Loading...
HomeMy WebLinkAboutRB25-0015 QyE 13 P, O� � VILLAGE OF RYE BROOK Building Department-Inspections 938 King St Rye Brook,NY 10573 1 Phone:(914)939-0668 1 Fax:(914)939-5801 CERTIFICATE OF OCCUPANCY Occupancy granted date: 11/13/2025 Permit Number: RB 25-0015,Issued on 09/18/2025 Visit result: Granted and fully completed Date of inspection: 11/13/2025 Parcel number: 135.82-1-2 Municipal Address: WESTCHESTER AVE Legal Description: 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 made, nor shall the building be moved from one location to another until a permit to accomplish such change has been obtained from the Building Inspector. Additional Occupancy permit description: 7TH FLOOR Outstanding matters: M I • Nikola Ilic 800 Westchester Ave,LLC 800 Westchester Avenue,Rye Brook +19144245220 nilic@rpwgroup.com Inspected : Alfredo(Freddy)DiVitto Building Inspector,Village of Rye Brook +19149390668 D E C E��/J E For office use only: �/ BUILDING����] TMENT PERMIT# VILLA E OF RYE WOK ��� ISSUED: NOV 1 0 2025 938 KING STRE YE BROOK, �uv YORK 10573 DATE: 9 «064 O% FEE: PAID VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT PLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION sssrrsrr»wsrrsrsrrsswsrssr»rwsrs»rr»rrss»rrrs»»wrrrr»s»»s»rwssrarrrsr»rrr»wr»wrr»r»wr»ws»rww»sssssrssssrsssrrsssss►sss►sss►►s Address: 2 0o \m� cb LS)&r Nycn oe- Occupancyp/Use: OfhCt Parcel ID#: I a r i 1 Zone: O B a Owner: 0 Q il�/{S ,h Ste,r AV{, L Address: .9, 0, 601, .3 9 # W h 1 tC hcii6,MY 1 UbDy P.E./R.A.or Contractor: SO P1h C .+-C b(P , Address: ,b, W.I N, wh;rt- 0� Imo, W I G 0 0 V Person in responsible charge: r i0 1 Tk(C Address: P. D. P(:x .3ya, w h;fC halnS, 'NY 1 U1j6y 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 for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as:1 r 1 Q1(k ha MW n q QQbeing duly sworn,deposes and says that he/she resides at P.D. BOY 3 N q (Print Name of Applicant) (No.and Street) in 'HIV h 1 tL r I Q W) ,in the County of W 6 t G h tstt r in the State of N,that (Cityfrown/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:$ ) q O, Q Q 0 , for the construction or alteration of: YytS+IYI 6d " `'I T n f1 06K CA 1 (ah(k)�S 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 )0 Sworn to before me this (� day of t' w v ,20 day of UCN�innbe� ,20 IX'j , Sign a of Property Owner ''ignature of Applicant Print Name of Property Owner Print Name of Applicant 0` tary Public HERTEN otary Public JANET A OF NEW PORK NO PUBLIC-STATE JANET A HERTEN No.01HE6085824 ty NOTARY PUBLIC-STATE OF NEW YORK Qualified in Westchester Coun � Tres 01-06-2027 No,01 HE6085824 My Commissi Expon Qualified in Westchester County My Commission Expires 01-06-2027 BR 0 2G Village of Rye Brook Building Department-Inspections 938 King St Rye Brook,NY 10573 1 Phone:(914)939-0668 1 Fax:(914)939-5801 Permit number: RB 25-0015 Permit type: Commercial— Remodel/Renovation— Interior Municipal address: WESTCHESTER AVE Legal address: Status of inspection: Completed Issue date: 09/18/2025 Deficiencies No deficiencies or remarks noted. Visits VISIT DATE INSPECTORRESULT VISIT SITECONDITIONS 10/20/2025,10:00 AM Alfredo(Freddy)DiVitto Passed +19149390668 Parties NAMEANDCOMPANY CONTACTROLES Andrew Fredman 1 Ferry Rd,Hadlyme Applicant +12125324334 Nikola llic 800 Westchester Avenue,Rye Brook Property owner 800 Westchester Ave,LLC +19144245220 O �m w � 198,2 BUILDING DEPARTMENT ❑B ILDINGINSPECTOR 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 :_ � _I Q�T� _- VE . DATE:_ I I - 17 ! ZOL.� PERMIT# ISSUED:T/^l-ZrSECT: /3r-OLBLOCK: LOT: T� LOCATION: 7 OCCUPANCY• ❑ VIOLATION NOTED THE WORK IS... 9--<CEPTED ❑ 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 �3 .7,_ ❑ FINAL PLUMBING C�C� /. ❑ CROSS CONNECTION J FINAL ❑ OTHER QyE BR(�� 1982 BUILDING DEPARTMENT ❑,,BUILDING INSPECTOR rJASSISTANT 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 : '_ �{ x _ s Ae, DATE: PERMIT# hV ZS- I_`l_ ____. ISSUED: SECT: BLOCK: LOT: t Poj%�'LOCATION: ? h/"tm _j OCCUPANCY: ❑ Violation Noted THE WORK IS... Fer PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION It ❑ Natural Gas (.n! ak- ❑ L.P. Gas ❑ FUEL TANK ` c4j O �' IRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��• cu � BUILDING DEPARTMENT �ILDING 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 : &0 w 9&o C�Wkto,. _A VF . DATE: ' 1 -S - Z O ZS— PERMIT# 2-S- ISSUED: 2-0'-SECT: • gL BLOCK:_LOT:�— f JA LOCATION: __ } IOo�� JAI& OCCUPANCY: ❑ Violation Noted THE WORK IS... 2`0<ASSED ❑ FAILIED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION c / ❑ Natural Gas ❑ L.P. Gas � Woe /_ ❑ FUEL TANK /� ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION � ,Ili / A ❑ FINAL M OTHER I/•V A�� BRC��• 1932 • BUILDING DEPARTMENT ❑B ILDING 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.rychrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :_ • DATE: 13 2Qz3 PERMIT#-P-f_25- 19,51 ISSUED: /' "l SECT:��LOCK: LOT: 21 LOCATION: f lool., 11 N�a�- � OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... R'<cCEPTED ❑ 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 1 Cl FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL u y I OTHER KA e-• �� �� 1-0 O � / N } \ � ) / � CS ƒ \ a O ekw e \ \ L6 j E22 / OL 9 r) a / 5 W L/: / § § w � E _ ± x ; % \ / 2 � � \ / & E m § 7 t E / w k w 5 z -0 z 2 w �_ % § o w OLr) \ \ \ � % > E \ q N O = = g , } Z� q rye co ° ® \ � % D � \ / � / 0 � 0 § O § o 0 w 2 § $ gib � ^ 2 M 228G / \ j � � k � \ � kk ƒ 0E D 7 00 \ \< 0 � c U \ \ } E \ } 0 / 2 % u % o E � § / / \ § E � (n \ e — e / m LL, % / m LLJ , = b § o LLI to % = , LL � � \ k k � \ j \ \ } \ Ong '� q & } ® / E w LLJ � 2 , § & / � > CO / 0o 0E COuw < E 7 �§ qN 6 / J L.L o 5 E CN / S U E 7 0 / cz-> to 0 w >- a � ?: C: � \ / C \ \ m 0 kj \ - q O / ƒ 2 \ § � » \ � \ m = ; = q \ k 2 0 2 0 G 2E0 0 CL rLLJ 0 0 \\ \ E 00G � _ 3 2 / 3 § ; % , b # 7 2 _ r o ® e , g § 2 � EG g �* Y/ � D \ ƒ ± / �� a c \ LU � f< w �\ / co 0-co coLu U \ o \ %\ t g / W Q Q ) k / / ƒ\ �yE 6R(iV� Interior Building Permit Application Village of Rye Brook w �'79b2 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information SBL Zone 135.82-1-2 800 Westchester Ave OB2 Proposed Improvement Renovation of current 7th floor interior Westmed Medical Group space to include limited demolition of non bearing walls, drywall, carpentry, electrical, sprinkler and finish work. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes © No Will the proposed project require the installation of a new, or (if yes, applicant must submit a separate Automatic Fire an extension/modification to an existing automatic fire Suppression System Permit application&2 sets of detailed suppression system? (Fire Sprinkler,ANSL System, FM-200 engineered plans) System,Type I Hood, etc...) © Yes ❑ No N.Y.State Construction Classification N.Y. State Use Classification Occupancy Pre-Construction Type 1B B Commercial Occupancy Post-Construction 0 fam., 2 fam., comm., etc...) Commercial What is the total estimated cost of construction: (NOTE: The estimated cost shall include all labor, material, 190000 USD scaffolding,fixed equipment, professional fees, and material and labor which may be donated gratis.) Interior Building Permit Application,page 1/1 7�2`'' BuildingDepartment Commercial/Interior(Remodel/Renovation) Permit Permit Set WESTCHESTER AVE P#RB 25-0015 R#135.82-1-2 PERMIT INFORMATION Address Permit number Date issued WESTCHESTER AVE RB 25-0015 09/18/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Steven Fews stevefews@ryebrook.org INSTRUCTION AND ATTENTION It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection. TABLE OF CONTENTS 1 Cover page Building Permit 2 Required Inspections 3 Architectural drawing 4-13 Building Inspector Stamped&Signed Set of Plans 14 Interior Building Permit Application 15 [1R `> VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W Q Phone:(914)939-0668 1 www.ryebrook.gov O ���• 02• i� Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQUIRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE REQUIRED INSPECTIONS Name Description Final Inspection Completion of all required items under the permit including the site grading and the surveyor's final grading certificate. VILLAGE OF RYE BROOK PERMIT#:EP 25-237 0 . BUILDING DEPARTMENT ISSUED: 9/19/2025 938 KING S'1"REET, RN'L BROOK, NY 10573 ExPIRES: 9/19/2026 (914) 939-0668 www.ryel)rookiiNI.gov t� t� ELECTRICAL INSTALLATION PERMIT > WIRING FOR & FTRF AiARRI; 7"' l'l ,OOhZ AT: 800 WESTCHESTER AVENUE ift BUILDING CLASSIFICATION & PARCEL ID#: BUSINESS GROUP—B / 135.82-1-2 PROPERTY OWNER: 760-800 OWNER LLC / 800 WESTCHESTER AVE LLC (914)285-1700 r' LICENSED ELECTRICIAN: KHALIL AL-RABADI LIC# 1530 / RABADI ELECTRIC CORP (914) 384-7110 10 1� 1� 1R! INSPECTION AGENCY: STATE WIDE INSPECTION SERVICES INC(845) 202-7224 ? 1� 1� BUILDING PERMIT #: RP#25-0015 �? FEE PAID: $425.00 t.� I i(Ac1 ctl( 1111 ST BF. I'KF;sEN ; ON TIF.JoBSITN. FOR ALL INSI'I`:(A*ION5 1� 1� HOURS OF OPERATION OF CONSTRUCTION EQUIPMENT/VILLAGE CODE§15&4:WEEKDAYS-8:OOAM TO 6:OOPM OR DUSK,WHICHEVER IS EARLIER; w SATURDAYS-9:OOAM To 4:00PM; - SU NDAYS&110HDAN S-No CONSTRUCTION A(mvrl-N U I i n lift 1 � 1e 1� Steven I . Fews 1� Builaig& Fire Inspector 1� 1 THIS PERMIT MUST BE CONSPICUOUSLY POSTED AT THE JOB SITE _ _ �! r r& r in • [3RC� D L� CIE �`y�IrE • y v BUIL DE MENT VIL E OF RYE OK SEP - 2 2025 01 938 KIN ET RYE BRNY 10573 —— --- -0668 VILUNGE OF- i*,`!_ t i-;COK w n - ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY �B�P'#�: j�j�j)5 ac 24 EP#: Q5 -,Q'?)-7 Approval Date: SEP 1 00210 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, IQ /a s is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Feder State,County and Local Codes. 1.Address: p l4S SBL: IFJ• -�-al: Zone: 06 a 2.Property Owner: -O Address: Phone#: Cell#: -1 1 K 0 q SQ:;k n email: 3.Master Electrician/Licensed Installer: AX I u I�Ga UC4 AA' Address: 1 V JR-1 ._Nlp th �� Lic.#:_jFS_3D Phone#: Q(T SC�Cell#: email: Company Name: (1" & eCkC t Address: N k O 4.Proposed Electrical Work/Fixture Count: b W t o W e `a�- 5.31 Party Electrical Inspection Agency: ME OnnF NEW Y 1,K,COUNTY OF WESTCHESTER ) as: V'L �=b( _G- k ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print naine of individual signing as the applic t) e 1 state that(s)he is theme J4 4acAC o the legal owner and is duly authorized to make and file this application. (Master ectrician/License Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn t efore e t is day of ,20 da of 20 5 Signature of Property Owner Signature of Applicant Print Name of Property Owner ame of Applican ARI EL Notary Public YIR>titltc.State of New York No.01ME6160063 6/l/2024 Qualified In Westchester County Commission Expires January 29.20� STATE WIDE INSPECTION SERVICES, INC. Service With Integrit.v 0•0 • SWIS JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit# t} ��--U(� Sy R Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑ 2nd FI. ❑3rd Fl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O 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 ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection I ❑Consultation LAY ACloo— r tz--- �1 G C - ,SP - 2 2025 EUI: '—.W4C; 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,ifat any time 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 i . VYY1 Name License# 1. J Date Signature Address City/State j!l Zip Code Company �, Phone# (� L� State Wide Inspection Services C 1080 Main Street � Fishkill, NY 12524 L_' NOV i 2 2�?5 845 202-7224 Phone a 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VA 1 Email: office@swisny.com 1 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: Rabadi Electric Corp. RPW Group 368 Illington Road 800 Westchester Avenue Ossining, NY 10562, Rye Brook, NY 10573 Located at: 800 Westchester Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: 25-237 II 135.82 1 Certificate Number:2025-7191 Building Permit Number: RB25-0015 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: 800 Westchester Avenue, Rye Brook, NY 10573 The Seventh floor offices, conference room, and break room were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 161h day of October 2025. Name Quantity Rating Circuit Type Receptacles 13 Switches 06 Floor Receptacles 01 LED Light Fixtures 07 Sub Panel 01 AC Units 02 Relocate Smoke Detectors 05 Horn/Strobe 01 Officer. Frank 1. 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. �-�^i^'�..�� N r :N�M^ r_rl_M"M•• N N N N N N N N N N' N r VILLAGE OF RYE BROOK PERMIT#:MP 25-145 Irs Ift BUILDING DEPARTMENT ISSUED: 9/19/2025 r938 KING S'IREFT, RYE BROOK, NY 10573 ExPIRES: 9/19/2026 01 (914) 939-0668 www.ryebrookny.gov MECHANICAL INSTALLATION PERMIT NEW DUCTED SPLIT SYSTEMS AT: 800 WESTCHESTER AVENUE >r Ift BUILDING CLASSIFICATION & PARCEL ID#: BUSINESS GROUP—B / 135.82-1-2 PROPERTY OWNER: 760-800 OWNER LLC / 800 WESTCHESTER AVE LLC (914) 285-1700 � LICENSED CONTRACTOR: CARE't'& WALSH INC (914) 762-9600 Ift LOCATION OF WORK: 7""' FLOOR& ROOFTOP Ift BUILDING PERMIT #: RB#25-0015 FEE PAID: $900.00 u In CONTRACTOR MUST BE PRESENT ON THE JOBSITE FOR ALL INSPECTIONS HOURS OF OPERATION OF CONSTRICTION EQUIPMENT/VILLAGE CODE 5158-4:WEEKDAYS-8:00AM TO 6:00PM OR DUSK,WHICHEVER IS EARLIER; 0 SATURDAYS-9:OOAMTo4:OOPnt; - St NI)Al'S& 1101.1 DAYS-Ntt WWI RI (-rTONAc;tINti� Atttt\\tu In 7his permit is valid for a penod not to exceed twelve(12)months from the date of issuance,and covers onh that work listed above. Separate permits are required for any electrical,plumbing,fire suppression, fire/smoke/carbon monoxide detectors/alarms,or anv other work nut covered under this permit.The approved plans must � be kept on the job site&be made available for review by the Building Department upon demand.Any amendments or changes to the approved plans must be designed by your architect/engineer and submitted to the Building Department for review and approval prior to performtng the work. A Certificate of OccupartcN or Certificate Of COmpliatn c 11 tcquired in order to close out this permit. & 0 � 1 t Steven E. Fews & Building & Fire Inspector �+ r- � THIS PERMIT MUST BE CONSPICUOUSLY POSTED AT THE JOB SITE - r r r r r • BUILDING DEPARTMENT VILLAGE OF RYE BROOK D 938 KING STREET RYE BROOK,NY 10 (914)939-0668 SEP - 2 2025 ivww.rvebrooknv.guv VILLAGE OF RYE BROOK APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE ENT HEATING, VENTILATION AND/Op_AIR CONDITIONING EQUIPMENT I Ok OI I I( I [ '-,I ()"-I ) I'1 ►tall I ::; / / I�UIt'��I T Approval Date: a — ) Z- 2D� s M Permit Fee: S Approval Signature: Other: Disapproved: (tees are non-rehtndable) *wwwwwwwwwwwwwwwww.rwwwv.wwwwwwwwwww*ww*wwwwwww*wwwwwwwwwww,twwwww*wwwwwwww,t,r.tw,twwwwww*wwww,rwww*wwwwwwwwww DO N01 S1:1R1 \\ORI: (it- C ONSTRI ( "IION I NTIL :\ PFWNII-1 ILAS BEE.\ ISSI LI) B1 THE BI ILDIM.: 1NSP1:( TOR. TH1: ,\D\11NIS7 RA'I I\'F: FEF FOR \\ORK PROGRESSED OR COMPLETED \\"1TTIOl I A PERMIT IS_ 12";. OF THE TOTAL COST OF(ONS1'RU( TIWN WITH ;A MININII')l FEE OF S75(lmo REQUIREMENTS FOR RELEASE OF PERMIT& CERTIFICATE OF COMPLIA\CE' 1. Properly completed & Signed Application. ?. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Contractor's Westchester County Home Improvement License. Liability Insurance. NI .q tlf R\ III k nnia i r I;�Iggi;•ggrl;liialc Iu /girl I& Workers Compensation Insurance on a NYS Board form (►,t,,,.- ( in,, ,,, Fot,,,: t"1(,.; ,,, �Y SI❑le\\'orkei>( ompcnNanon \\;ii\ri i 4. Payment ofFees/Unit: ItI:SII)I:\ 11:11. ti�(u1.Uu.un11 • ( (►�I�11 RC1.-11_ - - .4,;0.00Lunit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice iv(111ji-e(!) 7. Electrical work requires a separate Electrical Pennit & Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Pennit & Plumbing Inspection. wwwwwwwwwwwwwwrwwwwww,twwwwwwwwwwwwwwwwwwwwwwww,rwwwwwwwwwwwwwwwww,rwwwwwwwwww*wwwwwwwwwwwwwwwwwwwww Application dated.$j 1-007-5 is hereby made to the Building Inspector of the Village of Rye Brook for a pennit for the installation and or removal of the HVAC'equipment as listed below. The applicant and property owner.by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local.County.State& Federal laws. codes.rules and regulations. I. Address: too W MhdMC k.( 'K`u SBL: 11,S.Q2 .1 — Zone: 6 2. Property Owner. Q.lyCGAa.WtLL�.�Bpp1JaS�nt.S�d A-itU4 Address: tO60K 3M (-*AtQ1o,;05 try Phone#: 00-4) its • tico Cell #: entail: 3. Contractor: W o t Address: %&v2 1-A QC:Kd:Ri ( 1JV Plione#:Milk) Cell#: r-%O's email: tliEtt�l[ ��.,1St..teh_ 4. Scope of Work: New Installation(IC)•Replacement( 1• Removal( >•Other( ): 5. List Equipment: C Ten &&W SdQ 14S%ty- W-Ton 6. Location of Equipment: p4xK Ct*ox d d;CW}1„ ,i00W, 7. Method of Installation/Removal(list nil equipment needed to perform job): }�eti i►n;N& "A%- A CoA ? Lf�•S�� _t6yigh 40 W-( i 712025 STATE OF NEW' YORK. COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, (primt name of individual signing as the applicant) and further states that Whe is(lie 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 arc 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 Uniforms Fire Prevention R Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Swom to before me this )-Ct Sworn to before me this Zy day of day ofC ,�- 20 z�- Signs p e o perty Owrn-er, Si to re o App scant �� P�a. �vv j o cjr Print Name of Property Owner rims Na a of Applicant N ary u is otary Public JANET A HERTEN JANET A HERTEN NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATE OF NEW YORK No.0 1 H E6085824 No.01HE6085824 Qualified in Westchester County Qualified in Westchester County M My Commission Expires 01-06-2027 y Commission Expires 01-06-2027 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 ofrecord 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 winmi SVZ-AP48NL . 48 48,000 BTU/H DUCTED AIR HANDLER INDOOR UNIT AM ELECTFIC 48,000 PUMP OUTDOOR UNIT Job Name: — - - --- -- -- -� System Reference: Date: Indoor Unit SVZ-AP48NL �1111�' Outdoor Unit SUZ-AK48NL rrc- SFP 0 2 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INDOOR UNIT FEATURES Unique blow through design:Unique blow through design allows simple coil cleaning when the blower is removed • Selectable extemal static pressure:Selectable external static pressure:0.30,0.50 and 0.80 in.WG with 3 fan speeds at each static setting • Positive pressure cabinet: Positive pressure cabinet with air leakage of less than 1.0%at 1.0 in.WG Optional humidifier control and ERV control Optional electric heat kit:Optional electric heat kit for additional heat capacity Multiple control options,including the comfort app for remote access,third-party interfaces,and both wired and wireless controllers Multi-zone:A multi-zone unit provides the temperature management of multiple zones within a building. Multi-position installation: Multi-position installation:horizontal(left or right),vertical(up or down). For downflow configurations,the CMA-1 is recommended for proper management of condensate to prevent water blow-off in certain conditions Fiberglass free insulation: 1 inch R4.2 fiberglass free insulation reduces condensation and boosts efficiency Enclosed ECM motor:Highly efficient totally enclosed ECM motor • Ducted air handler: Ducted air handler provides a solution to cool and heat large zones OUTDOOR UNIT FEATURES • Blue Fin Coating:An anti-corrosion treatment applied to the aluminum fins of the heat exchanger of the outdoor unit to protect against corrosion caused by salt,sulfur,and other airborne contaminants,especially in coastal and industrial areas. High-performance grooved piping: High-performance grooved piping for increased heat exchange efficiency • Hot-Start Technology:Hot-Start Technology ensures the fan only activates once the heat exchanger is warm,preventing cold air blasts during start-up. INVERTER-driven compressor:An inverter-driven compressor generates the precise capacity needed to maintain a temperature set point. • Joint Lap DC Motor: Innovative Joint Lap DC Motor leads to high efficiency and reliability • Outdoor unit directed power:The outdoor unit powers the indoor unit,and should a power outage occur,the system is automatically restarted when power returns Pulse Amplitude Modulation technology:Pulse Amplitude Modulation technology enhances energy efficiency by adjusting the power supply to optimize compressor performance,ensuring precise capacity control and reduced energy consumption. • Quiet operation:Quiet operation units are as quiet as a typical conversation,and most indoor units are whisper quiet. • Single-zone:One outdoor unit connects to one indoor unit to control the comfort in a single space. Specifications are subject to change without notice. ©2025 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. A., . SUZ-AK48NL Maximum Capacity Btu/h 48.000 Rated Capacity Btu/h 48,000 Minimum Capacity Btu/h 18,100 Cooling at 95F Maximum Power Input W 4.450 Rated Power Input W 4.450 Moisture Removal Pints/h 10.5 Sensible Heat Factor - 077 Power Factor 1208V/230V] % 93/93 Maximum Capacity Btu/h 60,000 Rated Capacity Btu/h 60,000 Heating at 47F Minimum Capacity Btu/h 14.700 Maximum Power Input W 5.670 Rated Power Input W 5,670 Power Factor[208V/230V] % 94/94 Maximum Capacity Btu/h 38,000 Heating at 17P Rated Capacity Btu/h 38,000 Maximum Power Input W 4,640 Rated Power Input W 4,640 Heating at 5F' Maximum Capacity Btu/h 30.800 Maximum Power Input W 4,275 Heating at-41`' Maximum Capacity Btu/h 27,000 SEER2 17.1 EER2' 9.1 HSPF2[IV] 8 1 Efficiency COP at 47°F: 3.1 COP at 17°F at Maximum Capacity' 2 4 COP at 5°F at Maximum Capacity 2.1 COP at-4°F at Maximum Capacity` 1 96 ENERGY STAR'Certified No Voltage,Phase.Frequency V AC/V AC.o,Hz 208/230.1,60 Guaranteed Voltage Range VAC 198-253 Voltage:Indoor-Outdoor.S1-S2 VAC IDU Powered Separately Electrical Voltage:Indoor-Outdoor.S2-S3 V DC 12.24 Short-circuit Current Rating[SCCR] kA 5 Recommended Fuse/Breaker Size(Outdoor) A 40 Recommended Wire Size[Indoor-Outdoor] AWG 14 MCA A 5.63 Fan Motor Output W 430 Airflow Rate at Cooling.Dry CFM 1,040,1,262.1.485 Airflow Rate at Cooling.Wet CFM 1,040,1.262,1,485 Airflow Rate at Heating,Dry CFM 1.040,1,262,1,485 Sound Pressure Level[Cooling] dB(A) 45,48,52 Sound Pressure Level[Heating] dB(A) 45.48.52 External Static Pressure in.WG Indoor Unit 0.30,0.50,0.80 Drain Pipe Size O.D. inch[mmJ 3/4[19.05] External Finish Color 6.2PB 9/0.9 Unit Dimensions(W x D x H) inch x inch x inch [mm x mm x mm) 25 x 21-5/8 x 59-1/2[635 x 548 x 1.511J Package Dimensions(W x D x H) inch x inch x inch [mm x mm x mm) 26 x 28-3/4 x 66[660 x 730 x 1,675] Unit Weight Ibs[kg] 172[78] Package Weight Ibs[kg] 198[90J Fan Motor Type DC Motor Cooling Intake Air Temp[Maximum/Minimum] •FDB.°FWB/°FDB. IDU Operating Temp.Range °FWB 90.73/66,59 NOTES Heating Intake Air Temp[Maximum/Minimum] °FDB 82/50 'Cooling at 95°F(Indoor:807 DB,67'F WB//Outdoor:95°F DB.75°F WB) Heating at 47°F(Indoor.70•F DB,60°F WB//Outdoor:47°F DB.43°F WB) 'Heating at 17'F(Indoor:70`F DB,60'F WB//Outdoor.17°F DB,15`F WB) 'Heating at 5`F(Indoor:70°F DB,60'F WB//Outdoor.5`F DB,4•F WB) `Heating at-0•F(Indoor:707 IDS,60`F WB//Outdoor:-4°F DB.-57 WB) Indoor/Outdoor Unit Operating Temperature Range(Cooling Air Temp[Maximum/Minimum]): •Applications should be restricted to comfort cooling only,equipment cooling applications are not recommended for low ambient temperature conditions. Outdoor Unit Operating Temperature Range(Cooling Thermal Lock-out/Re-start Temperatures:Heating Thermal Lock-out/Re-start Temperatures): •System cuts out in healing mode and automatically restarts at these temperatures. Specifications are subject to change without notice. ©2025 Mitsuhmhi F:I.,tr.,Try o uverr i rc i iSUZ-AK48NL MCA A 38 MOCP A 67 Fan Motor Output W 213-213 Airflow Rate Cooling CFM 4.020 Airflow Rate Heating CFM 4.020 Defrost Method Reverse Cycle Coaling on Heat Exchanger(Bluefin.Sea Coast) Yes,Yes Sound Pressure Level,Cooling' dB(A) 60 Sound Pressure Level,Heating' dB(A) 62 Outdoor Unit Compressor Type Twin Rotary Compressor Model MRK53FFJMC-L Compressor Oil[Type//Charge] Type//oz RM68EH//60 External Finish Color Munsell 3Y 7.8/1.1 Base Pan Heater Not applicable Unit Dimensions(W x D x H) inch x inch x inch(mm x mm x mm) 41-11132 x 14 x 5243/64 11,050 x 355 x 1.338] Package Dimensions(W x D x H) inch x inch x inch 42-15/16 x 17-3/4 x 58-5116[1,090 x 450 x 1,480] [mm x mm x mm] Unit Weight Ibs(kgJ 265[120) Package Weight Ibs[kg] 291[132] Cooling Intake Air Temp [Maximum/Minimum'] 'FDB 115123 ODU Operating Temp.Range Heating Intake Air Temp[Maximum/Minimum] 'FDB.FWB/°FDB. 70.59/-4,-4 WB Heating Thermal Lock-out/Re-start Temperatures" °FDB -13/4 Type R454B Refrigerant Pre-Charged Refrigerant Amount Ibs,oz 11,7 Maximum Pre-Charged Piping Length ft(m) 100[30] Additional Refrigerant Charge Per Additional Piping Length oz/ft 0.6 Gas Pipe Size O.D.[Flared) inch[mm) 5/8[15.88) Liquid Pipe Size O.D.[Flared] inch[mm) 3/8[9.52] Piping Maximum Piping Length ft[m] 245(75] Maximum Height Difference ft[m] 100[30] Maximum Number of Bends 15 NOTES 'Cooling at 95'F(Indoor:80`F DB,67-F WB ll Outdoor:95'17 DB.75°F WB) Heating at 47'F(Indoor:70`F DB,60'F WB lI Outdoor:47'F DB.43`F WB) 'Heating at 17°F(Indoor:70'F DB.60°F WB//Outdoor:17'F DB.15'F WB) 'Heating at 5'F(Indoor:70'F DB.60'F WB//Outdoor:5'F DB.4'F WB) `Heating at 4'F(Indoor.70•F DB.60`F WB//Outdoor.4'F DB.-5'F WB) Indoor/Outdoor Unit Operating Temperature Range(Cooling Air Temp[Maximum/Minimum]): •Applications should be restricted to comfort cooling only,equipment cooling applications are not recommended for low ambient temperature conditions Outdoor Unit Operating Temperature Range(Cooling Thermal Lock-out/Re-start Temperatures:Heating Thermal Lock-out/Re-start Temperatures): •System cuts out in heating mode and automatically restarts at these temperatures. Specifications are subject to change without notice. ©2025 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. INDOOR UNIT ACCESSORIES: SVZ-AP48NL Blue Diamond Advanced Mini Condensate Pump w Reservoir Sensor 208230V recommended X87-721 Blue Diamond Maxi Blue Advanced Mini Condensate Pump w Reservoir Sensor 110V up to 48000 BTUH recommended X87-711 Blue Diamond MegaBlue Advanced Condensate Pump w Reservoir Sensor X87-835 Condensate Blue Diamond Sensor Extension Cable 15 Ft C13-103 Refco Condensate Pump 100-240 VAC up to 120000 BTUH COMBI Sauermann Condensate Pump S130-230 Control Wire 202PR 1 PR shielded 1 PR plenum wire for Airzone 100 fill reel CW2042S2-100 202PR shielded 1 PR plenum wire for Airzone 500 ft reel CW2042S2-500 10 x 3/8 x 10 x 5/8 Lineset Twin-Tube Insulation MPLS385812T-10 100 x 3/8 x 65 x 5/8 Lineset Twin-Tube Insulation MPLS385812T-100 Lineset 15 x 318 x 15 x 5/8 Lineset Twin-Tube Insulation MPLS385812T-15 30 x 3/8 x 30 x 5/8 Lineset Twin-Tube Insulation MPLS385812T-30 50 x 318 x 50 x 5/8 Lineset Twin-Tube Insulation MPLS385812T-50 65 x 3/8 x 65 x 5/8 Lineset Twin-Tube Insulation MPLS385812T-65 Electric Heal Lockout Electric Heat Lockout ETC-211020-MIT Airzone Wired Blueface Controller Black AZZBSBLUEZEROCN Airzone Wired Blueface Controller White AZZBSBLUEZEROCB Airzone Wired Lite Controller White AZZBSLITECB Airzone Wireless Lite Controller White AZZBSLITERB Airzone Wireless Think Controller Black AZZBSTHINKRN Control Interface Airzone Wireless Think Controller While AZZBSTHINKRB IT Extender for kumo station PAC-WHS011E-E kumo station for the Comfort app PAC-WHS01 HC-E Operation and Error Status Output Adapter PAC-SF40RM-E Procon BACnet and Modbus Interface PAC-UKPRC001-CN-1 Thermostat Interface for 3rd Party Thermostats PAC-US445CN-1 Wireless Interface Adapter for the Comfort app PAC-USWHS002-WF-2 10kW Electric Heater EH10-MPA-LB Electric Kit Heats 15kW Electric Heater EH15-MPAS-LB 17kW Electric Heater EH17-MPAS-LB Disconnect Switch 30A600VUL fits 2 X 4 utility box-Black TAZ-MS303 30A600VUL fits 2 X 4 utility box-White TAZ-MS303W Downfiow Kit Condensate Management Kit for downflow installation CMA-1 Deluxe Wired MA Remote Controller PAR-42MAAUB Wired Remote Controller Simple Direct Wired Remote Controller PAC-SDW01RC-1 Simple MA Remote Controller PAC-YT53CRAU-J Touch MA Wired Remote Controller PAR-CT01MAU-SB Flush Mount Remote Temperature Sensor for SEZ SLZ SVZ and all P-Series models PAC-USSEN002-FM-1 Remote Sensor Wall Mount Remote Temperature Sensor PAC-SE41TS-E Wireless temperature and humidity sensor for the Comfort app PAC-USWHS003-TH-1 3-Pin Wiring Harness PAC-715AD Power Supplies&Auxiliary Components 5-Pin Wiring Harness PAC-725AD ERV On/Off Input Adapter for CNER on SVZ PEAD and PVA models PAC-740 Lockdown Bracket for Wireless Handheld Remote Controllers RCMKPICB RedLINK Wireless Remote Controller MHK2 Wireless Remote Controller Universal Wireless MA Handheld Remote Controller PAR-FL32MA-E Universal Wireless Receiver for PAR-FL32MA-E PAR-FA32MA-W Power Supplies and Auxiliary Backup Heat Relay Kit Adapter for CN24 or CN152 Connector Components CN24RELAY-KIT-CM3 Terminal Block Separate Terminal Power Block SPTB1 NOTES Specifications are subject to change without notice. ©2025 Mitsubishi Electric Tirane HVAC US LLC.All rights reserved. OUTDOOR UNIT ACCESSORIES: SUZ-AK48NL ControlService Tool PAC-SK52ST Control/Service Tool M-&P-Series Maintenance Tool Cable Set M21ECO397 Maintenance Tool Interface PAC-USCMS-MN-1 18 Dual Fan Stand QSMS1802M 24 Dual Fan Stand QSMS2402M Condenser Wall Bracket Stand QS W 82000M-1 Condenser Wall Bracket-Stainless Steel Finish QSWBSS Outdoor Unit 3-14 inch Mounting Base Pair-Plastic OSD400P Outdoor Unit Stand 12 High QSMS1202M Front Wind Baffle WB-PA3(two pieces are Wind Baffle required) Rear Wind Baffle WB-RE6 Side Advanced Wind Baffle WB-SD6 Optional Defrost Heater Optional Defrost Heater PAC-SL11BH-E Snow/Rain Diverter SnowRain Diverter SRD-5 Mounting Pad Condensing Unit Mounting Pad 24 x 42 x 3 ULTRILITE2 Hail Guards Hail Guard HG-A2 14 Gauge 4 wire Armored MiniSplit Cable250 ft roll SW144-250 Mini-Split Wire14 Gauge 4 wire Armored MiniSplit Cable50 ft roll SW144-50 14 Gauge 4 wire MiniSpkt Cable250 ft roll S144-250 14 Gauge 4 wire MiniSplit Cable50 ft roll S144-50 Centralized Drain Pan Centralized Drain Pan PAC-SH97DP-E Power Supplies&Auxiliary 3-Pin Wiring Harness PAC-715AD Components 5-Pin Wiring Harness PAC-725AD Drain Socket Drain Socket PAC-SG61DS-E Air Outlet Guide Air Outlet Guide 1 Piece PAC-SH96SG-E(two pieces are required) M-NET Converter M-Net Interface for P-Seres PAC-SJ95MA-E NOTES Specifications are subject to change without notice. ©2025 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. N m 0 N 61 N N C CT fD n TOP s view v m f26 Knockout Hole 26 Knockout Hole 3E (Indoor / Outdoor unit connectlon) ( emote controller transmission) 0 0 c_ 2-04 Burrin Holes r for electric seat Inste uetlon B(Duct) 28,8C1-3/I6) — 548(21 5/8) (DR efrlgerent piping o, flare connectlon(ges) C 76(3) = 117.4 (4-5/8) 4020 5-7/8) 0Refrlgerent piDlng it outle 426 Knockout Hole flare connectlon(lleuid) = N Front (Duct) (Indoor / Outdoor Secondary drain pipe 4 view unit connection) — 2 (Emergpency dralalng) ToD /19.05(3/O 3/4 FP? Terminal block Primary drain pipe (Remote controller transmission) `� (OrevltYY dreln) Terminal block 026 Knockout Hole 0 11,8(3 I/8) 119,05(3/4) 3/4"FP1 (Indoor / Outdoor unit connection) • (Horizontel left) Control box (Remote Controller transmission) 8(3/8) 43(1-3/4) Primary drain pIDe 66(2-5/8) I avltT drain).3/4"FPT 43(1-3/4) 8(3/8) Secondary drain DIDe '. 92(3-5/8) _ 300-3/I6) 419 0�(3/4)3/4 FPj) pQ, LHorlzontat Right) • • • o Secondary drain pipe Primary drain pipe 019 05(3/4)d3/4AFPT) 8revltYY drain) 519.05(3/4) 3/PFPT m � 55(2-3/16) D w.omes • B otto m R Left side QAir Inlet Right side view A view © N N • NJ ®Air fitter JA •• Bottom Model a inalFheiSue Duct Connection C SVZ-AP48NL 508 x 609.6 x 25.4 579 x 4O2 rn — SVZ-AP60NL (20x24x11 (22.13/16x15-7/8) ? m m m m o A iw 36,8(I-1/2) m 2 D n Model A 8 C D E F G H 1 Gas Pipe 10 Liquid Pi SVZ-AP48NL ®15b8(5181 CCB SVZ-AP60NL 635(25) 579(22.13/16) 484.6119.1/8) 317S(12.1/2) 1511(59-112) 798.5(31.71161 1053(41-i/21 853.5133-5/8) 563(22.3/16) 19.0513/4) 952(318) r r n D_ �. N m (D m CD FL N m 1 o cn y Icn d O � N N C Q I-0 n A O O z n Z S N 7 fp m 1 FREE SPACE(Around the un4) 1 SERVICE SPACE 13 FOUNDATION BOLTS 4 PIPING WIRING DIRECTIONS] TheE 0 Exp 6da o below shows a basic esanple. ITmemiona d space needee Please seam the uel<W3( P019—b a a e k. 4 d,.b p EApleneon d pa<balw delass ere IV--- wM 1 bul0abon IAt10<W39>)Odh. un be mace hom�eaecbms. � FI C green n the a bM—mW.*W lh—n the W"diagram (Bob ma Kaslms nW be FRONT v Rghl RearaM Bebw. ss9aMl wlra pachased bcaRyl O N 61—doll-bolt helghU 9•M 1Y • /w FO111X1ATION � no-u/sa 51Q-once � i adt en r. wins.My� Y--pT. Q- - /In� • • Example Of Notes CI—Ralwp GAS voe^J on (FLARE) 15e&5MFI 0-R.MWe eLIOLAD p"conneceon IFLAREI 09.520MF1 •1•-Inaranon.1 VALVE canneceon lomllan. Piping Knock-Out Hole Detailes rrr xrr �-----� err • awr r I I I I t Z O_ e.Ya9Y rYY o- Y OCD — OW Y dee Y T WaY Rr h�lYlw h Y b�YY J Q Y \ y CO w G G — •• Q 0 � (A — a m w d � Y A� Y tD w N r+4Y CO = a p CO� N lA O C N (D = 41 N 3 a —• fn CA C O f r crCD m y S Q SD D_ O �. op 3 D co O N m 3 a m 2 m a il� ill VILLAGE OF RYE BROOK PERMIT#: MP 25-144 BUILDING DEPARTMENT ISSUED: 9/19/2025 938 K..ING STREET, RYF, BROOK, NY 10573 ExrIRES: 9/19/2026 0 t� (914) 939-0668 www.ryebrookny.gov >� MECHANICAL INSTALLATION PERMIT MODIMCA-HONS 'I'O EmSI"ING FIRE SPRINKLER SYSTEM; 7-IH FLOOR � AT: 800 WESTCHESTER AVENUE 1.) NX, 404 BUILDING CLASSIFICATION & PARCEL ID#: BUSINESS GROUP—B / 135.82-1-2 PROPERTY OWNER: 760-800 OWNER LLC / 800 WESTCHESTER AVE LLC (914) 285-1700 LICENSED CONTRACTOR: HANG FIRE SPRINKLER CO LLC (845) 475-2390 ilk it, EMERGENCY CONTACT:JEFFERSON ANJOS (845) 475-2390 ' ilia' for BUILDING PERMIT #: RB#25-0015 FEE PAID: $525.00 �» CON'IRAM, 'OR ML5"I' BE PRESL•NT ON THE JOB5I I'L I'OR ALL INSPECTIONS HOURS OF OPERATION OF CONSTRUCTION EQUIPMENT/VILLAGE CODE S158-4:WEEKDAYS—S:OOAM TO 6:OOPM OR DUSK,WHICHEVER IS EARLIER; SATURDAYS-9:OOAMTo4:00PM; - St 'NI)ANS& 11u1_IDAYS-NOCONsiuiCIJONAciniiNALL(1wo 40'- This permit is valid for a period not to exceed twelve(12)months from the date of issuance,and covers only that work listed above.Septrate perrruts are required for T.. anyelectrical,plumbing,fire suppression,fire/smoke/carbon monoxide d mi etectors/alarms,or an)-other work not eocered under this pert.The approved plans must i� be kept on the job site&be made available for review by the Building Department upon demand.Any amendments or changes to the approved plans must be designed by your architect/engineer and submitted to the Building Department for review and approval prior to performing the work. A Certificate of Occupanc, or Certificate 4Compliance is required in order to close out this permit. i� i1Q Steven E. Fews Building& Fire Inspector & THIS PERMIT MUST BE CONSPICUOUSLY POSTED AT THE JOB SITE r; _ x;n�.n r ■ r w BUILDIN ARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 SEP 1 1 ?;1hS (914)939-0668 Fax(914)939-5801 �NwNi ):ehrook.oru. APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Approval Date: SEP P#: c.Q-5 44 Application Fee:$ Approval Signature: Permit Fees: Disapproved: Other: Application dated: 9/11/2025 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 described below. 1. Job Address: 800 Westchester Avenue, Rye Brook, NY 2. Parcel I.D.: 1315•fpD—}—�;L Zone: c) 3. Proposed Work(Describe system in detail including suppression agent): Modify Existing Sprinkler System for office interior alterations (Sprinkler Head Relocation) 4. Number&Types of Fire Sprinkler Heads: 3/ Reliable G5-56 Concealed Sprinklers 5. NX State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job: 3,000.00 (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which maybe donated gratis.) 7. Prooca Owner: RPW Group Address: 800 Westchester Ave.Rn Brook Phone# (914)285-1700 Cell# email: nilli@rpwgroup.eom Applicant: Hang Fire Sprinkler Co. LLC Address: 106 Dakota Drive, Hopewell Jct., NY, 12533 Phone# (845)475-2390 Cell# (845)475-2390 email: jeff.anjos@hangfire.cc Architect/Eng DRpr:Fire Protection Design Address: 14 Denver Road,New City.NY Phone# (845)721-9835 email: mike@fireprotectiondesign.net General Contractor. f'?cw GRe.'e Address: &V W«t(I,44e Ao y yC` R/cct� Phone# OI J Lr-Z c 5 � 1766 Cell# email: 1 1/30/2020 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: Jefferson Anjos ,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 legal owner of the property to which this application pertains, or that (s)he is the Contractor 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. Sworn to before me this Sworn to before me this ,1 day of , 20 day of S Pe� , 20 Z � Signature of Property Owner Signah o [ licant Print Name of Property Owner nt Name of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester Count J—� Commission Expires January 29,20�— 1 1/30/2020 CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and the system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners, and contractors. It is understood that the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. Property Name: Permit# West Med Property Address: Job#: 800 Westchester Ave., Rye Brook, NY, 10573 RPW-301 Accepted by approving authorities(names) Address Village of Rye Brook Building Department Plans 938 King Street, Rye Brook, NY, 10573 Installation conforms to accepted plans FX1 Yes ❑ No Equipment used is approved r] Yes ❑ No If no, explain deviations Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment? ❑ Yes ❑ No If no, explain: Instructions Have copies of the following been left on premises? 1. System components instructions ® Yes ❑ No 2. Care and maintenance ® Yes ❑ No 3. NFPA 25 ® Yes ❑ No Location of Supplies buildings: 7th Floor System Year of Make Model Manufacture Orifice Size Quantit Tern . Rating RELIABLE G5-56 Concealed Pendents 2025 1/2 3 155 Sprinklers Type of Pipe. BLACK SCH 40 Pipe and Fittings Type of Fittings: THREADED CAST IRON#125 Grooved fittin s -- Maximum time to operate Alarm Valve Alarm Device through test connection or Flow Type Make Model Minutes Seconds Indicator FLOW SWITCH SYSTEM SENSOR WFD 40 __ Z b FN/A EXIXTING Dry Valve Q.O.D. Quick Opening Device Make Model Serial No. Make Model Serial No. Time to trip Time water Alarm Dry Pipe through test Water Air Trip Point Air Reached operated Operating connection Pressure Pressure Pressure test outlet properly Test Minutes Seconds psi psi psi Minutes Seconds Yes No []NIA Without ❑ ❑ Q.O.D. With ❑ ❑ Q.O.D. If no, explain: Operation: ❑ Pneumatic El Electric ❑ Hydraulic Piping Supervised? ❑ Yes ❑ No Detecting Media Supervised? ❑ Yes ❑ No Deluge and Does valve operate from the manual trip, remote,or both control stations? ❑ Yes ❑ No Preaction Is there an accessible facility in each circuit for testing? ❑ Yes ❑ No Valves If no,explain: ®NIA Does each circuit operate Does each circuit Maximum time to supervision loss alarm? operate valve release? operate release Make Model Yes I No Yes No Minutes Seconds ❑ 1 ❑ ❑ 11 Pressure Residual Pressure Reducing Location& Make& Static Pressure flowing) Flow Rate Valve Test Floor Model Setting Inlet si Outlet(psi) Inlet(psi) Outlet(psi) Flow m ®NIA HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi(13.6 bar)for 2 hours or 50 psi(3.4 bar) above static pressure in excess of 150 psi(10.2 bar)for 2 hours. Differential dry-pipe valve clappers shall be left Test open during the test to prevent damage. All aboveground piping leakage shall be stopped. Description PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1'/z psi(0.1 bar) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall not exceed 1'/z psi 0.1 bar in 24 hours. All piping hydrostatically tested at 200 psi 13.6 bar for 2 hours. ❑ Yes PC No Dry pipingpneumatically tested? ❑ Yes No If no, state reason: Equipment operates properly? ® Yes ❑ No Less than 20 heads modification SEC25.2.4 NFPA 13 Do you certify as the sprinkler contractor that additives and corrosive chemicals,sodium silicate or derivatives or sodium silicate, brine,or other corrosive chemicals were not used for ® Yes ❑ No testing systems or stopping leaks? Tests Drain Reading of gauge located near water Residual pressure with valve in test Test supply test connection: psi bar connection open wide: psi bar Underground mains and lead in connections to system risers flushed before connection made to sprinkler piping: Other Explain Verified by copy of the U Form No.85B ❑ Yes ❑ No ❑ Flushed by installer of underground s rinkler piping Yes ❑ No ❑ If powder-driver fasteners are used in concrete, has If no,explain: representative sample testing been satisfactorily completed? ❑ Yes ❑ No Blank Number Used: Locations: Number Removed: Testing ®NIA Gaskets Welded Piping? ❑x Yes ❑ No If es: Do you certify as the sprinkler contractor that welding procedures comply with the re uirements of at least AWS D10.9, level AR-3? 0Yes ❑ No Welding Do you certify that the welding was performed by welders qualified in compliance with the (-]NIA requirements of at least AWS D10.9,Level AR-3? 0 Yes ❑ No Do you certify that welding was carried out in compliance with a documented quality control procedure to insure that all discs are retrieved,that openings in piping are smooth,that slag and other welding residue are removed,and that the internal diameters of piping are not penetrated? ❑x Yes ❑ No Cutouts [_]NIA Do you certify that you have a control feature to ensure that all cutouts(discs)are ® Yes ❑ No Discs retrieved? Hydraulic Nameplate provided? ® Yes ❑ No Data Nameplate If no,explain:. Sprinkler Head Relocation Remarks Date left in service with all control valves open: Signatures Sprinkler contractor: Hang Fire Sprinkler Co.L.L.C. For Property Owopr Tests Witnessed By For Sprinkler Contractor Signature Signature/ Print Name .2 Print Name Ar- n 2 Title Title l tt C r Date -( Z Date Il Additional explanations and notes: AC" " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD VYYV) 5/23/2025 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 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: Cynthia Schmidt Allied Insurance Managers Inc. PHo N Ext: (248)853-0930 ac No: (24e)e53-1512 1055 South Blvd. East EMAIL ADDRESS: Suite #110 INSURERS AFFORDING COVERAGE NAIC# Rochester Hills MI 48307 INSURER A:Certain Underwriters at Lloyd's 100% 085202 INSURED INSURER B:Se:leCtiVe Insurance Cc of NY 13730 Hang Fire Sprinkler Co., LLC INSURERC: 106 Dakota Drive INSURER D: INSURER E Hopewell Junction NY 12533 INSURER F: COVERAGES CERTIFICATE NUMBER:25/26 GL, Auto s Umb REVISION NUMBER:0001 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 LMRS LTR POLICY NUMBER MWDDNYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTE A CLAIMS-MADE Fx]OCCUR PREM SESOE.occurrence $ 100,000 X Blanket AI,PNC,WOS SP2250098 5/22/2025 5/22/2026 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY �X PRO ❑ JECT LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. Enors&Omissions $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acodenl B X ANYAUIO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED S 2491771 5/22/2025 5/22/2026 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUIOS JX AUTOS Per accident $ X BLKTAI w/PNC BLKT WOS $ X UMBRELLA LWB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE SP2X250098 5/22/2025 5/22/2026 AGGREGATE $ 5,000,000 DED I I RETENTION$ Follows Form to GL $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TATUTE ER ANY PROPRIETORMARTNER/EXECUTNE L.L.EACH ACCIDEN I El $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If ycs.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability SP2250098 5/22/2025 5/22/2026 Limt: $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Village of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORED REPRESENTATIVE Jayson Bass/CMS - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 0 ^^^^^^ 833132921 HANG FIRE SPRINKLER CO LLC 106 DAKOTA DRIVE F0 i HOPEWELL JUNCTION NY 12533 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER HANG FIRE SPRINKLER CO LLC VILLAGE OF RYE BROOK 106 DAKOTA DRIVE 938 KING STREET HOPEWELL JUNCTION NY 12533 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2474 285-0 282959 05/23/2025 TO 05/23/2026 9/11/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2474 285-0, 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/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 STAT SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 236405695 U-26.3 �.., CARE&WA-01 TSALLER A�oRO" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 8/28/2025 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 Michelle Giordano AssuredPartners New England,Inc. HIC No,Ext):(860)426-6163 niXc,No:(860 426 Shelton, E- -6163 Beard Saw Mill Road Shelton,CT os4s4 RMAIL .Michelle.Giordano a(J�4ssuredPartners.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of NY 13730 INSURED INSURERB:TRM Specialty Insurance Company 38873 Carey&Walsh,Inc. INSURERC:AmTrust Insurance Company 15954 P.O.Box 2529 INSURER D:Hartford Life&Accident Ins.Co. 70815 Briarcliff Manor,NY 10510-1511 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 AD-0 L S UER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE a OCCUR X X S 2509239 9/1/2025 9/1 15 /2026 DAMAGE TO RENTED 5 ,000 MED EXP An one person) ,000 PERSONAL&ADV INJURY $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 4'000'OOO POLICY❑X JECT LOC PRODUCTS-COMPIOPAGG $ 4,000,000 OTHER: COMBINED SINGLE LIMIT 11000,000 A AUTOMOBILE LIABILITY - X ANY AUTO X X S 2509239 9/1/2025 9/1/2026 BODILY INJURY Per erson OWNED SCHEDULED AUTOS ONLY AUTOS E BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLDY PROPERTY AMAGE Per accdent $ B X UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X X TRCEEX00001300 9/1/2025 9/1/2026 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY OWC1011944 4/1/2025 4/1/2026 11000,000 ANY PROPRIETORIPARTNERIEXECUTIVE Y/N X E.L.EACH ACCIDENT FMandaR/MinNHSEXCLUDED? NIA 1,000,000 E.L DISEASE-FA EMPLOYE If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT D NY Disability jLNY612715 4/1/2025 3/31/2026 Statutory DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Coverage: Pollution Liability Insured: Berkley Insurance Company(NAIC 32603) Policy#FEI-ECC-2777"5 Effective Date:9/1/2025 Expiration Date:9/1/2026 Liability Limit per Occurrence$1,000,000 Aggregate$2,000,000 SEE ATTACHED ACORD 101 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 Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) V ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF TATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured Carey&Walsh,Inc. (914)762-9600 P.O.Box 2529 1c. NYS Unemployment Insurance Employer Registration Number of Insured 529 N. State Road Briarcliff Manor, NY 10510-1511 1d. Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 13-2591740 2.Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) mTrust Insurance Company Village of Rye Brook 3b. Policy Number of Entity Listed in Box"1a" 938 King Street OWC1011944 Rye Brook, NY 10573 3c. Policy effective period /1/2025 to 4/1/2026 3d. The Proprietor,Partners or Executive Officers are ® included.(Only check box if all partners/officers included) ❑all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or after 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: Michelle Giordano (Print name of authorized representative or licensed agent of insurance carrier) C4,4-114 Approved by: 1 04/02/2025 (Signature) (Date) Title: Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier: 860-426-6163 Andrew Fredman � �=_' THIS SET OF APPROVED a- --"—. COUNTY LICENSED) UST BE"~ PLUMBER PLANS M KEPT REQUIRED TO FILE ON THE JOB SITE + -_r..-•- ...... @ 17 14 is is SMOM — DIi."mot. REQUIRE --- -- - - - NyS BUILDING ,I.s te6 G SMOKE DETECTORS °G, 'I, REQUIRED AS PER NYS BUILDING CODE ON n � ... �. PERMIT AL...... WIN Interior Renovation aoo Westchester Avenue E.D TIh Fbor DATE F. Rye Brook,N.V.10573 � COUNTY LICENSED ELECTRICIAN vie Brook.NY iis.S- G N. G.n A Nob. REQUIRED TO FILE Bu�unNo INSPECTOR, I ,.,; T-100.00 f Interior Building Permit Application Village of Rye Brook 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information SBL Zone 135.82-1-2 800 Westchester Ave OB2 Proposed Improvement Renovation of current 7th floor interior Westmed Medical Group space to include limited demolition of non bearing walls, drywall, carpentry,electrical, sprinkler and finish work. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? ❑ Yes 0 No Will the proposed project require the installation of a new, or (if yes, applicant must submit a separate Automatic Fire an extension/modification to an existing automatic fire Suppression System Permit application&2 sets of detailed suppression system? (Fire Sprinkler,ANSL System, FM-200 engineered plans) System,Type I Hood, etc...) 0 Yes ❑ No N.Y.State Construction Classification N.Y. State Use Classification Occupancy Pre-Construction Type 1B B Commercial Occupancy Post-Construction (1 fam., 2 fam.,comm.,etc...) Commercial What is the total estimated cost of construction: (NOTE:The estimated cost shall include all labor, material, 190000 USD scaffolding,fixed equipment, professional fees, and material and labor which may be donated gratis.) Interior Building Permit Application,page 1/1 Andrew Fredman Qy y (22) 0 c 0 .......... -------- 112.5 1 1851 1 1 1 0 —————————— OR,GIN GI G. Gf Gb G. Gc GC Interior Renovation 800 Westchester Avenue 7th;Ioor Rye Brook,N.Y.10573 Tftll Sheet,Plot Pill,General Notes T-100.00 Andrew Fredman 2 Is T, 444 g F1 -E� L IFO 10 Interior Renovation 800 Westchester Avenue 7th Floor Rye Brook, N.Y.10573 Accessibility N,—&Details xyr.hoar T-101.00 13 14 15 1e 17 1e 1e `cal Y1 7! 7 Andrew Fredman du= I I I I I _._._ I ® I I I I I j I I I I I I _ i - - -1 ---- - I /- i I "-ivI -- -�--------i - ----------------1-- - — - - - 5-/ _. T------------ ---------------;= - - - -Q �' _ ^�°'°».....•....._."� .. interior Renovation ,� /` 'l �• .r�....�..........-_... 800 Mstchester Avenue /, /, » ,.......,,.,»..,...,........,,.,....... 7th Floor Rye Brook,N.Y.10573 .,, .,.f w.'..�^.»,...,.....<e.®o w»..>«»»w�.....m.....e..�. 7M Flo Mr of EYnn,T-1 Dft w Andrew Fredman If ? 1s 1� ? I I T 1 1 —-—-—-—---r —-—-—-—--—-—-—-—-—-—-—-—- - - --—-—-—--- -—-—-—-— -—-—-—- -—-—-—- - -—-—-—- - =7 1191 11 d cd ......................... .......... ------------- to I ...Z-1 rl ---------------- -- ------------------------ -- -------kl- Interior Renovation 800 Westchester Avenue rE 7th Floor Rye Brook,N.Y.10573 - -- ------—---— --- ------------ 7th Floor Donolklm Man Gb Gd A DM-100.00 Andrew Fredman 13 4 -------- ------- =F t�E=I m.rVIrn T�J F7 I LL 1 1 -- - ---- --------- .. . - - .............. .... - --------------- -------------- ------ -giv CM i ------------------- 44� - - ----------------------- MEM 811 ------- ------ Interior Renovation 800 Westchester Avenue 7th Floor ---------- Rye Brook N.Y.10573 7th Fl—Co,strucUon Plan,D—S,hM,U,, PaMdw Type Detail A-100.00 13 71 15 18 17 1B 18 (� . Andrew Fredman --- -- ����— — — -�— --- --i---- — i-- — ---i------- -i e I I ® I I I I — — — — -------- ® — — -- -- — ---} — — --- ---- — Q j I I I I I I j I I I I I j I I I I s I I I I I I I I _.. ......_._.._.______._ . I I I I I I to I Iinn ------------------- 12.5 I I I I I I I I I I I .....o..o.pom r I h-- Interior Renovation 800 Westchester Avenue 7th Floor Rye Brook,N.Y.10573 CS ,� /- 7U Floor Mehvore Plan,Millwork DIWh k kk ` t 13 11 15 18 17 1e 18 t[1!) 21 t!t/ �r r 7 7 Andrew Fredman ------ ------- - -- -�-1 -- ----i ----- i -------i- - - - - ---- I I ® I I I I — — — — ------- -—-—-—-— -- -j-------- -—-—-—- —-—-—-— ------- --0 I I o I I I I I I I I I I I I I I I I I I j I L. - •- I ........................ ........................ ............ ""-- m.<w.,ov.,a I -� l o • I I I — -- -—-—-— - j — --- - - - - Ir Ire.rrwsas, • _ _ _—_—_—_—_—_—_—_—_—_ G �cap� Gk `\ �'/ 1 ............ ..W.m • \ � •n..d•.W,R R.W.. Interior Renovation 800 We hestar Ave nue 7th loor Rye Brook,N.Y.10573 , A ..«. \ \ / ®�@ ..r` ® • ..cm..°r°W 7th Floor EN@rleal Plan-Demo@lon � • r / • .�WWm,v 1�;runiwvo. • A,.Wrr a.. wq.e�. M E-100.00 +a a +s +e n e w 2t Andrew Fredman —-—-—- -------- - -- -�— — — --i i -------i—-—-—-— -—-—-—-i e I I ® I I I I I I TTf-1 I I I I I I ® I FI I I - ------ - - - -® -------t-------- ------- ' ------- - - -- --0 I Sly I I •� * I I I I I I I I I I I I I I I I I_ t j _ I L. • I j i i _. - _ I i • I -- I I "" ��` I I - --------- - --- --- -- - - - - -- ----- - ---- I I I ------- I I - -- ------- ------------------- - - - -: --- - - -- �-�_ - v5 � I _._._._.-_ _ —_—_—_—_—_ I jcip) Ok I G ooe ww_+. \ +® In terior Renovation 80 er on ue /. • o,.o7th Floor Rye Brook,N.Y.10573 Gb -\ / ® • • •,•�^••++�• 7th Floor Eleotdcal Plan-Const—flon E-101.00� Andrew Fredman 13 11 15 18 17 19 19 - - - ----- ---- ------ ------ ------L------L------ -------L------I -q) I j j j I I I I I I j j j I I I I I I I I I I I ------ ------- I ----- ------ I ------�------ ---- --- - ---- -0 I I I I I I I I I - - - - - - - - - - - - - - - I I I -��- - - - - ----------- - - - - - --- t--0 1v.5 1v5 Cj I i I1 12.7 �_—_—_Q—J}ek `\_ / El ,................o»woa ' i Interior Renovation —•«°^----<«- 800 Westchester Avenue 7th Floor ® W....».«,.ro<,.. Rye Brook,N.Y.10573 Re Fba R.IIMW GIMP Ran-Wmolabn > w dEa f Y F�'Y'` RCP-100.00 Andrew Fredman 73 i{ 15 19 17 i8 1a � 31 - ----- 1-- - - - -- - - - J ------L --- 1 - - -�- --- -_q) I j j I I I I I I j j I I I I I I I I I I I -------- ------ ------ - - ---- I-------f----- ------ ------ I I I j j I j j I I I I I I I I I I I I I I - - - - I - - - - - - - - - - - -- I --0 I I ------ ------------------- ------i------f--- I I j --- ------------------ 12, ----- --- ----- o ��.�..,.w..�. El Interior Renovation 800 Westchester Avenue J ® 7th Floor Rye Brook,N.Y.10573 70,Floor Rlftlte Cellinq Man- Constro O— d v._ ....a._. Gd :. .. ®a lin„am,-ww ' t`` RCP-101.00