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HomeMy WebLinkAboutMP25-028 Qy�BR �. J tGGwj��� G C G v G t 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 January 5,2026 Andrew Rosson&Susan Rosson 27 Dorchester Drive Rye Brook,New York 10573 Re: 27 Dorchester Drive, Rye Brook,New York 10573 Parcel ID#: 129.66-1-16 This document certifies that the work done under Mechanical Permit #25-028 issued on 3/3/2025 for the installation of a new condenser and a new air handler has been satisfactorily completed. Sincerely, *; 4; Steven E. Fews Building&Fire Inspector /to BRC�v� O Zm w � OY �982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: O V` -`` �\ DATE: I`Z �Lk Cr PERMIT# n Z ISSUED: SECT: \ BLOCK: LOT: v LOCATION: OCCUPANCY: -I y ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION /lpl REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ INAL PLUMBING FINAL ❑ OTHER ■ s � a � a N W a N N N61 p. o IV Or. i 6 �■O/ O � � � N � � c a a Q ■ z a , a `o ono o W 0 3 ,5' V� No • O z Q Q o V v oU (,� 10, -� °° O © z z v X F- �-+ a3 3 x U QN � V W x cc� rV Q U � o L V w o U 0E H c z � ¢ x o op ob _ BUILDZC DEPARTMENTRVIL OF RYE BROOK FEB 2 B 2025 938 KING ET RYE BROc ,NY 10573 _ qL- 9-%0 VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: MAR 3 ZO Permit Fee: $ d� Approval Signature: Other: S 767C) Disapproved: (fees are non-refundable) r•�,r******,rw**:r*******,k,t,k******************,r*************�*:�********,t*se**,kat**,k**r,r*,r****vrr*,x*w,�*�******� 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#C 105.2 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. ****tk'k*4e de do tF*#9e ti*tk9:sk kt'*A'*#•*'kktk***k tk�fc*ttnklF*'k*dF tt'k**tk*eF t49F 1F ek 4t eF dr*'k**yk"ktY*k nk k*F itr:F*k*:F:F:E eF:F e4:4�t at ie*F�*Y it et kkic�:x Application dated, —<W—3 Sis 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: 2-4 17e • SBL: IQ Zone: 2. Property Owner: re ;�Qt:r � Address: 2_�- _ZCX04tP� D( Phone#: C111 - Cell#: email: ( 11M LJ 3. Contractor: t d��'LC'►���.s�I�LC� Address: 2b ti1te2xxe11Pl.k gAlM4�__-A k� Phone#: C�1 N—C.iS ! CUL) Cell#: email: VX)e 0 e(x 4 ec m 4. Scope of Work:New Installatio�on^^(4•Replacement( )•Removal( )•Other( ): 5. List Equipment: '[\VcA WM9 Io 'A'�tCU.):30 VDA.,P5 Rg- `V•,`E.( bod G fir, -,-Pr 6. Location of Equipment: 0YfNQCl l( R rc, o4c on U►n"rJ1 0r po fr 7. Method of Installation/Removal(fist all equipment needed to perform job): t 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: � (l �IIS,' 1( 1) ,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 Keating,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 this day of ,20 2 day of RM)a 20 Signature of Property Owner nature of Applicant Ar► Poss©'n tN31 Print Name of Property Owner Print Name of Applicant Notary Pub *- Notary Pub ' :T;�—' JENNIFER RIVERA JENNIFER RIVERA Notary Public.State of Now York Notary Public-Stat•of Now York NO.01 R1630SO56 N0.09116311110116 QwIIMad In Bronx County Qu&IIM*d In Oronit County [my Commf111"101`00 Fob 2d,2027 µy tunimi3sir�n Cz�16irps Mrb 22, 2017 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 � r N C-4 N y 1 O p OO pp arl .N+ M � cz A a, r: i f z a J W N • .r p Thy' cf;16 W >-4 Z z N w 8 F • IN Cl)oc a r ^�' C �. � �• �' U � ti W f i-i e4) Lin WCA Ln UPI O oo W. A x Z Q 0 z " r Z " � ; a , CN O cN en V w °� x � 7 z u z f H H � J O U W C d� � r ~ Q A a Q N w z7 v3 a N p W z on N Q w a. v R" CA oe • L yE BRQO BUIL E M ENT VIOL E OF RYE OK i 938 KIN , ET RYE B ,NY 10573 n v ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY # ✓+ EP#: 15 I Cx 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$750.00 Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an /or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. //,R,l!,^, /I //__ 1.Address: 7 �D�e_'p 5 01 SBL:���q (1JIlJ�/���J Zone: I 2.Property Owner:�riN//;�F,L- -/�2 J�e_5_ j' /Address: 2 7 oaqdt5gro Phone#: 9� ��d y' Cell#: email: 3.Master Electrician/Licensed Installer: ����7y m �✓u'� 1�- Address:73 5 �7106790 ` Lic.#:Lk7 Phone#:%n71?67 90 Cell m ft- e,O *31 7,C email: ' ` l Company Name: 171 L11149 Tile bL� X_ Address:33 - , LN 1�.l 4.Proposed Electrical Work/Fixture Count: �� 5.31 Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: pJ1'i ae^% WatYyICLFJk o 3 being duly sworn,deposes and states that he/she is the applicant above named,and does furth m a .; k1 Z.N-� a (print name of individu I Wing as thejpplicarµ) ' ,� " y state that(s)he is the , ti D C$Yf�,lC4n for the legal owner and is duly authorized to make and file this application. 0 °c) (Master Electrician/Licensed Installer) ¢m�O 00 The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any worlr;('n z y t! performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this r u 0 LL'af application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fir a 61 e Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. 00 a z ° Sworn to before me this Sworn o of a me this day of 20 day of 20 z a 111„ Signature of Property Owner Signature ant Print Name of Property Owner Print Name of Applicant_ ' - Notary Public INSPECTIONSTATEWIDE • SWIS • ;)fGre 11W r Date J 2S ►mat Certir,cate f •4.,I1a�y — zip /DS7 Town: 46'e2dv ! sr kicifess Cross Street Section Owner Name/Address P OMtrrt to n.b,— /� � O Contact Nurn M? 151 G lntl G 0[33''O t More Than 3 r 13G&aw 04ttic terde Restdenua 0Co„----� ,' N.wWa(v, Spec&&Rec7pt GFCa aF , Sw*ches Dimmers Smoke Alarms Carbon Mona Hood Trash Compact Arrr1 Amps pr r Cooutop w Oren ll Rol-gerator Disor" 0 r•noave Warm Draw Incandescent Fluorescent SERVICE Amperage vbttage 1P TP • s, M a Disconnect inaer.yoora New ❑Recmrn Overhead ❑Change ❑Visual Re-hrAwl,or. 0 R"nspecitat AOWttorallntamation tj �'� n � 1-7 11W ppKaton n rYd br ore.1:1"r'r tion 1M aarr t.rr+wO•Y StMI'f Tlaa.pptttY�w tntrnard b row.Vn.pO..N.lE�x b or rMp(Md.I M nr t.nt of ntpKtbn at]ARr+n�nrr.ty t+a.r Men+Ktattrio.rt>w rr wA110rIfA b wHIR tl1�.l�plorl rd M N WIN tlo MOM"awn ftPDMO The mere OK WM PW VWV 4 rM 410P 00k.tiDrs 4 ow Abv-411d 0.wtlh F•1'arM r WWI r•cP Wp y rtW 806&AM!ortw a nMtvUM pwtt yw+ro so 0-ftme r m one r odoa.a M!At br Mw pphts— Irypectw Date fmatl.mv. 'Mpettot a Company Name O CF Date �rc1na1 nr Address // City/State /" //ry/l -7�f Ltv Coat O�0 License I `+v P!0 0 l l f /�v���' �Z/S 1 State Wide Inspection Services 1080 Main Street � I Fishkill, NY 12524 � ]Q 845 202-7224 Phone 914-2194-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: off ice(�)swisny.com Service With Integrity E3UII.DING nEPARTMENT Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: McCormack Electric Inc Andrew&Susan Rosson 334 Sarles Lane 27 Dorchester Drive Pleasantville, NY 10570 Rye Brook, NY 10573 Located at: 27 Dorchester Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: 25-257 129.66 1 16 Certificate Number: 2025-8962 Building Permit Number: 25-028 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: 27 Dorchester Drive, Rye Brook, NY 10573 The Basement& 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 19th day of December 2025. Name Quantity Rating Circuit Type Air Handler 01 Condenser 01 Switches 01 GFCI 02 Officer: Frank]. 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. HBX/HCX Series BLOWER DATA MO- CFM vs.EXTERNAL STATIC PRESSURE UNIT FAN TOR MODEL SPEED DUTY HP 0.10 0.15 0.20 0.25 0.30 0.40 0.50 (240V) 18HBX LOW COOL 1/6 780 750 720 700 660 600 510 LOW HEAT 780 750 720 700 660 600 510 -sI za var ° e 24HBX HIGH COOL 1/6 900 880 860 830 790 700 600 LOW HEAT 740 710 690 660 630 570 490 LOW COOL 1210 1190 1160 1140 1110 1050 990 --r------ CIRCUROREWR POWER 30HBX LOW HEAT 1/3 1210 1190 1160 1140 1110 1050 990 1 1 IIF REWIRED) SUPPLY NORaoNrAL 1 1 HIGH COOL 1410 1380 1340 1310 1270 1190 1060 coNVERneLE 1 I 36HBX LOW HEAT 1/3 1170 1150 1130 1100 1 1080 1030 1 970 DRAIN PAN i A 1 IAIRFLOWI HIGH COOL 1760 1730 1680 1640 1580 1480 1360 COOLING COIL -_-- 48HCX MWD. COOL 1/2 1490 1460 1430 1400 1370 1300 1210 DIREEt E%PANSN)N °I � �vL LOW HEAT 1280 1260 1230 1210 1190 1130 1060 HIGH COOL 2130 2110 2090 2060 2025 1930 1820 60HCX LOW HEAT 3/4 1690 1680 1660 1640 1620 1580 1540 COiL coR=.s �E-►� -= D --►I 61HCX HIGH COOL 3/4 2175 2150 2130 2100 2065 1970 1855 (Al sWEAr_I LOW HEAT 1725 1715 1695 1675 1650 1610 1570 NOTE: Use 48HCX for 3.5 ton applications and field convert to medium speed for cooling. (See P.4 for Model Numbers) PHYSICAL DIMENSIONS UNIT A B C D E P G H LIO. SUCT. FILTER MODEL (SWEAT) (SWEAT) 18/24HBX 40 20 20 18-1/2 16 2 18 16 3 3/8 5/8 18 X 20 X 1 30/36HBX 42 23 20 21-1/2 16 2 18 17 5 318 3/4 20 X 22 X 1 48/60HCX 48 28 21-1/4 26-1/4 17 2 19-1/4 18-1/4 8-7/8 1/2 7/8 20 X 25 X 1 61HCX 54 28 21-1/4 26-1/4 17 2 19-1/4 18-1/4 8-7/8 1/2 7/8 20X25X1 ELECTRICAL DATA ELECTRIC HEAT CAPACITY MAX.FUSE NOTES: UNIT NOM. NOM. kW BTUH TOTAL MIN.CIR. OR MACR 1. Nom.cooling at 45°F suction temp. AMPS AMPACITY BREAKER MODEL CFM COOL 80°F DB/67°F WB air on. BTUH 240V 208V 240v 208V 240v 208V 240v 208V 240v 208v 2. 15kW and 20kW models require 2 supply -0 0 0 0 0 1.6 1.6 2 2 15 15 circuits. 25kW models require 3 supply -3 3 2.3 10,200 7,700 14 13 18 16 20 20 circuits. 16HBX -4 600 18,000 4 3 13,600 10,200 19 16 23 20 25 20 3. Units suitable for installation with 0" & -5 5 3.8 17,000 13,000 23 20 28 25 30 25 clearance to combustible material. 24HBX -6 800 24,000 6 4.5 20,500 15,400 27 24 36 29 40 30 -8 8 6 27,300 20,500 35 31 46 38 50 40 -10 10 7.5 34,100 25,600 44 38 54 47 60 50 -0 0 0 0 0 2.5 2.5 3 3 15 15 -5 1,000 30,000 5 3.8 17,000 13,000 24 21 30 26 30 30 30HBX 8 8 6 27,300 20,500 36 32 46 40 50 40 36HBX -10 1200 36000 10 7.5 34,100 25,600 45 39 56 49 60 50 (2) -15 15 11.3 51,100 38,500 45 39 56 49 60 50 21 18 26 23 30 25 -0 0 0 0 0 3.5 3.5 5 5 15 15 -5 5 3.8 17,000 13,000 25 22 30 27 30 30 -8 8 6 27,300 20,500 37 33 47 40 50 40 -10 10 7.5 34,100 25,600 46 40 57 50 60 50 48HCX (2) -15 1,600 45,000 /5 11.3 51,100 38,500 46 40 57 50 60 50 21 18 27 23 30 25 (2) -20 20 15 68,200 51,100 46 40 57 50 60 50 42 36 53 46 60 50 46 40 57 50 60 50 (2) -25 25 18.75 85,250 63,900 42 36 53 46 60 50 2/ 1 18 1 27 23 1 30 1 25 \11", c� -0 0 0 0 0 6.0 6.0 8 8 15 15 -5 5 3.8 17,000 13,000 27 24 34 30 35 30 -8 8 6 27,300 20,500 40 353 49 44 50 45 60HCX -10 10 7.5 34,100 25,600 48 42 60 53 60 60 C U S & (2) -15 2,000 60.000 15 11.3 51,100 38,500 48 42 60 53 60 60 ( T 61HCX 21 18 27 23 30 25 0STEDO (2) -20 20 15 68,200 51,100 48 42 60 53 60 60 ,I Wxr wno AvERnsstut",novEJxi�weu 42 36 53 46 60 50 a°>,c°r xw wwoa°<ane rlum 48 42 60 53 60 60 cant..m rro„bb.d.rAppu.:i npp,JuciRW Cameq Y Datlp RkPr°A..euv° (2) -25 25 18.75 85,200 63,900 42 36 53 46 60 50 21 118 127 123 1 30 25 FIRST CO. HBX/HCX SERIES SPEC Product Specifications 9 Dimensions AIR DISCHARGE:ALLOW 60" MINIMUM CLEARANCE. L \>� W f ALLOW A MINIMUM OF ?� .` ' J I', I I 12"CLEARANCE ON ONE SIDE OF ACCESS PANEL TOA WALL AND A H 1 I,•`� / MINIMUM OF 24"ON THE ADJACENT SIDE OF ^ �I �` �`i f ACCESS PANEL 3 J ll AIR INLET LOUVERED PANELS:ALLOW 12" MINIMUM CLEARANCE Figure 2 Moded Size Dimensions(Inches) BOVA24-15 24-15/16[633] 28[711] 28[711] BOVA36-15 24-15/16[6331 28[711] 28[7111 BOVA60-15 33-3/16[843] 29-1/8[740] 29-1/8[74( Table 29 Product Specifications 3 Product Specifications :. . . :. Dedbels((d6(A)] -_ Max @ 100%load 76 78 80 Min @ min load 59 60 60 _ ._ .. _. 1...- ._._ ..i_.. .x_ _1 1 ... Compressor RLA ........ _ -1 _ 19 19_ 29.. Condenser Fan Motor Horsepower(HP) 1/3 FLA 2.5 Refrigeration System Refrigerant Line Size' Liquid Line Size(OD) 3/8' 3/8" 3/8' Suction Line Size(OD) 3/4" 3/4" 7/8" Refrigerant Connection Size Liquid Valve Size(OD) 3/8" 3/8" 3/8" Suction Valve Size(OD) 3/4' 3/4" 7/8' Refrigerant Charge(R410-A,oz) 87 107 152 Expansion Device EEV EEV EEV Maximum Line Length 100 FT 100 FT 100 FT Maximum Elevation Difference 50 FT 50 FT 50 FT Operating Range Cooling 40°F-120°F Heating 5F-86`F Elecb"Data Voltage-Phase-Hz 208/230-1-60 208/230-1-60 208/230-1- Minimum Circuit AmpacityZ 22.9 26.7 39.2 Max.Overcurrent Protection 35 45 60 Min/Max Volts 172V/270V Weight Net Weight(without packaging) 126 134 186 Gross Weight(including packaging)' 154 162 218 Dimensions Unit L x W x H(in.) 28 x 28x 24-15/16 28 x 28x 24 15/16 I 29-1/8 x 29-1/8 r Outdoor Coil - - _ ........ - - _ Net face area-sq.ft.Outer Coil 12.7 12.7 18.3 Tube diameter in. 9/32'(7mm) 9/32"(7mm) 9/32'Yrn No.of rows 1 2 2 Fins per inch 19 17 19 Table 1 `Tested and rated in accordance with AHRI Standard 210/240. s Wire size should be determined in accordance with National Electrical Codes; extensive wire runs will require larger wire sizes. 3 Must use time-delay fuses or HACK-type circuit breakers of the same size as noted. ° Weight values are estimated. •Always check the rating plate for electrical data on the un PCinstalled. •Unit is factory charged with refrigerant for 15'of%"liquid A o O00 p W O z U 3 .= Z O z o E CL � � o i ~O C F W ." 1 z v� 1 ^i p c 1 L V V ,1 ' O ! CY CY U) W A 1 M C Z O �y x v p — a> CL ... w CY W LL w L 5 W Q ^" a. m = z - AU) LLI a o � Z C/) w � Lna loot co LL W o Q M � W '� 3 = w WN gyp// O NCO . Y ' i w L . Z �M Jl � 0 m Q H � Ccn 30 1 � > � W 2 0 w 1 0 CO `' O 1� W -00 �• m w Q W w O . � cn W A >- LLB N Q w w w 2 U A 0 4 ter, i a z , y _ O - 1 r � . .I . . '•�t'.♦r. ¢'� ��t� ,,fir' .,�fr� � � � �' _ If �r'AL , �. tf • . Ak yy� ,.' -•,,� ,��i+,� .0 1,,�� '-fir�'. r_�.���,i �! � ' _ .; y #' -� ' �r- ��^.fki�.. '��--� -,•. - 'r� - � ram - ! _� .,�• � Via►, _ + - c r - r i r t �•.'" ._1 �Y 1j1/1�/1�` s•.1 / 11 11 Wi i <( (1 �.:— s3'•:. 1 :^f�.a ./ e� : 1 1 .:� .: N111 -.� :r:..li 11/:=_- s'� NIII � � _ Itp'• \z OCO +� > 1\ o a O k as ed o o � o 10 •�+ O w M U LO "(mm) T;' -, r••1 Q W o io�ection U 2 E ¢ cC 0 co w � N Ll.GL .✓ `C p�tau<(0))1.:. Z.aS e w (n ( 05 =� w cfl w o t edae _ ¢ as CU Cd i 7 ca cz � ��= i- W C U � _ =• t(o)> o s N ' U cn co CA Q <(0)) .`�. . R` .f.;;..._� ,�_� . . . .���_' 11 I�:i":=� 1/11`•'''^�s a'" i7 1 1 's=is•- v .'`71��1„�S —s•� ,��<(0))�;/ O z z a - SS fljl ' liflllfi 1IIf11Nh y 1/h a11f/11111.' 11/ /111 ys�/yg* ' 1/1 ;qS yy A si;7t� ►1111 f11111� . / .O A •♦ �^ ^ •• -',lif/Ai��� •♦ .�/li�i�AY�•+i •1�/��Tl�A 1�Ai•• i: •♦ �A • •: w it sy� kSb . i2 5� �. � r5f .� r. •, �' n' r t,. J.� aG•1 r PHOEMEC-03 FHOLZHAY A`O�RO CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 31251225/2024 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). PRODUCER CONTACT Luann Silano Acrisure Insurance Partners Services of NY,LLC acNr o,E>tt:(914)937-1230 (A/C,No 90 S.Ridge Street Rye Brook,NY 10573 E-MAIL .lsliano@acrisure.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Stillwater Property 8r Casualty Insurance Company 16578 INSURED INSURERS: Phoenix Mechanical Corp INSURER C: 26 Vreeland Avenue INSURER D: Elmsford,NY 10523 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX� OCCUR X MPGR3802-02 3/16/2024 3/1612025 DAMAGE TO RENTED $ 100,000 MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F_x1 ipra LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident X ANY AUTO BAGR3802-02 3/16/2024 3/16/2025 BODILY INJURY Per n $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILYBODILY INJURY Per accident $ AUTOS ONLY AUOTO ONLY PefaERdN DAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S,000,OOO EXCESS LIAB CLAIMS-MADE XSGR3802-02 3/16/2024 3/16/2025 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 OTH- $ WORKERS COMPENSATION Y/N PER AND EMPLOYERS'LIABILITY R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook 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 Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEW Workers' YORK STATE Compensation Board CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured Phoenix Mechanical Corp 914) 690-1000 6 Vreeland Avenue 1c.NYS Unemployment Insurance Employer Registration Number of Elmsford, NY 10523 Insured 1d. Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State. i.e..a Wrap-Up Policy) 13-3934943 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Company of North America Village of Rye Brook 3b. Policy Number of Entity Listed in Box"'Ia" 38 King Street C72673621 Rye Brook, NY 10573 3c.Policy effective period 09/30/2024 to 09/30/2025 3d.The Proprietor, Partners or Executive Officers are 0 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 1a"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 Lvnne Boone (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ZLy 10/02/2024 (Signature) (Date) Title: Assistant Program Manager Telephone Number of authorized representative or licensed agent of insurance carrier 214-721-6248 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