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1982 BUILDING DEPARTMENT
❑B LDING 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 : / (,, ' �.N \T_ /12EE� DATE: 1 - 31 - Z(Wr
PERMIT# ��,�, !�' ►N_Ste_Gtlor-ISSUED: _ _ SECT: . Z BLOCK: LOT: 8 L
LOCATION: N%_L_p C_ _ OCCUPANCY:
❑ Violation Noted Tiff WORK IS... W PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas - L L m �aA f d•�/f I
❑ L.P. Gas
❑ FUEL TANK C
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
ff'OTHERV-
BUILDING DE' PARTMENT
VILLA OF RYE �tOOK Initial Inspection Date: ❑ Pass
STEVEN E.FEWS 938 KING STItQ) ,RYE BROOK,NEW YORK 10573 1 10 Z-5- 2Artie Fail
BUILDING&FIRE INSPECTOR (914)0 8 ' ww.rvebrookn Ov Re-Inspection Date: ❑ Pass
sfewsna.rvebrooknv.aov
9qh, ❑ Fail
FIRE INSPECTION REPOwr, NOTICE OF VIOLATION & ORDER TO REMEDY SAME
Site Address: -7 b V Q 5 .A Zone: SBL: 1.3 4. 21 - ZZ-
Occupancy: $T'. PAW �W \b C�Q/� wwState Use Classification: T�
Business Owner: �' - t?A%& S 9 yia,,Me.IAe. kyt` P%eA ►J QK;q`` 7 bone: l q" 93 9"JO7 9
Building Owner: I I le Phone: Q ��• 939 y 7
Emergency Contact: _ (h ed�N(G. 1 eje AS Phone: C)I Q q`_es IS
Building Representative in Attendance: Me-d I V 4, -Te lQ s e-0
--------------------------------------------------------------------------------------------------------------------------------------------------------
Take notice that the following violations of the New York State Uniform Fire Preventio &Building Code and/or the Code of the
Village of Rye Brook wer found to exist at, (e �C 1�1 Cs S'r/tQ� _ ,in the Village of
Rye Brook,NY on, . 2.b 20 cam,-.The person or entity served with this Order to Remedy shall
immediately commence to correct all listed violations and shall completely cure each violation described herein by no later than
N O11E N43A , n141 &&M" ,which is thirty(30)days after the date of this Order to Remedy.Furthermore,
upon curing any listed violation(s),you shall immediately contact the Building Department during normal business hours to schedule
a re-inspection of the premises to confirm full compliance with all applicable codes,laws,rules®ulations.
BE ADVISED THAT YOUR FAILURE TO CORRECT ALL VIOLATIONS IS A CRIME.PUNISHABLE BY FINE,INIPRISONMF,NT OR BOTH.
----------------------------------------------------------------------------------------------------------------------------------------------------
NO 1'Es N/A
1.PORTABLE FIRE EXTINGUISHERS (PFE's)
a.906.1. Are PFE's installed throughout the space&on the premises as required by code. a._ _✓
b.906.3.1. Is the maximum travel distance to a PFE 75 feet or less. b._ _✓
c.906.5.Are PFE's conspicuously located&readily accessible. c._ _✓
d.906.6.Are PFE's unobstructed/unobscured from view. d._ ✓ _
e.906.7.Are PFE's properly mounted as per the manufacturers instructions. e._ ✓ _
f.906.9.Are PFE's properly installed:<40 lbs.max.5'above floor;>40 lbs.max.3.5'above floor. f ✓
2.FIRE ALARM SYSTEM&SMOKE DETECTORS
a.901.6.1.Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72. a._ ✓
b.907.4.2.1.Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b._ ✓
c.907.4.2.2.Is the height of the pull station handle located between 42&48 inches above the floor. C._ ✓ _
d.907.3.Is a fire alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d.
3.FIRE SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS
a.901.6.1.Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a._ ✓ _
b.901.6.1.Are the main valves secured against tampering in the open position. b.
c.901.6.1.Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C.
d.901.6.1.Is a supply of six spare heads&a wrench maintained on the premises. d._ _✓
e.901.6.1.Are sprinkler heads&cover plates unfinished or of factory applied finish only. e._ ✓
f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f._ _✓
g.913.5.Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g._ ✓
h.507.5.2.Is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h._ ✓
i. 507.5.4.Are fire hydrants&fire protection equipment unobstructed. i.
j. 507.5.5.Is a clear space of not less that 3 feet maintained around all hydrants. j._ ✓
k.901.8.Are all fire protection systems in place and maintained untampered. k.
INSPECTOR:Ir_�'A `^_40 DATE: I C) o?oolS
It......16 12024
No YEs N/A
4.STANDPIPE.CABINETS&FIRE DEPARTMENT CONNECTIONS
a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. _✓ _
b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b. _✓
c.912.2.3 Are standpipe FDC threads compatible with fire department standards. C. _ ✓ _
d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d.
e.905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e. _✓
f.912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f. _ ✓
g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g. _ ✓
5.EXITS.MEANS OF EGRESS&OCCUPANCY
a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. _ �✓
b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b. o
c. 1031.6.Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... C. _ 1/
d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. _
e. 1031.10. Emergency lighting equipment inspection and testing. e.
f. 1010.1.Are egress doors provided and maintained as required by this section. f. ✓
g. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. g. ✓ _
h. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. h. _ VOW,
i. 1013.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. i.
j. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1.provided as required by code.
k. 1013.3.Are all exit signs illuminated at all times. k. _ ✓ _
1.1008.1.Are the means of egress&exit discharge illuminated at all times the building is occupied. 1. _ _✓
in. 1018.3.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures M.
are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides. ✓
n. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least n.
28"wide,or at least 36"wide where serving 50 or more people.
6.COMBUSTIBLE STORAGE&WASTE MATERIALS
a.304.1. Is the building(s)and premises maintained free from accumulated combustible waste material. a. _ _✓ _
b.304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b. _ ,L
c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C.
d.315.3.Are combustible materials properly stored&separated from ignition sources. d.
e.315.3.1.1s storage maintained 24"or more below the ceiling in nonsprinklered buildings, C.
and 18"or more below sprinkler head deflectors in sprinklered buildings.
f.315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f. _
g.315.3.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g.
h.313.1.Is building maintained free from stored fueled equipment.(motorcycles,mopeds,mowers,etc...) h. ✓
7.ELECTRICAL
a.604.1.Is the building free from modified/damaged wiring,devices,appliances,equipment a.
and maintained free from electrical hazards.
b.604.2.Are electrical service equipment areas properly illuminated. b._ ✓
c.604.3.Are proper working space clearances provided&maintained for electrical service equipment. C. ✓
d.604.3.Are electrical service equipment working spaces free from any stored materials. d.
e.604.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. C. ✓
f.604.4.Is the building free from unfused multi-plug electrical adapters. f. _ ✓
g.604.5.Are electrical extension cords being used in a safe manner as per code. g. _ ✓
h.604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h._ v
i.604.6.Is the building free from open-wiring spliced electrical connections. i.
j.604.8.Are electrical motors maintained free from accumulated oil,dirt&debris. j._
k.915.1.Are Carbon Monoxide Detectors installed&maintained as required by this section and by 1103.9. k._ ✓
NZZ
INSPECTOR: 1 DATE: )O- 2 3 - Z O 2-4--
Revised 6/1/2024
NO YES N/A
8.ELEVATORS.DUMBWAITERS&ESCALATORS
a.[PM]603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a.
b.606.3.Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b. _ _ 7[
floors reading; IN FIRE.EMERGENCY,DO NOT USE ELEVATOR,USE EXIT STAIRS
c.606.7.Are keys for elevator car doors&fire department service kept in an approved location. C.
d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. _
e.[B]3005.1.Are elevator machine room doors maintained unobstructed at all times. e.
9.COMMERCIAL KITCHENS
a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a.
b.904.12.5.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b.
c.904.12.5.2.Are automatic fire extinguishing systems serviced at least every 6 months. C.
d.904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d. )e
e.[RB] 122-5.B.Are grease traps provided and installed as required by Village Code. e.
f.[PC] 1003.10.[RBI 122-6.Are grease traps properly maintained as per State and Village Code. f.
g.[RB] 122-6.C., 122-9.Are all service,maintenance,&repair records for grease traps and related
plumbing maintained on the premises as required by Village Code. g.
10.HEATING SYSTEMS
a.[PM]603.1.Are all heating appliances properly installed&maintained in a safe working condition. a. ✓
b.[PM]603.2.Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. _ ✓
c.[PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C. _ •� _
d.[PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d. _ _✓
e.[PM]603.5.Is the fuel-burning equipment provided with adequate combustion&ventilation air. e. ✓
11.MOTOR FUEL-DISPENSING FACILITIES&REPAIR GARAGES
a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a.
in an approved location within 100'of,but not less than 20' from fuel dispensers.
b.2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b.
c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C. LC
d.2305.5.Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d.
2-A:20-B:C provided&located not more than 75' from pumps,dispensers&fill-pipe openings.
e.2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e. _ �C
f.2305.7.Are weeds and other combustible materials kept at least 10' from fuel-handling equipment. f.
g.2306.4.Are above-ground tanks provided with vehicle impact protection. g. _ �C
h.2306.5.Are above-ground tanks provided with secondary spill containment. h.
12.HAZARDOUS MATERIALS(HAZ-MATS)
a.407.2.Are S.D.S. Sheets for all haz-mats readily available on the premises. a. _ ✓ _
b.407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b. _ ✓
c.5004.2.Are stored haz-mats provided with approved secondary spill containment. C. _✓
d.5003.7.1.Are proper No SMOKING signs provided as per this section. d. ✓
13.MISCELLANEOUS
a.403.1.Is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. _✓
b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b.
c.405.5.Are records of emergency evacuation drills kept&maintained on the premises. C. ✓
d.505.1.Are approved address&building numbers properly placed&plainly visible from the street. d. _ 7
e.506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e. _✓
f.703.1.Is all required fire-resistance rated construction properly maintained as per code. f _
g.703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g.
h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h. X
i. 5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. i.
14.GENERAL HOUSEKEEPING
a.Good
b.Fair
c.Inadequate
d.Poor INSPECTOR: �� DATE: I O !T..3 Z O 2�
Revised 6/1/2024
ITEM NUMBER REMARKS
ove C ty&,,, J a L L-
INSPECTOR: 10 Z 3 - a o L,f
Revised 6/l2024
C
INSPECTION AND TESTING FORM
Date: 1-11-25 Time: 9:00 AM
SERVICE ORGANIZATION PROPERTY NAME (USER)
Name: RYE BROOK SECURITY, INC Name: SAINT PAULS CHURCH
Address: 4 JENNIFER LANE RYE BROOK,NY 10573 Address: 761 KING STREET RYE BROOK, NY 10573
Representative: JOHN BERARDI Owner Contact: JIM O'HANLON
License No.: 12000017294 Telephone: 914-939-3079
Telephone: 914-934-7700
APPROVING AGENCY
MONITORING ENTITY
Contact:
Contact: USA CENTRAL Telephone:
Telephone: 914-939-6660
SERVICE
Monitoring Account Ref.No.: 34-5483
❑Weekly [I Monthly ❑Quarterly
TYPE TRANSMISSION ❑Semiannually ®Annually
❑McCulloh ❑Multiplex ®Digital ❑Other(Specify)
❑Reverse Priority ❑RF
❑Other(Specify)
Control Unit Manufacturer: HONEYWELL
Model No.: 128-24 FB
Circuit Styles: POLLING
Number of Circuits: 1
Software Rev.:
Last Date System Had Any Service Performed:
Last Date That Any Software or Configuration Was Revised:
NFPA 72, Figure 10.6.2.3(p. 1 of 6)
Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale It may not be copied for commercial sale or dsiribution.
ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity of Quantity of
Devices Installed Circuit Style Devices Tested
7 POLLING 7 Manual Fire Alarm Boxes
0 0 Ion Detectors
31 POLLING 31 Photo Detectors
0 0 Duct Detectors
18 POLLING 18 Heat Detectors
1 POLLING DONE AT
SPRINKLER WaterFlow Switches
TEST
2 POLLING DONE AT Supervisory Switches
SPINKLER TEST
Other(Specify):
Alarm verification feature is ❑disabled ❑enabled
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION
Quantity of Quantity of
Appliances Installed Circuit Style Appliances Tested
0 0 Bells
0 0 Horns
0 0 Chimes
7 7 Strobes
0 0 Speakers
12 12 Other(Specify): HORN STROBE COMBO
No.of alarm notification appliance circuits:
Are circuits monitored for integrity? ®Yes ❑No
NFPA 72, Figure 10.6.2.3(p. 2 of 6)
Copyright 0 2009 National Fire protection Association.This form may be copied for indhAdual use other than for resale.It mey not be copied for commercial sale or distribution.
SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity of Quantity of
Devices Installed Circuit Style Devices Tested
0 0 Building Temp.
0 0 Site Water Temp.
0 0 Site Water Level
0 0 Fire Pump Power
0 0 Fire Pump Running
0 0 Fire Pump Auto Position
0 0 Fire Pump or Pump Controller Trouble
0 0 Fire Pump Running
0 0 Generator in Auto Position
0 0 Generator or Controller Trouble
0 0 Switch Transfer
0 0 Generator Engine Running
0 0 Other(Specify):
SIGNALING LINE CIRCUITS
Quantity and style of signaling line circuits connected to system(see NFPA 7211 Table 6.6.1):
Quantity Style(s)
SYSTEM POWER SUPPLIES
(a)Primary(Main): Nominal Voltage 120 Amps
Overcurrent Protection: Type CIRCUIT BREAKER Amps
Location(of Primary Supply Panelboard): BOILER ROOM
Disconnecting Means Location: ON WALL AT FIRE PANEL
(b)Secondary(Standby):
Storage Battery: Amp-Hr Rating 2-7 AMP HR
Calculated capacity in Amp-Hrs to operate system for 60 hours
Engine-driven generator dedicated to fire alarm system: NA
Location of fuel storage: NA
TYPE BATTERY
❑ Dry Cell ❑ Lead-Acid
❑Nickel-Cadmium ❑Other(Specify):
® Sealed Lead Acid
(c)Emergency or standby system used as a backup to primary power supply,instead of using a secondary power supply:
Emergency system described in NFPA 70®,Article 700
Legally required standby described in NFPA 70®,Article 701
Optional standby system described in NFPA 70®,Article 702,which also meets the performance
requirements of Article 700 or 701
NFPA 72, Figure 10.6.2.3(p. 3 of 6)
Copyright 0 2009 National Flre Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.
PRIOR TO ANY TESTING
NOTIFICATIONS ARE MADE Yes No Who Time
Monitoring Entity ® ❑ USA CENTRAL 9:11AM
Building Occupants ❑ ® NON ON PREMISE
Building Management ❑ ® NON ON PREMISE
Other(Specify) ® ❑ 60 CONTROL 9:12AM
AHJ Notified of Any Impairments ❑ ® NON FOUND
SYSTEM TESTS AND INSPECTIONS
TYPE Visual Functional Comments
Control Unit
Interface Equipment
Lamps/LEDs
Fuses
Primary Power Supply
Trouble Signals
Disconnect Switches
Ground-Fault Monitoring
SECONDARY POWER
TYPE Visual Functional Comments
Battery Condition
Load Voltage
Discharge Test ❑
Charger Test
Specific Gravity ❑
TRANSIENT SUPPRESSORS ❑
REMOTE ANNUNCIATORS
NOTIFICATION APPLIANCES
Audible
Visible
Speakers ❑ ❑
Voice Clarity ❑
NFPA 72, Figure 10.6.2.3(p. 4 of 6)
Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.
INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS
Device Visual Functional Measured
Loc.&S/N Type Check Test Factory Setting Setting Pass Fail
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
Comments:
EMERGENCY COMMUNICATIONS
EQUIPMENT Visual Functional Comments
Phone Set ❑ ❑
Phone Jacks ❑ ❑
Off-Hook Indicator ❑ ❑
Amplifier(s) ❑ ❑
Tone Generator(s) ❑ ❑
Call-in Signal ❑ ❑
System Performance ❑ ❑
Visual Device Operation Simulated Operation
COMBINATION SYSTEMS
Fire Extinguisher Monitoring Device/System ❑ ❑ ❑
Carbon Monoxide Detector/System ❑ ❑ ❑
(Specify) ❑ ❑ ❑
INTERFACE EQUIPMENT
(Specify) ❑ ❑ ❑
(Specify) ❑ ❑ ❑
(Specify) ❑ ❑ ❑
SPECIAL HAZARD SYSTEMS
(Specify) ❑ ❑ ❑
(Specify) ❑ ❑ ❑
(specify) ❑ ❑ ❑
Special Procedures:
NFPA 72, Figure 10.6.2.3(p. 5 of 6)
Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.
Comments:
SUPERVISING STATION MONITORING Yes No Time Comments
Alarm Signal ® ❑ 9:11AM 11:54
Alarm Restoration ® ❑ 9:11AM 11:54
Trouble Signal ® ❑ 9:11AM 11:54
Trouble Signal Restoration ® ❑ 9:11AM 11:54
Supervisory Signal ® ❑ 9:11AM 11:54
Supervisory Restoration ® ❑ 9:11AM 11:54
NOTIFICATIONS THAT TESTING IS Yes No Who Time
COMPLETE
Building Management ❑
Monitoring Agency ® ❑ USA CENTRAL 11:54AM
Building Occupants ❑ ED
Other(Specify) ® ❑ 60 CONTROL 11:52AM
The following did not operate correctly:
System restored to normal operation: Date: 1-11-25 Time: 11:54AM
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS
Name of Inspector: JOHN BERARDI Date: 1-11-25 Time: 12:30
Signature:
Name of Owner or Representative: Date: Time:
Signature:
NFPA 72, Figure 10.6.2.3(p. 6 of 6)
Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.
Comments:
SUPERVISING STATION MONITORING Yes No
Time Comments
Alarm Signal
® ❑ 9:11AM 11:54
Alarm Restoration
® ❑ 9:11AM 11:54
Trouble Signal
® ❑ 9:11AM 11:54
Trouble Signal Restoration ® ❑ 9:11AM 11:54
Supervisory Signal
® ❑ 9:11AM 11:54
Supervisory Restoration ® ❑ 9:11AM 11:54
NOTIFICATIONS THAT TESTING IS Yes No
COMPLETE Who Time
Building Management ❑
Monitoring Agency ® ❑ USA CENTRAL
11:54AM
Building Occupants ❑
Other(Specify) ® ❑ 60 CONTROL
11:52AM
The following did not operate correctly:
System restored to normal operation:
Date: 1-11-25 Time: 11:54AM
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS
Name of Inspector: JOHN BERARDI
Date: 1-11-25 Time: 12:30
Signature:
Name of ner or Representative:
Date: Time:
Signature:
NFPA 72, Figure 10.6.2.3(p.6 of 6)
Copyright C 2009 National Fire protection Association This form may be copied for individual use other than for resale,ft may not be copied for commercial sale or distrWion.
RYE BROOK SECURITY, INC.
4 JENNIFER LANE Phone: (914)934-7700
RYE BROOK,NY 10573
SAINT PAUL'S CHURCH 1-11-25
LOCATION DEVICE CONDITION
■ SIDE DOOR PULL STATION TESTED OK
■ LOWER LOBBY PULL STATION TESTED OK
■ LUTHER ROOM PULL STATION TESTED OK
■ REAR STAIR PULL STATION TESTED OK
■ HANDICAPPED DOOR PULL STATION TESTED OK
■ MAIN LOBBY PULL STATION TESTED OK
■ GARAGE PULL STATION TESTED OK
■ LUTHER ROOM SMOKE TESTED OK
■ KITCHEN HEAT TESTED OK
■ LOWER MENS ROOM HEAT TESTED OK
■ LOWER LADIES ROOM HEAT TESTED OK
■ LOWER LOBBY SMOKE TESTED OK
■ LOWER PANTRY HEAT TESTED OK
■ LOWER STORAGE ROOM SMOKE TESTED OK
■ BOILER ROOM HEAT COULD NOT GET TO DUE TO PIPES
■ WATER METER ROOM HEAT TESTED OK
■ MAIN NURSERY SMOKE TESTED OK
■ MAIN NURSERY SMOKE TESTED OK
■ MAIN NURSERY SMOKE TESTED OK
■ MAIN NURSERY SMOKE TESTED OK
■ MAIN NURSERY SMOKE TESTED OK
■ MAIN NURSERY SMOKE TESTED OK
■ SMALL NURSERY SMOKE TESTED OK
■ LAUNDRY ROOM HEAT TESTED OK
■ HANDICAPPED BATHROOM HEAT TESTED OK
■ CHOIR ROOM SMOKE TESTED OK
■ CHOIR ROOM CLOSET SMOKE TESTED OK
■ PASTOR'S OFFICE SMOKE TESTED OK
■ UPPER JANITORS CLOSET HEAT TESTED OK
■ UPPER MENS ROOM HEAT TESTED OK
■ UPPER LADIES ROOM HEAT TESTED OK `
■ OFFICE HALL SMOKE TESTED OK
■ MAIN OFFICE SMOKE TESTED OK
■ COPY ROOM SMOKE TESTED OK
■ SIDE STAIR SMOKE TESTED OK
■ MAIN HALL SMOKE TESTED OK
■ MAIN HALL SMOKE TESTED OK
■ PASTOR'S ROOM SMOKE TESTED OK
■ FRONT BATHROOM HEAT TESTED OK
■ SACRISTY ROOM HEAT TESTED OK
■ REAR STAIR SMOKE TESTED OK
■ BALCONY CLOSET SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ CHURCH SMOKE TESTED OK
■ BALCONY CLOSET SMOKE TESTED OK
■ ATTIC HEAT TESTED OK
■ ATTIC HEAT TESTED OK
■ ATTIC HEAT TESTED OK
■ ATTIC HEAT TESTED OK
■ GARAGE HEAT TESTED OK
■ SPRINKLER FLOW TESTED AT SPRINKLER INSP. NOT TESTED
■ SPRINKLER SHUT OFF NOT TESTED
■ SPRINKLER SHUT OFF NOTTESTED
HANDICAPPED BATHROOM STROBE TESTED OK
CHOIR ROOM HORN STROBE TESTED OK
UPPER MENS ROOM STROBE TESTED OK
UPPER LADIES ROOM STROBE TESTED OK
OFFICE HALL HORN STROBE TESTED OK
FRONT BATHROOM STROBE TESTED OK
SACRISTY ROOM STROBE TESTED OK
CHURCH HORN STROBE TESTED OK
CHURCH HORN STROBE TESTED OK
CHURCH HORN STROBE TESTED OK
CHURCH HORN STROBE TESTED OK
GARAGE HORN STROBE TESTED OK
LUTHER ROOM HORN STROBE TESTED OK
LOWER MENS ROOM STROBE TESTED OK
LOWER LADIES ROOM STROBE TESTED OK
LOWER LOBBY HORN STROBE TESTED OK
BOILER ROOM HORN STROBE TESTED OK
MAIN NURSERY HORN STROBE TESTED OK
MAIN NURSERY HORN STROBE TESTED OK
BUILDINT66EPARTMENT
VI LAGE OF RYE BROOK D v
938 KING STREET RYE BROOK,NY 10573 ID
(914)939-0668 O C T - 8 2025
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FIRE INSPECTION / OPERATING PERMIT AP
FOR OFFICE USE ONLY:
Fee Paid: $ :9�0. 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= S775.00
Application,dated: 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 Unifomn
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: BL: I?�C 2? I Z� Zone:
J"- �-2. Business/Occupancy Name: 1-d b YS Use Class:
3. Property Owner: ddress:
Phone# Cell# email: ►�
5. Business Owner:5" &WW > EkAnWICG1 I aF e+ "kAress: �() 2 'n c� '---
Phone# 1 y 93q 8I:7 Cell# email: . I
6. Emergency Contact: {PS( (> Address- �(rl__ ' P _6C)L /Vy
Phone# Cell# email:
7. Inspection Escort: Title: t
Phone#: q )95t)) Cell#: email Urs
8. Provide a brief description outlining the current and/or intended use of the pibpe .�'
061)16 CNV�p cmjcE :�&c (C)
S S
9. List all hazardous Materials:
10. Occupant Load: Existing: Proposed: Other:
11. Date& Disposition of Previous Fire Inspection: LIYPass ❑ Fail
I
6/1/2024
BUILDING DEPARTMENT
VILLAGE OF RY9 0ROOK
938 KING ,T ET RYE BROO ,NY 10573
�* �
.rX . ov
FIRE INSPECTION / OPERATING PERMIT APPLICATION INSTRUCTIONS
***NOTE: KEEP THIS INSTRUCTION FORM FOR FUTURE REFERENCE
REGARDING YOUR OPERATING PERMIT
A Fire Inspection, conducted by the Building Department must be
performed prior to the issuance or renewal of any Operating Permit. It shall
be the responsibility of the owner, applicant, operator or proprietor of the
Business, Private School or Place of Public Assembly to schedule the
requisite Fire Inspection with the Building Department. For permit renewals,
the Fire Inspection must be scheduled at least thirty, (30) days prior to the
expiration date listed on your Operating Permit.
Submittal Requirements:
1. A properly completed& notarized permit application.
2. One full size and one scaled I I"x 17"copies of a comprehensive dimensioned floor plan, prepared &
sealed by a NY State Licensed Professional Engineer or NY State Registered Architect, showing the
complete layout of the space including all doors, windows, exits, exit corridors, exit discharge,
emergency lighting, fire alarms, fire sprinklers, fire extinguishers, proposed seating arrangement(s), and
any other furnishings which affect the occupancy load and/or egress from the space, and anything else as
requested by the Building Inspector.
3. Payment of the permit fee: (Fees subject to change without notice)
Triennial & Private School Annual Inspection: = $450.00
Public Assembly Annual Inspection: <100 People= $525.00 • >100 People= $775.00
(Occupancy limits are determined by the Building Inspector)
4. Written documentation showing the following systems have been inspected, tested & serviced within the
past year shall be kept on the site and be made available to the Fire Inspector upon demand;
a. Fire Sprinkler, Standpipe, ANSL, Halon, FM200 or other Dry-Chemical Extinguishing Systems
b. Fire Hydrants
c. Fire & Carbon Monoxide Detection & Alarm System
d. Exit Signs, Emergency Lighting
e. Portable Fire Extinguishers
f. Elevators, Escalators or other Moving Conveyances
g. HVAC Systems
h. A copy of your Fire Evacuation Plan and Record of all Fire Drills
Please note that separate permits may be required for any corrective
work performed in conjunction with the Fire Inspection.
srti2o24
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:
�ejWj -P.,�C� , 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
l y e ( , 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 2 Sworn to before me this
day of , 20* day of , 20
i
Notary l� Notary Public
ignature of Property Owner Signature of Applicant
c�n 1 -e If c r,
Print Name of Property Owner Print Name of Applicant
GREGORY M.RIVERA
Notary Public,State of New York
No.01R164A1398
Qualified In Westchester County .
Commission Expires September 26,2
2
6/t/2024