s)) Sworn to before me this day of (�` �I Y.1 (� , 20� (Kota C Pub i,)CMERIN0 notes Public, State of r4ew York No. 4884001 Qualified x Yres chaster County�i,,�� Cemm'ssion Expires March 2, 1/199rr_``���' LJ (2) 8/12/2021 This form must be properly completed¬arized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR) To: The Building Inspector of the Village of Rye Brook. From: II QQ � I Subject Propegy:�� c't�e �c'1r /bqd SBL: Zone: Please take notice that the subject; ❑ One or Two Family; ❑ Commercial, ❑ New Structure ❑ Addition to an Existing Structure D I O V F. )!Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; FEB '3 20 DD ❑ Truss Type Construction(TT) VILLAGE OF RYE BROOK ❑ Pre-Engineered Wood Construction(PW) BUILDING DEPARTMENT )ffi Timber Construction(TC) in the following location(s); w Floor Framing, including Girders&Beams(F) x Roof Framing(R) w Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. )0 - Sworn to before this Sworn to before me this day of L ,20 day of ,20 Signature of Property Ownee Signature of Design Professional Print N e of pe O er C� Print Name of Design Professional TOT Not VEASSERIN Notary Public MANY ic, State of N MANY York No. 4884001 Qul on io irestchester ,4tnuD T Commi ion Expires Merck 2�.1't (3) This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of_�)P C ' 20 day of r �z p✓ , 20 Signature of Property Owner Sign a ure f Applicant Print Nat of Property Owner fr Print Name of Applican L.f v Not lic Notary Public SHARON SPINA Notary Public-State of New York CMERINO No.01SP4912189 ho of New York Qualified in Westchester County JVo. asaaooi Cor i�Expires tMa st rz�C Q j My Commission Espires Nov.30,2025 (4) 8/12/2021 i t CV N N aLn N W =N � ++ O W a v i OG T 0 U FC'i M1 CN � C z 0.0 F+-1 Ln p t V)) W ozo off w ' 0 tN w s � F = N °° o Ln , �•i A oo H w q 5 oz �'c V ' z W 000 oo cn Z U z v) ` M 0 N O N • �i W4 < o z �� `� A (� •A z � w � � �c , s W� 1-4CN I--I CA � w A °N a w A t ►� V a c°� z z . W W 0 w w N a 6N ` r•� N z A A Q O 0.4 F.+ W �t w U g U � W r~ W 44 W a z Er p p O H $ L W a M� • U o w z W � H v z w z A o � a � U w � w z w A a w a Fyl � a a z � w z � ` _ • _ • ti t i D V 3D BUILP�' �E R MENT JAN 3:0 :2:023] VI L E OF RYE OK 938 KIN , ET RYE B ' ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians i i--nse Required/ FOR OFFICE USE ONLY BP#: p�EJ""c�� / EP MAR 2023 Q Approval Date: Permit Fee: $ Approval Signature: _ Other: ************************************ ********************************************************** Application dated,I�&9--a3 is hereb made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: �� jee Ile SBL: /c)1/1 73 9 I Zone: 2.Property Owner: �4 v t 1 La e Address: L/6 Ii e Ile/�r �% �e� Phone#: q( 7"f/�1.3 Z Cell#: email: 10 Lod ��_ �a�i �S • o r� 3.Master Electrician: ,�� � T11 n I'd Address: 3j�f� Lic. #:�po�Phone#: Cell#: Q{�/__�f6--pn email: D e- Company Name: .37�2,0/U Address: 3 l�ph�y et"-;, C&!�/fj 1 -& 4.Proposed Electrical Work/Fixture Count: Z Q !'1 (J f ' an d e a 1, a 1)bil or r�t FP/Mode' 1 y vmi Ihai�<s , f - . �, sh�.rs.4 Nm�� _ 5.3`d Party Electrical Inspection Agency: �a�e Q1 I/ U e f?S,i /Qf f �ew,'cep - ********************************************************************************************************* STATE •O--F�NEW YORK,COUNTY OF WESTCHESTER ) as: /;� 111 ego ro p/n ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print narlWof individual tigning 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 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 CVC f the Village of Rye Brook and all other applicable laws,ordinances,and regulations. S-� U Sworn before me his -I Sworn to before me this n �� day of 12 day of r\ 20 w� Signature of Property Owner Signature of Applic t cX� a t-o:�e v ,C( Print N e of Pr p er �� Print N e of Appli ant Not ERIN AIDA A DA EIRA Notary Public,' 'blic,state of New Yolk Notary Public,State of tiowY^ ' 1l1�ANo. 4384001 Quali%4 in Westchester Cou�� ifi0dirl�"t(ESt�h: t' )'J^ Commissionaires March 1 9 --i Expircti C.:`. i 6/23/2022 STATEWIDE • Service With listegrity 0:0 SWIS JOBAPPLICATION0. of-'Ice Use Elect-Permit t Date f t �O . f Bldg Permit# r � �n Utility ID# Final Certificate# City/Village Zip , Township County ;/11 J Address Cross Street Section Block Lot n !� -/� id Owner Name/Address(If different than above) 1 /� C/ f / Contact Number Q l 4 _ /,Z/_ Zaze Basement 0 1st Fl. ❑2nd Fl. 3rd Fl. 4 More Than 3 Fl. Garage Attic Outside ;J Residential 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 Incande nt Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect Underground New Reconnect ❑Overhead ❑Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information t -,t�.,d �J a I,za l�o� � hila t R L�C� Cd�IC JAN 3 0 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name �Q Date / ` v Signature Address '//r City/State V t zip Code ` t License# Phone# _ `. D 3D 0 Main State Wide Inspection Services CAC> SEP 2 5 2024 FisOhkiill, NY 152524 a 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax ;TATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.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: D Tapia Electric, LLC David & Robin Lobel 37 Stone Avenue 46 Bellefaire Road Ossining, NY 10562 Rye Brook, NY 10573 Located at: 46 Bellefaire Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-131 124.73 LJL 69 Certificate Number: 2024-6552 Building Permit Number: BP24-128/BP20-229 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: 46 Bellefaire Road, Rye Brook, NY 10573 The Basement and First Floor Kitchen 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 20th day of September 2024. Name Quantity Rating Circuit Type Receptacles 12 GFCI 02 Switches 04 Hood 01 Range 01 Dishwasher 01 Refrigerator 01 Microwave 01 Luminaires 14 A Visual Inspection of existing conditions was performed on September 201', 2024 of the Basement and First Floor Kitchen and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for%,vork performed on the date of inspection only. t w ' O N N E N \ i QI N tn N) f°0-0 U a F U a rA ICI No z ~ NL � u.i oo W Z Lir) ^ \ �i o 3 � w 04 o� Q i W M 7 c' O ci w o w g ° . Fil .x hl A 00 00 y v u W cn w 00 lug h� p �1 rRT•i�/ M 00 W � � � ,D Q 0. a� O i to u EO 00 a MM MCN " ~ F+� 0 o a O N Q W a A o o - � u vg Mw _O N I o CLl z °' °a o, a v 0 $ � , � � a W w a F p F IL.0 o y a �c� 0-0 � o v . 0.4 o W V Hg ° � y .2 w o n. Vr z F W z A o � .� .. a' cn A Z A � 0 � 5 0 , BUILDING DEPARTMENT RJ ECE � VE VIL WAGE OF RYE ,OOK 938 KING TREET RYE BRO( ,NY 10573UL 17 2024 (914) 39-0668 w,�4rye6iooknY.uov VILLAGE OF RYE BROOK BUILDING_DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: q ]� Approval DaJUL 2 5 202 P#: a� MP#: )Zj�Q / Application Fee: $_1 0 0 Approval Signature: Permit Fees: $� L� Disapproved: Other: Application dated: /—/ 7 g)21 is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: y Bd I Y f � / �U�P�`0 (u 1 2. Parcel I.D.: /d L1/ 73 —/ & / Zone: L' 3. Proposed Work(Describe system in detail including suppression agent): Ta4o,�l 4. Number&Types of Fire Sprinkler Heads: � I1('i,l�A r)�� s C I 1 5. NX State Construction Classification: N.Y. State Use Classification: 6. Estimated Value of Job: $ b' o 0 o (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may be donated gratis.) 7. Property Owner: �Q(/I d 4O� '7� Address: 6 Ie lIPr4 I r rC JG Phone# 9/7 374 Cell# email: 8. Architect/Eng 1ineer: r l ll olfeJew ` -e g n, loci Address: Phone# 474 5- L�y-a►33 Cell# "S q5- 6f3Gy -, 3 3 n'—email: 9. Sprinkler Contractor: I Q �l I�, �(�{ ifs I�1 �`h rnSAddress �37!5 �°Lw4t\k Wod��1 M5Fa_d 1 ? (� k)+ -'12 57-23 �+ I��email:f)Tfl�'. fla�Al!Safe�°re Phone# � �S-5�-023�C� Cell# s� t 6/l/2024 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. s .a.7r•of Fes-YOP, ,Cnt -TY Or W src•llt-'SreK 11 ! a.-> : sue_ ,being duty sworn,deposes and 4tates that he/she is the applicant above named, , war of mJn z�tieig���tl�ircamrt� and farther states that 1,0he is the Sprinkler Contractor rot the legal owner and is duly authorized to make and file this- application That all statements contained herein are tnte to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned properly will be in conformance with the details asset forth and contained in this apphcarton and in an) acavrnpam ing approved plans and specifications,as well as in accordance with the New York State Uniform Fite Prevention R Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations -\A— Sworn to to fire me this; � Sworn to before rrw this,��� dal of_J v l 20 day of__J Ltd.._ 20 Jignaturc.+:P r.C).wT,rr \ Signatur-of Applicant y)CJ,- C� Pnn: o Prrwm Oatter '1 Print Name of Appiican., %0 n�i ,: �' Notary Public J CARCA 7. CASSEWMY NOtaiy Public, State of New York No. 4354001 SFpAM F EDWAMS - Qualifiedssin is Westchester CounJ�]`., i otary Public-Sul+of 0 'y+' timiSsion Expires March 26J , _ e+0.OtEt}643+S59 Quatift:d in Westchost+l+"CC&P"V my Commission ExQ+res Jun 2. "Olt r Bulletin 006 May 2022 Relimabld Model RFC Series Residential Sprinklers Flat Concealed Pendent cULus Listed Features • cULus Listed as Residential Sprinklers • Push-On cover plate installation a, • Low water flow requirements Product Description Model RFC30&RFC30LL Model RFC43&RFC43LL Model RFC Series residential sprinklers are flat cover plate, concealed pendent sprinklers intended for installation in accordance with NFPA 13, NFPA 13R,or NFPA 13D.The sprinklers are cULus Listed as Residential Sprinklers in accordance with UL 199. In addition, Model RFCLL Series � r sprinklers are cULus certified for Health Effects to NSF/ANSI/ CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified. Model RFC Series sprinklers are offered with either a 165°F Model RFC49&RFC49LL Model RFCb (74°C)or 212°F(100°C)temperature rated fusible-link operating element.Sprinklers with a 165°F(74°C)temperature rating are ordinary temperature classification and are listed for use with a 135°F(57°C)temperature rated cover plate. Sprinklers with a 212°F(100°C)temperature rating are 1,;-Z intermediate temperature classification and are listed for use with a 165°F(74°C)temperature rated cover plate. Model RFC Series sprinklers are installed with a Model G5 cover plate. Model G5 cover plates are installed by pushing the -z cover plate into the cup and turning in the clockwise direction until it is tight against the ceiling. Model RFC30, RFC30LL, RFC43, RFC43LL, RFC49 and RFC49LL sprinklers allow 112" Model RFC76 Model G5 Cover Plate (13 mm)of cover plate adjustment. Model RFC58 and RFC76 sprinklers allow 3/4" (19 mm)of cover plate adjustment. Model G5 cover plates are available in a variety of finishes as listed in Table H. Nominal K-Factor Max.Coverage Area Listings& Sprinkler Identification Sprinkler Model gpm/psi112(1/min/bar") ft x ft(m x m) Approvals Number(SIN) RFC30 3.0(43) 14 x 14(4.3 x 4.3) cULus RA0611 RFC30LL 3.0(43) 14 x 14(4.3 x 4.3) cULus, LL,WMCS RA3211 RFC43 4.3(62) 20 x 20(6.1 x 6.1) cULus RA0612 RFC43LL 4.3(62) 20 x 20(6.1 x 6.1) cULus, LL,WMCS RA3212 RFC49 4.9(71) 20 x 20(6.1 x 6.1) cULus RA0616 RFC49LL 4.9(71) 20 x 20(6.1 x 6.1) cULus, LL,WMCS RA3216 RFC58 5.8(84) 20 x 20(6.1 x 6.1) cULus RA0613 RFC76 7.6(109) 20 x 20(6.1 x 6.1) cULus RA0618 cULus: cULus listed for Safety to ANSI/UL199 LL: cULus certified for Health Effects to NSF/ANSI/CAN 600 cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G. WMCS:Australian WaterMark certified,certificate number 23347. www.reliablesphnkler.com ModelRFC3 1 & RFC30LL • - • 1 16 11 Technical Specifications Sensitivity Style:Flat Concealed Pendent Fast-response Threads:1/2"NPT or ISO 7-1R1/2 Nominal K-Factor:3.0(43 metric) Temperature Rating Max.Working Pressure: 175 psi(12 bar) Ordinary: Min.Spacing:8 ft.(2.4 m) 165*F(74*C)sprinkler [135*F(57°C)cover plate] Material Specifications Intermediate: Thermal Sensor:Nickel Alloy Solder Link 212*F(100*C)sprinkler Sprinkler Body:Brass Alloy [165'F(74'C)cover plate] Levers:Bronze Alloy 0 Yoke:Brass Alloy Cover Plate Sealing Assembly:Nickel Alloy with PTFE Model G5 Cover Plate Load Screw:Bronze Alloy Towers:Copper Alloy Sprinkler Wrench Pins:Stainless Steel Model FC(without wrench-able cap) �$ Deflector:Bronze Alloy Model W3(with wrench-able cap) Cup:Steel Listings and Approvals* Bottom View � Cover Plate Finishes cULus Listed to UL 199 (See Table H) *Note:RFC30LL is also cULus certified for Health Effects to NSF/ANSI/CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified(certificate number 23347). Model RFC30&RFC30LL Sprinkler Components and Dimensions 2-5/16" (58 mm) Threads — .- Cup Dia. Body -� i Cup Tower _ l 2-5/8"(67 mm) 1-3/4"(44 mm)+/-1/4"(6 mm) f x Hole in Ceiling Fusible Link Nominal face of fitting to ceiling { 3/16" Deflector(retracted) _ _ (5 mm) Pin(extended) — p1fiF'GL - — - Deflector(extended) - 3-5/16" Model G5 Cover Plate — (84 mm) — Ceiling Dia. Model RFC30 and RFC30LL Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure('> Max.Coverage Area tzl Ordinary Temperature Intermediate Temperature(') ft.x ft. Flow Pressure Flow Pressure (m x m) gpm psi gpm psi (1/min) (bar) (1/min) (bar) 12x12 9 9.0 9 9.0 (3.6 x 3.6) (34) (0.62) (34) (0.62) 14 x 14 10 11.0 (4.3 x 4.3) (38) (0.76) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table B above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. Intermediate temperature listing applies to SIN RA0611 only;not applicable to low-lead version. Bulletin 006 Page 2 of 8 May 2022 www.reliablesprinkler.com Model RFC43 & RFC43LL Residential Sprinklers RFC43: SINRA0612 RFC43LL: SINRA32121 Technical Specifications Sensitivity Style: Flat Concealed Pendent Fast-response Threads: 1/2"NPT or ISO 7-1131/2 Temperature Rating Nominal K-Factor:4.3(62 metric) Ordinary: Max.Working Pressure: 175 psi(12 bar) 165°F(74°C)sprinkler Min.Spacing:8 ft.(2.4 m) [135°F(57°C)cover plate] Material Specifications Intermediate: Thermal Sensor:Nickel Alloy Solder Link 212°F(100°C)sprinkler Sprinkler Body:Brass Alloy [165°F(74°C)cover plate] Levers: Bronze Alloy Yoke: Brass Alloy Cover Plate e� Sealing Assembly:Nickel Alloy with PTFE Model G5 Cover Plate Load Screw:Bronze Alloy Towers:Copper Alloy Sprinkler Wrench �Me Pins:Stainless Steel a - Model FC(without wrench-able cap) ^�.� ^��` Deflector:Bronze Alloy Model W3(with wrench-able cap) Bottom\dew � �' Cup:Steel Listings and Approvals' Cover Plate Finishes cULus Listed to UL 199 (See Table H) *Note:RFC43LL is also cULus certified for Health Effects to NSF/ANSI/CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified(certificate number 23347). Model RFC43& RFC43LL Sprinkler Components and Dimensions 2-5/16" (58 mm) Threads — Cup Dia. i Body ` Cup ` 01. Tower - B 1-3/4"(44 mm)+/-1/4"(6 mm) ' - Hole in Ceiling Fusible Link Nominal face of fitting to ceiling /Deflector(retracted) (5mm) Pin(extended) Deflector(extended) —- 3-5/16" Model G5 Cover Plate — (84 mm) — Ceiling Dia. Model RFC43&RFC43LL Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure(') Max.Coverage Area ili Ordinary Temperature Intermediate Temperature ft.x ft. Flow Pressure Flow Pressure (m x m) gpm psi gpm psi (Ilmin) (bar) (1/min) (bar) 15 x 15 12 7.8 12 7.8 (4.6 x 4.6) (45) (0.54) (45) (0.54) 16 x 16 13 9.1 13 9.1 (4.9 x 4.9) (49) (0.63) (49) (0.63) 18 x 18 18 17.5 (5.5 x 5.5) (68) (1.21) 20 x 20 21 23.8 (6.1 x 6.1) (79) (1.64) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table C above and(2)the flow -equired to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006 ReliablE� Page 3 of 8 May 2022 www.reliablesprinkler.com Model RFC49& RFC49LL Residential Sprinklers RFC49: SINRA0616 RFC49LL: Technical Specifications Sensitivity Style:Flat Concealed Pendent Fast-response Threads: 1/2"NPT or ISO 7-1R1/2 Nominal K-Factor:4.9(71 metric) Temperature Rating Max.Working Pressure: 175 psi(12 bar) Ordinary: Min.Spacing:8 ft.(2.4 m) 165°F(74°C)sprinkler [135°F(57°C)cover plate] Material Specifications Intermediate: Thermal Sensor:Nickel Alloy Solder Link 212°F(100°C)sprinkler Sprinkler Body:Brass Alloy [165°F(74•C)cover plate] Levers: Bronze Alloy Yoke:Brass Alloy Cover Plate Sealing Assembly:Nickel Alloy with PTFE Model G5 Cover Plate Load Screw:Bronze Alloy Towers:Copper Alloy Sprinkler Wrench Pins:Stainless Steel Model FC(without wrench-able cap) Deflector:Bronze Alloy Model W3(with wrench-able cap) Bottom View Cup: Steel Cover Plate Finishes Listings and Approvals' - cULus Listed to UL 199 (See Table H) `Note:RFC49LL is also cULus certified for Health Effects to NSF/ANSI/CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified(certificate number 23347). Model RFC49&RFC49LL Sprinkler Components and Dimensions �• 2-5/16" (58 mm) Threads Cup Dia. Body Cup 2-5/8"(67 mm) Tower �R 1-3/4"(44 mm)+/ 1/4"(6 mm) Hole in Ceiling Fusible Link Nominal face of fitting to ceiling - — - 3/16" I l5 mm)Deflector(retracted) — _ �o,oz Pin(extended) ��� i 1 I✓ -_---— -- � Deflector(extended) 3 5/16' Model G5 Cover Plate — (84 mm) Ceiling Dia. Model RFC49&RFC49LL Sprinkler Hydraulic Design Criteria Minimum Flow and Residual PressureM Max.Coverage Area(z) Ordinary Temperature Intermediate Temperature ft.x ft. Flow Pressure Flow Pressure (m x m) gpm psi gpm psi (1/min) (bar) (1/min) (bar) 16 x 16 13 7.0 13 7.0 (4.9 x 4.9) (49.0) (0.48) (49.0) (0.48) 18 x 18 17 12.0 17 12.0 (5.5 x 5.5) (64.3) (0.83) (64.3) (0.83) 20 x 20 20 16.7 21 18.4 (6.1 x6.1) (75.7) (1.15) (79.5) (1.27) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table D above and(2)the flow required to achieve a mini- mum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006 Reliable Page 4 of 8 May 2022 www.reliablesprinkler.com Model • RA0613 Technical Specifications Cover Plate Finishes Style:Flat Concealed Pendent (See Table H) Threads: 1/2"NPT or ISO 7-1R1/2 Nominal K-Factor:5.8(84 metric) Sensitivity Max.Working Pressure:175 psi(12 bar) Fast-response Min.Spacing:8 ft.(2.4 m) ;�e Temperature Ratings Material Specifications Ordinary: Thermal Sensor:Nickel Alloy Solder Link 165°F(74°C)sprinkler Sprinkler Body:Brass Alloy [135°F(57°C)cover plate] Levers:Bronze Alloy Intermediate: Yoke:Brass Alloy 212°F(100°C)sprinkler Sealing Assembly:Nickel Alloy with PTFE [165°F(74°C)cover plate] Load Screw:Bronze Alloy Towers:Copper Alloy Cover Plate Pins:Stainless Steel Model G5 Cover Plate Deflector:Chrome Plated Bronze Alloy Cup:Steel Sprinkler Wrench Bottom View '' Model FC(without wrench-able cap) Model W3(with wrench-able cap) Listings and Approvals cULus Listed to UL 199 Model RFC58 Sprinkler Components and Dimensions 2-5/16" Threads — (58 mm) Cup Dia. Body Cup — Tower ; — � 2-5/8"(67 mm) Fusible Link �� '; 1-7/8"(48 mm) +/ 3/8"(9 mm) Hole in Ceiling Nominal face of fitting to ceiling Deflector(retracted) (5 mm) Pin(extended) �--- Deflector(extended) t 3-5/16" Model G5 Cover Plate (84 mm) Ceiling Dia. Model RFC58 Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressuret'r Max.Coverage Area(2) Flow Pressure ft.x ft. gpm psi (m x m) (1/min) (bar) 16 x 16 16 7.6 (4.9 x 4.9) (60.6) (0.53) 18 x 18 18 9.6 (5.5 x 5.5) (68.1) (0.66) 20 x 20 20 11.9 (6.1 x 6.1) (75.7) (0.82) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table E above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006 Re is Page 5 of 8 May 2022 www.reliablesprinkler.com Model •ential Sprinkler SIN RA0618 Technical Specifications Cover Plate Finishes Style:Flat Concealed Pendent (See Table H) •+ ►.. Threads:3/4"NPT or ISO 7-1 R3/4 Nominal K-Factor:7.6(109 metric) Sensitivity 7 Max.Working Pressure: 175 psi(12 bar) Fast-response Min.Spacing:8 ft.(2.4 m) Temperature Ratings Material Specifications Ordinary: Thermal Sensor:Nickel Alloy Solder Link 165°F(74°C)sprinkler Sprinkler Body:Brass Alloy [135°F(57°C)cover plate] Levers:Bronze Alloy Intermediate: Yoke:Brass Alloy 212°F(100°C)sprinkler Sealing Assembly:Nickel Alloy with PTFE [165°F(74°C)cover plate] Load Screw:Bronze Alloy Towers:Copper Alloy Cover Plate Pins:Stainless Steel Model G5 Cover Plate Deflector:Bronze Alloy Cup:Steel Sprinkler Wrench Bottom View Model FC(without wrench-able cap) Model W3(with wrench-able cap) Listings and Approvals cULus Listed to UL 199 Model RFC76 Sprinkler Components and Dimensions 2-5/16" Threads — (58 mm) -- Cup Dia. Body Cup `F — Tower 2-5/8"(67 mm) Fusible Link 1-7/8"(48 mm)+/-3/8"(9 mm) I.. — — -- - Hole in Ceiling ) _I Nominal face of fitting to ceiling Deflector(retracted) 3/16" 1 ���� I —i � (5 mm) Pin(extended) — — —— Deflector(extended) 3-5/16" Model G5 Cover Plate (84 mm) Ceiling Dia. Model RFC76 Flat Concealed Sprinkler Hydraulic Design Criteria Minimum Flow and Residual PressureN Max.Coverage Area(2) Flow Pressure ft.x ft. gpm psi (m x m) (1/min) (bar) 16 x 16 21 7.6 (4.9 x 4.9) (79.5) (0.52) 18 x 18 24 9.9 (5.5 x 5.5) (90.8) (0.68) 20 x 20 34 20 (6.1 x 6.1) (128.7) (1.4) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table E above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 00670 Page 6 of 8 May 2022 www.reliablesprinkler.com Cover Plate Finishes"� Standard Finishes Special Application Finishes White Paint Off White Paint Black Paint Raw Brass Chrome Bright Brass Finished Bronze Custom Color Painti2) Satin Chrome Stainless Steel Cladi31 Custom Printed Notes: 1. Paint or any other coating applied over the factory finish will void all approvals and warranties. 2. Custom color paint is semi-gloss,unless specified otherwise. 3. Stainless steel clad cover plates are Type 316 Stainless Steel on the finished side and C102 Copper Allow on the back side.Cover plates are not listed or approved as corrosion resistant. Installation Dimensions Recommended Min.to Min,to Max. Sprinkler Cover Cover Plate Hole Diameter Cover Plate Max. Face Dropped Deflector Cover Plate Model Plate Diameter in Ceiling Adjustment of Fitting to Distance below Temperature Model inch(mm) inch(mm) inch(mm) Ceilingi,i Ceiling Rating inch(mm) inch(mm) RFC30, RFC30LL, 135°F" RFC431 3-5/16 2-5/8 112 1-1/2 to 2 112 to 1 (57°C) RFC43LL, G5 (84) (67) (13) (38 to 51) (13 tc 25) or 165°F13i RFC49, (74-C) RFC49LL RFC58, 3-5/16 2-5/8 3/4 1-1/2 to 2-1/4 1/4 to 1 135°Fi2>(57°C)o i3 RFC76 G5 (84) (67) (19) (38 to 57) (6 to 25) o(74°C) Notes: 1. Face of fitting to ceiling dimensions are based on a nominal thread make up.Verify dimensions based on fitting and thread sealing method prior to installation.A 112"x 112"brass nipple extension(Reliable P/N 6999991900)is available where necessary for replacement of existing sprinklers. 2. For use with 165°F(74°C)temperature rated sprinklers where the maximum ceiling temperature does not exceed 100°F(38°C). 3. For use with 212°F(100°C)temperature rated sprinklers where the maximum ceiling temperature does not exceed 150°F(66°C). Installation Model RFC series sprinklers are intended to be installed in Note:When used with gasketed fittings, follow fitting accordance with NFPA 13, NFPA 13R,or NFPA 13D, as well as manufacturer's installation instructions regarding tightening to the requirements of applicable authorities having jurisdiction. achieve a leak-free connection. Model RFC series sprinklers must not be installed in ceilings with positive pressure in the space above. Model RFC series Do not exceed the maximum recommended torque. Exceeding sprinklers are shipped with a wrench-able protective cap that the maximum recommended torque may cause leakage or should remain on the sprinkler until the sprinkler system is placed impairment of the sprinkler. Use care when inserting or removing in service following construction. the wrench from the sprinkler to avoid damage to the sprinkler. Model RFC series sprinklers can be installed without removing Install the cover plate by hand by pushing the cover plate into the the wrench-able protective cap using the Model W3 wrench. cup and turning the cover in the clockwise direction until it is tight Alternatively, Model RFC series sprinklers can be installed using against the ceiling. the Model FC wrench by temporarily removing the protective cap during installation of the sprinkler.The use of any other wrench to installed Model RFC series sprinklers is not permitted and may damage the sprinkler. Fully insert the Model W3 wrench over the cap until it reaches the bottom of the cup,or the Model FC wrench over the sprinkler until the wrench engages the body. Do not wrench any other part of the sprinkler/cup assembly.The Model W3 and FC wrenches are designed to be turned with a standard 1/2"square drive.Tighten the sprinkler into the fitting after applying a PTFE based thread sealant to the sprinkler's threads. Recommended installation torque for iron pipe fittings is 8 to 18 ft-Ibs(11 to 24 N-m)for 1/2"thread sprinklers and 14 to 20 ft-Ibs(19 to 27 N-m)for 3/4"thread sprinklers. Bulletin 006 ReliablC Page 7 of 8 May 2022 www.reliablesprinkler.com Installation Wrenches Model FC Model W3 For use with Model RFC Series sprinklers For use with Model RFC Series sprinkler3 with " without wrench-able cap installed wrench-able cap installed Service/SpareListings and Approvals cULus Listed for Safety to ANSI/UL199 Model W8 Additional Listings for RFC30LL, RFC43LL,and RFC49LL: High-strength plastic wrench cULus Certified for Health Effects to NSF/ANSI/CAN for limited(emergency) 600 use with Model RFC Series cULus Certified less than 0.25% Lead Content to NSF/ sprinklers without wrench-able cap installed. Meets NFPA ANSI 372 Annex G. requirements for sprinkler Australian WaterMark Certified,certificate number wrench on premises. 23347. Patents Model RFC30, RFC30LL, RFC43, RFC43LL, RFC49, RFC49LL, RFC58,and RFC76 sprinklers are covered by U.S. Patent No. 9,248,327 and U.S. Patent No. 7,275,603. Maintenance Model RFC30, RFC30LL, RFC43 and RFC43LL sprinklers are Model RFC series sprinklers should be inspected and the additionally covered by U.S. Patent No.8,776,903. sprinkler system maintained in accordance with NFPA 25. Do not clean sprinklers with soap and water, ammonia or any other cleaning fluids. Remove dust by gentle vacuuming. Replace any Ordering Information sprinkler cover plate assembly which has been painted(other Specify the following when ordering. than factory applied)or damaged in any way.A stock of spare sprinklers should be maintained to allow quick replacement of Sprinkler damaged or operated sprinklers. Prior to installation, sprinklers Model(RFC30, RFC30LL, RFC43, RFC43LL, should be maintained in the original cartons and packaging until RFC49, RFC49LL, RFC58, RFC76) used to minimize the potential for damage to sprinklers that would Temperature Rating cause improper operation or non-operation. Cover Plate • Model G5 Guarantee • Temperature Rating • Finish(See Table H) For the Reliable Automatic Sprinkler Co., Inc. guarantee, terms, Sprinkler Wrench and conditions,visit www.reliablesprinkler.com. Model FC - Model W3 • Model W8(Limited use) N O ti O m O O O Z �,e d Bulletin 006 Page 8 of 8 Re la Ei May 2022 www.reliablesprinkler.com HYDRAULIC CALCULATIONS FOR oF NE�,� ALL SAFE FIRE SPRINKLER CORP 0 ��P NI1LLIq,� CO 375 EXECUTIVE BOULEVARD S 'F ELMSFORD, NEW YORK 10523 (888) 325-5723 ',' � r DATE: June 13, 2023 �p 059212 JOB NAME: Legalization of Basement Only SS1(����� LOCATION: 96 Bellefair Road - Rye Brook, New York 10573 JOB NUMBER: J-2044-23 DRAWING NUMBER: 1 OF 1 SYSTEM NUMBER: 1 OF 1 CALCULATED BY: Jamie Koutsoftas CEILING HEIGHT: 10 '-0" -SYSTEM DESIGN DATA- CODE: N.F.P.A. #13D REVIEW AGENCY: Local Authority OCCUPANCY CLASSIFICATION: Residential Hazard CONSTRUCTION TYPE: Wood Frame SYSTEM TYPE: Wet Tree DENSITY: .05 gpm/sq. ft. FILE COPY AREA OF APPLICATION: Basement NUMBER OF SPRINKLERS CALCULATED: 2 sprinklers (16'xl6' ) FLOW AND PRESSURE (@ BOR) : 26.2 gpm @ 30.3 psi FLOW AND PRESSURE (@ SUPPLY POINT) : 36.2 GPM @ 82 .7 PSI TYPE OF SPRINKLER CALCULATED: Make: Reliable Model: RFC49 SPRINKLER ORIFICE and THREAD SIZE: Orifice: 1/2" Size: 1/2" Thread SPRINKLER K-FACTOR: 4 . 9 Tempreture Rating: 165 Degree -WATER SUPPLY TEST INFORMATION- Source: City Supply Test By: Veolia Westchester Inc. Location: Bellefair Road, Rye Brook Elevation: 0' Static: 100 psi NOTES: RD E C" IE �W FE D JUL 17 2024 3 VILLAGE OF RYE BROOK BUILDING DEPARTMENT SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 2 DATE: '6/14/2023 C: \HASS CALCS\46 BELLEFAIR(SYS 1) .SDF JOB TITLE: LEGALIZATION OF BASEMENT ONLY WATER SUPPLY ANALYSIS Fixed Source Pressure: 100. 00 psi 120 .0 LEGEND 100. 01 1 1 Available pressure 100.00 psi @ 36.2 gpm G 2 Required pressure A U 80 . 0 2 82 .71 psi @ 36.2 gpm G E A. Source Supply Curve B. System Demand Curve 60.0 P R E S 40 . 0 S U R E 20. 0 p B s 0 .0 i -14 .7 20 30 40 50 60 70 80 90 100 FLOW (GPM) Note: (1) Dashed Lines indicate extrapolated values from Test Results SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 3 DATE: '6/14/2023 C: \HASS CALCS\46 BELLEFAIR(SYS 1) .SDF yMB TITLE: LEGALIZATION OF BASEMENT ONLY NFPA WATER SUPPLY DATA SOURCE STATIC RESID. FLOW AVAIL. TOTAL REQ'D NODE PRESS. PRESS. @ PRESS. @ DEMAND PRESS. TAG (PSI) (PSI) (GPM) (PSI) (GPM) (PSI) SOURCE (N/A) 100.0 (N/A) 100. 0 36.2 82 .7 Available pressure is 17 .3 psi (17%) greater than required pressure. AGGREGATE FLOW ANALYSIS: TOTAL FLOW AT SOURCE 36.2 GPM TOTAL HOSE STREAM ALLOWANCE AT SOURCE 0 .0 GPM OTHER HOSE STREAM ALLOWANCES 10.0 GPM TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 26.2 GPM NODE ANALYSIS DATA NODE TAG ELEVATION NODE TYPE PRESSURE DISCHARGE (FT) (PSI) (GPM) S1 15. 0 K= 4 . 90 7 . 0 13.0 S2 15.0 K= 4 . 90 7 . 3 13.2 Al 15.0 - - - - 8. 3 - - - A2 15.0 - - - - 10. 9 - - - A3 15.0 - - - - 13. 9 - - - A4 15.0 - - - - 16.7 - - - A5 15.0 - - - - 21.8 - - - M1 11 .0 - - - - 25.3 - - - M2 11.0 - - - - 30.3 - - - M3 11.0 HOSE STREAM 32. 0 10.0 M4 8.0 - - - - 34 .2 - - - M5 8.0 - - - - 39.2 - - - M6 0.0 - - - - 47 . 6 - - - SOURCE 0.0 SOURCE 82 .7 36.2 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 4 DATE: '6/14/2023 C:\HASS CALCS\46 BELLEFAIR(SYS 1) .SDF J.OB TITLE: LEGALIZATION OF BASEMENT ONLY NFPA PIPE DATA 5 Pipe Tag K-fac Add F1 Add Fl To Fit: L C (Pt) Frm Node El (ft) PT (q) Node/ Nom ID Eq.Ln. F (Pe) To Node E1 (ft) PT Tot. (Q) Disch Act ID (ft. ) T Pf/ft. (Pf) Pipe: 1 4 . 90 13.0 Disch 15.00 120 1.2 Al 15. 0 8.3 0.0 A1 . 000 3E: 6.0 6.00 -0.0 Sl 15. 0 7.0 13.0 1.049 21.00 0.059 1.2 Pipe: 2 4.90 13.2 Disch 5.00 120 1.0 Al 15.0 8.3 0.0 A1 . 000 3E: 6.0 11.00 -0.0 S2 15.0 7.3 13.2 1 .049 T: 5.0 16.00 0.061 1 .0 Pipe: 3 0. 0 0. 0 5.00 120 2. 6 A2 15.0 10. 9 26.2 A1.000 E: 2.0 7 .00 -0.0 Al 15.0 8. 3 26.2 1.049 T: 5.0 12 .00 0.215 2 .6 Pipe: 4 0.0 0.0 14.00 120 3. 0 A3 15.0 13.9 26.2 Al A1 . 000 ---- 0.00 -0 .0 A2 15.0 10.9 26.2 1 . 049 14.00 0.215 3 .0 Pipe: 5 0.0 0.0 11.00 120 2 .8 A4 15.0 16.7 26.2 A2 A1 . 000 E: 2 . 0 2.00 -0 .0 A3 15.0 13.9 26.2 1 . 049 13.00 0.215 2 .8 Pipe: 6 0.0 0.0 18.00 120 5.2 A5 15. 0 21.8 26.2 A3 A1.000 3E: 6.0 6.00 -0.0 A4 15. 0 16.7 26.2 1.049 24.00 0.215 5.2 Pipe: 7 0.0 0.0 5.00 120 3.5 M1 11.0 25.3 26.2 A4 A1.000 E: 2.0 3.00 1.7 A5 15.0 21.8 26.2 1.049 G: 1.0 8.00 0.215 1.7 Pipe: 8 0.0 Fixed Pressure Loss Device M2 11.0 30.3 26.2 A5 5.0 psi, 26.2 gpm M1 11.0 25. 3 26.2 Pipe: 9 0 .0 0.0 3.00 150 1 . 8 M3 11 .0 32 .0 26.2 Ml L1.000 T: 7 .0 8.00 -0 . 0 M2 11 . 0 30.3 26.2 1.025 G: 1.0 11.00 0. 159 1 . 8 Pipe: 10 H.S. 10.0 Disch 3.00 150 2 .2 M4 8. 0 34.2 26.2 M2 L1.000 ---- 0.00 1 .3 M3 11 . 0 32.0 36.2 1.025 3.00 0.289 0 . 9 Pipe: 11 0.0 Fixed Pressure Loss Device M5 8.0 39.2 36.2 M3 5.0 psi, 36.2 gpm M4 8.0 34 .2 36.2 Pipe: 12 0.0 0.0 10.00 150 8.4 M6 0. 0 47. 6 36.2 M4 L1.000 2E: 6.0 7.00 3.5 M5 8. 0 39.2 36.2 1.025 G: 1.0 17.00 0.289 4. 9 Pipe: 13 Source 0.0 4E: 8.0 90.00 150 35.1 SOURCE 0. 0 82.7 36.2 M5 K1.000 T: 6.0 15.00 -0.0 M6 0. 0 47.6 36.2 0. 995 G: 1.0 105.00 0.335 35.1 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 5 DATE: `6/14/2023 C:\HASS CALCS\46 BELLEFAIR(SYS 1) .SDF ,JOB TITLE: LEGALIZATION OF BASEMENT ONLY NOTES (HASS) : (1) Calculations were performed by the HASS 2023 D computer program in accordance with NFPA (2020) under license no. 64621632 granted by HRS Systems, Inc. 208 Southside Square Petersburg, TN 37144 (931) 659-9760 (2) The system has been calculated to provide an average imbalance at each node of 0.001 gpm and a maximum imbalance at any node of 0.005 gpm. (3) Total pressure at each node is used in balancing the system. Maximum water velocity is 15.0 ft/sec at pipe 13. (4) Items listed in bold print on the cover sheet are automatically transferred from the calculation report. (5) Available pressure at source node SOURCE under full flow conditions is 100.00 psi with a flow of 40.42 gpm. (6) PIPE FITTINGS TABLE HASS Pipe Table Name: standard PAGE: A MATERIAL: S40 HWC: 120 Diameter Equivalent Fitting Lengths in Feet (in) E T L C B G A D N Ell Tee LngEll ChkVly BfyVly GatVly AlmChk DPVly NTee -------------------------------------------------------- F F45Ell 1.049 2 .00 5.00 2 .00 5. 00 6. 00 1 . 00 10.00 2 .00 5.00 1.00 PAGE: K MATERIAL: CT-K HWC: 150 Diameter Equivalent Fitting Lengths in Feet (in) E T F R K C G N Ell Tee 45-Ell TeeRun Kouplg ChkVly GatVly NPTee 0. 995 2.00 6.00 1.00 2.00 0.00 6.00 0.00 6.00 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 6 DATE: *6/14/2023 C:\HASS CALCS\46 BELLEFAIR(SYS 1) .SDF 30B 'TfTLE: LEGALIZATION OF BASEMENT ONLY PAGE: L MATERIAL: CT-L HWC: 150 Diameter Equivalent Fitting Lengths in Feet (in) E T F R K C G N Ell Tee 45-Ell TeeRun Kouplg ChkVly GatVly NPTee 1.025 3 .00 7.00 1.00 2.00 0.00 7.00 0.00 7 . 00 JJ Building Permit Check List&Zoning ARdysis `` l q Address: ''-I Gp w� I ( ��-� SBL: �d 1, 73 Zone:V. n Us • 2 �(� Const.Type:� Other. Submittal Date: Revisions Submittal Dates: Applicant: Nature of Work �— 2 ✓ N S Reviews:ZBA: MAR pt 3 2023_PB:_ _o T: Other. _ NIEFd2 QIC �` �\ ( ) ( FEES:Filing: BP: Cy : 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: ( ) (-PLANS:Date Stamped: °% Sealed. Copies: Electronic Other. ( ) ( ;License 'Workers Comp: Liability: Comp.Waiver. Other. ( ) ( ) CODE 753A Dated: N/A: (HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. (� (�FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) Permit: Nat. Gas: LP Gas: N/A/: Other. (� ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval• notes: ( )ZBA mtg. date: approval: notes: ( )PB mtg.date: approval• notes: REOLMED EXISTING PROPOSED NOTES Area: ■� r `�' Circle: S 9. Froze Front: Front: Sides ReAr. Main Cov Accs.Cov Ft.HS : S .H Sb: Trot,!=: F Ire : PkinQ HHight/Stories: notes ► �s t�••�,�2. -� Z 2. O� 3r i9 it r Asm.—..',Afaauetien.fat. F — 8—d1/Durrfan I EB 3 2023 8.11.Feu BI.A.R-N s k.K.Y.I/J73 November 16, 2022 VILLAGE OF RYA. BROOK BUILDING DEPARTMENT BelleFair ARB 24 Bellefair Blvd Rye Brook, New York 10573 David Lobel 46 BelleFair Road Rye Brook, New York 10573 Re: Installation of a Window Wall Et Egress Window in Basement Dear David, We write in response to your request to the ARB for approval of the installation of a window wall and egress window in the basement situated at 46 Bellefair Road, Rye Brook, New York. We are pleased to inform you that based on the details of your application, your application has been approved. Once this planting is complete contact our FirstService representatives, Rafael Reyes or Michael Napolitano so that a final inspection may take place. Please be advised that our approval will be expressly conditioned upon your continued compliance with Schedule D of the Declaration. Accordingly, if the aforementioned fails at any time to comply with the Regulations, the ARB reserves the right to direct modification or the removal of the improvements at your sole expense to ensure compliance. Please note that approvals are valid for one year as of the date of this letter. As a reminder, certain alterations will require the approval of the Village of Rye Brook's Building Inspector or Engineer. You shall be responsible for obtaining all required approvals and permits. The Village of Rye Brook will consider applications after BelleFair ARB approval is given. The Village of Rye Brook approval does not preclude the need for ARB approval, nor does ARB approval relieve you from any responsibility of obtaining Village of Rye Brook approval. If you have any questions, please do not hesitate to contact us. Very truly yours, The BelleFair Architectural Review Board J .rj.• res F Client#: 2498 ALLSAF2 ACORD CERTIFICATE OF LIABILITY INSURANCE DATDIYYYYi z/20/20o/2o2a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF71CATE 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 any rights to the certificate holder in lieu of such endorsement(s). CURT—PRODUCER NAME: Commercial Support Edgewood Partners Ins. Center PHONE 631-390-9700 631-390-9790 AIC No Ext: A/C,No 40 Marcus Drive E-MAIL ADDRESS: P NEConstructioncerts@ a icbrokers.com 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Melville, NY 11747 INSURER A:Crum&Forster Specialty Insurance Co 44520 INSURED INSURER B:NorGUARD Insurance Company 31470 All Safe Fire Protection8�Mechanical Inc Merchants Mutual Insurance Company INSURER C: Pa Y 23329 All Safe Fire Sprinkler Systems Inc INSURER D 375 Executive Blvd INSURER E: Elmsford, NY 10523 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR _ INSR WVD POLICY NUMBER MM/DD MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y GLOO99737 9/11/2023 09/11/2024 EACH OCCURRENCE $11000000 CLAIMS-MADE 4 OCCUR pAMA EIJTED PREM�I;�EsT EaaITED;currence) $50,000 X BI/PD Ded:5,000 MED EXP(Any one person) $5 000 X Contractual Liab. PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I xI ECTPRO- —1 LOC PRODUCTS-CO MP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY CAP9269941 9/16/2023 09/16/2024 COMBINED SINGLE LIMIT 1,000,000 Ea accident ANY AUTO BODILY INJURY;Per person) $ AUTOS ONLY X WNED SCHEDULED AUTOS BODILY INJURY Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Par accident $ A UMBRELLA LIAB X OCCUR SE0125991 9/27/2023 09/11/2024 EACH OCCURRENCE $1 OOO 000 �( EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 A DED RETENTION$ SE0125991 9/11/2023 09/27/202 Occur/A $1 000 000 WORKERS COMPENSATION ALWC450938 9/16/2023 09/16/202 X STR OTH- BANDD EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT $1,000,000 OFFICER,'MEMBER EXCLUDED? F_N] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured for general liability coverage as required by written contract. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6331674/M5997748 CCA03 YoaK NEw Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured II Safe Fire Sprinkler Systems,Inc. 914 773-7602 375 Executive Blvd - Elmsford, NY 10523 1 c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State.i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 473975166 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NorGUARD Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street ALWC450938 Rye Brook,NY 10573 3c.Policy effective period 09/16/2023 to 09/16/2024 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/ofcers 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 tha-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 ce tificate 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: Leonard Scioscia (Print name of authorized representative or licensed agent of insurance carrier) .fie Approved by: 2/27/24 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 631-390-9700 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 JO Q. "A z,. c . . . . . . . ...... . . . co C\I !t o C\j M cm C\I iE rA ca ... ....... ..... cl 40. A-0 of. 01 zs C4 LO lo I, kiectioll LLI LU LU z 4. 0 Z co > Cd LO 4. MO, f rA —--------..... . ... . . . . . . o l g -0%l\ 5i ► TiI : x g t g , igw. WO , AVf w .aCo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 02/02/2023 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 provisional 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: Cole Lahey PF Northeast Brokerage Inc PHONE (845)223-8107 FAX (845 227-8816 1035 Route 82E-MAIL En (A/C.No. ) ADDRESS: clahey@pfnortheast.com _ INSURER(S)AFFORDING COVERAGE NAIC e Hopewell Junction NY 12533 INSURER A: Ohio Casualty Ins Co. 24074 INSURED INSURER B: West American Insurance Company 44393 T Squared Contracting Inc. INSURER C 157 Tibbetts Road INSURER D INSURER E: Yonkers NY 10705 INSURER F: COVERAGES CERTIFICATE NUMBER: CL22122114375 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 DDL UBR f6_L1_Cy_E_F_F_ 1 Y EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMBS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 CLAIMS-MADE ®OCCUR PREMISES Eaoccurrencei S 300,000 Contractual Liability MED EXP(Any one person) $ 15.000 A BLO55885582 12/11/2022 12/11/2023 PERSONAL a ADV INJURY $ 1.000.000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000.000 POLICY ®JPERCOT- LOC PRODUCTS-COMP/OP AGG $ 2.000.000 OTHER. $ AUTOMOBILE LIABRJ(TY COMBINED SINGLE LIMIT $ Ea accident 1,000.000 ANYAUTO BODILY INJURY(Per person) S A OWNED OS ONLY AUTOS BA055885582 12/11/2022 12/11/2023 BODILY INJURY(Per acadenq $ HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY PRO accdim $ $ X UMBRELLA UAB I X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS�LIIAB ri CLAIMS-MADE US055885582 12/11/2022 12/11/2023 AGGREGATE g 5.000.000 RETENTION$ 10.000 $ WORKERS COMPENSATION �/ PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER B ONY FFICER EMBER/PARTNER/EXECUTIVE ❑ NIA XWW58749528 04/02/2022 04/02/2023 E.L.EACH ACCIDENT $ 1.000.000 (Mandatory EXCLUDED' (Mandatory in INN) E.L.DISEASE-EA EMPLOYEE g 1.000. It yes describe under 000 . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT g 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 l/r`�� 'K,1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (914)965-5955 T Squared Contracting Inc. 157 Tibbetts Road lc NYS Unemployment Insurance Employer Yonkers,NY 10705 Registration Number of Insured Work Location of Insured (Only required if coverage is Id.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 36-46971" 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) West American Insurance Company 3b.Policy Number of entity listed in box"la" Village of Rye Brook XWW58749528 938 King Street Rye Brook,NY 10573 3c. Policy effective period _4/2/2022 to 4/2/2023 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partner%tofficers included) X 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 "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3AA on the INFORMiATION 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"211 . The Insurance Carrier will also notify the above certificate holder 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 113c11, whichever is earlier. Please Note: Upon the 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 bolder 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: Joseph W.Pires (Print nameofthorized representative or licensed agent of insurance carrier) Approved by: � 2/2/2023 (Signature) (Date) Title: President—PF Northeast Brokerage Inc. Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 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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