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HomeMy WebLinkAboutMP23-166PERMIT SEC ON TYPE OF JOB LOC. 7ES .CO/S�T� O N C2 TCO 1J S�pF- TIG� ON RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBINGoei..�e-- —� GAS I�7 SPRINKLER ELECTRIC LOW -VOLT O -� o ALARM AS BUILT 09 g47C FINAL �- 837- y8#9 Al _dap/ c�iotJ Jai/urr6 nJ �ys 3- c��O/`-)O/✓A'�J2T G l eLiriCa�.l�l C OTHER APPROVALS ARB BOT PB ZBA OTHER �yE 4R tV�JV J�V � z 190 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 June 11,2024 Bruce Yawitz 3 West Ridge Drive Rye Brook,New York 10573 Re: 3 West Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 135.35-1-9 Mechanical Permit#23-166 issued 11/22/2023 for a New Generator This certifies that the lOkw natural gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to D For office use only: ��. I BUMMINGk�P RTMENT PERMIT rt#11TQ3`110& VILLAGE OF RYE BROOK ISSUED: //—�a— 3 APR 2 5 2024 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: cSs--c-) 1--. -- (914)939-0668 FEE: & //D 1 PAID IK VILLAGE OF RYc 3R00,<. i �yrkn,r`er+jol:.t3r�j BUILDING D Er:P AF? 1T i APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: 3 {unz-t- QV A9 e Occupancy/Use: / �i4M Parcel ID 4: /35-,3 5— Zone: /5 Owner: �1-.<c-Q -1At_---c-C'1- Address: 3 L6_1& ,� TJ-'.tee &F o P.E./R.A. or Contractor: �ra-t "� C-.a/V Address:P 0, RJtOx "1U, Aga,,,4 Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: ,p being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) ( ' in /*/--tec.t'va I\-` ,in the County of (.y�S in the State of/LP? ,that (CA Town Villa_ci he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S d for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or pen-nit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this 2 Z Sworn to before me this ^ day of 4 n 1 L , 20 Z L4 day�af Signature of Property Own Signature of Applicant Print Name of Property Owner P Na e of Applicant Notary Public Notary Public DONALD A. CASSONE SHARI MELILLO Notary Pubic, State of New Yo* Notary Public,State of New York No. OICA6061097 No.OIME6160063 Qualified in Westchester County Q!i-Iified In Westchester County r� Commission Expires July 9, 20? Commission Expires January 29,20!�_ �yE BRC�k. 193,2 . l7 BUILDING DEPARTMENT ❑BUILDING INSPECTOR D'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 : ...� S� F L DATE: PERMIT# 1j7f Z3 ISSUED: - zI a SECT: 3.5-3f BLOCK: LOT: 9 LOCATION: �F J �( ��Lj. 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 1 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION .❑ FINAL ❑ OTHER QyE BRC��, cu � 1932 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 Q (7 v Q DATE: / " Z6 — 2 U Z PERMIT# �` ra�3 �� ISSUED: -2Z -15SECT: BLOCK: / LOT: / LOCATION: C) O.A —Q OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION p ❑ SITE INSPECTION port, REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION nn ❑ Natural Gas �`� S �\,Q ❑ L.P. Gas y ❑ FUEL TANK ❑ FIRE SPRINKLER / J❑ FINAL PLUMBING ❑ CROSS CONNECTION J�FINAL ry) /J C3' OTHER Gf•��c /1 QyE BRC��. cu � • �9a2 BUILDING DEPARTMENT ❑D BUILDING INSPECTOR u 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.or¢ - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : . 3 W C,S Ara I✓e, DATE: � � 2 PERMIT#?? 2.4- 0 2 O ISSUED: 2-"'SECT: 75 BLOCK: ' LOT:. LOCATION: Le { S o"SC 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 n I n p-'Natural Gas ❑ L.P. Gas 40 N ❑ FUEL TANK ❑ FIRE SPRINKLER 3� Inc C ISSu2 (� 2 22 ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a N N N v W 96 Q T-4 o v v 0 m � � " � �o � wvoo v� AQ O � � � o NU � va w Z a v W or x � � OO 00 a v o W00 z A A ' b � v a Wz � .; WO ,1 o a M10, WQ � oQ �c 00 0-4 G1 . U H o0.4 . C� 06 OD •(z-4 g .y 2 0 Ccts O.b agvi a W O C- O o v v n �0-4 U r p O 44 0 v W � O V O z z O "" O M A W 04 z o � , 0-4 O W V � � .`� c4 v a• � s r BUILDING DEPARTMENT Q E C_�`-�'_".`�/ E VILLAGE OF RYE fitZOOK 938 KING STREET RYE BROOK, NY 10573 NOV5 202� i (914)939-0668 I e��v�t.ttektrt�t�k.oti; VILLAGE OF RYE BROOK BUILDING BFPARTNTNT FOR OFFICE USE ONI_.l : ,approval Date: it �✓�; Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other:Application Fee410a-Ab Permit Fees: APPLICATION TO INSTALL A PERMANENT STANDBY BACKUP GENERATOR Application dated: �/ d is hereby made to the Building Inspector of the Village of Rye Brook for the issuance of a Permit to install a permanent standby backup generator in accordance with§250-4.1,of the Code of the Village of Rye Brook,as per detailed statement described below. Please note that electrical and plumbing permit applications must be filed separately by those licensed professionals,and that separate permits are required for the installation of any related fuel tanks.Further note that all applications for commercial use will require a site plan approval from the Village Planning Board prior to the issuance of any permit.1. Job Address: Ur ]�5r- /��[p��1`�� 1,Jove, 2. Parcel ID#: /35> 3� �/ f J Zone:A r 3. N.Y. State Construction Classification: N.Y. State Use Classification: r 4. Proposed Generator&Fuel Type Wescribe in detail): L4-" 624jr."-c 5. Property Owner: 90 J—U C-e tT -A— Address- (] '� `.� Phone# —{ �.�' 3 i�745Z' Cell'# s�7 �7� email:F a D(•t 7 Applicant: 6 cQ`zn Address: ,O - 13 4x 1 L4(S, A- z4WQ-l k ,fie 1p Phone#-Cl kK-2410-73oo Cell # Q 14-4 Z' 0 email: ,C ease -` >l . •toev Architect or Engineer(if applicable): Address: Phone# Celli# email: General Contrac�pr: � ���-t� �L-C�'a' ter �rz`'�,1�� [Q �� Address: ((�1 a cJ L l e .�' ( Phone# `1 I I-� -1 `13r�� Cell#9 1 4` 3.7- l-I q email: t 6/112023 6. Give exact dimensions from proposed generator to lot lines: front yard: rear yard: right side yard: left side yard: 7. If building is located on a comer lot,which street does it front on: 8. Will the proposed project disturb 400 sq.ft.or more of land,requiring a Stormwater Management Control Permit from the Village Engineer as per Chapter 217 of the Code of the Village of Rye Brook'? Yes: No: 9. Will the proposed project require a Site Plan Review by the Village Planning Board as per Chapter 209 of the Code of the Village of Rye Brook? Yes: No: I/ (provide detailed drawings as per Chapter 209) 10. Will the proposed project require a Steep Slopes Permit as per Chapter 213 of the Code of the Village of Rye Brook? Yes: No: �/ (provide a detailed topographical survey) 11. Is the lot or any portion thereof located in a Wetland as per chapter 245 of the Code of the Village of Rye Brook? Yes: No: (provide a detailed survey indicating the Wetland&Buffer Zone) 12. is the lot or any portion thereof located in a Flood Zone as per the FEMA Flood Insurance Rate Map#36119CO279 dated 9/28/07? Yes: No: 13. Will the proposed olect require a Tree Removal Permit as per Chapter 235 of the Code of the Village of Rye Brook? Yes; No: (a tree replanting schedule may be required) 14. Does the proposedproject involve a Horne-Occupation as per Chapter 250-38 of the Code of the Village of Rye Brook? Yes: No: V/ If so,indicate: TIER L TIER 11: TIER III: 15. What is the total estimated cost of construction: S /V L(,d 6 ' `0 (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis) 16. Estimated date of completion: STA,LP OF NEW YO ,COUNTY OF WESTCHESTER ) as: 1?1*51-`,'-: �- ­ , ,being duly sworn,deposes and states that he/she is the applicant above named, app(print name of individual signing as the licant) a d further states that (s)he is the legal ownerGf the property to which this application pertains, or that (s)he is the '.04. , a �c1��,E'f'9 0 y _J+L C 40 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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to hcfc,rc me this Sworn to before me this day of NO v! /Y J5 fr nL 20 Z 3 d of , 20)�_J_ �— DONALD A CASSONE Signa re of Prope wrier Notary pubic, State Of New York Signature of Applicant No. 01CA6061097 f2.v G - A�-��T Z Qualified in Westchester County Commission Expires July 9, 207.7 Print Name of Property Owner Print Name of A pli ILLO Nota y Public,cKate of ew York /t4-� o.O1M 16 3 (�p o ttalifi ®unt3, Notary Public NotaryOtvbiinission Expires January 29,20 Z;— This application must be properly completed in its entirety and trust 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. Please note that application fees are non-refundable. 2 6/l/2023 O N N w N \ fTl n F+i W \ N 0 L . oG u M� W v it a H ca w Ln ON w a c ' a vw w a xj � V 8 cn W O w A 0-4 LO o F O w z � � 8 � w s zo O A o H p4 , H alot 00 Q �... � z W t� Z In W V W w o Cl) W 5 CC) 0 zy z 5 O O o V It Q O W 10.10) Z Iz w z u z CP%41 v� W Z C7 M � o � �, Z 'zoo a �� z Q ;t- o W a I1 F1 0c) V N A A e n 5 N G1 H N a w a V rx a 3 og a w o Q � w W a o o W U O W z w z w a 0 F �I as a a w xCIS R EC ENE BUILDING DEPARTMENT VILLAGE OF RYE BROOK NOV 2 7 2023 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 www.Kyebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required \ r� FOR OFFICE USE ONLY BP-#,- 6Q _J&& EP#: Q J—d q y NOV Approval Date: Permit Fee: $ 0 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,/ __-?'7 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: 3 G✓es 7" 121 d5 t' D2 i V to SBL: /_:K/ 3 S/��' Zone: 1 S 2.Property Owner: 0 w i T Z S T Address: 3 L✓e e1 GIST -,ar I V t° Phone#: Cell#: email: 3.Master Electrician/Licensed Installer: , ' /Azk DdL4N Address:ipO-Ad,<-37? N c!,< �4[r1JD5V' Lic.#: I S Z 3 Phone#: 9/� 771 C5�.3_ Cell#: email:Company Name:S011170'Zfe_T EIPC'T;ti ( Address:to 0, go'C 3-77 1'ya Lout r4«.► A4"' /' 4.Proposed Electrical Work/Fixture Count: 5.31 Party Electrical Inspection Agency: ********************************************************************************************************* STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,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 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 to before me this Swom to before me this Q day of 20 day of 0 20 Signature of Property Owner Signature pf Applicant r/t/ LC �Q L4�J Print Name of Property Owner P ' ame of Applic nt Notary Public Ngt u c,State of New York No.01 R"i 398 10/30/2023 QuaNf ed In Westchester County �/j Commkssion Expires September 26,2 Z STATE WIDE INSPECTION SERVICES, INC. Service With Integritv 0•0 • • *SWIS JOB APPLICATION0. Office Use Elect. Permit# i Date 11LIZ) Bldg Permit# — f L/7 Sq Ft Plumbing Permit# /� Final Certificate# City/Village 1!�� e��� Zip Building Dept. County Address L PST CAI e 0�+ve Cross Street Section Block Lot Owner Name/Address(If different than above) k/ IT 7 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/0 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 )unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation • ,� 41100, Pw ��✓�jot P /oust W RD NOV 2 7 2023 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 ro -� Name 42/i/ Y✓'�`�A.� License# S 2 Date Signature Address o f X �`� City/State . ,4�d Zip Code �L 5 7 Company 0'- IsC7 F I r C f r\ Phone# � / -77%Sbri S- J State Wide Inspection Services 1080 Main Street � �, MAR 12 2024 LLL��� Fishkill, NY 12524�a A- 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMEN1 Email: office(a)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: SOMERSET ELECTRIC Bruce Yawitz MARK DOLAN 3 West Ridge Drive P.O. BOX 372 Rye Brook, NY 10573 MAHOPAC FALLS, NY 10542 Located at: 3 West Ridge Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-240 135.35 1 9 Certificate Number: 2024-1480 Building Permit Number: MP 23-166 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: 3 West Ridge Drive, Rye Brook, NY 10573 The Garage &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 121h Day of March 2024. Name Quantity Rating Circuit Type Generator 01 10kw Automatic Transfer Switch 01 150 Amp 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. o N s W _ vl w LL W ai F,.e♦ Ln s M N ~ 0 r _ O Zo wLna H tsA a, 0 4p v' f O 0 N acn - s cu a � a if 0 w w � O z �, O w U ~ O uzA o +� � O z w I z W �la•-I—+ G1 ia—+ /, 1 M t LI CA � � ` p4 t � W 11 V 1+1 L Ln a � � C cd A H og U W QR� D IECIEWIE BUILDING DEPARTMENT VILLAGE OF RYE BOOK FEB 12 2024 938 KINdk ET RYE B ,',NY 10573 (914)936 ,)939-5801 VILLAGE OF RYE BROOK or BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE?ZbY1 6 201 "- PP#: � 0 Approval Date: r t Permit Fee: $ / />� Approval Signature: Other: Disapproved: (fees are non-refundable) 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 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 Local Codes.© , 1.Address: W -e2t SBL: 13J t — Zone: 2.Proposed Work: 3.Property Owner: Address: -G ,, gi✓ Phone#: 3 g 7 LIS Cell#: k email: f a as I. " 4.Master Plumber: V ar U-0, Address: I&4,<, 1+ �4, ,J r A,(,/ ,4) Lic.#: Phone#: ' Cell#: email: t Company Name: Address: 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 1st Floor 2nd Floor 311 Floor 4'h Floor 5`h Floor Exterior 5.* List Other EquipmentTrovide Details: r Ir`s (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 STATE F�iEW YO%OUNTY 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 legal owner of the property to which this application pertains,or that(s)he is the �+ r— for the legal owner and is duly authorized to make and file this application. (indicate azch t,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 u!!�V SwoItobe e �his day of .20 Z 4 day kl' ,20—A-t-- Signature of Pro y O Sidnature of Applicant Print Name of Property Owner Print Name of App ' ant 't8 A CASSONE Notary Public Notary Pubic, State of New York Notary Public, No. 01 CA6061097 Cynthia Chan Qualified in Westchester County Commission Expires July 9, 20 17 NOTARY PUBLIC,STATE OFNEWYORK Registration No.OICH6435523 QulifiedThis application must be properly completed in its entirety and must incl de ,r wFAss}terCoanty s o PP p P y P Ys9Avii ) 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- 3/21/19 E D • BUILDING DEPARTMENT D C� " VILLAGE OF RYEAROOK HHi] 938 KING STREET RYE BRc vX,NY 10573 1 (914)9*0668 FAX(914,)939-5801 OF VILLAGE RYE BROOK W" ]17_4 ok.: rg 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: , residing at, � �� / . 4e61-0,9�G (Print nanie) (Address where,au live) vd 3 being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)fie is the legal owner of the property to which this Affidavit of Compliance pertains at; 3 a14�_e (D/_' sll-� , 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&n6ture of Property ner(s)) t� ( ffit 'ame of Property Own kw) Sworn to before me this 2 day of�fftM V a ii2 Y , 20 2 K G%t^G!/t-tom�/L-GIiGG (Notary Public) DONALD A. CASSONE Notary Pubic, State of New York No. 01 CA6061097 Qualified in Westchester County Commission Expires July 9, 2027 _3_ 3/21/19 GENERAC° 10 1 /18 kW GUARDIAN° SERIES _ Residential Standby Generators Air-Cooled Gas Engine INCLUDES: Standby Power Rating G007171-0,G007172-0(Aluminum-Bisque)—10 kW 60 Hz • True Power'" Electrical Technology G007223-0,G007224-0,G007225-0(Aluminum-Bisque)—14 kW 60 Hz • Two-line multilingual digital LCD Evolution'" controller G007226-0,G007228-0(Aluminum-Bisque)—18 kW 60 Hz (English/Spanish/French/Portuguese) • Two transfer switch options available: 100 amp 16 circuit switch or 200 amp service rated smart switch • Electronic governor ` s • Standard Wi-Fi®'connectivity • System status&maintenance interval LED indicators • Sound attenuated enclosure • Flexible fuel line connector • Natural gas or LP gas operation GENERAC • 5 Year limited warranty • Listed and labeled by the Southwest Research Institute allowing installation as close as 18 in (457 mm) to a rI. structure.* c �s ` INN LISTED QU'� u Must be located away from doors, windows,and fresh air Mtnk intakes and in accordance with local codes. htips:!;assets.swri.ory,%library/DrrectoryOfListedProducts` Note:CETL or CUL certification only applies to unbundled units and units packaged with limited Constructionlndustry/973 DoC_204 13204-01-Ol Rev9.pdf circuit switches.units packaged with the Smart Switch are ETL or UL certified in the USA only. FEATURES C.) INNOVATIVE ENGINE DESIGN & RIGOROUS TESTING are at the heart of SOLID-STATE, FREQUENCY COMPENSATED VOLTAGE REGULATION: This Generac's success in providing the most reliable generators possible.Generac's G- state-of-the-art power maximizing regulation system is standard on all Generac Force engine lineup offers added peace of mind and reliability for when you need it models. It provides optimized FAST RESPONSE to changing load conditions and the most.The G-Force series engines are purpose built and designed to handle the MAXIMUM MOTOR STARTING CAPABILITY by electronically torque-matching the rigors of extended run times in high temperatures and extreme operating conditions. surge loads to the engine.Digital voltage regulation at±1%. TRUE POWER'"ELECTRICAL TECHNOLOGY:Superior harmonics and sine wave SINGLE SOURCE SERVICE RESPONSE from Generac's extensive dealer network form produce less than 5%Total Harmonic Distortion for utility quality power.This provides parts and service know-how for the entire unit, from the engine to the allows confident operation of sensitive electronic equipment and micro-chip based smallest electronic component. appliances,such as variable speed HVAC systems. TEST CRITERIA: GENERAC TRANSFER SWITCHES:Long life and reliability are synonymous with ✓ PROTOTYPE TESTED NEMA MG1-22 EVALUATION GENERAC POWER SYSTEMS. One reason for this confidence is the GENERAC SYSTEM TORSIONAL TESTED ✓ MOTOR STARTING ABILITY product line is offered with its own transfer systems and controls for total system compatibility. O MOBILE LINIO WI-FI CONNECTIVITY: FREE with select Guardian Series home standby generators, Mobile Link Wi-Fi allows users to monitor the status of the generator from anywhere in the world using a smartphone, tablet, or PC. Easily access information such as the current operating status and maintenance alerts. Users can connect an account to an authorized service dealer for fast,friendly,and proactive service.With Mobile Link, users are taken care of before the next power outage. GENERAC PROMISE GENERAC' 10/14/18 kW Features and Benefits Engine • Generac G-Force design Maximizes engine"breathing"for increased fuel efficiency.Plateau honed cylinder walls and plasma moly rings help the engine run cooler,reducing oil consumption and resulting in longer engine life. • "Spiny-lok"cast iron cylinder walls Rigid construction and added durability provide long engine life. • Electronic ignition/spark advance These features combine to assure smooth,quick starting every time. • Full pressure lubrication system Pressurized lubrication to all vital bearings means better performance, less maintenance, and longer engine life.Now featuring up to a 2 year/200 hour oil change interval. • Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil. • High temperature shutdown Prevents damage due to overheating. Generator • Revolving field Allows for a smaller, light weight unit that operates 25% more efficiently than a revolving armature generator. • Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. • Displaced phase excitation Maximizes motor starting capability. • Automatic voltage regulation Regulating output voltage to±1%prevents damaging voltage spikes. • UL 2200 listed For your safety. Transfer Switch (if applicable) • Fully automatic Transfers vital electrical loads to the energized source of power. • NEMA 3R Can be installed inside or outside for maximum flexibility. • Remote mounting Mounts near an existing distribution panel for simple,low-cost installation. Evolution7' Controls • AUTO/MANUAUOFF illuminated buttons Select the operating mode and provide easy,at-a-glance status indication in any condition. • Two-line multilingual LCD Provides homeowners easily visible logs of history,maintenance,and events up to 50 occurrences. • Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations. • Utility voltage sensing Constantly monitors utility voltage,setpoints 65%dropout,80%pick-up,of standard voltage. • Generator voltage sensing Constantly monitors generator voltage to verify the cleanest power is delivered to the home. • Utility interrupt delay Prevents nuisance startups of the engine,adjustable 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer. • Engine warm-up Verifies engine is ready to assume the load.Setpoint approximately 5 seconds. • Engine cool-down Allows engine to cool prior to shutdown.Setpoint approximately 1 minute. • Programmable exercise Operates engine to prevent oil seal drying and damage between power outages by running the generator for 5 minutes every other week.Offers a selectable setting for weekly or monthly operation,providing flexibility and potentially lower fuel costs to the owner. • Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature. Compatible with lead acid and AGM-style batteries. • Main line circuit breaker Protects generator from overload. • Electronic governor Maintains constant 60 Hz frequency. Unit • SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature,withstanding winds up to 150 mph(241 km/h).Hinged key locking roof panel for security.Lift-out front for easy access to all routine maintenance items.Electrostatically applied textured epoxy paint for added durability. • Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries. • Small,compact,attractive Makes for an easy,eye appealing installation,as close as 18 in(457 mm)away from a structure. GENERAC' MMMONUM 10/14/18 kW Features and Benefits '— Installation System • 14 in(35.6 cm)flexible fuel line connector Listed ANSI Z21.75/CSA 6.27 outdoor appliance connector for the required connection to the gas supply piping. • Integral sediment trap Meets IFGC and NFPA 54 installation requirements. Connectivity • Ability to view generator status Monitor your generator with a smartphone,tablet,or computer at any time via the Mobile Link application for complete peace of mind. • Ability to view generator Exercise/Run and Total Hours Review the generator's complete protection profile for exercise hours and total hours. • Ability to view generator maintenance information Provides maintenance information for your specific model generator when scheduled maintenance is due. • Monthly report with previous month's activity Detailed monthly reports provide historical generator information. • Ability to view generator battery information Built in battery diagnostics displaying current state of the battery. • Weather information Provides detailed local ambient weather conditions for generator location. GENERAC 10/14/18 kW Specifications Generator Model G007171-0.G007172-0 G007223-0.G007224-0. G007226-0,G007228-0 If kW) G007225-0(14 kW) (18 kW) Rated maximum continuous power capacity(LP) 10.000 Watts" 14,000 Watts' 18,000 Watts' *ated maximum continuous power capacity(NG) 9,000 Watts' 14,000 Watts' 17,000 Watts' Rated voltage 240 Rated maximum continuous load current-240 volts(LP/NG) 41 7,137.5 58.3/58.3 75.0/70.8 Total Harmonic Distortion Less than 5% of "Jain line circuit breaker 45 Amp 60 Amp 80 Amp Phase 1 �: �� € +'umber of rotor poles 2 Rated AC frequency 60 Hz g; Power factor 1.0 Battery requirement(not included) 12 Volts,Group 26R 540 CCA Minimum or Group 35AGM 650 CCA Minimum , Unit weight(lb/kg) 338i'153 385/175 4201191 Dimensions(L x W x H)in/cm 48 x 25 x 29/121.9 x 63.5 x 73.7 Sound output in dB(A)at 2311(7 m)with generator operating at normal load'` 61 65 65 Sound output in dB(A)at 23 ft(7 m)with generator in Quiet-Test`"low-speed exercise mode" 57 55 55 Exercise duration 5 min Engine Engine type GENERAC G-Force 400 Series GENERAC G-Force 800 Series Number of cylinders 1 2 A.MMM Displacement 460 cc 816 cc Cylinder block Aluminum w/cast iron sleeve Vaive arrangement Overhead valve Lifter type Solid Hydraulic Ignition system Solid-slate w/magneto Governor system Electronic ie Compression ratio 9,51 Starter 12 VDC ? Oil capacity including filter Approx.1.1 qt/1.0 L Approx,2.2 qt/2.1 L Operating rpm 3,600 Fuel consumption Natural Gas ft3/hr(m3/hr) 112 Load 101(2.86) 195(5.52) 169(4.79) Full Load 127(3.60) 256(7.25) 247(6.99) Liquid Propane ft3/hr(gal/hr)[Uhr] 112 Load 36(0.97)[3.661 65(1.81)(6.871 62(1.70)[6.451 Full Load 54(1.48)[5.621 112(3.07)[11.611 110(3.02)[11.441 Note:Fuel pipe must be sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3.5-7.0 in water column(0.87-1.74 kPa)for NG,10-12 in water column(2.49-2.99 kPa)for LP gas.For BTU content,multiply 113/hr x 2,500(LP)or ft3/ht x 1,000(NG).For Me ajoule content,multiply ni x 93.15(LP)of m">!hr x 37.26(NG). Controls Two-line plain text multilingual LCD Simple user interface for ease of operation. Mode buttons:AUTO Automatic start on utility failure.Weekly.Bi-Weekly,or Monthly selectable exerciser MANUAL Start with starter control,unit stays on.If utility fails,transfer to load takes place. OFF Stops unit Power is removed.Control and charger still operate. Ready to Run/Maintenance messages Standard Engine run hours indication Standard Programmable start delay between 2-15GO seconds Standard(programmable by dealer only) Utility voltage loss/Return to utility adjustable(brownout setting) From 140-171 V/190-216 V Future set capable exerciser/Exercise set error warning Standard RuWAlarrrVMainlenance logs 50 events each Engine start sequence Cyclic cranking:16 sec on,7 sec rest(90 sec maximum duration). Starter lock-out Starter cannot re-engage until 5 sec after engine has stopped. Smart Battery Charger Standard Charger Fault/Missing AC Warning Standard Low Battery/Battery Problem Protection and Battery Condition Indication Standard Automatic Voltage Regulation with Over and Under Voltage Proteclion Standard Under-Frequency/Ovedoad/Stepper Overcurrent Protection Standard Safety Fused/Fuse Problem Protection Standard Automatic Low Oil Pressure/High Oil Temperature Shutdown Standard Over crank/Overspeed(Co)72 Hz)/rpm Sense Loss Shutdown Standard High Engine Temperature Shutdown Standard Internal FaulVlncorrect Wiring Protection Standard Common External Fault Capability Standard Field Upgradable Firmware Standard Rating definitions-Optional Standby:Applicable for supplying backup power for the duration of the utility power outage with correct maintenance performed.No overload capability is available for this rating.(All ratings in accordance with BS5514,IS03046,UL2200,and DIN6271). Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU/Megajoule content,ambient temperature,altitude,engine power and condition,etc.Maximum power decreases approximately 3.5%for each 1.000 it(304.8 m)above sea level and approximately 1%for each 10°F(6°C)above 60 IF(16°C)."Sound levels are taken from the front of the generator.Sound levels taken from other sides of the generator may be higher depending on installation parameters. GENERAC' 10/14/18 kW Switch Options Limited Circuits Switch Features Model G007172-0 G007224-0 (10 kW) (14 kW) • 16 space,24 circuit.Breakers not included. No.of poles 2 • Electrically operated,mechanically-held contacts for fast,positive connections. Current rating(amps) 100 • Rated for all classes of load,100%equipment rated,both inductive and Voltage rating(VAC) 120/240,10 resistive. Utility voltage monitor(fixed)' • 2-pole,250 VAC contactors. -Pick-up 80% • 30 millisecond transfer time. Dropout 65% • Dual coil design. Return to utility* Approx.15 sec • Rated for both copper and aluminum conductors. Exercises bi-weekly for 5 minutes* Standard • Main contacts are silver plated or silver alloy to resist welding and sticking. ETL or UL Listed Standard • NEMA/UL 313 aluminum outdoor enclosure allows for indoor or outdoor Total circuits available 24 mounting flexibility. Tandem breaker capabilities 8tandems • Multi listed for use with 1 in standard,tandem,GFCI,and AFCI breakers from Siemens,Murray,Eaton,and Square D for the most flexible and cost effective Circuit breaker protected install. Available RMS Symmetrical 10,000 Fault Current @ 250 Volts Dimensions *Function of Evolution controller Exercise can be set to weekly or monthly Height Width Depth Hi H2 W1 W2 .___ in 26.75 30.1 10.5 1 13.5 6.91 cm 67.94 76.43 26.67 34. 88 17.54 Wire Ranges Conductor Lug Neutral Lug Ground Lug 210-#14 210-#14 210-#14 Service Rated Smart Switch Features Model G007225-0 G007228-0 • Includes Smart A/C Management(SACM)module standard. No.of pales 2(14 kw) (18 kW) • Intelligently manages up to four air conditioner loads with no additional Current rating(amps) 200 hardware. • Up to eight large(240 VAC)loads can be managed with Smart Management Voltage rating(VAC) 120/240,10 Modules(SMMs). Utility voltage monitor(fixed)* • Electrically operated,mechanically-held contacts for fast,clean connections. -Pick-up 80% • Rated for all classes of load,100%equipment rated,both inductive and -Dropout 65% resistive. Return to utility* 15 sec • 2-pole,250 VAC contactors. Exercises bi-weekly for 5 minutes* Standard • Service equipment rated,dual coil design. ETL or UL Listed Standard • Rated for both aluminum and copper conductors. Enclosure type NEMA/UL 313 • Main contacts are silver plated or silver alloy to resist welding and sticking. Circuit breaker protected 22,000 • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor Lug range 250 MCM-#6 mounting flexibility. *Function of Evolution Controller Dimensions Exercise can be set to weekly or monthly 200 Amps 120/240,1 e . Open Transition Service Rated Height Width Depth H1 H2 W1 W2 in 26.75 30.1 10.5 13.5 6.3 cm 67.94 76.45 26.67 34.3 16.01 Wire Ranges Conductor Lug Neutral Lug Ground Lug �.-__...._, `.• 400 MCM-#4 350 MCM-#6 210-#14 GENERAC' 10/14/18 kW Available Accessories Model# Product Description G005819 0 26R Wet Cell Battery Every standby generator requires a battery to start the system.Generac the recommended 26R wet cell bat- tery for use with all air-cooled standby product(excluding PowerPact ). G007101-0 Battery Pad Warmer The pad warmer rests under the battery.Recommended for use if the temperature regularly falls below 0 OF(-18 °C).(Not necessary for use with AGM-style batteries). of G007102-0 Oil Warmer Oil warmer slips directly overthe oil filter.Recommended for use if the temperature regularly falls below 0 OF(-18°C). G007103-1 Breather Warmer The breather warmer is for use in extreme cold weather applications.For use with Evolution controllers only in climates where heavy icing occurs. G005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical load you may Contact Kit not need.Not compatible with 50 amp pre-wired switches. The fascia base wrap snaps together around the bottom of the new air cooled generators.This offers a sleek,con- G007027-0-Bisque Fascia Base Wrap Kit toured appearance as well as offering protection from rodents and insects by covering the lifting holes located in the base. If the generator enclosure is scratched or damaged,it is important to touch up the paint to protect from future G005703-0-Bisque Touch-Up Paint Kit corrosion.The touch-up paint kit includes the necessary paint to correctly maintain or touch up a generator en- closure. G006482-0—10 kW Scheduled Maintenance Kit Generac's scheduled maintenance kits provide all the items necessary to perform complete routine maintenance G007216-0—14/18 kW on a Generac automatic standby generator(oil not included). The Wi-Fi enabled LP fuel level monitor provides constant monitoring of the connected LP fuel tank.Monitoring G007005-0 Wi-Fi LP Fuel Level Monitor the LP tank's fuel level is an important step in verifying the generator is ready to run during an unexpected power failure.Status alerts are available through a free application to notify users when the LP tank is in need of a refill. G007000-0(50 amps) Smart Management Modules (SMM)are used to optimize the performance of a standby generator.It manages G007006-0(100 amps) Smart Management Module large electrical loads upon startup and sheds them to aid in recovery when overloaded.In many cases,using SMM's can reduce the overall size and cost of the system. G007169-0(4G LTE) The Mobile Link family of Cellular Accessories allow users to monitor the status of the generator from anywhere G007170-0(Wi-Fi/Ether- Mobile Link Cellular in the world,using a smartphone,tablet,or PC.Easily access information such as the current operating status and net) Accessories maintenance alerts.Users can connect an account with an authorized service dealer for fast,friendly,and proac- tive service.With Mobile Link,users are taken care of before the next power outage. Dimensions & UPCs 1218 mm 637.6 mm 148.0�nl Model UPC 25.1 inI G007171-0 696471074680 G007172-0 696471074673 G007223-0 696471082548 72.2 mm ,2a.6 in, G007224-0 696471082555 G007225-0 696471082562 11 im G007226-0 696471082579 0 1011 G007228-0 696471082586 648 mm 1232 mm 125.5 inf 148.5 mi LEFT SIDE VIEW FRONT VIEW Dimensions shown are approximate.See installation manual for exact dimensions.DO NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES. G E N E RAC' Generac Power Systems,Inc. • S45 W29290 HWY.59,Waukesha,WI 53189 • generac.com ©2020 Generac Power Systems,Inc.All rights reserved.All specifications are subject to change without notice.Part No.AGDO0973374 Rev.A 10/22/2020 --------+ .Buildin Pe t Check List&Zonin Analysis �� Address: ^n \ _ SBL• e — Zone: l L— "S Use: kV Const.Type: Other. Submittal Date: \S �U LRe"visions Submittal Dates: Applicant: Nature of Work: Reviews:ZBA PB: BOT• Other K •�FEES:Filing. C/O: Flood Plane: Legalization: O (c)-APP: Dated: otarized: SBL: Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening ( ) ( ) ENVIRO: Long. Short Fees: N/A: ( ) ( ) >SFI E PLAN:Topo: Site Protection S/W Mgmt: Tree Plan: Other SURVEY:Dated: Current Archival: Sealed: Unacceptable: ( ) , PLANS:Date Stamped Sealed: Copies: Electronic: Other. License: Workers Comp: Liability Comp.Waiver. Other. CODE 753#: Dated. N/A; ( ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery. Other. ( ( ) PLUMBING Plans: Permit Nat. Gas: LP Gas: N/A/: Order. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval• notes: REQUIRED ExISITNG PROPOSED NOTES APP OV � a�NOV 1 6 2 Frgnt: Front: Sides: Main Co Accs.Cov Ft.H S S .HS • Tot : Ft.I : P k'n Height/Stories: notes: A�=URo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/28/2023 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 CONTACT Andy Nelson NAME: BNC Insurance Agency PHONE (914)937-1230 FAX (914)937-1124 WC. IC No Ext: AIC No 90 S Ridge St Ste UL-2 E-MAIL anelson@bncagency.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Rye Brook NY 10573-2836 INSURERA: Ohio Security Insurance Co. 24082 INSURED INSURER B: Ohio Casualty Ins Co. 24074 Granite Generator Corp. INSURER C: PO Box 415 INSURER D: INSURER E: Amawalk NY 10501 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 GL master with no W REVISION NUMBER: 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. INS EXP RR TYPE OF INSURANCE INSD WVD POLICY NUMBER r06/21/2023 MM/DD EFF YYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE7CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) S 15,000 A Y BKS59884874 06/21/2024 PERSONAL SADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICYPRO 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $1:1 OTHER: Experience Mod Factor 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 2,000,000 B EXCESS LIAB HCLAIMS-MADE US059884874 06/21/2023 06/21/2024 AGGREGATE S 2,000.000 DED I X RETENTION S 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE � NIA E.L.EACHACCIDENT S OFFICERIMEMBER EXCLUDED) (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook Building Department is included as an additional insured when required under written Contract or Agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 A- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD f"NEWK Workers' STATE Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) Ib.Business Telephone Number of Insured (914)837-4850 Granite Generator Corp PO Box 415 Ic.Nl'S Unemployment Insurance Employer Amawalk,NY 10501 Registration Number of Insured Work Location of Insured(Only required if coverage is specifically I d.Federal Employer Identification Number of Insured limited to certain locations in New York,i.e.,a Wrap-Up Policy) or Social Security Number 474068283 2.Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Ohio Casualty Ins Co. 3b.Policy Number of entity_ listed in box"la" Village of Rye Brook XW059884874 Building Department 938 King Street 3c.Policy effective period Rye Brook,NY 10573 6/21/2023 to 6/21/2024 3d.The Proprietor,Partner or Executive Officer are ❑ included.(onh check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carder 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 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: Paul Sohigian (Print name of authorized representative or licensed agent of insurance company) Approved by: � 8/28/2023 (Signature) (Date) Title: Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: (914) 937-1230 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 THIS IS TO CERTIFY THAT I HAVE SURVEYED RICHARD A.SPINEW Lod s, B/acfc Q, Sic lion A iS�.6d."v.�,on 776 IArr BOSTON POST ROAD MO� pF f11 yC /G 'c 3 Town of Rye, /YcsfcheSf MAMARONECK.N.Y. TEL.381.1357 FILED IN THE WESTCHESTER COUNTY CLERICS OFFICE. DIVISION OF LAND RECORDS �I (FORMERLY REGISTER'S OFFICE) AS MAP ® I HAVE LOCATED ALL EXISTING BUILDINGS AND LINES OF POSSESSION AS SHOWN HEREON. I HEREBY CERTIFY THIS SURVEY TO TO WHOM LIABILITY IS LIMITED. SURVEY AND MAP COMPLETEDrT/y 6, lyb6, SCALE ONE INCH TO 30 FEET. GUARANTEED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS OF THE NEW YORK STATE LAND TITLE ASSOCIATION NOTE:ALL CERTIFICATIONS MADE HEREON ARE VALID FOR THIS MAP ANDnQ COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. 6' RICHARD A. ELLI n ,LOLOfG udd%/,on Uder Gong/ruCi zl919. /o.7 N.YJ.LIC.LANO°VNV[Y011N0.�°40 ` pills ; 0 O.fs 23 3g8f� toy�o- R >� °c• 5p irjs'o A Qo.7 gw�9 56.ae r V ; vq ego% 01 D �J 7 ct, /55 9 . Ncw ro4 Fz f FIELD BOOK PAGE 7 PERMIT# o�3-- DA ROV D ILI BUILDING INSPECTOR, illage of Rye Brook NY NOV 1 5 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT