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HomeMy WebLinkAboutMP24-164 �cQy� 8,, � t` c l7 7. t9 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 David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 24,2025 Brett Goodman&Stephanie Goodman 11 Edgewood Drive Rye Brook,New York 10573 Re: 11 Edgewood Drive, Rye Brook,New York 10573 Parcel ID#: 135.28-1-21 This document certifies that the work done under Mechanical Permit#24-164 issued on 12/10/2024 for the installation of a new condenser,new coil and new gas fired furnace has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to 4 � /�. 198'2 BUILDING DEPARTMENT ❑BBUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEML+NT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914)939-5801 www.UebrooLorg - - - - - - - - -- - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - ADDRESS :- _ �J I/ �17 1 yE DA E: - Z3-GCJZ . PERMIT# YYIT Z y- I�_ISSUED: IL'Jp-SECT: 3S•L S BLOCK I LOT: 2I LOCATION: ok'%Z.ok OCCUPANCY: ❑ VIOLATION Narm) THE WORK IS... ACCEPTED ❑ REJECTED/REINSPhCTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �� ❑ NATURAL GAS LA4�&N Co 1 ❑ L.P. GAS - ❑ FUEL TANK me-" ) —a6A AO on_ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ,Q' FINAL 4ErOTHER�. , n. o m /�• �9a2 BUILDING DEPARTMENT �JILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OI FICER 938 ICING STREET• RYE BROOK.,NY 10573 (914) 939-0668 FAX (914)939-5801 www ryebr_ ooLorg - - - - - - - - - - - - - -- - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :A hJ OO � � +Z�V� -- - - ��- ---- DATE: PERMIT, 4 -' 'Z 1SSUED:_/0-lSISECT: I-W.28 BLOCK-1—LOT: Z l LOCATION: _ t�A�S�E Me iV-T— OCCUPANCY: ❑ VIOLATION NO'PT:h THE WORK IS... I" ACCEPTED ❑ R iIL'C'CED/REINSPNCTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ (INSULATION kf NATURAL GAS 9A S t e ❑ L.P. GAS ❑ FUEL TANK 41��"-� Vk,N`CA ❑ FIRE SPRINKLER FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER . 1 N p4 C1 `n ■ O p +�• N \ \ W ■ a + ■ � O � a a _ W c o cn w a' �, z a u M W N © c �`' o w w oo a 4 gv - Gov W M 11 eel � ~ v020 Ica N o a5 o•a W = oCA c If■1 � A M �, � � v v r;,'� i O ■ O � oo b ►� w x E A � m ' O wob o `1 W 00 ¢ w § � EAao � m G1 Q ci w w >_ C W 1� 00 0 o_) gel W Ei rz O cn z z o � a". o ° o � � a 44 pro C w W z y� C! O lz e--I s a BUILDING DE4 , MENT [ECENr VIL E OF RYkj( OOK 938 KING ET RYE BRq; � NY 10573 : DEC - 9 2024 `r ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: alL --/ 6 DEC 1 024 Approval Date: Permit Fee: $ &Cis© 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: I. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must 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, — 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 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: G J,-VCWjj De" rY IL A��� SBL: � i —�1 Zone: 2. Property^Owner: � Gda F�'�''r'' Address: Phone#: 7el.'L ���Z- O/ Cell email: /,zu/ 6-,J-*,4W P 6."Fa.. Ca 3. Contractor: Alt C-i r t { 440,✓r C-4 Address: Y6 o ,v M E4/.d 3-;-- Phone#: f 3 O/ Cell#: email:S-kA ' Q'me-i 4 C -m,�2rf✓ice-J.0 4. Scope of Work:New Installation( )•Replacements.•Removal( )•Other( }: 5. List Equipment: V1t IJ4<, 0. rl a w. 6. Location of Equipment: 7. Method of Installation/RemOVal(list all equipment needed to perform job): Q/V/-�` C 1 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are 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 Sworn to before me th's day of ,20 _ day o cce Signature of Property Owner atur6 of Applicant SHARI MELILLO �" k4 r Name of Property tM er Notary Public,State of New York P—rN Name of Applicant • No.01ME6160063 i � Qualified In Westchester County NoPublic Commission EXPIM kou. •y 29,2 otary Public This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 6/1/2024 n . N c N w F• vi � x C C s nr ryy W N H UzoW of ti ' M Z a = o w Z F e z 8 - Ln z00 a O C� = � Z O Q cn r � ' V ✓) M ^ � W U E � ` MM� � Z W U i u W ram,' , Z N u O a a o ° 0.0 o w z 649, z a w z A ° d U Q o A o W w a � w 1 2: s = a "ail 4;to 46446441414 46 o4;44444064�t.,Q*A*A#A*A to41444;4#fAQ,4;t#A4 " �E.aRC�v� .D BUIL I�E�AtNffVIL E OF RYEK j� DEC 9 9 2 024938 KIN ET RYE BY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 2 FOR OFFICE USE ONLY - / �7�c� / "/CO / EP#: <:)q 3 —7 Approval Date: Z �^ Permit Fee: $ Approval Signature: Other: ********************************************** *************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated,/a i 9- s hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in/conformance with all applicable Federal,State,County and Local Codes. p 1.Address:f I �d�.c,�y��fl �� /J�+►� yH SBL:13J`►dQ �—�� Zone: A 2.Property Owner: it ['Jbo A �✓ Address: Phone#: ?32- (19 2- <D/`�y Cell#: email: G 6A of ,.a G 4 0 C, co-, 3.Master Electrician/Licensed Installer:�'E.1� �ieoloa--�nh & Address: 7$S.K'Lj,�d 5r-)- Lic.#:I�-316 Phone#: 9 U/ y3 S' 3 22 Cell#: /Y-3 5;—321 email: Ncv- (00,AJ L, Cc vu Company Name: ddress: 4.Proposed Electrical Work/Fixture Count. h.✓a,-. Q. (- Q i,,4, ,, S-04 5.31d Party Electrical Inspection Agency: �w1 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: 644*"e— b �ti being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual si 'ngpt g as the appli�yt state that(s)he is the (��.V — M�� for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) 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 before me is tom` Sworn to b re me this day of �0 D�A _ day of .�- . 20 Sign e o roperty Owner ign n �� P t ame of Property nt e o Prif Applicant ,E LL ALEJANDRALARIZZAIJ �^ NO f tpte of New ork NOTARY PUBLIC,STATE OF NEW YORK y b No.01ME6160063 Registration No.OILA6383118 6/1/2024 Qualified In Westchester County-L� Qualified in Westchester County Commission Expires RDIL• y 29,20_ Commission Expires 03/27I2027 STATE WIDE INSPECTION SERVICES, INC. CA—) Service With liziliegrity 0:0 • • SWIS JOB APPLICATION0. SWISTRAINING.0010 Office Use Elect. Permit# Date iai�y �y Bldg Permit#' " C/_ /6 L/ Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation D CC IUVE N , DEC 19 M4 ED) VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# Date Signature Address City/State Zip Code Company (_L Phone# _ D FC ILE, lWE DState Wide Inspection Services I 1080 Main Street MAY 16 2025 Fishkill, NY 12524 � 845 202-7224 Phone TO WV VILLAGE OF RYE BROOK 914-219-1062 Fax STATE 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: Gene Branca Electrical Contractor Brett&Stephanie Goodman Gene Branca 11 Edgewood Drive 78 South Regent Street Rye Brook, NY 10573 Port Chester, NY 10573 Located at: 11 Edgewood Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-237 135.28 1 21 i Certificate Number: 2025-3191 Mechanical Permit Number: MP 24-164 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: 11 Edgewood Drive, Rye Brook, NY 10573 The Basement Utility Room & Exterior were 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 15Ih Day of May 2025. Name Quantity Rating Circuit Type Condenser 01 Furnace 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. ���il•�il�`Iil�il�i�l�i �"r�l�i�i ��`ii���il���ii�i�i " �i�ii��i �i ° �i �'il�il " �'il�'ii�il�il ''�I���i " " rr � ° N N ~ a -* a W a w O 0-4 ., ■ � � N Q 1 � • W z o ` 8 u MM M cn Q xJ3 z Z � x A w o z Z .D: O (� oo con 1 U W Q " z 3z cn W � z z M � Q Q w = a W 00 \.J N Cf o Z � e x H zg � 0 � W' w o o ; H V. E C [E �CV E BUILD _EPARTMENT VIL E OF RYE � 601( DEC - 9 20A —U) 938 KIN ET RYE B fit,NY 10573 VILLAGE OF RYE BROOK ' BUILDING DEPARTIIIEN] wwv v E606y.gov —Dull__ PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY PP#: —Ab Approval Date: DEC a Permit Fee: $ Q)0 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, �d� / / 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 plumbin/g�work will be in conformance with all applicable Federal,State,County and Local Codes.9 I.Address: J�A 4►�a,j� _�Q �Jt. }��1av,e /li y SBL:/ i d —j—c- Zone:/Ae- 2.Proposed Work: ra R'v'0!�-1- 3.Property Owner: 51 Gov JM *,y Address: �� F J N� .� Uu4c t✓� /� Phone#: 73L 6 g 2 O, Vy Cell#: email: �+- 4.Master Plumber: IPA IN 4►✓,6 G- ✓j 't,6,v Address: L/6 d N/hA Lic.#: /�61 Phone# — ',9u/ S3 Y'>0/ Cell#: email: foK- Company Name: A/L c-I c- Address: 76 o N AM�� f 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 1 st Floor 2nd Floor 31 Floor 41 Floor 51'Floor Exterior * �...� l'O�JQ„iy Ste, 5. List Other Equipment/Provide Details: �'J+�N/a�a 1010 (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual 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 Sworn to before me this day of -e 20 day of ,20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant 1 Notary PublicSHARI MELILLO o PublicIMAYMAUN Notary Public,State of New York PUW 8tmo of New** No.OIME6160063 Na OIWH6394580 Quaified In Westchester County Quaffed in Westchester C Ccrnrniss'or Expires 1:0u I y 29,20 Z I C0�11117�iilOfl�Yi�S, This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. 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- 6/1/2024 BUILDING ]`EPARTMENT VIWtot OF RYE-$ROOK ,.9ni,� DEC ' 9 2024 ° 938 KING STI*ET RYE BlR60K,NY 10573 L__..___ ('#.4) VILLAGE OF RYE BROOK wwW_xV nv.gov BUILDING DEPARTMENT -/ >r_ 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: 31, U✓ "I 6 Q 4 Jkn -A N , residing at, // ��•. ,/ 0,2 (Prim 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; qz- , Rye Brook,NY. (Joh Addres) 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. i (Signature of Property Owner(s)) (Print Name oi'Property Owner(s)) Sworn to before me this d of �C r� l^ , 202 1,' �n 1. L (Notary Public) t1ARI MELILLO State of New York <):d.1,r11E.6160063 4Jc5tchester county ;au' y29,202� -3- 6/1/2024 a� a le o�' r p � ems✓,C}-`k t�'`;t"�.`{n^�+iy�'ss.�.,b. '�'• ... � [', � r � r Awl Mff M ��q � � t w` a rN.'. ,�;� •• -� .� +�e► �� yid � .Q• � ��. ��� Submittal Upflow / Downflow / Horizontal Left/Right Single Stage Non-condensing Gas Fired Furnace 120,000 BTUH S8X1 D120M5PSCA/B �O ' o o Note:Models may have a"T"in the 12th digit designating they meet California less than 40 ng/J(NOx)emissions requirements. Note:Graphics in this document are for representation only.Actual model may differ in appearance. April2024 S8X1 D120M5-SUB-2F-EN Outline Drawing Table 1. 24.5"Width Cabinet N W 1' .i y = e C x �R W N - 000 0 0o u o000 �000 e000 oo�o� y R - ttp Arn T �. 2 S8X1 D120M5-SUB-2F-EN Product Specifications MODEL S8X1D12OMSPSCA/B MODEL SBXID120MSPSCA/B (a) (a) Upflow/Horizontal/ VENT PIPE DIAMETER-Min. Type Downflow (in.)'') 4 Round RATINGS(b) HEAT EXCHANGER-Type Aluminized Steel Input BTUH 120,000 Gauge(Fired) 20-19 Capacity BTUH(ICS)(c) 98,000 ORIFICES-Main Temp.Rise(Min.-Max.)IF 35-65 Nat.Gas Qty.-Drill Size 6-45 AFUE-Rating(c) 80 L.P.Gas Qty.-Drill Size 6-56 Return Air Temp.(Min.-Max.) IF 55OF-80OF GAS VALVE Redundant-Single Stage BLOWER DRIVE DIRECT PILOT SAFETY DEVICE-Type 120 V SiNi Igniter Diameter-Width(in.) 11 X 11 BURNERS-QTY 6 No.Used 1 POWER CONN.-V/Ph/HZ M 120/1/60 Speeds(No.)(a) CTM-9 Ampacity(Amps) 14.1/ 14.4 CFM vs.in,w.g. See Fan Performance Table Max.Overcurrent Protection 15 (Amps) Motor HP 1 PIPE CONN.SIZE(IN.) 1/2 R.P.M. 1050 DIMENSIONS H x W x D Volts/Ph/Hz 120/1/60 Uncrated(in.) 34 x 24.5 x 28.75 FLA 10.9 Crated(in.) 35.5 x 26.5 x 30.87 COMBUSTION FAN-Type PSC WEIGHT Drive-No.Speeds Direct-1 Shipping(Lbs.)/Net(Lbs.) 160/152 Motor RPM 3300/3025 (a) Central Furnace heating designs are certified to ANSI Z21.47-latest Volts/Ph/Hz 120/1/60 edition. (b) For U.S.applications,above input ratings(BTUH)are up to 2,000 FLA 0.33/0.57 feet,derate 4%per 1,000 feet for elevations above 2,000 feet above sea level. Inducer Orifice 2.15 () Based on U.S.government standard tests. (a) 9 Speed constant torque ECM Blower Motor. �) Refer to the Installer's Guide. FILTER-Furnished? No J) The above wiring specifications are in accordance with National Type Recommended High Velocity Electric Code,however,installations must comply with local codes. Hi Vel.(No.-Size-Thk.) 1-24 X 25-1 in. S8X1 D120M5-SUB-2F-EN 3 Airflow Table Furnace Airflow(CFM)Vs.External Static Pressure(in.W.C.) Model Tap Static 0.1 0.3 0.5 0.7 0.9 SUM 1469 912 355 1 Watts 184 126 68 SUM 1429 1165 900 636 371 2 Watts 17S 171 168 164 160 SUM 1567 1401 1235 1069 903 3 Watts 215 232 248 264 280 SUM 1858 1731 1605 1478 1351 4 Watts 334 361 388 415 441 SUM 2004 1890 1776 1662 1548 SSXID120MSPSC 5 Watts 418 447 476 505 534 SUM 2110 2004 1898 1792 1686 6 Watts 488 518 549 580 611 SUM 2245 2148 2052 1956 1860 7 Watts 596 629 662 695 729 SUM 2440 2345 2250 2155 2060 8 Watts 765 794 824 854 884 SUM 2536 2431 2325 2220 2114 9 Watts 882 904 927 949 972 4 S8X1 D120M5-SUB-2F-EN CFM Versus Temperature Rise SSXI Furnaces have one stage heating Table 2. S8X1 CFM Versus Temperature Rise Model 400 500 60D 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1 1800 1900 2000 2100 2200 2300 2400 S8X1D120M5PSC 59 1 56 1 52 1 49 47 44 1 42 40 39 37 S8X1 D120M5-SUB-2F-EN 5 General Features NATURAL GAS MODELS valve,flame control and includes self diagnostics for Central Heating furnace designs are certified by Intertek ease of service. for both natural and L.P.gas. Limit setting and rating ENERGY EFFICIENT OPERATION data were established and approved under standard Air-TiteTI cabinet design is certified to<1%air leakage rating conditions using American National Standards per ASHRAE 193 "Method of Test for Determining the Institute standards. Airtightness of HVAC Equipment." SAFE OPERATION AIR DELIVERY The Integrated System Control is a solid state device The 9 speed constant torque blower motor has which continuously monitors for presence of flame sufficient airflow for most heating and cooling when the system is in the heating mode of operation. requirements and will switch from heating to cooling Dual solenoid combination gas valve and regulator speeds on demand from room thermostat. provide additional safety. STYLING QUICK HEATING Heavy gauge steel and "wrap-around"cabinet Durable,cycle tested,heavy gauge tubular aluminized construction is used in the cabinet with baked-on steel heat exchanger quickly transfers heat to provide enamel finish for strength and beauty.Every warm conditioned air to the structure. Low energy orientation has at least two venting options.There are power vent blower,to increase efficiency and provide no knockouts on cabinet. a discharge of gas fumes to the outside. BURNERS FEATURES AND GENERAL OPERATION The S-Series furnace utilizes a Silicon Nitride Hot Multiport,Inshot burners will give years of quiet and Surface Ignition system,which eliminates the waste of efficient service.All models can be converted to L.P. a constant burning pilot.The integrated system control gas with LP conversion kit. lights the main burners upon a demand for heat from INTEGRATED SYSTEM CONTROL the room thermostat. Complete front service access. Exclusively designed operational program provides a. Low energy power venter total control of furnace limit sensors,blowers,gas b.Vent proving pressure switches. 6 SW D120W-SUB-2F-EN Features and Benefits 80%AFUE on S8X1 FURNACE MODELS Cabinet is compatible with industry standard coils,as Lowers utility bills well as,other accessories ELECTRICALLY EFFICIENT INTEGRATED FURNACE CONTROL Efficient airflow design reduces electrical energy use Setup/Status/Diagnostics/Digital Display 341NCH TALL No dip switches Lighter,easier to move and fit into tight spaces like Last six errors stored short basements or tight closets Dry contact EAC and HUM connections Works great with larger, high-efficiency coils All Molex connections; no spade terminals No knockouts Low voltage labeled above and below 4—WAY MULTI-POISE Rain shield over IFC keeps condensate off the control 8 SKU's — Upflow/Downflow/Horizontal Left/ TUBULAR ALUMINIZED STEEL HEAT EXCHANGER Horizontal Right VORTiCA 11 BLOWER,DESIGNED EXCLUSIVELY Added application flexibility and reduction in FOR THE S-SERIES FURNACE specification errors Improved airflow efficiency AIRFLOW Durable,easy to clean,housing At least 400 CFM/ton at 0.5 in. H2O external static Single piece belly band/motor arm assembly pressure Blower deck has full-length rails for easy removal and REGULATORY replacement, regardless of poise All models are airtight; 1%or less air leakage as per FOUR—WAY MULTI-POISE (UPFLOW,DOWNFLOW, ASHRAE 193 HORIZONTAL LEFT AND RIGHT) Open vestibule design provides a full 34" high open Easier to specify vestibule for ease of installation and service DIMENSIONS Shipped ready to install (no conversion kits required) Width is industry standard: 24.5" Every model has at least two venting options Depth remains approximately 28" SW D120M5-SUB-2F-EN 7 About Trane and American Standard Heating and Air Conditioning Trane and American Standard create comfortable,energy efficient indoor environments for residential applications. For more information,please visit www.trane.com or www.americanstandardair.com. E 1 I us Intertek The manufacturer has a policy of continuous data improvement and it reserves the right to change design and specifications without notice.We are committed to using environmentally conscious print practices. S8X1D120M5-SUB-2F-EN 08Ap12024 Supersedes S8X1 D1 20M5-SUB-2E-EN (March 2023) ©2024 4TXC-DS-SUB-2B-EN TAG: _ 0 1 .5 - 5 ton Coils, Split System Aluminum Premium Heat Pump / Cooling Coils 4TXC Series Coils PRODUCT SPECIFICATIONSI'1 4TXC-DS --- HIGH EFFICIENCY STAGED SPLIT SYSTEM HEAT PUMP / COOLING COMFORrm COILS -- CASED UPFLOW/ DOWNFLOW/ HORIZONTAL 4TXCA002DS3HCB 4TXCB003DS3HCB 4TXCA032DS3HCB 4TXCB004DS3HCB 4TXCC005DS3HCB INDOOR COIL--Type PLATE FIN PLATE FIN PLATE FIN PLATE FIN PLATE FIN Cooling Capacity(Tons) 1.5-2.0 1.5-2.5 2.5-3.0 3.0-3.5 3.0-3.5 Rows/F.P.I. 2/20 3/14 2/20 3/12 3/12 Face Area(sq.ft.) 3.0 3.5 4.5 5.0 5.0 Tube Size 3/8 3/8 3/8 3/8 3/8 Refrigerant Control Non-Bleed TXV Non-Bleed TXV Non-Bleed TXV Non-Bleed TXV Non-Bleed TXV Internal check valve Yes Yes Yes Yes Yes Drain Conn.Size(in.) 3/4 NPT 3/4 NPT 3/4 NPT 3/4 NPT 3/4 NPT Duct Connections See Outline Drawing See Outline Drawing See Outline Drawing See Outline Drawing See Outline Drawing REFRIGERANT R-410A R-410A R-410A R-410A R-410A CONNECTIONS BRAZED BRAZED BRAZED BRAZED BRAZED Line Size- Gas(in.) 3/4 3/4 3/4 7/8 7/8 Line Size Liquid(in.) 3/8 3/8 3/8 3/8 3/8 DIMENSIONS(in.) H X W X D H X W X D H X W X D H X W X D H X W X D Crated(H x W x D) 21-9/16 x 18-1/2 x 27-1/2 21-9/16 x 21-1/2 x 27-1/2 26-9/16 x 18-1/2 x 27-1/2 26-9/16 x 21-1/2 x 27-1/2 26-9/16 x 25 x 27-1/2 Uncrated 17-1/2 x 14-1/2 x 21-112 17-1/2 x 17-1/2 x 21-1/2 22-1/2 x 14-1/2 x 21-1/2 22-1/2 x 17-1/2 x 21-1/2 22-1/2 x 21 x 21-1/2 WEIGHT(Ibs) 42/34 50/42 49/41 58/50 60/52 Shipping-Net 4TXCB006DS3HCB 4TXCC007DS3HCB 4TXCD008DS3HCB 4TXCC009DS3HCB 4TXCD010DS3HCB INDOOR COIL--Type PLATE FIN PLATE FIN PLATE FIN PLATE FIN PLATE FIN Cooling Capacity(Tons) 3.5-4.0 3.5-4.0 3.5-5.0 3.5-5.0 3.5-5.0 Rows 1F.P.l. 3/14 3/14 3/14 3/16 3/16 Face Area(sq.ft.) 5.5 6.0 6.0 7.0 7.0 Tube Size 3/8 3/8 3/8 3/8 3/8 Refrigerant Control Non-Bleed TXV Non-Bleed TXV Non-Bleed TXV Non-Bleed TXV Non-Bleed TXV Internal check valve Yes Yes Yes Yes Yes Drain Conn.Size(in.) 3/4 NPT 3/4 NPT 3/4 NPT 3/4 NPT 3/4 NPT Duct Connections See Outline Drawing See Outline Drawing See Outline Drawing See Outline Drawing See Outline Drawing REFRIGERANT R-410A R-410A R-410A R-410A R-410A CONNECTIONS BRAZED BRAZED BRAZED BRAZED BRAZED Line Size--Gas(M.) V8 7l8 7l8 7l8 719 Line Size Liquid(in.) 3/8 3/8 3/8 3/8 3/8 DIMENSIONS(in.) H X W X D H X W X D H X W X D H X W X D H X W X D Crated(H x W x D) 30-13/16 x 21-1/2 x 27-1/2 30-13/16 x 25 x 27-1/2 30-5/8 x 28-1/2 x 27-1/2 34-3/4 x 25 x 27-1/2 34-3/4 x 28-1/2 x 27-1/2 Uncrated 26-3/4 x 17-1/2 x 21-112 26-3/4 x 21 x 21-112 26-3/4 x 24-1/2 x 21-112 30-3/4 x 21 x 21-112 30-3/4 x 24-1/2 x 21.112 WEIGHT(Ibs) 63/55 69/61 72/64 78/70 81/73 Shipping--Net [11 These indoor coils are A.H.R.I.certified with various split system air conditioners and heat pumps(A.H.R.I.Standard 210/240). Refer to the Split System Outdoor product information site or www.ahrinet.org Installer's Guide 0 0 Q � - , 1! e — M - e M Yl Q 7 C w N m (D f U � S � (J e � LO _ 'r 3 co M O � � vc� ~ � No U o CO a U u_. x S (nco wNaov ` co p f p X o O o 7- I -- - W Um _ - N XN � - S It CYO)U) o v w 00 p co _ w m m p U w: !Z o N X ' 6 s'- �, - - - - oaa Q C o 0 U z U U X a M U) _ QO m =4" � = O f O p U L 0 0 C) F- W N N ao v 00 m cd l7 h N X U f = o < o CO U X n o - o v Uc V' ch — vi - � oa e?a uy m Q O X III 6 _ N N c0 ran N U o o � - p � i m ow 0 0 0 1 o wo O t- W a 2 4TXC-DS-SUB-2B-EN Installer's Guide Mechanical Specifications General Accessories Upflow, Downflow, or Horizontal coils shall be designed for cooling and heat The following TXV accessories may be pump applications. The coil shall be 3/8" seamless aluminum tubing used with these coils as needed. Refer to mechanically bonded to aluminum plate fin. kit installation guide for further details. Refrigerant for the 4TXC Coils factory installed Non-Bleed TXV refrigerant 4AYTXVH4A1830A Adjustable TXV Kit control. Refrigerant connections are brazed fittings. 4AYTXVH4A3042A Adjustable TXV Kit The coil cabinet shall have a removable front and interior access panel for 4AYTXVH4A4860A Adjustable TXV Kit evaporator coil entering air surface cleaning. The coil includes a vertical drain pan with primary and secondary drain connections for vertical operation and a horizontal drain pan with primary and secondary drain connections for horizontal operation. These coils are A.H.R.I. certified. R-22 CONVERSION NON-BLEED TXV KITS Coil R-22 TXV Kit 4TXCA002DS3HCB 4TXCA032DS3HCB 4TXCB003DS3HCB 2AYTXVH3H1836A 4TXCB004DS3HCB 4TXCC005DS3HCB 4TXCB006DS3HCB 4TXCC007DS3HCB 2AYTXVH3H4248A 4TXCD008DS3HCB 4TXCC009DS3HCB 2AYTXVH3H6060A 4TXCD010DS3HCB PRESSURE DROP CHARACTERISTICS FOR COOLING AND HEAT PUMP COILS AIRFLOW(CFM)VS.PRESSURE DROP ACROSS WET COIL PRESSURE DROP(INCHES OF WATER COLUMN) Model 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 4TXCA002DS3HCB 225 340 430 510 585 650 715 775 4TXCA032DS3HCB 375 570 725 860 985 1100 1200 1305 4TXCB003DS3HCB 350 525 665 790 900 1000 1095 1180 4TXCB004DS3HCB 440 655 825 970 1100 1220 1330 1435 4TXCB006DS3HCB 430 640 815 965 1095 1220 1335 1445 4TXCC005DS3HCB 520 770 970 1145 1300 1440 1570 1695 4TXCC007DS3HCB 505 760 965 1140 1300 1445 1580 1710 4TXCC009DS3HCB 490 740 940 1120 1280 1425 1565 1695 4TXCD008DS3HCB 580 870 1100 1300 1485 1650 1805 1950 4TXCD010DS3HCB 555 835 1065 1265 1445 1615 1770 1915 4TXC-DS-SUB-2B-EN 3 About Trane and American Standard Heating and Air Conditioning Trane and American Standard create comfortable, energy efficient indoor environments for residential applications. For more information, please visit www.trane.com or www.americanstandardair.com c UL uS c E / us Ue� LISTED Intertek The manufacturer has a policy of continuous data improvement and it reserves the right to change design and specifications without notice.We are committed to using environmentally conscious print practices. 4TXC-DS-SUB-2B-EN 12 Apr 2021 Supersedes 4TXC-DS-SUB-2A-EN (October 2020) ©2021 rRa�vE• Submittal Split System Cooling 5.0 Ton 4TTR306O N 1000A 000, :zz now ^ - February2023 4TTR306ON-SUB-1 B-EN 7� n N E. TECHNOLOGIES' ® Taws, 8 SERVICE PANEL C ELECTRICAL AND REFRIGERANT COMPONENT CLEARANCES PER PREVAILING CODES TOP DISCHARGE AREA SHOULD BE UNRESTRICTED FOR AT LEAST 1524(5 FEET) ABOVE UNIT.UNIT SHOULD BE PLACED SO ROOF RUN-OFF WATER DOES NOT POUR DIRECTLY ON UNIT AND SHOULD BE AT LEAST 305(12")FROM WALL AND ALL SURROUNDING SHRUBBERY ONTWO SIDES. OTHERTWO SIDES UNRESTRICTED ELECTRICAL SERVICE K PANEL 't 25(1) E 22.2(7/8)DIA.HOL A LOW VOLTAGE 28.6(1-1/8)DIA.K.O.WITH 22.2(7/8)DIA.HOLE IN CONTROL BOX BOTTOM FOR ELECTRICAL POWER SUPLY LIQUID LINE SERVICE VALVE, H „E„ I.D.FEMALE BRAZE IllR CONNECTION WITH 1/4"SAE J FLARE PRESSURETAP FITTINGS Gi FIG.1 K.O.FOR ALTERNATE ELECTRICAL ROUTING From Dwg.D152898 GAS LINE 1/4TURN BALL SERVICE VALVE, „D„ I.D.FEMALE BRAZED CONNECTION WITH 1/4"SAE FLARE PRESSURE TAP FITTING.A Model Base A B C D E F G H J K 4TTR3060N 4 943 946 870 7/8 3/8 152 98 219 86 508 (379-1/8) (37-1/4) (34-1/4) (6) (3-7/8) (8-5/8) (3-3/8) (20) Sound Power Level A-Weighted Sound Full Octave Sound Power(dB) MODEL Power Level[dB(A)] 63 Hz 125 Hz 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 8000 Hz 4TTR3060N 71 81 72 69 69 66 60 57 54 Note:Rated in accordance with AHRI Standard 270-2008*For Reference Only 2 4TfR3060N-SUB-1 B-EN TRINE` Product Specifications OUTDOOR UNIT(a)(b) 4TTR3060N1000A a) Certified in accordance with the Air-Source Unitary Air-conditioner POWER CON NS.-V/PH/HZ i ) 208/230/1/60 Equipment certification program,which is based on AHRI standard 210/240. MIN.BRCH.CIR.AMPACITY 27 (b) Rated in accordance with AHRI standard 270. 0 Calculated in accordance with Natl.Elec.Codes.Use only HACR BR.CIR.PROT.RTG.-MAX.(AMPS) 45 circuit breakers or fuses. (d) This value shown for compressor RLA on the unit nameplate and on COMPRESSOR CLIMATUFFO-SCROLL this specification sheet is used to compute minimum branch circuit NO.USED-NO.STAGES 1-1 ampacity and max.fuse size.The value shown is the branch circuit selection current. VOLTS/PH/HZ 208/230/1/60 (1) Use start components only when compressor is found to enter locked rotor condition and will not start or when lights dim at compressor R.L.AMPS id)-L.R.AMPS 20.8-127.1 start.No means no start components.Yes means quick start kit FACTORY INSTALLED components.PTC means positive temperature coefficient starter. Optional kit shown. START COMPONENTS'C NO(Uses BAYKSKT263) M Standard Air-Dry Coil-Outdoor (g) This value approximate.For more precise value see unit nameplate. INSULATION/SOUND BLANKET NO (h) Max.linear length 60 ft.;Max.lift-Suction 60 ft.;Max.lift-Liquid 60 ft.For greater length consult refrigerant piping software Pub.No. COMPRESSOR HEAT NO 32-3312-0'(" denotes latest revision). OUTDOOR FAN PROPELLER DIA.(IN.)-NO.USED 27.5-1 TYPE DRIVE-NO.SPEEDS DIRECT-1 CFM @ 0.0IN.W.G.M 4340 NO.MOTORS-HP 1-1/5 MOTOR SPEED R.P.M. 835 VOLTS/PH/HZ 208/230/1/60 F.L.AMPS 1.05 OUTDOOR COIL-TYPE SPINE FIN7M ROWS-F.P.I. 1-24 FACE AREA(SQ.FT.) 24.93 TUBE SIZE(IN.) 3/8 REFRIGERANT LBS.-R-410A(O.D.UNIT)A) 7 LBS.,10 OZ FACTORY SUPPLIED YES LINE SIZE-IN.O.D.GAS'h) 7/8 LINE SIZE-1N.O.D.LIQ. 3/8 CHARGING SPECIFICATIONS SUBCOOLING 10°F DIMENSIONS H X W X D CRATED(IN.) 42.4 x 35.1 x 38.7 WEIGHT SHIPPING(LBS.) 246 NET(LBS.) 211 4TTR3060N-SUB-1 B-EN 3 rAWE` Mechanical Specification Options General Compressor The outdoor condensing units are factory charged with The compressor features internal over temperature and the system charge required for the outdoor condensing pressure protection. Other features include: Centrifugal unit,ten (10)feet of tested connecting line,and the oil pump and low vibration and noise. smallest rated indoor evaporative coil match.This unit Condenser Coil is designed to operate at outdoor ambient temperatures as high as 115°F. Cooling capacities are The outdoor coil provides low airflow resistance and matched with a wide selection of air handlers and efficient heat transfer.The coil is protected on all four furnace coils that are AHRI certified.The unit is certified sides by louvered panels. to UL 1995.Exterior is designed for outdoor Low Ambient Cooling application. As manufactured,this system has a cooling capacity to Casing 55°F.The addition of an evaporator defrost control Unit casing is constructed of heavy gauge,galvanized permits operation to 40°F.The addition of an steel and painted with a weather-resistant powder evaporator defrost control with TXV permits low paint finish.The corner panels are prepainted.All ambient cooling to 30°F. panels are subjected to our 1,000 hour salt spray test. The addition of the BAYLOAM107A low ambient kit Refrigerant Controls permits ambient cooling to 20°F. Refrigeration system controls include condenser fan, Thermostats—Cooling only and heat/cooling (manual compressor contactor and low and high pressure and automatic change over).Sub-base to match switches.A factory supplied,field installed liquid line thermostat and locking thermostat cover. drier is standard. 4 4TTR3060N-SUB-1 B-EN TR4NE' Trane - by Trane Technologies (NYSE: TT), a global innovator - creates comfortable, energy efficient indoor environments for commercial and residential applications. For more information, please visit trane. com or tranetechnologies.com. UmtM Small AC C UL US LISTED The AHRI Certified mark indicates Trans U.S.Inc.participation in the AHRI Certification program.For verification of individual certified products,go to ahridirectory. org. Trane has a policy of continuous data improvement and it reserves the right to change design and specifications without notice.We are committed to using environmentally conscious print practices. 4TTR306ON-SUB-I B-EN 15 Feb 2023 Supersedes 4TTR3060N-SUB-tA-EN (July 2022) ©2023 Trane DATE(MM/DD/YYYY) �,,.. CERTIFICATE OF LIABILITY INSURANCE 1 02/16/2024 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). ACT PRODUCER NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX HOME OFFICE: P.O. BOX 328 A/C,No,EXq:888-333-4949 (A/C,No):507 446 4664 OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER,,&_FEDINS.COM INSURERS AFFORDING COVERAGE NAIL# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 2864684 INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 ARCTIC MECHANICAL INCORPORATED INSURER C: 460 N MAIN ST — - PORT CHESTER, NY 10573-3310 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:90 REVISION NUMBER: 1 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 SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR AM AGE TO'curren RENTED PREMISES $100,000 MED EXP(Any one person) EXCLUDED A N N 1887386 01/18/2024 01/18/2025 PERSONAL&ADV INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2 000 000 X POLICY �E�T ❑LOC PRODUCTS 8 COMPlOP AGO $2,000,000 OTHER: AUTOMOBILE ABILITY COMBINED SINGLE LIMIT LI Ea BINEn $1,000,000 X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY SCHEDULED N N 1887386 01118/2024 0111812025 BODILY INJURY(Per Accident) AUTOHIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY X UMBRELLA LIAB ICLAIMS-MADE OCCUR EACH OCCURRENCE $5,000,000 A EXCESSLIAB N N 9907994 01/18/2024 01/18/2025 AGGREGATE $5,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION X I PER STATUTE 1 THER AND EMPLOYERS'LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1,000,000 B OFFICERIMEMBEREXCLUDED? N/A N 9298530 01/18/2024 01/18/2025 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 286-468-4 901 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 oR Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured (914)934-8301 Arctic Mechanical Incorporated 286-468-4 460 N Main St 1 c.NYS Unemployment Insurance Employer Registration Number of Port Chester, NY 10573-3310 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 06-1596446 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 3b.Policy Number of Entity Listed in Box 1 a" 938 King St 9298530 Rye Brook, NY 10573-1226 3c.Policy effective period 01/18/2024 to 01/18/2025 3d.The Proprietor,Partners or Executive Officers are QX included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"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: Emily Petzel (Print name of authorized rerfebpritative or licensed agent of insurance carrier) Approved by: Z��L P 12/05/2023 (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