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• 1932 BUILDING DEPARTMENT
❑ UILDING 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.orsr
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
0 s�v ) 1 I t2[�Lo')-3
ADDRESS :_
�CS 1iCS� -21 Y�ATE:
Za7L
PERMIT# \ tUED: SECT: BLOCK: LOT:
LOCATION: C� � �y �J LJ�U OCCUPANCY: t
❑ 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 w V 1 N<'0P61
❑ NATURAL GAS
❑ L.P.GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
NAL
OTHER
BUILCDE RTMENT
VILL OOKInitial Inspection Date: ❑ Pass
iwCHAEL J.IzzO 93H KING STOO , Ew YORK 105731 Fail
BUILDING&FIRE INSPECTOR (914)9 939-5801 Re-Inspection Date: ❑ Pass
mizzonrvebrook.ore 1+ �` rZ o
11 1 ❑ Fail
FIRE INSPECTION REPORT, NOTICE OF VIOLATION & ORDER TO REMEDY SAME
Site Address: ✓� Zone:(ZAS SBL:
1
Occupancy: ,C ?" Q u ' State Use Classification:
Business Owner: 6 11,r Or _ TJC) AQ(h(? Phone: �^
Building Owner: ( Phone:
Emergency Contact: C Q Phone: ( � pi O 0
Building Representative in Attendance: '5;,��,��"�
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Take notice that the following violations of the N York Stag Unif rm Fire Prevention&Building Code and/or the Code of the
Village of a Brook were found to exist at, L rC ,in the Village of Rye Brook,
NY on, 17 20 The person or entity served with this Order to Remedy must completely cure
each violation described id this Order to Remedy by ,which is thirty(30)days after the date of this Order
to Remedy.You are further directed to 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®ulations.
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 plemises as required by code. a._ AZ _
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. _
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: DATE:
2.1` l
-1-
Revised 6/11/2020
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. _ 4.- _
e. 1010.1.Are egress doors provided and maintained as required by this section. e. _ -11�_
f. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f. _ -44'
g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g. _ __Zz
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. i. _
j. 1013.3.Are all exit signs illuminated at all times. j.
k.1008.1. Are the means of egress&exit discharge illuminated at all times the building is occupied. k. _ _LZ
1. 1018.3. Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures 1. _ -ice
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 m.
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.$.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 1 _
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. _tZ
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.V-1 _
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._
i
t2
INSPECTOR: DATE: a
-2-
Revised 6/11/2020
' No YEs N/A
8.ELEVATORS.DUMBWAITERS&ESCALATORS �`V\&
a. [PM]603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a. U _
b. 606.3.Are approved standardized, pictorial signs posted adjacent to each elevator call station on all b. tl t•'a u�L
floors reading; IN FIRE EMERGENCY,DO NOT USE ELEVATOR,USE ESIT 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&after system C.
activation,and is the certificate of inspection forwarded to the code enforcement official.
d.904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d.
10.HEATING SYSTEMS
a. [PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a. i
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 sighilof 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)
c. 407.2.Are S.D.S. Sheets for all haz-mats readily available on the premises. a.
d. 407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b.
e. 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. _ 4�
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.
e.506.1.Are approved key boxes(Imox 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
PING
a.Good
b. Fair
c. Inadequate
d. Poor
INSPECTOR: DATE:
-3-
Revised 6/11/2020
ITEM NUMBER REMARKS
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Remit to: P.O.Box 502 Correspondence to: P.O.Box 4165 0000058442
Harrison NY 10628 Greemnlch CT 08831
(914) 937-6100 ■ (203) 531-1333 0 (914) 937-9723-FAX
www.intmbftflrearKlsftV.net
flrearKlsttV.net
NYC
NJP01090-e17s4aiz me-219 FIRE EXTINGUISHERS/FIRE SUPPRESSION SYSTEMS I RESTAURANT HOOD INSTALLATIONS HASSAU-AEtA1280
NJ
CT-F30002 RESTAURANT VENTILATION CLEANING t FIRE SPRINKLER SYSTEMS NASSAU-PEL01573
CT-SMS-5598 SALES&SERVICE NASSAU-HDL00857
tM-CR*=
Gladhaven Club Gladhaven Club
Attn:Accounts Payable 10 Bishop Drive
10 Bishop Drive Rye Brook NY 10573
Rye Brook NY 10573
P.O-
DUE ON RECEIPT Dwayne Richards 3112/2020 3/12=20
DcSCripl oilPrice Each
1.00 Fire Extinguisher Service per the applicable sections of the 290.80000 290.80
N.F.P.A. 10 Fire Code.
12.00 Fire Extinguisher Tamper Seals per N.F.P.A. 10 Section 0.22000 2.64
7.3.2.2.
1.00 Hazmat 7.00000 7.00
Please note your calendar to call for next interval service prior
to March 5, 2021
Cwms d rrtudisledo y nodkam.,M,op mug be made wihin 48 hors of serviw. Imroioee ere arged to an der..e rate of the patter Of
15%per mark(19%per amass)or the mndmum rals Mowed by aw on ally unpaid invoices ow are not paid wahin 90 days. In the Tax $25.16
anent or ddault,lrfsrsIN Fire s sarety Equpma it Company.Inc(1FS)vW be arrtlied to racawr o"M d ooUGCiM kcbj nag nNsortable
adorney less,IFS is rot an auuer,au IiebiWy on dntropes.nep6pera or othnwiat are Gndted par the terms IWWd on the reveraa sift ofPayrrmniftMmdits $325.60
mm.this doae The aartarw Can reins to apes to ON tenrm by carIceNep their serwoe 48 hours prior to service. The ontomer is
resporwbb for Wouinp that the firs prwm*on pupmary and Ritdten hood syslam nrvice cydas are kdowerl Your slpahre vx in
VW you hm reed.utdandmod and agreed In ero temn an bah.idea of wt don anent Total $0.00
Thank you for your business! Your cm pay your bill via cmdit card online,
bymNarbyphose
SYSTEM SERVICE CYCLE REFERENCE PER N.F.PA STANDARDS
(NOTE: Customer Is responsible for ensuring services are completed as required. For more Irlfomiation,please contact the N.F.P.A.at(617)770-M)
-Hood systems serving sad fuel operations-Inspected every month -Hood systems serving moderate operation-Inspected trerrd-artmmmy
-Hood systems serving high votwne(wok,char broiler)-Inspected quarterly -Hood systems serving tow-volume operations-Inspected annually
-Kitchen fire suppression systems-Inspected and serviced semi-annually -Fire Extinguishers-Inspected and serviced annually
narrraprt nr W"D W9e1111rtYlCh CT ON31
(914) 937-6100 0 (203) 531-1333 0 (914) 937-9723-FAX
www.intenstatefi ma ndafty.net
NJ
tiYC era FIRE EXTINGUISHERS f FIRE SUPPRESSION SYSTEMS f RESTAURANT HOOD INSTALLATIONS NASSAU-Amoimo
ru-Portr90
CT-F30002 RESTAURANT VENTILATION CLEANING FIRE SPRINKLER SYSTEMS NASW-PRMIS73
CT•SM515598 SALES dr SERVICE NASSAU-HOUM7
Mh-CRAIM
Gladhaven Club Gladhaven Club
Attn:Accounts Payable 10 Bishop Drive
10 Bishop Drive Rye Brook NY 10573
Rye Brook NY 10573
Serv:ce Tecn Service Tech Invoice Date Date of Service
DUE ON RECEIPT Tyquan Franks 4/212021 3/29/2021
3.00 10-LB ABC Fire Extinguisher wMall Bracket 190.50000 571.50
1.00 5-LB ABC Fire Extinguisher 119.70000 119.70
1.00 35% Discount -241.92000 -241.92
3.00 Fire Extinguisher Installation 12.95000 38.85
1.00 Fire Extinguisher Service per the applicable sections of the 184.90000 184.90
N.F.P_A. 10 Fire Code.
10.00 Fire Extinguisher Tamper Seals per N.F.P.A 10 Section 0.22000 2.20
7.3.2.2.
1.00 Hazmat 7.00000 7.00
Please note your calendar to call for next interval service prior
to March 22,2022
r
Ch"'MO(urw9wildINY east be ands wit is 48 hour of sows kwomas two subiad w an rri s rate of to heater of
1.5%per rmtih 08%per araaon)crow s a orso rote slowed by Iowan any upeid invo ces art aro not paid wOwn 30 c" in the Tax $57.14
1 event of detsub,Yderetla Fn i Safoty FAupaso Carpary Ins.;IFS)slot bs entitled to rooanr cost of oc0edi, iM,6np reasonable
iI attorney fees.IFS w not an Wairar,ar tidily on d orrog a.neptlpsnt or aus rwisa are ,Wiled par"talnia;:eted an mo rover"side of Payments/Credits $739.37
fts donerwa The 0"ina er can raMe to apros to au terms by coats p tlear service sa hours prior to esvim Tile aalonw is
respar>sibt for d Iatrhen hood sy,tm ssvios cydas are fd Yaw SONIAra ind coss
f wra wl you t road.ufd.rdeod and spread to the to an both sides of Uss dmmnt Total $0.00
Thank you for your businessl Your can pay your bN!via creO card onihm
by map or byphWe
NUN
SYSTEM SERVICE CYCLE REFERENCE PER N.F.P.A.STANDARDS
(NOTE: Customer is responsible for ensuring services are completed as required. For more informatim,please contact the N.F.P.A-at(617)770-3000)
� Hood systems serving solid fuel operations-inspected every month -Hood systems serving moderate operation-Inspected semi-annually
-Hood systems serving high volume(wok,char broiler)-inspected quarterly -Hood systems serving low-volume operations-Inspected annually
i-Kitchen fire suppression systems-Inspected and serviced semi-annualty -Fire Extinguishers-Inspected and serviced annually
Member N.F.P A.,Member i.K.E.C.A.,Member N.F.S.A.,Member NA.F.E.D.
0 INTERSTATE FIRE & SAFETY EQUIPMENT COMPANY, INC. INVOICE
Remit to: P.O.Box$02 Correspondence to: P.O.Box 4165 0000052201
Harrison NY 10628 Greenwich CT 06831
(914) 937-6100 0 (203) 531-1333 ■ (914) 937-9723-FAX
www.interstatefireandsfty.net
NYC-9109D NYC-21s
ru-Poroeo FIRE EXTINGUISHERS/FIRE SUPPRESSION SYSTEMS i RESTAURANT HOOD INSTALLATIONS NASSOW-AEL012W
CT-Fs000z RESTAURANT VENTILATION CLEANING/FIRE SPRINKLER SYSTEMS KASSAu-PEL0t573
cr-sMsssse SALES 8 SERVICE NASSAU-HDLOO817
MA-CR48YZ
Gladhaven Club Gladhaven Club
Attn:Accounts Payable 10 Bishop Drive
10 Bishop Drive Rye Brook NY 10573 f
Rye Brook NY 10573
Service Tc-c'i Serv;ce Tech llivo;cc 0.;t' Date of Service
DUE ON RECEIPT James Williams 3/8/2019 3/8/2019
cescr:p!ion Price Each ArnoLint
1.00 Class"IC'Fire Extinguisher 383.25000 383.25
2.00 10-LB ABC Fire Extinguisher wM/ali Bracket 190.50000 381.00
1.00 35% Discount -267.49000 -267.49
3.00 Fire Extinguisher Removal Fee 3.50000 10.50
1.00 Fire Extinguisher Service per the applicable sections of the 251.50000 251.50
N.F.P.A. 10 Fire Code.
7.00 Fire Extinguisher Tamper Seals per N.F.P.A. 10 Section 0.22000 1.54
7.3.2.2.
1.00 Hazmat 7.00000 7.00
Please note your calendar to call for next interval service prior
to March 1, 2020
Clam of unsatbfatby woftwo*dp must be reads w1w 48 hours of service invokes rs subjsd lo an im rm raw at Rte weew of
1.5%per mroth(18%per arnim)or the maximum raft eiwwed by law on any urp@W oivowas that an not paid within 30 days. to ow Tax
aura d default.4asralUe Fea E Safety EgwpmeM Company,Inc(IFS)shag be a rmW to noovar coMa of eoascum irtdudng ressonsb{a
w omsy is".IFS is not an imm.our babdAy an damages,negbWa or ouwxwtse we I.t I per me arms bled a,dts revsrss Mde of PaymertttlCredits $823.89
this doamtant. The anoxner can refuse to agree to all terms by cancelling Thew serwoe 48 hours prior a service. The aurornsr Fs
responsibts for anew"00 R»fire prevention*qu,Vn -4 and ldtdten hood system wvice cycles an fotbvred. Your sepnaturs Tote! $0.00
that ya,hamrind,tatdratgo an I d agreed to ate arms on both sides of Ras doaenert
Thank you for your businessl Your can pay your bill via credit card online,
byMoorby phorw
SYSTEM SERVICE CYCLE REFERENCE PER N.F.P.A.STANDARDS
(NOTE: Customer is responsible for ensuring services are completed as requhed. For more information,please contact the N.F.PA.at(617)770-3000)
-Hood systems serving solid fuel operations-inspected every month -hood systems serving modwale operation-Inspected -tlwMwally
-Hood systems serving high volume(wok,char broiler)-Inspected quarterly -Hood systems serving otwrohurre operations-buptecAed ammwAy
-Kitchen fire suppression systems-Inspected and serviced semi-annually -FNe Extinguishers-Inspected and serviced annually
Remit to: P.O.Box 502 Correspondence to: P.O.Box 4165
Harrison NY 10528 Greenwich CT 06831
(914) 937-6100 9 (203) 531-1333 • (914) 937-9723-FAX
http://www.interstatefireandsfty.net
NASSAU-AEL01260
NYC-81754822 FIRE EXTINGUISHERS/FIRE SUPPRESSION SYSTEMS/RESTAURANT NASSAU-969977428
NYC-218 HOOD INSTALLATIONS/RESTAURANT VENTILATION CLEANING NASSAU-72200004780
NJ-P01090 SUFFOLK-122
CT-F30002 SALES&SERVICE HUNTINGTON-F015927
CT-SMS-5598 _ MA-CR4622
CUSTOMER NAME: TECH ID: DATE:
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PHYSICAL ADDRf PHYSICAL CITY,STATE,ZIP: �r•�� PHONE:
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D!R \,-.) L�� I
BILLING ADDRESS: BIL ITY,STAI ,
KITCHEN SERVICE INFORMATION
CHECK IN: CHECK OUT:
1 Fans working ro erl ? []YES []NO ❑N/A 1 Fans working ro erl ? ❑YES ❑NO ❑N/f;'
2 Defects in fan wiring? ❑YES ❑NO [:]NIA" 2 Hood wiped down? ❑YES ❑NO ❑NfA
3 Hood lights working? ❑YES ❑NO ❑WA 3 Kitchen floor mopped? ❑YES [-]NO ❑N/A
4 Hood globes resent? ❑YES ❑NO ❑N/A 4 Outside area clean? ❑YES ❑NO ❑N/A
5 Hood globes undamaged? DYES ❑NO;-❑N/A 5 Hood lights working? ❑YES ❑NG E]N/A
6 All filters in hood? ❑YES ❑NO ❑N/A 6 All filters in hood? []YES ❑NO ❑N/A
7 Filters conform to code? DYES ❑NO ❑N/A 7 Do inaccessible areas exist? ❑YES ❑NO ❑N/A
8 Grease build-up on fan ,' 8 Frequency of cleaning ok? DYES :❑NO ❑N/A
9 Grease build-up around fan 9 Pilots lit? ❑YE9 [:]NO ❑N/A
10 Grease build-up in ducts 10 Photos taken? ❑YES LINO ❑N/A
11 Grease build-up in hood 11 Fires stem within service interval? ❑YES ❑NO ❑N/A
12 Grease build-up on filters 12 Fire extinguishers within service interval? ❑YES LINO ❑N/A
COMMENTS:
•..'l `-d•.
.-•t'.y ✓ice.Ji..l1t:�7 '. •y�.� '.vf:?s..' ►iJ iiyt•...... ...... .,.•WiRY•l,. �:l/. �:.................
1F�k# SYSTEM SERVICE CYCLE REFERENCE PER N.F.P.-A. STANDARDS
NOTE:CUSTOMER IS RESPONSIBLE FOR ENSURING SERICES ARE COMPLETED AS REQUIRED.FOR MORE INFORMATION,PLEASE CONTACT THE N.F.P.A.AT 617 770-3000
Hoods stems serving solid fuel operations-Inspected every month Hoods stems serving moderate operations-inspected semi-annual)
Hood systems serving high volume wok,char broiler -Inspected quartedy Hoods stems serving low-volume operations church,etc. -Inspected annually
Kitchen fire suppression systems-Inspected&serviced semi-annual{ Fire Extinguishers-Inspected&serviced annual)
QTY :DESCRIPTION PRICE EXTENDED
4
2 Ct 1
3 �
4
5
6
7
8
9 SALES TAX - RATE: % (TAX EXEMPT #: )
TOTAL DUE
CLAIMS OF UNSATISFACTORY WORKMANSHIP MUST BE MADE WITHIN 48 HOURS OF SERVICE.INVOICES ARE SUBJECT TO AN INTEREST RATE OF THE GREATER OF 1.5%PER MONTH
(18%PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY UNPAID INVOICES THAT ARE NOT PAID WITHIN 15 DAYS.IN THE EVENT OF DEFAULT,INTERSTATE FIRE&SAFETY
EQUIPMENT CO.INC.SHALL BE ENTITILED TO RECOVER COSTS OF COLLECTION,INCLUDING REASONABLE ATTORNEY FEES.INTERSTATE FIRE&SAFETY EQUIPMENT CO.INC-IS NOT
AN INSURER,OUR LIABILITY ON DAMAGES,NEGLIGENT OR OTHERWISE ARE LIMITED PER THE TERMS LISTED ON THE REVERSE SIDE OF THIS DOCUMENT-THE CUSTOMER CAN
REFUSE TO AGREE TO ALL TERMS BY CANCELLING THEIR SERVICE 48 HOURS PRIOR TO SERVICE.THE CUSTOMER IS RESPONSIBLE FOR ENSURING THAT FIRE PREVENTION
EQUIPMENT AND KITCHEN HOOD SYSTEM SERVICE CYCLES ARE FOLLOWED.
CUSTOMER PRINTED NAME: TITLE: DATE:
CUSTOMER�IGW1jU E ( ®®
tt�1�� !. i fjl i I �jJ �
Vol
YOUR SIGNATURE ABOVE INDICATES THAT YOU HAVE READ,UNDERSTOOD AND AGREED TO THE TERMS ON BOTH SIDES OF THIS DOCUMENT.
WHITE-OFFICE COPY YELLOW-CUSTOMER COPY PINK-ACCOUNTING COPY
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR
Jason A.Klein (914) 939-0668 Christopher J.Bradbur,
«-w,A,.ryebrook.org
TRUSTEES BUILDING&FIRE INSPECTOR
Susan R.Epstein Michael J. Izzo
Stephanie J.Fischer
David M.Heiser
Salvatore W.Morlino
July 29,2022
Via 1st Class Certified Mail
Gladhaven Club
c/o Ms.Susan Roche
10 Bishop Drive South
Rye Brook,New York 10573
Re: Gladhaven Club, 10 Bishop Drive South,Rye Brook,New York 10573
Dear Ms. Susan Roche,
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.B,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,
August 29,2022,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.
Michael J. Izzo
Building&Fire Inspector
mizzoO.Webrook.org
cc: Steven E. Fews,Assistant Building&Fire Inspector
/to
`4Z t o t
( v4 Vvy
19
M O
W" CLwdve*jaW
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 Michael J. Izzo
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
July 29,2022
Gladhaven Club
c/o Ms. Susan Roche
10 Bishop Drive South
Rye Brook,New York 10573
Re: Gladhaven Club, 10 Bishop Drive South,Rye Brook,New York 10573
Dear Ms. Susan Roche,
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,
August 29,2022,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.
Michael J. Izzo
Building&Fire Inspector
mizzong.ryebr� ook.org
cc: Steven E. Fews,Assistant Building& Fire Inspector
/to
, -
BUILD 16 TMENT
VILI,d OF RYE . QOK
`' � AUG 2 2022
938 KING ST4ET RYE BR60k NY 10573
_4 AOf 8; I VII_LADF- ill= RYE BROOK
w� _ a4ktir« �.BU►LDii,aG DERAR TME^JT._
FIRE INSPECTION / OPERATING PERMIT APPLICATION A
FOR OFFICE USE ONLY: /� 9" .30�1eq
Fee Paid: S�,� ''/" Inspection Date&Time: G1/. q bee, 8�re�Or�
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 conducted at 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. p
1. Address: f J SBL: 30 / —�"'� / Zone:
2. Business/Occupancy Name: e��( NYS Use Class:
3. Property Owner: 3V5 dress: "ICam(
Phone# I E Cell # c'�j to ' (�i j7 email: Maw )_
5. Business Owner: _ NN� a(�� Wyedress: (G
Phone# 1'44 Cell# A-A email: /1 G
6. Emergency Contact: VJC Rd[��/(P, Address: s s0 r�3/av
Phone# Jig- Vj-, _Cell # jig, alb- J�jj email: IAI
7. Inspection Escort: j(��4A.) A,d (_ e- Title:
(J4' P-w—
Phone#: 464 Cell #: SA 4 email: W
8. Provide a brief description outlining the current and/or intended use of the property:
c J
9. List all Hazardous Materials: 65�A�1�_ 1161 b 'n(k dal Acre
10. Occupant Load: Existing: ` 0 Proposed: I Other:
11. Date& Disposition of Previous Fire Inspection: tAA 2419 Pass ❑ Fail
i
- LF Pose 13l e vJ - 01 ne Ve J� ►✓l i N5 eG� r�v�
btCAV.Se 6� *P 1 I
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 CT )
COUNTY OF AZESWHESM as:
Fa;(L^e' e C
1' N RP ,being duly sworn, deposes and states that he66 is the applicant above named,
(print name of individual 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
,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 ee*owledge 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.
1 LI
Sworn to before me this Sworn to before me this
day of v C_ ,20 day of y w r , 20-iL_
do
Notta C{w+� ��o ti v� c c t � Nn kcCo n44,54c --c t -e
Jam'—"/�"','___
Signature of Property Owner Signature of Applicant
Av ov-, Se c,h G /}�jr/ I'Qce-q e�
Print Name of Property Owner Print Name of Applicant
2
9/12/2021
I