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HomeMy WebLinkAboutMP22-147 BRCS,�A u GG 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 Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE October 3,2024 760-800 Owner LLC PO Box 349 White Plains,New York 10605 Re: 760 Westchester Avenue,Rye Brook,New York 10573 Parcel ID#: 135.82-1-2.1 This document certifies that the work done under Mechanical Permit #22-147 issued on 10/3/2022 for the installation of two new condensers and two new air handlers have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRC�v� . 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 : :7 Te! ',F'] f IC /I V DATE: 10 - Z - C O Z 7 PERMIT# i Y lP ��Z j q 7 ISSUED;/y-3 - Z 4SECT: /J,S YL BLOCK: / LOT: Z-1 LOCATION: t / J-2 -_-rT 9 1 �I OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... jQ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ,/C / ❑ NATURAL GAS Y / �✓r r GI�� c�L ti p L.P. GAS C/ .: T �Uy�'� a•-� ❑ FUEL TANK _ ❑ FIRE SPRINKLER / L�U L ❑ FINAL PLUMBING ❑ CROSS CONNECTION 0 FINAL D OTHER /-I.✓. A.C- s s x e � N M � � � ■ x cn tow Lin U �_ © _ 00 c 5b AW0 a44 CO a Q W ob PH, .�v; 1 R. a a LL , iL44 �+zp 0o0iU 0 w (� W H cn y � Z W � OO pp � � � � QY ■ +� w W V U �J W V 0CD Caw " • Q � 4600 � O ■ e 00CA . 16, ■ 'ACT U �" Q �" .°� C x E � J � v0o ° ° tea F W W V n UZo voyv W Vj W " ° W 8 � . H zo V Q O V °` o a, va a sL O C7 fl A A O � •N �� zo -90q 4� '� o �' ■ U Q U 4 Itl 4;41414N04-044499944444444;4441414144441414;414141-644141941419049 BUILD ' MENT V1 oaK / . ,= SEP 2 3 2022 LL >t1 ;:RY 938 KING ET R Qi�YI 1�illt, 1 NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT to rg APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING ��E UIPME-NT FOIL OFFICE USE 06ft _ 4 2022 PERMIT !i: ��' / -7 / Approval Date: Permit Fee:$ '�50.OD -�/' '��j O S 0` Approval Signature: Other.- Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE' l. 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 forth(Form k CI05.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RI:SIDL'.N IAL ==S 100.00-unit -COMMERCIAL _$350.00/unit. 5_ Inspection by the Building Department for removal and/or installation.(48 hour notice required 6. Electrical work requires a separate Electrical Permit&Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, 9 23 2o2.Z is 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 appticant 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. L I. Address:_ -740 1r�S etilttS�e� r1Ut SBL: / 3�t o�r'-tD•Lone: 0,6-c) 2. Property Owner: RPw Grnlo Address: Av. Phone#: 191 4-21S 000 Cell#: email: 3. Contractor: �C c��,-I�n 3,r[. _ Address: 6 F'{p A Sf., ({� CT 064aaS Phone#: 10*3 -168-61M —Cell 4: 203-3qJ- y58q email: c�I unwykrS#G�a� �r}�n4,wc.cuw, 4. Applicant: -( iws�,u�si _ Address: -79(hair54., Krw%roc fC"T Q061 Phone#:_ Z03-263 4279 Cell#: 203 -343-953q email: � ,ass+ eA•a r b�,G,w,c.cc+t, 5. Scope of Work:New Installation(J)•Replacement( )•Removal( )•Other( ): 6. List Equipment: TA kvd( -lwa c0114L,%-.,-s CoD( J(A. (s-t--loor T-TKam ti � I�1le of erlwil�c.00l-A,2.4-floor ITRosM. Lantyti4' i,•_ a. I,.AW v,(inAl, w'iltir j ��O' eSS r♦�1-4r �� i+n- r3 �2.rPn.i�. _. _..._.T 7. Location of Equipment: 1�� �r�opr r for. Z.,� loot 1T RooM �ocF r~ow>co( Csev. -s 8. Method of Installation/Removal(list all equipment needed to perform job): C rMAL w5 1 +o kUi 5+ c avt�cvvsp r5 FG Sm . t 8/1212021 14 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: vL q,;.—C .t.i t— ,being duly sworn,deposes and states that he/she is the applicant above named, (print name or indiv d ai 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 Cpu we for the legal owner and is duly authorized to make and file this application. (indicate 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 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^.4 Sworn to before me this 22"`A day of S• _ .b� ,20 Z2 day of S-!t t 6v ,20 2Z Signature o Property Owner Sign re of Applicant Pnnlame of Property Owner Print Name of A&icant Cory ry Public Notary Public JANET A HERTEN NOTARY pUgLIC-STATE OF NEW YORK No.01 HE6085824 Qualified in New York County 23 1'tl Gtpp*Mik)fi r3S4a'§ M p-rope Iy completed in its entirety and must include the notarized signatures)of. the legal u«mer(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 he deemed null and void and will be returned to the applicant. 2 an 212021 EDGERTON, INC. , THE COMPANY OF PROFESSIONALS - EST. 1956 Municipality \ --&Ae c' '(Zye \7ccx,k Job Name: CAL P v\ Start Date q!'28'Zz Job Description 1'1-10 Co A iszn ovs At%e ccy,-V avj +wo iy&or uwif-s A-LA ce,I �t, I S,f o✓ICI 2ya r lair 2�� r oarv�S. T 54wLi av\Q r k V� C.IJCA-5 C4ro.�n i \o) re ue.,j },ni�ar� C_ > e7t (per Public Act 91-95) This Letter authorizes hr'v,L.` To sign the PERMIT as an agent for t >te above mentioned 1011 and Municipality Applicable Licensee 7 r- Z S-I 0302765 P-1 E-1 PO Box 304 • 786 Main St. • Monroe, CT 06468 • Phone: (203) 268-6279 • Fax: (203) 268-99/0 • www.edgertonhvac.coni DATE(MM/DD/YYYY) ,aco CERTIFICATE OF LIABILITY INSURANCE '20� 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 endorsements. PRODUCER NAME:CT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE HOME OFFICE: P.O. BOX 328 A/C .. EXt:888-333-4949 FA/C No:507 446�664 E-MAIL OWATONNA, MN 55060 ADDREss:CLIENTCONTACTCENTER(cbFEDINS.COM INSURERIS)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 358-951-2 INSURER B: EDGERTON INC INSURER C: PO BOX 304 INSURER D: MONROE,CT 06468-0304 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:540 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. 6-T SUBR POLICY EFF POLICY EXP LIMITS rA rAGGREGATE URANCE INSR WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY $1,000,000 EACH OCCURRENCEAL LIABILITY DAMAGE TO RENTED $1DQ,0QQ OCCUR PREMI ES a occurrenceMED EXP(Any one person) $5,000 N N 9385634 04/01/2022 04/01/2023 PERSONAL a ADV INJURY $1,000,000 - GENERAL AGGREGATE $2,000,000 APPLIES PER ❑PRO ❑LOC POLICY PRODUCTS-COMPIOP AGO $2+0�+000 X JECT OTHER' COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY Ea accid. " X ANY AUTO BODILY INJURY(Per person) SCHEDULED N N 9385634 04/01/2022 04/01/2023 BODILY INJURY(Per accident) A OWNED AUTOS ONLY AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS ONLY AUTOS ONLY Per acciden X O EACH OCCURRENCE $5,000,000 X UMBRELLA LIAB CCUR A EXCESS LIAB CLAIMS-MADE N N 9385636 04/01/2022 04/01/2023 AGGREGATE $5,000,000 DED RETENTION OTH- WORKERS COMPENSATION PER STATUTE I ER AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) It yes,describe under E.1- DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached i1 more space is required) CERTIFICATE HOLDER CANCELLATION 358-951-2 540 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF RYE BROOK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 KING ST ACCORDANCE WITH THE POLICY PROVISIONS. RYE BROOK, NY 10573-1226 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW : Workers' YORK ' STATt COMPellSa iOfl CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured 2032686279 ADP TotalSource MI XXX,Inc. 5800 Windward Parkway Alpharetta,GA 30005 1c.NYS Unemployment Insurance Employer UV: Registration Number of Insured Edgerton,Inc 69-22158 0 786MainStreet ld. Federal Employer Identification Number of Insured or Social Security Monroe,CT 06468 Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e., a Wrap-Up Policy) 060777087 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Insurance Co. 3b.Policy Number of Entity Listed in Box"l a" Village of Rye Brook We 053436446 NY 938 King Street All worksite employees working for Edgerton,Inc paid under Rye Brook,NY 10573 ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. 3c. Policy effective period 07/01/2022 to 07/0112023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. El This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la"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 bog"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: Michael Price aame,ofa onud repnsemative or licensed agent ofinsurance tamer) Approved by: � 23JUN 2022 (Signature) (Date) Title: CEO North America Telephone Number of authorized representative or licensed agent of insurance carrier: 804743-8130 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) Certificate Number: www.wcb.ny.gov