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HomeMy WebLinkAboutMP24-080PERMIT # /— O DATE; SECTIQN MENi 3 BLOCK LOT 3 //-- TYPE OF WORK /.(� a ral 4S /J e/Q7'fJ� JOB LOCATI N Poe ri V2 OWNER 17 & S1,44,Q/ Q/Q S lJ �giy)Adell� /ago CONTRACTOR u / ro PC % .s LC % 7 5 3 ado �To COSTS O — FEE YCO # FE ' L ' DATE S TCO # FEE DATE DATE INSP FOOTING FOUNDATION FRAMING - RGH FRAMING INSULATION PLUMBING O RGH PLUMBING/ GAS - 3 o. do �u - SPRINKLER ELECTRIC mr,9—�y LOW -VOLT C7 ALARM C] AS BUILT OPAO- CA FINAL M/14��luM6��y way nino E/ec4f�i co OTHER APPROVALS ARB BOT P8 zBA Emma OTHER DRS � t� 1q 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 David M. Heiser Donald T.Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 15,2025 Vincent Barbarisi&Barbara Goldstein 1 Rock Ridge Drive Rye Brook,New York 10573 Re: 1 Rock Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 135.43-1-36 Mechanical Permit#24-080 issued 6/13/2024 for a New Generator This certifies that the 18kw natural gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to For office use only BUILDING DEPARTMENT PERMIT# -r�SG VILLAGE OF RYE BROOK ISSUED: v 8 KING STREET,RYE BROOK,NEN PORK 10573 DATE: LjI — D (914)9, 9-0668 FEE:- / PAID ! NOV 2 6 2024 NvWW,[j rooknv.gov L. VILI_, APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, BUILL;iv 1, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION wrsssswsssrsswsssrrsss.wsssssswsswswsstsssssswwsssssssssssarrwsssssstsssssssssssssssssrsrsssrssrwasssssssssssswwsswstssswssss Address: Z /*'L Occupancy/Use: Ae s Parcel ID #: 2 3 — gyp Zone: Owner:ZAa.bAx6 Address: /Z&p,A—,,,e�-e A'K-1 yr P.E./R.A. or Contractor, Address: <_y Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW Y RK, OUNTY OF WESTCHESTER as: duly sworn,deposes and says that he/she resides at (Print Nat I cat t County L/ (No ai sheet) oI Ix in ,in the of � ���� in the State of l that tot% fox%n'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:S for the construction or alteration of: /.ys T.d/l-s To.� �f i�/�.� �� ram'a.ye.c.s cz P.✓ea a�.� Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to befo me this Sworn to before me this day o /V a✓e/l�l , 20� day of , 20 Signature of Pro/p�erty O ner Signature of Applicant At4le/ P�am roperty Ow Print Name of Applicant Notary Public Notary Public MICHELE WFQTHFIMER FREDMANI No. FR4%3604 Oualified In Westchester Cuu Commission Expires 07/02/20& DRC�� w � BUILDING DEPARTMENT ❑BUILDING INSPECTOR 9SSISTANT 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.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:A____ Lam-- �_�S.• 2_\�`� DATE: 12. 2-0 24 PERMIT#_ 4q _ ISSUED:A ;3&SECT:13654/3 BLOCK: LOT:3�o LOCATION: � OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Er-'ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION .off-FINAL LU CiL M U-Cl O• lC . BOTHER /SS 141 �E BRC�� cu � 1982 BUILDING DEPARTMENT VLDING INSPECTOR ISTANT 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 : DATE: PERMIT# ISSUED: 'SECT: - BLOCK: LOT:3 0 LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑" ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION I a ( REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE lv/ ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS L L W o ❑ L.P. GAS Lo SC ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Tcf FINAL `om, ❑ OTHER by l C e„ , C �yE BRC�k• • 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 :- , �C_� " �CP_- ��Z \��J DATE: PERMIT# �' 1 ISSUED:2_"�' L� SECT: /3 S'�3 BLOCK: ; LOT: LOCATION: � \� P 7 t Ju\0 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 \T)" ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER } 15, 20 P'LP SERI 25 30 35 kPa psi �rT 'l _ a O H � _ 00 W NOC ar _ 72 : .ter y 0Ey a _ 'cnJ x u o. O / O to ai � v OGp cm v ; R" a w t� � •d -[ O ` Q o �I W ° Q ° L (U4, A ` sa W H O $ Y H o 3.�Q ■ � � � O � W H C O � ° 0. Ln ow q ^� �a o 41 Q O x rT = o cu to z O 11 N v t200 G _ � w 00 � �--� z rn A © q U U � : 7 Wz � Q v con a s Fri G1 hl M Ix ° 11 Z , w %t� [ c� c.' �y v a _ DD x H I ~ OUG d Q y O5: p. s H a . � W .� O Q k N w w W z w w '7 O a , °' o v >~ o . v cr s ►-� U R: W �"'� F Q O «c a a W p z o O ° z W o O I ° A W z F @ wo (d� � E o � t�+ a u b x Q C.) ] ►7 y a 416 ■ w w BUILDING DEPARTMENT IECIEMED VILLAGE OF RYE` OOK MAY Z 4 2024 938 KING STT RYE BRO ,NY 10573 4�939-06 VILLAGE OF RYA BROOK wwryebrook.or� BUILDING DEPARTMENT FOR OFFICE USE ONLY: P��_ Approval Date: �4 er it# nRo Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: I © Permit Fees: APPLICATION TO INSTALL A PERMANENT STANDBY BACKUP GENERATOR Application dated:) JL is hereby made to the Building Inspector of the Village of Rye Brook for the issuance of a Permit to install a permanent standby backup generator in accordance with§250-4.1.of the Code of the Village of Rye Brook,as per detailed statement described below. Please note that electrical and plumbing permit applications must be filed separately by those licensed professionals,and that separate permits are required for the installation of any related fuel tanks. Further note that all applications for commercial use will require a site plan approval from the Village Planning Board prior to the issuance of any permit. I. Job Address: _:;I, �d� ,� /2i o e ��,✓t�t - - 2. Parcel ID#: s/ —1— 62 Zone 3. N.Y. State Construction Classification: �J N.Y.State Use Classification: 4. Proposed Generator&Fuel Type(Describe in detail): 5. Property Owner: ,Q �,Fr� Address: /� a , '-e Phone# /-Q/d Cell# , -'-2 "2 email: �ji¢,c6•�,we ,avow �-�„�v Applicant: 'e-D �!try� � << , GGC g•J. �sr-. Address: �/J .vlG Phone# � QG Cell# l ^J' Lo email:/Ote,"/a rpa yrJ t,� Architect or Engineer(if applicable): Address: Phone# Cell# email: General Contractor: ,0i-44-4�AZ)oT liux j7`W %faAal--aF.GGC Address: �!� �wl '�-S g rt<P Phone Cell# /7- �j� email: i A4,p eOgPuxe� t 6/1/2023 6. Give exact dimensions from proposed generator to lot lines: front yard: Z49& " rear yard: 5C7 right side yard: 4 J, _left side yard: /l,S 7. If building is located on a comer lot,which street does it front on: 8. Will the proposed project disturb 400 sq.ft.or more of land,requiring a Stormwater Management Control Permit from the Village Engineer as per Chapter 217 of the Code of the Village of Rye Brook'? Yes: No: /"-' 9. Will the proposed project require a Site Plan Review by the Village Planning Board as per Chapter 209 of the Code of the Village of Rye Brook? Yes: No: provide detailed drawings as per Chapter 2W 10. Will the proposed project require a Steep Slopes Permit as per Chapter 213 of the Code of the Village of Rye Brook? Yes: No: provide a detailed topographical survey) 11. Is the lot or any portion thereof located in a Wetland as per chapter 245 of the Code of the Village of Rye Brook? Yes:�No: r(provide a detailed survey indicating the Wetland&Buffer Zone) 12. Is the lot or any portion thereof located in a Flood Zone as per the FEMA Flood Insurance Rate Map#36119CO279 dated 9/28/07? Yes: No: V 13. Will the proposed project require a Tree Removal Pen-nit as per Chapter 235 of the Code of the Village of Rye Brook? Yes:�No: tree replanting schedule may be required) 14. Does the proposed protect involve a Home-Occupation as per Chapter 250-38 of the Code of the Village of Rye Brook? Yes: _No: � If so, indicate: TIER I: TIER It: TIER Ill: 15. What is the total estimated cost of construction: S —cp (�/b, Q j—D (The estimated cast shall include all site improvements,labor,material,scaffolding,fixed equipment,,professional fees,and material and labor which may be donated gratis) 16. Estimated date of completion: S���TF OF NE'W' )' RK,C UN Y F WESTCHESTER ) as: i7a_r-k 04— M ,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.i That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed.or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of RZ , 20 day of , 20 Signature of Property wire Signature of Applicant Print Nam of Property Owner Print Name of Applicant No P411c �e'�"'�r�"u rl3i� Notary Public This application must be propeYly completed in its entirety and must include the notarized slgnature(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. 2 6/1!2023 r N N N N W ►. N N N O \ V w � `e) cu w `•' r" v' x `�f � _ let, yr o c� a oLO Ll x • r tn00 � Z u " W C • t �q �, N z wrA W � ` Ate ~ O ti w O �, 0-4 . z � W � O C7 w � Z o a 000 ow t O s ~ H A c7 �z a A V r M�� CIS 00 rn w Q N ►Z 00 !�! V R. w B o itp zz ►� w a � a V U. 0 Cl) o z x W z a p O [o. a w w w oa �I a e az w ac , yE,BR D / LF, i BUIL MENT ` JUL - 5 2024 ID V>Z, E cif Rom: ox 938 KIN 1✓T:RYEB NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or - ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY - : /y��`7 ��O EP#: Approval Date: rj- '- 2 o 4,1 Permit Fee: S / Approval Signature: �.c &L Other: Application dated,7/2/24 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. 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 Rock Ridge Dr, Rye Brook NY 10573 SBL: 135.43-1-36 Zone: Ce-/d 2.Property owner:Barbara Goodstein Address: Same Phone#: Cell#: email: 3,Master Electrician: Angelo Zaccagnino Address:_81 Maple Ave, Rye NY 10580 Lic.#: 755 Phone#: 914-921-3244 Cell#: email: Office@Zaccagnino.net Company Name: Zaccagnino Electric Address: 4.Proposed Electrical Work/Fixture Count: Wiring of 18kw generac generator 5.31 Party Electrical Inspection Agency: SWIS STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: AnqPIn a . agnino ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Electrician 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 Cqde of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Swo kforme rehis Sworn to befo a thisda of ,20 day of )20 � e of Property er Signa a of p i Print Name of Property Owner Print Ndme of Applicant STEVf NON Notate PUELtC- ATF Of NEW YORK NotaryXssic t�N No. 0 238 71n ' NEW YORK Qualified stchestw Count l►t1� N231f My Commission Expires October 14, d_-T_ Qualifietbf CountyMy Commisbor 1� STATEWIDE INSPECTION SERVICES, INC. I81 Main Street,Fishkill, NY 12524 1 emoil:office@swisny.com SWIS JOBAPPLICATION tel845.202.7224 • • 1•21 SWISNY.com I SWISTraining.corn Office Use Elect.Permit# Date 4� c (0 ^ Utility ID# Final Certificate## L/J U City/Village �`._ Zip Township J�GC County Address Cross Street Section Sr,, Block I Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information UL - 5 2024 FJ- VIL LAGE OF RYE BROOK BUILDING DEPARTMENT_ ? r r This application Is valid for one(1)year from the date received by SVAS.This application is intended to cover the above listed items to be Inspected,if at any time of inspection additional kerns haw ban installed,you am authorized to make the inspection and adjust the fee for the additional ttems Inspected.The applicant declares that there Is no open applications for the above address with any other Inspection company.The applicant,owner or autlsotlzed agent agrees to sll the above temp and wndfdons as se[forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# D ! State Wide Inspection Services 1080 Main Street Fishlihkill, NY 12524 AUG 19 2024 845 202-7224 Phone swus VILLAGE OF RYE BROOK 914-219-1sny Fax STATE 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: Zaccagnino Electric Vincent Barbarisi& Barbara Goodstein Angelo P.Zaccagnino 1 Rock Ridge Drive 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 1 Rock Ridge Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-142 135.43 1 36 Certificate Number: 2024-5704 Building Permit Number: MP24-080 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: 1 Rock Ridge Drive, Rye Brook, NY 10573 The Exterior was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 19t'day of August 2024. Name Quantity Rating Circuit Type Generator 01 18KW ATS 01 200AMP 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. ■ L ' � w N N ^ O W ' QI 00 00 'fit z ado _ va v w lZ • h..� r' z z A wo x = . Q 0 H o x g V) PO ■ O Lr) w IS W o w F-4 a O �1 w O a Z y O o V = w : O00 O � � z � 0 _ o z z M w z =_ on OC) Z A w ,�, ■ s M M o ' of U P�1 O �- _ A V Za w O Z zCA 0 Cn V N U $ V a x o � �..., _ z a 09a �I m a a w z < _ _ _ BUILDING DEPARTMENT RL' AU!G2 6 202 D VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 ._ BUILDING DEPARTMENT (914)939-0668 www.ryebrookny.gov PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY �gP-kr /�' � ©�� PP#: Approval Date: v Permit Fee: S Approval Signature: Disapproved: (fees are non-refundable) ************************************************************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IDS/12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 )&—c -/ is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of Application dated, L—c a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: /� G p�a• 42 • SBL: 3 Zone: I 2.Proposed Work: /t Sly eta 3.Property Owner: a GL Address: Phone#: Cell #: email: 4.Master Plumber: .0 Address: j!'�>/W �o!oVe an /a/ Lic.#: Phone#:IF*-40'CX-yr-ys—Cel1 #: 71#1—VO_F email: G1/Jl��r�or•o�GLGO,� Company Name: iy � �Address:�3OW O/�!� l*oy ! /1� &w!'sC2�6eQ INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 3,d Floor 4'Floor 5'Floor Exterior 5.* List Other Equipment/Provide Details: 'eG4 �`r O�/�y -5-�e//Ji; (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 STATE OF NEW YORK,//COUNTY OF WESTCHESTER ) as: �ie,1tk&/ 6;a, �fd ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individuai signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this �)�o Sworn to before me this day of ,20 � day of 20- Signature of Pro M Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant NotLLO N�tary Public,State of New York No P I MEe of Nott�ry Public,State of New York No.01ME6160063 No.01ME6160063 Qualified In Westchester County Qualified In Westchester County Commission Expires January 29,20a Commission Expires January 29,20Z---7 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/1/2024 BUILDING DEPAR MENT DD VILLAGE OF RYE OOK AUG 2 6 2024 938 KING STREET RYE BR ,NY 10573 (, �9 � VILLAGE OF RYE BROOK www rVemol>t ov BUILDING DEPARTMENT Iyu AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YQORRK,COUNTY OF WESTCHESTER ) as:�, �J _ f `• �Lx , residing at, gock f�p eve (Print name) (Address here 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; 1.92 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. (Z&S.gnature of Property w (s)) (Print Name of Property 0%%ner(s)) Sworn to before me thisL day of , 20 (Notar), Public) ^AICHELE WERTHEIMER FREDMAN �,10tary PuhliC, StatP Of New'rurk No, 02FR4968604 I Qualified In Westchester Cott Commission Expires 07/02/20 6/l/2024 / Buddin Perrrut Check List&Zoning Analysis Address: OC� N SBL Zone: Use: COWL Type: Other: Subrnitul Due �2. Rcvuioro Sub rrutul Daces: Applicant Nanrre of Work: 1 `L— &CG Reviews ZBA: �B BOT: Other. NEED �LK 2� ( �( V •FJmg- �0 BP: 7 C/O: Flood Plaae: LegaL=on: ( ) ( ), APP: Duel Notarized SBL: True I.D. Cross Connection H O.A.: ( ) ( ) Scenic Roads: Steep Slopes Wetlands: Storm Water Review Street Opening. ( ) ( ) ENVIRO: Long Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Proaccuon: S/W MgmL: Tree Plus Other. ( ) ( ) SURVEY:Dated Current ArchivaL• Sealed Unacceptable ( ( ) PLANS Date Stampe& Soled Copies: Electronic Other. e License Workers Comp: Liability Comp.Waiver. Other: ( ( ) CODE 753#: Dated N/A ( ( ) HIGH-VOLTAGE ELECTRICAL Plans: Peruuc N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:-plans: Permit N/A Other: ( ) ( ) FIRE ALARM/SMOKE DETECTORS Plum: Permit H.W.I.C.:_Battery:_Other. (� ( ) PLUMBING:Plans Permit Nu Gas: LP Cos: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Pernik N/A Other. ( ) ( ) H.V.A.C.: Plum: Permit N/A Other. FUEL TANK Plans: Pule Fuel Type. Other. ( ) ( ) 2020 NY State ECCG N/A: Other. ( ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ( ) BP DENTIAL L.E TTER C/O DENLAL LE I"ITR. Other. ( ( ) Other: ( ARB mtg.date: approvaL" notes: ( )ZBA mtg.date: approvaL• notes: ( )PB mtg.date: approva: notes: REQUIRED EXISilNG PROPOSED I`O'IIiS eate. Arei CadG Frorua�c From F�nc des: R. Mann Cor Acg C v. Ft.HIS : d—H — GFA: TpIm i Fes' PP Hcgbt/Stones notes: r s GENERAC CR GUARDIAN° SERIES 1 �/14/1 $ kIN Residential Standby Generators FILE COPYAir-Cooled Gas Engine r INCLUDES: Standby Power Rating G007171-0,G007172-0(Aluminum-Bisque)—10 kW 60 Hz • True Power" Electrical Technology G007223-0,G007224-0,G007225-0(Aluminum-Bisque)—14 kW 60 Hz • Two-line multilingual digital LCD Evolution'" controller G007226-0,G007228-0(Aluminum-Bisque)—18 kW 60 Hz (English/Spanish/French/Portuguese) • Two transfer switch options available: 100 amp 16 circuit switch or 200 amp service rated smart switch d pr— • Electronic governor • Standard Wi-Fia connectivity • System status&maintenance interval LED indicators • Sound attenuated enclosure • Flexible fuel line connector GENERAC —— • Natural gas or LP gas operation —_ • 5 Year limited warranty • Listed and labeled by the Southwest Research Institute allowing installation as close as 18 in (457 mm) to a TI structure.* c E 1 i/ us or c �l us nU' � *Must be located away from doors, windows, and fresh air `][ EHEH intakes and in accordance with local codes. LISTED https://assets.swrl.org/iibrary/DirectoryOfListedProducts/ Note:CETL or CUL certification only applies to unbundled units and units packaged with limited Construetionlndustry/973_DOC`204-13204-01-01 RM,pdf circuit switches.Units packaged with the Smart Switch are ETL or UL certified in the USA only. FEATURES Ij INNOVATIVE ENGINE DESIGN & RIGOROUS TESTING are at the heart of 0 SOLID-STATE, FREQUENCY COMPENSATED VOLTAGE REGULATION: This Generac's success in providing the most reliable generators possible.Generac's G- state-of-the-art power maximizing regulation system is standard on all Generac Force engine lineup offers added peace of mind and reliability for when you need it models. It provides optimized FAST RESPONSE to changing load conditions and the most.The G-Force series engines are purpose built and designed to handle the MAXIMUM MOTOR STARTING CAPABILITY by electronically torque-matching the rigors of extended run times in high temperatures and extreme operating conditions. surge loads to the engine.Digital voltage regulation at±1%. O TRUE POWER" ELECTRICAL TECHNOLOGY:Superior harmonics and sine wave 0 SINGLE SOURCE SERVICE RESPONSE from Generac's extensive dealer network form produce less than 5%Total Harmonic Distortion for utility quality power.This provides parts and service know-how for the entire unit, from the engine to the allows confident operation of sensitive electronic equipment and micro-chip based smallest electronic component. appliances,such as variable speed HVAC systems. • TEST CRITERIA: O GENERAC TRANSFER SWITCHES: Long life and reliability are synonymous with PROTOTYPE TESTED NEMA MG1.22 EVALUATION GENERAC POWER SYSTEMS. One reason for this confidence is the GENERAC SYSTEM TORSIONAL TESTED MOTOR STARTING ABILITY product line is offered with its own transfer systems and controls for total system compatibility. v MOBILE LINK" WI-FI CONNECTIVITY: FREE with select Guardian Series home standby generators, Mobile Link Wi-Fi allows users to monitor the status of the generator from anywhere in the world using a smartphone, tablet, or PC. Easily access information such as the current operating status and maintenance alerts. Users can connect an account to an authorized service dealer for fast,friendly,and proactive service.With Mobile Link, users are taken care of before the next power outage. w GENERAC :....s M.-lei PROMISE '� "� GENERAC` 10/14/18 kW Features and Benefits Engine • Generac G-Force design Maximizes engine"breathing"for increased fuel efficiency.Plateau honed cylinder walls and plasma moly rings help the engine run cooler,reducing oil consumption and resulting in longer engine life. • "Spiny-lok"cast iron cylinder walls Rigid construction and added durability provide long engine life. • Electronic ignition/spark advance These features combine to assure smooth,quick starting every time. • Full pressure lubrication system Pressurized lubrication to all vital bearings means better performance, less maintenance. and longer ' engine life.Now featuring up to a 2 year/200 hour oil change interval. • Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil. • High temperature shutdown Prevents damage due to overheating. Generator • Revolving field Allows for a smaller, light weight unit that operates 25% more efficiently than a revolving armature generator. • Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. • Displaced phase excitation Maximizes motor starting capability. • Automatic voltage regulation Regulating output voltage to ±1%prevents damaging voltage spikes. • UL 2200 listed For your safety. Transfer Switch(if applicable) • Fully automatic Transfers vital electrical loads to the energized source of power. • NEMA 3R Can be installed inside or outside for maximum flexibility. • Remote mounting Mounts near an existing distribution panel for simple,low-cost installation. Evolution" Controls • AUTO/MANUAUOFF illuminated buttons Select the operating mode and provide easy,at-a-glance status indication in any condition. • Two-line multilingual LCD Provides homeowners easily visible logs of history,maintenance,and events up to 50 occurrences. • Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations. • Utility voltage sensing Constantly monitors utility voltage,setpoints 65%dropout,80%pick-up,of standard voltage. • Generator voltage sensing Constantly monitors generator voltage to verify the cleanest power is delivered to the home. • Utility interrupt delay Prevents nuisance startups of the engine,adjustable 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer. • Engine warm-up Verifies engine is ready to assume the load.Setpoint approximately 5 seconds. • Engine cool-down Allows engine to cool prior to shutdown.Setpoint approximately 1 minute. • Programmable exercise Operates engine to prevent oil seal drying and damage between power outages by running the generator for 5 minutes every other week. Offers a selectable setting for weekly or monthly operation, providing flexibility and potentially lower fuel costs to the owner. • Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature. Compatible with lead acid and AGM-style batteries. • Main line circuit breaker Protects generator from overload. • Electronic governor Maintains constant 60 Hz frequency. Unit • SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature,withstanding winds up to 150 mph(241 km/h).Hinged key locking roof panel for security.Lift-out front for easy access to all routine maintenance items.Electrostatically applied textured epoxy paint for added durability. • Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries. • Small,compact,attractive Makes for an easy,eye appealing installation,as close as 18 in(457 mm)away from a structure. GENERAL — W, 10/14/18 kW Features and Benefits Installation System • 14 in(35.6 cm)flexible fuel line connector Listed ANSI Z21.75/CSA 6.27 outdoor appliance connector for the required connection to the gas supply piping. • Integral sediment trap Meets IFGC and NFPA 54 installation requirements. Connectivity • Ability to view generator status Monitor your generator with a smartphone,tablet,or computer at any time via the Mobile Link application ' for complete peace of mind. • Ability to view generator Exercise/Run and Total Hours Review the generator's complete protection profile for exercise hours and total hours. • Ability to view generator maintenance information Provides maintenance information for your specific model generator when scheduled maintenance is due. • Monthly report with previous month's activity Detailed monthly reports provide historical generator information. • Ability to view generator battery information Built in battery diagnostics displaying current state of the battery. • Weather information Provides detailed local ambient weather conditions for generator location. GENERAL' 10/14/18 kW Specifications Model G007171-0,G007172.0 G0072234 G007224-0. G007226-0.G007228-0 It kW) G007225-0(14 kW) (18 kW) Rated maximum continuous power capacity(LP) 10,000 Wafts' 14.000 Watts' 18,000 Watts' Rated maximum continuous power capacity(NG) 9.000 Watts' 14,000 Watts' 17,000 Rated voltage 240 Rated maximum continuous load current—240 volts(LP/NG) 41.7/37.5 58.3/58.3 75.0 i 7C' Total Harmonic Distortion Less than 5% r Main line circuit breaker 45 Amp 60 Amp 80 Ari Phase 1 Number of rotor poles 2 Rated AC frequency 60 Hz Power factor 10 Oattery requirement(not included) 12 Volts,Group 26R 540 CCA Minimum or Group 35AGM 650 CCA Minimum Unit weight(lb/kg) 338/153 385/175 420/191 ]Dimensions(L x W x H)in/cm 48 x 25 x 29/121.9 x 63.5 x 73.7 Sound output in dB(A)at 23 it(7 m)with generator operating at normal load`" 61 65 E5 Sound output in dB(A)at 23 ft(7 m)with generator in Quiet-Test"low-speed exercise mode" 57 55 55 Exercise duration 5 min Engine Engine type GENERAC G-Force 400 Series GENERAC G-Force 800 Series Number of cylinders 1 2 Displacement 460 cc 816 cc Cylinder block Aluminum w/cast iron sleeve Valve arrangement Overhead valve Lifter type Solid Hydraulic Ignition system Solid-state w/magneto Governor system Electronic Compression ratio 9.5:1 Starter 12 VDC Oil capacity includ ng filter Approx.1.1 qt/1,0 L Approx.2.2 qt/2.1 L Operating rpm 3,600 Fuel consumption Natural Gas tt3/hr ) 1/22 Load 101(2.86) 195(5.52) 169(4.79) Full Load 127(3.60) 256(7.25) 247(6.99) Liquid Propane ft3/hr(gal/hr)[Uhr] 112 Load 36(0.97)[3.661 65(1.81)[6.871 62(1.70)[6.451 Full Load 54(1.48)[5.62] 112(3.07)]11.61] 110(3.02)111.441 Note:Fuel pipe must be sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3.5-7.0 in water column(0.87-1.74 kPa)for NG,10-12 in water column(2.49-2.99 kPa)for LP gas For BTU content multiply 0/hr x 2,500(LP)or ft3/hr x 1,000 INS).For Meoaioule content,multiply m'/hr x 93.15(LP)or ni x 37.26(NG). Controls Two-line plain text multilingual LCD Simple user interface for ease of operation. Mode buttons AUTO Automatic start on utility failure.Weekly,Bi-Weekly.or Monthly selectable exerciser. MANUAL Start with starter control,unit stays on.if utility fails,transfer to load takes place. OFF Stops unit.Power is removed.Control and charger still operate. Ready to Run/Maintenance messages Standard Engine run hours indication Standard Programmable start delay between 2-1500 seconds Standard(programmable by dealer only) Utility voltage loss%Return to utility adjustable(brownout setting) From 140-171 V/190-216 V Future set capable exerciser/Exercise set error warning Standard Run/Alarm,,Maintenance logs 50 events each Engine start sequence Cyclic cranking:16 sec on,7 sec rest(90 sec maximum duration). Starter lock-cu: Starter cannot re-engage until 5 sec after engine has stopped. Smart Battery Charger Standard Charger Fault/Missing AC Warning Standard Low Baltery/Badery Problem Protection and Battery Condition Indication Standard Automatic Voltage Regulation with Over and Under Voltage Protect on Standard Under-frequency/Overload/Stepper Overcurrent Protection Standard Safety Fused/Fuse Problem Protection Standard Automatic Low Oil Pressure/High oil Temperature Shutdown Standard Overcrank/Overspeed(@ 72 Hz)/rpm Sense Loss Shutdown Standard High Engine Temperature Shutdown Standard Internal FaulVlncorrect Wiring Protection Standard Common External Fault Capability Standard Field Upgradable Firmware Standard Rating definitions—Optional Standby:Applicable for supplying backup power for the duration of the utility power outage with correct maintenance performed.No overload capability is available for this rating.(All ratings in accordance with BS5514,ISO3046,UL2200,and DIN6271). `Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU/Megajoule content,ambient temperature,altitude.engine power and condition,etc.Maximum power decreases approximately 3.5%for each 1,000 It(304.8 m)above sea level and approximately 1%for each 10°F(6'C)above 60°F(16'C)."Sound levels are taken from the front of the generator.Sound levels taken from other sides of the generator may be higher depending on installation parameters. GENERAC" - 10/14/18 kW Switch Options Limited Circuits Switch Features Model G007172-0 G007224-0 (10 kW) (14 kW) • 16 space,24 circuit.Breakers not included. No.of poles 2 • Electrically operated,mechanically-held contacts for fast,positive connections. Current rating(amps) 100 • Rated for all classes of load,100%equipment rated,both inductive and Voltage rating(VAC) 120/240,10 resistive. Utility voltage monitor(fixed)` • 2-pole,250 VAC contactors. -Pick-up 80% • 30 millisecond transfer time. -Dropout 65% ' • Dual coil design. Return to utility* Approx.15 sec • Rated for both copper and aluminum conductors. Exercises bi-weekly for 5 minutes* Standard • Main contacts are silver plated or silver alloy to resist welding and sticking. ETL or UL Listed Standard • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor Total circuits available 24 mounting flexibility. Tandem breaker capabilities 8 tandems • Multi listed for use with 1 in standard,tandem,GFCI,and AFCI breakers from Siemens,Murray,Eaton,and Square D for the most flexible and cost effective Circuit breaker protected install. Available RMS Symmetrical 10,000 Fault Current @ 250 Volts Dimensions *Function of Evolution controller Exercise can be set to weekly or monthly Height Width Depth Wi H1t76.43 W1 W2 inE67.94 1 10.5 13.5 6.91 cm 26.67 34.18 17.54 H2 I1 Wire Ranges Conductor Lug Neutral Lug Ground Lug 2/0-#14 210-#14 2/0-#14 �-DEPif1 � 'W2 Service Rated Smart Switch Features Model 0007225-0 G007228-0 (14 kw) (18 kW) • Includes Smart A/C Management(SACM)module standard. No.of poles 2 • Intelligently manages up to four air conditioner loads with no additional Current rating(amps) 200 hardware. Voltage rating(VAC) 120/240,10 • Up to eight large(240 VAC)loads can be managed with Smart Management Modules(SMMs). Utility voltage monitor(fixed)* -Pick-up % • Electrically operated,mechanically-held contacts for fast,clean connections. 65 • Rated for all classes of load,100%equipment rated,both inductive and -Dropout resistive. Return to utility" 15 sec re Exercises bi-weekly for 5 minutes* Standard • re pole,250 VAC contactors. • Service equipment rated,dual coil design. ETL or UL Listed Standard • Rated for both aluminum and copper conductors. Enclosure type NEMA/UL 311 • Main contacts are silver plated or silver alloy to resist welding and sticking. Circuit breaker protected 22,000 • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor Lug range 250 MCM-#6 mounting flexibility. *Function of Evolution Controller Dimensions Exercise can be set to weekly or monthly W, 200 Amps 120/240,to Open Transition Service Rated Height Width Depth H1 H2 W1 W2 Lcmi 26.75 30.1 10.5 13.5 6.3 67.94 76.45 26.67 34..1 16.01 Wire Ranges Conductor Lug Neutral Lug Ground Lug - 400 MCM-#4 350 MCM-#6 2/0-#14 GENERAC 10/14/18 kW Available Accessories Model# Product Description G005819-0 26R Wet Cell Battery Every standby generator requires a battery to start the system.Generac offers the recommended 26R wet cell bat- tery for use with all air-cooled standby product(excluding PowerPact®). G007101-0 Battery Pad Warmer The pad warmer rests under the battery.Recommended for use if the temperature regularly falls below 0°F(-18 °C).(Not necessary for use with AGM-style batteries). G007102-0 Oil Warmer Oil warmer slips directly overthe oil fitter.Recommended for use if the temperature regularly falls below 0°F(-18°C). r G007103-1 Breather Warmer The breather warmer is for use in extreme cold weather applications.For use with Evolution controllers only in climates where heavy icing occurs. G005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical load you may Contact Kit not need.Not compatible with 50 amp pre-wired switches. The fascia base wrap snaps together around the bottom of the new air cooled generators.This offers a sleek,con- G007027-0-Bisque Fascia Base Wrap Kit toured appearance as well as offering protection from rodents and insects by covering the lifting holes located in the base. If the generator enclosure is scratched or damaged, it is important to touch up the paint to protect from future G005703-0-Bisque Touch-Up Paint Kit corrosion.The touch-up paint kit includes the necessary paint to correctly maintain or touch up a generator en- closure. G006482-0—10 kW Scheduled Maintenance Kit Generac's scheduled maintenance kits provide all the items necessary to perform complete routine maintenance G007216-0—14/18 kW on a Generac automatic standby generator(oil not included). The Wi-Fi enabled LP fuel level monitor provides constant monitoring of the connected LP fuel tank.Monitoring G007005-0 Wi-Fi LP Fuel Level Monitor the LP tank's fuel level is an important step in verifying the generator is ready to run during an unexpected power failure.Status alerts are available through a free application to notify users when the LP tank is in need of a refill. G007000-0(50 amps) Smart Management Modules(SMM)are used to optimize the performance of a standby generator.It manages G007006-0(100 amps) Smart Management Module large electrical loads upon startup and sheds them to aid in recovery when overloaded.In many cases,using SMM's can reduce the overall size and cost of the system. G007169-0(413 LTE) ® The Mobile Link family of Cellular Accessories allow users to monitor the status of the generator from anywhere G007170-0(Wi-Fi/Ether- Mobile Link Cellular in the world,using a smartphone,tablet,or PC.Easily access information such as the current operating status and net) Accessories maintenance alerts.Users can connect an account with an authorized service dealer for fast,friendly,and proac- tive service.With Mobile Link,users are taken care of before the next power outage. Dimensions & UPCs 1218 mm 637.6 mm [48.0 in] [25.1 in] Model UPC G007171-0 696471074680 G007172-0 696471074673 G007223-0 696471082548 72.2mm [21.6 in] G007224-0 696471082555 G007225-0 696471082562 G007226-0 696471082579 o a G007228-0 696471082586 648 mm 1232 mm 125.5 In] [48.5 ini LEFT SIDE VIEW FRONT VIEW Dimensions shown are approximate.See installation manual for exact dimensions.DO NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES. GENE RAC Generac Power Systems,Inc. • S45 W29290 HWY.59,Waukesha,WI 53189 • generac.com ©2020 Generac Power Systems,Inc. All rights reserved. All specifications are subject to change without notice. Part No.A0000973374 Rev.A 10/22/2020 o ,n T (c 4/ ' I � Yo J O J � R cA ea61 1 U L. J . ol a oo v' F— LLl f O O U w Y 3 o ` 2 U y ►.. 1.. CC Y z � � � rG G w >- w, b { Cr cd QLn4, Nr C y 1 c y v rn p G y r � LL +3 ,� o DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/22/2024 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 be endorsed. If SUBROGATIONIS 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: ALBERT PALANCIA AGENCY INC 16162596 PHONE (914)698-1373 FAx (A/C,No,Ext): (AIC,No): 116 MAMARONECK AVENUE E-MAIL ADDRESS: MAMARONECK NY 10543 INSURER(S)AFFORDING COVERAGE NAICtt INSURER A: Hartford Underwriters Insurance Company 30104 INSURED INSURER B: Hartford Accident and Indemnity Company 22357 MICHAEL CARDOSA DBA POWER PROJECT INSURER C: SERVICES INSURER D 50 YONKERS TER APT 6H YONKERS NY 10704-3339 INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR MM/DD/YYYY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $1,000,000 x� PREMISES(Ea occurrence) X General Liability MED EXP(Any one person) $10,000 A X 16 SBA AW5W5H 04/10/2024 04/10/2025 PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY❑PRO ❑LOC PRODUCTS-COMPIOPAGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) A ALL OWNED SCHEDULED 16 SBA AW5W5H 04/10/2024 04/10/2025 BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS L. CLAIMS- MADE AGGREGATE ID ED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER ANY Y/N E.L.EACH ACCIDENT $1,000,000 B PROPRIETORiPARTNER/EXECUTIVE N/A 16 WEC AW5W8C 04/03/2024 04/03/2025 OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) if yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Those usual to the Insured's Operations.Certificate holder is an additional insured per the Business Liability Coverage Form SL3032 attached to this policy. CERTIFICATE HOLDER CANCELLATION Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Village of Rye Brook BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 938 KING ST IN ACCORDANCE WITH THE POLICY PROVISIONS, RYE BROOK NY 10573 AUTHORIZED REPRESENTATIVE �uB"Ltn� �C20Za zcc��> ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NE Workers' Certificate of Attestation of Exemption YORK STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **Thu form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Home Improvement Power Project Services,LLC From: Village of Rye Brook 50 Yonkers Terrace 6H Yonkers,NY 10704 PHONE:917-553-3220 FEIN:XXXXX4813 Workers'Compensation Exemption Statement: The applicant is NOT applying for a workers'compensation certificate of attestation of exemption and will show a separate certificate of NYS workers'compensation insurance coverage. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Michael Cardosa,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN / HERE Si re: Date: S'� Receilved Exemption ertificate Number 2024-039718 May 22, 2024 NYS Workers' Compensation Board CE-200 01/2018 'D SECTION 1 0 SHEET 7-3 0 BLOCK. 6AA jLOTS 16A2, Now or Formerly 16B & 17A L —pip. Kengo Fukamach, 0 Q round s-I n w 1 Ss• IN87'56'10" W s-see 162.24',r—pip.DR.f k I/Y.r Y fl. .f ix ♦�' OQ R o. o f P L R 0000� ,W0,50 Other � .t l N-1.9 Ao.of Pinta hAck@r "-s "-� Part Of sr!V@ � 4918' Par %Lot" � ♦916 ; ^ �'N 88,42'00" w � Lot[ ;50.00' 16 No Physical Bounds 0 —64,56' Parcel I c I" Part of M E-on U pN N-nzr-ff 0 'LotNPdd\'' n I`� 17 • B f r R9r; o. SO D1 V`! /jam # ©o P 1•..E� 11 -B s I o of l °ti 'so° 15 "s ®� a o! e v 5 may\ e , g -0.82'. J\ a 0 p�.e j fi o 4 10�' 4. Yo t"��,d'`p40.20 Other Part Of p i Lot ', 95.00' 1 7 1—Pip . t4 rwnd y 00 d +<F` 1 Unity Ax) PERF4 T 7 — C)c"!!--�,, `iceCOP SsL# 3 ,3•- - i 8ry DATE 4 2024 4 ,, BUILDING INSPECTOR,Village of Rye c — 0 DDQ- MAY 2 4 2024 VILLAGE OF RYE BROOK API A=23,553 SO FT OR 0.541 ACRE BUILDING DE..PARTI%1ENT SJRVEY OF PORTIONS OF LOTS 16 & 17 AS SHOWN ON A MAP ENTITLED SECTION ONE, MAP OF RICH MANOR,' DATED ,TUNE 15, 1950 & FILED NOVEMBER 8, 1950 AS COUNTY CLERK MAP No. 7248. SURVEYED AS IN POSSESSION A/arch 26 2002 THE MUNSON COMPANY --s�� B/0u9h/ !a doje Feb. /.3 2007 9 NORTH GOODWIN AVENUE N .S �icensar soOst-2 ELMSFORD, N.Y. 10523 Scale 1"=30' .r ,Outhortzed alterotions or additions to a sur+ey mop ;s a vioiat,c,n