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Home My WebLink AboutBP24-134PERMIT;f! je =42' 3'7 DATE: ;)7 49mmZ SECTION �% �3 BLOCK LOT TYPE OF WORK 4SP ✓ C�Oo,LI roorl 10B LOCATI N 4e j jeva f OWNER /C svJ S IP ,LU 1/2 / 3y C)3aT CONTRACTOR Il l"fl7' — e, 7e IIQ4 Cjy)So /4M3 /E `�T. COST � 7 000 - FEE NCO # ` FEE c3 7S �.� DATE TCO # FEE DATE DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING 17' q " 71Uay .4SJ2 INSULATION 12 ' 13' ?oozy - PLUMBING RGH PLUMBING I t' g" Z�oZ`I ASSe GAS 0 SPRINKLER ELECTRIC LOW -VOLT ALARM LC%1 AS BUILT O FINAL Qq2 SiillK �op�y �,5�.y �P Cavell; �1��6i�y � 7�le��i�►c� �7- !i & � ll SQJ'"� �irp Sl1nr' -jn/Cle jr" 0 Coy o s 07NER APPROVALS OTHER FINISHED BASEMENT NOT APPROl/ED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT •I�-li°� y- jS��Su��e•ne � C' � %He4/i/j VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK O�: 25-0 i cl Certificate of Occupancy his is to certify that /- -h^ ' �k F ZQ of, having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, AL1J �/'1i1 _ �i�/�YQ/ , Rye Brook,NY, located in a PUA Zoning District and shown on the most current Tax Map as Section: 4. 73 Block: C.:?) Lot: 1 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. — e, issued b720�such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: )e6 -46U-" n1*1U Construction: 00 for the following purposes: rell6l� a Qjm �Q r Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: FI APPROVED FOR USE AS A SEPARATE DWELLING UNIT This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts o ilding or in the ex> >lities shall be made, and no enlargement, whether by extending on any side or by increasing i height hall be ,nor hal the b be moved from one location to another until a permit to accomplish such change as obt ' ed fro the mg Inspector. WBuilding Inspector,Village of Rye Brook: Date: JUN 2 5 2Q25 BR 1 c 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 June 25,2025 Patrick Kumf&Ashley LoBue 6 BelleFair Boulevard Rye Brook,New York 10573 Re: 6 BelleFair Boulevard, Rye Brook,New York 10573 Parcel ID#: 124.73-2-19 Mechanical Permit#24-161 issued on 12/5/2024 to Install Fire Sprinkler Heads This certifies that the fire sprinkler heads,installed under the above captioned permit,have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to b 4+ut -a 1 VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason .\. Klein (914)939-0668 ChristopherJ.Bradbury www.ryebrooknv.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE June 25,2025 Patrick Kumf&Ashley LoBue 6 BelleFair Boulevard Rye Brook,New York 10573 Re: 6 BelleFair Boulevard,Rye Brook,New York 10573 Parcel ID#: 124.73-2-19 This document certifies that the work done under Mechanical Permit#24-156 issued on 11/22/2024 for the installation of five additional registers to the existing ductwork has been satisfactorily completed. Sincerely, / 9 1 11 Steven E. Fews Building&Fire Inspector /to ECENE MAY - 6 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT BUILD ENT o r us IT N VIL OF D: [n—�7—eAy 938 KING S YORK 10573 S c y, J—Pam APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO (T'HE FINAL INSPECTION Address.....i�......3e.....��2��'d "1�•�� N ... VSi�............. Occupan "��C ^ t I i s v,-7 3 -a-/co pu'b Owner. l L L)i" sun/Address: P.E./R.A.orContractor fy . ddress: Person in responsiblc 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: TATE OF N<E�W'YOR[Ky,COUNTY OF WESTCHESTER as: Q via�0 u(``'/'"being duly swom,deposes and says*At he/she resides at torn Nees.rAppbc>.tt Ma.aatl fltaal Kit S ,in the County of l A.4 S&S ere 4 in the State of�_,that 'C*y.To.s vd1w) hc%she has supervised the work at the location indicated above,and that the actual toW cost of the work,including all site improvements. labor,materials,scaffolding,fixed equipmen4 professional fees,and including the monetary value of any materials and labor which may have been donated gratis was.S 7 for the construction or aIteration of drr t2a5 Q)/v- Deponent further states that hetshe has examined the approved plans of the structure/work herein referred to for which a Certificate of (kcupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structurciwork has been erected completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authonml,and as eretteNcompleted complies with the laws governing building construction.Deponent further understands that a shall be unlawful foran owner to use or permit the use of any building or premises or pan 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 u per§250-IO.A.of the Code of the Village of Rye Brook Swom to before me this 02 Sworn to bebrc me this OL day of .20.5- dry of 20-29 stOnae. PcIe ltaatawdAAlieal Orr t Prig N..t o.ee JOFRYMAL ALVAREZ GUERRERO NOTARY PUBLIC STATE OF NEW JERSEY �K ID 050117M MY COMMISSION E PMES Nov.22.203 �,E RRC��• O Z� lJ �O,c ��• '9a�•� BUILDING DEPARTMENT ❑BUILDING INSPECTOR )2<SSISTANT 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 : I j� L� `Ve� ��i�.l!� � L yD - DATE: PERMIT# !2 / /3 / ISSUED: ECT: �Z -7 BLOCK: LOT: LOCATION: �k�81 .�L- LC��t - 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 I ❑ Natural Gas ' NS C C-4 r o-J 0 PS ❑ L.P.Gas V ❑ FUEL TANK d q V6..�eAd ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER LL- �yE 4RO cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 2/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 zeu--e- ra t 2. Z-4✓b- DATE: �rXj - A8 " ZC>X*, PERMIT# )o a 1351 ISSUED: V-a ECT: y'7 BLOCK:_oo LOT: LOCATION: �RS6 /�Gw� n.)0 YA,��O�J 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 //�� ,Y/ ❑ NATURAL GAS 9A404 40 eA 0'%J c( NeGC// 64.)AS V Cl L.P. GAS J04,J - PJI"bOa; 1'00) 4�6ep ❑ FUEL TANK ❑ FIRE SPRINKLER /�/�� p /SC ❑ FINAL PLUMBING ep ❑ CROSS CONNECTION 00e^ ,g' FINAL ❑ OTHER rAa Ina ^f!� I fttoVetvloo Q. 4 r+ai L • Con �E BRC��. Fb • 1982• BUILDING DEPARTMENT ❑BUILDING INSPECTOR a 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.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: L % t r= DATE: PERMIT# �C -,� ISSUED: SECT: BLOCK: LOT: LOCATION: mom.- OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED EJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS iG,,S e i'tGi�`/ /GL�✓U(��iy-J ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION e' FINAL ❑ OTHER 2 /CZa rr- i 1 F /IEFe � to� yE. A.) DC..) �E 4Rcb, O� Z� cu � • 1982 BUILDING DEPARTMENT ❑DING 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 : (,o _t)_0 LLgo i 2 -P=,L DATE: PERMIT# /��-S / ISSUED:/V/2 SECT: BLOCK: „.-` LOT: I LOCATION: �G �� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED "REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: Cl ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION J ❑ NATURAL GAS L-L �'T✓t"��" ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER FINAL PLUMBING ❑ CROSS CONNECTION �� n ❑ FINAL ❑ OTHER �yE BRC��. O�` tim cu � 1982 BUILDING DEPARTMENT ❑��BUUILDING INSPECTOR Rg�(-SSISTANT 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 : Co Z> DATE: PERMIT# 117 / - (o ISSUED:Az--` - ECT: Z7• /3 BLOCK: 2 LOT: LOCATION: / OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Q-,ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION /� L ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRCZk. F o 19812 BUILDING DEPARTMENT ❑I BUILDING INSPECTOR D 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 : IL e-ne_ t.. �� o �0.�C3 DATE: PERMIT# "RA9 ;k`4 - 3 ISSUED: ' L SECT: BLOCK: LOT:�� LOCATION: '�)n 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 13, INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E BRC��, 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 01ASSISTANT 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: ICJ QE LLL�CA iF' _ DATE:i Z. PERMIT# VAR ISSUED: SECT: BLOCK: LOT: LOCATION: 1'�if�1'JF / ' C�� 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 ❑ L.P. GAS , ❑ FUEL TANK V c ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION , �-` NN ❑ FINAL ❑" OTHER QyE BRC�uk 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 : 1n L- LAC C� / �Zi .L� y� DATE: / Z / I?U Z PERMIT# ! ! ISSUED: -) ECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING �] ROUGH FRAMING ❑ INSULATION ❑ NATURAL GASH ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC�jk. cu � 1982 BUILDING DEPARTMENT VILDING INSPECTOR SISTANT 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: �% Z J 2 �f PERMIT# ISSUED: SECT: Z/ q-73 BLOCK: — LOT: LOCATION: `J "''JP �` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION ery'E +�V REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION Q UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION J ❑ NATURAL GAS ❑ L.P. GAS >� t. ❑ FUEL TANK 4- ❑ FIRE SPRINKLER CJ ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL /J i �' ,JCA, C^ JJ J�- ❑ OTHER ff 411 S �� c� �� a = a v O � a v p� W a c; vv = uw bz � m Ho � �y O C LrA i 1 .°�. W O W M It oLo $ c a �1 �W�I pMp M � aOa � G7•d � �, 00 w w W � � w Q----11 W d � 0 a� � Vp o o •v v z m uz y O00 W s `n Fil r—, w CT ■ � O O a?3 ac C7 z � � � � u � � N ° I r y m _ rl a cya o a o A H a U d w Ug o a v , � O OF A � V W E- S w Q C.7 w° � - _ m m w w w Q,` �. C7 A z O LLJ o Q 3 Z w�,CL CC V) - xCl) � b = BUILDING DEPARTMENT Q F CM W VILLAGE OF RYE BROOK 938 KING STREET RYE B><toolc,NY 10573 J U N - 6 2024 (914)939-Na VILLAGE OF RYE BROOK BUILIJING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION Approval Date: 1 07 4 f'c,, Application Fee:S / Qy Approval Signatttre: Permit Fees:S 3 U Other: Application dated: (O ^is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: Jt f SBL: —ID- 9 Zone: 2. Proposed Improvement. hc in (let;:1 l): S ,t R 3. Does the proposed improvement involve Home-Occupation as per§25 -38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER II: TIER Ill: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system f I ire ,priirkIcr. ANtii. ,i_cm. l ,ICtiI. I ne I I I, god,t_-tc .r :No: Yes: 5. Occupancy;(1 fam,2 fam.,comm.,etc...)Prior to Construction: 14aohy _ After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: tt �0 pp {{ 7. Property Owner: VA"1�I C � Y-UYV\`� Address: 10 hQ_I ht I+Y y Phone#421 '' -3Z/'r , �Cell# email: 8. Applicant' Address: 1 IULku-fav Akwon ,Ar Ivy to�v I Phone# 1 Cell# email: '2p 9. Architect: Tk8 -5 _ _atrs 0 V1 Address: V- n Phone# �-1 kJ l Q Cell# email:+!k►v y Zt� q_wat^f.-©m 10. Engineer: Address: Phone# Cell# email: 70 11. General Contracto . Address: ( j G G'X.W00 C4 A IJ L Y W-l—'If fq /U Phone#�jT-3 Cell# ern ail:fc,(Ak9-P,4 t Wky rah Wqn 11 COW) 12. Estimated cost of construction $ V 13. Job Timetable: Start: ( UuAL , `� Finish: 5 4- [ G� tt) +r r t .6/1/2024 BUILDING DEPARTMENTE C[E- VILLAGE OF RYE BROOK �J 938 KING STREET RYE ftom,NY 10573 LN - 6 9024 (914)939-0668 3 c„ . �`• VILLAGE OF RYE BROOK BUItiJItvG FPARTM'EN-T tttxxwxxtttxttttxx,t*xwti*+,rtttt*wt*ttttr*twrtxxx*xtttt*+�:�t#tx+rwx+rttttxtt*twww*w*r++t*rtirs**�xxtxx+++tttrw AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST SEAR THE NOTARIZED SIGNAT(W. OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 1, T f )( C residing at, V a cc 1/ 2c N� being duly sworn,deposes and states that(s)he is the applicant above named,and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at, Rye Brook.NY. 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 al I State, County and Village Codes. ,oc Sworn to before me this day of MO. ._ , 20. I JofrYmal Alvapoz Guerrero Notary Public commission No 501 17272 LMy Comm. expires€')Nov 22, 2024-.J 1 R11212021 This form must be properly completed&notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. E C 2 ME J UN - 6 2024 Notice of Utilization of Truss Type, Pre-Engineered I Vood or Timber Frame Construction. VILLAGE OF RYE BROOK BUILDING DEPARTMENT To:The Building Inspector of the Village of Rye Brook. E.: Subject Pry ti p Jr I-v. SBI„ Zone: Please take notice that the subject;*One or Two Family; ❑ Commercial, ❑New Structure m Addition to an Existing Structure ❑ Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction(7T) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction(TC) in the following locatiou(s); ❑ Floor Framing,including Girders&Beams(F) ❑ Roof Framing(R) ❑ Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR §1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Sworn to before me this Gj Swom to before me this day. 20 Z4 day of .20 Z t er Si store of Design I rofcgs na p Print ame Print Name of Notary tblic =: Notary e - v Fiofrymal Alvarez Guerrero rJofrymal Alvarez Guerrero Notary Public Notary Public Commission No. 50117272 Commission No. 50117272 LMy Comm.expires Nov. 22, 2024 1 (3) LMy Comm.expires Nov. 22, 2024 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ('7c �{ .� being duly sworn,deposes and states that he/she is the applicant above named, �- J(Qrin of imividwl aigmng as the applicant) and furthers s that (s)he is 1 owner of the property to which this application pertains, or that (s)he is the v for the legal owner and is duly authorized to make and file this application. (indicate architect,conirador,agent.at OTT,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications, as well as in accordance with the New York State Uniform Fire Prevention& Building Code, the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day© . 20 day off ,20 Signature of owner Signature of Applicant " Print Nana oY Print Name of P_z I imp, Notary Publ rjofryrnal Alvarez Guerrero rjofrymal Alvarez Guerrero Notary Public Notary Public Commission No. 50117272 Commission No. 50117272 �My Comm.expires Nov. 22, 2024 1 LMy Comm.expires Nov.22,2024 (4) a/12n(r21 BUIImov MENT VIOOK 938 KING ,NY 10573 DEC - 3 2024 FOR OFFICE USE ONLY:rif [� Approval Date: DEC erm it# / �'�'�� Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: # Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Amendment Fee: _Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: /d --�-3V is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. Job Address: �� l l e �GIf Existing Permit#: —/ 2. Parcel ID#: IQ z 73 --c�)—� 9 Zone: Original Approval Date:_' L( 3. Proposed Amendment(Describe in detail):�Q I bA r CA Y' a-G - rl¢w�0 r S"h rw the/ceiriAkt&,e Woo al /UW LVQ a4YW4/1 4. Property Ow,rter: Address: IIU� (,I Phone# Cell# e-mail Applicant: Address: /// Phone# ry / AlCell# e-mail I�G q�b4vu i hn yr1►1/t n Architect/Engineer: e LO VI-N Address: l e ,� tyl N l t7-5 6 02 Phone# Cell# 9 klO IJ5 O e-mail 5. Occupancy;(1-Fam.,2-Fam.,Comm.,etc...)Prior to construction: After construction: 6. Will the proposed amendment require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:N�L/No:_(if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes:_No: r✓ Area: 1 6/1/2024 o. win me proposed amendment require a Site Plan Review by the Village Planning Board as per §209 of Villagc Code." Yes: No: (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No:L,,--(ifyes.you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey& site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No:_k' (ifyes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per`250-38 of Village Code? Yes: No: - If yes,indicate: TIER 1: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so, provide such additional footage here. Q.1 u (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 2t 1/4/0 (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y. State Construction Classification: N.Y. State Use Classification: 17. Estimated date of completion: '�02 Z?/ 1,2 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. SJ1kTE OF NEW YORK,C OF WESTCHESTER ) as: Lax C ,6,t � , 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 tD w� V u/n` Ir r Wit,--. F for the legal owner and is duly authorized to make and file this application. (indiclife architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted iit the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn3 to before me this 4 day of ()1 U tAkV— , 20 ?,q day of ' e u , 20 Signal,e of fropertv Owner — Sifnature of Applicant Print Na-Mie o riot Nam Notary Public -\ 2 JOFRYMAL ALVAREZ GUERRERO JOFRYMAL ALVAREZ GUERRERQ NOTARY PUBLIC NOTARY PUBt 1C . STATE OF NEW JERSEY • STATE OF NEW JERSEY-- I D#50117272 ID#50117272 MY COMMISSION EXPIRES NOV.22,2029 MY COMMISSION EXPIRES NOV.22,2029 -._. .. 6/I2024 a s O � N � � = N s .r � << W • N L� vlu a EA X O V ti h V-4 aoen 4 W 1; M � ?04 r r N LL' S " pw o00p ctr M 1 " N V R. z r1 z Z �+ _ 0 % �G = W � = • a ✓ z v w Q t `' F" _ ... i- < Q , as (A a a , Q U _J �" U _ W r _. 0CA r1 a tx U QU. < a z W Q oA ;.To = CA ... v VIL { E K 938 KIN ' $ ,NY 10573 R (� t - n � '°N OCT 17 2024 P11j, ELECTRICAL PERMIT APPLICATION I...__. ,E OF RYE BROOK Westchester County /Master Electricians License Required; NG DEPr",Rl"f cNT FOR OFFICE USE ONLY BP#: 7—�� EP#: a O� ZL� Approval Date: �-� Permit Fee: $ Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY 1-HE BUILDING INSPGC'TOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COSTOF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 Application dated, /0—/ 7 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. CR/ J�6� SBL: IQ Ti 73—Q 9 Zone: 2.Property gwner e Address: Phone#: Pr Cell#: email: 3.Master Electrician/Licensed Insta ler: � � Address: a W I Tr,n _ Lic. #:�oPhonne(#?: q Z/ �—Cell#: emailU�7� 030 l� Company Name: `i Iw ((C'' W Address: 4.Proposed lectrical Work/Fixture Count: W Iboj1h a49D(f) vr 1 i_ m dU( T 5.31d Party Electrical Inspection Agency: >� _ STATE OF NAW YORK,COUNTY OF WESTCHESTER ) as: _.being duly swom,deposes and states that he/she is the applicant above named,and does further (prim name of individual si nin plic t) state that(s)he is the n for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of hivher knowledge and belicf,and that am work performed,or use conducted at the above captioned property will be in conformance with the details as set lorth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York Stan:Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws.ordinances,and regulations. _ I Sworn to beforeme this 2 r Sworn to befo me this��t� day of 0 JOfrytmal Alvarez Guerrero 0 y :! Notary Public uQL�7La (,tom Zi Commission No. 50117272 Si ature of A licant Signatu of Property Owner LMy Comm. expires Nov. 22,2024 f g—^ pp P�k(c:k-- �V M -t-�4,J cts�� (tics Pri>;t Nar ----(>_PtppettyJ;vner Print Name ot'Applicant_ Jof mal Alvarez Guerrero r� _ Notary Pbb' - Notary Public Notary Pub - Commission No. 50117272 `t;2024 y Comm. expires Nov. 22,2024 _ STATE WIDE INSPECTION SERVICES, INC.:� CAD Service With Integrity ••0 OFFICE(coSWISNY.CONI SWIS JOB APPLICATION0. • Office Use Elect. Permit# `r- Gi J Date /0//7/ `� Bldg Permit# BP 2q - 1344 Sq Ft Plumbing Permit# Final Certificate# City/Village W ilu L F fuL' Zip Building Dept. County Address 6 be &-,J1eLa/J Cross Street Section Block Lot Owner Name/Address(If different than above) PC4 r f 0'. K UMr +/ 5L Iiy C 0 V L 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 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 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair 'OL" i ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation RIEC� MVE -F� j IF FOCT 17 2024 ! . VILLAGE %=. +;f,COK This application is valid for one(t)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,fat anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to/all the above terms and conditions as set forth for the application.lt r Email Address �� <"' 13&' L` k Name fG�I a SCiU /'�QrQ License# �J Date Signature fkju S Address ,,q'-f t) City/State Zip Code 10801 Company 2r` t�� —FPhone# I! State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 �m U Aj 845 202-7224 914-219-1062 Fax Fax STATE WIDE INSPECTION SERVICES Email: office(d)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: JBG Electric Corp Patrick Kumf&Ashley LoBue Francisco Barajas 6 Bellefair Boulevard 24 Walnut Street Rye Brook, NY 10573 New Rochelle, NY 10801 Located at: 6 Bellefair Boulevard, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-207 124.73 2 19 —_1 Certificate Number: 2025-2301 Building Permit Number: BP 24-134 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: 6 Bellefair Boulevard, Rye Brook, NY 10573 The Basement and Family Room were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 9th day of April 2025. Name Quantity Rating Circuit Type Receptacles 18 GFCI 03 AFCI 06 Switches 15 Dimmers 04 Smoke Detectors 05 Luminaires 28 s Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for%vork performed on the date of inspection only. , •' N N a qj0.4 Oft PC v a� c ►� � M z z � w �o x s qj rA s A � ci; w `a V Z � ►� � v V y. W �.,i O Z O W •0 ` A 0O z tit O 00 en MM ■ `�" a x ,� x .7 wo 0. V W zz " It 1.4 �k HH O ° W � r� con !Z O >, , BUIL MENT VIL E;OF.RYE OK OCT ' 1 2024 938 KIN ET RYE B ,NY 10573 L— i VILLAGE OF RYE BROOK n _gov BUILDING DEPART MENT PLUMBING PERMIT APPLICATION ,L PP#: �7 FOR OFFICE USE ONLY BP#: - Approval Date: Permit Fee:S Approval Signature: Disapproved: (fees are non-refundable) ***#########M#*##*###+h##tlk#+Y#**#Mkt#k#*t########M##R#####fk######R#+R####kM######*#**#*#**#******** - DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLEI ED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MIYIMLIM FEE OF$750-M Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by sighing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: J e- -4 ' r SBL: /�'7�� 73 -01- y Zone: 1941D 2.Proposed Work: ` 4 ' I& 3.Property Owner: Address: Phone#: Cell#: email: 4.Master Plumber: �' Address:l-11 9- �a��'+� Lic.#: Fgr Phone* L'446 Cell#: —email: Company Name:a i" n, �' `�/� .!1�' Address: J 0' INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDUL_.ff fy'F'1F Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary NaturaU Other" Total Closets Fountains 1 Tubs Tubs Service Service Sewer LP Gas Basement I st Floor —._. 2nd Floor 3,d Floor 4'h Floor 5th Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) er I/Z02a STATE OF NEW YU COUNTY OF WESTCHESTER ) as: j..Q � +`� t ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the and further states that(s)he is a Master Plumber f 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. h Sworn to before me this Sworn to before me this�_ t QM6c� day of tA.� .20 _ day of ,20�_. Signature f Property Owner Signatur of Applicant 5 - Lu Pro Print Name of Applicant Print7iatac perty Owner rjofrymal Alvarez Guerrero? = Notary Public lic Commission No. 50117272 qt4p,�p-cGiv. a� J My Comm.expires Nov.22,2024 Nam!'r 'WIN lf+otlltt My Coombsiat Ellik s fhb.25,30-�Z�?D 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- 0 2024 BUILD ,gTMENT � C IE M `/ VIL of RY OOK 938 KING E' .fit BR NV 10573 OCT - 2U24 EIDD VILLAGE OF RYE BROOK e ov BUILDING DEPARTMENT trttttttttrtrrttrttttrrrtttttttttrtrttrrtt*trtttrttttttttrttttttttrttttt♦rtrtttttrtttrtttttttrtttrtwttt AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAvrT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL. PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: &K t�z residing at, 4 ��ntel //��/2 �V< ,c•-'��`L� (Print name) (Address where you Iivc) 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; ( �' �/ Allfto� , Rye Brook,NY. (Job 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. +j" (Signature of P erty Owner(s)) /-[` Ur5 (Print Name of Pr( rty Owncr(s)) Sworn to before me this day of�e Q , 20 2 q__ rJofrymal Alvarez Guerrero (ti :ra Public) Notary Public v: Commission No. 50117272 _ — LMy Comm. expires Nov. 22.2024� -3- wit no2a a a N e a N :r, m o ►.. W U V w H .— W A � w 10 O � Z o j Q z 60 u z cn � v, Z r W A � M O � p 00 a cn "'� ✓ z Z o � N � a x Us x a Le) O HS V � " x e w 1 p w z q oG c 4 444 444444444 goo , 44 e 1 BUI DEP,�IgMENT VI OF RYe K JUN 10 2025 939 KIN" RYE ,NY 10373 VILLAGE OF RYE BROOK v BUILDING DEPARTMENT PLVNIBIN*G PERMIT APPLICATION FOR OMCE USE ONLV BP PP M: APFMWM DWr. v 1� 2S Permit Fee: S Approval pp l fi n• t DhapprowW. ttlw.n ) DO NOT START WOK w CWNSU ' TJO0N LINY11- A rERA IT HAS R _ .N Isci!) BY rllf is ►t DING INSPECTOR, THE A✓DMINISTRAT1YR FILL TOR% l K PM;RLUED OR C ►M . .T D WITHOL i A PERMIT IS 11%OF 111E_ Tor AL COST OM )s5TR `('T10Y N'iTH A w-Nim tit FIEL OF 117-4 oo Appkabun dated. 1�27 f,Q--,)� is bacb) wwdc to the Nuald>;n, Inspc%;tat of the Vlbw of Rare Bre& NY. for the 1s wncc of a pcfM11 10 M14all and,tst rcmcn•e PlumbinS as per detailed stairmcal 6mfobcd below 7*applteaat R prropeny 06.1e..by sts)M&this %hk wrwnt agree that said plumbing w +rill bs to onlurausc w ball hcaale Federal.tWe.('tsunh and Local Codas. l Addren+. _ -� s9L: /a y,73 1't��xisc�d Wo is 1.prop.tty Owner '� A-M . Phone N: cell w email: 4 Master Pkarabtr Address Lr'c,a: r' Mw.w r s I cen r: ----1 coed. r CO MPISM Name419Q AddFM ?s '' INDICATIE FIXTURIES A U.Nn NE INSTA 2 wD AS PERTHE FOLLOWING KHIZ74 LwaMtet N'ata Umiak Dnakw -Sa►a ba- som Sma IAWA& [)omr+nc ►av Sa wawy tiatwal (Mva TWd / Cho ► F•uhoaw Tiara Tra Serhec Scnwc Sower LPG" �aaarmrnl / 1st Plow I 2M Pleor 3 Ploar 4 rum Fluor isaststanar 14 026 S. • L1.1 Ottwr I gwpnusht.NO%adc Iacwk: 13A IV (Notarised Signatures WAnuised Mtlnct 2 pages) -I- 6 1 2U2A BU1L � ENT vl OF.jtY K JUN 1 0 2025 43S Kt%G RvOklk KY 1"7 VILLAGE OF RYE BROOK BUILDING DEPARTMENT �iNiiii�iiiN NiN��iiiii�iii i�iii•ii��ii•�i�iiii�iii•#$**0 •Ni��i iiiiN�i�••�iNNiiii�fi�• AFFIDAVIT OF COMPLIANCE VUAQE CQPL6216 • STORM SEw _as A SAWTAKY SEWERS Tai/ AITIDAVIT 10111 Kai Ts= MWA 92D SIGMTCRa 06 IM LAaA.L POOKiTT ON 41<D Ng soal6TTW AL,1000 11" AWT WIIDIM OR MASM PMUT &PTUCATIOR. AM ao2LaIaa OR naMIM ramaT A&MI CATION 99OUrrso ■I TIMM TRI a CCWLSTTa AD W7Alt11m MOO WILL sa RZ?tN = To rM &M:Cs." STATE OF NEW YOM COUNTY OF WESTCHESTER ) u: 1 Prod erg.) (A &m.use"ti.01 bcing duty sworn, deposes sad slates that (s)be Is the appixant above named.and Nrdm stases that(s)hc a ttw kcal cn^Txr of the property to w#vch t6s Af Wavit of C4cnplmxe pertsins at; `!cL lC r>j 12.- -- - Rye Brook, NY (Job A4Umm) Fw1ber that all itaurmcnu contained harm we true, aria the to the best of hts,'her hnowkd`e and belief,Mat there are no known t1leQal amKt-cpmmectiam caom. ing either the storm sewer or sanitaty sewer,nand iw1ber thu torte are no roof arsons, sump ptu mqw or adw prohibited stomwaar or graundwaler coaaecnom a sotrces of inflow or mfiltma m of any kud im On taiwy /ewer from the P*ect property m aecardance "nth all Sots. Cvuaty and V&Il W Codcs PA.... .,/, k, "'i is*.re of Anpor oomw o i �,ULV..vn� (Pno No=arlmoma ml swomIb m6b 30 day of Iu NOTARY F%)B JC STATE Of NEW JERKY 1D r00t172T2 J �:NpIM.pOdQ1A�00mhnRahlf 1 f�Ir100ot ?nroMttors/ t 4TATE aF NEW Y'ORX OOl1 M 0r elc .d hBtw own ttw(9*is ek MW@w rho"Ar do bo~gW r d*W&W .r tr ado tad lb rr 4PHOOM Trot r arrt..a.d aowitatt bwW3 w IFU r dw Mao e(MA r howb4a r6aL tarot MW nq"t pwbWL arm aad in a w"co■ipaar*op pbu and wacdai6ft 0 wa ift In gyres ims so rr Maw Yaw am*unmwn"M Plewearim!8idWbs OWkL`e Oak o(*A VOW 01t1lr and nj r saw t> Sm6b I g%NOUN"wd NPk* . l ei�v 4\ now r M t#ir aw of 11,1 j F t Name o( Oww 11■�t A��+I IcyF MICHAE-L LAGE PUBLIC,STATE OF NEW YORK stration No.01 LA6297980 fied in Westchester County Commission Expires May 24th, 2026, T ap�kcaR�ort Pra"ly in its etrtit+et). WW XWO ire 1V&dW nodr iaKid s)of the tI'awOW')o'd*>fttbjM PgMty.rend the applkW O(r+xord is the tlprc�es pativided, ApplicatiotL� not PeOPO Y iN it$GgdFWY afd+lar not property S*W sh.p be dea4ed null Md void and A-itl br moved to die sppkaa JOFRYNAL ALVI M GLOOM NOTA Y PUBLIC STATE Of WW,WEY 10 111001I rM w �i a s a N N �� g ,. \ � T w Ica, m �i 0 = t s W a C O K W Con g J E 7� F �i 4 is o c ° �1 .L cV sI 00 '�: �ia� r^] 3 �..+ � Lim � � 7 ,�x, �, w 2 0 !: •� r x v w 00 Z GQ W ° �• � �'"' W OC W 3 � v a ;� ao� ig � u F \ < W z z Q J M v z x BUILD MENT VIL E OF RY \ OOK DEC - 2 2024 938 KING ET RYE BR ,NY 10573 4 w ov APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Approval Y&�T _ #: — MP#: � �(.f! Application Fee:$ 00 / Approval Signature Permit Fees:$ y Disapproved: Other: Application dated: I a/( A/aQ aq is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: �(J `�U�i'I CC.l r ` l V C t l!� e bfo c7 L\ !y 1 2. Parcel I.D.: 1 c_)171r ? 3 —vt _u/ 9 Zone: /- �6 3. Proposed Work(Describe system in detail including sup ression agent): den din f •,r s�f n l��e,r a 4. Number&Types of Fire Sprinkler Heads: e i C h l Q t" ) 1`es 1eO CIM T .6 (�F C 'l G 5. MY State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job:$ ` 0 500 (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may bedonated gratis.) 7. Property Owner: %Vf i cy, 1�t)nr- Address: 6 �*w 1:4 l A 6 Phone# , ICerll1_#, 1�(� email: {� 8. Architect/Engineer:TtlQ IlQS t�tQ f*C( 00 hl�P_&fgL dress:�� zy� F' -rip ;j2f�-' go Phone# l! 00"053 O Cell# ( l -610 '-OS30 email:-f 6offLps hodb-e� �g1j,C0,4 9. Sprinkler Contractor: A [I �2 SQf i ilK l ei S ir►S Address: 3 7 S &f C LAh le b 1 U G( j rJq_S ZX J j V?0 Phone# Ff 32S-5123c9(4- 1 It'-Cell#O p 3-)5-57a3 6(j- )D email:ATA P�i4 i 6/1/2024 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STA E OF NEW YORK.COU�}TY OF WESTCHESTER ) as. CtH(; C—IL iL ,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 Sprinkler Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein arc true to the hest 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 Unifonn 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 .42 Sworn to before ntc this 2jo day of_V,jC?\Ic�; LjC:4L , 20 2-1 _ day of N10Qc:1k6c4_ - 20 r)_ Signs of erty Owner I Signature of Applicant K _ Print Name of Prnperty owntt Print Ndtne ofApplicantr— ry Nutan pub oralic JOFRYMAL ALVAREZ GUERRERO -:70FRYMAL-ALWEZ GUERRERO NOTARY PUBLIC NOTARY PUBLIC STATE OF NEW JERSEY -SID TATF NE)N JERSEY 10#50117272 I M5111 t7272 MY COMMISSION EXPIRES NOV.22 2T4 NI 2024 Bulletin 135 August 2024 Rel Q Model F1 Res Series Glass Bulb Residential Sprinklers cULus Listed Features Importantl Reliable fire sprinklers must be handled,stored,and • cULus Listed Residential Sprinklers installed in accordance with the guidelines in Caution Sheet 310 • Available in pendent and horizontal sidewall orientations and this bulletin.Failure to follow these instructions may result in • Decorative finishes available, including recessed unintended operation or nonoperation of the fire protection system. escutcheons and conical concealed cover plates Important Note: Model D wrench and Model GFR2 wrench Product Description are no longer compatible with this product. Model W2(non- recessed)and Model W4(recessed,concealed)are required. Model F1 Res Series sprinklers are residential sprinklers with a 3 mm glass bulb operating element.A variety of K-Factors as well as recessed and conical concealed options are available as detailed in this Bulletin. The F1 Res Series sprinklers are specially engineered for fast thermal response to meet the requirements of UL 1626.They are intended for installation in accordance with NFPA 13, 13R,and 13D. Application The Model F1 Res Series sprinklers cULus Listed Residential sprinklers are intended for use in accordance with NFPA 13, NFPA 13R,or NFPA 13D.The Model F1 Res residential sprinklers are cULus Listed for use in residential occupancies t and residential portions of any occupancy,where permitted by ; h NFPA 13, NFPA 13R,or NFPA 13D. For NFPA 13R and NFPA 13D applications,the design flow and pressure shall not be less than the minimum flow and pressure specified in the Listed Design Criteria tables in this Bulletin.For NFPA 13 applications, minimum flow and pressure specified in the Listed Design Criteria the design density shall be a minimum of 0.1 gpm/sf(4.1 mm/ tables in this bulletin.Model F1 Res Series sprinklers are listed for min), but in no case shall the flow and pressure be less than the use in wet systems only. Residential Sprinkler Summary Sprinkler K-Factor Thread Size Max.Covera a Area ft Sprinkler Identification Orientation gpm/psi12 Installation Options g Model Number(SIN) (Ipm/bar12) NPT or ISO7-1 x ft(m x m) F1 Res30 R3511 Pendent 3.0(43) 1/2 Pendent or Recessed 16 x16(4.9 x 4.9) F1 Res49 R3516 Pendent 4.9(71) 112 Pendent or Recessed 20 x 20(6.1 x 6.1) F1 Res58 R3513 Pendent 5.8(84) 112 Pendent or Recessed 20 x 20(6.1 x 6.1) F1 Res76 R7618 Pendent 7.6(109) 3/4 Pendent or Recessed 20 x 20(6.1 x 6.1) F1 Res30 CCP R3511 Pendent 3.0(43) 1/2 Conical Concealed 14 x 14(4.3 x 4.3) F1 Res49 CCP R3516 Pendent 4.9(71) 1/2 Conical Concealed 20 x 20(6.1 x 6.1) F1Res58 CCP R3513 Pendent 5.8(84) 1/2 Conical Concealed 20 x 20(6.1 x 6.1) F1Res76 CCP R7618 Pendent 7.6(109) 3/4 Conical Concealed 20 x 20(6.1 x 6.1) F1 Res44 HSW R3531 Horizontal Sidewall 4.4(63) 112 Recessed 16 x 20(4.9 x 6.1) F1 Res44 SWC R3531 Horizontal Sidewall 4.4(63) 1/2 Conical Concealed 16 x 20(4.9 x 6.1) F1 Res58 HSW R3533 Horizontal Sidewall 5.8(84) 112 Recessed 16 x 20(4.9 x 6.1) F1 Res 58 HSWX RA3533 Horizontal Sidewall 5.8(84) 112 Recessed 14 x 26(4.3 x 7.9) Note: Please note SIN difference between F1 Res58 HSW(R3533)and F1 Res58 HSWX(RA3533). www.reliablesprinkler.com Model FlRes30 Residential Pendent Sprinkler&Model F2 Escutcheon SIN R3511 Technical Specifications Finishes Style:Pendent and Recessed Pendent (See Table N) Threads:112"NPT or IS07-1R1/2 Sensitivity Nominal K-Factor:3.0(43 metric) Fast-response Max.Working Pressure:175 psi It bar) Temperature Ratings 155°F(68°C) Material Specifications 175°F(79oC) Thermal Sensor:3 mm glass bulb Recessed Escutcheons Sprinkler Frame:Brass Alloy F2 Recessed r Button:Copper Alloy Sprinkler Wrenches Sealing Assembly:Nickel Alloy with PTFE Model W2 Load Screw:Bronze Alloy Model W4(Recessed) Deflector:Bronze Alloy Model FiRes30 Residential Pendent Sprinkler Components and Installation Dimensions • 2-1/4"(57mm) DIA. Face of fitting 1-15/16" to finished (49mm)DIA. ceiling 1/2'(13mm) +l-1/4'(6mm) Threads Wrench Flat r/1 03SIM Sealing Assembly 2-1/4" 0�5Va Glass Bulb (57mm) 4, i 1-3/4'(44mm) +/-1/4'(6mm) Load Screw Deflector 1-1/4 2-7/8"(72mm)DIA. (32mm)2m Components Dimensions F2 Recessed Escutcheon Installation Model F1 Res30 Residential Pendent Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems") Maximum Coverage Area," Flow Pressure Deflector to ft.x ft.(m x m) gpm(1/min) psi(bar) Ceiling Distance 12 x 12(3.7 x 3.7) 8(30) 7.0(0.48) 14 x 14(4.3 x 4.3) 10(38) 11.0(0.76) 1 to 4 inches 15 x 15(4.6 x 4.6) 12(45) 16.0(1.1) (25 to 100 mm) 16 x 16 (4.9 x 4.9) 13(49) 18.8(1.3) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 135 ad., Page 2 of 15 August 2024 www.reliablesprinkler.com Model F1 Res49 Residential Sprinkler&Models F1 &F2 Escutcheons SIN R351 Technical Specifications Finishes Style:Pendent and Recessed Pendent (See Table N) Threads:112"NPT or IS07-1R1/2 Sensitivity Nominal K-Factor:4.9(71 metric) Fast-response Max.Working Pressure: 175 psi(12 bar) Temperature Ratings 155`F(68°C) Material Specifications 175`F(79-C) Thermal Sensor:3 mm glass-bulb Recessed Escutcheons Sprinkler Frame:Brass Alloy F1 Recessed Button:Copper Alloy F2 Recessed Sealing Assembly:Nickel Alloy with PTFE Sprinkler Wrenches Load Screw:Bronze Alloy Model W2 Deflector:Bronze Alloy Model W4(Recessed) Model F1 Res49 Residential Pendent Sprinkler Components and Installation Dimensions 2-1/4"(57mm) (57mm) DIA. Face of fitting4 - 1-1/4' DIA. Face of fitting 1-15/16" to finished1-15/16" to finished 4(49mm)DIA. ceiling (4 mm)DIA. ceiling 5/8"(16mm) 1/2'(13mm) +/-3/8"(9mm) +/-1/4'(6mm) I O�sVa 2-1/4' (57) 1-5/8"(41mm)+/- I 1-3/4'(44mm) +/_1/4"(6mm) 3/8"(9mm) 1 (32mm) 2-7/8"(72mm)DIA. 2-7/8'(72mm)DIA. Dimensions F1 Recessed Escutcheon Installation F2 Recessed Escutcheon Installation Model F1 Res49 Residential Pendent Sprinkler Hydraulic Design Criteria • - Minimum Flow and Residual Pressure in Wet Pipe Systems" Maximum Coverage Areai2l Flow Pressure Deflector to ft.x ft.(m x m) gpm(1/min) psi(bar) Ceiling Distance 12 x 12(3.7 x 3.7) 13(49) 7.0(0.48) 14 x 14(4.3 x 4.3) 13(49) 7.0(0.48) 16 x 16(4.9 x 4.9) 13(49) 7.0(0.48) 1 to 4 inches (25 to 100 mm) 18 x 18(5.5 x 5.5) 17(64) 12.0(0.83) 20 x 20(6.1 x 6.1) 20(76) 16.7(1.15) 12 x 12(3.7 x 3.7) 15(57) 9.4(0.65) 14 x 14(4.3 x 4.3) 16(61) 10.7(0.74) 16 x 16(4.9 x 4.9) 17(64) 12.0(0.83) 4 to 8 inches (100 to 200 mm) 18 x 18(5.5 x 5.5) 19(72) 15.0(1.03) 20 x 20(6.1 x 6.1) 22(83) 20.2(1.39) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 135 Page 3 of 15 August 2024 Rellabl www.reliablesprinkler.com Model FlRes58 Residential Pendent Sprinkler& F1 & F2 Recessed Escutcheons SIN R3513 Technical Specifications Finishes Style: Pendent and Recessed Pendent (See Table N) Threads: 1/2"NPT or IS07-1R1/2 Sensitivity Nominal K-Factor:5.8(84 metric) Fast-response Max.Working Pressure:175 psi(12 bar) Temperature Ratings 155-F(68°C) Material Specifications 175°F(79°C) Thermal Sensor:3 mm glass bulb Recessed Escutcheons Sprinkler Frame:Brass Alloy F1 Recessed Button:Copper Alloy F2 Recessed Sealing Assembly:Nickel Alloy with PTFE Sprinkler Wrenches Load Screw:Bronze Alloy Model W2 Deflector:Bronze Alloy Model W4(Recessed) Model F1 Res58 Residential Pendent Sprinkler Components and Installation Dimensions 2-1/4"(57mm)_ 2-1/4"(57mm) DIA. Face of fitting DIA. Face of fitting 1-15/16" to finished 1-15/16" to finished (49mm)DIA. ceiling (49mm)DIA. ceiling 5/8"(16mm) 1/2'(13mm) +/-3/8"(9mm) +/-1/4"(6mm) t]3S1Ill 2-1/4' (57) i 1-5/8"(41 mm)+/- 1-3/4"(44mm) 318"�mm) +/-1/4"(6mm) Jl- 1-1/4' I I (32mm) 2-7/8"(72mm)DIA. 2-7/8"(72mm)DIA. Dimensions F1 Recessed Escutcheon Installation F2 Recessed Escutcheon Installation Model F1 Res58 Residential Pendent Sprinkler Hydraulic Design Criteria - Minimum Flow and Residual Pressure in Wet Pipe Systems(" Maximum Coverage Area") Flow Pressure Deflector to ft.x ft.(m x m) gpm(I/min) psi(bar) Ceiling Distance 16 x 16(4.9 x 4.9) 16(61) 7.6(0.52) 18 x 18(5.5 x 5.5) 19(72) 10.8(0.75) 1 to 4 inches (25 to 100 mm) 20 x 20(6.1 x 6.1) 22(83) 14.4(1.0) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 135 able Page 4 of 15 August 2024 www.reliabk;sprinkler.com Model :. Finishes Technical Specifications (See Table N) Style:Pendent and Recessed Pendent Sensitivity Threads:3/4"NPT or ISO7-1 R3/4 Fast-response Nominal K-Factor:7.6(109 metric) Max.Working Pressure: 175 psi(12 bar) Temperature Ratings 155°F(68°C) 175°F(79°C) Material Specifications Recessed Escutcheons Thermal Sensor:3 mm glass bulb F1 Recessed Sprinkler Frame:Brass Alloy F2 Recessed Button:Copper Alloy Sprinkler Wrenches - Sealing Assembly:Nickel Alloy with PTFE Model Load Screw:Bronze Alloy Model W4(Recessed) Deflector:Bronze Alloy Model F1 Res76 Residential Pendent Sprinkler Components and Installation Dimensions 2-1/4"(57mm) 2-1/4"(57mm) DIA• Face of fitting e(49D"l Face of fitting 1-15/16" to finished to finished 4(49mm)DIA. ceiling ceiling 5/8"(16mm) 1/2"(13mm) 3/8"(9mm) +/-1/4"(6mm) 113M 2-1/4" (57) 1-3/4"(44mm) 1-518"(41mm) 114"(6mm) 3/8"(9mm) 1-5/8" I (44mm) 2-718"(72mm)DIA. 2-7/8"(72mm)DIA. Dimensions F1 Recessed Escutcheon Installation F2 Recessed Escutcheon Installation Model F1 Res76 Residential Pendent Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems") Maximum Coverage AreaJ2) Flow Pressure Deflector to ft.x ft.(m x m) gpm(1/min) psi(bar) Ceiling Distance 18 x 18(5.5 x 5.5) 21 (80) 7.6(0.52) 1 to 4 inches 20 x 20(6.1 x 6.1) 23(87) 9.2(0.63) (25 to 100 mm) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 135 100 Page 5 of 15 August 2024 www.reliablesprinkler.com Model F1 Res3O CCP Conical Concealed Pendent&Model FP Recessed Escutcheon Pendent SIN R3511 Sprinkler Technical Specifications Finishes Style:Conical Concealed Pendent and (See Table N) Recessed Pendent Sensitivity Threads:1/2"NPT or IS07-1R1/2 Fast-response Nominal K-Factor:3.0(43 metric) Temperature Ratings Max.Working Pressure: 175 psi(12 bar) 155°F(68°C) Recessed Escutcheons/Cover Plates Material Specifications CCP Conical Concealed Plate 135°F(57°C)' Thermal Sensor:3 mm glass bulb FP Recessed* Sprinkler Frame:Brass Alloy Sprinkler Wrenches Button:Copper Alloy Model W4 Sealing Assembly:Nickel Alloy with PTFE Load Screw:Bronze Alloy Deflector:Bronze Alloy *Note: Model F1 Res sprinklers with Model FP recessed escutcheon or Model CCP cover plate may not be used where the pressure above the ceiling is positive with respect to the protected area. Ensure openings in the sprinkler cup are unobstructed following installation. Model F1 Res30 CCP and FP Recessed Pendent Sprinkler Installation Dimensions 2-5/8"(67mm) 2-5/8"(67mm) DIA. DIA. 2-5/16" 2-5/16' (59mm)DIA. (59mm)DIA. Face of fitting Face of fitting to finished to finished ceiling ceiling 1-1/4'(32mm) 1-1/4"(32mm) +/-1/4"(6mm) +/-1/4"(6mm) MJ 1"(25mm) 15/16" 1/4"(6mm) (24mm) 3-3/16"(78mm)DIA 3-5/16"(84mm)DIA. CCP Recessed Escutcheon Installation FP Recessed Escutcheon Installation Model F1 Res30 CCP Pendent&FP Recessed Pendent Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems0" Maximum Coverage Area"' Flow Pressure ft.x ft.(m x m) gpm(I/min) psi(bar) Deflector to Ceiling Distance 12 x 12(3.7 x 3.7) 8(30) 7.0(0.48) 1/2 to 1 inch 14 x 14(4.3 x 4.3) 11 (38) 13.4(0.92) (13 to 25 mm) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. The sprinkler must be installed into a ceiling with the listed cover plate installed. Bulletin 135 Page 6 of 15 August 2024 www.reliablesprinkler.com Model F1 Res49 CCP Conical Concealed Pendent&Model FP Recessed Escutcheon Pendent Sprinkler SIN R3516 Technical Specifications Finishes Style:Conical Concealed Pendent and (See Table N) Recessed Pendent Sensitivity Threads:1/2"NPT or ISO7-1 R1/2 Fast-response Nominal K-Factor:4.9(71 metric) Temperature Ratings fir. Max.Working Pressure:175 psi(12 bar) 155°F(68°C) Recessed Escutcheons/Cover Plates Material Specifications CCP Conical Concealed Plate 135°F(57°C)* Thermal Sensor:3 mm glass bulb FP Recessed' Sprinkler Frame:Brass Alloy Sprinkler Wrenches Button:Copper Alloy Model W4 Sealing Assembly:Nickel Alloy with PTFE Load Screw:Bronze Alloy Deflector:Bronze Alloy *Note: Model F1 Res sprinklers with Model FP recessed escutcheon or Model CCP cover plate may not be used where the pressure above the ceiling is positive with respect to the protected area. Ensure openings in the sprinkler cup are unobstructed following installation. Model F1 Res49 CCP&FP Recessed Pendent Sprinkler Installation Dimensions 2-5/8"(67mm) 2-5/8"(67mm) DIA. DIA. 2-5/16" 2-5/16" (59mm)DlA. (59mm)DIA. Face of fitting Face of fitting to finished to finished ceiling ceiling 1-1/4"(32mm) 1-1/4"(32mm) +/-1/4"(6mm) 17- M +/-1!4"(6mm) 15/16" 1"(25mm) (24mm) L3-3/16'(78mm)DIA. 1l4"(6mm) 3-5/16"(84mm)DIA. CCP Recessed Escutcheon Installation FP Recessed Escutcheon Installation Model F1 Res49 CCP Pendent and FP Recessed Pendent Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems') Maximum Coverage Area(2) Flow Pressure ft.x ft.(m x m) gpm(1/min) psi(bar) Deflector to Ceiling Distance 14 x 14(4.3 x 4.3) 13(49) 7.0(0.48) 16 x 16(4.9 x 4.9) 14(53) 8.2(0.57) 112 to 1 inch 18 x 18(5.5 x 5.5) 18(68) 13.5(0.93) (13 to 25 mm) 20 x 20(6.1 x 6.1) 20(76) 16.7(1.15) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. The sprinkler must be installed into a ceiling with the listed cover plate installed. Bulletin 135 ..T Page 7 of 15 August 2024 Milabld www.reliablesprinkler.com Model F1 Res58 CCP Conical Concealed Pendent&Model FP Recessed Escutcheon Pendent Wnkler SIN R3513 Technical Specifications Finishes Style:Conical Concealed Pendent and (See Table N) Recessed Pendent Sensitivity I Threads:112"NPT or ISO7-1 R1/2 Fast-response Nominal K-Factor:5.8(84 metric) Temperature Ratings Max.Working Pressure:175 psi(12 bar) 155°F(68°C) Recessed Escutcheons/Cover Plates j Material Specifications CCP Conical Concealed Plate 135°F(57°C)* Thermal Sensor:3 mm glass bulb FP Recessed* Sprinkler Frame:Brass Alloy Sprinkler Wrenches Button:Copper Alloy Model W4 Sealing Assembly:Nickel Alloy with PTFE Load Screw:Bronze Alloy Deflector:Bronze Alloy *Note:Model F1 Res sprinklers with Model FP recessed escutcheon or Model CCP cover plate may not be used where the pressure above the ceiling is positive with respect to the protected area. Ensure openings in the sprinkler cup are unobstructed following installation. Model F1 Res58 CCP and FP Recessed Pendent Sprinkler Installation Dimensions 2-5/8"(67mm) 2-518"(67mm) DIA. DIA. 2-5/16" 2-5/16" (59mm)DIA. (59mm)DIA. Face of fitting Face of fitting -- ' to finished i to finished ceiling ceiling _ 1-1/4"(32mm) 1-1/4"(32mm) +/-1/4"(6mm) +/-1/4"(6mm) 15/16" 1"(25mm) (24mm) +/-1/4"(6mm) L3-3/16"(78mm)DIA. 3-5/16"(84mm)DIA. CCP Recessed Escutcheon Installation FP Recessed Escutcheon Installation Model F1 Res58 CCP Pendent&FP Recessed Pendent Hydraulic Design Criteria - Minimum Flow and Residual Pressure in Wet Pipe Systems"' Maximum Coverage Area(') Flow gpm Pressure psi Deflector to Ceiling ft.x ft.(m x m) (1/min) (bar) Distance 16 x 16(4.9 x 4.9) 16(61) 7.6(0.52) 18 x 18(5.5 x 5.5) 19(72) 10.8(0.75) 1/2 to 1 inch (13 to 25 mm) 20 x 20(6.1 x 6.1) 22(83) 14.4(1.0) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. The sprinkler must be installed into a ceiling with the listed cover plate installed. Bulletin 135 e Page 8 of 15 August 2024 www.reliablesprinkler.com Model F1 Res76 CCP Conical Concealed Pendent and Model FP Recessed Escutcheon Pendent Sprinkler SIN R7618 Technical Specifications Finishes Style:Conical Concealed Pendent and (See Table N) Recessed Pendent Sensitivity Threads:3/4"NPT or ISO7-1 R3/4 Fast-response Nominal K-Factor:7.6(109 metric) Temperature Ratings Max.Working Pressure:175 psi(12 bar) 155°F(68°C) Recessed Escutcheons/Cover Plates Material Specifications CCP Conical Concealed Plate 135°F(57°C)' Thermal Sensor:3 mm glass bulb FP Recessed' Sprinkler Frame:Brass Alloy Sprinkler Wrenches Button:Copper Alloy Model W4 Sealing Assembly:Nickel Alloy with PTFE 4L- Load Screw:Bronze Alloy Deflector:Bronze Alloy 'Note:Model F1 Res sprinklers with Model FP recessed escutcheon or Model CCP cover plate may not be used where the pressure above the ceiling is positive with respect to the protected area. Ensure openings in the sprinkler cup are unobstructed following installation. Model F1 Res76 CCP and FP Recessed Pendent Sprinkler Installation Dimensions 2-5/8"(67mm) 2-5/8"(67mm) DIA. DIA. 2-5/16" 2-5/16" (59mm)DIA. (59mm)DIA. Face of fitting Face of fitting to finished to finished ceiling ceiling 1-1/4'(32mm) 1-1/4"(32mm) +/-114"(6mm) +/-1/4"(6mm) 1"(25mm) 14mm +/-1/4"(6mm) (24mm) lr_ 3-5/16"(84mm)DIA. CCP Recessed Escutcheon Installation FP Recessed Escutcheon Installation Model F1 Res76 CCP Pendent&FP Recessed Pendent Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems(' Maximum Coverage AreaJ2) Flow Pressure ft.x ft.(m x m) gpm(1/min) psi(bar) Deflector to Ceiling Distance 16 x 16(4.9 x 4.9) 21 (80) 7.6(0.52) 18 x 18(5.5 x 5.5) 22(83) 8.4(0.58) 1/2(13 to 1 inch o 25 mm) 20 x 20(6.1 x 6.1) 25(95) 10.8(0.75) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. The sprinkler must be installed into a ceiling with the listed cover plate installed. Bulletin 135 Page 9 of 15 August 2024 www.reliablesprinkler.c.com Model . .. Technical Specifications Finishes Style:Sidewall and Recessed Sidewall (See Table N) Threads: 112"NPT or ISO7-1 R1/2 Sensitivity Nominal K-Factor:4.4(63 metric) Fast-response Max.Working Pressure: 175 psi(12 bar) Temperature Ratings 155-F(68°C) Material Specifications 175°F(79°C) , Recessed Escutcheons Thermal Sensor:3 mm glass bulb ti�1 r� Sprinkler Frame:Brass Alloy F2 Recessed Button:Copper Alloy Sprinkler Wrenches j Sealing Assembly:Nickel Alloy with PTFE Model W2 Load Screw:Bronze Alloy Model W4(Recessed) Deflector:Bronze Alloy Model F1 Res44 Horizontal Sidewall Sprinkler Installation Dimensions Face of fitting to finished wall 1-5/8"(41mm) 3/8'(10mm) */ 1/4"(6mm) 1/4"(6mm) 2-7/16"(62mm) Top of Deflector Down from 2-1/4" 1-15/16" Ceiling to be Either 4"to 6" (57mm) (49mm) - - (100 to 150 mm)or 6"to 12" DIA. DIA. (150 to 300 mm)Based on 5/16' Hydraulic Calculations (8mm) Dimensions F2 Recessed Escutcheon Installation Model F1 Res44 Horizontal Sidewall Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems"" Maximum Coverage Area 12) Flow Pressure Deflector to ft.x ft.(m x m) gpm(1/min) psi(bar) Ceiling Distance 12 x 12(3.7 x 3.7) 12(45) 7.5(0.52) 14 x 14(4.3 x 4.3) 14(53) 10.2(0.70) 15 x 15(4.6 x 4.6) 15(57) 11.6(0.80) 16 x 16(4.9 x 4.9) 16(61) 13.3(0.92) 4 to 6 inches (100 to 150 mm) 16 x 18(4.9 x 5.5) 18(68) 16.8(1.16) 16 x 20(4.9 x 6.1) 23(87) 27.4(1.89) 18 x 18(5.5 x 5.5) 19(72) 18.7(1.29) 12 x 12(3.7 x 3.7) 14(53) 10.2(0.7) 14 x 14(4.3 x 4.3) 16(61) 13.2(0.91) 15 x 15(4.6 x 4.6) 16(61) 13.2(0.91) 6to12inches 16 x 16(4.9 x 4.9) 17(64) 15.0(1.03) (150 to 300 mm) 16 x 18(4.9 x 5.5) 20(76) 20.7(1.43) 16 x 20(4.9 x 6.1) 23(87) 27.4(1.89) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 135 e1 a , Page 10 of 15 August 2024 www.reliablesprinkler.com HorizontalModel FlRes44 SWC Conical Concealed . Technical Specifications Finishes Style:Conical Concealed Sidewall (See Table N) Threads: 1/2"NPT or ISO 7-1 R1/2 Sensitivity Nominal K-Factor:4.4(63 metric) Fast-response Max.Working Pressure: 175 psi(12 bar) Temperature Ratings 155°F(68°C) t Material Specifications 175°F(79°C)(') ° Thermal Sensor:3 mm glass-bulb Cover Plates SWC Sprinkler Frame:Brass Alloy SWC Conical Concealed Plateil) Button:Copper Alloy SWC-2(Slotted)Conical Concealed Piatel'1 Sealing Assembly:Nickel Alloy with PTFE Sprinkler Wrenches Load Screw:Bronze Alloy Model W4 Deflector:Bronze Alloy SWC-2 Note: 0)Not for installation where the maximum ceiling temperature exceeds 100°F due to cover plate temperature rating. (2)135°F SWC Conical Concealed Plate for 155°F(68°C)sprinklers (1)135°F SWC-2(Slotted)Conical Concealed Plate for 175°F(79°C)sprinklers Model F1 Res44 SWC Conical Concealed Horizontal Sidewall Sprinkler and Installation Dimensions 1'(25mm) _ _ _ _ 1"(25mm) */-1/4"(6mm) +/-1/4•(6mm) Face of fitting to Note:Model F 1 Res44 finished weft sprinklers with SWC �2-7/16•(s2rrxn>� cover plate may not be used where the pressure - behind the sprinkler is Top or DeBedw Down positive with respect to the 2ADW is----� from Ceiling to be Either 3 5/16• p y; (67mm)(5 �_ - -- 4•to 6•(100 to 150 mm) (84mm) pressure in the protected DiA. or 6•to 12•(150 to 300 DIA. area. Ensure that open- mm)mm)Based on Hydraulic Calculations ings in the sprinkler cup (8mm) are unobstructed following installation. 1sw (41mm) Dimensions SWC 8 SWC-2 Concealed Cover Plate Installation Model F1 Res44 SWC Conical Concealed Horizontal Sidewall Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems0) Ordinary Temperature Rating Intermediate Temperature Rating Maximum Coverage Areai'l 155°F(68°C) 175°F(79°C) Deflector to Ceiling ft.x ft.(m x m) Flow Pressure Flow Pressure Distance gpm(1/min) psi(bar) gpm(1/min) psi(bar) 12 x 12(3.7 x 3.7) 13(49) 8.7(0.60) 14(53) 10.2(0.7) 14 x 14(4.3 x 4.3) 14(53) 10.2(0.7) 14(53) 10.2(0.7) 15 x 15(4.6 x 4.6) 16(61) 13.2(0.91) -- -- 4 to 6 inches 16 x 16(4.9 x 4.9) 17(64) 15.0(1.03) -- __ (100 to 150 mm) 16 x 18(5.5 x 5.5) 19(72) 18.7(1.31) -- -- 16 x 20(4.9 x 6.1) 23(87) 27.4(1.89) -- -- 12 x 12(3.7 x 3.7) 14(53) 10.2(0.7) -- -- 14x14(4.3x4.3) 15(57) 11.7(0.81) -- -- 15 x 15(4.6 x 4.6) 17(64) 15.0(1.03) __ __ 6 to 12 inches (150 to 300 mm) 16 x 16(4.9 x 4.9) 18(68) 16.8(1.16) -- -- 16 x 18(4.9 x 5.5) 20(76) 20.7(1.43) -- -- Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 135 Page 11 of 15 August 2024 www.reliablesprinkler.c.com HorizontalModel FlRes58 . Technical Specifications Finishes Style:Sidewall and Recessed Sidewall (See Table N) Threads: 1/2"NPT or IS07-1R112 Sensitivity Nominal K-Factor:5.8(84 metric) Fast-response Max.Working Pressure:175 psi(12 bar) Temperature Ratings 155-F(68°C) Material Specifications 175-F(79°C) Thermal Sensor:3 mm glass bulb Recessed Escutcheons Sprinkler Frame:Brass Alloy F2 Recessed Button:Copper Alloy Sprinkler Wrenches Sealing Assembly:Nickel Alloy with PTFE Model W2 Load Screw:Bronze Alloy Model W4(Recessed) Deflector:Bronze Alloy Model F1 Res58 Residential Horizontal Sidewall Sprinkler Installation Dimensions Face of fitting to finished wall 1-5/8"(41mm) 3/8"(10mm) +/ 1/4"(6mm) +l-1/4"(6mm) 2-7l16"(62mm) To of Deflector Down from 2-1/4" 1-15/16" p (57mm) (49mm) - Ceiling to be Either 4"to 6" DIA. DIA. (100 to 150 mm)or 6"to 12" (150 to 300 mm)Based on 5/1 "" Hydraulic Calculations (8mm)- Dimensions F2 Recessed Escutcheon Installation Model F1 Res58 Horizontal Sidewall Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems(" Maximum Coverage Area(2) Flow Pressure Deflector to ft.x ft.(m x m) gpm(I/min) psi(bar) Ceiling Distance 12 x 12(3.7 x 3.7) 16(61) 7.6(0.52) 14 x 14(4.3 x 4.3) 18(68) 9.7(0.66) 15 x 15(4.6 x 4.6) 19(72) 10.7(0.74) 4 to 6 inches 16 x 16(4.9 x 4.9) 21 (80) 13.2(0.91) (100 to 150 mm) 16 x 18(4.9 x 5.5) 25(95) 18.6(1.28) 16 x 20(4.9 x 6.1) 29(110) 25.0(1.72) 12 x 12(3.7 x 3.7) 22(83) 14.4(1.0) 14 x 14(4.3 x 4.3) 22(83) 14.4(1.0) 15 x 15(4.6 x 4.6) 24(91) 17.1 (1.18) 6 to 12 inches (150 to 300 mm) 16 x 16(4.9 x 4.9) 26(98) 20.1 (1.39) 16 x 18(4.9 x 5.5) 31 (117) 28.6(1.97) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. Please note SIN difference between F1 Res58 HSW(R3533)and F1 Res58 HSWX(RA3533). Bulletin 135 Page 12 of 15 August 2024 www.reliablesprinkler.c.com EscutcheonModel F1 Res58 HSWX Horizontal Sidewall Sprinkler&Model F2 Recessed SIN RA3533 Finishes Technical Specifications (See Table N) Style:Sidewall and Recessed Sidewall Sensitivity Threads:112"NPT or IS07-1 R1/2 Fast-response Nominal K-Factor:5.8(84 metric) Temperature Ratings Max.Working Pressure:175 psi(12 bar) 155°F(68°C) 175-F(79°C) Material Specifications Recessed Escutcheons l , Thermal Sensor:3 mm glass bulb F2 Recessed i t• Sprinkler Frame:Brass Alloy Sprinkler Wrenches f ' Button:Copper Alloy Model W2 J Sealing Assembly:Nickel Alloy with PTFE Model W4(Recessed) Load Screw:Bronze Alloy Deflector:Bronze Alloy Model F1 Res58 HSWX Residential Horizontal Sidewall Sprinkler Installation Dimensions Face of fitting to finished wall 1-7/8"(48mm) 3/8"(10mm) +/ 1/4"(6mm) +/-1/4"(6mm) 2-7/8"(73mm) -f 2-1/4" 1-15/16" Top of Deflector Down From (57mm) (49mm) -_ _ Ceiling to be Either 4"to 6" DIA. DIA. (100 to 150 mm)or 6"to 12" (150 to 300 mm)Based on ff"�5/16" Hydraulic Calculations (8mm) 1_ Dimensions F2 Recessed Escutcheon Installation Model F1 Res58 HSWX Horizontal Sidewall Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure in Wet Pipe Systems" Maximum Coverage Area(2) Flow Pressure Deflector to ft.x ft.(m x m) gpm(1/min) psi(bar) Ceiling Distance 18 x 20(5.5 x 6.1) 30(114) 26.8(1.85) 20 x 20(6.1 x 6.1) 30(114) 26.8(1.85) 16 x 22(4.9 x 6.7) 33(125) 32.4(2.23) 4 to 6 inches (100 to 150 mm) 16 x 24(4.9 x 7.3) 38(144) 42.9(2.96) 14 x 26(4.3 x 7.9) 42(160) 52.4(3.63) 18 x 20(5.5 x 6.1) 35(133) 36.4(2.51) 16 x 22(4.9 x 6.7) 38(144) 42.9(2.96) 6 to 12 inches 16 x 24(4.9 x 7.3) 42(160) 52.4(3.61) (150 to 300 mm) 14 x 26(4.3 x 7.9) 46(174) 62.9(4.34) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in the table above or(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. Please note SIN difference between F1 Res58 HSW(R3533)and F1 Res58 HSWX(RA3533). Bulletin 135 Page 13 of 15 August 2024 e a "La www.reliablesprinkler.c.com Finishes Standard Finishes Special Application Finishes F1,F2.&FPS'), CCP,SWC(Conical) F1,F2,&FP(3) CCP,SWC(Conical) Sprinkler(') Escutcheons Cover Plates ' Sprinkler" Escutcheons Cover Plates ' Bronze Brass Bright Brass Bright Brass Bright Brass Chrome Plated Chrome Plated Chrome Plated Satin Chrome Satin Chrome Satin Chrome White White White Paint Black Black Black Paint Polyester(2) Polyester Polyester(2) Polyester Custom Color Custom Color Polyester Polyester Custom Color Paint Electroless Nickel PTFE(2) Notes: (1)Paint or any other coating applied over the factory finish will void all approvals and warranties. (2)cULus Listed Corrosion Resistant. (3)The Model FP escutcheon assembly consists of an unfinished galvanized cup with a finished escutcheon ring. Installation Models F1 Res sprinklers are to be installed as shown in this bulletin. Model F1, F2,and FP recessed escutcheons are the only recessed escutcheons to be used with Model F1 Res sprinklers. Not all F1 Res sprinklers may be used with all recessed escutcheons offered.Confirm listing of escutcheon type for use with individual sprinklers.Use of any other recessed escutcheon will void all approvals and warranties. Model W2 For installing Model F1 Res sprinklers, use only the Model W2 sprinkler Wrench;for installing Models F1 Res Recessed Pendent, Model W4 Sidewall,Conical Concealed Pendent(CCP),and Sidewall Concealed(SWC and SWC-2)sprinklers use only the Model W4 sprinkler wrench. Use of wrenches other than those specified Model W4 Wrench Installation Example may damage these sprinklers. All Installation of F1 Res sprinklers in a wall or ceiling will require a hole diameter of 2-1/4"(57 mm)for F1 or F2 recessed escutcheons;or 2-5/8"(67 mm)for FP recessed escutcheons, CCP, SWC,and SWC-2 cover plates. Install F1 Res HSW sprinklers with a ceiling to deflector distance that complies with the hydraulic design criteria tables in this bulletin.The flow arrow on deflector must point away from near wall and"Top"marking must face the ceiling. A'leak tight"sprinkler joint can be obtained with the following torque: • 112"NPT and ISO7-1 R1/2:8-18 ft-Ibs(11 —24 N-m) • 3/4" NPT and IS07-1 R3/4: 14-20 ft-Ibs(19—27 N-m) Do not tighten sprinklers over maximum recommended torque. The Model W4 wrench includes two sets of jaws.One set of jaws This may cause leakage or impairment of the sprinklers. is equivalent to a Model GFR2 wrench and the other set of jaws Do not install any glass bulb sprinklers where the bulb is cracked is equivalent to a Model W1 wrench.Use the smallest of the two or there is a loss of liquid from the bulb. sets of jaws that will fit on the sprinkler's wrench flats.The Model W4 wrench is used in conjunction with the installer's nominal 1/2" Glass bulb sprinklers have orange bulb protectors to minimize square drive ratchet and nominal 5"(125mm)long extension(not bulb damage during shipping, handling and installation. Remove provided)as shown in Figure 13. this protection at the time the sprinkler system is placed in service. Removal of the protectors before this time may leave the bulb vulnerable to damage. RASCO wrenches are designed to install sprinklers when protectors are in place. Remove protectors by undoing the clasp by hand. Do not use tools to remove the protectors. Bulletin 135 Page 14 of 15 August 2024 www.reliablesprinkler.com Maintenance Ordering Information Reliable Model F1 Res Sprinklers should be inspected and the Specify the following when ordering: sprinkler system maintained in accordance with NFPA 25, 13, 13D,and 13R,as well as the requirements of any Authorities Sprinkler Having Jurisdiction. Model(See Table A) • Temperature Rating Prior to installation,sprinklers should remain in the original Threads(NPT or IS07-1) cartons and packaging until used.This will minimize the potential Finish(See Table N) for damage to sprinklers that could cause improper operation or Escutcheon or Cover Plate non-operation. Model Do not clean sprinklers with soap and water,ammonia liquid or Finish(See Table N) any other cleaning fluids. Remove dust by gentle vacuuming without touching the sprinkler. Sprinkler Wrench • Model W2(Pendent and HSW) Replace any sprinkler which has been painted(other than factory W4(Recessed and Concealed) applied). Properly installed CCP,SWC,and SWC-2 cover plates Note:Please note SIN difference between F1 Res58 HSW will have an air gap that is required for proper operation,do not (R3533)and F1 Res58 HSWX(RA3533). seal the gap or paint the cover plates. Replace any sprinkler which has been damaged,where cracks are observed in the glass bulb,or when liquid has been lost from the glass bulb. A stock of spare sprinklers should be maintained to allow quick replacement of damaged or operated sprinklers. Failure to properly maintain sprinklers may result in inadvertent operation or non-operation during a fire event. Listings &Approvals Listed by Underwriters Laboratories Inc.and UL Certified for Canada(cULus) Guarantee For Reliable Automatic Sprinkler Company guarantee,terms,and conditions,visit www.reliablesprinkler.com. Patents For patents applicable to products contained in this technical bulletin,please visit www.r-s.co Lo N O CD Z a Bulletin 135 Page 15 of 15 August 2024 www.reliablesprinkler.com Bulletin 006 August 2024 Rel Q Model RFC Series Residential Sprinklers Flat Concealed Pendent cULus Listed Features Importantl Reliable fire sprinklers must be handled,stored,and • cULus Listed as Residential Sprinklers installed in accordance with the guidelines in Caution Sheet 310 • Push-On cover plate installation and this bulletin.Failure to follow these instructions may result in • Low water flow requirements unintended operation or nonoperation of the fire protection system. Product Description Model RFC Series residential sprinklers are flat cover plate, concealed pendent sprinklers intended for installation in accordance with NFPA 13,NFPA 13R,or NFPA 13D.The sprinklers are cULus Listed as Residential Sprinklers in accordance with UL 199. In addition, Model RFCLL Series sprinklers are cULus certified for Health Effects to NSF/ANSI/ Model RFC30&RFC30LL Model RFC43&RFC43LL CAN 600,cULus certified less than 0.25%Lead Content to NSF/ ANSI 372 Annex G,and Australian WaterMark certified. Model RFC Series sprinklers are offered with either a 165°F (74°C)or 212°F(100°C)temperature rated fusible-link operating element.Sprinklers with a 165°F(74°C)temperature rating are ordinary temperature classification and are listed for use with a 135°F(57°C)temperature rated cover plate.Sprinklers with a 212°F(100°C)temperature rating are intermediate temperature Model RFC49&RFC49LL Model RFC58 classification and are listed for use with a 165°F(74°C) temperature rated cover plate. Model RFC Series sprinklers are installed with a Model G5 cover ;. plate. Model G5 cover plates are installed by pushing the cover '^ plate into the cup and turning in the clockwise direction until it is tight against the ceiling. Model RFC30,RFC30LL,RFC43, RFC43LL, RFC49 and RFC49LL sprinklers allow 1/2"(13 mm) of cover plate adjustment. Model RFC58 and RFC76 sprinklers allow 3/4"(19 mm)of cover plate adjustment. Model G5 cover plates are available in a variety of finishes as listed in Table H. Model RFC76 Model G5 Cover Plate Nominal K-Factor Max.Coverage Area Listings& Sprinkler Identification Sprinkler Model gpm/psi1z(1/min/bar") ft x ft(m x m) Approvals Number(SIN) RFC30 3.0(43) 14 x 14(4.3 x 4.3) cULus RA0611 RFC30LL 3.0(43) 14 x 14(4.3 x 4.3) cULus, LL,WMCS RA3211 RFC43 4.3(62) 20 x 20(6.1 x 6.1) cULus RA0612 RFC43LL 4.3(62) 20 x 20(6.1 x 6.1) cULus,LL,WMCS RA3212 RFC49 4.9(71) 20 x 20(6.1 x 6.1) cULus RA0616 RFC49LL 4.9(71) 20 x 20(6.1 x 6.1) cULus, LL,WMCS RA3216 RFC58 5.8(84) 20 x 20(6.1 x 6.1) cULus I RA0613 RFC76 7.6(109) 20 x 20(6.1 x 6.1) cULus RA0618 cULus: cULus listed for Safety to ANSI/UL199 LL: cULus certified for Health Effects to NSF/ANSI/CAN 600 cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G. WMCS:Australian WaterMark certified,certificate number 23347. www.reliablespdnkler.com Model1 & RFC30LLRFC30: A16 11 Technical Specifications Sensitivity Style:Flat Concealed Pendent Fast-response Threads:1/2"NPT or ISO 7-1R1/2 Nominal K-Factor:3.0(43 metric) Temperature Rating Max.Working Pressure:175 psi(12 bar) Ordinary: Min.Spacing:8 ft.(2.4 m) 165°F(74°C)sprinkler [135°F(57°C)cover plate] Material Specifications Intermediate: Thermal Sensor:Nickel Alloy Solder Link 212°F(100°C)sprinkler Sprinkler Body:Brass Alloy [165°F(74°C)cover plate] Levers:Bronze Alloy Yoke:Brass Alloy Cover Plate Sealing Assembly:Nickel Alloy with PTFE Model G5 Cover Plate Load Screw:Bronze Alloy Towers:Copper Alloy Sprinkler Wrench Pins:Stainless Steel Model FC(without wrench-able cap) Model W3 with wrench-able cap) �"6' Deflector:Bronze Alloy ( P) � Cup:Steel �- Listings and Approvals' Bottom View 1 Cover Plate Finishes cULus Listed to UL 199 (See Table H) 'Note:RFC30LL is also cULus certified for Health Effects to NSF/ANSI/CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified(certificate number 23347). Model RFC30&RFC30LL Sprinkler Components and Dimensions 2-5/16" (58 mm) Threads Cup Dia. Body Cup�` Tower 2-5/8"(67 mm) 1-3/4"(44 mm)+/-1/4"(6 mm) Hole in Ceiling Fusible Link Nominal face of fitting to ceiling 3/16" Deflector(retracted) — (5 mm) i OWM ce M Pin(extended) — t1 tj Deflector(extended) 3-5/16" Model G5 Cover Plate (84 mm) Ceiling Dia. Model RFC30 and RFC30LL Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure r) Max.Coverage Area(2) Ordinary Temperature Intermediate Temperature(3) ft.x ft. Flow Pressure Flow Pressure (m x m) gpm psi gpm psi (1/min) (bar) (I/min) (bar) 12x12 9 9.0 9 9.0 (3.6 x 3.6) (34) (0.62) (34) (0.62) 14 x 14 10 11.0 (4.3 x 4.3) (38) (0.76) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table B above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. 3. Intermediate temperature listing applies to SIN RA0611 only;not applicable to low-lead version. Bulletin 006 Page 2 of 8 August 2024 e b� www.reliablesprinkler.com Model RFC43 & RFC43LL 0. Residential RFC43LL: SINRA3212 Technical Specifications Sensitivity Style:Flat Concealed Pendent Fast-response Threads: 1/2"NPT or ISO 7-1 R1/2 Nominal K-Factor:4.3(62 metric) Temperature Rating Max.Working Pressure: 175 psi(12 bar) Ordinary: Min.Spacing:8 ft.(2.4 m) [135°F 57 165°F((57oC sprinkler )cover plate] Material Specifications Intermediate: Thermal Sensor:Nickel Alloy Solder Link [165' (74'C) sprinkler Sprinkler Body:Brass Alloy [165°F(74°C)cover plate] Levers:Bronze Alloy Yoke:Brass Alloy Cover Plate Sealing Assembly:Nickel Alloy with PTFE Model G5 Cover Plate Load Screw:Bronze Alloy Sprinkler Wrench Towers:Copper Alloy •� Pins:Stainless Steel Model FC(without wrench-able cap) Deflector:Bronze Alloy Model W3(with wrench-able cap) Bottom View Cup:Steel Listings and Approvals' Cover Plate Finishes cULus Listed to UL 199 (See Table H) 'Note:RFC43LL is also cULus certified for Health Effects to NSF/ANSI/CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified(certificate number 23347). Model RFC43&RFC43LL Sprinkler Components and Dimensions - 2-5/16" I-- (58 mm) ThreadijT Cup Dia. Body Cup Tower 2-5/8"(67 mm) 1-3/4'(44 mm)+/-1/4"(6 mm) Hole in Ceiling Fusible Li Nominal face of fitting to ceiling 3/16" Deflector(retracted) — (5 mm) oa�icni m m Pin(extended) — H ti Deflector(extended) 3-5/16" Model G5 Cover Plate (84 mm) Ceiling Dia. Model RFC43&RFC43LL Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure Max.Coverage Area tsi Ordinary Temperature Intermediate Temperature ft.x ft. Flow Pressure Flow Pressure (m x m) gpm psi gpm psi (1/min) (bar) (1/min) (bar) 15 x 15 12 7.8 12 7.8 (4.6 x 4.6) (45) (0.54) (45) (0.54) 16 x 16 13 9.1 13 9.1 (4.9 x 4.9) (49) (0.63) (49) (0.63) 18 x 18 18 17.5 (5.5 x 5.5) (68) (1.21) 20 x 20 21 23.8 (6.1 x 6.1) (79) (1.64) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table C above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006 1Page 3 of 8 August 2024 a ' 1 www.reliablesprinkler.com Model • ' & RFC49LL • - • 1 . RFC49LL: SINRA3216 Technical Specifications Sensitivity Style:Flat Concealed Pendent Fast-response Threads: 112"NPT or ISO 7-1R1/2 , Nominal K-Factor:4.9(71 metric) Temperature Rating Max.Working Pressure: 175 psi(12 bar) Ordinary: '� Min.Spacing:8 ft.(2.4 m) 165°F(74°C)sprinkler [135'F(57°C)cover plate] Material Specifications Intermediate: Thermal Sensor:Nickel Alloy Solder Link 212°F(100°C)sprinkler Sprinkler Body:Brass Alloy [165'F(74°C)cover plate] Levers:Bronze Alloy Yoke:Brass Alloy Cover Plate Sealing Assembly:Nickel Alloy with PTFE Model G5 Cover Plate Load Screw:Bronze Alloy Towers:Copper Alloy Sprinkler Wrench Pins:Stainless Steel Model FC(without wrench-able cap) Deflector:Bronze Alloy Model W3(with wrench-able cap) Bottom View Cup:Steel Listings and Approvals* Cover Plate Finishes cULus Listed to UL 199 •`� (See Table H) *Note:RFC49LL is also cULus certified for Health Effects to NSF/ANSI/CAN 600,cULus certified less than 0.25%Lead Content to NSF/ANSI 372 Annex G, and Australian WaterMark certified(certificate number 23347). Model RFC49&RFC49LL Sprinkler Components and Dimensions 2-5/16" (58 mm) Threads Cup Dia. Body Cup it Tower 2-5/8"(67 mm) 1-3/4"(44 mm)+/-1/4"(6 mm) Hole in Ceiling Fusible LiNominal face of fitting to ceiling 3/16° Deflector(retracted) — j (5 mm) Pin(extended) — ' 00BFpD1°�m I Y1 Yi Deflector(extended) 3-5/16" Model G5 Cover Plate (84 mm) — Ceiling Dia. Model RFC49&RFC49LL Sprinkler Hydraulic Design Criteria Minimum Flow and Residual Pressure M Max.Coverage Area(2), Ordinary Temperature Intermediate Temperature ft.x ft. Flow Pressure Flow Pressure (m x m) gpm psi gpm psi (1/min) (bar) (1/min) (bar) 16 x 16 13 7.0 13 7.0 (4.9 x 4.9) (49.0) (0.48) (49.0) (0.48) 18 x 18 17 12.0 17 12.0 (5.5 x 5.5) (64.3) (0.83) (64.3) (0.83) 20 x 20 20 16.7 21 18.4 (6.1 x6.1) (75.7) (1.15) (79.5) (1.27) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table D above and(2)the flow required to achieve a mini- mum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006 Reliabl"t Page 4 of 8 August 2024 wvvw.reliablesprinkler.com Model •ential Sprinkler SIN RA0613M Technical Specifications Cover Plate Finishes Style: Flat Concealed Pendent (See Table H) Threads: 1/2"NPT or ISO 7-1 R1/2 Nominal K-Factor:5.8(84 metric) Sensitivity Max.Working Pressure: 175 psi(12 bar) Fast-response Min.Spacing:8 ft.(2.4 m) 9 Temperature Ratings Z 4 Material Specifications Ordinary: Thermal Sensor:Nickel Alloy Solder Link 165°F(74°C)sprinkler Sprinkler Body:Brass Alloy [135"F(57"C)cover plate] Levers:Bronze Alloy Intermediate: Yoke:Brass Alloy 212"F(100°C)sprinkler Sealing Assembly:Nickel Alloy with PTFE [165°F(74"C)cover plate] Load Screw:Bronze Alloy Towers:Copper Alloy Cover Plate Pins:Stainless Steel Model G5 Cover Plate Deflector:Chrome Plated Bronze Alloy Cup:Steel Sprinkler Wrench Bottom View Model FC(without wrench-able cap) Model W3(with wrench-able cap) Listings and Approvals cULus Listed to UL 199 Model RFC58 Sprinkler Components and Dimensions 2-5/16" Threads Cu Dia Cup Dia. Body Cup-�` Tower Fusible Link 1-7/8"(48 mm)+/ 3/8"(9 mm) Hole in Ceiling Nominal face of fitting to ceiling Deflector(retracted) 3/16" (5 mm) Pin(extended) Fi hi 00fi G6A Deflector(extended) 3-5/16' Model G5 Cover Plate (84 mm) Ceiling Dia. Model RFC58 Sprinkler Hydraulic Design Criteria • Minimum Flow and Residual PressureN Max.Coverage Area(2) Flow Pressure ft.x ft. gpm psi (m x m) (1/min) (bar) 16 x 16 16 7.6 (4.9 x 4.9) (60.6) (0.53) 18 x 18 18 9.6 (5.5 x 5.5) (68.1) (0.66) 20 x 20 20 11.9 (6.1 x 6.1) (75.7) (0.82) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table E above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006Page r.of 8 August 202024 www.reliablesprinkler.com Model RFC76 Residential • RA0618 Technical Specifications Cover Plate Finishes Style:Flat Concealed Pendent (See Table H) Threads:3/4"NPT or ISO 7-1 R3/4 Nominal K-Factor:7.6(109 metric) Sensitivity Max.Working Pressure: 175 psi(12 bar) Fast-response Min.Spacing:8 ft.(2.4 m) Temperature Ratings Material Specifications Ordinary: Thermal Sensor:Nickel Alloy Solder Link 165°F(74°C)sprinkler Sprinkler Body:Brass Alloy [135°F(57°C)cover plate] Levers:Bronze Alloy Intermediate: Yoke: Brass Alloy 212'F(100'C)sprinkler Sealing Assembly:Nickel Alloy with PTFF [165°F(74'C)cover plate] Load Screw:Bronze Alloy Towers:Copper Alloy Cover Plate Pins:Stainless Steel Model G5 Cover Plate Deflector:Bronze Alloy _ o o Cup:Steel Sprinkler Wrench Bottom View � Model FC(without wrench-able cap) Model W3(with wrench-able cap) Listings and Approvals cULus Listed to UL 199 Model RFC76 Sprinkler Components and Dimensions 2-5/16' Threads (58 mm) Cup Dia. BodyCupAt TowerFusible Li 1-7/8"(48 mm)+/-3/8"(9 mm) Hole in Ceiling Nominal face of fitting to ceiling3/16" Deflector(retracted) (5 mm) Pin(extended) — :H 1 H: Deflector(extended) — 3-5/16" Model G5 Cover Plate (84 mm) Ceiling Dia. Model RFC76 Flat Concealed Sprinkler Hydraulic Design Criteria Minimum Flow and Residual PressureM Max.Coverage Area(2) Flow Pressure ft.x ft. gpm psi (m x m) (1/min) (bar) 16 x 16 21 7.6 (4.9 x 4.9) (79.5) (0.52) 18 x 18 24 9.9 (5.5 x 5.5) (90.8) (0.68) _T F 20 x 20 34 20 (6.1 x 6.1) (128.7) (1.4) Notes: 1. For NFPA 13 installations the flow per sprinkler must be the greater of:(1)the flow listed in Table E above and(2)the flow required to achieve a minimum design density of 0.1 gpm/sq ft over the design area of the sprinkler. 2. For coverage area dimensions less than those listed above,use the minimum required flow for the next larger max.coverage area listed. Bulletin 006 „a Page 6 of 8 August 2024 www.reliablesprinkler.com Cover Plate Finishes') Standard Finishes Special Application Finishes White Paint Off White Paint Black Paint Raw Brass Chrome Bright Brass Finished Bronze Custom Color Paint(2) Satin Chrome Stainless Steel Clad(3) Custom Printed Notes: 1. Paint or any other coating applied over the factory finish will void all approvals and warranties. 2. Custom color paint is semi-gloss,unless specified otherwise. 3. Stainless steel clad cover plates are Type 316 Stainless Steel on the finished side and C102 Copper Allow on the back side.Cover plates are not listed or approved as corrosion resistant. Installation Dimensions Recommended Min.to Min.to Max. � prinkler Cover Cover Plate Hole Diameter Cover Plate Max. Face Dropped Deflector Cover Plate S Plate Diameter Adjustment of Fitting to Distance below Temperature Model Model inch(mm) in Ceiling inch(mm) Ceilings') Ceiling Rating inch (mm) inch(mm) inch(mm) RFC30, RFC30LL, 135°FF21 RFC43, 3-5/16 2-5/8 1/2 1-1/2 to 2 1/2 to 1 (57°C) RFC43LL, G5 (84) (67) (13) (38 to 51) (13 to 25) or 165°F(3) RFC49, (74-C) RFC49LL 135°F(2)(57�C) RFC58, 3-5/16 2-5/8 3/4 1-1/2 to 2-1/4 1/4 to 1 , (3 RFC76 G5 (84) (67) (19) (38 to 57) (6 to 25) o(74 C) Notes: 1. Face of fitting to ceiling dimensions are based on a nominal thread make up.Verify dimensions based on fitting and thread sealing method prior to installation.A 1/2"x 1/2"brass nipple extension(Reliable P/N 6999991900)is available where necessary for replacement of existing sprinklers. 2. For use with 165°F(74°C)temperature rated sprinklers where the maximum ceiling temperature does not exceed 100°F(38°C). 3. For use with 212°F(100°C)temperature rated sprinklers where the maximum ceiling temperature does not exceed 150°F(66°C). Installation Model RFC series sprinklers are intended to be installed in Note:When used with gasketed fittings,follow fitting accordance with NFPA 13,NFPA 13R,or NFPA 13D,as well as manufacturer's installation instructions regarding tightening to the requirements of applicable authorities having jurisdiction. achieve a leak-free connection. Model RFC series sprinklers must not be installed in ceilings with positive pressure in the space above. Model RFC series Do not exceed the maximum recommended torque. Exceeding sprinklers are shipped with a wrench-able protective cap that the maximum recommended torque may cause leakage or should remain on the sprinkler until the sprinkler system is placed impairment of the sprinkler.Use care when inserting or removing in service following construction. the wrench from the sprinkler to avoid damage to the sprinkler. Model RFC series sprinklers can be installed without removing Install the cover plate by hand by pushing the cover plate into the the wrench-able protective cap using the Model W3 wrench. cup and turning the cover in the clockwise direction until it is tight Alternatively, Model RFC series sprinklers can be installed using against the ceiling. the Model FC wrench by temporarily removing the protective cap during installation of the sprinkler.The use of any other wrench to installed Model RFC series sprinklers is not permitted and may damage the sprinkler. Fully insert the Model W3 wrench over the cap until it reaches the bottom of the cup,or the Model FC wrench over the sprinkler until the wrench engages the body. Do not wrench any other part of the sprinkler/cup assembly.The Model W3 and FC wrenches are designed to be turned with a standard 1/2"square drive.Tighten the sprinkler into the fitting after applying a PTFE based thread sealant to the sprinkler's threads.Recommended installation torque for iron pipe fittings is 8 to 18 ft-Ibs(11 to 24 N-m)for 1/2"thread sprinklers and 14 to 20 ft-Ibs(19 to 27 N-m)for 3/4"thread sprinklers. Bulletin 006 Page 7 of 8 August 2024 a www.reliablesprinkler.com Installation Wrenches Model FC Model W3 For use with Model RFC Series sprinklers For use with Model RFC Series sprinklers with without wrench-able cap installed wrench-able cap installed ---------- Service/Spare Head Cabinet Wrench Listings and Approvals cULus Listed for Safety to ANSI/UL199 Model W8 Additional Listings for RFC30LL, RFC43LL,and RFC49LL: High-strength plastic wrench cULus Certified for Health Effects to NSF/ANSI/CAN for limited(emergency) use with Model RFC Series 600 sprinklers without wrench-able cULus Certified less than 0.25%Lead Content to NSF/ cap installed. Meets NFPA ANSI 372 Annex G. requirements for sprinkler Australian WaterMark Certified,certificate number wrench on premises. 23347. Patents Model RFC30, RFC30LL,RFC43, RFC43LL, RFC49, RFC49LL, RFC58,and RFC76 sprinklers are covered by U.S. Patent No. 9,248,327 and U.S. Patent No.7,275,603. Maintenance Model RFC30, RFC30LL,RFC43 and RFC43LL sprinklers are Model RFC series sprinklers should be inspected and the additionally covered by U.S. Patent No.8,776,903. sprinkler system maintained in accordance with NFPA 25. Do not clean sprinklers with soap and water,ammonia or any other cleaning fluids.Remove dust by gentle vacuuming.Replace any Ordering Information sprinkler cover plate assembly which has been painted(other Specify the following when ordering. than factory applied)or damaged in any way.A stock of spare sprinklers should be maintained to allow quick replacement of Sprinkler damaged or operated sprinklers.Prior to installation,sprinklers Model(RFC30, RFC30LL,RFC43, RFC43LL, should be maintained in the original cartons and packaging until RFC49, RFC49LL, RFC58, RFC76) used to minimize the potential for damage to sprinklers that would Temperature Rating cause improper operation or non-operation. Cover Plate • Model G5 Guarantee Temperature Rating • Finish(See Table H) For the Reliable Automatic Sprinkler Co., Inc.guarantee,terms, Sprinkler Wrench and conditions,visit www.reliablesprinkler.com. • Model FC • Model W3 • Model W8(Limited use) CN N O O W W m m Z a Bulletin 006 Reliable Page 8 of 8 August 2024 www.reliablesprinkler.com w " v vQ14 C. O 7PLO w o > v Q 0qu col rf ^ O c v i `i w 800 U w z °• W ?94 cn Vi F L � F- M Q 1 v W 1 v V L 7 rl U . .., W � o w " U0.. Q z a W Q 0t = .4 `O w z a oA� g o � BUI ;ET DEPAR MENT CENE VIL OF RYE OOK NOV 2 2 2024 938 KING RYE BRO ,NY 10 73 4 -0668-J VILLAGE OF RYE BROOK kny ov BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTIILLATION AND/OR AIR CONDITION�IN/GDEouomENT FOR OFFICE USE ONLY: P�q� /3� PERMIT#: Approval Date: AV 2 024 Permit Fee: $ / Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed&Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy Of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance On a NYS Board form(Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL =$150.00/unit• COMMERCIAL =$450.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation.(48 hour notice required 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Wis Application dated, c)-c) hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. \ q 1. Address: 11 //� �� Y' /1-[e�2)Z) SBL: �c�'7/73—d l Zone:Pu 2. Property Owner: D,11- / 1<1)/I1,y Address: Phone#: I l y Cell#: email: 3. Contractor: /)iT' !�/r 4EL,7�v i< /.,7 C_ Address: if,Pd riF C 2 M!/Of 7,3 Phone#: Cell#: email: 4. Scope of Work:New Installation( )•Replacement( )•Removal( )•Other( ): 5. List Equipment: N d4o S /7) f'1(/5 rlo, �,it t12�DYk n 6. Location of Equipment: /') J- 7. Method of Installation/Removal(list all equipment needed to perform job): r 6/l/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this as day of 20 day of NOJ e< ,20 Signature of Property Owner Sign ture of Applicant Print Name of Property Owner „lx3 1:11A3 of Applicant ul pal iTO'oN Notary Public .ollgn Public d latlHS Z�( OZ'6Z A 1t,'r sajldx3 uolsslwwo0 ,tluno0 jalsatiolsaM ul pallllenb £9009T93WT0'oN )iao,k mON;o alelS'oll4nd AMON Ol"II13W 18VHS This application must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 b/l/2024 Certificate INV-073024 Date: 12/15/2024 Bill to: Description Payment Information:Zelle:r.rsprayfbaM207@gmail.co The following spray foam product(s) has/have been installed in the areas of the project Job address: 6 BeRefair Blvd Port Chester, NY 10573 • Apply spray foam exterior walls closed cell doing the code Rv19 • Apply spray foam rim joist • Foam Pack around all doors & windows Can Foam low expectations foam, caulking the open lines of the wood, to prevent air filtration. Rodrigo Rodriguez President D MAY 15 2025 3D VILLAGE OF RYE BROOK BUILDING DEPARTMENT Certificate: ATURA1 ® Any doubts or questions you can call the office '• n IYMERS N YS I F NCFI number.# 203-522-2207-475-2109327 Email r.rsprayfoam207@gmaii.com https://ryrinsulation.com NeW York 5-ainwrenvePon° '° " ` " '"'" " ROdCWOOL Facebook:R&R Spray Insulation G=Flex A4'o. Certified Applicator Building Permit Check Luc&Zoning Analysis Zonc 0., `. ! sc: 1. ContL Type: Odwr Subn=W Date: Z Revuiorn Subnuttal Dares: Applicant Nam=of Work Re.tews Mk- 'JUN 2 S 2024 P& BO F: Other. NEED 9L ( -550 ) •Filing- L� BP: `t - C/O: Flood Plane Legah=om ( APP: Dated Notarmcd SBI.: Truss I.D. Cross Connection FLOA.: Scenic ( ) ( ) Scec Roads Steep Slopes: Wetlands: Storm Water Rmew: Street Opening. ( ) ( ) ENVIRO: Long Shore Fees: N/A ( ) ( ) S PLAN:Togo: Siu Proucnore S/W MgmL: Tne Plan: Other. ( ) ( ) VEY:Dated: Current: Archival• Sealed Unacccpable ( ) ( PLANS Date Stamped Scaled Copies: Electronic Other License Workers Comp: Lability. Comp.Waiver. Other- CODE 75, Dated. N/A: ( ) FUGH-VOLTAGE ELECTRICAL Plans: Pcmut N/A: Other. ( ) LOW-VOLTAGE ELECTRICAL PUns: Permit N/A: Other. FIRE ALARM/SMOKE DETECTORS Plans: Permit H W.I.C.:_Battery:_Other. ( ( ) PLUMMVCs Plans Pem r NaL Gas: LP Gas: N/A/: Other. (�( ) FIRE SUPPRESSION:Plans Pent N/A: Other. ( ) RVA.C_ Plans: Pcrrmr N/A: Other. ( ) FUEL TANK Plans: Pcm= Fuel T vpc. Other. ( ( ) 2020 NY Slue ECCC N/A: Other. ( ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plans: Other. ( ; ( ) BP DE?QAL I E IFr`ER: C/O DENIAL I_E I"I F _ Other. O O Other: ( ARB mug.dates approvaL• notes: ( )ZRA mrg.date: approvaL• notes: ( )PB mug.dam- approval• notes: REQU1Rf D EXMING PROPOSED N(,-►.-S APPROVED Am: sMae F l� Famp Main Acm FL H/Sb: Sd.H/Sb: .FA TTor- ELI=: P� Hm&/Scones notes: c—,c I 1 �4 1 t I 1 1. 1 I 1' I l DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 09r29/2024 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Camille M.Rizzo NAME C.Quick Insurance Agency PHONE (gq5)497-1119 7012 FAX (845)533-1179 AIC No Eat): AIC.No: 13 W.Main Street E-MAIL camiller@cquickinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC e Washingtonville NY 10992 INSURER A: Main Street America 29939 INSURED INSURER 8: NGM Insurance Company 14788 Supreme Air Comfort Inc INSURER C: Property and Casualty CO of Hartford 34690 76 PERRY AVE INSURER D INSURER E PORT CHESTER NY 10573-2922 INSURER F COVERAGES CERTIFICATE NUMBER: CL2482806694 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. IN SR ADDL SUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MWDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE FX OCCUR PREMISES Ea occurrence S SO0,000 MED EXP(Any one person) S 10,000 A Y MPU1425Y 09/10/2024 09/10/2025 PERSONAL aADVINJURY S 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY PRO © 2,000,000 JECT LOC PRODUCTSCOMP/OP AGG S OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 300,000 Ea accdent ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED B1 U1425Y 08/20/2024 08/20/2025 BODILY INJURY(Per af,adentl S AUTOS ONLY AUTOS XHIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR Ld CLAIMS-MADE AGGREGATE S DED I I RETENTION S $ WORKERS COMPENSATION X STATUTE EOT. AND EMPLOYERS'LIABILITY ANVPROPRIETOR/PARTNER/EXECUTIVE YIN 100,000 C OFFICER/MEMBER EXCLUDED' � N/A 16WECAAODOF 12/03/2023 12/03/2024 E.L.EACH Acc1DENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100.000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Rernarks Schedule,may be attached if more space is required) Rye Brook Building Department is included as Addtonal Insured per the attached BPM3105 A 0515 endorsement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Rye Brook Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 Kinq Street AUTHORIZED REPRESENTATIVE � � Rye Brook NY 10573 4 JtS'„'M"__ /k O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers' CERTIFICATE OF Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la Legal Name 8 Address of Insured(Use street address only lb Business Telephone Number of I115Ured Supreme Air Comfort Inc 203-919 9918 68 Grant St Port Chester NY 10573 lc NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to ld Federal Employer Identification Number of Insured or Social Security Number certain locations in New York State.i e a Wrap Up Policy) 82-1499190 2 Name and Address of the Entity Requesting Proof of Coverage 3a Name of Insurance Carnef (Entity Being Listed as the Certificate Holden Property and Casualty Insurance Company of Hartford Ryebrook Building Department 3b Policy Number of entity listed In box la 938 King Street A16 WEC AAODOFI Rye Brook NY 10573 3c Policy effective period 1 2/3120 2 3 to 12/3/2024 3d The Proprietor.Partners or Executive Officers are ®included (Only check box if all partners/officers included) []all excluded or certain partners/officers excluded This certifies that the insurance Garner indicated above In box 3"Insures the business referenced above in box I for workers' compensation under the New York State Workers Compensation Law (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or Its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box 2" The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate (These notices may be sent by regular mail ) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate Is Issued as a matter of information only and confers no rights upon the certificate holder This certificate does not amend. extend or alter the coverage afforded by the policy listed. nor does It confer any rights or responsibilities beyond those contained in the referenced policy This certificate may be used as evidence of a Workers'Compensation contract of Insurance only while the underlying policy Is rn effect Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form 4pproved by Camille M_Rizzo (Pnnt name of authorized representative or licensed agent of insurance tamer/ _ August 29.2024 Approved by: (Signature) (Date) Title: Authonzed Representative Telephone Number of authorized representative or licensed agent Of Insurance carrier 845-497-1119 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www wcb.ny gov Client#: 2498 ALLSAF2 ACORD., DATE(MMIDD/YYYY)CERTIFICATE OF LIABILITY INSURANCE 12/05/2024 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T Commercial support Edgewood Partners Ins.Center PHONE g31 380-9700 FAX A/C No Ell: AIC No): Marcus Drive E-MAIL 3r Floor SS: NEconstructioncerts@epicbroksm.com Melville, NY 11747 INSURER(S)AFFORDING COVERAGE NAIC0 Me INSURER A:CrUM 8 Forster Specialty Insurance Co 44520 INSURED All Safe Fire Protection&Mechanical Inc INSURERS:Merchants Mutual Insurance Company 23329 All Safe Fire Sprinkler Systems Inc INSURERC: INSURER D: 375 Executive Blvd Elmsford, NY 10523 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR TYPE OF INSURANCE ADD&SUER POLICY NUMBER MWDD� MWDDY� LIMITS A X COMMERCIAL GENERAL LIABILITY Y GLO108647 9/11/2024 09/11/2026 EACH OCCURRENCE $1 000000 CLAIMS-MADE a OCCUR PREMISES EaEoccccuErrence a50 000 X BI/PD Ded:5,000 MED EXP(Any one person) $S 000 X Contractual Liab. PERSONAL 8 ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E2,000,000 POLICY a ECOT• LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: I S B AUTOMOBILE LIABILITY CAP9269941 8/1 g/2024 09/16/202 COMBID SINGLE LIMIT Ea accNEident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED OS ONLY X SCHEDULED AUTOS BODILY INJURY(Per atddent) $ XRED NON-OWNED PRO aPcEdRYtDAMAGE A ONLY AUTOS ONLY Perd $ S A UMBRELLA LIAB IV I OCCUR SE0132209 9/11/2024 09/11/2026 EACH OCCURRENCE $1 000 000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $1 00O 000 DED RETENTIONS _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TA UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED7 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yea,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached If more space is required) Certificate holder is included as additional insured for general liability coverage as required by written contract. CERTIFICATE HOLDER CANCELLATION Village Of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S7070736/M6897115 LMU02 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 061503131 EPIC INSURANCE BROKERS &CONSULTANTS 40 MARCUS DR, 3RD FLOOR a], .R-0 MELVILLE NY 11747 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ALL SAFE FIRE PROTECTION, INC. VILLAGE OF RYE BROOK 375 EXECUTIVE BLVD 938 KING ST ELMSFORD NY 10523 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2593 528-9 535115 07/07/2024 TO 07/07/2025 12/5/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2593 528-9, 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:/M/WW.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. VICE PRESIDENT MAUREEN ULLEY ONE OF TWO OFFICERS OF ALL SAFE FIRE PROTECTION INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND T �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 573207220 U-26.3 ,wow A� 4# k- j4w dDoo., \.gP toq%�P�* C", . ... —11. . K., — . - M '... 11 V.Kill r=xxx cv G. C-4 9 -kl K CN t E Ix 1K x C tK N. tj 10 CJ LLJ LLJ 0 Xd UJ Y- Qt0kection Ix 0 LIJ a. LL; o LLJ LLJ -x 16o 4.0 > r INI 0 JK x cm 7 zr xxx till- - f .•. . i l q. p is AC" 06/CERTIFICATE OF LIABILITY INSURANCE DATE(04//2024024 Y) III THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER CONTACT ANAIS NUNEZ TONY BRAGG INSURANCE Pq C,N Ext 914-355-5385 A No: 914-355-5381 776 WHITE PLAINS RD E-MAIL ANA@BRAGGCAPITALGROUP.COM SCARSDALE.NY 10583 INSURER(S)AFFORDING COVERAGE NAIC s INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER B: RENE GUEVARA ANDRADE INSURER C: DBA RGA HOME IMPROVEMENT INSURER D: 111 S LOCKWOOD AVE STE 1 INSURER E: YONKERS, NY 10701 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. LTR� TYPE OF INSURANCE INSD WVD, POLICY NUMBER � MMlDD/YYYY � MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE /� OCCUR DAMAGE TO RENTED PREMISES fF,occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 Y 98-C3-E585-4 09/27/2023 09/27/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- PRODUCTS-COMP/OP AGG $ 1,000,000 1' POLICY JECT 7 LOC OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ X ANY AUTO 351 5932-C27-52C 09/27/2023 09/27/2024 BODILY INJURY(Per person) $ 500,000 OWNED SCHEDULED BODILY INJURY(Per accident) $ 500,000 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMA 100,000 AUTOS ONLY AUTOS ONLY - Per accident $ �/ $ X UMBRELLA U.AB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE Y 98-C3-E588-0 09/27/2023 09/27/2024 AGGREGATE $ 5,000,000 DIED !RETENTION $ $ WORKERS COMPENSATION V PERTUTE OTH-A ER $ AND EMPLOYERS'LIABILITY /� YIN ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N NIA Y 98-C3-E586-6 09/27/2023 09/27/2024 - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ 1,000,000 MOBILE EQUIPMENT $30,000 INLAND MARINE 98-C3-E587-8 09/27/2023 09/27/2024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PATRICK KUMF&ASHLEY LOBUE 6 BELLEFAIR BLVD. RYEBROOK, NY 10573, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE 938 KING STREET RYE BROOK NY 10573 Anais Nunez ©1988-2016 ACORD CORPORATION. All rights reserved- ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD t 001486 13284914 04-13-2022 s NIiW i Workers` CERTIFICATE OF STATE Compensation "I - Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(usT§tteet address only) 1 b.Business Telephone Number of Insured ANDRADE, RENE GUEVARA DBA-MA HOME IMPROVEMENT (914)327-1493 111 LOCKWOOD AVE STE 1 YONKERS, NY 10701-5048 1c.NYS Unemployment Insurance Employer Registration Number of • Insured Work Location of Insured(Only required if coverage is specifically limited to I 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carver (Entity Being Listed as the Certificate Holder) State Farm Fire and Casualty Company VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET 3b.Policy Number of Entity Listed in Box"la" RYE BROOK, NY 10573 98-C2-D486-0 3c.Policy effective period 9/27/2023 to 9/27/2024 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) II excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"l a"for wome" compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2" The insurance carrier must notifv the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Anais Nunez (Print name of authorized representative or licensed agent of Insurance carrier Approved by: � & p2 (Signature) (Date) Title: Agent Staff Telephone Number of authorized representative or licensed agent of insurance carrier: 914-355-5385 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. 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