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Operating Permit 2024-2025
o W Z W00 0.0 04 ozH o z N L M�1 ►� �W cn cn Q A N N O ~ w M■� c j W "" z N N V wpq � U pq w � wQ � w E� x.. U 04 cn �, 0 � z H � p (n 0-44, zH � Q w A dO W 0-4 H w z z ACA x A W O O �' w z p `� WWN � HH w ° A V W U '� H .� � aw � V) � H �; a H � A � zw H Q w z a �yE BR(�uk. • �9�2 BUILDING DEPARTMENT OUILDING 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 : - ` ` DATE' 7 PERMIT# , ISSUED:`` """SECT: BLOCK: LOT: LOCATION: { , `• \ �� �"`- OCCUPANCY: ❑ Violation Noted THE WORK IS... [/PASSED ❑ FAILED /REINSPECTION SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P.Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER 1 1 C 'L \ CU QyE BR(�� FO 198,2 BUILDING DEPARTMENT P/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 : DATE: PERMIT# ` \`" \ ISSUED: SECT: BLOCK: LOT: LOCATION: { � C>�- I C. C 0� Q ru-CICCUPANCY: C- ❑ Violation Noted THE WORK IS.. PASSED ❑ FAILED REINSPECTION SITE INSPECTION r ,1 �� u + REQUIRED f�❑ FOOTING w' ❑ 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 ❑ FINAL ❑ OTHER QyE BRC�� t7 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 : < _ Y C DATE: PERMIT# `ISSUED: SECT: BLOCK: LOT: 1 _ LOCAT,fbN: , CCUPANCY: ❑' Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING , ❑ INSULATION ; e n ❑ Natural Gas L _Q ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING r ❑ CROSS CONNECTION ❑ FINAL S �� ��� 1 ( � ( �1r t ❑ OTHER v �E BRC�k, �7 c /�• 1932� 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: D \ 11� A -),I( ✓(>,,Lj DATE: / 23 - Oz`� PERMIT# �/� ISSUED: SECT: 2 2_3 BLOCK: 2 LOT: S /l LOCATION: I I vv� P r ► OCCUPANCY: 15IV ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED / REINSPECTION &-SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas J PO i 2 G C ❑ L.P. Gas L L L )04 D Z G ❑ FUEL TANK / / ❑ FIRE SPRINKLER �C'f•i / )'`-/�G Ze // cl Q ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BUILDPEBROO TMENT VILL QQg Initial Inspection Date: ❑ Pass MILoiAF,IQ 938 KING ST EW YORK10573 ` - � Fail BUILDING&FIRE INSPECTOR (914)9 rook.Or Re-Inspection Date: ❑ Pass mizzo@rvebrook.org ❑ Fail FIRE INSPECTION REPORT,NfO"T�ICE OF VIOLATION & ORDER TO REMEDY SAME Site Address: 2 `\ _ ZonP U �>SBL: � '�. � Occupancy: C (1A C State Use Classification: Business Owner.� �Q���. C 1 �� l� �r Phone: Building Owner: ` Phone: Emergency Contact: Phone:( Building Representative in Attendance: 1 �{�<' C 1 C� Q C C "1 \ `A �� 2. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ Take notice that the following violations of the Ne rk to nifQ�Fire Prevention/ uilding Code and/or the Code of the Village of Rye Brook were f9un_d to xist at, ��Q `mac t� C�, J� ,in the Village of Rye Brook,NY on, y\ L ��"� 2" 20 The person or entity served with this Order to Remedy shall immediately commence to correct all listed violations and shall completely cure each violation described herein by no later than ,which is thirty(30)days after the date of this Order to Remedy.Furthermore, upon curing any listed violation(s),you shall immediately contact the Building Department during normal business hours to schedule a re-inspection of the premises to confirm full compliance with all applicable codes,laws,rules®ulations. BE ADVISED THAT YOUR FAILURE TO CORRECT ALL VIOLATIONS IS A CRIME PUNISHABLE BY FINE,IMPRISONMENT OR BOTH. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ No YES N/A 1.PORTABLE FIRE EXTINGUISHERS (PFE's) R a.906.1. Are PFE's installed throughout the space&on the premises as required by code. a. b.906.3.1.Is the maximum travel distance to a PFE 75 feet or less. b. c.906.5.Are PFE's conspicuously located&readily accessible. c._ 4 - d.906.6.Are PFE's unobstructed/unobscured from view. d. e.906.7.Are PFE's properly mounted as per the manufacturers instructions. e. f.906.9.Are PFE's properly installed:<401bs.max.5'above floor;>40 lbs.max.3.5'above floor. f. 2.FIRE ALARM SYSTEM&SMOKE DETECTORS a.901.6.1.Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72. a. b.907.4.2.1.Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b. c.907.4.2.2.Is the height of the pull station handle located between 42&48 inches above the floor. c. d.907.3.Is a fire alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d. 3.FIRE SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS a.901.6.1.Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a. b.901.6.1.Are the main valves secured against tampering in the open position. b._ _✓ __ c.901.6.1.Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C. _ _✓ _ d.901.6.1.Is a supply of six spare heads&a wrench maintained on the premises. d._ _✓ e.901.6.1.Are sprinkler heads&cover plates unfinished or of factory applied finish only. e. f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f. g.913.5.Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g._ h.507.5.2.Is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h._ _✓ i.507.5.4.Are fire hydrants&fire protection equipment unobstructed. i._ VJ _ j.507.5.5.Is a clear space of not less that 3 feet maintained around all hydrants. j. k.901.8.Are all fire protection systems in place d maintained untampered. k._ INSPECTOR: tl \_ DATE: 4- RevLwd 2/10/22 No YES N/A 4.STANDPIPE,CABINETS&FIRE DEPARTMENT CONNECTIONS a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b. _ ✓ _ c.912.2.3 Are standpipe FDC threads compatible with fire department standards. c. d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d. e.905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e. _ f 912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f. g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g. 5.EXITS,MEANS OF EGRESS&OCCUPANCY a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b. _ J� c. 1031.6.Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... C. d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. e. 1010.1.Are egress doors provided and maintained as required by this section. e. / f. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f. g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g. k"" h. 1013.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h. l✓ _ i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1.provided as required by code. i. -, _ j. 1013.3.Are all exit signs illuminated at all times. j. .>25- k.1008.1.Are the means of egress&exit discharge illuminated at all times the building is occupied. k. 1. 1018.3.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides. in. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least in. 28"wide,or at least 36"wide where serving 50 or more people. 6.COMBUSTIBLE STORAGE&WASTE MATERIALS a.304.1.Is the building(s)and premises maintained free from accumulated combustible waste material. a. b.304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C. y d.315.3.Are combustible materials properly stored&separated from ignition sources. d. e.315.3.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e. _ and 18"or more below sprinkler head deflectors in sprinklered buildings. _ f.315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f. g.315.3.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g. _ h.313.1.Is building maintained free from stored fueled equipment.(motorcycles,mopeds,mowers,etc...) h. 7.ELECTRICAL a.604.1.Is the building free from modified/damaged wiring,devices,appliances,equipment a. and maintained free from electrical hazards. b.604.2.Are electrical service equipment areas properly illuminated. b._ _✓ _ c.604.3.Are proper working space clearances provided&maintained for electrical service equipment. C._ d.604.3.Are electrical service equipment working spaces free from any stored materials. d. e.604.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. e._ J� f.604.4.Is the building free from unf ised multi-plug electrical adapters. .g.604.5.Are electrical extension cords being used in a safe manner as per code. h.604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h._ L1 _ i.604.6.Is the building free from open-wiring spliced electrical connections. i. j.604.8.Are electrical motors maintained free from accumulated oil,dirt&debris. j._ k.915.1.Are Carbon Monoxide Detec.Uwk installed&maintained as required by this section and by 1103.9. k._ INSPECTOR: � �~ DATE: -2- Revised 6/11/2020 No YES N/A S.ELEVATORS.DUMBWAITERS&ESCALATORS a.[Pm]603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a. S b.606.3.Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b. _ — floors reading; IN FIRE EMERGENCY,DO NOT USE ELEVATOR.USE EXIT STAIRS c.606.7.Are keys for elevator car doors&fire department service kept in an approved location. C. v d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. — — e. [B]3005.1.Are elevator machine room doors maintained unobstructed at all times. e. 9.COMMERCIAL KITCHENS a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a. _ b.904.12.5.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b. c.904.12.5.2.Are automatic fire extinguishing systems serviced at least every 6 months. C. d.904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d. e.[RBI 122-5.B.Are grease traps provided and installed as required by Village Code. e. f.[[PC] 1003.10."1122-6.Are grease traps properly maintained as per State and Village Code. f. _ g.[RB] 122-6.C., 122-9.Are all service,maintenance,&repair records for grease traps and related plumbing maintained on the premises as required by Village Code. g. — — 10.HEATING SYSTEMS a.[PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a. — _1 — b.[PM]603.2.Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. c. [PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C. d. [PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d. e. [PM]603.5.Is the fuel-burning equipment provided with adequate combustion&ventilation air. e. 11.MOTOR FUEL-DISPENSING FACILITIES&REPAIR GARAGES a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a. in an approved location within 100' of,but not less than 20'from fuel dispensers. b.2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C. d.2305.5.Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. 2-A:20-B:C provided&located not more than 75' from pumps,dispensers&fill-pipe openings. e.2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e. f.2305.7.Are weeds and other combustible materials kept at least 10' from fuel-handling equipment. f. g.2306.4.Are above-ground tanks provided with vehicle impact protection. g. h.2306.5.Are above-ground tanks provided with secondary spill containment. h. 12.HAZARDOUS MATERIALS(HAZ-MATS) a.407.2.Are S.D.S. Sheets for all haz-mats readily available on the premises. a. b.407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b. c.5004.2.Are stored haz-mats provided with approved secondary spill containment. C. _ d.5003.7.1.Are proper No SMOKING signs provided as per this section. d. 13.MISCELLANEOUS a.403.1. Is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b. c.405.5.Are records of emergency evacuation drills kept&maintained on the premises. C. _ d.505.1.Are approved address&building numbers properly placed&plainly visible from the street. d. e.506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e. f.703.1.Is all required fire-resistance rated construction properly maintained as per code. f. g. 703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g. h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h. — — i.5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. �i.. 14.GENERAL HOUSEKEEPING ` a.Good b.Fair c.Inadequate d.Poor INSPECTOR: �_ DATE: IO'� -3- Rcvised 9/17/21 ozozn 1/9 PWA31f :siva :110133asrcI ,e i S?I21VW� 2I�gWflj�W3.LI dEMPIRE WATER BASED FIRE PROTECTION , INSPECTION & TEST REPORT FIRE PROTECTION SERVICES INC.. OFFICE PHONE NUMBER: DATE 01/16/2024 08:00am E SITE Childtime#0068 Commercial CONTACT ADDRESS 38 Bellefair Boulevard PHONE CITY Rye Brook STATE NY ZIP 10573 This inspection is: Annual ❑ Other 1 —OWNERS SECTION This section is to be answered and signed by the Owner or Owners Representative YES N/A NO A. Is the building occupied? B. Has the occupancy classification and hazard contents remained the same since the last inspection(Ifno.survey required) C.Are all fire protection systems in service? D. Are all Wet Sprinkler System piping and Wet portions of Dry Systems protected from temperatures below 40"? X E. Owner has been instructed on maintaining the Dry System Auxiliary Drains? Inspection of Sprinklers, Hangers, Pipe and Fittings will be conducted from Floor Level,Concealed Spaces are not required to be Inspected Name of Owner or Representative: Signature: 2—GENERAL (Questions A,B, C,D,E,F,H,J&K are inspection items)(Questions G,L&Mare tested items) YES N/A NO A. Have the sprinkler systems been extended to all visible areas of the building? (If NO,an Engineenng Surveyis reguifed) B. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector? C.Are the hydraulic nameplate(s)securely attached to the riser and legible? (Answer N/A if system is Pipe Scheduled) D. Is there a spare head box with the proper number and type of spare sprinklers and wrenches? E. Siamese Connection in good condition, couplings free, caps/plugs and ball drip in place and check valve tight? F. Siamese Connection visible, accessible and marked with ID signs? G. Have all gauges 5 or more years old been replaced or calibrated? Year Replaced: 2023 Year Due: 11/13/202 H. Internal inspection of the Pipe, Valves and Strainers has been performed within the last 5 years? Year Due: 11/131202 J. Are all hoses and hose valves in good condition, free from physical damage and no leaks? K. Hose(>5 yrs)connected to the system has been serviced per NFPA 1962? Year of Hose: Year Due: L. Fire backflow prevention device tested per the authority having jurisdiction? Month Due: NOV Year Due:2024 X M. Forward flow test has been conducted on fire backflow device-NA for systems w/fire pumps? Year Due: X 3-CONTROL VALVES (Questions A,B&E are inspection items)(Question D is a test item)(Question C is a maintenance item) YES N/A NO A. Are all sprinkler system main control valves and all other control valves in the appropriate open or closed position? B. Are all control valves supervised in the appropriate open or closed position? (supervision Type) Tamper Switch C. Were all control valves operated through full range of motion, lubricated and returned to normal position? D. Did all electrical supervisory switches actuate supervisory alarms? E. Are all control valves easily accessible and marked with ID signs? (valve Location) Mechanical Room 4-WATER SUPPLY (Question A is a inspection item)(Questions B 8 C for information)(Main Drain is a test item) YES N/A NO A. Did flow results have the same or greater PSI readings than previous tests? (A reduction of 10%should be noted as No) B. System water supplied from: JXJ City Water DElevated Tank OPressure Tank Suction Tank Pond Other C.Main drain is piped outside JXjYes I No I !NA, if no how many 25' hoses required to get outside for a Forward Flow Test? Riser Static Residual PSI Alarm H draulic Information Location (Riser) Size Design Design PSI@ GPM Number Pressure Pressure Return Time Density Area Base Demand 1 mechanical room 2" 40 30 40 <90 2 mechanical room 2" 45 <90 Water Based Test and Inspection Page 1 of 2 SITE Childtime#0068 Commercial DATE 01/16/2024 08:00am 1 5-FLOW ALARMS (Questions A&B are inspection&test items,based on type of inspection performed) YES N/A NO A. Did waterflow through the inspectors test actuate all mechanical alarms? X B. Did waterflow through the inspectors test actuate all electrical alarms? I X 6-WET SYSTEMS (Questions A&Bare inspection items)(Questions C,D&E are tested items)(Question F is for information) YES N/A NO Number of systems 2 Sizes 4" 4" NA NA ModeMake lsRELIABLE A.Alarm valves, riser check valves, gauges and associated trim are free from physical damage? B.Trim valves, alarm and supervisory lines are in the appropriate open or closed position? (Are Appropriate Signs provided) C. Is the antifreeze system protected correctly based on the listed cold zone? cold zone Designator: NA D. The antifreeze system protection is normal and is not overcharged? (protection above the cold zone is considered overcharged) E. Was the antifreeze system tested at the point of connection to the system and at the remote point of the system? X iF.Area Protected? NA Type NA lConnection NA°I Remote NA' 7-DRY/PREACTION/DELUGE SYSTEMS /t is the owner's responsibility to maintain auxiliary drains between inspections Owner NA Notified Number of Dry Systems 0 Make and Model NA NA Trip test report attached XTrip test not required Number of Pre-Action Systems 0 Make and Model NA NA Trip test report attached XTrip test not required Number of Deluge Systems 0 Make and Model NA NA Trip test report attached ZTrip test not required (Questions A,B,C, G&H are inspection items)(Questions D,E&I are tested items)(Question F is a maintenance item) YES NIA NO A. Valves, gauges and associated trim are free from physical damage? X B. Trim valves, alarm and supervisory lines are in the appropriate open or closed position? X C.What is the air pressure? 35 X D. Did the air compressor operate satisfactorily? X E. Did the low air pressure alarm operate during the test? X F. Auxiliary drains that were identified by the owner were drained during this inspection? G.Valves and trim appear to be protected from temperatures below 40°F? H. Pipe that passes through freezers is free of ice blockage? I. Has the Air Leakage Test been conducted on the Dry System within the last 3 years? Year Performed: NA 8-SPRINKLERS, PIPE,AND HANGERS (Questions A,B&Care inspection items)(Questions D,E&Fare tested items) YES N/A NO A. Is all visible pipe in good condition with no external corrosion, physical damage and no leaks? X B. Are visible pipe hangers and seismic braces free of physical damage? X C. Are all sprinklers free from damage, obstructions to spray patterns, foreign materials&correct orientation? X D. Have standard sprinklers 50 or more years old been replaced or successfully tested? X E. Have fast response sprinklers 20 or more years old been replaced or successfully tested? Date of Sprinklers NA X F. Have dry type sprinklers 10 or more years old been replaced or successfully tested? Date of Sprinklers NA X 9-FIRE PUMPS AND STORAGE TANKS (General Information concerning the property) System has Fire Pump:Y N X Fire Pump Test Performed This Inspection: Y N N/A X Report Attached:Y NLJ N/A X lWater Storage Tank Supplies Water: Y 0 N X Tank Inspection Performed:Y KLJ N/ X Report Attached:YL NL N/A X OExplanation of"NO"answers,system deficiencies,and/or inspector recommendations are listed Below I state that the information on this form is correct at the time and place of this inspection. All test and inspections were performed in accordance with applicable NFPA 25 test and inspection sections. All equipment tested at this time was left' operational condition upon completion of this inspection except as noted on any DEFICIENCY REPORT as stated above. Name of Inspector Dan J. Beason Signature I acknowledge that the inspection,deficiencies,and suggested improvements were di;As me upon completion of the inspection. It is understood that all information contained herein is provided to the best of the knoY&4dge of the person providing the information and that, if requested,will be forwarded to the authority having jurisdiction. Name of Owner or Representative Signature Water Based Test and Inspection Page 2 of 2 Work Order for Learning Care Group Think Safetyr Have you evaluated the risks your work can cause to the operations or safety of the customer? Work Order#: 43305568 WO Status: Completed(99) Customer: Learning Care Group(373202) WO Change Date: 8/3/2023 9:06:50AM Location: Childtime of Rye Brook(1162928) Requested Date: 6/7/2023 12:00:OOAM 38 BelleFair Blvd Rye Brook, NY 10573 Requested Start Date: - Customer WO: - Requested Comp Date: - Customer PO: BLD1000000053 Required Comp Date: 7/7/2023 12:00:OOAM Business Unit: 6818AVS LCG Sery Z-B(6818402201) Act Start Date: 7/14/2023 10:46:OOAM Act Comp Date: 7/17/2023 10:39:OOAM Activity: HVACR (3373) Respond By Date: 7/7/2023 12:00:OOAM Est. Hrs.: Requester: Patricia Peak Request Class: HVACR Requester Phone: (513)846-4297 Request Code: HVACR Requester Email: ppeak@emcor.net Service Class: HVACR Contact: Patricia Peak Service Code: HVACR Contact Phone: (513)846-4297 WO Type: General Maintenance(G) Contact Email: ppeak@emcor.net WO Priority: 30 Days(3) Requestor Ref/Max WO: Warranty Work: N Site Contact 1: Service Provider: Marsanico, Michael C SP Contact: Michael C. Marsanico(1114238) Vendor Type: E- Employee SP Phone: WORK (718)9050000 Service Description: Basic HVAC inspection scope 1: Ensure that each thermostat is programmed appropriately for time, date, and preferred heat and cool settings. Test run each unit in both heat and cool settings and confirm that the units kick on. . Document your findings. 2: Check all air filters. Replace as needed and write the current date on each new filter 3: Clear the area around the outdoor condensing unit of any debris. Please document findings. 4: Confirm that the unit is r Service Location: - Work Order Status History Change Date User Status Wait Reason Comments 6/8/2023 11:21:00AM PPEAK Dispatched N/A New work order created. 7/14/2023 10:46:OOAM MMARSANICO On Site N/A onsite 7/14/2023 11:37:OOAM MMARSANICO Dispatched N/A 7/17/2023 8:45:OOAM MMARSANICO On Site N/A onsite 7/17/2023 10:39:OOAM MMARSANICO Completed N/A completed AC &Heating checks . checked All thermostats to make sure set properly and working. ran all Ac to make sure working properly, checked and replaced and cleaned filters as needed .Check and cleared around all condensers. Checked on the hot air heating unit in the attic replace filter and ran to make sure it was working properly the shut it down V23.08.14.JDE03FP_PDB1 WO#:43305568 Run Date: 8/14/2023 12:12:14PM Paqe 1 of 2 Steven Fews From: Brandon Dickerson <b.dickerson@empirefps.com> Sent: Tuesday, December 5, 2023 7:33 AM To: Steven Fews Cc: Laura Petersen Subject: RE: Childtime 68 Hi Steven, Just a quick update on this one. We are going to the site today for the emergency lights on site and as well we are going to be gaining all the information for the fire alarm panel on site and completing testing of the system for engineering purposes. Thank you, Brandon Dickerson C:585-775-5290 75 Bermar Park Rochester, NY 14624 From:Steven Fews<SteveFews@ryebrook.org> Sent: Monday, November 27, 2023 11:59 AM To: Brandon Dickerson<b.dickerson@empirefps.com> Cc: Laura Petersen<LPetersen@ryebrook.org> Subject: RE:Childtime 68 Good Afternoon Brandon... Nice talking with you today, and thank you for being on top of this situation. I have attached the inspection report. Please take note of the 41h page which outlines the outstanding items. Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914)939-0668 From: Brandon Dickerson<b.dickerson@empirefps.com> Sent: Monday, November 27, 2023 9:13 AM To:Steven Fews<SteveFews@ rye brook.org> Subject:Childtime 68 Hi Steven, 1 Thanks for taking my call this morning on this one. If you could please provide the documentation for the failed fire inspection so I may begin working on all repairs on site to bring them into compliance. Thank you, Brandon Dickerson) I flG� C k t C:585-775-5290 75 Bermar Park Rochester, NY 14624 z Quality Elevator Inspection Inc. Quality Elevator Inspection Michael A Byrnes P.O. Box 563 QEI INSPECTION SUPER VISOR Millwood NY 10546 Certification #E000283 50 Years' Experience, There is no Substitute Tel (914) 924-8563 fax (914) 762-0296 Email mbgei(a),aol.com December 22, 2022 (� M Daniel Murphy D � `=�(�`� IE � V E Senior Facility Manager OCT 12 2023 Re; VILLAGE OF RYE BROOK BUILDING DEPARTMENT Bright Horizons 38 Belle Fair Blvd, Rye Brook NY 10573 On December 22, 2022, at your request, Quality Elevator Inspection Inc. performed a code required Re Inspection of the violations found during the Category 5 Full Load test on one hydraulic Lift located at 38 Belle Fair Blvd, Bright Horizons Rye Brook. The test was to be performed in compliance with the rules and regulations of the American Society of Mechanical Engineers, ASME A17.1 Safety Code for Eleva- tors and Escalators. The test was performed by your elevator maintenance company ThyssenKrupp Elevator Corp. Federal Elevator, Contract # F1599, 3 Stops, Capacity 750 LBS, FL 550PSI/ RP 70OPSI All violations Have been cleared, lift has no violations If you have any questions or concerns, feel free to contact me at your convenience. Sincerely, Michael A. Byrnes QEI Inspection Supervisor Work Order for Learning Care Group Think Safety.!Have you evaluated the risks your work can cause to the operations or safety of the customer? Work Order#: 43305568 WO Status: Completed(99) Customer: Learning Care Group(373202) WO Change Date: 8/3/2023 9:06:50AM Location: Childtime of Rye Brook(1162928) Requested Date: 6/7/2023 12:00:OOAM 38 BelleFair Blvd Rye Brook, NY 10573 Requested Start Date: - Customer WO: - Requested Comp Date: - Customer PO: BLD1000000053 Required Comp Date: 7/7/2023 12:00:OOAM Business Unit: 6818AVS LCG Sery Z-B(6818402201) Act Start Date: 7/14/2023 10:46:OOAM Act Comp Date: 7/17/2023 10:39:OOAM Activity: HVACR(3373) Respond By Date: 7/7/2023 12:00:OOAM Est.Hrs.: - Requester: Patricia Peak Request Class: HVACR Requester Phone: (513)846-4297 Request Code: HVACR Requester Email: ppeak@emcor.net Service Class: HVACR Contact: Patricia Peak Service Code: HVACR Contact Phone: (513)846-4297 WO Type: General Maintenance(G) Contact Email: ppeak@emcor.net WO Priority: 30 Days(3) Requestor Ref/Max WO: Warranty Work: N Site Contact 1: Service Provider: Marsanico,Michael C SP Contact: Michael C. Marsanico(1114238) Vendor Type: E-Employee SP Phone: WORK (718)9050000 Service Description: Basic HVAC inspection scope 1: Ensure that each thermostat is programmed appropriately for time,date,and preferred heat and cool settings. Test run each unit in both heat and cool settings and confirm that the units kick on. . Document your findings. 2: Check all air filters. Replace as needed and write the current date on each new filter 3: Clear the area around the outdoor condensing unit of any debris. Please document findings. 4:Confirm that the unit is r Service Location: - Work Order Status History Change Date User Status Wait Reason Comments 6/8/2023 11:21:OOAM PPEAK Dispatched N/A New work order created. 7/14/2023 10:46:OOAM MMARSANICO On Site N/A onsite 7/14/2023 11:37:OOAM MMARSANICO Dispatched N/A 7/17/2023 8:45:OOAM MMARSANICO On Site N/A onsite 7/17/2023 10:39:OOAM MMARSANICO Completed N/A completed AC&Heating checks. checked All thermostats to make sure set properly and working. ran all Ac to make sure working properly,checked and replaced and cleaned filters as needed .Check and cleared around all condensers. Checked on the hot air heating unit in the attic replace filter and ran to make sure it was working properly the shut it down V23.08.14.JDE03FP_PDB1 WOM 43305568 Run Date: 8/14/2023 12:12:14PM Paqe 1 of 2 Inspection Companv Name Newburgh Fire Extinguisher Address 1401 Nev., York 300 Inspection Report C,t, Ne%%burgh state NYZip Code. 12550 Customer Chlldhille 40068 C0I11111etCial Date of Inspection. 071M.12023 09 00am EDT Address 38 Bellefair Boulevard C., Rye Brook state NY Zip Code. 10573 phone (513) 335-4506 ,ten',s :oGlDor `'_e of FE Type of FE W11—LA.ICtWe T33 le` -sty -d^ Due year of FE7 entrance --1 101b ABC ❑ ❑ ❑✓ ❑ ❑ 7101l2011 a jupstairs a ❑ ❑ ❑ ❑ 07l01/2019 ❑ doNnstairs 101b ABC ❑ ❑ ❑ ❑ 07l01/2020 ❑ basement 201b ABC ❑ ❑ ❑ ❑ 07l01/2022 ❑ 00 ❑ ❑ ❑ D ❑ 0 C❑ ❑ ❑ D ❑ I F-7 ❑ ❑1 ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑D El H H I 0 ❑ 771 F-' o ❑ 1-1 Ela ■ ■ ❑ ❑ ❑El F1 El El El I I Notes OCT 12 2023 is a return tnp needed to complete repairs? I VILLAGE OF RYE BROOK Are aA extinguishers tagged and a return trip is not needed' BUILDING DEPARTMENT Mitch Magner 7/20/23 Customer S�nature Cus,omer tJan�eDate __ __ _____ roam ror inspecnon, iesung ana maintenance of Ill /VFSA Dry-Pipe Fire Sprinkler Systems National Fire Sprinkler Association,Inc. This form covers the minimum requirements of NFPA 25-2002 for dry-pipe fire sprinkler systems connected to water supplies without tanks or fire pumps. Separate forms are available for inspection,testing and maintenance of fire pumps,tanks,and other fire protection systems. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. The work covered on this form is(check one): [ ]Monthly ( ]Quarterly f ]Annual [ ]Third Year ( j Fifth Year Owner: Owner's Phone Number: Owner's Address: Property Being Evaluated: 4 44 oo Property Address: v p Date of Work: < All rebponses refer to the current work Inspection,testing and maintenance)performed on this date. Notes: 1)All questions are to be answered Yes, No or Not Applicable. All"No"answers are to be explained in Part III of this form. 2) Inspection,Testing and Maintenance are to be performed with water supplies(including fire pumps)in service, unless the impairment procedures of Chapter 14 of NFPA 25 are followed. Part - ner s Section 3.Quarterly Inspection Items(continued) A. Is the building occupied? [ ]Yes [ ]No c.Alarm devices free from physical damage? [ ]Yes [ J No [ ]N/A B. Has the occupancy and hazard of contents remained d. Pressure reducing valves in open position, not leaking,with the same since the last inspection? [ ]Yes [ ]No l�- downstream pressure per design criteria,and in good � C.Are all fire protection systems in service? [ ]Yes [ ]No condition with handwheels not broken? [ ]Yes [ ]No /A D. Has the system remained in service without 4.Annual Inspection Items(in addition to above items) modification since the last inspection? [ ]Yes [ ]No(11, a. Proper number and type of spare sprinklers?['ryes [ ]No [ ]N/A E.Was the system free of actuation of devices or b.Visible sprinklers: alarms since the last inspection? [ ]Yes [ ]No N 1. Free of corrosion and physical damage? s [ ]No [ ]N/A 2. Free of obstructions to spray patterns? FAs [ ] No [ ]N/A 3. Free of foreign materials including paint? Y s [ ]No [ ]N/A caner or Representative print name Signature an e 4. Liquid in all glass bulb sprinklers? 'es [ ] No [ ]N/A Part II-Inspector's Section c. Visible pipe: /' A. Inspections 1. In good condition/no external corrosion? [✓j'Y ' [ ]No [ ]N/A 1. Daily and Weekly Items 2. No mechanical damage or leaks? [ " [ ]No [ ]N/A a. Control valves supervised with seals passed inspection 3. Properly aligned and no external loads? (4!es [ ] No [ ]N/A in accordance with II.A.2.a below? { .]Yes [ ]No [ ]N/A d. Visible pipe hangers and seismic braces b. Dry-pipe valve enclosures maintaining a minimum not damaged or loose? [ Yes [ ]No. [ J N/A of 40*F and gages in good condition e. Dry-pipe valve passed internal inspection? ( ]Yes FfNio [ ]N/A showing normal water and air pressure? t es [ ]No [ ]N/A f. Must be done before cold weather: c. Backflow preventers: 1.Adequate heat in areas with wet piping? [']Yes [ ]No [ ]N/A 1.Accessible and isolation valves open? WPyles es [ ]No ( ]N/A 2. Low temperature alarms functioning? [ ]Yes [ ]No [ ]N/A 2. Sealed, locked or supervised? [ ]No [ )N/A 3. Interior of pipe that passes through freezers 3. Relief port on RPZ not discharging? [ ]Yes [ ]No [ ]N/A free of ice blockage? [ ]Yes [ ] No [ J N/A d. For freezer systems,gage near the compressor reading g. Has an internal inspection of the pipe been performed by removing the same as the gage near the dry-pipe valve?[ ]Yes[ ]No( ]N/A the flushing connection and one sprinkler near the end 2. Monthly Inspection Items(in addition to above Items) of a branch line within the last 5 years? [ ] Yes [ ]No [ j N/A a.Control valves and valves on back flow preventers with locks or (if"No", conduct internal inspection) electrical supervision: 5. Fifth Year Inspection Items(in addition to above items) 1. In correct(open or closed: position)? [ ,des. [ ]No [ ]N/A a. Check valves internally inspected,all parts 2. Lock or supervision in place? { Yes [ ]No [ ]N/A operate properly and are in good condition?[ ]Yes [ ]No [']N/A 3.Accessible and free from external leaks?[1 Yes ( ]No [ ]N/A b. Strainers,filters, restricted orifices and diaphragm chambers 4. Provided with appropriate wrenches? [ ]Yes ( ]No [ ]N/A on dry-pipe valves and trim passed internal inspection?[ ]Yes[ ]No[ ]N/A 5. Provided with appropriate identification [kes [ ]No [ ]N/A c. Internal pipe inspection performed per 4.g? [ ]Yes [ ]No { ]N/A b. Sprinkler wrench with spare sprinklers? ( ]Yes [ ] No [ ]N/A B.Testing Report any failures on Part III of this torm. c. Dry-pipe valve free from physical damage,trim in 1.Quarterly Tests correct(open or closed)position and no leakage from a. Mechanical waterflow alarm devices passed tests btr intermediate chamber? [ ]Yes [ ] No ( ]N/A opening of the bypass connection with alarms .�� 3.Quarterly Inspection Items(in addition to above items) actuating and flow observed? [ 1 Yes [ ] No [ ]N/A a. Hydraulic nameplate(calculated systems) b. Post indicating vavles opened until spring or torsion securely attached to riser and legible? [ ]Yes [ ]No f"J N/A felt in the rod then closed back 1/4 turn? [ ],Yes [ ] No f I N/A b. Fire department connections visible, accessible, couplings and c. Priming level correct? [-fYes [ ]No [ ]NVA swivels not damaged,gaskets in place and in good condition, d. Low air pressure signal passed test? [ ]Yes [ ] No {'fvr identification sign(s)in place,check valve is not leaking, e. Quick opening device passed test? [ ]Yes [ ]No [,TN/A clapper in place and operating properly and automatic drain f. Main drain test for system downstream of back flow device valve in place and operating properly? {']Yes [ ]No [ ]N/A or pressure reducing valve: (if plugs or caps are not in place, inspect interior for obstuctions) 1. Record static pressure psi, residual pressure psi ' 02004 National Fire Sprinkler Association,P.O.Box 1000,Patterson NY 12563 2.Was flow observed? [ ]Yes [ ]No { (845)878-4200 Form 25-13Y Sheet 1 of 2 3.Are results comparable to previous tests? [ ]Yes [ ]No { ]N/A 2.Semiannual Tests(in addition to previous items) 1. Regular Maintenance Items(continued) a. Valve supervisory switches indicate 5. Plugging of pipe or sprinklers found during activation or work movement? [ ]Yes [ ] No [ ]N/A 6. Fairlure to flush yard piping or surrounding mains following new b. Electrical waterflow alarm devices passed installation or repairs tests by opening bypass connection 7. Record of broken mains in the vicinity with alarms actuating and flow observed?[ ]Yes [ ]No [ ]N/A 8.Abnormally frequent false-tripping of dry-pipe valves 3.Annual Tests(in addition to previous items) 9. System is returned to service after an extended period of time a. Main drain test for systems not tested quarterly: out of service(more than one year) 1. Record Static psi and Residual Pressure ? psi 10. There is reason to believe the system contains sodium silicate 2. Was flow observed? ( }.)(es [ ]No [ ]N/A or its derivatives or highly corrosive fluxes in copper pipe 3.Are results comparable to previous tests?[ ]Yes [ ]No [-}?(/A f. If conditions were found that required flushing, b.Are all sprinklers dated 1920 or later? [ ]'(es [ ]No [ ]N/A was flushing of system conducted? [ ]Yes [ )No [ I-KIA c. Fast response sprinklers 20 years old or more replaced or 2.Annual Maintenance Items(in addition to previous items) successfully sample tested in last 10 years?[ ]Yes [ ]No [ 11V/A a. Operating stem of all OS&Y valves lubricated, d. Standard response sprinklers 50 years old or more replaced or completely closed, and reopened? [ YY/es [ ]No [ ]N/A successfully sample tested in last 10 years?[ ]Yes [ J No [ ]WA b. Interior or dry-pipe valves cleaned? [ ]Yes [ ]No [+,N/A e. Standard response sprinklers 75 years old or more replaced or c. Low points drained before freezing weather?[ ]Yes [ ]No [4 VIA successfully sample tested in last 5 years?[ J Yes [ ]No, [ ]N/A d. Sprinklers and spray nozzles protecting commercial f. Dry-type sprinklers replaced or successfully cooking equipment and ventilating systems replaced sample tested in last 10 years? [ ]Yes [ I No [ J N/A except for bulb-type which show no signs of g.All control valves operated through tull range grease build-up'? [ ]Yes [ ]No [ 1,N/A and returned to normal position? h. Low temperature alarms passed test? [ ]Yes [ ]No [ IA, Part III-Comments(Any"NO answers.test failures or other problems i. Dry-pipe valve partial flow trip test(unless full trip test done): found with the sprinkler system must be explained here. Also note here 1. Initial air pressure psi and water pressure psi / any products noticed on the system that have been the subject of a 2.When valve tripped, air pressure psi and timec recall or replacement program.) 3. Results comparable to previous tests?[ ]Yes [ J No [ ']N/A " , j.Automated air maintenance devices passed?[ )Yes [ ]No [ ]N/A td �d/U.4, U L! k. Backflow devices passed backflow test?[ ]Yes [ )No [ ]N/A t I. Backflow devices passed forward flow test?[ ]Yes [ ]No ( ]NIA / ) 1G� m. Pressure reducing vavles passed partial flow?[ ]Yes [ ]No['I N/A 4.Test for every third year(in addition to previous items) Dry pipe full flow trip test: a. Initial air pressure psi and water pressure psi b. When valve tripped,air pressure psi and time sec c Water delivery time min sec Water delivery time not required to be 60 seconds per NFPA 25 d. Results comparable to previous tests?[ ]Yes [ ]No [ ]N/A 5.Tests for every fifth year(in addition to appropriate items) a. Sprinklers above high temperature tested?[ ]Yes [ )No N/�, b. Gages checked by calibrated gage or replaced?[ ]Yes( ]No I r]N/A c. Pressure reducing valves passed full flow test?[ ]Yes [ ]No C. Maintenance 1. Regular Maintenance Items a. If sprinkler have been replaced,were they proper enhancements? [ ]Yes [ ]No WNIA b.Air leaks in dry-pipe system resulting in air pressure loss more than 10 psi/week repaired? ['f�(eS [ ]No [ ]N/A c. Dry-pipe systems kept in dry condition? [�f Yes [ )Nb [ ]N/A Part IV- Inspector's information d. Have low point drains been emptied? [ J Yes ( ]No [ ]N/A e. If any of the following were discovered,was r Am NRL Fire Protection Services,Inh P.0.Box 194,Monroe,CT 06468 an obstruction investigation conducted? [ ]Yes [ ]No J N/A , / r Explain reason(s)and obstruction investigation findings in Part 111 Inspector: � ,Prl 1. Defective intake screen on pump supplied from open sources I state that the information on this form is corn t the time and place of my 2. Obstructive material discharged during flow tests inspection, and that all equipment tested at,thiq ' e�vas left in operating 3. Foreign material in dry-pipe valves,check valves,check valves or pumps condition upon completion of i -fn71; n e5c�ept'�s noted in Part III above 4. Foreign material in water during drain test or plugging of inspector's �" 1 /,/' test connection Signature of Inspector: '` Date:q� ©2004 National Fire Sprinkler Association,P.O Box 1000,Patterson NY 12563 (845)878-4200 Form 25-13Y Sheet 2 of 2 License of Certification Number(if applicable): Form for Inspection,Testing and Maintenance of WET NFSA Wet Pipe Fire Sprinkler Systems The Voice of the Fire Sprinkler Industry This form covers the minimum requirements of NFPA 25-2008 for wet pipe fire sprinkler systems connected to water supplies without tanks or fire pumps. Separate forms are available for inspection, testing and maintenance of fire pumps, tanks, and other fire protection systems. More frequent inspection,testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. The work covered on this form is(check one): [ ]Monthly [ ]Quarterly [ ]Annual [ ]Third Year [ ] Fifth Year Owner: Owner's Phone Number: Owners Address: Property Being Evaluated: Property Address: .3 VA41IT10, V P Afy9c,4 A Y. Date of Work: All responses refer to the current work(inspection,testing and maintenance)performed on this date. Notes: 1)All que ions are to be answered Yes, No or Not Applicable. All"No"answers are to be explained in Part III of this form 2) Inspection,Testing and Maintenance are to be performed with water supplies(including fire pumps)in service, unless the impairment procedures of Chapter 15 of NFPA 25 are followed. Part I-Owner's Section 3.Quarterly Inspection Items(continued) A. Is the building occupied? [ ]Yes [, c. Pressure reducing valves in open position, not leaking, with B. Has the occupancy and hazard of contents remained downstream pressure per design criteria, and in good condition / the same since the last inspection? [ J Yes [ ]Noo with handwheels not broken? [ ]Yes [ ]No [-}1 lA C.Are all fire protection systems in service? [ ]Yes [ ]No d. Hydraulic nameplate(calculated systems) D. Has the system remained in service without securely attached to riser and legible? [ ]Yes [ ]No [-]NIA modification since the last inspection? [ ]Yes ( ]Noh 4.Annual Inspection Items(in addition to above items) E. Was the system free of actuation of devices or a. Proper number and type of spare sprinklers?[,}Yes [ ]No [ ]N/A alarms since the last inspection? ( ]Yes [ ]No j�' Q b.Visible sprinklers: F. Name and address of property insurance contact; 1. Proper position(upright, pendent. sidewall)?[,4 [ ]No [ ]N/A 2. Free of corrosion and physical damage? [. 'Yes [ ]No [ )N/A G.,Policy number(if known). 3. Proper clearance below sprinklers? [- Yea ( j No [ )N/A 11 r, !, G-, 4. Free of foreign materials including paint? J..,lY,�,s [ ]No [ ]N/A caner or epresentative print nameSignature and Datt 5. Liquid in all glass bulb sprinklers? [,]'Yes [ ] No ( ]N/A Part II-Inspector's Section c. Visible pipe: A. Inspections 1. In good condition/no external corrosion? [�,as [ J No [ J N/A 1. Daily and Weekly Items 2. No mechanical damage or leaks? [ s ( ]No [ ]N/A a. Control valves supervised with seals passed inspection 3. No external loads? [ yes ( ]No [ J N/A in accordance with II.A.2.a below? [_}'Ygs [ ]No [ ]N/A d.Visible pipe hangers and seismic braces b. Backflow preventers: not damaged or loose? [ Yes [ ]No [ ]N/A 1.Accessible and isolation valves open? [ ]No [ ]N/A e. Hose, hose couplings and nozzles on sprinkler 2. Sealed, locked or supervised? [ },Yes ( ]Now'[ ]N/A system passed inspection per NFPA 1962? [ ]Yes [ ]No [ /A 3. Relief port on RPZ not discharging? [ ]Yes [ T No ( ]N/A f.Adaquate heat in areas with wet piping? [-1-Y16s [ ]No [ j N/A 2.Monthly Inspection Items(in addition to above Items) g. Internal inspection of the pipe performed in the a. Control valves and valves on back flow preventers with locks or last 5 years(remove a flushing connection and electrical supervision: and sprinkler near the end of a branch line)?( ]Yes [ ]No [ }N/A 1. In correct(open or closed: position)? [ [ ]No [ ]N/A (if"No", conduct internal inspection) 2. Lock or supervision in place? K1 es [ ]No [ ]N/A 5. Fifth Year Inspection Items(in addition to above items) 3.Accessible and free from external leaks?n Yes [ ]No [ ]N/A a.Alarm valves and associated strainers,filters and 4. Provided with appropriate wrenches? ( ]Yes. [ ]No [ ]N%A restricted orifices passed internal inpsection?[ ]Yes [ ]No [ N/A 5. Provided with appropriate identification? (-j Yes ( J No [ ]N/A b. Check valves internally inspected, all parts b. Sprinkler wrench with spare sprinklers? [ ]Yes [ ]No [ ]N/A operate properly and are in good condition?[ ]Yes [ ]No KfWA c. Gages on system in good condition and c. Internal pipe inspection performed per 4.g?[ j Yes [ ]No rf NIA showing normal water supply pressure? [ "}Yes [ ]No [ ]N/A B.Testing d.Alarm valve free from physical damage,trim Report any failures on Part Ill of this form. in correct(open or closed)position and no 1.Quarterly Tests leakage from retarding chamber or drains?[ ]Yes [ ]No [ }N/A a. Mechanical waterflow alarm devices passed 3.Quarterly Inspection Items(in addition to above items) tests by opening the inspector's test connection a. Fire department connections visible,accessible, couplings and with alarms actuating and flow observed? [ ]Yes ( ]No [-I"N/A swivels not damaged,gaskets in place and in good condition, b. Post indicating vavles opened until spring or torsion identification sign(s) in place, check valve is not leaking, felt in the rod then closed back 1/4 turn? [ ]Yes [ ]No rKNIA clapper in place and operating properly and automatic drain c. Main drain test for system downstream of backflow device or valve in place and operating properly? [ ]Yes [ ]No [ ]N/A pressure reducing valve: (if plugs or caps are not in place, inspect interior for obstuctions) 1. Record static pressure psi,residual pressure psi b.Alarm devices free from physical damage? [ ]Yes [ ]No ( ]N/A 2. Was flow observed? [ ]Yes [ ]No [ j N%A 9)2009 National ire Spnnkler Association,40 Jon Barreft Rd.Patlerson, 3.Are results comparable to previous tests? [ ]Yes [ ] No [ I N/A (845)878-4200 Form 25-13W-08 Sheet 1 of 2 2. Semiannual Tests(in addition to previous items) 6. Failure to flush yard piping or surrounding mains following new a. Valve supervisory switches indicate installation or repairs movement? [ ]Yes [ ]No [ ]N/A 7. Record of broken mains in the vicinity b. Electrical waterflow alarm devices passed 8.Abnormally frequent false-tripping of dry-pipe valves tests by opening inspector's test connection 9. System is returned to service after an extended period of time out of with alarms actuating and flow observed?[Ws [ ]No [ ]N/A service(more than on year) 3.Annual Tests(in addition to previous items) 10.There is reason to believe the system contains sodium silicate or its a. Main drain test for systems not tested quarterly: f� derivatives or highly corrosive fluxes in copper pipe. 1. Record Static psi and Residual Pressure 3 O psi g. If conditions were found that required flushing,was flushing 2.Was flow observed? [ ]Yes [ ]No [ ]N/A of system conducted? [ ]Yes [ ]No [ ]N/A 3.Are results comparable to previous tests?[ ]Yes ( J No [,I N/A h. Was a drain test conducted after opening any coed valves? b.Are all sprinklers dated 1920 or later? [ j Yes [ ]No [ )N/A ['IYes [ ]No [ ]N/A c. Sprinklers with fast response elements 20 years i.Adjusted, repaired, reconditioned or replaced components old or more replaced or successful sample had the associated tests and/or inspections required tested in last 10 years? [ ]Yes [ ]No [-I NIA by Table 5.5.1 of NFPA 25 performed? [ ]Yes [ )No [j N/A d. Standard response sprinklers 50 years old or more replaced or 2.Annual Maintenance Items(in addition to previous items) successfully sample tested in last 5 years?[ ]Yes [ ]No [ N/A a. Operating stem of all OS&Y valves lubricated, e. Standard response sprinklers 75 years old or more replaced or completely closed,and reopened? [ ]Yes [ ]No [ ]NIA successfully sample tested in last 5 years?[ ]Yes [ ]No ( /A b. Sprinklers subject to recall replaced? [ ]Yes [ ]No [I N/A f. Dry-type sprinklers replaced or successfully c. Sprinklers and spray nozzles protecting commercial sample tested in last 10 years? [ ]Yes [ ]No [ N/A cooking equipment and ventilating systems g.Antifreeze solution specific gravity: / replaced except for bulp-type which show no 1. Correct at most remote point? [ ]Yes [ ]No signs of grease build-up? [ ]Yes [ ] No [ ]N/A 2. Correct at intertace with wet system? [ J Yes [ J No [-1 NIA 3. Correct at other test points(over 150 gal)?[ ]Yes[ ]No[�-</A a -Comments(Any NU answers. test tailures or o er problems h.All control valves operated through full range - found with the sprinkler system must be explained here. Also note here and returned to normal position? [�Kes [ ]No [ ],WA any products noticed on the system that have been the subject of a i. Backflow devices passed backflow test? [ ]Yes [ ]No [ ].NIA recall or replacement program.) j. Backflow devices passed forward flow test?[ ]Yes [ ]No [`]NI I � __ l `� , 1,°•�G� �� / _ k. Pressure reducing valves passed partial flow?[ ]Yes [ ]No [ �N/A /v 4.Test for every third year(in addition to previous items) ` Hose more than 5 years old connected to the system r - _� r9l c0 has been service tested per NFPA 1962. L� Water discharged and water flow alarms operated?[ ]Yes[ ]No[ N/A Q 41A&4�_ �����i Tv 5.Tests for every fifth year(in addition to appropriate items) a. Sprinklers above high temperature tested. [ ]Yes [ ]No 4N/&--,b. Gages checked by calibration gage or replaced?[ ]Yes[ ]No[ ' c. Pressure reducing valves passed full flow test?[ ]Yes [ ]No [ N/A C.Maintenance 1. Regular Maintenance Items a. If any sprinklers failed the sampling testing of Parts II,13.3.c,d,e or f of this form, were all sprinklers represented by that sample replaced? [ J Yes [ ]No KN/A b. If sprinkler have been replaced?Were they proper replacements? [ ]Yes [ ]No [ �N/ c. Used hose was cleaned,drained and dried before being placed back in service? [ ]Yes [ ]No (<N/A Part IV- Inspector's Information d. Hose exposed to hazardous materials was disposed . or decontaminated in an approved manner?[ J Yes [ ]No [ T N/A � .,, NRL Fire Protection Services,Inc.P.0.Box 194,Monroe,CT 06468 e. Systems normally filled with fresh water were drained and refilled twice if raw water got into the system?[ ]Yes ( ]No [6N/A Inspector: f. If any of the following were discovered,was I state that the information on this form is correct at the;ime and place of my an obstruction investigation conducted? [ ]Yes [ ]No ["]N/A inspection, and that all equipment tested at t]ais tim , left in operating Explain reason(s)and obstruction investigation findings in Part Ill condition upon completion of Is.inspecti(*exc rioted in Part 111 above 1. Defective intake screen on pump supplied from open sources f 2. Obstructive material discharged during flow tests Signature of Inspector: -� � i; Date:0 Q7 3. Foreign material in dry-pipe valves,check valves,check valves or pumps 4. Foreign material in water during drain test or plugging of inspector's License of Certification Number(if applicable). test connection 02009 National Fire Sprinkler Association,40 Jon Barrett Rd.Patterson,NY 12563 5. Plugging of pipe or sprinklers found during activation or work (845)878A200 Form 25-13W-08 Sheet 2 of 2 FIRE ALARM INSPECTION & TEST REPORT FIRE PROTEC770M OFFICE PHONE NUMBER: tFIRE PROTECTION DATE 10/02/2023 03:00pm EDT ADDITIONAL BUILDING DATA SITE Childtime#0068 Commercial CONTACT ADDRESS 38 Bellefair Boulevard PHONE CITY Rye Brook STATE NY ZIP 10573 MONITORING ENTITY commercial fire PHONE This inspection is: a Annual El Semi-Annual ❑ Quarterly Monthly ❑ Weekly Other Panel Manufacturer fire lite by Honeywell I Model Number MS-96000DLS Type X Addressable Hard Wired ALARM INITIATING DEVICES AND CIRCUIT INFORMATION Qty of devices Type of device Qty of devices Type of device 7 Manual Stations 7 Heat Detectors 3 Co Detectors/Date 1 Waterflow Switches 14 Photo Detectors Supervisory Switches Duct Detectors Other Devices ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION City of devices Type of device Qty of devices Type of device Bells 5 Strobes Horns 10 Horn/Strobes Speakers Aux Panels/Cell communicator's Chimes Annunciators RECORDED DATES Dates Type of device 7/27/23 Battery Install Date 9/20/2016 CO Detector Install Date Heat Detector Install Date Sensitivity Testing Date Amount of Door Holders Restricted Rooms SIGNALING LINE CIRCUITS Qty and Style(see NFPA 72,Table 6-6.1)of Signaling line circuits connected to system Qty ] SYSTEM POWER SUPPLIES A. Primary(Main):Nominal Voltage Over Current Protection: Type Fuse X1 Circuit Breaker Location(Primary Supply Panelboard) Disconnecting Means Location(Fuse or Breaker#) B. Secondary(Standby): X Storage Battery Other: AMP HR Rating (2)12v7 TYPE BATTERY Dry Cell Nickel Cadmium I X Sealed Lead-Acid Lead-Acid Other: Fire Alarm Test and Inspection Page 1 of SITE Childtime#0068 Commercial DATE 10/02/2023 03:00pi PRIOR TO ANY TESTING SECONDARY POWER Notifications Are Made Yes NA I No Who Time Type I Visual I Functional NA Comments Building Management X Battery Condition Monitoring Entity Load Voltage X Other: Amp Hour Reading X INITIATING&SUPERVISORY DEVICE TESTS & INSPECTIONS Batteries Meet NFPA 72 Test Requirements: Yes No NA (ON SEPARATE FORM)-#OF PAGES ATTACHED EMERGENCY COMMUNICATIONS EQUIPMENT SYSTEM TESTS&INSPECTIONS Type Visual Functional NA Comments Type Visual Functional NA Comments Control Panel X Transient Suppressors Interface Equipment Remote Annunciators Lamps/LEDS X Audible X Fuses XVisual Primary Power Supply X Speakers X Trouble Signals X Voice Clarity Disconnect Switches XDoor Holders X Ground Fault Monitor X I I IDoor Unlock Parts replaced Total Comments Interface Equipment Visual Functional NA Comments 12v 7a battery Elevator Recall X 12v 18a battery HVAC Shut Down X Other battery replaced Specify: Special Hazards Visual Functional NA Comments Specify: Specify: Specify: SUPERVISING STATION MONITORING Yes NA No Time Comments Alarm Signal Alarm Restoral Trouble Signal Trouble Restoral Supervisory Signal Supervisory Restoral NOTIFIED TESTING COMPLETE Yes NA No Who Time Building Management Monitoring Entity Other: HAS SENSITIVITY BEEN COMPLETED AS PER NFPA 72 OR LOCAL STATE CODES: YES NOONAO Year Sensitivity Testing Completed: Year Sensitivity Testing Due: How Was Sensitivity Tested: WHILE PERFORMING THE INSPECTION ADDITIONAL ITEMS WERE NOTED THAT NEED CORRECTED: YES NO NA No SERVICE FOLLOW UP REPORT was required during this inspection. 1 state that the Information on this form Is correct at the time and place of this inspection. All test and Inspections were performed in accordance with applicable NFPA 72 test and Inspection sections. All equipment tested at this time was left in operational condition upon completion of this Inspection except as noted on any SERVICE FOLLOW UP REPORT as stated above. Name of Inspector Melquisedec Valentin Signature nt\-i Certification# I acknowledge that the inspection,deficiencies,and suggested improvements were discussed with me upon completion of the inspection. It is understood that all information contained herein is provided to the best of the knowledge of the person providing the information and that,If requested,will be forwarded to the authority having Jurisdiction. Name of Owner Angela Choate Si natur or Representative g LUJ o z w C"i CD I w Q JJ vv W L ra _ "MEMO M N r+ 0 V � C H * ; z a1 #A a. 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Submittal Date: Revisions Submittal Dates: '22-" Applicant: F < 4__1 C"U VCC� c) Nature of Work 12 I {V n 1 { �l CI r.�►K�eSZ Reviews:ZBA: PB. BP: Other. _ NEED OK rr� tc oQ ( ) (X •Filing. BP: C/O: Legalization: ( ) ( APP.: Date Stamped: Properly Signed: SBL Verified Cross Connection: F.O.G.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm 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: ( ) (,; LANS:Date Stamped: Sealed: Copies: Electronic Other. ( ) ( ) License: Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) Code 753#: 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. ( ) ( ) PLUMBING:Plans: Permic Nat.Gas: LP Gas: Grease Trap: 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: REQUIRED EXIS ING PROPOSED NOTES Area: Circle: Fron�taee _ Front: Front: Sides: Rear. F.A.R.: en Space He4ht: Stories: notes: Laura Petersen From: Chris Dickerson <c.dickerson@empirefps.com> Sent: Wednesday, April 3, 2024 11:45 AM To: Chad Miller; Laura Petersen; Steven Fews Subject: Re: Site 68 Permit Update - Rye Brook, NY Attachments: SWISAPP(1).pdf Per our conversation attached is our swis app for the work complete and the location of the dry pendent was the basement classroom and you will be adding it to my permit. Thank you for all your help here! Chris Dickerson Operations 585-720-0390 From:Chad Miller<Chad.Miller@commercialfire.com> Sent:Wednesday,April 3, 2024 11:40:06 AM To:Chris Dickerson<c.dickerson@empirefps.com> Subject: Re: Site 68 Permit Update- Rye Brook, NY Please let me know ASAP as I have to update the VP of Operations within the next 20 minutes. If you have any questions or need any additional information please feel free to contact me at any time. Sincerely, Chad M. Miller I Commercial Fire, LLC Director of Repair& Deficiencies 800-241-1277 ext 7167 From: Chris Dickerson <c.dickerson@empirefps.com> Date: Wednesday, April 3, 2024 at 11:39 AM To: Chad Miller<Chad.Miller@commercialfire.com> Subject: Re: Site 68 Permit Update - Rye Brook, NY Everything is submitted to swis I am going to fall the town to ask if I can email the swis app of if it needs to be dropped off same if they can note the location or if we need to stop in Chris Dickerson Operations 585-720-0390 From: Chad Miller<Chad.Miller@commercialfire.com> Sent:Wednesday,April 3, 2024 10:57:10 AM To:Chris Dickerson<c.dickerson@empirefps.com> Subject: Re:Site 68 Permit Update- Rye Brook, NY 1 �A`CQ� 11,C7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/02/13/2024 Y) 024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the tenor 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 NAME:CONTACT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O.BOX 328 JA/CNNo,EXt►:888-333-4949 jac,No):507-446-4664 OWATONNA, MN 55060 ADDRIESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 192-002A INSURER B: EMPIRE FIRE PROTECTION SERVICES, INC. INSURER C: PO BOX 440 NORTH GREECE, NY 14515-0440 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:249 REVISION NUMBER:0 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES $100,000 MED EXP(Any one person) $5,000 A N N 6145131 02/18/2024 02/18/2025 PERSONAL&ADV INJURY $1,000,0oo MOTHER t AGG:REGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2 000 000 POLICY �ECT LOC PRODUCTS&COMP/OP AGG $2,000,000 INE AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT $1,000,000 Ea _n X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY SCHEDULED N N 6145131 02/18/2024 02/18/2025 BODILY INJURY(Per Accident) AUTOS HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY ,Per UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION PER STATUTE OTHER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERI EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L EACH ACCIDENT (Mandatory in NH) I E.L DISEASE EA EMPLOYEE f yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT EMPLOYMENT RELATED PRACTICES LIAB N N 1811695 02/18/2024 02/18/2025 PER CLAIM $100,000 AAGGREGATE $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION 192 249 0 VILLAGE THE VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 938 KING ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Oc 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE T" A A A A A 161570483 EMPIRE FIRE PROTECTION SERVICES INC '� ■ PO BOX 440 '�!*� NORTH GREECE NY 14515 ❑ shy SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER EMPIRE FIRE PROTECTION SERVICES INC The Village of Rye brook 75 BERMAR PARK SUITE 3 938 King St ROCHESTER NY 14624 Rye Brook NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE R2570 260-6 224409 02/18/2024 TO 02/18/2025 2/13/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2570 260-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DANIEL DICKERSON CEO DINO GATTO EMPIRE FIRE PROTECTION SERVICES INC 2 PERSON CORP THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S7NCE FUND V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 981615462 U-26.3 i t s i a � � N 0 a w U ~ V/ _ o X0 x a p F W d i O o 4 Q w � oN w � qA M ■ w° Ln I-O 00Ln 00 u '� w o .� _ � a ^W Z o u Z , ~ w D c1 o a a � a _ � V) � �j a O p z F z cn W U z W Z � a z � } O z w O (� ~' a c V a A Z W A o W �o W ■ �-.� V W > a a Z N x a en 00 s LL] •� cn F H G1 '� U ° w < wo z a Q � ►.. _ o cn� W dos W f� u a z w 0 cn a N w w o ° `. 0-4 Z w z N oS /N V O Ii z fR M A a w w 02 D EC W a`R t u�BUILE MENT MAR 2 7 2024VILOF,RYE OK 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Wkv-gymjOo .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required I J FOR OFFICE USE ONLY EP#: 6zl! Approval Date: APR 0 Permit Fee: S Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 Application dated,M�ON r54'� 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:3f6 the ',�i .�;f(�V CY SBL: Z QX// 7 3r —�c/ Zone: �� 2.Property Owner:cx 11� t'MP b Address: , 9 1�[�'� _ Phone#: sl3 3 3 `L/ wog Cell#: email:N' ?`n.l C� L -]t 0 3.Master Electrician/Licensed Installer: brC4 4)(\ -Add...: &1"' )er' Lic.#: hone#:-'W —7,it-034 JCell#: email: Z y C�O.O^, Company Name: (' �m��-t�(e :7 Cn Address: 1Ntr �/— 4.Proposed Electrical Work/Fixture Count: 5.3`d Party Electrical Inspection Agency: �J r STA E OF N Y RK,COUNTY OF WESTCHESTER ) as: �Z� �SU�Being du swom,deposes and states that he/she is the applicant above named,and does further (print name of ind vidual s ning as the ap h state that(s)he is the for the legal owner and is duty authorized to make and file this application. (Master Electrician/ icenscd Installer) The undersigned further states that all statements contained herein arc 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 j L t Sworn to b fore m lhis I day of 146Ac;. 20 ay day of 20 Sign to eragn era o1Pro erty Owner ' �)yteu.�uytf, Si ature of Applicant �j'c1( r4ry J TT 5�� I`r✓t.t �CJ �SSGc.�cfictt �itSi ?'� QJ,Ct mt Name of Pr Ow er Print at o A $ t Notary Public t t MlCK4a A. 111 ya M BIERWOM ]0l3ol2oz3 NOWReg,� �t NetsryW York t�ua dw M�1� Ouel�ed In CommissW ExpKM MOO 1°a�_-�< STATE WIDE INSPECTION SERVICES, INC. Service With liziregrio 0•0 • • SWIS JOB APPLICATION tel 845.202.7224 1 fax 0. • Office Use Elect. Permit# 4— _0~l/ Date Bldg Permit# Scl Ft ,`l► a i Plumbing Permit# Final Certificate# City/Village Rye-brook Zip 10573 Building Dept. Rye brook County Westchester Address 38 belle fairy blvd Cross Street Section Block Lot Owner Name/Address(If different than above) Ch ild.time Contact Number ❑Basement ❑1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential Q Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels iP 3P #Meters #Disconnect ❑Underground ❑ New ❑ Reconnect ❑✓ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# []Con Ed ❑NYSEG ❑Central Hudson El orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑✓ Safety Inspection ❑Consultation Scope of Work Re-engineer existing fire alarm system was replaced by another company -— D VIE APR - 3 2024 -ID VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(p year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,d 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 asset forth for the application. Email Address B.dickerson@empirefps.com Name Brandon dickerson License# 12000067480 Date 4/3/24 Signature Brandon dickerson Address 75 bermar park City/State Rochester zip Code 14624 Company Empire fire protection Phone # 585-720-0390 BUILD r n �'MENT D IE C E VlLL- E OF RY OOK Fo T 12 2023 938 KING ET RYE BR , , NY 10573 1 4ILM � VILLAGE OF RYE BROOK BUILDING DEPARTMENT FIRE INSPECTION / OPERATING PERMIT APPLICATION FOR OFFICE USE ONLY: / 3v�✓�! Fee Paid: $ �-� /Q,� Inspection Date&Time:A0-1(kv G , c 3 ao n FEE SCHEDULE: Re-inspection Date&Time: 1 Triennial &Private School Annual Inspection: _$450.00 Public Assembly Annual Inspection: <100 People=S525.00/>100 People=$775.00 *f.tf+r#**tr+**t:**,r..ire*+rt**:,r**w*rrt:***,r:r**.xt*3*::ft*t*r�r*+r**�r***ir:.•:•wwr:.*s,�**r,r***«t.,rr,►.,r**:**,�.�* Application,dated: 8/1/2023 ,is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business, private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform Fire Prevention&Building Code,Title 19 NYCRR Part 1201, and all other applicable local, County, State& Federal laws, rules& regulations,as per detailed statement described below. 1. Address: 38 BelleFair Blvd, Rye Brook, NY 10573 SBL:IQ Y, 73 —,D-59 Zone: 2. Business/Occupancy Name: Childtime Learning Center NYS Use Class: 3. Property Owner: BelleFair Homeowners Association, Inc Address: 24 BelleFair Blvd, Rye Brook, NY 10573 Phone# 914-690-1371 Cell# email: 5. Business Owner: Childtime Childcare, Inc Address: 21333 Haggerty Rd, Novi, MI 48375 Phone# Cell#248-370-0461 email:kely.garrison@ieamingcaregroup.com 6. Emergency Contact: Jennifer Cameron Address: 38 BelleFair Blvd, Rye Brook, NY 10573 Phone# I#518-203-9246 email: Jcameron@leamingcaregroup.com .*7. Inspection Escort:Angela Choate Title: Director/School Manager i►7C. � Phone#:g/V—SS,,-J 77/ Cell#:914-935R06TII' email: angela.choate 8. Provide a brief description outlining the current and/or intended use of the property: child care The site will be providing childcare Monday thru Friday, year round. Infants to School Age children. 9. List all Hazardous Materials: none 10. Occupant Load:Existing: Proposed: Other: 11. Date&Disposition of Previous Fire Inspection: ❑ Pass ❑ Fall `',7 WIM021 tC41,'� 0, This application must include the notarized signature(s) of the legal owner(s) of the above mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. 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 application) and farther states that he/she is the legal owner of the property to which this application pertains,or that he/she is the for the legal owner and is duly authorized to make and file this application. That all (indicate architect,business owner,attorney,agent,etc.) statements contained herein are true to the best ofhis/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 �s Sworn to before me this day of :`�}4�4$ 120 day of ,20 �hl Notary Public Notary Public Si ture of Pro Owner Signature of Applicant n Print Name of Property Owner $eAk,e V::�;r Print Name of Applicant aMKyMAM A.NAPOUTANoU � sw of New luu rkN ►P9. C n ConrNwon Es�lrie�tt wel 16. 2(p z si l anon i