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• �9�z 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.ors
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
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ADDRESS: � DATE:101,
PERMIT# ` 1`vim � ISSUED: , �"'C�JECT: (�" (� %LOCK: 2 LOT:A 1
LOCATION: �� <-�7_� OCCUPANCY:
❑ Violation Noted THE WORK IS... ❑ �ASSED 9/ FAILED / REINSPECTION
❑ SITE INSPECTION , REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas
❑ L.P. Gas -� Au `7✓W3
❑ FUEL TANK
❑ FIRE SPRINKLER A C
❑ FINAL PLUMBING
❑ CROSS CONNECTION-.- �1
❑ FINAL
❑ OTHER
BUILDPTI
VILL OOOKInitial I spec icon Date: 0 Pass
MICHAELJ.IziO 938 KING ST REw YORK 10573 � IAda3❑ Fail
BUILDING&FIRE INSPECTOR (914)9OOk.or Re-Inspection Date: ❑ Pass
mizzo@rvebrook.org
/ . ❑ Fail
FIRE INSPECTION REP RT NOTICE OF VIOLATION & ORDER TO REMEDY SAME
✓Site Address: `� �� ` �- `, Zone: SBL:
Occupancy: Y 1',`t ��C 't \-' -State Use Classi ation-
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Business Owner: Phone:
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Building Owner: l ` L�� /Phone:
Emergency Contact: Phone: b
Building Representative in Attendance:
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Take notice that the following violations of the New York State Uniform Fire Prevention&Building Code and/or the Code of the
Village of Rye Brook w nd e�' tat, ,in the Village of
Rye Brook,NY on, 20� The person or entity served with this Order to Remedy shall
immediately com.m nc t�pc"ll listed violations and shall completely cure each violation described herein by no later than
,which is thirty(30)days after the date of this Order to Remedy.Furthermore,
upon curing any listed violation(s),you shall immediately contact the Building Department during normal business hours to schedule a
re-inspection of the premises to confirm full compliance with all applicable codes,laws,rules®ulations.
BE ADVISED THAT YOUR FAILURE TO CORRECT ALL VIOLATIONS IS A CRIME PUNISHABLE BY FINE,IMPRISONMENT OR BOTH.
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NO YES N/A
1.PORTABLE FIRE EXTINGUISHERS (PFE's)
a.906.1. Are PFE's installed throughout the space&on the premises as required by code. a.—
b.906.3.1.Is the maximum travel distance to a PFE 75 feet or less. b.
c.906.5.Are PFE's conspicuously located&readily accessible. c.—
d.906.6.Are PFE's unobstructed/unobscured from view. d.
e.906.7.Are PFE's properly mounted as per the manufacturers instructions. e.
f.906.9.Are PFE's properly installed:<40 lbs.max.5'above floor;>40 lbs.max.3.5'above floor. f.
2.FIRE ALARM SYSTEM&SMOKE DETECTORS —
a.901.6.1.Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72.
b.907.4.2.1.Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b._ 7
c.907.4.2.2.Is the height of the pull station handle located between 42&48 inches above the floor. C.— —
d.907.3.Is a fire alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d.
3.FIRE SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS
a.901.6.1.Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a.—
b.901.6.1.Are the main valves secured against tampering in the open position. b.—
c.901.6.1.Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C.—
d.901.6.1.Is a supply of six spare heads&a wrench maintained on the premises. d.— 4 —
e.901.6.1.Are sprinkler heads&cover plates unfinished or of factory applied finish only. e._ _ —
f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f.— —
g.913.5.Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g.— 7
h.507.5.2.Is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h.—
i.507.5.4.Are fire hydrants&fire protection equipment unobstructed. i._ —
j.507.5.5.Is a clear space of not less that 3 feet maintained around all hydrants. j.— —
k.901.8.Are all fire protection s 6S ems in place and maintained untampered. -7 k.— %
J
INSPECTOR: ` DATE
-1-
Revised 2/10/22
No YEs N/A
8.ELEVATORS.DUMBWAITERS&ESCALATORS
a.[PM]603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a. 6 —
b.606.3.Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b.
floors reading; IN FIRE EMERGENCY,DO NOT USE ELEVATOR,USE EXIT STAIRS —
c.606.7.Are keys for elevator car doors&fire department service kept in an approved location. C.
d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. — —
e.[B]3005.1.Are elevator machine room doors maintained unobstructed at all times. e. — —
9.COMMERCIAL KITCHENS
a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a. — —
b.904.12.5.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b. — —
c.904.12.5.2.Are automatic fire extinguishing systems serviced at least every 6 months. C.
d.904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d.
e.[RBI 122-5.13.Are grease traps provided and installed as required by Village Code. e.
f.[[PC] 1003.10. [RBI 122-6.Are grease traps properly maintained as per State and Village Code. f
g.[RB] 122-6.C., 122-9.Are all service,maintenance,&repair records for grease traps and related
plumbing maintained on the premises as required by Village Code. g.
10.HEATING SYSTEMS
a. [PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a.
b.[PM]603.2.Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. — —
c. [PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C. —
d.[PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d. — —
e. [PM]603.5.Is the fuel-burning equipment provided with adequate combustion&ventilation air. e.
11.MOTOR FUEL-DISPENSING FACILITIES&REPAIR GARAGES I
a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a. — —
in an approved location within 100' of,but not less than 20'from fuel dispensers.
b.2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. — —
c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C.
d.2305.5.Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. — —
2-A:20-B:C provided&located not more than 75' from pumps,dispensers&fill-pipe openings. i
e.2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e. — —
f.2305.7.Are weeds and other combustible materials kept at least 10' from fuel-handling equipment. f. — —
g.2306.4.Are above-ground tanks provided with vehicle impact protection. g. — —
h.2306.5.Are above-ground tanks provided with secondary spill containment. h.
12.HAZARDOUS MATERIALS(HAZ-MATS)
a.407.2.Are S.D.S.Sheets for all haz-mats readily available on the premises. a.
b.407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b. _
c.5004.2.Are stored haz-mats provided with approved secondary spill containment. C. _ —
d.5003.7.1.Are proper No SMOKING signs provided as per this section. d.
13.MISCELLANEOUS
a.403.1.Is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. � — —
b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b. — —
c.405.5.Are records of emergency evacuation drills kept&maintained on the premises. C. — —
d.505.1.Are approved address&building numbers properly placed&plainly visible from the street. d., _ —
e.506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e. — _kZ —
f.703.1.Is all required fire-resistance rated construction properly maintained as per code. f. — —
g.703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g. — — —
h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h�
i. 5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. i.
14.GENERAL HOUSEKEEPING
a.Good
b.Fair ,
c.Inadequate / p��
d.Poor INSPECTOR: DATE: � Z
-3-
Rcviscd 9/17/21
No YEs N/A
4.STANDPIPE.CABINETS&FIRE DEPARTMENT CONNECTIONS
a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a.
b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b.
c.912.2.3 Are standpipe FDC threads compatible with fire department standards. C. _
d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d.
e.905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e.
f.912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f.
g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g.
5.EXITs.MEANS OF EGRESS&OCCUPANCY
a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. _ �-
b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b.
c. 1031.6.Are exits maintained unobstructed by fumishings,decorations,draperies,mirrors,etc... C. _ (1
d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d.
e. 1010.1.Are egress doors provided and maintained as required by this section. e.
f. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f.
g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g.
h. 1013.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h.
i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1.provided as required by code. i. _ v
j. 1013.3.Are all exit signs illuminated at all times. j, — —
k.1008.1.Are the means of egress&exit discharge illuminated at all times the building is occupied. k. JZ
1. 1018.3.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures 1.
are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides.
in. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least in.
28"wide,or at least 36"wide where serving 50 or more people.
6.COMBUSTIBLE STORAGE&WASTE MATERIALS
a. 304.1. Is the building(s)and premises maintained free from accumulated combustible waste material. a. +/ _
b.304.,E.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. _
c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C.
d.315.3.Are combustible materials properly stored&separated from ignition sources. d.
e.315.3.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e.
and 18"or more below sprinkler head deflectors in sprinklered buildings.
f.315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f. _ _✓_
g.315.3.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g.
h.313.1.Is building maintained free from stored fueled equipment. (motorcycles,mopeds,mowers,etc...) h. _ L
7.ELECTRICAL
a.604.1.Is the building free from modified/damaged wiring,devices,appliances,equipment a.
and maintained free from electrical hazards.
b.604.2.Are electrical service equipment areas properly illuminated. b.
c.604.3.Are proper working space clearances provided&maintained for electrical service equipment. C. '
d.604.3.Are electrical service equipment working spaces free from any stored materials. d. _
e.604.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. e.
f.604.4.Is the building free from unfused multi-plug electrical adapters. f.
g.604.5.Are electrical extension cords being used in a safe manner as per code. g.
h.604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h. _
i.604.6.Is the building free from open-wiring spliced electrical connections. i.
j.604.8.Are electrical motors maintained free from accumulated oil,dirt&debris. j.
k.915.1.Are Carbon Monoxide Detectors installed&maintained as required by this section and by 1103.9. 15 T
INSPECTOR: DATE: 4
-2-
Revised 6/11/2020
ITEM NUMBER REMARKS
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INSPECTOR: 975 DATE:
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Revised 6111/2020
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1982 BUILDING DEPARTMENT
iaJ 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:— � �" — �� _ DATE:
PERMIT# ISSUED. SECT: BLOCK: LOT:
LOCATION: �G` C OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION t REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER �{� l Imo\ w< A W\V"h
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
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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 Uebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
';�
ADDRESS: (► 1 , J DATE:
PERMIT# ydl. ` ��` J ISSUED:\�� 4 SECT: BLOCK: LOT:
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VIOLATION NOTED ' THE WORK IS... El ACCEPTED REJECTED/ REINSPECTION
SITE INSPECTION \,-A-cy\ e--\ \ REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION CL
-
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
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❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
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♦ .� Via Certified Mail
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
�9>sz 938 KING STREET,RYE BROOK,NY 10573
(914)939-0668 FAX(914)939-5801 www.ryebrook.org
NOTICE OF VIOLATION AND ORDER TO REMEDY SAME
BUSINESS OWNER: CVS Health VIOLATION#: E 1124
One CVS Drive NOTICE#: 2na
Woonsocket, Rhode Island 02895 S.B.L.: 141.3 5-2-51
The following violation(s) of the Code of the Village of Rye Brook were found to exist at;
253 South Ridge Street located in a, OB-S zoning district, in the County of Westchester, Village of
Rye Brook,NY on, October 3, 2019.
CODE SECTION&TITLE DESCRIPTION
Village of Rye Brook §91-4.B.(4) Failure to apply for Fire Safety Inspection.
You are hereby directed to contact the Building Department to obtain all necessary permits & commence to
correct the above captioned violation(s) immediately. Failure to comply with this directive will result in further
legal action against you. Note that a re-inspection of the premises is required by law to confirm compliance with
this notice& all other applicable codes.
FAILURE TO COMPLY WITH THIS NOTICE IS A CRIME PUNISHABLE BY FINES IMPRISONMENTS OR BOTH.
(/BUILDIN% TOR
( ) ASSISTANT BUILDING INSPECTOR
( )VILLAGE ENGINEER
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404 artrtivmarW
VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J.Bradbury
www.iyebrook.org
TRUSTEES BUILDING&FIRE INSPECTOR
Susan R.Epstein Michael J. Izzo
Stephanie J. Fischer
David M.Heiser
Salvatore W.Morlino
July 29,2022
Via 15,Class Certified Mail
CVS Health
C/o Lease Administration
One CVS Drive
Woonsocket,Rhode Island 02895
Re: CVS#490,253 South Ridge Street,Rye Brook,New York 10573
Dear Lease Administration,
It has come to the attention of the Building Department that it has been over three years since the premises located at the
above captioned address has undergone and successfully completed a Fire Inspection.Please note that you are required by Rye
Brook Village Code 591-4.B,to undergo and successfully complete a Fire Inspection for this location at least every thirty six
(36) months.
In order to avoid a violation,please complete and submit the attached Fire Inspection/Operating Permit Application form,
remit the correct application fee,and schedule your triennial Fire Inspection with the Building Department by no later than,
August 29,2022,which is thirty(30) days after the date of this notice.Please note that the property owner's notarized
signature,as well as the business owner's notarized signature must appear on the application form in the appropriate spaces.
Upon successful completion of the Fire Inspection,you will be issued a Fire Inspection Certificate valid for three(3)years.
Please remember that you must schedule your Fire Inspection every three (3)years by filing a Fire Inspection/Operating
Permit Application,remitting the applicable fee,and scheduling your Fire Inspection with the Building Department at least
thirty(30) days prior to the expiration date listed on your Fire Inspection Certificate.
Thank you.
Michael J. Izzo
Building&Fire Inspector
mizzo_.=brook.org
cc: Steven E. Fews,Assistant Building&Fire Inspector
cc:Martha Levy,Property Manager
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BUILDING DEPARTMENT
❑�BVILDING INSPECTOR
,�Q"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 : �t 43 J (-a� 8 �\ DATE:
PERMIT# Q ISSUED: SECT: BLOCK: LOT:
LOCATION: A( r OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION
/❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE 1
❑ FOUNDATION ; 1�-)
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION M r\
❑ NATURAL GAS ��J V C� Q L C
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING y.� •1
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
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'9a2 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.ors
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- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - -- - - - - - - - - - - - -
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ADDRESS : J �c-'p DATE:
PERMIT# NO ISSUED: SECT: BLOCK: LOT:
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LOCATION: C �e- �hc, �� OCCUPANCY:
VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/ REINSPECTION
Lf SITE INSPECTION REQUIRED
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❑ FOOTING ` ''
❑ FOOTING DRAINAGE �Q\� Ca Ac'
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: r
Nth oc ' ' ail
❑ ROUGH PLUMBING ` (
❑ ROUGH FRAMING
❑ INSULATION �I r \W '
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NATURAL GAS 1� `o r -
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING c�\ `n O
❑ CROSS CONNECTION J
❑ FINAL �t o
❑ OTHER
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JUSTICE COURT OF THE TOWN OF RYE
STATE OF NEW YORK: COUNTY OF WESTCHESTER
-------------------------------------------------------------------X
PEOPLE OF THE STATE OF NEW YOM
-against- No. E. 1099
CVS PHARMACY,c/o Any Owner, Manager, Principle
or Agent.
- -----------------------------------------------------------------------X
Be it known that I, STEVEN E FEWS, the complainant herein and duly authorized Code Enforcement Officer of the
Village of Rye Brook, do hereby accuse the defendant(s) named above, doing business at 253 SOUTH RIDGE
STREET RYE BROOK NY who is an owner, manager, principle or agent; of the property at which the following
offences were committed, at 253 SOUTH RIDGE STRET,&ye Brook NY 10573 on or about March 4, 2022 rZe
l:QQD111
COUNT ONE:Village Code 5704.A APPLICATION FOR PERMIT
TO WIT: In that the above-named defendant failed to make application or cause an application to be made for a permit
so that the business could have Fire Alarm system work done.
COUNT TWO: Village Code§70-4.C. PERMIT REOUIRED.
TO WIT: In that the above-named defendant(s)did allow or cause to allow the work to be done upon the Fire Alarm
system without the required permit. Said work is including but not limited to changing out the main alarm panel and
changing out devices,components as well as detectors.
COUNT THREE: Village Code 4113-6. ECTRICAL PERMIT REOUIRED.
TO WIT: In that the above-named defendant(s)did allow or cause to allow work to be done upon the building electrical
system and Fire Alarm Panel without electrical permit and inspection.
All the above is contrary to the provisions of the statutes in such case made and provided. The above allegations of fact are made
by the complainant herein on direct knowledge and upon information and belief pjo"i ed by Steven 1_Fews Code Enforcement
Officer and Building Department Official. Some of which being an inspection(s)�f I sub'ect isog on,Marcb4*2022. Any
false s�tur tts mak*rein are punishable as a Class"A"Misdemeanor pursuant 16 th 'MY PP*Law.
Dated Code Enforcement rcer
APPEARANCE TICKET
You are hereby directed to appear before the Justice 4;rrf of the Town of Rye, 350 North Main Street,Port Chester,
New York 10573,(914)-939-3305,at 9:00am on the day of 2022, in connection with your
alleged commission of the above-described offense.
NOTE: UPON FAILURE TO APPEAR A WARRANT MAY B YO R ARREST
Dated Code Enf &cement Officer ,�,,c'
Laura Petersen
From: Jennifer Gerace <jennifer@nwmgc.com>
Sent: Wednesday, March 15, 2023 2:23 PM
To: Tara Orlando; Laura Petersen; Steven Fews
Cc: Marcie Manfredonia
Subject: CVS#490 - 253 South Ridge Road
Attachments: workack_922245978532609.pdf;workack_922246699639040.pdf; photos - CVS 490.pdf
Good Afternoon,
Please see the attached report and the photos to show that all work has been completed as per the notice received for
the CVS locate at 253 South Ridge Road.
Cage has been removed, all boxes and overstock has been removed from areas of egress, as well as 12"down from the
sprinklers.
Please review and let us know if you have any questions or need any other information.
Thank You,
0 (1 JENNIFER GERACE
y� Emergency Line:866 S78-6692
Nationwide -)i►ect rvumbcr.914 368 19IU42
Off,ce 914 2-41 1010 ex 'b 1 ax 914-459 1139
1
WORK ACKNOWLEDGEMENT
Your Technician: From Empire Fire Protection Services
rMelquisedec Valentin 75 Bermar Park Suite 3
Rochester,NY 14624
5857200390206
Job No. 28794832 Job For CVS 0049OL01 RYE BROOK
Type Preventative Maintenance 253 SOUTH RIDGE ROAD
PO No. 240087540 RYE BROOK,NY 10573
Job description
po#15664
Services completed
'S Annual Fire Alarm Inspection-
Sprinkler system is the landlord maintained.Can you also have the tech check what is present for fire sprinklers just to
see if there is anything CVS is responsible for.
Parts,labor and items used QTY
Parts Carbon Monoxide Detector- 10year lithium battery 6
Files and Photos
Comments
No Comments
Signature 03/15/202311:01am EDT
Accepted By:Matt Ramirez Marcie@nwmgc.com
WORK ACKNOWLEDGEMENT
f Your Technician: From Empire Fire Protection Services
rMelquisedec Valentin 75 Bermar Park Suite 3
On site 3/15/2023 at 9:53am Rochester,NY 14624
5857200390206
Job No. 28794845 Job For CVS 0049OL01 RYE BROOK
Type Preventative Maintenance 253 SOUTH RIDGE ROAD
PO No. 240087583 RYE BROOK,NY 10573
Job description
po#15665
Services completed
r Annual Fire Extinguisher Inspection
Parts,labor and items used QTY
Services Six Year Internal Maintenance-10#Dry Chemical 11
Parts Extinguisher-5#ABC-Strike First 1
Files and Photos
e
Deficiencies
FIXED 5 lb ABC pharmacy exit door
Description:
Deficient
(11)10#extinguishers due for 6 year service.(1)5#needs to be replaced in pharmacy due to damage
DISCOVERED
03/15/2023
11:06 AM
Comments
No Comments
Signature 03/15/202312:26pm EDT
I
Accepted By:Matt Ramirez RobertlII.Wehrle@CVSHealth.com
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Inspection Company Name: Albany
Fire Extinguisher Address: 16 Jupiter Lane Suite 4
Inspection Report City: Colonie State: NY Zip Code: 12205
Customer: CVS 00490L01 RYE BROOK Date of Inspection: 03/15/202309:00am EDT
Address: 253 SOUTH RIDGE ROAD
City: RYE BROOK State: NY Zip Code: 10573 Phone: (914) 937-2301
Item# Location Size of FE Type of FE New Inspection New FE Hydro? Recharge? 6 yr Manufacture
Tag left on FE? Installed? Due year of FE?
71 entrance 101b ABC ❑ ❑ ❑ ❑ ❑✓ 03/01/2014
71 outside of office 115 Ib IABC ❑ ❑ ❑ ❑ ❑✓ 03/01/2016
teller area 1110 Ib IABC ❑ ❑ ❑ ❑✓ ❑ 03/01/2020
stockroom emergenj 110 Ib IABC ❑ ❑ ❑ ❑ ❑✓ 03/01/2015
stockroom entrancel 110 Ib 1ABC ❑✓ ❑ ❑ ❑ ❑ 03/01/2021
outside of breakrood 15 Ib 1ABC ❑✓ ❑ ❑ ❑ ❑ 03/01/2019
13# 10Ib 1ABC ❑ ❑ ❑ ❑ 03/01/2015
electrical room I 10 Ib 1ABC ❑ ❑ ❑ ❑ 09/01/2016
in front of pharmacy 10 Ib IABC ❑ ❑ ❑ ❑ R1 10/01/2015
pharmacy exit door F5 Ib ABC ❑ ❑✓ ❑ ❑ ❑ 03/01/2019
stockroom basemen 10 Ib ABC ❑ ❑ ❑ ❑ 03/01/2015
stockroom basemen 10 Ib ABC ❑ ❑ ❑ ❑ 03/01/2015
stockroom basemen 10 Ib 1ABC ❑ ❑ ❑ ❑ R] 03/01/20 77
stockroom basemen 10 Ib IABC ❑ ❑ ❑ ❑ R] 03/01/2015
❑ 00 ❑ ❑ ❑ ❑ ❑
❑ 00 ❑ ❑ ❑ ❑ ❑
❑ 00 ❑ ❑ ❑ ❑ ❑
❑ F ❑ ❑ ❑ ❑ ❑
❑ 00 ❑ ❑ ❑ ❑ ❑
❑ 00 ❑ ❑ ❑ ❑ ❑
❑ 00 ❑ ❑ ❑ ❑ ❑
Notes: I I i
,`I 1
LMAR 0 20223
1
Is a return trip needed to complete repairs? VILLAGE OF RY1= BR0(
BUILDING' ")c:PARTMEN i j
Are all extinguishers tagged and a return trip is not needed? ❑�
Customer Signature: Customer Name: Matt Ramirez Date: 3/15/23
lip
oosfire
Q 909 Marconi Avenue Ronkonkoma NY
(631)689-6869 0 (631)689-6866
----- inc 0 info@foosfire.com Q Facebook
WET ANNUAL INSPECTION
Customer CVS Pharmacy, Inc. Bldg. Name CVS 0049OL01 RYE BROOK Inspector Phil Bavero
Customer W.O. Bldg. Street 253 SOUTH RIDGE ROAD Signature 'nw
Job 28803019 City/State/Zip RYE BROOK NY Insp. Date 03/15/2023 12:00pm EDT
• SECTION
Is the building occupied? YEs Authorized Representative Printed
MOD Matt
Has the occupancy and hazard of contents remained the same since the last inspection? YES
Authorized Representative Signature
Are all fire protection systems in services? YES
Has the system remained in service without modification since the last inspection? YES
Date Completed
Was the system free of actuation of devices or alarms since the last inspection? YES
03/15/2023 12:00pm EDT
I state the information on this form is correct at the time and place of my inspection,and al/the equipment tested at this time was left in operational condition upon completion of this inspection except as noted.
LOCATION
RISER 1 Wet Main Acme grocery SVR
g' 75
RISER 2
RISER 3
RISER 4
WATER BASED SYSTEM ISPECTION FIRE DEPARTMENT CONNECTION
Visible and accessible? YES
Are there landlord/access issues that requires visual Proper#8 type of spare heads 8 wrench? YES
YES Plugs or Caps in place and undamaged? YES
inspection only? Caps painted as per AHJ code? N/A Free of comosion/foreign meter al/paint? YES
Is this a shared Fire Sprinkler System? YES Identification signs(s)in place? YES Installed in proper orientation? YES
Upon arrival,was the fire alarm YES Ball Drip Valve in place and operating property? YES Free from obstructions to spray pattems? YES
po panel reading normal?
Couplings and swivels are in good condition and
Gauges on wet system in good condition and showing rotate smoothly? YES Free from leaks and physical damaged? YES
FYES Liquid in all glass bulb sprinklers? YES
normal water supply pressure? Check valve free from leakage? YES
Are gauges up to date? YES Gaskets in place in good condition(I caps are not in YES
place)?
Alarm valve free from physical damage,trim in correct YES Interior free of obstructions(if caps are not in place)? YES In good visual condition? YES
position and no leakage from retarding chamber or drains? ANTIFREEZE LOOP Free of external corosioMoads? YES
Hydraulic plaque present? YES Antifreeze solution tested? N/A Free of mechanical damage and leaks? YES
Alarm 8 supervisory free from physical damage? YES Solution specification sign placed? N/A Property aligned? YES
N/A
Water m Type of Solution motor gong or electric bell operable and in good Visible pipe hangers and seismic braces free of YES
N/A Solution found acceptable? NIA
looking conditions? 1st Antifreeze solution freezing point=F° damaged or loose?
NYC only-Pipes
2nd Antifreeze solution freezing point=F° NaNes painted per code? N/A
COMMENTS
Neighboring tenant Acme grocery is responsible for inspections of shared sprinkler system.Visual inspection of riser in grocery store and exposed sprinkler piping
and sprinkler heads inside CVS's space.
MAR 2 0 2023
VILLAGE Or RYE BROOK
I BUILDii�dr r`' . .RTW:N'T —
MAIN DRAIN VALVES
TYPE RISER ID LOCATION SIZE PRESSURE(PSI( RESULTS DRAINS
COMPARABLE TO SIGNAGE
INITIAL RESIDUAL STATIC PRIOR PROPERLY
Acme grocery SVR
INSPECTOR'S TEST VALVES
�+ AUDIBLE ALARM WATER FLOW EASILY
TYPE RISER ID LOCATION SIZE REPORTED TIME TO ALARM SMOOTH ORIFICE DEVICE PASS SIGNAGE ACCESSIBLE
TEST
grocery receiving area
CONTROL VALVES
TYPE RISER ID LOCATION SIZE INSPECTION
SECURED LEAKAGE OPEN ACCESSIBLE SIGNS
Acme grocery SVR
CONTROL VALVES -ANNUAL SECTION ONLY
MAINTENANCE TEST
EXERCISED #OF TURNS LUBRICATED TAMPER SIGNAL TIME TO ALARM
FIRE ALARM INSPECTION
& TEST REPORT
OFFICE PHONE NUMBER: (585)720-0390 x 206
DATE 03/15/2023 10:00am EDT ADDITIONAL BUILDING DATA
SITE CVS 00490L01 RYE BROOK CONTACT
ADDRESS 253 SOUTH RIDGE ROAD PHONE
CITY RYE BROOK STATE NY ZIP 10573
MONITORING ENTITY PHONE 1 (800)430-0664
This inspection is: ❑X Annual11 Semi-Annual ❑ Quarterly ❑Monthly Weekly ❑Other
Panel Manufacturer I Fire Lite Model Number ES-200X I Type T-17Addressabie Hard Wired
ALARM INITIATING DEVICES AND CIRCUIT INFORMATION
City of devices Type of device Qty of devices Type of device
8 Manual Stations Heat Detectors
6 Co Detectors/Date Waterflow Switches
30 Photo Detectors Supervisory Switches
3 Duct Detectors Other Devices
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION
Qty of devices Type of device Qty of devices Type of device
Bells 3 Strobes
Horns 22 Hom/Strobes
Speakers Aux Panels/Cell communicator's
Chimes Annunciators
RECORDED DATES
Dates Type of device
Battery Install Date
CO Detector Install Date
Heat Detector Install Date
Sensitivity Testing Date
Amount of Door Holders
Restricted Rooms
SIGNALING LINE CIRCUITS
Qty and Style(see NFPA 72,Table 6-6.1)of Signaling line circuits connected to system Qty
SYSTEM POWER SUPPLIES
A. Primary(Main):Nominal Voltage
Over Current Protection: Type JXJ Circuit Breaker
Location(Primary Supply Panelboard) Disconnecting Means Location(Fuse or Breaker#)
B. Secondary(Standby): X Storage Battery Other: AMP HR Rating (2)12V7
TYPE BATTERY
Dry Cell Nickel Cadmium Sealed Lead-Acid Lead-Acid Other:
Fire Alarm Test and Inspection Page 1 of
MAR 2 0 2023
VILLAGE Or RYE: BROOK
BUILDING DEPARTMENT
• SITE CVS 0049OL01 RYE BROOK DATE 03/15/2023 10:00ai
PRIOR TO ANY TESTING SECONDARY POWER
Notifications Are Made Yes I NA No Who Time Type Visual Functional NA Comments
Building Management Battery Condition X
Monitoring Entity Load Voltage rX
Other: Amp Hour Reading
INITIATING&SUPERVISORY DEVICE TESTS&INSPECTIONS Batteries Meet NFPA 72 Test Requirements: J0JYesJ [No NA
(ON SEPARATE FORM)-#OF PAGES ATTACHED EMERGENCY
COMMUNICATIONS EQUIPMENT
SYSTEM TESTS&INSPECTIONS
Type Visual Functional NA Comments Type Visual Functional NA Comments
Control Panel X Transient Suppressors X
Interface Equipment X Remote Annunciators
Lamps/LEDS X Audible X
Fuses X Visual
Primary Power Supply X Speakers X
Trouble Signals X Voice Clarity X
Disconnect Switches X I I Door Holders X
Ground Fault Monitor X Door Unlock
Parts replaced Total Comments Interface Equipment Visual Functional NA Comments
12v 7a battery Elevator Recall X
12v 18a battery HVAC Shut Down X
Other battery replaced Specify:
Special Hazards Visual Functional NA Comments
Specify:
Specify:
Specify:
SUPERVISING STATION MONITORING Yes NA No Time Comments
Alarm Signal
Alarm Restoral X
Trouble Signal
Trouble Restoral
Supervisory Signal
Supervisory Restoral
NOTIFIED TESTING COMPLETE Yes NA No Who Time
Building Management X
Monitoring Entity X
Other:
HAS SENSITIVITY BEEN COMPLETED AS PER NFPA 72 OR LOCAL STATE CODES: YES NOONAO
Year Sensitivity Testing Completed: Year Sensitivity Testing Due: How Was Sensitivity Tested:
WHILE PERFORMING THE INSPECTION ADDITIONAL ITEMS WERE NOTED THAT NEED CORRECTED: YES NOO NA
No SERVICE FOLLOW UP REPORT was required during this inspection. ,
I state that the information on this form is correct at the time and place of this inspection. All test and inspections were performed in accordance with applicable NFPA
72 test and inspection sections. All equipment tested at this time was left in operational condition upon completion of this inspection except as noted on any SERVICE
FOLLOW UP REPORT as stated above. ` '
Name of Inspector Melquisedec Valentin Signature �V Certification#
I acknowledge that the inspection,deficiencies,and suggested improvements were discussed with me upon completion of the inspection. It is understood that all
information contained herein is provided to the best of the knowledge of the person providing the information and that uested,will be forwarded to the authority
having jurisdiction.
Name of Owner Matt Ramirez
or Representative Signature
Fire Alarm Test and Inspection Page 2 of
WARREN ELEVATOR SERVICE CO., INC.
Sales Service
227 Eagle Street
Brooklyn, NY 11222
Tel: 718-389-1234 * Fax: 718-349-2523
DI,
MAY 102023
April 18, 2023
VILLAGE O' R'r EE BR00K
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 King Street
Rye Brook, NY 11530
Attn: Steve Fews
Tel: 516-228-3929
Re: 253 South Ridge Road
Rye Brook, NY
Dear Mr. Fews:
We have inspected the material lift at 253 South Ridge Road on 04/10/23. The lift is in
proper working condition and no violating conditions sited.
Yours truly,
WARREN ELEVATOR SERVICE CO., INC.
Z 7
I ennet eiferth, Jr.
QEI Inspector
Certification#C3320
WARREN ELEVATOR SERVICE CO., INC.
Sales Service
227 Eagle Street
Brooklyn, NY 11222
Tel: 718-389-1234 * Fax: 718-349-2523
L
Y 10 2023 DD
+ VILLAGE OF i? �3ROOK
April 18, 2023 BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 King Street
Rye Brook, NY 11530
Attn: Steve Fews
Tel: 516-228-3929
Re: 253 South Ridge Road
Rye Brook, NY
Dear Mr. Fews:
We have inspected the material lift at 253 South Ridge Road on 04/10/23. The lift is in
proper working condition and no violating conditions sited.
Yours truly,
WARREN ELEVATOR SERVICE CO., INC.
?onotneth4ciferth,
I Jr.
QEI Inspector
Certification#C3320
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR
Paul S. Rosenberg (914) 939-0668 • Fax (914) 939-5801 Christopher J. Bradbury
www�ebrook.org
TRUSTEES BUILDING &FIRE
Susan R. Epstein INSPECTOR
Stephanie J. Fischer Michael J. l=o
David M. Heiser
Jason A. Klein
August 14,2019
Via I'Class Certified Mail
CVS Health
c/o Lease Administration
One CVS Drive
Woonsocket, Rhode Island 02895
Re: CVS#490, 253 South Ridge Street,Rye Brook,New York 10573
Dear Lease Administration,
It has come to the attention of the Building Department that it has been over three years since the premises located
at the above captioned address has undergone and successfully completed a Fire Inspection. Please note that you
are required by Rye Brook Village Code§914.13,to undergo and successfully complete a Fire Inspection for this
location at least every thirty six(36)months.
In order to avoid a violation,please complete and submit the attached Fire Inspection/Operating Permit
Application form,remit the correct application fee,and schedule your triennial Fire Inspection with the Building
Department by no later than, September 14, 2019, which is thirty(30)days after the date of this notice. Please
note that the property owner's notarized signature, as well as the business owner's notarized signature must
appear on the application form in the appropriate spaces. Upon successful completion of the Fire Inspection,you
will be issued a Fire Inspection Certificate valid for three(3)years.
Please remember that you must schedule your Fire Inspection every three(3)years by filing a Fire Inspection/
Operating Permit Application,remitting the applicable fee,and scheduling your Fire Inspection with the Building
Department at least thirty(30)days prior to the expiration date listed on your Fire Inspection Certificate.
Thank you.
Michael J. Izzo
Building&Fire Inspector
mizzo�ryebrook.org
cc: Steven E. Fews,Assistant Building&Fire Inspector
Ms. Martha Levy,Managing Agent
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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK MAR 15 2023
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
w"'.aebrook.org L BUILDING DEPARTMENT
FIRE INSPECTION / OPERATING PERMIT APPLICATION
FOR OFFICE USE ONLY: / f/ 36)0.44
Fee Paid: $ '7` 5a —/� Inspection Date & Time:�Pd/ %'// aC)c�
FEE SCHEDULE: Re-inspection Date & Time:
Triennial &Private School Annual Inspection: = $450.00
Public Assembly Annual Inspection: <100 People= $525.00/>100 People=$775.00
***********************************************************************************************************
Application,dated: ���y 2�j ,is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting
that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business,
private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform
Fire Prevention & Building Code, Title 19 NYCRR Part 1201, and all other applicable local, County, State & Federal laws, rules &
regulations,as per detailed statement described below.
1. Address: 2,5�> SOS J�1 '(ZI)& SjkM QNE (�el)0>L SBL: 1q1. f)5-2-51 Zone:
2. Business/Occupancy Name: US# NYS Use Class:
3. Property Owner:NAWM LEA`I Address:
Phone# (?)qq Cell#QIy-41q- 31LOU email:
5. Business Owner:Ns T01)EAtE Address: Ne NS W F__MW5 E(1(I 09N�)
Phone#Lk01-r1 ri 0- 2300 Cell# email: /�
6. Emergency Contact: A 6 Ty l r Z G /V 13e0'(n rZ0/Zd,q��
Phone# 1[Z7 1 j 61 Cell# 1/7 y/(,(SY/ email: 6e_ t_ bd 1dtss- p�L(
7. Inspection Escort: Title: A w - cAl
Phone#: Cell#: email:
8. Provide a brief description outlining the current and/or intended use of the property:
marmu-0I roLj
tauI yre
9. List all Hazardous Materials:
10. Occupant Load: Existing: Proposed: Other:
11. Date& Disposition of Previous Fire Inspection: l /(� lZZ_ tl-<ss ❑ Fail
t
8/12/2021
This application must include the notarized signature(s) of the legal owner(s) of
the above mentioned property, in the space provided below. Any application not
bearing the legal property owner's notarized signature(s) shall be deemed null
and void, and will be returned to the applicant.
**********************************************************************************************************
STATE OF NEW YORK )
COUNTY OF WESTCHESTER ) as:
.L�vq ,being duly sworn, deposes and states that he/she is the applicant above named,
(print name of individual signing application)
and further states that he/she is the legal owner of the property to which this application pertains, or that he/she is the
1�704yq(�1&)!�a 00d for the legal owner and is duly authorized to make and file this application. That all
(indicate architect,business owner,attorney,agent,etc.)
statements contained herein are true to the best of his/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 /5 Sworn to before me this
'S
day of )9WP-.A1 , 2Qgg day of k%/,\ (R t-L , 20
N u lic No ary Public
aw
Signature of Property Owner Signature of Applicant
1flA�g1&r, ri��-Jv� �1/�2.G!P �_W� 11 L d o Af
Print Name of Property Owner Print Name of Applicant
JOHN M SUOZZO SHARI MEULLO
NOVW PUBLIC STATE OF NEWYOW Notary Public,State of New York
Registration Na 01SU6070919 No.01ME6160063
Qualified inweewhestercounty Qualified In Westchester county
My Commission Expires March 11,2026 commission Expires January 29,20ZD
2
8/12/2021