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HomeMy WebLinkAboutMP24-112 DR, 4' O C4 C c�C4.°Ja�Jj i� 198 J•�•� 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 K Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 22,2025 John Dorchik&Eleanor Dorchik 52 Hawthooe Avenue Rye Brook,New York 10573 Re: 52 Hawthorne Avenue, Rye Brook,New York 10573 Parcel ID#: 135.75-1-72 This document certifies that the work done under Mechanical Permit#24-112 issued on 8/26/2024 for the installation of a new oil fired boiler and a hot water storage tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BRC�� BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q 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 : {LI W t 1 A V DATE: ` PERMIT# ISSUED: e-Zb-esECT: �' BLOCK: LOT: LOCATION: + .��-j ��� OCCUPANCY: ❑ Violation Noted THE WORK IS... D /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 Q FINAL Q' OTHER QyE BR o`` tim Q>X F • 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 - - - - - - - - - - - - - - - - - - - - A%46-- ADDRESS : DATE: PERMIT# ISSUED: SECT: 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 GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��, cu � • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 13-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 : ��7 Y1/ i �t �;< ✓� DATE: PERMIT# �� ' �� l ISSUED: -Z�/ ` SECT: 5�J �j BLOCK: LOT: ,-2 LOCATION: i""' �� 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 L ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ^J ❑ FIRE SPRINKLER (} FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER = 00 00 � w •� a� a W cn 0 Old W z , O o C $ 0, 0 O r © ► M M W °� 'O V� W �O W cN MON d $ o w9 a o H rn W W x Wo � ov � o U w oes 1 uz z o H Av f uU w � v � '� A a, z v � vo v� gib ❑ z _ a o . V � 4 w MCN ��T�T V� u p y ■ a s a�i O Q ■ A [1 N 0-0 - �, O zo go o o a� � U z a d x o4. _ V V W `I � A z a vi p' w o icy o -0 - a - �I G� P r--1 W xu�i � v BUILD DEPTMENT VIL 'E OF RYE. OOK AUG 2 2 2024 938 KING ET RYE BRA ,NY 10573 ..0 . ov APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: " 2 Permit Fee: $!Z_JC_.J 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 roust be listed as certificate holder) &Workers Compensation Insurance on a NYS Board form(Form#C105.2 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. Application dated,kiq. c1 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or rem val 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: ESA 1y[�, 1, _Nye- SBL: I' -Ic-' - �]� Zone: 2. Property Owner: E.�AQt - T� Address:�ANArn►p6ra a- NX r A - Phone#: f 4- CEI .' F) Cell#: email:F PUNU+,'�L\ I P (tX� 3. Contractor: 1,� mcx'P. l ca1 Co, .I r,{, . _!Address:An is\— �;N . .62gnw,c- ) CT Phone#:'�VA Wn •`x -AM) Cell#:2X53•!:-ak • kj2M email:.ert cAd tYuh1G"l t. .ee9� 4. Scope of Work: New Installation( }• Replacement*Removal( )• Other( ): 5. List Equipment: �% , UlK- 1 L7)t\ Z -C �0*�, arch 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): 'AO -} p�-y,��Q{ Amk cc, 1 6/112024 �rtinQe�i�4.t- 'Fa,r,;a(CD STATE OF NEWA�63N{,COUNTY OF R ) as: 0!\, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of inbividual 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 .2( Sworn to before me this 46r- day of �g,�sk 20 Z�-11, day of 1 ' 20 CvYtJ7 Ci� tgnature of Property Owner Signature of Applicant EItaIn0r 06rC.aik An+hmv Kleem Print Name of Property Owner Print Na licant Notary Public Notary Public SEAN L.YTLE SEAN LYTLE NO2AAyPUBLIC Y NOTA.RYPUBLIC YCOMMIUlan EXPIreo Aug.31,"of COMMI slen Expires Aug,31 �3 Tli1s application mast be properly completed in its entirety and must include the notarized signature(s) of the legal owners) 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. z 611/2024 EM 1.0 GPH MAX EK2 1.75 GPH MAX PRODUCT DATA SHEET PRODUCT DATA SHEET System 2000 - Energy Kinetics' hybrid ilh o eat I system for every home! rw►,� F SySTE 7 l ,k EN�R�Y SjAR off yf�f# ..� u' ot to be • - • • - _ - i�.iTEM 0 - 2 00 Call us today for 800-66-1-0902 more information www.system2000.Com System 111 Oilheat performance: Features Benerits Energy Converter System 2000 is an integrated heat and hot Chimney venting Ideal for retrofit installations Power vent chimneyless option available Save thousands on chimney construction water system - makes both heat and hot water! 10 feet forced counter flow passages Maximum heat recovery Homeowners enjoy economical heat, plus a 300e net stack temperature As high as 87.9%efficiency Water content:EK1 2.5 gal.,EK2 4 gal. Rapid heat up,cool down virtually endless supply of hot water with lower energy Wet base design Minimizes heal losses costs throughout the year. Plus, System 2000 delivers High temperature ceramic combustion chamber Incinerates fuel—clean,safe heat significant savings over electric or traditional hot Jacket&Insulation:EK1 90 lbs.,EK2 110 lbs. Minimize heat losses Bused combustion Quiet operation � water making methods with whisper quiet operation. 3/161 pressure vessel steel throughout 50%thicker than boiler tubes POWER VENTING ASME code construction Carefully inspected,pressure tested All welded and threaded connections No gaskets to leak or service Homeowners who plan to save money Built in de-aerator Eliminates air from system.No"gurgles" by converting from expensive electric Back cover removable Easy to inspect and clean �* heat to oilheat often find themselves Large open passages Easy to inspect and clean up against a brick wall: It's the high Standard burner and accessories Serviceable with normal stock parts �,. cost of chimney construction. But with Small size Compact installations m System 2000's unique combustion Limited 11/etime warranty/Option to transfer.Energy recovery standard on all systems. chamber,combined with a 10 foot long flue passage,gases leave System Storage Tank ., 2000 clean,and relatively cool.So they 40 gallon capacity Plenty of storage for peak demands can be vented directly through-the- 80 and 120 gallon tank options Even more storage for extraordinary needs wall. No chimney needed!An excellent Heavily insulated tanks Very low heat loss No chimney needed!Ground level benefit for homeowners with electric Heat trap on outlet Stops heat drift venting stays relatively cool! heat, heat pumps or for new home Glass lined with anode rod protection High corrosion resistance construction. Power venting is the safest Bronze circulating pump Trouble free,long life method of side wall venting and is a low Layered heat stratification Hottest water to outlet,cooler water at bottom cost alternative to chimney construction. for most efficient energy recovery Adjustable aquastat For temperature control Stainless steel tank options Extended warranties SPECIFICATIONS: EK1 Domestic Input Gross output AFUE Hot Water* Hot Water Exchanger .68 GPH 83,000 BTU/HR 87.9% 170 Gal/Hr. External unit Not in boiler,not in tank...easy access .74 GPH 90,000 BTU/HR 87.7% 180 Gal/Hr. Stainless steel construction Durable,corrosion resistant .85 GPH 104,000 BTU/HR 87.5% 162 Gal/Hr. Wrinkle flow counterflow heat transfer High turbulence for rapid heal transfer 1.00 GPH 121,000 BTU/HR 86.2% 228 Gal/Hr. 170 to GPH High output Compact Low water content EK1 Energy Converter Total Weight: 270 lbs. Easily backwashed or chemically cleaned Maintains capacity even with marginal EK1 Dimensions: 24.5"x 26.5"x 17.5" water conditions EK1 Total System Weight 450 lbs. Union connections Easily serviced EK1 Storage Tank:Weight 115 lbs. Dimensions: 20"x 50" EK1 Domestic water GPH: 170 to 228 Zone Controls EK1 Hot Water Cost: $19 to$25/month typical Motorized valves Quiet,proven and reliable (less than 1/3 the cost of electric hot water) Zone circulators Optional Standard or clock thermostats Uses conventional controls SPECIFICATIONS: EK2 Domestic Digital Energy Manager with Energy Recovery Hot Water* Solid state printed circuit with surge protection Rugged and reliable Input Gross output AFUE LED indicators For all functions;super service aid 1.20 GPH 147,000 BTU/HR 87.6% 293 Gal/Hr. 5 zones standard Four heating zones,one hot water zone 1.40 GPH 170,500 BTU/HR 87.0% 334 Gal/Hr. Expand Up to 15 zones available 1.60 GPH 190,500 BTU/HR 85.5% 368 Gal/Hr. A complete Energy Manager Programmed response to heat and hot 1.75 GPH 2O6,000 BTU/HR 84.0% 395 Gal/Hr. water demand Quick connector terminals Easy installation or service EK2 Energy Converter Total Weight: 350 lbs. Printed circuit service board An easy way to check out system function EK2 Dimensions: 24.5"x 27.5"x 24.75" Limited lifetime warranty Minimal rebuild charge after 5 years EK2 Total System Weight 550 lbs. EK2 Storage Tank:Weight 115 lbs. Dimensions:20"x 50" Options EK2 Domestic water GPH: 293 to 395 EK2 Hot Water Cost: $19 to$25/month typical Outside combustion air Isolated from home;whisper quiet operation Pre-packaged units Installation time reduced (less than 1/3 the cost of electric hot water) Outside Freedom Model Location optional mineral hot water tanks Performs in severe water conditions 'Domestic hot water rating based on first hour draw with 77F rise and 40 gallon tank. As an ENERGY STAR Partner,Energy Kinetics has determined that this Product mets ENERGY STAR guidelines for energy efficiency. 1)The color yellow for heating boilers is a registered trademark of Energy Kinetics. YOUR SYSTEM 2000 DEALER: ENERGY non NJ 088R3 Road ;_, ad- KINETICS® Fax: 800 735 2068 visit www.system2000.com V A a lA_ W z 1 N j� a 14 Ln 0.0 s v N z T w _ v0 'n o V_ 000 Q A u W O U W0.4 Z M 0 z La v,1 � z z o w r G z F, < OMo Z w Q Z o z � a Ln �ET3RC�v� Q V E BUIL v ,; MENT Va, ;a Rom;. OK AUG 3 0 2024 938 KIN YE$` NY 10573 VILLAGE OF RYE BROOK ora BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required/ FOR OFFICE USE ONLY -UP-*. /"// :)4/ d- EP#: D I— 7 Approval Date: 9" 3— 2 o 2- Permit Fee: $ Approval Signature: ��• 1��� Other: 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 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: 52 Hawthorne Ave, Rye Brook SBL: 135.75-1-72 Zone: 2.Property owner: Eleanor Dorchick Address: Phone#: 9149373417 Cell#: email: 3.Master Electrician: Angelo Zaccagnino Address: 81 Maple Ave Rye NY 10580 Lic.#: 755 Phone#: 914-921-3244 Cell#: email: Office(&Zaccagnino.net Company Name: Address: 4.Proposed Electrical Work/Fixture Count:Wring and connections for replacment boiler and hot water storage tank 5.31 Party Electrical Inspection Agency: SWIS STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: _Angelo Zaccagnino ,being duly swots,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Electrician for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to be ore me this a Sworn to be re this �0 day of - ,20 da o ,20 a Signature of Pr erty Owner Signature Vf App STFV I. GAGNON Fkeawril N Print Narr�eof } J er — ►4�iTd1e �}F Qualified in StIdstnhpatar No. 01G Cc>urrt� N004YR01W Expires October 14, 20� b + My Commission Expires October 14. 20 A_ 6/23/2022 STATE WIDE INSPECTION SERVICES, INC. Service With Integrity 0:0 • • SWIS JOB APPLICATIONi. SWISTRAINING.CONI Office Use Elect. Permit# c) t_ f Date f Bldg Permit# MP c)U— 9 S Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County I E Address Cross Street Section 507,E Block Lot ', ) /x Owner Name/Address(If different than above) / or,( Contact Number (� ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential/ [:]commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels I 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 Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation Ctvo (o\piA'gC ntn5 C)� �t:luce4eu'� ,'')otf�.� y � DDI AUG 3 0 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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,if at 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. Email Address (�? { Name License# r/5'� Date `�/ y Signat,re Address City/State r , Zp&de Company Phone # pection Services c �� R D 1080 Main Street OCT — 8 2024 Fishkill, NY 12524 U 845 202-7224 Phone wriVILLAGE OF RYE BROOK 914-219 1062 Fax TbA" TbSTATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Zaccagnino Electric Eleanor Dorchick Angelo P. Zaccagnino 52 Hawthorne Avenue 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 52 Hawthorne Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-177 135.75 1 72 Certificate Number: 2024-7049 Building Permit Number: MP24-112 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: 52 Hawthorne Avenue, Rye Brook, NY 10573 The Basement Utility Room 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 7th day of October 2024. Name Quantity Rating Circuit Type Boiler 01 Hot Water Tank 01 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. _ CN N N M f Nt o Neq N a PLO z 4 o 0.4 Ca a W O x LO 0. MCI 0 ' V 0 cc A x ON _ L4 ur Q ° It _ : A W a W Oc z a 4 ^ a x w it J z off. u,H 0 0 w z w x o rJ F C 11 �144 D LO oG F' Q ° U W U _ e = �� D EC EME BUIL G DEpAR MENT VIL ,E OF RYE B OK SEP 2 3 2024 r,. 938 KIN `brrzta T RYE B(ZOO ,NY 10573 VILLAGE OF RYE BROOK �­O BUILDING DEPARTMENT Y.gov . PLUMBING PERMITAPPLICATION FOR OFFICE USE ONLY .BP7#r /` —��c� PP#: Approval Date: SEP 2 4 2024 Permit Fee: $ V 0o%'"2� Approval Signature: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 9-a3-ay 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 signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and dd1LLoocal Codes. C l.Address: SBL: 125�j 5— 1 — I o� Zone: 2.Proposed Work: do i 3.Property Owner: E 1 Pn cL\n t Address: Cj VLe Phone#: q\y � ' 1� Cell#: email: 4.Master Plumber: ��(-�� NiCcu�ot__ Address:12� A L '�zV M Lic.#: 44(Phone#:q I4.-7_n •a(o3�Cell#: email: LI 1 Company Name: �CC-);l2 i?Cam,al.CtQ CorrpAddress:IC INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 13n I er 1 st Floor 2nd Floor 3`d Floor 4"Floor 5"Floor Exterior 5.* List Other Equipment/Provide Details� 1�P�( (Notarized Signatures Required Next 2 Pages) -I- 6/I/2024 r STAT F K,COUNTY OF WFH_ -- — ) as: E (�Q being duly sworn,deposes and states that he/she is the applicant above named, (print name of indi dual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this l Sworn to before me this a 3 4 f day of ?�entbP�- 20�t� day of 20 1� Signature of Property Owner Signature of Applicant 'E-\f!st-r-r-r- Print Name of Property Owner Print Name of Applicant 0.4 ublic Notary Publi SEA LYTLE SEAN LYTLE NOTARYPUBLIC NOrARYPUBLIC MY COMMIssl0n EXPOI Aug.31,2025 MY Commisalon E>�lres Aug.91,p025 II appiication must be properly completed in its entirety and must include the notarized signaturP(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/I/2024 BUILDING-MP, RTMENT D V VILI`A'G�E OF R'YL ROOK ID 938 KING T ` ET RYE BR NY 10573 SEP 2 3 2024 ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: e r oor ` r��1�-�� residing at, rQ (Print name) (Address where you live) being duly sworn, deposes and states that (s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; A"n�c Cl.[ 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. (Si'k6ature of Property Owner(s)) D f CxQ-,� ��_eyk i k (Print Name of Property Owner(s)) Sworn to before me this day of s' kC�b cr , 20�� (Notary Public) SEAN LYTLE NOT.IRYPUBLIC My Commissioc aphs Aqq N,W -3- 6/1/2024 EK1 1.0 GPH MAX EK2 1.75 GPH MAX PRODUCT DATA SHEET PRODUCT DATA SHEET System 2000 - Energy Kinetics' hybrid oilheat system for every home! SYSTEM -- NSt.M 4000 - a•- �A �k's.". Y STAR i /t's got to be • - YSTEM . - . - . . - 2000- Call us today for 800-661-0902 more information www.system2000.Com System 111 Oilheat performance: EK1 EK20ilheat Features Benefits Energy Converter System 2000 is an integrated heat and hot Chimney venting Ideal for retrofit installations Power vent chimneyless option available Save thousands on chimney construction water system - makes both heat and hot water! 10 feet forced counter flow passages Maximum heat recovery Homeowners enjoy economical heat, plus a 300*net stack temperature As high as 87.9%efficiency Water content:EK1 2.5 gal.,EK2 4 gal. Rapid heat up,cool down virtually endless supply of hot water with lower energy Wet base design Minimizes heat losses costs throughout the year. Plus, System 2000 delivers High temperature ceramic combustion chamber Incinerates fuel—clean,safe heat significant savings over electric or traditional hot Jacket 8 Insulation:EK1 90 lbs.,EK2 110 lbs. Minimize heat losses Buried combustion Quiet operation water making methods with whisper quiet operation. 3/16TM pressure vessel steel throughout 50%thicker than boiler tubes POWER VENTING ASME code construction Carefully inspected,pressure tested Homeowners who plan to save money All welded and threaded connections No gaskets to leak or service by Built in de-aerator Eliminates air from system.No"gurgles" he converting from expensive electric Back cover removable Easy to inspect and clean heat to oilheat often find themselves Large open passages Easy to inspect and clean up against a brick wall: It's the high Standard burner and accessories Serviceable with normal stock parts cost of chimney construction. But with Small size Compact installations System 2000's unique combustion Limited lifetime warranty/Option to transfer.Energy recovery standard on all systems. chamber,combined with a 10 foot long flue passage,gases leave System Storage Tank 2000 clean,and relatively cool. So they 40 gallon capacity Plenty of storage for peak demands can be vented directly through-the- 80 and 120 gallon tank options Even more storage for extraordinary needs wall. No chimney needed!An excellent Heavily insulated tanks Very low heat loss No chimney needed!Ground level benefit for homeowners with electric Heat trap on outlet Stops heat drift venting stays relatively cool! heat, heat pumps or for new home Glass lined with anode rod protection High corrosion resistance construction. Power venting is the safest Bronze circulating pump Trouble free,long life method of side wall venting and is a low Layered heat stratification Hottest water to outlet,cooler water at bottom cost alternative to chimney construction. for most efficient energy recovery Adjustable aquastat For temperature control Stainless steel tank options Extended warranties SPECIFICATIONS: EK1 Domestic Input Gross output AFUE Hot Water* Hot Water Exchanger .68 GPH 83,000 BTU/HR 87.9% 170 Gal/Hr. External unit Not in boiler,not in tank...easy access .74 GPH 90,000 BTU/HR 87.7% 180 Gal/Hr. Stainless steel construction Durable,corrosion resistant .85 GPH 104,000 BTU/HR 87.5% 162 Gal/Hr. Wrinkle flow counterflow heat transfer High turbulence for rapid heat transfer 0 1.00 GPH 121,000 BTU/HR 86.2/0 170 to 395 GPH High output 228 Gal/Hr. Compact Low water content EK1 Energy Converter Total Weight: 270 lbs. Easily backwashed or chemically cleaned Maintains capacity even with marginal EK1 Dimensions: 24.5"x 26.5"x 17.5" water conditions EK1 Total System Weight 450 lbs. Union connections Easily serviced EK1 Storage Tank:Weight 115 lbs. Dimensions: 20"x 50" EK1 Domestic water GPH: 170 to 228 Zone Controls EK1 Hot Water Cost: $19 to$25/month typical Motorized valves Quiet,proven and reliable (less than 1/3 the cost of electric hot water) Zone circulators Optional Standard or clock thermostats Uses conventional controls SPECIFICATIONS: EK2 Domestic Digital Energy Manager with Energy Recovery Input Gross output AFUE Hot Water* Solid state printed circuit with surge protection Rugged and reliable 1.20 GPH 147,000 BTU/HR 87.6% 293 Gel/Hr. LED indicators For all functions;super service aid 5 zones standard Four heating zones,one hot water zone 1.40 GPH 170,500 BTU/HR 87.0% 334 Gal/Hr. Expand Up to 15 zones available 1.60 GPH 190,500 BTU/HR 85.5% 368 Gal/Hr. A complete Energy Manager Programmed response to heat and hot 1.75 GPH 2O6,000 BTU/HR 84.0% 395 Gal/Hr. water demand Quick connector terminals Easy installation or service EK2 Energy Converter Total Weight: 350 lbs. Printed circuit service board An easy way to check out system function EK2 Dimensions: 24.5"x 27.5"x 24.75" Limited lifetime warranty Minimal rebuild charge after 5 years EK2 Total System Weight 550 lbs. EK2 Storage Tank:Weight 115 lbs. Dimensions: 20"x 50" Options EK2 Domestic water GPH: 293 to 395 EK2 Hot Water Cost: $19 to$25/month typical Outside combustion air Isolated from home;whisper quiet operation (less than 1/3 the cost of electric hot water) Pre-packaged units Installation time reduced Outside Freedom Model Location optional •Domestic hot water rating based on firs[hour draw with 77°F rise and 40 gallon tank. Mineral resistant hot water tanks Performs in severe water conditions As an ENERGY STAR`Partner,Energy Kinetics has determined that this product meets ENERGY sTAR guidelines for energy efficiency. 19 The color yellow for heating boilers is a registered trademark of Energy Kinetics. YOUR SYSTEM 2000 DEALER: 51 Molasses Hit ENERGY Lebanon NJ 088R3ad KINETICS® l 8 Fax: 800 735 2068 visit www.system2000.com ENERGY • (&iKINETICS Tanks Glass Lined Product Data 80 gallon 120 gallon standard standard Glass Lined Tanks t All System 2000 tanks are heavily insulated. Glass lined tanks have a specially engineered design and dip tube to maximize the quality of hot water and most effectively use Hybrid Energy Recovery.® \ 40 gallon -� low-boy 40 gallon standard Energy Kinetics hereby assigns to the end user the 10 year limited warranty of the original manufacturer of glass lined tanks. Standard System 2000 Glass Lined Stora a Tank Tank Size Diameter Height All Piping Model 40 Gallon Standard 20" 48'/z" 3/4" 100263144 40 Gallon Low-boy 22" 32" 3/4" 100263834 80 Gallon 24" 59'/z" 3/4" 100263835 120 Gallon 28" 62Y2" 3/4" 100263836 'All tanks have 2"foam insulation although 40 gal low-boy tanks may have 1" foam to suit tighter spaces. sissp�.�an Aft ftm NIWW N"WS PIoftU This warranty does not cover any labor for removal or reinstallation of ---� ----- --- the alleged defective part, transportation to Energy Kinetics if `- necessary and other materials necessary to perform the exchange. -� Register your tank at: -- "- htto://www.americanwaterheater.com/service-suoporUproduct-registration Energy Kinetics Inc. • 51 Molasses Hill Rd. • Lebanon, NJ 08833 • (800) 323-2066• www.energykinetics.com r� .� ,y °♦°♦' � : , `♦+♦° ��.,. ,�'♦°♦♦� ,� ;�' ♦♦ yr •♦ • ♦ �r ♦♦ .�,. ,. a ft a<.•.._Sr ��e ,�' ..N e°i. c.el +e:. a.41 V.,.. N 1 �. . 1 IV . N/dV'. �� hiss) o Cd CL N I DIM 00 U U c i r V .o.N. Co _ •�i. 6! O Q U s." I (oj a`i LLI r i s ^L+' v w F— cyv' -;i U W V) >1 � 0 O 04 tiectioq V W r„ 4 1 An � Q L N o awue at1 4-. •bi O LL Z O �.. 00 X �° Z I : cd w w ` o K v CD } IN y cn .a o z O i SS��YY .�= p :n N N V I ter•. .E.i; Al <(�c•H> F 3 s 11 11 '.i'.° F ei I pis c `s �e le;a4 i. '. 1 «}. +. . . .1 ..;' VI Ni ' r Ve 14 Ve +4 'II �' :VI'e a l'1 e1/°+°e �� B e1+°+°I a°+++°I eQe+♦e� a °°++1 ;... gee°I++°14 :`� ` 60• �•',t�� ��' �xlE'a'pa♦i' sriu �r rJ +7� kn ' Q ^ ' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/10/2024 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 NAME:CONTACT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE I FAX HOME OFFICE: P.O. BOX 328 (A/C.No,Ext):888-333-4949 fA/c,No):507-446-4664 OWATONNA, MN 55060 ADDRIESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURERA:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 330-130-6 INSURER B: WESTMORE FUEL COMPANY INCORPORATED INSURER C: 86 N WATER ST GREENWICH,CT 06830-5886 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES $100,000 MED EXP(Any one person) $5,000 A N N 9062815 06/01/2024 06/01/2025 PERSONAL s ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY �ECT ❑LOC PRODUCTS&COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY ISCHEDULED N N 9062815 06/01/2024 06/01/2025 BODILY INJURY(Per Accident) HIRED AUTOS ONLY NON-pLAMED PPERTY DAMAGE AUTOS RO ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $7,000,000 A EXCESS LIAB CLAIMS-MADE N N 9062816 06/01/2024 06/01/2025 AGGREGATE $7,000,000 DED RETENTION WORKERS COMPENSATION X I PER STATUTE OTHER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERI EXECUTIVE E.L EACH ACCIDENT $500,000 A OFFICERIMEMBEREXCLUDED? L N/A N 9917566 06/01/2024 06/01/2025 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 330-130-6 35 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED VILLAGE OF RYE BROOK 938 KING ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD vYOR Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured 203-531-6800 Westmore Fuel Company Incorporated 330-130-6 86 N Water St 1 c. NYS Unemployment Insurance Employer Registration Number of Greenwich,CT 06830-5886 Insured Work Location of Insured (Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State, i.e.,a Wrap-Up Policy) Number 06-0739367 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company Village Of Rye Brook #35 938 King St 3b.Policy Number of Entity Listed in Box"1 a" 9917566 Rye Brook NY 10573-1226 3c. Policy effective period 06/01/2024 to 06/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) �X 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 1 a"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: Erin K Christensen (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �2 K(,` 05/10/2024 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 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