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HomeMy WebLinkAboutMP25-010 �yE DR C J J� vJ r7 1q VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www�ebrooknygov TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 3,2025 Luigi Ferraro 11 Whittemore Place Rye Brook,New York 10573 Re: 11 Whittemore Place, Rye Brook,New York 10573 Parcel ID#: 135.76-1-18 This document certifies that the work done under Mechanical Permit #25-010 issued on 2/3/2025 for the installation of a new oil fired boiler has been satisfactorily completed. Sincerely, z 4 Steven E. Fews Building&Fire Inspector /to �yE BRC��. cu � t7 1982 BUILDING DEPARTMENT ❑$UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 1 , ��\ T r-f,-)J DATE: PERMIT# � ? ` V ISSUED: SECT: I (o BLOCK: LOT: LOCATION: �' ?'JP`��.�� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION (/ ❑ NATURAL GAS { w L C ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 14 V A, C a01 QyE BRC�k w � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ©ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 1 ��1 N �1�Yl� P (A Lj DATE: PERMIT# Z S l)\ ISSUED: .) 2-1 rzl SECT:13 7{,BLOCK: LOT: i LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑' /ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS J ❑ L.P. GAS s ❑ FUEL TANK N ❑ FIRE SPRINKLER `1 ' 0. FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER J : N o w N C= N I� . M M m 1+•1� N �j w id p C1 r, a "o a� � en z o 72 Cl : bA o O S s W M W o10 ow 14, �iP4 � , we aN Q z w V110 c ° V U2 .114 V1 ' aQ �0-0 00 cy to z U O o v O � gb Z W 1-4 O w4 as cu .F 0 a"+ O C.) U W ti v v ,7 1 R a BUILC'1�,'E_T DIE MENT [E C E lJ V VILI; RyiN OOK 938 KINGRYE BRn ,NY 10573 JAN 3 5 '0 6�$� ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONII�N/G/�E UIPME)NT FOR OFFICE USE ONLY: PERMIT#: / `j/ © f 0 Approval Date: FEB 2 Permit Fee: $ l-0 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. r Application dated,\-q. 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. I. Address: Zone: T �- 2. Property Owner: ► Vprrrcn Address: tit'blr''4e rtnre Phone#: O y Cell#: email: J 3. Contractor: Address: Phone#A\,, 'q`�R1 +3AC0 Cell#: e m a i i, de ,tee 4. Scope of Work:New Installation( )•Replacement OQ•Removal O•Other( ): 5. List Equipment: 1 l ' -Pl ' - d n <,C)S'pe e)o4lLr4I 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): 1—tt@���� t 611/2024 STAT OF NEW YOR , OUNTY OF WESTCHESTER ) as: _ 'IA! e , r`�eM� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indh4clual signing as the applicant) and further states that(s)he is the Tank Removal/Abandonment 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 perfon-ned,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 S',hy`'� ,20Z day of 7CItA.r,.�r ,208L5' ignature of Pr erty Own r Signature of Applicant {� Q�v-c,t, o Ft,-,reArro Q� c�.rrrhv�C',Ze a���• nkhonv IP�►�tm Print Name f roperty Owner 1 Print Name 6f Applicant oti.---li JASQN'GARCIA _ i Commission#HH 111010 ` ary Pu c N9,. 11 .`J Expires July 30,40�f Notary Public r�oFFL15 Ea dedrhn,Sudgalf4 afl§Wr SCAN LYTLE: NCIT,M f'Xf;BUC MY COMI'Mssiun Exrlres Aug,31,2025 This a tcation 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. z 6/1/2024 a ` a ° e Ln u7 \.D tq fed w \ \ 0u a N N �7 'sal 61 w t cu CAw 00 O r � � H � OG a (n CO si en W en Ncis ZA z rcr O t, 00 1 ¢ �" r M _ CA Ln Ln o z � a O Q � O Cn W z CA ��. M 3 V ... :i G1 U w a � � Z ICI � 00 1-4 tii V W d O w ` M N s � r ►w p o w Q W z A94 x H W [+ U W W o z x o w z H A z A o ; w a s a - �4444t4141*6444;41t4;44;4M4;4;�6 4-MfAU44tt44444144i41- 4-614i4-5t4- 444 yEDRC�v i D � � � V BUIL MENT VIL E�; Rl :: OK FEB 18 2025 938 KIN , $ ` ,NY 10573 VILLAGE OF RYE BROOK In v BUILDING D_FPART_M-NT ELECTRICAL PERMIT APPLICATION �. - Westchester County Master Electricians License Required FOR OFFICE USE ONLY 4w*- I` � 0 EP#: Approval Date: FEB 19 2UZAl" Permit Fee: $ Approval Signature: W 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,2117125 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:11 Whittemore Place SBL:135.76 - 1 - 18 Zone: 2.Property Owner: Luigi Ferraro (C/O Pietrangelo/son) Address: Phone#:312-607-7846 Cell#: email: Luigi.Feraro100@gmail.com 3.Master Electrician/Licensed Installer:Angelo Zaccagnino Address:81 Maple Ave, Rye NY 10580 Lic.#:755 Phone#:914-921-3244 Cell#: email:Office@Zaccagnino.net Company Name:Zaccagnino Electric Address: 4.Proposed Electrical Work/Fixture Count: Wring for an EK-1 Boiler 5.3rd Party Electrical Inspection Agency: SWIS STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: "Affidavit Separate" Angelo Zaccagnino ,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 Master Electrician 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 Sworn to be fe me this day of 20 day 20 Signature of Property Owner ` I Sign e o pp .A),J� Print Name of Property Owner nt NAmW YIW 1 r F NOTARY PUBLIC-ST NEW YORK Notary Public �c,t�ry pp 1 9u�litre tw w* he ter County My commission Expi s Oct ber 14, �/1/ 4 STAT OF NEW YORK,COUNTY OF WESTCHESTER ) as: ne ly Zqccu gO i Ao ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual sibming as the applicanQ and further states that(s)he is the T 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. -{1 Sworn to before me this Sworn to before me this day of S`h u G 20 2 S day of /, µ/v r ,20 2 Jr 4V ��� . ,t5 a4oy-(2e,� r4 Signature of roperty Ow her r `1 Signatt1 of Ap 1 C Y`q t ��✓rl t� t c s e(V�Of tJ !ic,plv� 'A 0 Print Name o Pr p y Owner f J pp tt NNaa WOP SQ F NEW YORK JASON GARCIA No. 01 u 10 38 N r * tc} Commission#HH 111010 mf= Expires My 30,2025 y�orrrm sa n Expires October 14, 20_ ff BondedThruBudgeW—,12'YSmi— This ap ion 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/I/2024 STATEWIDE • Service With hitegrity 1'1 • • SWIS JOB APPLICATION84 1 914.219.1062 • • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information D FEB 18 2025 VILLAGE OF RYE BROOK r BUILDING DEPARTMENT I 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 anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional Items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions asset forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# !D LE C E �W�� State Wide Inspection Services cjk-C) DDi p 1080 Main Street I MAR 14 202� Fishkill, NY 12524 S 110V"T'iUS 845 202-7224 Phone VILLAGE t�F RYi= 13R�QK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTki-IdT Email: officeCc swisny.com —' Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Zaccagnino Electric Luigi Ferraro Angelo P.Zaccagnino 11 Whitemore Place 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 11 Whitemore Place, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-045 135.76 1 18 Certificate Number: 2025-1524 Building Permit Number: MP25-10 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 Whitemore Place, Rye Brook, NY 10573 The Basement was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 12Th Day of March 2025. Name Quantity Rating Circuit Type Boiler 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. e L , Lin O + N O C N Q? pZ N M ft] N rq A a z V Ch lz a 4 w oc a A4tc 14 x vo H z z z w Hy Ooc V z w N W ' 0-4 z a V y 00 Z w w W `^�. ~ c cn x � v Fg ►.• si � z � Q c z A oM CA 4A4;4A4641 44(l4r44.4!4A4A4606414A444tw44464aara464&4$6 ��4zjz 4.(w4�fiir t, • �EaR��k p LS��� V l.S BUIL ,v :_ MENT DD VIL ;O ,:: OK JAN 16 2025 938 KIN , ` c°.:> 8: ,NY 10113 VILLAGE OF RYE BROOK Y.gov _ BUILDING DEPARTMENT PLUMBING PERMMIIT APPLICATION FOR OFFICE USE ONL -S"—/0 _O I C' PP#: Approval Date: 40Z5 Permit Fee: $ �C 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, 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: L,���1 tG1lp►���, ��1 LJLx X2 WA SBL: 1� 1 b �. - 9) Zone: 2.Proposed Work: C�fNc-eCA-�—C _t 1�,r1�CE6C 'c'CL-AD_ O1, t) 3.Property Owner:L �cCG_S-n Address: 1 1lh��P QI.. ,lie- ADZ m\ i Phone#: <Cel``l#:J1� � 4.Master Plumber: Calm S Ol `U U`I^'1 Address: I�-1 %�M Ct_4_0 k'� S Ll 6�- S; Q Lkln Lie.#: G Phone#: �� -�.3"l+ ell#: email: u r O IhO�,(� Company Name: CA to Address: 3 4 o ` C V>� FC� INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE��l� � 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 3,d Floor 4`h Floor 5`h Floor Exterior 5.* List Other Equipment/Provide Details: _11 - �1-r�n�"�Pj- ',.el- HP.Ct (Notarized Signatures Required Next 2 Pages) -1- 6/l/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,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 Tank RemovaUAbandonment 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. y fih 1 Sworn to before me this Sworn to before me this day of S�hu ,20 2'S- day of qnidC4 ,220''' i jc5 d hwc ztll f rnf � gignattke of roperty O ner Ainatire of Applicant 1 1 �t eA v%L—t ,e l o Fevyg(o CAS &Jk"+0'62cD a Qvt — A/)"1- C— V-" Print Name of r y ner -1 Print N me of Ap lican ot�`:P6Bt� JASON GARCIA C• 2 .•' '•. o„ Commission#HH 111010 I b Z 7 Expires July 30,2025 Notary PuFfic TF0 Bonded rhru Budget Ncul Svc 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. VOR MUEZ N011 M Kal"o ST-NTE OF MW YM *11 AA0031066 tr *.14enx COU* Na��15,2tt4� z 6/1/2024 BUILD MENT D '� I VILY) ;' ?Y OOK lvf'.::.: :. 938 KING 'T ET R 'BR ,NY 10573 JAN 16 2025 w '0 fi ov VILLAGE OF RYE BROOK �--'/ BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE $216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 3, LQ l � 1 I-trV'C-f 0 , residing at, �� ���-�� -v-1 orC f ick ��{�rc,' k, A)Y (Print name) (Address where you live) T- being duly sworn, deposes and states that (s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; A'e �" o rc c-,cc, , 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. a au �o►� Ze� (Signature of Pr(rperty Ow er(s)) PI (-a✓i .e1 6 Fe�.rQ�a Ll zcj (Print Name of Property ner(s)) Sworn to be a this day,of , 20 "L (Notary Pu i ) f0y P146,, JASON OARCIA o Commission#HH 111010 ,r �„ 37 Expires July 30,2025 9TFOF F,.OF Bonded Thru Budget Notary Services -3- 6/I/2024 - I I 1 - • I . - - - • . • • - • . I .. ;. to "I r x { 4gli' t I `A .a There are models and sizes available for every installation and environment. Fits under stairs and inside small closets! x Our patented spiral boiler precisely controls the flow of water and flue gases i for the best heat transfer. Plus! No pins, baffles or micro passages to foul and reduce efficiency overtime. EK2 Swing down door for easy service and cleaning! • Exceptionally clean burning is Virtually unlimited hot showers! —qqqqe ASME certified construction • Stackable model available • 5 zone control • Easily piped to multiple zones • Plus! Outside combustion air connection ENERGY • Cuts up to 40% off home heating bills! KINETICS u • Light weight construction Better heating. Bigger 5avings. 0 Accepted For Use City of New York Call us LISTED Department of Buildings MEA 140-03-E •d. • / / . . I • / more • • .,O .System 2000 is an integrated system — R' makes both heat and hot water! 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Energy Converter Weight 350 lbs. . b IIbUYEo,Iry 3U� o o c Lifetime limited IS wanal ty on EnerCDsL1fE11ME LIMITED WARRANTY Digital Energy =7 _ Managerand z1 ENERGY ASME pressure -•* ..rKINETMS vessels LISTED H As an ENERGY STAR*Partner,Energy Kinetics has - determined that model EK1 meets the ENERGY STAR® ra guidelines for energy efficiency for oil heat input from 0.68 to 0.85 gph.®The color yellow for heating boilers is a registered trademark of Energy Kinetics. &x Accepted For Use City of New York ' Department of Buildings MEA 140-03-E web site ENERGY �. j<;iKINETICSO Easy service compact oilheat EK1 Frontier, with 40 gallon low boy tank and stand 51 Molasses Hill Road, Lebanon, New Jersey 08833 T. 800 323 2066 • F: 800 735 2068 visit: www.energykinetics.com � •♦ 1F •a '1R ♦• • •♦ •' s f� tlis { gg t Y Jsl s / < '1 � �� t•♦ � � 1.1.1 =`! v t n►1./•/1 � „j `w .'1 i: ► 1 1 11 111► ►111�, ►1/1►, a� 1 • - hh 1`is. 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IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT CLIENT CONTACT CENTER_ FEDERATED MUTUAL INSURANCE COMPANY PHONE I FAX HOME OFFICE: P.O. BOX 328 (A/C,No,Ext):888-333-4949 (A/c,No):507-4464664 OWATONNA, MN 55060 E-MAADDRESS:CLIENTCONTACTCENTER ct FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURERA:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 330-130-6 INSURER B: WESTMORE FUEL COMPANY INCORPORATED INSURER C: 86 N WATER ST GREENWICH,CT 06830-5886 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPI To LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES $100,000 MED EXP(Any one person) $5,000 A N N 9062815 06/01/2024 06/01/2025 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY �CT ❑LOC PRODUCTS S COMPIOP AGG $2,000,000 OTHER: INE AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea n X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY SCHEDULED N N 9062815 06/01/2024 06/01/2025 BODILY INJURY(Per Accident) AUTOHIRED AUTOS ONLY NON- WNED PROPERTY DAMAGE AUTOS ONLY Per Aid�nb X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $7,000,000 A EXCESS LIAB CLAIMS-MADE N N 9062816 06/01/2024 06/01/2025 AGGREGATE $7,000,000 DED I RETENTION WORKERS COMPENSATION X PER STATUTE I OTHER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $500,000 A OFFICERIMEMBEREXCLUDED? N/A N 9917566 06/01/2024 06/01/2025 (Mandatory in NH) E.L DISEASE EA EMPLOYEE $500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION 0-6 35 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED VILLA 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 - O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured 203-531-6800 Westmore Fuel Company Incorporated 330-130-6 86 N Water St 1 c.NYS Unemployment Insurance Employer Registration Number of Greenwich,CT 06830-5886 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State, i.e.,a Wrap-Up Policy) Number 06-0739367 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company Village Of Rye Brook #35 938 King St 3b.Policy Number of Entity Listed in Box"1a" 9917566 Rye Brook NY 10573-1226 3c. Policy effective period 06/01/2024 to 06/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) ❑X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Erin K Christensen (Print name of authorized representative or licensed agent of insurance carrier) Approved by: C 2U— /(�, ` 05/10/2024 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov