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BP25-179
PERMIT # /LJ'-% 7 9. SECTION ZA021 BLOCK�c LOT TYPE OF WORK l0oeo, 2o'I01 ?,?L —n k JOB LOCATION S�D - Sol,A aloe �C�, 0 / ojo41�j Cen7ter S6 4#? /r. 7 V/� YVC..L7 CONTRACTOR i� orq Q� /�S C o� ./`LC - u S C14C (Ol)906O'/Qo CO #i FEE DATE TCO # FEE DATE SATE INSM FpTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING1001*4 � L RGH PLUMBING GAS SPRINKLER et ELECTRIC & `-- OTHER APPROVALS BOT - PB ZBA - OTHER LOW -VOLT )4///o/a 4e* 4Lk)4t/ ),;)IIT)6f /A 1) Sol e � PCdaleseCu 4v ALARM � AS BUILT . LoL 5 65 FINAL f arcl4alepn /um Ally _ t2' VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 25-153 Certificate of Occupancy 'This is to certify that In Rla�qe Reo l Lb of, �L ,t�Y�� i / V y having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, V siyel ' Rye Brook,NY, located in a �l—r Zoning District and shown on the most current Tax Map as Section: Block: CQ Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.�6_ / , issued � 5 20, -), such authority and permission is hereby granted to the property owner to lawfully occupy or use saidpremises or building or part thereof listed under the following New York State Classifications,Use: ! �) Construction: , for the following purposes: � }��� �(� --'j 4—ou 4 j Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be mad ,no hall the building be moved from one location to another until a permit to accomplish such change en ob ' ed fr th Build' Inspector. Building Inspector,Village of Rye Brook: Date: DEC 15 2025 QyE BR tC. t(boa yJ V V VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrooknXvov TRUSTEES BUILDING&FIRE INSPECTOR Susan R.Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE December 15,2025 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 204 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.35-2-36 Mechanical Permit#25-128 issued on 8/14/2025 for Fire Sprinkler System Modifications This certifies that the fire sprinkler heads,installed under the above captioned permit,have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE DR 4" O `�4 V�✓� y 190 tC�4nJ;av V 4 ICCY+4 yv�' VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www.rXebtookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R.Epstein Steven E. Fews David M. Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE December 15,2025 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 204 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.35-2-36 This document certifies that the work done under Mechanical Permit #25-121 issued on 8/5/2025 for the modifications to the existing HVAC system has been satisfactorily completed. Sincerely, Steven E.Fews Building&Fire Inspector /to f V For o�sco / BUILDING' DE' PARI'MENT PF•RM /DEC - 2025 VILLAGE OF RYE'BROOKS 8 KING SI'RF.FT§RVE BROOK,NtW YORK 10573 DA m /,"7—/—a 5 VILLAGE OF RYE BROOK (914)9 -0669 FEE: �' PAID BUILDING DEPARTMENT m W% o ! . o%- APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO DR SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address:,0 )—oolk IUQe. ��/P dJ1770 1"y_ 0S Occupancy:User" S Gy,_►'Yt Parcel ID#: Zone: '(2 Owner: L e Address:,2 I •p -1 �`(✓(OOK P.E.,R.A.or Contractor:�',�fv[,&11i1�I!n W L-MM lltF:t-r_ddress:"95 L.CWt° QUe. [1f�7 t" 076f)7 Person in responsible charge: L b 1)�� r,j)[� Addres5. ,") LrtAV 1Nt)r IJT 7657- Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy Certificate of Compliance forth s tructure/construction/a Iteration herein mentioned in accordance with law STATE OF NEW YORK.COUNTY OF WESTCHESTER as: n I' 1 T U l r5 0'0 0— being duly swom,deposes and says that he/she resides at5ll� LO lit°. P mt Name ofApplr u (No and Street) in�- C{e�I I/ ,in the County of ere) C I)Qn�Y in the State of that (0 To"n Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S for the construction or alteration of y--, 6 l l �r/13n I io U TD Ca-5 L �. O007-- Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this 7^01 Sworn to before me this 3y day of ij W/ I ,20 day of !?w-u— ,20 e of Propem -W Signa o pp ffcant EjQiJ 1 Dnvlb cauw- L CA C Pratt N of Prope ` Print Name of ant o WK No7lic. • =NA" VALEWYAPAK ,Notary Public•State 4 N �,jeniy My Commission Expires Apr 14,2026 akCd�,r• w � 1982 BUILDING D1 1'ARTMENT ❑B ILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OMI:ICER 938 KING STREET. RYE BROOK,NY 10573 (914)939-0668 FAX (914)939-5801 wwwxygbrook.or,.g - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - -- - - - - ADDRESS : 20 q Z.An R,_2�4 s`T� i DATE: 1 L- 10 - ZOLS' PERMIT#_ � 2S' 1-7 1%SUEn: SECT:IVI, BLOCK:2_LOT: J LOCATION: --joc�_1 —cs ST2b"-JC= OCCUPANCY: ❑ VIOLATION NO-FED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL.GAS ❑ L.P. GAS yn.l Gr- ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION k `INAL - 1 ❑ OTHER U198VBUILDING M IDARTMENT ,❑1//3VILDING INSPECT-oR I olo",%mi-AN'1'UUILDIM.INbm-clok VILLAGE OF RY1: BROOD ❑C0111.UNI-ORCEMLNT OFFICER 938 KING STREET . RrE BROOK,NY 105:3 (914) 939-0668 FAx (914)939-5801 w-wAa—bruuk.O - - - --- - - - - - - - - - - -- - liNSE-31:CTION REPORT - - - - - - - - - - - - - - - - - - - - ADDKGSS• 20 44 -ci� . �1 �uA• I)A't'1.: I�� PEttMIT= W 2 vv �/ 2- Lar: -- - -. _ � - - _lssc�l:n:---- - ---- St:c:'I: _ • BLOCK: LoCAI'ION: ' b.$�' Jal�- -— Oc:(:UI-ANCY: ❑ VIOLATION NOTGI) THL-• WORK IS... RE1L•'CTED/ REINSPF:CTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUNt) PLUMIllms NOTFS ON INSPEcnON: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION , Q ❑ NATURAL GAS 12 ❑ L.P. GAS XFVELTANK _ FIRE SPRINKLER k � 0 FIN ❑ AL PLUMBING LazkSw` CROSS CONNECTION / ,%) ❑ FINAL �([�'• C��✓ . ❑ OTHER %"J J � E akC�� O �m BUILDING DEPARTMENT ❑B 1LDING 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 wwwxycbrookorg -- - - - - - - - - - - - - - - - - - - INSI)ECTION REPORT - - - - - - - - - - - ---- --- - - ADDRESS: Z o 1 --�4cti _ k,� S1"J• DATE•. 12` l o - L oZS` 'P Zs- 1(e . PERMIT= Ff ?S- _LZ ISSUED: SECT:)V S BLOCK: Z LOT: Jre LOCATION: l p S T R��`T• _ OCCUPANCY: ❑ VIOLATION NOTED THE WORK 1S... ACCEPTED ❑ REJECTED/ REINSPF,CTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING 'VOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION Q ❑ NATURAL GAS / Z,-e i /7� b / , Ne,`++ p L.P.GAS ❑ FUEL TANK �C ❑ FIRE SPRINKLER FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BUILDYNG DL,,PART.NlENT ❑BUILDING INSPECtok QAMMANTBUILDIM.I\tiPLC.TOIt VILLAGE OF RYE BROOK ❑Ct/t!E E,%witcr-mu -Ouulclat 938 KING STREET- ItrE BRooK,NY 10573 (914)939-06t)8 FAX (914)939-5801 ww%v,rygbrook.gj% -- --- -- - - - - - - - - - - - - - INSPECTION REPORT - --- --- -- - - - -- - --- - - .ADDRESS:_2o y SOAL% el` 4 -sT ud ` - - - DATE.: IZ- 10-2 OLS PERMIT= m[ K7 "__LZ, 1 Isst I:n: tit"t 1: J/./• 347RLOCK: ftL I LOT:13(0_. LOCATION: _!� "'2Qv • OccClmnNcY: _ ❑ VIOLATION NOTED THE WORK 1%... p ACCEPTED ❑ RLIECTED1 REINSPEc-r1ON ❑ SITE INSPECTION REQUIRED ❑ Foo,rING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECI1ON: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION /� ❑ NATURAL GAS � � � Y A.e, ❑ L.P.GAS ❑ FUEL'1ANK ❑ FIRE SPRINKLER ❑ FINAL PLLatI;iN(. _ a � ❑ CROSS CONNECTION - LpCA FINAL .OTHER .1/�/ BR(�uk O y W � �9t12 BUILDING DEPARTMENT BMDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ CODE ENFORCEMENT OFFICER (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - I ADDRESS: t cc- 1 1 DATE: PERMIT# ^ ISSUED: SECT: BLOCK: LOT: LOCATION: i �(� 7� \�l"` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ^ \�" cvo ❑ FOOTING DRAINAGE ( l•� 1 ❑ FOUNDATION 0 UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION 0 NATURAL GAS cc-),_-' L\() ❑ L.P. GAS 0 FUEL TANK .C `' (0 ❑ FIRE SPRINKLER n Q ❑ FINAL PLUMBLING ❑l FINAL (} OTHER .y QyE BRC��. 'p- w � • �9°2 BUILDING DEPARTMENT ❑,,,,BBuILDING INSPECTOR 2JASSISTANT 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.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :_ 0'l _ 21 DATE: PERMIT# mf 2s_1 2. _....... h��UUUSUED�� SECT:_ T�• BLOCK: 2- LOT: X LOCATION: t :J 5_T_2w-j ` OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 'r^c l ❑ L.P. GasAWL Aa-� j4 ❑ FUEL TANK �J FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O �m w � 04 lJ �Q 198,2 BUILDING DEPARTMENT VIMING INSPE(A-OR ISTANT BUILDING INSPEXA-014 VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook, NY 10573 (914)939-0668 FAx (914) 939-5801 www.rnbLook.org - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ZO ,-A R,,* J'►,j DATE: 1.1sRMiISt��ZS — ' Z � ISSUED: SI ( '1: t _� _ ___ BLOCK: LOCATION: OCCUPANCY: ❑ Violation Noted 1►1 «4)it 1. 1"... ASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ErV UGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas Q ,� A 's ❑ I-P. (.gas �Iy ❑ FUEL TANK j 1 y 04 !c l.. C ❑ FIRE SPRINKLER ' ❑ FINAL PLUMBING _— — ❑ CROSS CONNECTION --- — ❑ FINAL. - �-e^ - ot;l,lll,IN►: BUILDING DEPARTMENT ���SIS'1'AN'1'111�ILIH\ll. I,vsrrun>u VILLAGE 01, RYI; BitooK Q<:�►ua 1'.N1:01t( 1-411A AT 9.18 King S1re t . Ilya• Rrook, N)' 10573 (914) 9,19-0668 FAX (91.1) 939-58OI www ryebrook.olg _ INSPECTION REPORT - AI)i)Itl 2 Plat M rr# �'P Z S— 17 9 ISSUIiI>:$-5-�11+(;•i. 2 LOCATION: � I,� S ❑ Violation Noted TIIF wc►ltlt IS... I►ns!►1;u ❑ FAII.1:1) / REINSPECTION d SI'I'l! INti1,1i(:•1'1ON 0 Fc►(rrlNc n F(N►'I•ING DRAINAGE Cl FOUNDATION CI (1Nl)lilt(:It()(1N1► PLUNIHIN(: NOTES ON INSPFC'I'I()N: 0 11O11(:il PLUMIi1N(: ,Jeto�R(►It(:11 Mtn MIN(; ❑ 1NS111,A•1'I4)N D Natural (,;I � .s Q r►-1 r .V p` f„ " / . , Q I"Illtl.TANK Q INA1. hLUMItIN(: XV. NJ ----- S s ■ Cs w ■ � � N w � N L Ln Goo v ~ ■ N • F d El : R Qv ■ p!Fyj V 1 � U � � � •� to V/ cn CZ v ■ �T1 O C: 0 � y t v �_ to 2 v � 4 A ■ O w o cn � x0 272 w ■ ■ bA H o O $ 4 a o ° �,� ■ o °' w � = b o 4 O N CA _ o a s J x n uo P. Q. CD ci Lin V LO ao x w 0 a ;n Ln : 0 00 ,n w 1 v n W .✓ ., A C7 cCi „� I V V o �,,, a. v o w V ii 1-4 ro ■ � `� Imo!00 E'+ a a ra z O ti up y J• c� r "� cn U W Q " O �' S r as $ © ee ■ N J u V o O o o HF y U O p U j rA V V U z w � > —12�o � o z di aj 84 N y [-I s BUILDING DEPARTMENT F Q IE� VILLAGE OF RYE BROOK ECI 938 KING STREET RYE BROOK,NY 10573 JUL - 3 2025 (914)9�3;�9-0�6� 6$ www,rve *y gov VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY; Approval Date: JUL 2 4 2y P PT Application Fee:$ Approval Signature: Permit Fees:$ � Disapproved: Other: Application dated: vJ is hereby made to the Building Inspectorof the Villageof Rye Brook,NY,for the issuance ofa Permit forthe interior alteration of an isti building,or for a change in use,as per detailed statement described below. 1. Job Address: o 41 &5 O SBL: Zone:C, 2. Proposed[ provement.(Describe in detail): o r L 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes:X If yes,indicate: TIER I: '� TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic Ere suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes:-X= (if yes,please submit a separate Automatic Fire Suppression System `` Permit application&2 sets of detailed engineered plans) 5. Occupancy',(I fam.,2 fam.,comm.,etc...)Prior to Construction: 4 After Construction: 6. N.Y State Construction Class' eati n: N.Y. State Use Classification: �A - 7. Property OwnerAt.1 lR I Alt' _C���4Cldress: l Us e ' C K NY Phone# ©1- Q Cell# email: Of() 8. Applicant 7 iOMddress: Ow o7JW%u- Phone# Cell#Z01 -206`0yz0 emae Z& • _�ti �C�'tlml 9. Architect: I Address:92,L M m�OCU �'� + Q[C�� l n:r Phone# Cell# email:tl� v 10. Engineer: Address: Phone# Cell# email: , 11. General Contractor: U t,� r Address:5 S L oLu •_ UQ • _t �e CIO el N d?fou Phone# Cell# !' O - Zo email-Lo l cii C . rr14roJ3,0r1. 12. Estimated cost of construction $ C), (3 d c) Oa (N(?'hE.The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional tees,and material and labor which ma} he dcmutr,l gratis.) l L ? 13. Job Timetable: Start: L Finish: be, ICJ (1) 6/1/2024 BUILD DEPARTMENT [E C R I Q V LS VIL E OF RYE BROOK JUL - 3 2025 938 KING ET RYE BROOK, NY 10573 (9141,U9-0668 VILLAGE OF RYE BROOK wrww nv. ov 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 NEEWW[YORKK,COUNTY OF WESTCHESTER ) as: }} uG �'1` J ,residing at, f u 1 c—�7 (Print name) (Address where you live) being duly sworn,deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; O t� 5+' ,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. ignatur f i6p "41-�(s)) k±i5 AUNT �)"tA �_Q(Awt' (Print Name of Property A )) Sworn to before me this dzLv of (klo 20 � (N , LRiC) ALEMA MARAUN WTAttY PUK C,CAYE OF MEW CORK (2) iwtrsUen MO.61140017KS Oyolled le 1MqtcAMMfC OY 6/1/2024 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. Please note that application fees are non-refundable. STATE F„NEV YORj{„COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signtng�plicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the _��A CAIV= for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications, as well as in accordance with the New York State Uniform Fire Prevention & Building Code, the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. fit,Sworn to be re me this 1i� Sworn to before me this day of vl/ , 24 I S, day of '/&/ , 20 2S ignat of Propenvq. Signature of Applicant DU D ID El` �*As l_. i �.I c— irin slame of Pro 04~ ' Print Name of A ant Nota blic No VALERIYA PAK Notary Public:-State of Mew Jersey ME My Commission Expires Apr 14, 2026 (4) 6n no24 O 44 £ N N N W 0 H pp 00r N Y v C; C.. i F W O Ln � x C fq . L N � r z M Q � ` W WItt 3 Z v V 00 0 CA 00 CY ar � N U "r. � U U JI U Ln �! ✓ Cn V O W z a � , .. dl ca a a z BUILDING DEPARTMENT ECENED VILLAGE OF RYE BROOK 938 KING STnET RYE BROOK,NY 10573 JUL 1 1 2025 f }4) -060g wwwh9atny. ov VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATION BUILDING DEPARTMENT Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 7 / EP#: Approval Date: �+ �'��^ Permit Fee: $ Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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, 2025-i;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:,?.(.) c) d 'e '5VKy CfoQ W SBL: J /136 —t�- ,3G one: Cj 2.Property Owner: Address Q Phone#: 0 4- 0 Q Cell#: email: 11 11 ( / 3.Master Electrician/Licensed Installer: Sem �k,!�-�, ��l''C�11 ddress:2-1K5-a A'V O"X Lic.#: �a Phone#:��� %� 95Y Cell#:�lT�/,d S�I 2-!2?0 email:e-/ /gL�- .c�D EIP�f�y/1 wry Company Name:-i�/ !2/(7 � P�7'11��-�4ddress: Z/ y� 7/��� Nr- fDd 2 9 4.Proposed Electrical Work/Fixture Count: I �z tv�� (c2 y� 2X 2 Z-e / X v�E's O c. (Pfi N C i4e C/!-T !,w�S (�S� Cy�,•1 v 5.3rd Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ZyJ eyl/ 19 tzi—,7411`a,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual sift e.aBplicant state that(s)he is the /Y� T������1!'�J L 14bf ttte legal owner and is duly authorized to make and file this application. SMaster Electrician/Licensed Installer) The undersigned furtherIs Tal-�t hat 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 4ore this 2- Sworn to before me this a3r- day of ,20_5 day of _ TLL4-.Q ,201 _ gnatur of Prop rty Own" Si tore of Applicant � P t me of Print Name of Applicant t 1 ' ° ENA 14AP NJI taryPubitc RBTARYiUBUC CHRISTIANA T JANITAN 6/i/202R"t�Iatration N iAOO�� tary Public, State of New Jerseyaus"fi in w--c starCCommis$ oryCommiidlon Expires Fpb 27, 2027 STATE WIDE INSPECTION SERVICES, INC. Service With 1n1vi:t'i1Y 0•• • • SWIS JOB APPLICATION • • Office Use Elect. Permit# �C; ��V Date Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village / e ,-QO/r� Zip Building Dept. County Address S �—y 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 C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation IECEoVIED JUL 1 12025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at 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 as set forth for the application. Email Address Lit j Name License# c;;' o�j y Date Signature Address' � City/State Zip Code Company Phone# _D E C E �tl �7 EDState Wide Inspection Services v 1080 Main Street Fishkill, NY 12524 a DEC - 8 2025 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES I Email: office@swisny.com VILLAGE OF RYE. BROOK Website: www.swisny.com Service With Integrity ^t 11• rntr.t.^.. r1J"709OTM1Cr=n!T BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Scarsdale Security Systems Win Ridge Realty LLC 132 Montgomery Avenue 204 South Ridge Street Scarsdale, NY 10583 Rye Brook,NY 10573 Located at: 204 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-201 141.35 2 36 Certificate Number:2025-8538 Building Permit Number: BP25-179 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:204 South Ridge Street, Rye Brook, NY 10573 The First Floor 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 51h day of December 2025. Name Quantity Rating Circuit Type Smoke Detectors 10 Smoke/CO Detectors 02 Pull Stations 02 Control Modules 02 Horn Strobes 07 Strobe 02 1 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. State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 845 202-7224 Phone NOV 14 2025 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Arsenio NYC Electrical Inc. Win Ridge Realty LLC 221 Tom Hunter Road 24 Rye Ridge Plaza Fort Lee, NJ 07024 Rye Brook, NY 10573 Located at: 204 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-200 141.35 2 36 I Certificate Number: 2025-6862 Building Permit Number: BP25-179 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 204 South Ridge Street, Rye Brook, NY 10573 The Basement: Children's Gymnasium 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 13th day of November 2025. Name Quantity Rating Circuit Type Receptacles 38 GFCIs 02 Switches 08 Luminaires 65 Cat 6 Lines 06 Bathroom Exhaust Fans 02 lb Officer: Frankel. 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. 4; C. t; 1-0 t to 1:4 4.t U t 41 t to U C- t t;to 420 4;t tw 416 42P 4-0 Ca C.C.4-0 C.t tv to Cp C ff rq t14 cc 0-0 tc � z � � c% � N - � w = rz Lir) Ln rn 00 u W-4 ON z Ljr4 %-,' -, C) U (A Ln Cf) A-4 O 71 u po" (1) 0 u u u go cr, 00 elf) IMM d <w z 2 0. C) z z E <rq ;4 E Zc. 144 to to to$4 4646to 44A 4444 4144 40 444 4A 44444444 4; D ECEWE BUILD"GDE'P'.tR.TMENT JUL 2 3 2025 VILbOkAft OF RYE OW)OK 938 KiNCi•11; CkET RYE B4,40k,NY 10573 VILLAGE OF c �Z}4J '3A�b _ BUILD/rJG Ry` BROOK +tug tt DEPgRTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP 4: J 7 EP#: c/_S C](0 ' Approval Date: JUL 2 4 2025 Permit Fee: S Approval Signature: _� Other: DO NOT 51ART 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 120a OF THE TOTAL COST OF CONSTRuc,rION WITH A MINIMUM FF.E OF S'75-10.00 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/ r re ve 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: 204 South Ridge St sBL: �`��.3 -�-3w zone:C/-P 2.Property owner: Win Ridge Realty LLC `Address: 24 Rye Ridge Plaza, Rye Brook, NY 10573 Phone#:914-701-4005 Cell#: —email: 11 3.M s c 1c r t /Licensed Installer.David Raizen Address: 132 Montgomery Ave, Scarsdale ic.4: �� 914-722-2334 914-372-8924 Lic.u: Phone a: Cen #: email:Ipassabet@scarsdalesecurity.com Company Name: Scarsdale Security System Address: 132 Montgomery Ave, Scarsdale, NY 10583 4.Proposed Electrical Work/Fixture Count: Installation of commercial fire detection system 5.3`d Party Electrical Inspection Agency: Statewide Inspection Services inc. #**A##*R**********R*#*******#***#*R************w#**k##***k***#*h#k*#*kR**#******#*##*RRR*#*##*#******##Rk STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: David Raizen ,being duly sworn,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 Dand Rauen for the legal owner and is duly authorized to make and file this application. (Master Hectncian Licensed Installer) The undersigned further states that all statements contained herein are true to the best ol'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. h Swom to efore a this 'Z ' Sworn to or me this I ,day-of IUL 20 ' day�,FApplicant 20 1- �Signat�e of Pro�erty Ownef-,46_UN,— �V Eav i �fSt/ David Raizen P ame of Pro a Owner�+� - I Prir Name of Applicant t Vi ANNE MARY CAMP ' �n r Notary Public, State of New Y ' 4 Y � I�Mlli tvT swrImmgo" No. OICA6074259 Notary Public tRe lWati"sidtt41111111111111,t AM364f � Qualified in Orange CountyIs j 10130;z023 Commisson Expires May 13, 2(),;, STATE WIDE INSPECTION SERVICES, IN (A') Service Oiih Integra) 1080 OFFICE Swis JOB APPLICATION tel • k. • Otflte I Elect. Permit # _ P a _ �O I Date i 7h,3�a� Bldg Permit # �� — / 7 / Sq Ft Plumbing Permit rr Final Certificate u City/Village Rye Brook Zip 10573 Budding Dept. Village of Rye Brook County Westcheseter Address 204 South Ridge St Cross Street Section Block lot Owner Name/Address,if(im ent than aa>re; Win Ridge Realty LLC Contact Number 914-701-4005 Q Basement ❑Ist FL ❑2nd FL ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential Q Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood 'rash Compact Amt Amps 10 2 Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage +rPanels IP 3P z Meters tr Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Cnn Ed ❑NYSEG ❑Central Hudson ❑Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑,/ Legalization ❑ Safety Inspection ❑Consultation Scope of Work Install commercial fire detection system LJUL[E2 3 2025 VILLAGE OF R(E BROOK BUILDING DEPARTMENT Thn appircatron n valid for one 0;yeu from the date recrrmd by SWIS This apd—ton is rrttended to mvrr the above Inted items to be nspecteQ d at any time of mspectron atldannal hems have been insaaliltl,yoY act aut homed to make the nspecTion and adlust the fee for the additional items nspec red.The applicant deciares that there is no open appitcatons for the above address with any other mspect ion company The applKwi.owner of authorued agent agrees to all the above terms and conditions as set"h lot the opisl—ton Email Address jpassabet@scarsdalesecurity.com Name Dav d R i License # 12000040723 Date 10/17/24 Signature / �- Address 132 Montgomery Ave City/State Scarsdale, NY I csde L--16583 Company Scarsdale Security System Phone# 914-722-2334 l DATE(MMIDD/YYYY) A�oRo CERTIFICATE OF LIABILITY INSURANCE 2/5/202(MM/DD5 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 World Insurance Associates, LLC NAME: Tina LevorsePHONE FAX 100 South Wood Ave • 973-346-8094 ac No:973-467-0725 Iselin NJ 08830 ADDRESS: tinalevorse@worldinsurance.com INSURER(S)AFFORDING COVERAGE_ NAIC S INSURER A:Evanston Insurance Company 35378 INSURED SCARSEC-01 INSURER B:Markel Insurance Company _ 38970 Scarsdale Security Systems, Inc. INSURER At-Bay Specialty Insurance Co. 19607 dba Arcuri Alarm Systems, Raizenette Inc dba Lakeside Security -.- Systems INSURER D: 132 Montgomery Avenue INSURER E: Scarsdale NY 10583 INSURER F: COVERAGES CERTIFICATE NUMBER:1747705154 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. LtTR TYPE OF INSURANCE ADDL UB POLICY NUMBER MMIDD/YYYY MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY BMAG100016 3/2/2024 3/2/2025 EACH OCCURRENCE $1,000,000 AMAGE To CLAIMS-MADE FXI OCCUR PREMISES Ea occurrence $100,000 X Prof Uab MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY�JEC LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: Professional Liab $1,000,000 B AUTOMOBILE LIABILITY BMAA100002 3/2/2024 3/2/2025 Ea acddEerOitSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ �( OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED Ix NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ A UMBRELLALIAB X OCCUR BMAE100020 3/2/2024 3/2/2025 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Cyber Liability AB-6612841-04 9/10/2024 9/10/2025 1st 8 3rd occlaggr 2,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers Compensation is provided under a separate certificate of insurance.This certificate supersedes any previously issued certificate. Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York state insurance Fun: PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE m 0 ^^^^^^ 133139173 ?Tj e KEEVILY.. SPERO-WHITELAW INC. 500 MAMARONECK AVENUE ! HARRISON NY 10528 t SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SCARSDALE SECURITY SYSTEMS INC. T/A VILLAGE OF RYE BROOK MACY'S HOME SECURITY 938 KING STREET 132 MONTGOMERY AVENUE RYE BROOK NY 10573 SCARSDALE NY 10583 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 815 549-1 703332 11/01/2024 TO 11/01/2025 2/5/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 815 549-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/fWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY, NEW YORK STATE SUR NCE FUND F �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 22504568 U-26.3 _ State Wide Inspection Services 1080 Main Street DECO g Fishkill, NY 12524 TO` U� C 2025 845 4-219 1 Phone 914-219-1062 Fax STATEWIDE INSPECTION SERVICES Email: office @swisny.ccm 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: Scarsdale Security Systems Win Ridge Realty LLC 132 Montgomery Avenue 204 South Ridge Street Scarsdale, NY 10583 Rye Brook, NY 10573 Located at: 204 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-201 141.35 2 36 Certificate Number: 2025-8538 Building Permit Number: BP25-179 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 204 South Ridge Street, Rye Brook, NY 10573 The First Floor 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 5"day of December 2025. Name Quantity Rating Circuit Type Smoke Detectors 10 Smoke/CO Detectors 02 Pull Stations 02 Control Modules 02 Horn Strobes 07 Strobe 02 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. N N N ■ py o N K t N k: L Ln a FY a � � cn w p ►-+ JW ~ Q W z 5 v � F _o ►-- " z MM � 00 o x uz • 90 z M , 14OZO r. W ° N � �i J • a 4t C4 w L o � cn � U O a a �, � °' x ■ F c M EC f BUILDING DEPARTMENT R DDVILLAGE OF RYE BROOK JUL 18 2025 938 KING STREET RYE BROOK,NY 10573 1 (914)939-0668 j VILLAGE OF RYE BROOK BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: / 7 C/ PP#: p` 2 5 Approval Date: JUL Permit Fee: $ 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, ; 1'1 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or renhove 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. I.Address: pZQ L( o c41. y! l04k �! SBL:J'�� —��p Zone:C/ 2.Proposed Work: i/1r,4-a f 4,'le FS' 01 ra K c e 3.Property Owner: /1 R :o(!l t R to {�c� �-�-( Address: 24,)AY� _ Phone#: 7/tI — 7Q 1 -- 4o06 Cell#: J email: C�k1* / b& 4.Master Plumber: a r C 4 /p kQ A Address: %'SI �ro ac�+t� /2a/ 51/Y2�tf0 - O 6�'�5► Lic.#: /4/01 Phone#: l Cell#:OZ-0 n,17—?Wit email: n 1 .1-D Company Name: IV.,le 6fl %KMb.�1' I-Ilea 4,A4 Address:16'I A, fo., rat✓ Rd .S�.,d /olio C7 cwrl t} INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor j 2nd Floor 31 Floor 4'h Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 STATE OF NEW YO,�R/K,COUNTY OF WESTCHESTER ) as: M&RC 1 y 1�(��0 being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this I Sworn to before me this ? day of V L 20 day of —7U&4 202 i re of Pro rty Owner Signature of Applicant 1DAviD E :G t Le-l4 At / vl�le�oZ t N e of Pr erty 9wtte>: Print Name of p licant T Notary lic NpTMV IUSC,tTIITE avow ae�fat wen pe.01HASS13645 G 0 GHE BREAHNA arelMler is tlteetchemr cffoy tary Public Connecticut lAy 0mrnission Expires.tan 31,2026 This application must be properly completed in its entirety an ature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/l/2024 BUILDING DEPARTMENT D VILLAGE OF RYE 14�00K 1 I 938 KING STREET RYE BROOK,NY 10573 ,1 JUL 1 8 2025 (914)939-0668_ L - " VILLAGE OF RYE BROOK t Ir _. BJILD►f� , nEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: residing at, M P r-q'L� oul 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; 21 D+ S I P—�b&11 L � , Rye Brook,NY. 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. DAle(I) 14 LU S Sworn to before me a this da of ., , 20 2 AL A MaRRt Mooa��li1t�ss�ottrrrdUW�te1Cn. a, K Y M 3- In wetchomf Co -MyC�iewno 6/1/2024 � U s s � � a � N N z cn � v0. Ln Ln cy 0.64 V U w t of CAZ p 2 < cn o = c _ g x n v O �, � o z N Q fz J W E- BUIL �NT VIL 938 K1N NY 10573 ov PLUMBING PERMIT APPLICATION FOR OFFICE USF ONLY 13Iz#: Pp ii:_ , 4 1'l�C>6 Approval Date: Permit Fee: S Approval Signature:_ � Disapproved: Mts � - *##x****x*##*#*#**##x*k************ *#********##*****#**#**##**f****k*** #***+refundable) 7c). �LJ DO NOT START WORK or CONSTRUCTION UNTIL A t'ER, THE BUILDING*** P� INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLCTED WITHOUT A PERMIT IS 12%OF THE T03'AL COST OF CONSTRUCTION WITH A MINIM-UM F1a,E?OF S750.00 Application dated, { � is hereby made to the a Permit to install and/or rem ve Plumbing as per detailed statement Building lcribed below.ne a nspector of the VillAli ant&e Booeof t NY' for the issuance s document agree that said plumbing work will be in conformance with all applicable Federal,State,County and ocaly ow eCodesl�g this 1.Address: " � �i�u�, Yrrn SBL: 2.Pro Zone: — — Proposed Work: 3.Property Owner: ,y� i �� �.L Address: -- Phone#: 43a� Cell#: " r� email: ^4xiL"t 4.Master Plumber: oWG -31e-�Cn Address: 15� ��{ SMc9I t)r� I ()hl,Jy Y ^'1[+YN Lic.#:� l-}O Phone#:—_ _Cell#:��j-- Company Name: T 9 a Address:_ V ICATE FIXTURES&LINES TO BE INSTALLED AS ER THE FOLLOWING SCHEDULE Location Water Unnals Drinking Sinks .howem Bath Lau Closets Foes �y Domestic Fire Sanitary Natural/ Other* Total Basement Tubs Service Service ' Sewer LP Gas 1st Floor C� 2nd Flo or 3"i Floor - 4�'Floor Sei Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Neat 2 Pages) -I- 6/l/1024 S F NEW YORK,COUNTY OF WESTCHESTER ) as: f I...n —.being duly swom,deposes and states that he/she is the applicant above named, (print name of individual signtn-.as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations Sworn to before me this Z I ��� -- Sworn to before me this HTI day of �;'C.i liC� _,20 �� day of (Y� t� 20 02 — re of Pro etty(huger. - Signature of Applicant 4- LNAA �� Print N e of Property(lamer ,- t f'Z Print Name of Applic Notary Public _^T_ AtfNANAKANirk otary /i1,u��l�Cr1;�7��11flu kly NOTARY YUKIC,STATE Of NEW YM rn C L"IY1TYl . Rtgistradon No.OINAGO13645 putiilitd in Westchegw County �'3t' "S teeu�t bn SH9 027 I 1 t1 must e pt•operiy completed in its entirety and must include the notarized si1?nature(s)of the legal o��ner(s)of the subject property,and the applicant of record in the spaces Provided.JApplicatiops not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -'- 6/1/2024 BUILD MENT VILE.B= OOK 938 KINGR ,NY 10573 z� ox 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 PLMMING PERMIT APPLICATICN. A.N- HUSLDINC oR PI.UNMXNG PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM -PILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 3, 1 N(' J . A ,residing at, 2� ��'( � ' 'k"A (Print name) — you live) being duly sworn,deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; - -— , Rye Brook,NY. c,$) ugh ndd — — 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. (Sign re of Proper[m ��tff Tts)) r 1' (Print Name of P-operty QvrrrCr(S)) -- Sworn to before me this y f Dibc`'iL'Q— 20 � (i otary Public) AL NA NAKANA NOTARY PU W.STATE Of NEW YORK Regiitratlon No.01HA000645 Q".ifl�d{n WevwMolor Count - MY Comn�itrlon EYpkN 2112 0- 6/12024 r t s s e N E s ►n fN O c s N N n e+ d \ 'x\i OC nn v a// O O �, / eq Q� 4 z 2 1! li ;D C114, Oi� U ' " 0 C: 'o' � vc � 8 V �hh C� a la 00 OZ cor i z7 � � o F- V � o � c r"" Zz h > w — o u aui t• , • ¢ 0 o �b L < U.J p � cn C 0 �z u a. v� � c. � p z a o �- ° � . x r w �. � N C z A a ° BUILDING DEPARTMENT R � IE � `� E VILLAGE OF RYE BROOK JUL 18 2025 ID 938 KING STREET RYE BRooK,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT Approval Date: JU 2025 Permit Fee: $ 5 A6 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 1S 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 holden&Workers Compensation Insurance on a NYS Board form I Dorm#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL= $200.00/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 r quires a separate Plumbing Permit&Plumbing Inspection. Application dated, L is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or re -vat f 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: c�O 4 So fk pjg z 5k )Cy( / /00r SBL:f 4111 Zone: {C�--/0 2. Property Owner: i/1 Address:o 214 yR r_ Phone#: '20I yOOI' CAI#: email: - �Y1 3. Contractor: /`lQ(G f'-14 h k4l) Address: 15, J5m,q,.&ere Ind C( Phone#: Cell#: .29 3-7�7— ?qd r( email: I'l w e fgn-11@ q jn c/fit.(j,, 4. Scope of Work:New Installation( )•Replacement el'--Removal( )•Other 04 r l io r� f p//1 u•�St��. 5. List Equipment: a KA- 1'&c i" J t_ cc 1 l &e,w 9 r,`I d 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): 1 6/l/2025 STATE OE NEW Y O OF WESTCHESTER ) as: A ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this d I + Sworn to before me this day of !� ,20 ZS day of 20 2`j De4Pro Signature of Applicant A&EV1. i7 "U—q+ mA r /'Lia le- Print Name of Pr pe A---..Fr Print=!i W �li otary Public o!Notary lic HEBREAHNA ■ PublicnecticutMy Comxpires Jan 31]20226 r 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/l/2025 t� a' Lr si W CA k rf Z C cn �" z a tj eq t •-� � o v ;� 0 3 � � "7 a' 7cnO M v° oo oei 0-4 Q O j W E (COO U z a W r C Ga a z 19) W .. cn W F a .4 � W � c Cc $ y rn 1 y - F I�1 � en 1-1 cl% wct c � � ; �' � z_ rH Fo as o z C � vs a U H w Q cn � O i o C7 A C7 a � °• v o z w z A ° �N .- � a A d g � � � �;-i --- - BUILD ._ TMENT VIL E OF R OOK AUG - 6 NO 938 KING � ET RYE BR ,NY 10573 4 L VILLAGE OF ��RBRONI_ ` w ov APPL ATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: p Approval Date: 8- //- 2 OZSBP#: ��-� 7 MP#: 5 c`) Application Fee:$ zD5o—f- 4-J Approval Signature: 7tn.� LIL ��d Permit Fees: Disapproved: Other: •*«,r***•wrrt*.****«*«,r•*********************tr+r,r****•*«***rr*r*,►,r««***w•**,w******•**•*•w*rt****,t*.**«rttr*rtr**,t* Application dated: OWN l W S is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement AJgs desccrQ ribed below. 1. Job Address: �( ` (1 5�W+ ( 1� j e I[)`I w m . /y y --/�'16 S/ ! v`)67 2. Parcel I.D.: f 1, 3-5 3 I- Zone: 3. Proposed Work(Describe system in detail including suppression agent): -1 gj, ( - 11 Tf. r;n ,�S_ �-n boa ce GLs nP.f e�� �� v,�,� a h d local mac► (O Le s 'A C_P_G�(a:run s. 4. Number&Types of Fire Sprinkler Heads: C 3 `W) ge t o a,U t e l`6 S ,! �j��►�/1 II��� 5. N.Y State Construction Classification:&ffi lgl N.Y.State Use Classification: I&Slyve° s 6. Estimated Value of Job:$ .011510(9 (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may be donated gratis.) (� Ha,l� oir*n U 7. PropertyOvmer:Wlll J'11'Age- �&I , LL. AhQ Address: 0� -` Ry.Uut°, Phone#9tq- ;!Q(- 4005 Cell# 54/1 email: a�Q�lQ�yt�iV\�( 1(1�CGtQQ. Com 8. Architect/EE�n�gineer:�CETO* �),)(k51w Lac Address: I q llel'Llxf pft�� t f L.IJ C�,�jy Phone# �1S'�j3`{'2i33 t,<+ [Celt# email: �l I °dIl6fe 91IO c,f.- NS-n.nst 9. Sprinkler Contractor:at aK� f` f1Y1[SIPl rjU,5 ►►S Address:3 j P11P1 U'�11/Q �' V(�t �It�tS GI .vY Phone4ff-3)Sf altg Cell# email:�QU��UU �� 1 Pe�(�t¢}eCsy •CW 1 6/1/2024 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. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: hB 9rlth1 j f' r�{ 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 Sprinkler 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 beff�ore,me this 5 day of /1 t/�: V� 20 25 day of 1 !v G U_W , 202 igna a of P erty Ownci C.�-- Signature of Applicant �/�� ()AVC �Stf' Vlw a PantoNamc of Property Oww ( 1� Print me of Ap cant No Public N Pu 1CAIIMA 14ARAUS NOlFU8M,S 0FN1wtM Joseph Cinicolo it btratlen No.01MANI3Nf Notar P b In Westchesu�oven Y ublic, Stete of New York of coombs-W lMU Reg. No. 01C10027568 Qualified in Westchester County Commission Expires Auqust 5. 2028 2 6/12024 Bulletin 034 August 2024 ® Model G5 Series Sprinklers Standard Spray, Flat Concealed Pendent Available with Gasketed Cover Plate Features Importantl Reliable fire sprinklers must be handled,stored,and • Standard Coverage,Concealed Pendent(K2.8,4.2,5.6,&8.0 installed in accordance with the guidelines in Caution Sheet 310 [40,60,80,&115 metric]) and this bulletin.Failure to follow these instructions may result in • Flat concealed cover plate available in a variety of finishes. unintended operation or nonoperation of the fire protection system. • Available with Stainless Steel Clad cover plate(see Table 1). • 3/4-inch(19 mm)cover plate adjustment. • Cover plate available with optional gasket. Product Description Model G5 series sprinklers are standard coverage,flat plate concealed sprinklers designed for installation in accordance with NFPA 13 and FM Global Property Loss Prevention Data Sheets.All Model G5 series sprinklers use a fusible-link operating element. The sprinklers are offered with a standard Model G5 cover plate, Model G5 Cover Plate Model G5 Cover Plate a Model G5 cover plate with a quick-response(QR)gasket,or a with QR Gasket Model G5 cover plate with a standard-response(SR)gasket.Model G5 sprinklers with a gasketed cover plate are intended for use in dust free environments such as clean rooms. Note:Gasket material is Model G5 sprinklers must only be used with the Model G5 cover silicone rubber, available in plate listed or approved with the sprinkler.Table A provides a white only. summary of available Model G5 series sprinklers,along with Listing and Approval information for each sprinkler and cover plate combination. Model G5 Cover Plate with SR Gasket Model G5 Series Sprinkler ummary K-Factor Listings Max.Working Sprinkler Sprinkler gpm/psi" Cover Plate and Sensitivity Pressure Identification Model (Umin/bar'') Model Approvals psi(bar) Number(SIN) G5 cULus QR SR G5-28 2.8(40) G5 QR Gasket cULus OR 175(12) RA3411 G5 SR Gasket cULus, FM SR 4.2 G5 G5-42 (60) G5 QR Gasket cULus QR 175(12) RA3413 G5 SR Gasket cULus SR cULus QR 250(17) G5 FM, LPCB,VdS,CE, SR 175(12) UKCA G5 56 (80) G5 QR Gasket cULus QR 250(17) RA3415 G5 SR Gasket cULus SR 250(17) FM SR 175(12) G5 G5-56 300 (8'0) G5 QR Gasket cULus QR 300(21) RA4014 G5 SR Gasket cULus SR 8. G5 G5-80 (110) G5 OR Gasket cULus QR 175(12) RA3412 G5 SR Gasket cULus SR G5-80F (8.0) G5 SR Gasket FM SR 175(12) RA3417 www.reliablespdnkler.com Model G5-28 Standard Coverage.Concealed Pendent Sprinkler SIN RA3411 Technical Specifications Temperature Ratings Style:Flat Concealed Pendent Ordinary Threads:'/,"NPT or ISO 7-1 R,/z 165°F(74°C)(Sprinkler) Nominal K-Factor:2.8(40 metric) [135°F(57°C)(Cover Plate)] Max.Working Pressure:175 psi(12 bar) Intermediate Material Specifications 212°F(100°C)(Sprinkler) Fusible Link:Beryllium Nickel [165°F(74°C)(Cover Plate)] Sprinkler Body:Brass Alloy Levers:Bronze Alloy Sensitivity « Yoke:Brass Alloy (See Table B) " Sealing washer:Nickel with PTFE Cover Plates Load Screw:Bronze Alloy Model G5 Towers:Copper Alloy Model G5 OR Gasket(cULus only) Pins:Stainless Steel Model G5 SR Gasket e Deflector:Bronze Alloy Cover Plate Finishes Cup:Steel (See Table 1) Sprinkler Wrench Model W3 Model FC Listings and Approvals cULus Listed(Light Hazard only) FM Approved Model G5-28 Sprinkler Components and Dimensions 2-5/16" (58 mm) Dia. Threads Body Cup Ceiling Tower Fusible Link 3/4"(19 mm)Max. Deflector(retracted) I Cover Plate Adjustment 3/16"(5 mm) Pin(extended) Deflector(extended) } Model G4/G5 Cover Plate 3-5/16"(84 mm)Dia. Ceiling Model G5-28 Sprinkler Sensitivity - Cover Plate Model Listing or Approval Agency cULus FM G5 OR SR G5 OR Gasket OR G5 SR Gasket SR SR QR:Quick-response SR: Standard-response Bulletin 034 Page 2 of 9 August 2024 www.reliablesprinkler.com Model G5-42 Standard Coverage,Concealed Pendent Sprinkler SIN RA3413 Technical Specifications Temperature Ratings Style:Flat Concealed Pendent Ordinary Threads:,/,"NPT or ISO 7-1 R1/2 1650F(74°C)(Sprinkler) Nominal K-Factor:4.2(60 metric) [135OF(57°C)(Cover Plate)] Max.Working Pressure:175 psi(12 bar) Intermediate Material Specifications 212OF(100°C)(Sprinkler) Fusible Link:Beryllium Nickel [165°F(74°C)(Cover Plate)] Sprinkler Body:Brass Alloy Sensitivity Levers:Bronze Alloy (See Table C) Yoke:Brass Alloy Cover Plates Sealing washer:Nickel with PTFE Model G5 Load Screw:Bronze Alloy Model G5 QR Gasket '. Towers:Copper Alloy Model G5 SR Gasket ` Pins:Stainless Steel Cover Plate Finishes Deflector:Bronze Alloy (See Table 1) Cup:Steel Sprinkler Wrench Model W3 Model FC Listings and Approvals cULus Listed(Light Hazard only) Model G5-42 Sprinkler Components and Dimensions 2-5/16" (58 mm) Dia. Threads Body Cup Ceiling Tower ` Fusible Link 3/4"(19 mm)Max. Deflector(retracted) Cover Plate Adjustment ;;;;;;; 3/16"(5 mm) Pin(extended) Deflector(extended) Model G4/G5 Cover Plate 3-5/16"(84 mm)Dia. Ceiling Model G5-42 Sensitivity Cover Plate Model Listing or Approval Agency cULus G5 QR G5 QR Gasket QR G5 SR Gasket SR QR:Quick-response SR: Standard-response Bulletin 034 p� Page 3 of 9 August 2024 R"U 1 www.reliablesprinkler.com StandardModel G5-56 Coverage, Concealed Pendent Sprinkler SIN RA3415 Technical Specifications Temperature Ratings Style:Flat Concealed Pendent Ordinary Threads:'/ 'NPT or ISO 7-1 RV2 1650F(74°C)(Sprinkler) Nominal K-Factor:5.6(80 metric) [135°F(57°C)(Cover Plate)] Max.Working Pressure: Intermediate 175 psi(12 bar) 212OF(100°C)(Sprinkler) 250 psi(17 bar)(cULus only) [165°F(74°C)(Cover Plate)] Material Specifications Fusible Link:Beryllium Nickel Sensitivity Sprinkler Body:Brass Alloy (See Table D) Levers:Bronze Alloy Cover Plates Yoke:Brass Alloy Model G5 Sealing washer:Nickel with PTFE Model G5 OR Gasket(cULus only) Load Screw:Bronze Alloy Model G5 SR Gasket(cULus and FM only) Towers:Copper Alloy Cover Plate Finishes j��'• Pins:Stainless Steel (See Table 1) Deflector:Bronze Alloy Cup:Steel Sprinkler Wrench Model W3 Model FC Listings and Approvals cULus Listed(Light&Ordinary Hazard only) FM Approved LPCB Approved VdS Approved[165'F(74°C)only] CE Listed(2831-CPR-S2062) UKCA:0832-UKCA-CPR-S5045 Model G5-56 Sprinkler Components and Dimensions 2-5/16" (58 mm) Dia. Threads Body Cup Ceiling ,.,.. Tower Fusible Link 3/4"(19 mm)Max. Deflector(retracted) /' Cover Plate Adjustment ;;;;;;; 3/16"(5 mm) Pin(extended) j Deflector(extended) Model G4/G5 Cover Plate 3-5/16"(84 mm)Dia. Ceiling Model G5-56 Sensitivity Listing or Approval Agency Cover Plate Model cULus FM LPCB,VdS,CE,UKCA G5 OR SR SR G5 OR Gasket OR G5 SR Gasket SR SR QR:Quick-response SR: Standard-response Bulletin 034 e11-�Ilrie Page 4 of 9 August 2024 www.reliablesprinkler.com Model . 300 Standard Coverage, • • Pendent SprinklerI Technical Specifications Temperature Ratings Style:Flat Concealed Pendent Ordinary Threads:'12"NPT or ISO 7-1 R'/z 165'F(74'C)(Sprinkler) Nominal K-Factor:5.6(80 metric) [135'F(57'C)(Cover Plate)] Max.Working Pressure:300 psi(21 bar) Intermediate Material Specifications 212OF(100°C)(Sprinkler) Fusible Link:Beryllium Nickel [165OF(74°C)(Cover Plate)] Sprinkler Body:Brass Alloy Levers:Bronze Alloy Sensitivity Yoke:Brass Alloy (See Table E) rr� Sealing washer:Nickel with PTFE Cover Plates _ 0 Load Screw:Bronze Alloy Model G5 Towers:Copper Alloy Model G5 QR Gasket t Pins:Stainless Steel Model G5 SR Gasket Deflector:Bronze Alloy Cup:Steel Cover Plate Finishes (See Table 1) Sprinkler Wrench Model W3 Model FC Listings and Approvals cULus Listed(Light&Ordinary Hazard only) Model G5-56 300 Sprinkler Components and Dimensions 2-5/16" ——(58 mm) Dia. Threads Body Cup Ceiling Tower J_ _:::� Fusible Link 3/4•(19 mm)Max. Deflector(retracted) Cover Plate Adjustment 3/16"(5 mm) Pin(extended) Deflector(extended) Model G4/G5 Cover Plate 3-5/16"(84 mm)Dia. Ceiling Model G5-56 300 Sensitivity Listing or Approval Agency Cover Plate Model cULus G5 QR G5 QR Gasket QR G5 SR Gasket SR QR: Quick-response SR: Standard-response Bulletin 034 R lab Page r.of 9 August 2024 www.reliablesprinkler.com Model :1 Standard Coverage, • -• Pendent Sprinkler Technical Specifications Temperature Ratings Style:Flat Concealed Pendent Ordinary Threads:,/,"NPT or ISO 7-1 R3/, 165°F(74°C)(Sprinkler) Nominal K-Factor:8.0(115 metric) [135°F(57°C)(Cover Plate)] Max.Working Pressure:175 psi(12 bar) Intermediate Material Specifications 212°F(100°C)(Sprinkler) Fusible Link:Beryllium Nickel [165°F(74°C)(Cover Plate)] Sprinkler Body:Brass Alloy F_ Levers:Bronze Alloy Sensitivity - Yoke:Brass Alloy (See Table F) Sealing washer:Nickel with PTFE Cover Plates sr Load Screw:Bronze Alloy Model G5 Towers:Copper Alloy Model G5 QR Gasket c 1 Pins:Stainless Steel Model G5 SR Gasket Deflector:Bronze Alloy Cover Plate Finishes Cup:Steel (See Table I) Sprinkler Wrench Model W3 Model FC Listings and Approvals cULus Listed(Light&Ordinary Hazard only) Model G5-80 Sprinkler Components and Dimensions 2-5/16" (58 mm) Dia. Threads Body Cup Ceiling Tower Fusible Link I 3/4"(19 mm)Max. Deflector(retracted) I Cover Plate Adjustment 3/16"(5 mm) Pin(extended) i .I ..... Deflector(extended) Model G4/G5 Cover Plate 3-5/16"(84 mm)Dia. Ceiling Model G5-80 Sensitivity Listing or Approval Agency Cover Plate Model cULus G5 QR G5 QR Gasket QR G5 SR Gasket SR QR:Quick-response SR: Standard-response Bulletin 034 Page 6 of 9 August 2024 ! EL-N-.& www.reliablesprinkler.com Model :1 • • Coverage. Concealed Pendent Sprinkler Technical Specifications Temperature Ratings Style:Flat Concealed Pendent Ordinary Threads:;/4"NPT or ISO 7-1 133/4 165"F(74°C)(Sprinkler) Nominal K-Factor:8.0(115 metric) [135°F(57°C)(Cover Plate)] Max.Working Pressure:175 psi(12 bar) Intermediate Material Specifications 212°F(100°C)(Sprinkler) Fusible Link:Beryllium Nickel [1650F(74°C)(Cover Plate)] Sprinkler Body:Brass Alloy Sensitivity Levers:Bronze Alloy Standard Response Yoke:Brass Alloy Cover Plates Sealing washer:Nickel with PTFE Model G5 Load Screw:Bronze Alloy Model G5 SR Gasket Towers:Copper Alloy Cover Plate Finishes Pins:Stainless Steel (See Table 1) Deflector:Stainless Steel i Cup:Steel Sprinkler Wrench Model W3 Model FC Listings and Approvals FM Approved Model G5-80F Sprinkler Components and Dimensions • 2-5/16" (58 mm) Dia. Threads Body Cup Ceiling Tower Fusible Link 3/4"(19 mm)Max. Deflector(retracted) Cover Plate Adjustment 3/16"(5 mm) Pin(extended) Deflector(extended) Model G4/G5 Cover Plate 3-5/16"(84 mm)Dia. Ceiling Model G5-80F Sensitivity .. Listing or Approval Agency Cover Plate Model FM G5 SR GSSR Gasket SR SR:Standard-response Bulletin 034 Page 7 of 9 August 2024 www.reliablesprinkler.com Installation Dimensions and Cover Plate Information Min.to Max. Min.to Max. Cover Plate Recommended Cover Plate Face of Fitting Dropped Cover Plate Cover Plate Diameter Hole Diameter in Adjustment to Deflector Temperature Ceiling Distance Rating Model Inch Inch Ceilingt') (mm) Inch (mm) Inch below Ceiling °F (mm) (mm) Inch (°C) mm G5 3-5/16 (84) 135°F(3) 3-11/16 (57°C) G5 QR Gasket") (94) 2-5/8 3/4 1-1/2 to 2-1/4 1/4 to 1 (67) (19) (38 to 57) (6 to 25) or G5 SR Gasket" 4 165°F'd) (101 mm) (74°C) Notes: 1. Face of fitting to ceiling dimensions are based on nominal thread make up.Verify dimensions based on fitting and thread sealing method prior to installation.A 1/2"x 112"brass nipple extension(Reliable P/N 6999991900)is available to assist with replacement of Reliable Model G4A sprinklers. 2. Model G5 QR Gasket and Model G5 SR Gasket cover plates are sold as assembled units including both the cover plate and gasket.Model G5 QR Gasket and Model G5 SR Gasket cover plates and gaskets are not interchangeable 3. For use with 165°F(74°C)temperature rated sprinklers where the Maximum Ceiling Temperature does not exceed 100°F(38°C). 4. For use with 212°F(100°C)temperature rated sprinklers where the Maximum Ceiling Temperature does not exceed 150°F(660C). Cover Plate Finishes(')(z) • - Standard Finishes Special Application Finishes Listing $Approval Agencies White Paint Off-White Paint Individual Model G5 series sprinkler may be listed or approved by Chrome Black Paint the following agencies: Custom Color Paint(Specify)j31 Underwriters Laboratories, Inc. and UL Canada(cULus) Raw Brass(Lacquered) Listing Category: Sprinklers,Automatic and Open Bright Brass Guide Number:VNIV Finished Bronze FM Approvals(FM) Satin Chrome Stainless Steel Clad'"� Loss Prevention Certification Board(LPCB) Custom Printed VdS Schadenverhutung GmbH (VdS) Notes: EC-Certificate of Conformity 0832-CPD-2062(CE) 1. Paint or any other coating applied over the factory finish will void all UKCA EN 12259-1 : 1999+A3:2006 approvals and warranties. See Table A and the individual sprinkler data sheets in this Bulletin 2. Cover plates do not carry corrosion resistant listings or approvals. for listings and approvals applicable to each sprinkler. 3. Custom color paint is semi-gloss unless specified otherwise. 4. Stainless steel clad cover plates are Type 316 Stainless Steel on the finished side and C102 Copper Alloy on the back side. Installation Model G5 series sprinklers are intended to be installed in accordance with NFPA 13, FM Global Property Loss Prevention Application Data Sheets,and the requirements of applicable authorities Model G5 series sprinklers are standard coverage,flat plate having jurisdiction. Model G5 series sprinklers must not be installed in ceilings with positive pressure in the space above. concealed pendent sprinklers.The sprinklers are intended for Ensure that the 4 slots in the cup are open and unobstructed use in accordance with NFPA 13 and FM Global Property Loss following installation. Prevention Data Sheets,as well as the requirements of the applicable approval agencies. Model G5 series sprinklers are shipped with awrench-able protective cap that should remain on the sprinkler until the Model G5 series sprinklers are available as either Quick-response sprinkler system is placed in service following construction. (QR)or Standard-response(SR)depending on the approval Model G5 series sprinklers can be installed without removing agency and cover plate selected. the wrench-able protective cap using the Model W3 wrench. Alternatively, Model G5 series sprinklers can be installed using the Model FC wrench by temporarily removing the protective cap Model G5 series sprinklers use Model G5 flat cover plates. Model during installation of the sprinkler.The use of any other wrench G5 QR Gasket and G5 SR Gasket cover plates are available to to installed Model G5 series sprinklers is not permitted and may limit air and dust movement through the ceiling. damage the sprinkler. Bulletin 034 e ,a Page 8 of 9 August 2024 www.reliablesprinkler.com ;1 Model FC Model W3 For use with Model G5 Series sprinklers For use with Model G5 Series sprinklers with without wrench-able cap installed wrench-able cap installed Fully insert the Model W3 wrench over the cap until it reaches Replace any sprinkler or cover plate which has been painted(other the bottom of the cup,or the Model FC wrench over the sprinkler than factory applied).Properly installed Model G5 cover plates will until the wrench engages the body. Do not wrench any other have an air gap that is required for proper operation, do not seal part of the sprinkler/cup assembly.The Model W3 and FC the gap or paint the cover plates. Model G5 series sprinklers have wrenches are designed to be turned with a standard 1/2"square holes in the cup that must remain unobstructed. drive.Tighten the sprinkler into the fitting after applying a PTFE Replace any sprinkler which has been damaged.A stock of spare based thread sealant to the sprinkler's threads. Recommended sprinklers should be maintained to allow installation torque is specified in Table J. p quick re of damaged or operated sprinklers. Failure to properly y maintain sprinklers may result in inadvertent operation or non-operation during a fire event. Installation Torque . - Recommended Installation Guarantee Sprinkler Threads Torque (min.—max.) For the Reliable Automatic Sprinkler Co., Inc. guarantee, terms, ft.lb N•m and conditions,visit www.reliablesprinkler.com. '/2" NPT or IS07-1R1/2 8-18 11-24 1/4' NPT or IS07-1 R3/4 14-20 19-27 Patents Do not exceed the maximum recommended torque.Exceeding the Model G5 series sprinklers may be covered by one or more of the maximum recommended torque may cause leakage or impairment following patents: of the sprinkler. Use care when inserting or removing the wrench U.S. Patent 6,554,077, U.S. Patent 7,275,603, U.S. Patent from the sprinkler to avoid damage to the sprinkler. 8,776,903, U.S. Patent 9,248,327 Install the cover plate by hand, pushing and then turning the cover Ordering Information in the clockwise direction until it is tight against the ceiling. For Specify the following when ordering. Model G5 QR Gasket and Model G5 SR Gasket cover plates, the gasket should be attached to the flange of the cover plate skirt Sprinkler only. Do not glue the gasket in place or allow the gasket to overlap Model[G5-28][G5-42][G5-56][G5-56 300] both the cover plate and the flange of the skirt. [G5-80][G5-80F] • Temperature Rating[165°F(74°C)][212°F(100°C)] Maintenance Threads[NPT or ISO 7-1] Reliable Model G5 series sprinkler should be inspected and the Cover Plate sprinkler system maintained in accordance with NFPA 25, as well Model[G5,G5 OR Gasket,G5 SR Gasket] as the requirements of any Authorities Having Jurisdiction. Finish(See Table[) Prior to installation,sprinklers should remain in the original cartons Sprinkler Wrench and packaging until used. This will minimize the potential for Model W3 damage to sprinklers that could cause improper operation or non- Model FC operation. Do not clean sprinklers with soap and water,ammonia liquid or any N v other cleaning fluids. Remove dust by gentle vacuuming without touching the sprinkler. rn rn rn z a Bulletin 034 Page 9 of 9 August 2024 ReNINON www.reliablesprinkler.com ppl SYSTEM RECORD OF INSPECTION AND TESTING This loan is to be completed by the system inspection and lestino contractor a11he lime ola system test It shall be perrnilted to modify this form as needed to provide a more complete and/or clear record. / ert N/A in all unused lines. Attach additional shee data, calculations as necessary to provide a complete record. _ Inspection/Test Start Daterrime: %. `O Inspection/Test Completion Daterfime: Z 2 Supplemental ormfs) ttached: NO (yes/no) 1. PROPERTY INFORMATION Name of property: V,O Address: l0 Description of property: C., Name of property representative: Address: Phone: Fay E-mail: 2. TESTING AND MONITORING INFORMATION Testing organization: Scarsdale Security Systems, Inc Address: 132 Montgomery Avenue, Scarsdale, NY 10583 Phone: (914)722-2200 Fax: (914)722-2299 E-mail: Monitoring organization: S. Address: Phone: Fax: E-mail: Account number: S Phone line 1: Phone line 2: Means of transmission: v Entity to which alarms are retransmitted: Cia cj� Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit 0 n Manufacturer: 1� "(e— ��� Model number: 41 Software and Firmware Firmware revision number: 43 System Power 43.1 Primary(Main)Power Nominal voltage: 11 V P'G Amps: Location: Overcurrent protection type: Amps: Disconnecting means location: copyright®2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. it= 1 of -1) SYSTEM RECORD OF INSPECTION AND TESTING (continued) 4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.31 Secondary Po er Type: _ C;ft � r-{ Location: , J Battery type(if applicable): Z �'� •p Ci �— ev/G• Calculated capacity of batteries to drive the system In standby mode(hours): a_. In alarm mode(minutes): 5 5. NOTIFICATIONS MADE PRIOR TO TESTING .Monitoring organization Contact: Time: Building management Contact: 'rime: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other, if Contact: 'rime: required 6. TESTING RESULTS 6.1 Control I nit and Related Equipment Visual Functional Description Inspection Test Comments Control unit Lam s/LEDs/LCDs Fuses Trouble signals Disconnect switches Ground-fault monitoring Supervision Local annunciator Remote annunciators Remote power panels y000r- 0 ❑ 6.2 Secondary Power Visual Functional Description Inspection Test Comments Batter condition 2 Load voltage Discharge test Charger test Remote anel batteries Copyrght C 2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distdbutkML Ip z of 4) SYSTEM RECORD OF INSPECTION AND TESTING (continued) 6. TESTING RESULTS (continued) 6 3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices. 6A Notification Appliances Attach supplementary appliance test sheets for all notification appliances. 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface/Signaling Line Circuit Interface/Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes No Ti a Comments _ Alarm signal ❑ Alarm restoration / ❑ Trouble signal C3' ❑ Trouble restoration ❑ Supervisory signal ❑ Supervisory restoration ❑ 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal ❑ ❑ Alarm restoration ❑ ❑ Trouble signal ❑ ❑ Trouble restoration ❑ ❑ Supervisory signal ❑ ❑ Supervisory restoration 1 ❑ 1 ❑ Copyright�2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. (p. 3 of-1j SYSTEM RECORD OF INSPECTION AND TESTING (continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Time: Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other, if Contact: Time: required S. SYSTEM RESTIOR TO NO MALOPERATION Date: J— \d lime: i/ e' CIO J 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72, 2013 edit ion,,Chapter 14. Signed G' ' Printed name: �1� �C `� Date: Organization: Title: V Phone: 1 Z 2Z Qualifications(refer to 10.5.3)- � �- 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Printed name: Date: Organization: Title: Phone: Copyright C)2012 National Fire Protection Association This form may be copied for individual use other than for resale.It may not be copied for commercial sate or distribulbn. (L� .1 of 41) Buil /�ermit heck List&Zoning Anal sis Address O' � . `3 " 1 SBL• / Ll r Zone: - se Const.Type Other: 1 Submittal Date 2� Revisions Sub 'ttal Dates: Applicant: co "Q . t._0 ,n -C,_� \ \ Nature of Work: �( \ Reviews:ZBA• JUL 15 2025 pB: BOT: Other: NEED OK ( ) FEES:Filing.�BP: C/O: Flood Plane: Legalization: ( ) ( ) APP: Dated: Notarized: SBL: Truss I.D. Cross Connection H.O.A: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening- ( ) ( ) ENVIRO:Long. Short: Fees: N/A; ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed Unacceptable: ( ) ( ) ,PLANS:Date Stamped Sealed Copies: Electronic: Other. (✓)' ( License Workers Comp: Liability: Comp.Waiver. Other. ( ) ) CODE 753#: Dated N/A: ( p/HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) HOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. �'J iy=LuMBING ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. ( Plans: Permit Nat.Gas: LP Gas: N/A/: Other. (�( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: REQUIItED EXISTING PROPOSED NOTES APVH- UII L Z 4 Date•_ Circle: F%ems Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA- Tot : Ft.Im Parlunv: H ' ht Stories: notes: ` CA41 �`vC G t � t N \C-L 4 AC RO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) O6/11/2025 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 NAME JUNY VARGAS Juny's Professional Services PHONE (201)624-8010 FAX (A/C Nq.F,nl• W No),(201)624-8013 8400 Kennedy Blvd pp AIL Jvar as Jun ProServices.com North Bergen NJ 07047 INSURERS)AFFORDING COVERAGE NAICB INSURER A: CLEAR SPRING PROPERTY&CASUALTY INSURED INSURERB: MT.HAWLEY INSURANCE CO. C&C PAINTING AND CONSTRUCTION LLG INSURER C: EMPLOYERS INSURANCE CO. _ 515 Lowe Avenue INSURERD: Ridgefield NJ 07657 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 EFF POLICY EXP LT. POLICY NUMBER iMMn3QlYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE LX OCCUR DAMAGMJ'E TO ROE fED $ 100,000 RE El X X CB003392202 02/17/2025 02/17/2026 MED EXP(Arry one son $5,000 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 JPRO- POLICY X❑ LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Peraccidenl) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY F — $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $5 000,000 3 EXCESS LIAB CLAIMS-MADE GXS0019214 09/17/2024 09/17/2025 AGGREGATE $5,000,000 DED RETENTION $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N A TER - ANY C OFFICER/MEMBER/EXCLUDED?ECUTIVE� NIA E.L EACH ACCIDENT $ 1,000000 EIG5755471-00 11112/2024 11/12/2025 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000 000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF sTArE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured C&C PAINTING AND CONSTRUCTION 201-906-0420 204 S RIDGE ST RYE BROOK,NY 10573 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 384010085 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) EMPLOYERS PREFERRED INSURANCE COMPANY Village Of Rye Brook 938 King Street 3b.Policy Number of Entity Listed In Box"1 a" Rye Brook,NY 10573 EIG5755471-00 3c. Policy effective period 11m9j?r9d to L/i9i9n9.6 3d.The Proprietor,Partners or Executive Officers are included.(Only check box If all part norsloffcers Induded) ® 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 Iter�_3� 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: Matthew Barton (Print name of authorized representative or Ilcensed agent of insurance carrier) Approved by: ,AT1 07/10/2025 (Signature) (Date) Title: Document Services Telephone Number of authorized representative or licensed agent of insurance carrier: 800-700-91 13 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.gcv ";4Cofro" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY)07/10/2025 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 Genesis Mariscal NAME: North Main Street Insurance Agency HNE . (914)481-5334 FAX No): 375 North Main St. EMAIL ADDRESS: �9 nmsinsuranoel mail.Com Port Chester, NY 10573 INSURE11i AFFORDING COVERAGE NAICS INSURERA: Utica First Insurance Company INSURED INSURER B• Marc Maleton DBA INSURERC: Marc Maleton Plumbing& Heating INSURERD: _ 151 Broadmere Rd INSURERE: Stratford,CT 06614 INSURER F: +_ I 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 I ADDL TYPE OF INSURANCE IN&SUER POLICY NUMBER MIMID POLICYEFF POLICY EXP LIMITS LTR WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ® OCCUR PREMISES MeRENTED occuriecm $ 100,000 NED EXP(Any one person) $ 5,000 A X ART3000763030 01/30/2025 01/30/2026 PERSONAL BADVINJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICYJD311�• ""�' "'r+ • PRODUCTS-COMP/OP AGG S 2,000,000 OTHER $ AUTOMOBILE LIABILITY EOMBINEDD SINGLE LIMIT $ ANY AUTO;,.. BODILY INJURY(Per person) $ OWNED' 1' 8MIfftLtEl*1_ BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident s UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIM CLAIMS-MADE AGGREGATE $ DIED RETENTION$ S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNERlEXECUTIVE E.L EACH ACCIDENT $ OFFICE RIMEMBEREXCLUDED? ❑ N/A (Mandatory in NH) E.LDISEASE-EAEMPLOYEE S 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) Additional Insured. Village of Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St. AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 r ekeiL..s- A-rLical ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany. NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE mw ^^^ ^^^ 118706327 X *t,r. GENESIS MARISCAL D/B/A {�r �'•' NORTH MAIN STREET INSURANCE i 375 N MAIN ST PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MARC MALETON D/B/A VILLAGE OF RYE BROOK MARC MALETON PLUMBING AND HEATING 938 KING ST. 151 BROADMERE RD RYE BROOK NY 10573 STRATFORD CT 066142506 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE X2406 388-5 594649 12/30/2024 TO 12/30/2025 7/10/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2406 388-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/fWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR. PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND T �V DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 703531188 U-26.3 may ► _. A y1f� ,.10 mob- lows .s.�. .,..�,.. . .�-- I � Q � �t--.act _ ..�+$� '��•�i... C J ° :3 3 cQ ed W w 4• Or ••U•i F— C•M V) _ CO .— > W } U c• \action uj V L U) x 3 � w_ WLLJ L � o ✓D `Y' ° W W a j o c as z 3 LL X w :. N . � Z ti C � •— O C at O A A Client#: 2498 ALLSAF2 DATE(MM/DD/YYYY) ACORD.. CERTIFICATE OF LIABILITY INSURANCE 12/05/2024 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(les)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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONCT NAME: Commercial support Edgewood Partners Ins. Center a2 NoFAX ,Ez0:631 390-9700 MC No; 40 Marcus Drive ADDRDRESS. NEconstructioncerts@epicbrokers.com 3rd Floor INSURER(S)AFFORDING COVERAGE NAIL# Melville, NY 11747 INSURER A:Crum&Forster Specialty Insurance Co 44520 INSURED INSURERS:Merchants Mutual Insurance Company 23329 All Safe Fire Protection&Mechanical Inc INSURER C All Safe Fire Sprinkler Systems Inc INSURER D 375 Executive Blvd INSURER E Elmsford,NY 10523 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 CONTRACTOR 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. LTT IN TYPE OF INSURANCE A°R' yyyp POLICY NUMBER (IPIOLILICY EFF LlMrrs A X COMMERCIAL GENERAL LIABILITY Y GLO108647 9/11/2024 09111/2025 EACH OCCURRENCE $1 000 000 CLAIMS-MADE a OCCUR PREMISES Ea o nDanca $50 000 X BUPD Ded:5,000 MED EXP(Any one person) s5,000 X Contractual Liab. PERSONAL&ADV INJURY $1,000,000 r'OTHER: L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s2,000,000 POLICY aJECOTLOC PRODUCTS-COMP/OPAGG s2,000,000 $ B AUTOMOBILE LIABILITY IF CAP9269941 9/16/2024 09/16/202 COMBINED n SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ UTA OSE ONLY X SCHEDULED BODILY INJURY(Par accident) $ AUTOS PROPERTY DAMAGE X HIRED AUTOS ONLY X AUTOS ONLY Y Per accident) $ $ A UMBRELLA UAIS X OCCUR SE0132209 0911112024 09/1112025 EACH OCCURRENCE _ $1_000 000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $1 000 000 DED I RETENTION$ $ WORKERS COMPENSATION ISPTERTUTr OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 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) Certificate holder is included as additional insured for general liability coverage as required by written contract. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S7070736/M6897115 LMU02 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a. * W H n n An AA 061503131 EPIC INSURANCE BROKERS &CONSULTANTS 1 a 40 MARCUS DR,3RD FLOOR MELVILLE NY 11747 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ALL SAFE FIRE PROTECTION, INC. VILLAGE OF RYE BROOK 375 EXECUTIVE BLVD 938 KING ST ELMSFORD NY 10523 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2593 528-9 535115 07/07/2024 TO 07/07/2025 12/5/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2593 528-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. VICE PRESIDENT MAUREEN ULLEY ONE OF TWO OFFICERS OF ALL SAFE FIRE PROTECTION INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND 74 �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:573207220 U-26.3