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HomeMy WebLinkAboutMP24-099 DR C c4G4�o°J�i VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.iyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE September 16,2024 Hope Vespia 14 Arlington Place Rye Brook,New York 10573 Re: 14 Arlington Place, Rye Brook,New York 10573 Parcel ID#: 135.44-1-41 This document certifies that the work done under Mechanical Permit #24-099 issued on 7/29/2024 for the installation of a new heat pump and ductless unit has been satisfactorily completed. Sincerely, /2a; Steven E. Fews Building&Fire Inspector /to QyE DR(luk• cu � 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.rytbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: PERMIT# t ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER G1 ,° a Ln b _ ` O No W v N c� cv y W = IPy r (Ar z � R � .. A P-4rA V v P z ■rA p. ` �� -- z W Tt Fi.� \ C)Z A _ �J g a w - o ° _ Q v o � 2 o y 0 V cj w 14 W g 4-4 Ln 0) wZovo °[' `° o U 0 (� W00 w A b v u - W z CDQ 5 waa W M o x W cw . bv a `./ A4 � c!S W Q tt °a � a v 0.0 � ; A - G1,en � ��" Q �T� I--, U MW L� R. 2 . " u z Z 0-4 Q p a x OR v � o � sa � W 40 z N W y�� O '7 O F a di _ ~ 14 GL� O V H e 0 Z a m W C7 A - z w z © � o � •� � o � BUILDING DEPARTMENT E C ��a VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573H JUL 2 6 2024 (914)939-0668 mi ivw.ryebrooknv.gov VILLAGE OF RYE BROOK BUILDING DEPARTi1�ENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT ,/WQ�09 Approval Date: Permit Fee:$ L Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or fON tiTRt CTION UNTIL A PERNIIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COtiT OF CONSTRUCTION WITH A N1INIh111M FEE OF S750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: I. 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 Brvwk must be listed as wrlircale holder)& Workers Compensation Insurance on a NYS Board form(Fonn 4 C 105.2 or Fonn if 1124.3/or NY Stale Workers Compensalion 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 Pen-nit& Plumbing Inspection_ $'.F]Yti�%=F•:•:'si•SSYT'Tl[%%R%x':F%X]fX>fJ[]f]k 16 YtR%}it%%YY�:�%::::X:CX Ys%iC:F]C%][%%%%%%%%iC%X;LX:':�5t:'A]CXTi:]C%%%]t%X%%%::i'ic)C:f]F)C Y Application dated, ?qis hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. 1. Address: I qI► a rG,G SBL: J. j. �l� -�J I Zone: �L it 2. Property Owner: e_ f It. er; ( C`aS Ak Address: y r� v ao Phone#; Qi 1 �- gQ Cell#: /�/-3gr-��OS#1_email:^,$ t/cat/Er 3. Contractor: ,G k 15 1 C--, '%G— Address: Gr t Phone#: C//9 "^� 3_7 Cell#: �✓"r �S?y email: &a,- c@l�J✓��5��1.���o/� 4. Scope of Work:New Installation(V - Replacement( )•Removal( )=Other( ): 5. List Equipment: yy���g IX�4 �T?/1 ' S 2o� �-/1✓�I'��i� Dr�c �sS rAi�Ccir,d> OfT Vj /7/ti 1��✓4�V Crc'07" 6. Location of E� ment �A p(,{ S C� �, �q w� ul e 7. Method of Installation/Removal(list all equipment needed to perform job): /7 S 1/Ci �� k! 2� /nGl��( 3 t� t 6/1/2024 STA EW Y� ,COUNTY OF WESTCHESTER ) as: (� jnZgIQ✓ ,being duly sworn,deposes and states that he/she is the applicant above named, (pnnt nifine 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 trite 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 p day of tit L- 20_ - day of ��� ,20 2�` Signatafe of Property O r t of App Print are of Property O ner n are of Applicant Notary Public ' No"MRPMKILLO Notary Public,State of New York Notary Publie.State of New Ybrk No,GIMMM063 No.01RI624277 Qualified In Westchester County Oui0fied In Westchester Carty Commission Expires January 29,20 Z Term Ex Tres June 6,2027 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. 6/l/2024 , ■ o !t N N W t • � N N � � ■ a N N + occ u • U ' aCA Oato w s v a o > x p� M > z v . oz � � F � W U w s ■ C N ��., v� �OCA Ln t o00 zw w o w o M W it o00 U ` Z a av � oz "0 � � '� o W O ce cam z c. W W 01, 0o, 4 o C4 a ►� 00 0-0 W w Cs z ON � 0. • a Z z w ■ o cn z a W x u U PLO .., Z � G Cf) z W x = a o a o � ' a a W 914 W U a2 QCi R+ ..a ► ( L 4 • � G����goUQ44444Ugo444444U444444444N4;44446444 Q'ETRYE NQ LS C I E � �J BUIMENT VIL OK JUL 2 6 2024 938 KIN ,NY 10573 VILLAGE OF RYE BROOK v BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY v /trCL EP#: Approval Date: Permit Fee: $ Approval Signature: Other: ******************************************** *************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, Li is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: I SBL: 135.4y- 1 y Zone: 2.Property Owner: V e 0. Address: (y W;jA n Q lQ c Phone#: C(I� 3q �W c,�Cell#: email: 3.Master Electrician/Licensed InstallerAr4hoow C Sch ari o Address: y$ l-Q ei 51Y� Lic.#: �,J�Phone#: q�L-12�-1-1L_3 Cell#: // email:f1C1L�1rCAr►c_%So %k" ea"41,kc�w Company Name:N%t_1�t% F I�7Y i ro.I SP11 u1CJ1.WLAL'ddress: KK U1'Geyl Sh!c t AkyV&c W ILg ju_Y /6f� 4.Proposed Electrical Work/Fixture Count: Wire. p ne ne.1 Ac—�� s SkM 2y0 V o t+ -2/0p �/ pur cL & Ili 0 5.31 Party Electrical Inspection Agency: Sw I S STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: h CoS being duly swom,depo _Ile is the applicant above named,and does further (print name of indivi ual signing as th plicant) � state that(s)he is the i for the I al o�er and is authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein eto the his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will Womwen h the details as set forth and contained in this application and in any accompanying approved plans and specific ei cordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Broo 9cia� ble laws,ordinances,and regulations. V Q o Sworn to before me this U U Sworn ty before me this as4oN co X day of 20 day ofA &Jsi W 2 Z7jco a= m Signature of Property Owner Lna j a S' App w ¢ -o Print Name of Property Owner �<_ Print Name of Applicant Q Z U O It �M ��I.CY�xRA�i'ka Notary Public Notary Public 6/1/2024 STATE WIDE INSPECTION SERVICES, INC. CA0 Service With lntegri�y 0•0 • ASWI*S JOB APPLICATION0. • Office Use Elect. Permit# - Date Bldg Permit# � 9 9 Scl Ft Plumbing Permit# Final Certificate# City/Village Y c)c Zlp U5,3 Building Dept. e �� County Address ' Y Cross Street Section' y�• 4 4. Block Lot , I g Owner Name/Address(If different than above) V P P S l C Contact Number C1 (U _ 3 _ � Q I ❑Basement ❑ 1st Fl. ❑ 2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside "l❑1 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 rrPanels 1P 3P » Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation - wlfe one AC RCEME 01 '[JUL 2 6 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address P P y �/�� r O m Name A n S License# Date Signature ArflIll Address clyo City/State _,P I Zip Code �11 CompanytyPV Vt(f2 N LL Phone# ( 7 DState Wide Inspection Services I 1080 Main Street Fishkill, NY 12524 SEP�3 2024 845 202 7224 Phone 9�14-219-1062 Fax STATE WIDE INSPEC71ON SERVICES - VILLAGE OF RYE BROOK Email: off[ice@swisny.com BUILDING DEPARTMENT j 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: Nicks Electrical Service of NY, LLC Steve & Hope Vespia Anthony Coschigano 14 Arlington Place 48 Grand Street Rye Brook, NY 10573 New Rochelle, NY 10801 Located at: 14 Arlington Place, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-158 135.44 1 41 Certificate Number: 2024-6067 Mechanical Permit Number: MP24-099 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: 14 Arlington Place, Rye Brook, NY 10573 The Exterior was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 28th day of August 2024. Name Quantity Rating Circuit Type HVAC System 01 20AMP 240V 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 work performed on the date of inspection only. Product information Technical Details Brand Name MAXWELL Model Info RXNG1 8AXVJU+IKM1412+FTXNG1 8AXVJU Item Weight 115 pounds Product Dimensions 10.75 x 39 x 11 inches Country of Origin Malaysia Item model number RXNG1 8AXVJU+IKM1412+FTXNG1 8AXVJU Efficiency 18 SEER2, 10.5 EER Capacity 1.5 Tons Noise 48 dB Installation Type Split System Part Number RXNG1 8AXVJU+IKM1 412+FTXNG1 8AXVJU Form Factor Mini-Split Special Features Vertical Auto-Swing (up and down), Wide Angle Louvers, Indoor Unit On/Off Switch, Powerful Operation, Auto and Quiet Operation, Eco+, Dry Function, Sleep Mode, Auto Restart Heating Elements 1 Color White Voltage 230 Volts Wattage 1714 watts Included Components Indoor Unit, Outdoor Unit, Installation Kit, Wall Mounting Bracket Batteries Required? No Additional Information ASIN BOC4CXHHVJ Customer Reviews 4.5 4.5 out of 5 stars_ 47 ratings 4.5 out of 5 stars Best Sellers Rank #85,431 in Home & Kitchen (See Top 100 in Home & Kitchen) #15 in Split-System Air Conditioners Date First Available May 4, 2023 Warranty & Support Amazon.com Return Policy:Amazon.com Voluntary 30-Day Return Guarantee: You can return many items you have purchased within 30 days following delivery of the item to you. Our Voluntary 30-Day Return Guarantee does not affect your legal right of withdrawal in any way. You can find out more about the exceptions and conditions here. Product Warranty: For warranty information about this product, please click here Feedback Would you like to tell us about a lower price? What's in the box • Indoor Unit, Outdoor Unit • Installation Kit, Wall Mounting Bracket Introducing the NEW Goodman 18 SEER2 ductless heat pump mini split. Inverter mini-split systems ensure faster cooling with significant energy savings. Moreover, it helps maintain a consistent temperature in the room for a comfortable feel throughout nights and days. The Goodman FTXGN-A Series has a sleek white indoor unit with a floating dual panel, gradually curved side edges, minimalist LED ring indication, and a metallic silver spray paint touch-up for extra shine. The system includes a remote control that allows you to access all the comfort control options offered by the system. Cleanliness is very important in our modern-day living which is why the Goodman mini split made it a top priority. Goodman manufactured the new FTXN-A mini splits with a Titanium Apatite Deodorizing Filter, Catechin Air Filter, and Wipe- Clean Flat Panel. 5 Years Limited Manufacturer Warranty. The system must be installed by a licensed HVAC technician to correctly complete the product registration and to obtain the product warranty. Y � C Y LL • .. OWN rrio LA • • E C: • 4-d ■ O : _ �c . ro • • I . , ra • = [ Rili "lIIIIlilllllllli►il�. �dilllllllllllllllllllillllllllllllllll► IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIilll�lllll . .� t,_ �, �IIIIIIIIIIIilllllllllllllllllllill III" 1 i I °Illllllil�iiiiiilll��ii�illll►1► ��� 0 � T h� - - - - - - - - - - - - ! r Y i n ��11!.. •� • i nV !y W L r ti ►� . I r �- u C 5 � � L— CL 0) o O a) - c L L. `^ E O c V � = o 4� CL c L L o a L rz j Q O ui uj L 4� O o O v CC L s Ln L N ff a v � � s � � m tA w • 06 bn —1*0 • 0 v [' Q 3 7 ^ 1 � ro LL ci CL E w 1�I� Q o LA r a� LA iz ou uu. V 1 a �V � w ' V ca • Its C (B 0 � o • c 0 r � s �� • I e r I 0 N rio L �Ln p O 10 (v ro •N QJ L O C = Q) LL i Q) O bA O •v ru :3 O •— C Q a. Ln Q H O w • 11-11/16 0 r a u A M M m 00 .•-. • - m m cc Q W O N �2 n G1 • In1 cn C c c ry O m 4J c v x v o 0 o o o �. V c '' v v c c °' a • rn > i v w N - - a a, • OO �� p En 3 v :3 w cu o a M • °' cu a' 23 m o a v v v a 0 C voi n � 0 Ln v, J v Q c O C v � � Q C O 4-J W °- 06 N n o O 4Z +=+ a O •}, rp aJ � Y C £ C rp — O C Y� o Q p a: a o Q m v z {� CD o J - p 3 0CL 4J aJ y O d v V U > m�v + _ C u- Q J cu ' r o 0 O W p Z Q C • O O O V V O 11 Li c v O "17 00 z : E u a C p C — � -d i V i + i Q1 N c Ll V m y U- r- kn C .- ■ ■ ■ • u Ln +� C6 i kn on �O Ol E • aJ QJ > C: • U- J LA > I I Specifications FTXNG09/12A FTXNGI 8A RXNG09/12A RXNGI 8A Heatpump _ 09 12 18 Indoor FTXNG09AXVJU FTXNG12AXVJU FTXNG18AXVJU G09AXVJU RXNG12AXVJU RXNG18AXVJU Rated Cooling Btu/hr 8,800(4,400-10,200) 11,000(4,400-13,300) 18,000(6,700-20,000) Capacity(Min-Max) kW 2.57(1.30-3.00) 3.22(1.30-3.90) 5.27(1.96-5.86) Rated Heating Btu/hr 9,400(4,400-13,000) 11,300(4,400-16,400) 17,900(5,800-22,500) Capacity(Min-Max) kW 2.75(1.30-3.80) 3.31(1.30-4.81) 5.24(1.70-6.60) CoolingpBtulhrrW 800 1294 1714 Rated Power Input Heating 774 1004 1590 11.0 8.5 10.5 Rated EER2 3.22 2.49 3.08 12.15 11.26 11.26 Rated COP 3.56 3.30 3.30 SEER 18.0 18.0 18.0 HSPF 9.0 9.0 8.5 Power Supply (V/pH/Hz) 2 0 8/2 3011160 Maximum Piping Length ft(m) 65-5/8(20) 655/8(20) 98-1/2(30) Maximum Piping Elevation ft(m) 32-13/16(10) 32-13/16(10) 32-13/16(10) Chargeless ft(m) 32-13/16(10) 32-13116(10) 32-13/16(10) Piping Liquid inch(mm) 1/4(6.4) 1/4(6.4) 1/4(6.4) Connections Gas inch(mm) 3/8(9.5) 3/8(9.5) 1/2(12.7) Operating range-Cooling 'F('C) 50.114.8(10-46) 50.114.8(10-46) 50.114.8(10-46) Operating range-Heating -F('C) 5-64.4(-15-18) 5-64.4(-15-18) 5-64.4(-15-18) Operating range-Ambient Cooling 'F('C) 5-114.8(-15-46) 5.114.8(-15-46) 5.114.8(-15-46) H inch(mm) 11.1/3(288) 11-113(288) 11.11/16(297) Unit W inch(mm) 30-5116(770) 30-5116(770) 39-9116(990) Dimension D inch(mm) 9-3116(234) 9-3/16(234) 10-3/4(273) Sound Cooling 45/43136/29/19 48145/37/31119 50148/43/37/33 Pressure Level dBA (T/H/MIL/SL) Heating 45/42/35/29/25 47/43/36130/26 49146141/36/33 Cooling 4661431/322/2491142 473/436/316/2471132 7541716/6051467/395 Airflow(T/H/M/L/SL) CFM Heating 466/402/322/249/219 473/412/316/247/210 754/716/605/467/395 Unit weight Ibs(kg) 20.3(9.2) 21.4(9.7) 31(14) Outdoor Unit H inch(mm) 21-11/16(550) 21-11/16(550) 27-13/32(696) Unit W inch(mm) 26-1/2(675) 26-1/2(675) 36-5/8(930) Dimension D inch(mm) 11-3/16(284) 11.3/16(284) 13-13/16(351) Sound Cooling 46 48 53 H Pressure Level dBA ( ) Heating 48 48 53 Unit weight Ibs(kg) 55(25) 62(28) 97(44) Remarks. 1.Due to product innovation,all specifications are sublected to change by the manufaclwer without prior nolice 2.All units are being lasted nccording to AHRI 2101240 Standard. 3,Nominal cooling capacity are haled on the conditions 80 F(26.7 C)DB/67 F(14 4 C)WB indoor and 95 F(35 C)DB outdoor, 4,Nominal heating capacity are based on the rundilions•.70 F(21.1'C)DB indoor and 47'F(a.3'C)DB 143 F(6.1 C)WB outdoor. .•:�,»�a,<ae-„.aeepn.aut ntn»."nm 1 arm»annq n.mi;hvv hor»m»-.�,.»�n a.or!uiy Into t.,n an.n,rr n, ................ ©All rights reserved ® DATE(MMIDDIYYYY) l� CERTIFICATE OF LIABILITY INSURANCE 0 1/2 312 0 24 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 Jessica Pantalone NAME: Shoff Darby Companies PHONENo (203)445-2131 FAX Ext: C.No (203)354-6480 A/C AI 488 Main Avenue E-MAIL pantalone�@' SHOFFDARBYCOM ADDRESS: 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC p Norwalk CT 06851 INSURER A: Selective Ins Co of the SoEast 39926 INSURED INSURER B: Selective Ins CO Of America 12572 Nick's Electric Service of New York,LLC INSURER C: 48 Grand Street INSURER D INSURER E New Rochelle NY 10801 INSURER F: COVERAGES CERTIFICATE NUMBER: 24-25 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL15UtlK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 500,000 X Contractual Liability MED EXP(Any one person) $ 15,000 A Y S 2190304 02/10/2024 02/10/2025 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ❑X JECT PRO- ❑LOC !PRODUCTS-COMPIOP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _ IANYAUTO BODILY INJURY(Per person) $ AOWNED SCHEDULED S 2190304 02/10/2024 02/10/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLALIAB M OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE S 2190304 02/10/2024 02/10/2025 AGGREGATE $ 5,000,000 DED I RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? NIA WC 9024189 02/10/2024 02/10/2025 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 if yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The Village of Rye Brook is included as additional insured when required by written contract or agreement per policy form CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW Workers' STATE E CERTIFICATE OF Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Nick's Electric Services of New York LLC 914-723-1133 48 Grand Street 1c.NYS Unemployment Insurance Employer Registration Number of New Rochelle, NY 10801 Insured Work Location of Insured(Only required if coverage is specifically limited to Id.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 463263199 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company of America 3b.Policy Number of Entity Listed in Box"1 a" Village of Rye Brook WC9024189 938 King Street 3c.Policy effective period Rye Brook, NY 10573 2/10/2024 to 2/10/2025 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 carrier indicated above in box"3"insures the business referenced above in box 1a"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 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: Jessica Mulhall (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _— 1/23/2024 (Signature) (Date) Title: Commercial Lines Account Manager Telephone Number of authorized representative or licensed agent of insurance carrier: Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov J cif.�ii rvjlF�lI�It�(jJil" rr4fjJymC�I-I--Aff-� I�a�C��(1rL�Crl�i��l'�� f�C�JCJ �L � �.-LlLjCjrLpii rrci.j—rjpF—pr-Ffij-oDE {C3�L�C�JI�JL�f�C �JL�C�J��f�L�C�F1li C�L�f��LJ��CJ�1C��CJ—LrC�C�C��Ci�CJL�C�f�1C�J��fL��L�LjCrC�CJL�FfL�F�F�f�'.C.-C� 0 IC ��a n sluawwjdwl Jagjo Jo sa.1njonip 'saauaj, jo t11111onJIsUoo JDj pasty :?q of PaPual q l ou alD sagl f Iliadold 0l saln)Dnl js IUOJj. 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