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HomeMy WebLinkAboutFire Inspection Certificate 2024-2027 'G O Q h+�+ � •.•, cn o �) C. .0 ,� � cn •� v 4� w � w CIS Ln PLO 7s E"r o cu 0 3 z N N ~Qu N N w �••� y �T� -d y ►� C1i Nr■■I W � '� � A" 3 �' an aA •� N v ci 'd U4 = W w 00 4.4 .r ^ W .4t 4 " z o A V w x r w o : v x k ►-� F � �yE BRCby-. Fb 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 : ! / Rye iz I � 93'e RLZ.. DATE:�� PERMIT# \+ r't T��`��'C �y J ISSUED: SECT: r 1 7 BLOCK: LOT: 0e LOCATION: � OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK r ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BUILD TMENT VILL Qj' R QQg Initial Inspection Date: ❑ Pass 938 DING ST RYE BROO , E YYORK 10573 � - "-5- 2 O '2 y E�Fail BUILDING&FIRE INSPECTOR (914)9 w rook.or Re-Inspection Date: ❑ Pass 44-6o k: •e T /�!• 19812 �� ❑ Fail lJ p� FIRE INSPECTION REPORT NOTICE OF VIOLATION & ORDER TO REMEDY SAME Site Address: R i 1 R 1 <k e. 'L G -L C_- Zone: SBL: / W• 2 7 Occupancy: G C' S} ?Z't t'3�c. G. L State Use Classification: Business Owner: A e 5<: R Phone: Building Owner: W I 1; C��c 2r i�e�' Phone: Emergency Contact: [_ �P_r A L C' y S Phone: ` 1 ' -3 Q O- O 2 �t S Building Representative in Attendance: A 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ Take notice that the following violations of the New York fate Uniform F' a Preven 'on&Building Code and/or the Code of the Village of Rye Brook were found to exist at, I La ,in the Village of Rye Brook,NY on, A L I 20 L The persYn or entity served with this Order to Remedy shall immediately co ence to correct all listed violations and sh�mpletely cure each violation described herein by no later than OAA ( 5T 1 2 o L� ,which is thirty(30)days after the date of this Order to Remedy.Furthermore, upon can g any listed violation(s),you shall immediately contact the Building Department during normal business hours to schedule a re-inspection of the premises to confirm full compliance with all applicable codes,laws,rules&regulations. BE ADVISED THAT YOUR FAILURE TO CORRECT ALL VIOLATIONS IS A CRIME PUNISHABLE BY FINE,IMPRISONMENT OR BOTH. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ No YES N/A 1.PORTABLE FIRE EXTINGUISHERS (PFE's) a.906.1. Are PFE's installed throughout the space&on the premises as required by code. a. b.906.3.1.Is the maximum travel distance to a PFE 75 feet or less. b. c.906.5.Are PFE's conspicuously located&readily accessible. C. d.906.6.Are PFE's unobstructed/unobscured from view. d._ _✓ _ e.906.7.Are PFE's properly mounted as per the manufacturers instructions. e._ ✓ f.906.9.Are PFE's properly installed:<40 lbs.max.5'above floor;>40 lbs.max.3.5'above floor. f. ✓ 2.FIRE ALARM SYSTEM&SMOKE DETECTORS / a.901.6.1.Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72. a._ ✓ _ b.907.4.2.1.Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b. c.907.4.2.2.Is the height of the pull station handle located between 42&48 inches above the floor. C._ d.907.3.Is a fire alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d. 3.FIRE SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS a.901.6.1.Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a._ _ b.901.6.1.Are the main valves secured against tampering in the open position. b._ we c.901.6.1.Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C. _ _✓ _ d.901.6.1.Is a supply of six spare heads&a wrench maintained on the premises. d._ _✓ _ e.901.6.1.Are sprinkler heads&cover plates unfinished or of factory applied finish only. e._ _ f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f. g.913.5.Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g. h.507.5.2.Is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h._ ✓ _ i.507.5.4.Are fire hydrants&fire protection equipment unobstructed. i._ ✓ j.507.5.5.Is a clear space of not less that 3 feet maintained around all hydrants. j._ ✓ k.901.8.Are all fire protection systems in place and maintained untampered. k. INSPECTOR: 77 X `\ DATE: aZ -1- RcwYa vwizz No YES N/A 4.STANDPIPE.CABINETS&FIRE DEPARTMENT CONNECTIONS a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. _ _ ✓ b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b. _ _ _✓ c.912.2.3 Are standpipe FDC threads compatible with fire department standards. C. _ _✓ d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d. _ ✓ e.905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e. _ ✓ f.912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f. _ ✓ g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g. 5.EXITS,MEANS OF EGRESS&OCCUPANCY a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. _ ✓ _ b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b. _ ✓ _ c. 1031.6.Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... C. d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. _ ✓ _ e. 1010.1.Are egress doors provided and maintained as required by this section. e. f. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f. g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g. h. 1013.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h. i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1.provided as required by code. j. 1013.3.Are all exit signs illuminated at all times. k.1008.1.Are the means of egress&exit discharge illuminated at all times the building is occupied. k. 1. 1018.3.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides. m. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least in. 28"wide,or at least 36"wide where serving 50 or more people. 6.COMBUSTIBLE STORAGE&WASTE MATERIALS a.304.1.Is the building(s)and premises maintained free from accumulated combustible waste material. a. _ _✓ _ b.304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. _ . _ c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C. d.315.3.Are combustible materials properly stored&separated from ignition sources. d. e.315.3.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e. and 18"or more below sprinkler head deflectors in sprinklered buildings. f.315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f. _ g.315.3.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g. — — h.313.1.Is building maintained free from stored fueled equipment. (motorcycles,mopeds,mowers,etc...) h. 7.ELECTRICAL a.604.1.Is the building free from modified/damaged wiring,devices,appliances,equipment a. and maintained free from electrical hazards. b.604.2.Are electrical service equipment areas properly illuminated. b. c. 604.3.Are proper working space clearances provided&maintained for electrical service equipment. C. _ d.604.3.Are electrical service equipment working spaces free from any stored materials. d. e.604.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. e. f.604.4.Is the building free from unfused multi-plug electrical adapters. f. g.604.5.Are electrical extension cords being used in a safe manner as per code. g. h.604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h. i.604.6.Is the building free from open-wiring spliced electrical connections. i. j.604.8.Are electrical motors maintained free from accumulated oil,dirt&debris. j._ _ k.915.1.Are Carbon Monoxide Detectors installed&maintained as required by this section and by 1103.9. k._ 7-INSPECTOR: DATE: 7 I S Z O Z Y -2- Revised 6/11/2020 No YES N/A 8.ELEVATORS.DUMBWAITERS&ESCALATORS a.[PM]603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a. _ _ ✓ b.606.3.Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b. _ _ Vol floors reading; IN FIRE EMERGENCY,Do NOT USE ELEVATOR.USE EXIT STAIRS c.606.7.Are keys for elevator car doors&fire department service kept in an approved location. C. _ _ _✓ d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. e.[B]3005.1.Are elevator machine room doors maintained unobstructed at all times. e. ✓ 9.COMMERCIAL KITCHENS a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a. _ b.904.12.5.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b. c.904.12.5.2.Are automatic fire extinguishing systems serviced at least every 6 months. C. _ _ ,/ d.904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d. _ _ ,G e.[RBI 122-5.13.Are grease traps provided and installed as required by Village Code. e. _ f.[[PC] 1003.10. [RBI 122-6.Are grease traps properly maintained as per State and Village Code. g.[RB]122-6.C., 122-9.Are all service,maintenance,&repair records for grease traps and related plumbing maintained on the premises as required by Village Code. g. 10.HEATING SYSTEMS a. [PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a. Vol b. [PM]603.2.Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. _ _✓ c. [PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C. _ d. [PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d. e. [PM]603.5.Is the fuel-burning equipment provided with adequate combustion&ventilation air. e. ✓ 11.MOTOR FUEL-DISPENSING FACILITIES&REPAIR GARAGES a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a. in an approved location within 100' of,but not less than 20'from fuel dispensers. b.2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C. d.2305.5.Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. _ _ _✓ 2-A:20-B:C provided&located not more than 75' from pumps,dispensers&fill-pipe openings. e.2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e. f.2305.7.Are weeds and other combustible materials kept at least 10' from fuel-handling equipment. f. g.2306.4.Are above-ground tanks provided with vehicle impact protection. g. h.2306.5.Are above-ground tanks provided with secondary spill containment. h. 12.HAZARDOUS MATERIALS(HAZ-MATS) a.407.2.Are S.D.S.Sheets for all haz-mats readily available on the premises. a. b.407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b. c.5004.2.Are stored haz-mats provided with approved secondary spill containment. C. d.5003.7.1.Are proper No SMOKING signs provided as per this section. d. 13.MISCELLANEOUS a.403.1.Is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b. _ c.405.5.Are records of emergency evacuation drills kept&maintained on the premises. C. _ d. 505.1.Are approved address&building numbers properly placed&plainly visible from the street. d. ,C _ e.506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e. f. 703.1.Is all required fire-resistance rated construction properly maintained as per code. f. _ g.703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g. h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h. — — i.5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. i. 14.GENERAL HOUSEKEEPING a.Good ,/ b.Fair c.Inadequate � _ d.Poor INSPECTOR: L DATE: 2- -3- Revised 9/17/21 ITEM NUMBER REMARKS G s x � �s r► �1vv�el< �� Q� ►vie R i J s Nee s c, I( MC,VP INSPECTOR: DATE: 7 S 2 V 1 �. -4- Revised 6/11/2020 BUILDNG DEPARTMENT VI E OF RYE`', .R OK I 938 KING ET RYE BR NY 10573 APR 1 7 2024 _UJI ( 14 _0 _ VILLAGE O►= RYE BROOK BUILDING DEPARTMENT FIRE INSPECTION / OPERATING PERMIT APPLICATION FOR OFFICE USE ON Y: n \ 9.'304 — Fee Paid: $ Inspection Date&Time, 10'iCXQy�l FEE SCHEDULE: Re-inspection Date& Time: Triennial & Private School Annual Inspection: =$450.00 Public Assembly Annual Inspection: <100 People=$525.00/>100 People=$775.00 Application,dated: is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting that a Fire Inspection be cobducled a the building and premises listed below for the purpose of issuing a Permit to Operate the business, private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform Fire Prevention &Building Code,Title 19 NYCRR Part 1201, and all other applicable local, County,State & Federal laws, rules & regulations,as per detailed statement described below. 1. Address: SBL: =1&2 Zone: of 2. Business/Occu ncy Name. � -�—���� .(1C_0 NYS Use Class: 3. Property Owner: W 11n ? e-, Address:IrL ow Phone ql*0/ '9bG'�_ ,Cell# email:tbwaLii i(1 .on 5. Business Owner: AW V_ KeA4kr, Address: i3'9' S hGiGlaL0 T�,Cti' 016% Phone# Cell# * k"-3ul''Ci/00 email: E&WO pkaar<X411111 6. Emergency Contact: 6iStt..l�,ltr Address: Phone# x r' Cell# 42klk-';l�0 7-1Ll email: r✓Wr V1%VVN_ � ��- 7. Inspection Escort:a-Ak KL,l U Title: Phone#: � Cell#: ( email: a4ax-1 8. Provide a brief description outlining the current and/or intended use of the property: 1 L - 9. List all Hazardous Materials: 10. Occupant Load: Existing: Proposed: Other: 11. Date&Disposition of Previous Fire Inspection: ❑ Pass ❑ Fail 8/12/2021 This application must include the notarized signature(s) of the legal owner(s) of the above mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK COUNTY OF WESTCHESTER as: &Uk ki-o�m"K ,being duly sworn,deposes and states that he/she is the applicant above named, (print naifie of i divid F,signing application) and further states that he/she is the legal owner of the property to which this application pertains,or that he/she is the dC4-v , for the legal owner and is duly authorized to make and file this application. That all (indicate architect,business owner,attorney,agent,etc.) statements contained herein are true to the best 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 wel I 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 10 Sworn to before me this day of I f h l , 20� day of — 20 Z� of ry Public - Notary Publicrj 4&V t Si Nature of Property QuAw `9 Sig tur f A c nAA- MA19VL Print Name of Property Owcer Print me of Applicant tfiM) ALENA MAKAN,NN NOTMtY►U9LIC,STATE OF NEW YORK -v York RaSiatratlon No.OIHA0013645 Qualified in Westchester County f " i County Commleslon Expires 911912027 2 sn 212021 �E N acc • ■ o o u.u.wlnw 'd r r z �x m • m �' `° `° as ;¢ N m x❑❑❑❑❑ o c m 1m U In w a CA �U rri ni Lf nF 7nnn nnin m7ini r ('&; {I\#\ ( 32 ..Ea■a 2 2f772 %ki)G 2-2� )/k§f;!#I { © °�«� �°®%E !`f) �■�¥ |�§` �)kf; «^a�a#®|�7;�©` $ �f)!7 R#� &aa«7{`) k)E);`k�� 2 -r{—.2 9;t(7Q$ ■ �$a#(®, :Q-- --`3«�=\k 2 7 ©iee§!\#f�2fk\() \]k=)fl12 . \ �) § {k 7) ]I2f �k\E5E � � '-f$� k ©` 7 - �ff3 E ££ � 2■@) 2� a#=«)` kf)tR i mƒ !)ff ■ff] $e2 a !=2�= �f.©=_�a,�� �� . t § ,3#@%{m={*2{ff #®�, ,a3;) ��a=,=tee! R=f±a37k A;c&3f =a,=;a;a . N a`F.y u •o cc .c N Q N N C N N y i0 i0 W 7oN aF ¢ EEC a[ Q } Z x ro ro c c c _ o o O mva UU,o `a❑ ca � ❑ ❑ �Y1012`�J� CC E 3 N o a- O¢¢ (n(n¢ En ❑OD O❑ c • E N Z N N N Z > 2 @ @ W U N 'o N v O u d ar O .` E) N a U N o ¢ u d @ N N N N �. j�¢a d S 2 i6 > o Q X (� �QQUUUc o viO0000[ rl O M r� !� cl > a � cO c _ @ �` M ' E v C O -c V V L(J fU C O70 O�ui , 'It p n in (a Y E — o 2 M v m N �1J _ Cl) E cf CL Q N ro 7 O a O* co • to N "O„— N �_ �v O f _ • C U U O ,��� ru • 0+ Q v o Tror a) � LO r • E c Y m o 75 Q s £ Ua` mQ `oa � _ � < u N Q IL — U o �i o m06 0 9 m a) Z U O'� w m E ca — a 0CL c� N Y 1— C O z C UJ X�/ C @ C L x /1 ocl F-- w 0 _ w co 0 w a) O _(D Z — li'� m LLI ' O Q- c J_ a > m tU m � aca Ln 0 Ir o Z c — m u- m m a ru IT- ca ai Ln 00 =)d t�4.VyJJ V G VJ k'tI"�V 9 VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E.Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino March 18,2024 Via In Class Certified Mail East Pointe Dance c/o Ms.Alyse Keyser 11 Rye Ridge Plaza Rye Brook,New York 10573 Re: East Pointe Dance,11 Rye Ridge Plaza, Rye Brook,New York 10573 Dear Ms.Alyse Keyser, It has come to the attention of the Building Department that it has been over three years since the premises located at the above captioned address has undergone and successfully completed a Fire Inspection.Please note that you are required by Rye Brook Village Code§91-4.13,to undergo and successfully complete a Fire Inspection for this location at least every thirty six (36)months. In order to avoid a violation,please complete and submit the attached Fire Inspection/Operating Permit Application form, remit the correct application fee,and schedule your triennial Fire Inspection with the Building Department by no later than, April 18,2024,which is thirty(30)days after the date of this notice.Please note that the property owner's notarized signature, as well as the business owner's notarized signature must appear on the application form in the appropriate spaces. Upon successful completion of the Fire Inspection,you will be issued a Fire Inspection Certificate valid for three(3)years. Please remember that you must schedule your Fire Inspection every three(3)years by filing a Fire Inspection/ Operating Permit Application,remitting the applicable fee,and scheduling your Fire Inspection with the Building Department at least thirty(30)days prior to the expiration date listed on your Fire Inspection Certificate. Thank you. Steven E.Fews Building&Fire Inspector stevefews Webrrook.org cc:Alfredo DiVitto,Assistant Building&Fire Inspector Laura Petersen,Office Assistant Alena Hakanj n,Property Manager /to L�• c � t� VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino March 18,2024 Via 1s,Class Mail East Pointe Dance c/o Ms.Alyse Keyser 11 Rye Ridge Plaza Rye Brook,New York 10573 Re: East Pointe Dance,11 Rye Ridge Plaza, Rye Brook,New York 10573 Dear Ms.Alyse Keyser, It has come to the attention of the Building Department that it has been over three years since the premises located at the above captioned address has undergone and successfully completed a Fire Inspection.Please note that you are required by Rye Brook Village Code§91-4.15,to undergo and successfully complete a Fire Inspection for this location at least every thirty six (36)months. In order to avoid a violation,please complete and submit the attached Fire Inspection/ Operating Permit Application form, remit the correct application fee,and schedule your triennial Fire Inspection with the Building Department by no later than, April 18,2024,which is thirty(30)days after the date of this notice.Please note that the property owner's notarized signature, as well as the business owner's notarized signature must appear on the application form in the appropriate spaces.Upon successful completion of the Fire Inspection,you will be issued a Fire Inspection Certificate valid for three(3)years. Please remember that you must schedule your Fire Inspection every three(3)years by filing a Fire Inspection/Operating Permit Application,remitting the applicable fee,and scheduling your Fire Inspection with the Building Department at least thirty(30)days prior to the expiration date fisted on your Fire Inspection Certificate. Thank you. Steven E. Fews Building&Fire Inspector s teve Fews0laebrook.ore cc:Alfredo DiVitto,Assistant Building&Fire Inspector Laura Petersen,Office Assistant Alena Hakanj n,Property Manager /to NNT WESTCHESTER COUNTY DEPARTMENT OF HEALTH estL1l��ylfYc���Srter GYM AND FITNESS CENTER COVID-19 COMPLIANCE INSPECTION gvV co i 1 25 Moore Avenue Mount Kisco,NY 10549 cc 7� Phone.(914)813-5000 Fax (914)813-5003 Facility Name Email Address. t+4�i O►��-�l�t�GF Facility Address: I I �v �Z F --k"CLD j P O,� Operator's Name:I l�L Y PLTL (S -(, elephone O Activity Code Inspecme tion AM M Inspection Date Time spent conducting service Facilit o en and operating Violations/Corrective Actions/Comments GYM REOPENING DATE. Facility Capacity 33%of Facility Capacity SZ. NY Forward Plan on site Yes N gnage posted for an was ing,social distancing,use of PPE,and cleaning and ves No disinfection protocols Physical Distancing Capacity limited to 33% es 6'Distancing Maintained es N Communal showers not in use es N Individual showers in useb1h es N ower stalls c eane an sanitizebetween ves use No On-Site Activities Fitness class numbers limited Yes No Approved ace coverings in use(bandanas, Yes buffs,gaiters are not acceptable for use) No Social distancing measures enforced Yes No Equipment properly spaced at least 6 ft apart ves No L ntact activities prohibited esNa aunas,steamrooms an water Yes osed No Facility meets minimum Merv-13 or equivalent ves No MERV level provided Facility adopting a itona air handling Yes mitigation protocols per ASHRAE and CDC No Filtration mitigation protocols provided es N ocumentation is provided or any or all o t e ves above No Protective Equipment pprove ace coverings( an anas, u s, gaiters are not acceptable for use)are ves rovided for all staff,inc ludin face shields No pprove ace coverings are avai a es ou ves a patron be in need No Employees are required to wear gloves es 0 Hygiene, and Disinfection ANiga;&!ofLW!�CDOH Employee or Representative: an ygiene s a ions prove e an Yes maintained No Agency Performing Inspection Hand hygiene signage provided Yes o Signature of Representative: Approved cleaning and disinfection supplies Yes rovided No Representative phone#. are an rents equpment is ceane an Yes Signature of Responsible Individual. sanitized between each use No Lockers rooms and restrooms are cleaned Yes print Name. and disinfected eve two hours No Cleaning and disinfection logs maintained es Title: screening By signing this inpection report the facility agrees to abide by and maintain eat screening con uc a or emp oyess ves and atrons NO all guidelines set forth by the Governor of the State of New York. the New Facility has designated site safety monitor Yes York State Department of Health, and any and all applicable State, Local ogo persons entering aciity ept or 8 Yes and Municipal laws, ordinances, codes, rules, and regulations. days and provided onsite for review No