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TABLE OF CONTENTS Cover page 1 Building Permit 2 Required Inspections 3 Mechanical Equipment Specifications pages 4-9 Contract Proposal for work 10 Electrical Permit Application 11 HVAC Permit Application 12 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BRnv� VILLAGE OF RYE BROOK O 938 King St Rye Brook,NY 10573 W QPhone:(914)939-0668 1 www.ryebrook.gov > �O . 1 02 •`t Building Department INSTRUCTIONS THE PERM IT HOLDER AND/OR PROPERTY OWNER IS RESPONSI BLE FOR ENSURI NG THAT ALL REQU IRED/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. 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U N :eE0 a a, m ig v - y a+ O a +� U00. m V m � m � aaol � � yt 0`_ 8 c- E v NEW yp� Q F °' > c uj cii a� Lu CD LLJ W O OF D U H 0 0 u v 4A v ._ a v cl ��p�9d��\C a Q a a 0 Q ►�- cu VILLAGE OF RYE BROOK ■&, .!Rffl1 938 King St Rye Brook,NY 10573 lv Phone:(914)939-0668 i www.ryebrook.gov 32• Building Department RE Electrical/New Fixtures And Wiring(Remodel)Permit Permit Set 140 BRUSH HOLLOW CRIES P#RB25-0044 R#129.76-1-120 PERMIT INFORMATION Address Permit number Date issued 140 BRUSH HOLLOW CRES RB25-0044 10/11/2025 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 Cover page 1 Building Permit 2 Required Inspections 3 Electrical Permit Application 4 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 �y BIR VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W � Q Phone:(914)939-06681 www.ryebrook.gov �O �• �2• 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 o a o, 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. Electrical 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 Proposed Electrical Work/Fixture Count 3rd Party Electrical Inspection Agency SWIS Master Electrician/Licensed Installer Information Name Lic# Address email FRANCISCO BARAJAS 1868 24 WALNUT STREET NEW ROCHELLE NY 10801 INFO@JBGELECTRICCORP.COM Phone# Cell# Company Name Company Address 9144380282 JBG ELECTRIC CORP 24 WALNUT STREET NEW ROCHELLE NY 10801 Address of Work? Homeowner Information 140 BRISH HOLLOW CRESCENT RYE BROOK NY Electrical Permit Application,page 1/1 STATE WIDE INSPECTION SERVICES, INC.;, Service With Integrii), 0•0 • • APPLICATIONSWIS JOB 0. • Office Use Elect. Permit Date Bldg Permit K Sq Ft Plumbing Permit # Final Certificate u City/Village - Zvok Zip Building Dept. County Address / l0 /3/1;�5/ A/ O C"� s Street Section Block Lot Owner Name/Address dfWdifferent than above; w)�� �Q�� �� Contact Nwnber &Y& 1 96 J, ❑Basement ❑Ist Fl. ❑2nd Fl. 1❑r '3rd Fl. ❑More Than 3 A. ❑Garage ❑Attic ❑Outside v❑1(RRessiidential ❑Commercial Receptacles Special Recept GFCI AFC1 Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Aint Amps Range(s) Cocktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage ,Panels IP 3P Meters 9 Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑NYSEG ❑Central Hudson ❑Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect [:]Legalization ❑ Safety Inspection ❑Consultation Scope of Work This application is valid for one(1)year from the date received by SMIS.This application is intended to cover the above listed items to be inspected,rf at any time of inspection additional items have been instalkd.you are autlwazed 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 ocher inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address IiJ fb ��,g( ec , � Name `�{�,�(, rra License# J 0 Date'21 \/'', Signatu LUCE.� p Cif Address W n(ifl City/State /` (� � - Zip Code Company J R) -, Phone it 1 4 3 L Z Jome / All Products / Heating&Cooling-/ Residential E uipmen / Air Conditioner Condensers $ Print rrane 2.5 Ton - 14.3 SEER2=Single-Stage Air Conditioner - R-454B - 208/230V \ w COMPATIBLE 'art*T5TTR5030A1000A Item#11501760 Manufacturer Part#5TTR5030A1000A (0) Write a Review CYou last purchased this on June 10,2025. View Purchase History Q $1,834.00- ronnage:2.5 Ton 2.5 Ton Package Quantity Info: :ach: 1 Inner Pack: 1 1 + Add to Cart -+ Add To My Lists Pick Up Available 7 in Elmsford,NY Av i blg,in 2a5SQm_nea- © Shipping Available Available for immediate shipment Product Details • HVAC equipment products sold to licensed contractors only. Products sold in select areas only, please contact your local branch for availability in your area. • With a SEER2 of up to 17,the 15 single stage air conditioner combines energy efficiency and comfort • This ENERGY STAR® qualified AC unit uses a more sustainable refrigerant while offering exceptional performance • Trane HVAC products go through months of extreme testing and only the strongest survive,we build reliability into every air conditioner to give you long-lasting comfort OF Green JM A21.Compatible Documents SPECIFICATION WARRANTY USE_AND_CARE ENERGY GUIDE Specifications A21L Compatible:Yes BTU Cooling Rating:30000 Btu/h CEC Compliant: For Sale in CA Compressor Stages:Single Stage Decibel Rating (dB): 73 dB Depth:33 in EER2:11.7 Energy Star Compliant:Yes Factory Std. Refrigerant Charge:8 oz Height:37 in Liquid Line(OD): 5/16 in Max Fuse Size:2S Minimum Circuit Ampacity(MCA): 15 Phase:Single Phase Proposition 65: WARNINGIThis product can expose you to chemicals including lead,which are known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go towww.P65Warnings.ca.gov. Refrigerant: R-454B SEER: 15 SEER2: 14.3 Tonnage:2.5 Ton Volts:208/230V Width:30 in Reviews o Reviews Review this Product Be the first to review this product tome / All Products / Heating&Cooling-/ Residential Ea�LiRment / Air Handler� $ Print 4merican Standard HVAC -DTEM4 Series 1.5 - 2.5 Ton - Multi-Speed ECM-Air Handler - R-454B - 18.5" W COMPATIBLE 'art#ASTEM4B03AC31SA I Item#11525179 Manufacturer Part#5TEM4B03AC31SA *"*** 5.0 (1) Write a Review $1,744.258- ronnage: 1.5 -2.5 Ton 1.5-2.5 Ton aackage Quantity Info: _ach: 1 Inner Pack: 1 1 + Add to Cart =+ Add To My Lists iow to get it: Pick Up Available 4 In Elmsford,NY W Available for immediate shipment Product Details • HVAC equipment products sold to licensed contractors only. Products sold in select areas only, please.contact your local branch for availability in your area. • A2L compatible • Painted metal cabinet with captured foil face insulation • 2%or less air leakage • Multi-position up/down flow, horizontal left/right • Electric heaters with polarized plug connections • R-454B thermal expansion valve • ECM motor • Low voltage pigtail connections • Horizontal drain pan J& A2L Compatible Documents - SPECIFICATION ,. INSTALLATION Specifications A2L Compatible:Yes AMP:3.9 BTU:30000 Blower Type: ECM CFM:1000 ft3/min Coil Type:Plate Fin Collection: 5TEM4 Series Communicating:Non-Communicating Configuration:Convertible Depth:21-1/8 in Fan Speeds:8 Height:46-3/4 in Horsepower:0.5 hp Liquid Line(OD):3/8 in MBH:30 Material:Aluminum, Metal Max CFM: 1000 cfm Phase:Single Phase Refrigerant:R-454B Refrigeration Control Type:TXV Suction Line(OD):3/4 in Tonnage: 1.5-IS Ton Volts:208/230V Width: 18-1/2 in Reviews i Reviews Rating Snapshot Select a row below to filter reviews. 5 stars 1 ELECTRICAL PERMITS A-. plyins -fir 1) DATE OF REQUEST '' 136125 C I 2) NAMEOFCLIENT rwtne (err -�' 4113��Z� 3) CLIENTADDRESS 11fo 3(US6 /�o116b.J �SL�n� 4) TYPEOFWORK"'�pIQClf C'_or-Jenser (RESIDENTIAL ❑ COMMERCIAL 5) IS IT A LEGALIZATION YES ❑ NO 6) BUILDING DEPARTMENT ?9 e-. Y�(l- 7) OWNER'S EMAIL M) n� I C)3ci�( 1 ry- I � 8) OWNER'S PHONE NUMBER (py(p, qL56_ 13Iq 9) SCOPE OF WORK'�Re-Pl aCe GZi')denSf-l- 4-tl-�--' 10) HOW MANY UNITS?( PLEASE INCLUDE TYPE OF UNITS AND LOCATION) 11) IS THERE AN EXISTING OUTLET I YES i NO ❑ 12) IS THERE AN EXISTING SAFETY SWIC H/DISCONN ET YES od NO 0 1 Electrical 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 Proposed Electrical Work/Fixture Count 3rd Party Electrical Inspection Agency Master Electrician/Licensed Installer Information Name Lic# Address email Phone# Cell# Company Name Company Address Electrcian Barajas Address of Work? Homeowner Information 140 Brush Hollow Crescent Electrical Permit Application,page 1/1 - r �• -�4.._Js_1i.Ji 9L'f' 'Il -i_.. ,c. 1.. 1K, +'. :. y •r - Ae I .• `r i C v� C) L > a. cv Ln I F U U r Q L C t•�. � & ;•7. cd •Ir it V I- ti co _ �• ' W O TcO Fw� o�ection F. y a IL is 4. 2 C, o CL 4A Ono ca i \. ci �i ot► o � y Z �n ��� 'i U cu 00 L / .fin n' ' fi` . l ® DATE(MMIDD/VYYY) `4jW o CERTIFICATE OF LIABILITY INSURANCE 12/14/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or he 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 exforsement(s). PRODUCER NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX HOME OFFICE: P.O.BOX 328 (Aic,No,EXt):888-333-4949 tac,Not:5074464864 OWATONNA,MN 55060 AuoREss:CUENTCONT_ACTCENTER®FEDINS.COM INSURERS AFFORDING COVERAGE RAIL i INSURER A.-FEDERATED MUTUAL INSURANCE COMPANY 13MS INSURED INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 ARCTIC MECHANICAL INCORPORATED INSURER C: 460 N MAIN ST — - PORT CHESTER, NY 10573-3310 INSURER o: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:90 REVISION NUMBER:0 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. ILTR TYPE OF INSURANCE l�SR POLICY NUMBER MMlDD/Y1'YY LIPWO MCI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES ocasini^U s100AW MED EXP lArq one praoll) EXCLUDED A N N 1887386 01/18/202S 01/18/2026 PERSONAL S ADV 11IJ Rr SIAMM OENLAOOREOATE LIMIT APPLIES PER: GENERAL AGGREGATE MOW= X RO- POLICY �JECT ❑LOD PRODUCTS A COMPNIP ACC $2,000,000 OTHER: AUTOMOBILE LIABWTY EOMBI Ea d ED SINOUE LIMIT $1,000,000 enti X ANY AUTO BODILY INJURY(Par Perm) A OWNED AUTOS ONLY - SCHEDULED N N 1887386 01/18/2025 Ol/18/2026 BODILY INJURY(Per Aoddan0 HIRED AUTOS ONLY AUTOS W PRONLYAcLR'IdryanIDA111AGE I X UMBRELLA UAS X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS UAB CLAIMS-MADE N N 9907994 01/18/2025 01/1&P2= AGGREGATE 55,000,000 DIED 1 X RETENTION sic,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X PER STATUTE THER ANY PROPRIETORIPARTNERI EXECUTIVE El EACH ACCIDENT s1 O�(pO B OFFICER/MEMBEREXCLUDED? - NIA N 929&5W D1/1B2D25 D1/18/2026 I1 yes,describe Inds Mandatory In NH) E.L DISEASE EA EMPLOYEE sipw ow -_-_--- DESCRIPTION OF OPERATIONS below F-L DISEASE-POLICY LIMIT $1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Ada1aW Ramaltta ShclataN,splay be athd)ad It more space is recluired) CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK 90 0 938 KING ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED RYE BROOK,NY 10573-1226 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE/ \I © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YOR Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured (914)934-8301 Arctic Mechanical Incorporated 286-468-4 460 N Main St Port Chester,NY 10573-3310 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 06-1596446 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company Village Of Rye Brook 938 King St 3b.Policy Number of Entity Listed in Box"1a" Rye Brook,NY 10573-1226 9298530 � 3c.Policy effective period 01/18/2025 to 01/18/2026 3d.The Proprietor,Partners or Executive Officers are �x 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 underJttm_3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Melissa Kopperud (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �� &61�� 12/142024 (Signatu ) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov