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BUILDING DEPARTMENT
❑ly,/II.DING INSPI-CTOK
{d ASNISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ISNrOuca•.nniN r(h ru;lal 938 King Street • Ryt: Brook, NY 10573
(914) 939-0668 FAX (914) 939-5801
www.rychrook�r�
- INSPECTION REPORT - - - - - - - - - - - - - -
Ai)DRESS : 100 �t�-�,�1 R,c+6.g S DAA L: 10 - ZZ- ZOZ.,-
I)Ii1tMt'1'# T 1I� �S2L.�SPiOJ 1SSUIiDp�( � 27 BLOCK:
LOCATION: G" ` I P D � �, IVW ICI C Citr' -_ --- OCCUI'ANC1:
❑ Violation Noted 1 111: wt)ulc Iti... V( 1°AStihl► ❑ FAILED / REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOT1;S ON INSPECTION:
❑ ROU(:ll PLUMBING
❑ ROUG11 FRAMING
❑ INSULATION
❑ Natural GasN 3 ,�,,, 41
❑ L.R Gas
❑ FUELTANK __-
❑ FIRE SPRINKLER ER LL..... V LO-L
❑ FINAL l)LUMIIING ----� � --.1_'►�L.
❑ CROSS CONNECTION �— Q�O� � /�/�J� �►+��� /C)1J `
,fT FINAL
QyE BRCv�•
1932 BUILDING DEPARTMENT
,❑BBUILDING INSPECTOR
�]ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAX (914) 939-5801
www ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : DATE: �.
PERMIT# ISSUED: SECT: BLOCK: LOT:
LOCATION: OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED 2--.'REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
J
BUILDING DEPARTMENT
VILLAGE O:(�' RYE BROOK Initial Inspection Date: ❑ Pass
STI:vEN E.FHWS 938 K1N4G STRU'I?T,Rvh..131toox,NEW YORK 10573 9- /2 -20 2'/ )( F,lil
BUILDING&FIRE INSPi,-(r JR (91.4)939-0668• VAX(914)939-5801 Re-Inspection Date: ❑ hass
stcyctcwsU/h ycbrgok•or,{ W W w,ryrlll'1l��1:.�►1';;
Fail
F1RF INSI1F,('T1ON RFT()I T Nl)'I'll 'h, ode VI(11,ATRION &, Qimie •ro Rh;wi)V SAME
Site Address:_A—QQ Sau - v - 6,�, k- -- -- Zone:C SBL:
Occupancy:-00 1 PQV-1-& (h ro,�l�� J -f-7e 1 LL __-;0O y3_ State Use Classification:
Business Owner:AC-�n&g4k0_ MeK% to ��►`�.4_ _(��, u Phone: 3$o -_2 Z 2' 72 '®c�
Building owner:._. W i a_.� R�a.1.
Emergency Contact: aMi -..�_.�aa�oc.,� F�.�Is�_ .L&4Q►_.Phone: 92 9- 3 69- 782 w
Building Represcntative in Attendance: v
---------------------------------------------------------------------------------------------------------------------------------------------------------
'rake notice that the following violations of the New York State Unitil1-11)Tire Prevention&Building Code and/or the Code of the
Village of Rye Brook were found to exist at, 1 p p _g ��Ct•� ,in the Village of Rye Brook,
NY on,_$�P ��_ _20 2 ,You arc hereby dial to obtain the necessary permits and to correct all
violations immediately.You are farther directed.to coutael.the tittilding De partnient during normal business hours to schedule a re-
inspection of the premises to confirm that all violations have hcun corrected,and that the premises is in full compliance with all
applicable codes,laws,riles®ulations.Be advised that:your t iilure to comply with the directives contained herein and to correct
all violation~is a crime punishable by tine,imprisonment or 1)0t11.
---- ---------------------------------------------------------------------
N u 1 12, N/A
]..1'oRrn111,H.FIRu 1axTlNculwil�Itti1Pl'}�'til
a.906.1 Arc 1'FE's imitalled tbroughout the space&,oil the preulisys:.I.s required by code. a.
b.906.3.1 Is the maximum travel distance to a I)1` i 75 feet or 1c:;s. b - —
c.906.5 Are PFE's conspicuously located&readily accessible.
d.906.6 Are PFE's unobstructed/unolncu el lioui view. c.d.
- — —
c.906.7 Are PFE's properly mounted as per the mallufaeturcr.s instructions. e.
f 906.9 Are PFE's installed so that the top is not 1ligher t:hart 5 feet above the floor. e — —
2.Fiu,ALARM SYti,rr�,m&Snlolcl,l)M,1 rc l oRti
a.901.6.1 Is the firc alarm system inspected,tested&maintained in accordance with NFPA 72.
b.907.4.1 Are manual pull stations located within 5 feet of exit:~, within 200 feet of each other. a
c.907.4.2 Is the height of the pull station handle located between 42&48 inches above the floor. C.
— —
d.907.3 Is a fire alarm system provided in exisli1 buildings as per:;ection 907.3.1 &907.3.2. c —
d.— ✓ —
3.Fin,SPRINiC.1..b;R SY$'17;M&FIRK HYDRANIN
a.901.6.1 Is the sprinkler system inspected,tested&ulaintttined in accordance with NFPA 25-13.
b.901.6.1 Are the main valves secu cd against:tampering in the open position. a.
c.901.6.1 Are suffiicient clearances maintained from fire sprinkler bcads to fixtures or materials. b —
d.901.6.1 .Is a supply of six spacc Reacts&a WA-11ch III-lint:tincd on the promises. C.
e.901.6.1 Arc sprinkler heads&cover plates unfinished or of factor applied finish only. e —
y pl y. e. X _
f.901.6.2 Are records of all system ilispecti0111s,t:csts Ok maintenance reports maintained on the premises. f.
g.913.5 Is the fire pump inspected,tested&nlaint.tincd in accordance with this section&NFPA 25. —
h.508.5.2 Is t11e fire hydrant system properly maintained,operatiortt:d,compatible w/NST&tested annually. h.
i.508.5.4 Arc;fire hydrants&fire protection equipment:Lmolntructed. — —
i.
j.508.5.5 Is a clear space of not less that 3 feet maintrtinel around all hydrants. j — —
INSPUK'MR: DATE. 9 - 1 Z — Z l) 2
1..
revis«12i10i1 1
No 'VI?;i N/A,
4.STANDPIPE,CABINETS&FIRE DEPARTMENT CONNECTIONS
a. 901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a.
b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b.
c.905.1.Are FDC threads in the standpipe system compatible with National Standard specifications. C. _ je
d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d. A
e.905.7.1.Are cabinets containing tire fighting equipment properly identified&labeled. e• _
f.912.2.1.Are exterior FDC's fully visible&recognizable from tine point of fire department access. f
g. 912.3 Are FDC's unobstructed and available for immediate access by the fire department. 9.
5.ExITS.MEANS OR EGRESS&OCCUPANCY
a. 1028.2.Are exits&exit enclosures continuously maintained free fiom obstructions or impediments. a.
b. 1028.3.Is the means of egress free from obstructions including accumulated ice&snow. b.
c. 1028.5.Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... c.
d. 1028.6.Are existing emergency escape&rescue openings maintained as per this section. d. — —
e. 1029.2.Are egress doors readily operable from the egress side as per this section&Section 1008.1.8.3. e.
f. 1029.4.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f �►
g. 1029.7.1.Are exits marked by a properly located,approved&readily visible exit sign. g. _ —
h. 1029.7.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h.
i. 1029.7.3.Are all stairway exits provided with tactile exit signs in compliance with ICC/ANSI 117.1. i.
j. 1029.7.4.Are all exit signs illuminated at all times. j _ —
k.1029.8.Are the means of egress&exit discharge illuminated at all times the building is occupied. k _ L/ _
1. 1029.11.1.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures 1.
are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides.
in. 1029.11.2.Are non-public/non-accessible aisles serving less than 50 people maintained at least in. WO28"wide,or at least 36"wide where serving 50 or more people. — — —
6.COMBUSTIBLE STORAGE&WASTE MATERIALS
a.304.1.Is premises&building maintained free from accumulated combustible waste material. a• _b.304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. � —
e.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C. —
d.315.2.Are combustible materials properly stored&separated from ignition sources. d. — —
e. 315.2.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e. X and 18"or more below sprinkler head deflectors in sprinklered buildings. — —
f 315.2.2.Are exits&exit enclosures maintained free from stored combustible materials. f
g.315.2.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g. _ r/
h.313.1.Is building maintained free from stored fueled equipment. (motorcycles,mopeds,mowers,etc...) h. _
7.ELECTRICAL
a. 604.1.Are emergency&standby power systems properly maintained. a.
b.605.1.Is the building free from modified/damaged wiring,devices,appliances,equipment and b. —
maintained free from electrical hazards. X — —
c. 605.2.Are electrical service equipment areas properly illuminated. C.
d.605.3.Are proper working space clearances provided&maintained for electrical service equipment. d. _
e. 605.3.Are electrical service equipment working spaces free from any Stored materials. e. —
f.605.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. f ✓ —
g. 605.4.Is the building free from unfused-imrlti-plug electrical adapters. g —
h. 605.5.Are electrical extension cords being used in a safe manner as per code. h. — —
i.605.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. i. X
j.605.6.Is the building free frorn open-wiring spliced electrical connections. j — —
k.605.8.Are electrical motors maintained free from accumulated oil,dirt&debris. k. X — —
1. 610.Are Carbon Monoxide Detectors installed&maintained as required by code.
INSPECTOR: `.�1 �� Q"
— - DATE: ! Z " Z O 2
Revised 2/10/11
8.Eix iyATo1LS,DUMIIWAITFRS O&I+;tif'AI A'1'()It'i No N/A
a. [PM1606.1.Are elevator.,;properly maintailuxl,and is tlx:curTent certificate of inspection on the premises. a.
b. 607.2.Are approved standardized,pictorial si�,ns posted adjacent to each elevator can station on all b. �/
floor%rending; IN I�Iltl;I+;MU;R(:I:N('1' I/(/N(1'1'I Itil;1+;1,1?VA'I'1/lt IISI+;I+;XrI'ti'1'AIItS —
c.607.3.Arc keys for elevator car doors&fire dcpartnlctit scrvi.ce in au approved location. C.
d.315.2.3.Are elevator machine rooms maintained free fi•onl stored combustible material. d•
C.[I3]3006.1.Are elevator machine room doors"Militztinecl unobsh'ucted at all times. e. —I1C
9.COMMGRCIAI.,KgrigI NS
a.904.11.5.Arc portable Class K fire cminguishels within 30 feet of cooking equipment. a•
b.904.11.6.1.Is the lire protection equipment inspected, test:cd&maintained as per Section 901.6. b. _ —
c.904.11.6.4.Are automatic fire extinguishing systems serviced at least every 6 months&after system C.
activation,and is the certificate of inspection forwarded to the code enforcement official.
d.904.11.6.5.Are fusible links&automatic sprinkler heads replaced annually. d. _X -- —
1.0.TJFATING Sys,rFMs
a.rpm.1603.1.Are all heating appliances properly installed(V maintained in a safe working condition. a.
b. [I'M]603.2.Arc all Teel-burning appliances&equipment con tiected to an approved chimney or vent~ b. _
c.[PMl 603.3.Arc heating apphances In dutltincd with proper clearances TTolla combustible material. C. _ Z —
d.[PMl 603.4.Arc sal.ety controls for filer-buruinl;cquipineut.mainla:incd in effective operation. d.
e. [Iw1603.5.Is the fuel-blrrrlinlg equipment Provide([wit)adequate combustion&ventilation air.
I'L MOTOR Fuut1ANsgriNSING FACII,ITII„'i&REPAIR(-.ARAGI?,S
a.2203.2. Is an approved,readily identified(ci:readily acccssible emergency disconnect switch provided a. _
in an approved location within 10()'ol:,but not:loss than 20' from fuel dispensers. —
b.2204.3.4.Are dispenser opet-,ting instructions conspicuously posted on every fuel dispenser. b•
c.2204.2.4.Are fuel-dispensers unobstructed&ill clear view of the attendant at all times.
d.2205.5.Are approved portable fire extinguishers cola lyiMl a ( c. —
g p (. wll:h.'Section)O6 with a ruiuunum rating of d. ✓
2-A:20-13:C provided.&located.not more than 75' f:'rorn punnps,dispensers&fill-pipe openings. — — —
e.2205.5.Are warning signs provided&postad within sight of each dispenser as per this section. e. Woef.2205.7.Are combustible materials kept at least. 10' front fiicl-ba:ndling equipment. f — —
g.2206.4.Are above-ground tanks provided with vehicle impact protection. — — l
h.2206.5.Are above-ground tanks provided with secondaly Spill containment. 9-
h.
_ _ _✓
12.T-IAZAR1x)ti.%MATERIAI„1
c. 407.2.Are M.S.D.S.for all h"Airdous materials readily availatblc on the premises. a.
d.407.3.Arc spaces and individual containers conWiniuf;lr<u-Inais properly labeled&,identified. b. —
c. 2701.4.Arc ll•lz-mats reported annually as required by Goveral M itlicipal Law Section 209u. C. —
d.2703.7.L Arc proper N()SMOKING signs providcd its per 1:lus section. d —
1.3:MISCFI.I,ANVO(IS
a.404.2.Is an approved fire safety&evacuation plan prcpa l-cd&n.iaintaiued for the building/occupancy. a. X
b.405.2.Are emergency evacuation drills conducted at:tile:intervals as specified in Table 405.2. b, � — --
c.405.5.Are records kept&maintained on the premises 1'()r cincl' Orney CVACrratlOn drills. C. --
d.505.1.Are approved address&building nuuri)els properly Placod&plainly visible from the stTeet. d. _ _—
c.506.1.Are approved key boxes(knox Iwxa,>)provided,properly located&equipped with the proper keys. e. �
f 703.1.Is all required fare-resist:auu:c tatted eorlstxuction properly maintained as per code. f — —
g.703.L Arc openings through fire-resistance al.ted au seniblics properly protected&maintained. g• —
h.3003.5.Are compressed gas cylinders&systcnns secured&sa:fcguarded against damage&access. h. _
i.3003.6.1.Arc compressed gas cylinder caps or collars in place at all times except when tanks are in use.
14.GENERAL IIOUNUh:FFPIN(:
a.Good
b. Fair _---_
c.Inadequate _
d..Poor
DATE:
3.
RcwisW 2/10/11
ITEM NUMBER REMARKS
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INSPECTOR: Z�. G �� OZ ` Z.OZ
DATE:
�I.
/ 2, Revised 2/10/11
A'a'Hw Numi.;m REMARKS
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INSPLCI'OR: f- /L-
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`� /J Revised 2/30/1 t
Alfredo DiVitto
From: Alfredo DiVitto
Sent: Thursday, September 18, 2025 9:03 AM
To: 'shannon.sief ring @chipotle.com'
Cc: 'Alena Hakanjin'; Steven Fews
Subject: CHIPOTLE #1348 FIRE INSPECTION
Good morning,
Our records show that the 2024 fire inspection has not yet been completed.There are a few outstanding items that
need to be addressed by your team:
1. Install a Carbon Monoxide detector at the front of the store.
2. Replace the strobe/annunciator in the rear prep area by the dishwasher.
3. Provide the latest reports for hood cleaning and hood fire suppression testing.
I have availability for the reinspection on September 25th at 9:30 A.M.. Please confirm if this time works.
Thank you,
Alfredo (Freddy) DiVitto
Assistant Building Inspector
Village of Rye Brook
938 King St.
Rye Brook,N.Y. 10573
Office: 914-939-0668
INVOICE Academy Fire Life Safety LLC
Date: 5/20/2025 42 Broadway
Lynbrook, NY 11563
Invoice No.: 2855469
(800) 773-4736 (347)473-7335 (fax)
Bill to: Chipotle Mexican Grill -Service Service at: CHIPOTLE#1348
Channel - Bill
610 Newport Center Dr 100 South Ridge Street
Suite 1300
Newport Beach, CA 92660 Rye Brook, NY 10573
Payment Terms: Date of Service: 5/13/2025
Customer ID: CHIPOTLE#1348 Internal ID: 3238883
P01W0#: 311777579
Detail: RS INSPECTION
Billed By: Sonita Keo
Invoice Summary:
Description Unit Quantity Unit Price Amount
Service/Labor
RS Inspection ins-ea 1.00000 $125.00 $125.00
MS Web Portal Administration ea 1.00000 $5.00 $5.00
RS System Piping Integrity Test-Additional ins-ea 1.00000 $40.00 $40.00
Cylinders
RS System Piping Integrity Test ins-ea 1.00000 $60.00 $60.00
RS Inspection addcylinder 1.00000 $70.00 $70.00
Nozzle Cleaning hr 0.50000 $125.00 $62.50
Service/ Labor $362.50
Parts
RS Fusible Link ea 4.00000 $14.00 $56.00
Parts $56.00
Subtotal: $418.50
Sales Tax: $35.04
Payments: $0.00
Total Due: $453.54
3238883 TO REACH OUR MAIN LINE OR AFTER-HOURS DISPATCHER CALL (800)T73-4736 OPTION 1
NQRK TO BE 5RE0RMfQAT WO ISSUED-@Y: ACADEMY FIRE LIFE SAFETY, LLC
Chipotle Mexican Grill #1348 Call Type: PM
100 South Ridge Street Problem: RS INSPECTION
Rye Brook. NY 10573 E.T.A.: 5/23/2025
Ph CNTY Westchester AFLS Coordinator: Krisl►na Busst ext 1247
Bill Code: Chipol►e (7/?.3) FE4 EL5 FA15 - OLD AFPVID: 433199 Cust PO: 31 1777579
Landlord Representative. Daniel Pearsall Phone $V (1914) 468 7314 r Email PM Month May 2025
dpearsallLwinprop com
Emergency Contact .lose Romano Phone .914-384-5064/Email, Must Gall Emergency
Number
Property Manager Alena Hakanjrn Phone a 914-701-4005 + Emari
ahakdnjin rw wmndge.com
Restaurant Suppression System Inspection Semi-Annual
Notes:
.......--•---. ...................------......................... . . . . ...........................................
IVR PH#• 51 r�_:;00.77116 PIN # I W6 t Check In# 3 1 1 777579 CLOSE OUT 9
IVR REOUIRED (ANY PHONE ) - Technician must check u1 and out Failurca may result m nun-payment
...................................................................•--•----•---................... .-----.......
pty Name Manufacturer Model Size
Tochnluan Instructions Tochntelan artist hvwn*dWWy call Academy whk on site M:
• Schedtat►with site peat to hsrl to stun down cooking equipment • Sysieat has been Red Tagged
•GtwK-k to and out of IVR(it IVR irtaro prclsea above) - Vu4 inspers:bon carxlca be ccxnpteled for anv reason
• 5lttm?lt report to eppfnpruite AHJ(whEte required)
NU Filing Requiernents AHJ triomtr7Uon(Fig out completely)
Is filrw Fwpterl7 Y I N AHJ Names —
Fi f- been filW?Y'N ANJ Phone _
N reWred but not filed wM? AtIJ wet;s*e
Worir Ccwnpielyd
�%ddinonal Work tided
Ma kttormahon Area S((me Slarrip
Pteasa ve.q#V t1 w f olirrwM I~ to W. wxj Deiuw
•T ec rwwc ran had access to all pertrr>errt areas
•InsPectow Tes"convkneeel rn"
Data Ccxrtpietecl
Managc-r Stgnalt.ae --
Part Name '` i Qyr!)t
Academy Fwe lute Safety 42 aroadway Lym+rcmk NY t 1561 Moro SM-7734 rib
RANGE HOOD SYSTEM REPORT
CUSTOMER )ATE cam`W y , p"E AM Pu
NAME6L J ` / tNNUAI tiEMI AN#jLItL �F '�iAt1(;E IN.�TAiL 17040V
LDrATION LW cittHUEFIS
ADDRESS IIw South RKIQB Scree! /t/
MF;G L T
CITY Rye Brook ST Z;P NY 105;3 1 L t 41
CYL SIZE. ASTErI C;YL SIZE.`,'L CYL 5LM SUAVE
TELEPHONE VdC�m"3sm
FUSE LINKS Wl t- 4t.�F taxi F OTF+FF1
MA,N'AGER!OWNECi A-
rUEL SHUT Q►F CLEF• r IC. NC W tANWAL SIZE
SETNAL i L&bT t1YiNi0 DATE LAtrT IIIECHAAGE
rT�
COOKING APPLIANCES LOCATIONS LEFT TO RIGHT WITH DIMENSIONS OF COOKING SURFACES
/ m
SIZES OF PLENUM AND DUCTS LEFT TO RIGHT
O A APPLIANCES AR `EI r�VE N' 7PC NGi FS (Vt1 ) (YIN)
:4 nEPLACED FUS•L;LC LINKS
DUCT A MENUM E-OVEMD W.'COPI1EC'T NOZZLES — 29 CHECK TgAVCJ W C;AIlLE t!�-4. 0_>K5 Vol"
03 CI AECK MOpER POSEnON1NG Or ALL NG ZLF"i ✓ .i PIPING AND l c)NOU!T PROPFRLY BRACKETED ✓
04 SYSTEM tNSTALLED Wrn4lN MF* A.300 OUTING ✓ ?J r%P*F-[R GEPARATK)k BETWEETI F-FYER ANr,is FME �
06 HOOD DLX T P NETTIAT IONS SEALED W,-n o WF.'Ln OR IIL DEVICE ✓ 23 PFVaFER CLEAPANC:E PTK}M FLAME TO F►LTERS _IC
W CHECK jr SCAL.S INTACT t E'JIGENCE Or"TAMPEqWc. � J4 EXHAUST FAN Mi UPrnATINt..ORDER
U7 it%Y$TEM QAS @£EN DISL'AARGED REPORT SAME 2�j ALL FtLTER9 W 1 PUPEi11'CY.0JON
O!I PRESSURE GAUGE IN Pi31DPER RMXX Iif'UAUC.CD1 i'T. F'JLI.SIB OFF VALVE IN CAN i'UXITR-W
nQ CiwEr>CAV"MCIE WEN':HT(If AFftlCABLE Y -7 MANUAL ANn nEMOTE SET,,SEALS IN FLAuE
IU 0IYCI CISTATICTEST DATE OF CARTaIIME1S? 'tt AEPLAI-ESY.iTEEM COVER v
it INSPECT CYUNc#cR ANa w"4T ✓ ra £v!xTEhl 4DPEAATNDNAL AND SEALS IN PLACE
11 TEST 0ETEC7k--N FROMTERMMIAL LINK 1 K U!41NC. ✓ S1 -LAVE TANKS OPEFATTONAL f
I I TEST t•I)n PnOrLm OPERATION FROM REMOTE 31 CLEAN UYLINDER ANT)MOUNT
IJ CHECK GPERAT.ON OF:MICRO SWrTCI l t� 'C FAN LVAFtpNG SiuN EWI NOW ✓
19 C:e4EC.1(OPERATi(1N CIF GAS VALVE /%' XI PETI.ONNEL tNSTnUCTED ON HM TO OPERATE �
1@ CLEAN NU-4G3XS L/ ..1 PRC)PEA K-CLASS IN PLACE _yam
17 ?F()Prn NI)Zne(;Am IN PLAC X-- �'� 15 PORTAUt.0 tj-kT!NuUl!A FCRS SW VICZ0 V/
10 PROPER L,NK INSTALLLG PEP+0IA7JARD �'r 30 SEifV7CE AND CERTlrrATK)N TAG ON EyW.M
SYSTEM COMPLIANT SYMM NON-COMPLIANT
NOTE DEM1 ENCIES"
SEMI-ANNUAL PIPING INTEGRITY TEST HAS BEEN PERFORMED PER NFPA 17A 7.4 4.2 Mt EDITION YES.YNO
SYSTEM HAS BEEN RED TAW
4RO ACADEMY HAS BEEN CONTACTED WHILE ON SITE BY TECHNICIAN BEFORE OPARTURE YES N _
SERVICE TECHNICIAN 1:/�i PERMIT x DATE
Academy Fire Life SAlrAy 42&oWway LynLxoc* NY 11563 Main NpO-773-4736
�..b..d nu.......a......M1....-yen..,u..•.� �ar:..U.....Mn:.vn n. t .to•1.17,1 T7_7Z 16
COMPLETE SEPTIC SERVICE
ESTABLISE�D 1919
90 Midland Avenue e Midland Park, NJ 07432
Tel: 201-445-3188 - 888-901-7392 - www.DavidZuidema.com
Invoice: 1 ✓'�-'�UTech:-sue• I Date:
CUSTOMER INFORMATION Time on site:
Name. t.e { Phone:
Addr s: ry '
City: State: ip: County:
T ��
BILLI G INFORMATION
Service Description Charge
Pumping Gallons
Inspection
Treatment
Riser/Extension
Labor/Digging
Cover/Lid
Jetting/Snaking _
Camera j
Service Call
Baffles
j O Check# O MasterCard O Visa O Amex D Discover ! u btotal
O Cash C.C. # Exp. Permit/Tax
O CC Name on CC: Sec. Code__ Total
ASSESSMENT _ —
Depth to Top of Tank
Type of Tank Cesspool I Isteel I lConcrete lFiberglass Other I
Tank Condition Any visible sign of I Cracking Root Decay I Other
Effluent Level Below Outlet I Operational Level I jAbove0utlet
Baffle (Inlet) Intact IMissing' 1 Damaged I lNot Applicable
Baffle (Outlet) Intact Imissingi IDamagedlJ of Applicable
Flow From Tank NoRunBackNotedi lRunBackNotedi
Tank Location Front Yard Back Yardl I Side Yard (L/Rj I Other
Comments:
Work Completed to Customer Satisfaction I Signature:
111terest 18%per Pear Not 4sponsible far lers,it/'1Ve1•t'c7yS or U.IidL ,�+1'OLllid ti�'a'iJ7,
E
DAVID ZU1bEMA INC .
&Ice:
COMPLETE SEPTIC SERVICE
ESTABLIS D 1919
90 Midland Avenue e Mi land Park, NJ 07432
el: 20 -445-3188 - 888-901-739 • www.DavidZuidema.com
r� L �'I�1��' Tec� .i Date:d -6
CUSTOMER I OR ATION !Time on site: �y aU _� DcC--_.
Name: �e `G ' i Phone:
Addre s: r _—_
City: e , f— State: Zip: County:
BILLING INFORMATION
Service Description Charge
Pumping Gallons
� t '
Inspection
Treatment
Riser/Extension
Labor/Digging
Cover/Lid
Jetting/Snaking ! ��
Camera
Service Call
B affles
D Check# D MasterCard D Visa D Amex D Discover Subtotal
1
D Cash C.C. # Exp. ; Permit/Tax
D CC Name on CC:_ _ Sec. Code Total
ASSESSMENT
Depth to Top of Tank
Type of Tank Cesspool I ISteel I lConcrete I iFiberglass 10ther
Tank Condition Any visible sign of I Cracking Root Decay Other
Effluent Level Below Outlet I Operational Level I Above Outlet
Baffle (Inlet) Intact I IMissing I I Damaged Not Applicable _
Baffle (Outlet) Intacti ImissingiDamaged Not Applicable _
Flow From Tank NoRunBackNotedl jRunBackNotedj
Tank Location Front Yard Back Yard Side Yard (L/Rj I Other
Comments:
Work Completed to Customer Satisfaction Signature: :14h= - 7'
Interest 16%per year Not responsible for prinklet's, driveways or 1111derground ivirin .
D
BUILDING 6ikRTMENT j
J U N 2 3 2025 DD
VILLAGE OF RY 'POK j
938 KING STREET RYE BR )NY 10573 VILLAGE OF RYE BROOK
{ 4 -0 t BUILDING DEPARTMENT
w _ .1 ov
FIRE INSPECTION / OPERATING PERMIT APPLICATION
FOR OFFICE USE ONLY:
Fee Paid: $ Q1 Inspection Date&Time:
FEE SCHEDULE: Re-inspection Date&Time:
Triennial & Private School Annual Inspection: _$450.00
Public Assembly Annual Inspection: <100 People=$525.00/>100 People=$775.00
Application,dated: 6/18/2025 is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting
that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business,
private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform
Fire Prevention&Building Code, Title 19 NYCRR Part 1201, and all other applicable local, County, State&Federal laws, rules&
regulations,as per detailed statement described below.
1. Address: 100 S Ridge St. Rye Brook, NY 10573 SBL: Zone:
2. Business/Occupancy Name: Chipotle Mexican Grill#1348 NYS Use Class:
3. Property Owner: WIN RIDGE REALTY,LLC Address: 24 Rye Ridge Plaza,Rye Brook,NY
Phone# 914-701-4005 Cell# email: ahakanjin@winridge.com
5. Business Owner: Chipotle Mexican Grill of Colorado,LLC Address: PO Box 182566,Columbus,OH 43218
Phone# 380-222-7298 Cell# email: licensing@chipotle.com
6. Emergency Contact: Jamie Glasgow-Field Leader Address:
Phone# 929-369-7826 Cell# email: jamie.glasgow@chipotle.com
7. Inspection Escort: Elibenia Polanco Title: Apprentice Hourly
Phone#: 914-937-0351 Cell#: email: ny.1348.ryebrook@chipotle.com
8. Provide a brief description outlining the current and/or intended use of the property:
Fast Casual Mexican Restaurant
9. List all Hazardous Materials: NIA
10. Occupant Load: Existing: Proposed: Other:
11. Date&Disposition of Previous Fire Inspection: ❑ Pa : ❑ Fall
1
W W024
This application must include the notarized signature(s) of the legal owner(s) of
the above mentioned property, in the space provided below. Any application not
bearing the legal property owner's notarized signature(s) shall be deemed null
and void, and will be returned to the applicant.
STATE OF NEW YORK
COUNTY OF WESTCHESTER ) as:
Ryan George ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing application)
and further states that he/she is the legal owner of the property to which this application pertains,or that he/she is the
License Coordinator-Agent ,for the legal owner and is duly authorized to make and file this application. That all
(indicate architect,business owner,attorney,agent,etc.)
statements contained herein are true to the best of his/her knowledge and belief,and that any work performed or use conducted
at the above captioned property will be in conformance with the details as set forth and contained in this application and in any
accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention
&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this Sworn to before me this 18
day of , 20 "Z j day of June 12025
Not i a c Notary Public
Ai�
Signature of Property wner Sign ure App
4L;41,4 fia-n�� Ryan George
Print Name of Property Owner Print Name of Applicant
ALCAIVp� ,`,���111111/11/1I0
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r 8a//��
'r4r ��N Nd �011�' i rr t1•
•, �aY ExPlitEg-r �
1111111 N 111 SO
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- - � .r•' Mee., .e..o�°°''
;i.
MEC [E �IJL
J U L 2 3 2024 ID 1
BUIL j ` XWNT VILLAGE OF RYE BROOK
VI L E of RY ox BUILDING DEPARTMENT
938 KING
ETRYE Bk ,K NY 10573
\ 4 =0
w�uS. ov
FIRE INSPECTION/ OPERATING PERMIT APPLICATION
FOR OFFICE USE ONLY: 5 3
Fee Paid: $ '��-�.�� �" Inspection Date&Time: u/S ck � �, /,Z; 0A
y
FEE SCHEDULE: Re-inspection Date&Time:
Triennial&Private School Annual Inspection: _$450.00
Public Assembly Annual Inspection: <100 People=S525.00/>100 People=S775.00
*tatz,rz*zztt,r*tzt*�r.ztzzz+tz*zzt.�*sat:tttazir#*z�*t,trt**t,rt::ztt*t,rtattz:ttz*is++�ttzttzttzz*zRzttt�zz*ztx*z:
Application,dated: 7/18/2024 is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting
that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business,
private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform
Fire Prevention&Building Code,Title 19 NYCRR Part 1201,and all other applicable local,County,State & Federal laws,rules&
regulations,as per detailed statement described below. —7
1. Address: 100 S Ridge St. Rye Brook, NY 10573 SBL: Zil, c) /—/—�, Zone.
2. Business/Occupancy Name: Chipotle Mexican Grill#1348 NYS Use Class:
3. Property Owner: WIN RIDGE REALTY, LLC Address:24 Rye Ridge Plaza, Rye Brook, NY
Phone# 914-701-4005 Cell# email: ahakanjin@winridge.com
5. Business Owner: Chipotle Mexican Grill of Colorado LLC Address: PO Box 182566,Columbus, OH 43218
Phone# 380-222-7298 Cell# email: licensing@chipotle.com
6. Emergency Contact: Jamie Glasqow-Field Leader Address:
Phone# 929-369-7826 Cell# 929-369-7826 email: jamie.glasgow@chipotle.com
7. Inspection Escort:Elibenia Polanco Title:.Apprentice Hourly
Phone#: 914-937-0351 Cell#: 347-818-3872 email: ny.1348.ryebrook@chipotle.com
8. Provide a brief description outlining the current and/or intended use of the property:
Fast Casual Mexican Restaurant
9. List all Hazardous Materials: NIA
10. Occupant Load: Existing: Proposed: Other:
11. Date&Disposition of Previous Fire Inspection: ❑ Pass ❑ Fail
6/1/2024
This application must include the notarized signature(s) of the legal owner(s) of
the above mentioned property, in the space provided below. Any application not
bearing the legal property owner's notarized signature(s) shall be deemed null
and void, and will be returned to the applicant.
STATE OF NEW YORK
COUNTY OF WESTCHESTER as:
Ryan George ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing application)
and further states that he/she is the legal owner of the property to which this application pertains,or that he/she is the
License Coordinator-Agent ,for the legal owner and is duly authorized to make and file this application. That all
(indicate architect,business owner,attorney,agent,etc.)
statements contained herein are true to the best of his/her knowledge and belief,and that any work performed or use conducted
at the above captioned property will be in conformance with the details as set forth and contained in this application and in any
accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention
&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
�
Swom to before me this ` U Sworn to before me this 18
day of (To(,y ,20 day of July 120 24
o f P lic _ _ Nota Pu "c
Signature of Prop rty Owner Signatur of Applicant
AVICI)yft Ryan George
Print Name of Property Owsnsr/ r Print Name of Applicant
M 11 II!!p,
SACHIN HEJEEBU
RICHARD A. YARMY Il = Notary Public,State of Ohio
NOTARY PU BUC,STATE OF NEW YORK =My Commiss(on Expires 02.03-2026
Registration No.OIYA0013323 `
111 1 1p
Qualified in Westchester County
Commission Expires Se tember 08, 2027
G/I/2024