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HomeMy WebLinkAboutMP15-177 y R t� VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher 1. Bradbury www.tyebrookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE November 7,2024 Pedro Acevedo 21 Whittemore Place Rye Brook,New York 10573 Re: 21 Whittemore Place, Rye Brook,New York 10573 Parcel ID#: 135.76-1-16 As per the Documentation from New York State Department of Environmental Conservation Spill Close Out Record dated December 2, 2015, the removal of an underground oil tank under Mechanical Permit#15-177 issued on 10/21/2015 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to [•QyE DR '1".A (�t t+4 wvy VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.cyebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE November 7,2024 Pedro Acevedo 21 Whittemore Place Rye Brook,New York 10573 Re: 21 Whittemore Place,Rye Brook,New York 10573 Parcel ID#: 135.76-1-16 This document certifies that the work done under Mechanical Permit#15-177 issued on 10/15/2015 for the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRCuk row BUILDING DEPARTMENT VI' ILDING INSPECTOR SISTANT 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 : 2 t DATE' PERMIT# / 7 7 ISSUED:10-2%- SECT: BLOCK: LOT: rI �� rl.� ( J LOCATION: �� J OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS rj P 1 L H 193 C 60Sf e-1 O.J .❑ FUEL TANK ❑ FIRE SPRINKLER Z — Z Z O ,) . SEE ❑ FINAL PLUMBING l o ❑ CROSS CONNECTION ❑ FINAL S ( G. ❑ OTHER �cQy�BR(�uk �• 1902 BUILDING DEPARTMENT 0 BUILDING INSPECTOR VILLAGE OF RYE BROOK 0 VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ,,lL,X SISTANT BUR DING INSPECTOR (914)939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: l W�'� ��� 1C `� �� DATE: PERMIT# ISSUED: �O\Z( 1` SECT: 1� l7BI.OQC: ` LOT: �� � LOCATION: OCCUPANCY: 2- 0 VIOLATION NOTED THE WORK IS... fJ ACCEP ED E REINSPECTION ❑ SITE INSPECTION � {1 IXWUIRED 0 FooT NG ❑ FOOTING DRAINAGE 0 FOUNDATION 0 UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING 0 ROUGH FRAMFNG ❑ INSULATION D NATURAL GAS cA D L.P. GAS D FUEL TANK 0 F SPRINKLER � 1 �-�� ❑ FINIiN k AL PLUMBING � � Quell S o POTHER S S \1�1 \� 1 cQ c-A _ � c v � a � � � •� w JAI o con x W O 03 z O tz �, a 00w OS p� z ten U Z �35 C7 U.0 ON g • H T ` 34 ,;� '�`"� mar w E°• �, °' �, '� as [--�+ W. kn Oo `ova $ � �' d _ - U � � O pO ►V, w y � a a VILLAGE OF RYE BROOK �� E-1 BUILDING DEPARTMENT ROCT 21 2015 938 KING STREET,RYE BROOK,NY 10573 (914)939-0668 FAX: (914)939-5801 www.rvebrook.org VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO REMOVE,ABANDON AND/OR INSTALL FUEL STORAGE TANK UP TO 1100 GALLON CAPACITY (*Storage tanks in excess of j1100 gallons require registration with the County of West ester) Permit#: P 1 -7 Building Inspector: Fee Paid: �+ v Date of Approval: l0k7_� (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Application Completed by Bonded,Licensed Contractor 2. Copy of Licensed Contractor's Liability & Workers Compensation Insurance (naming the Village of Rye Brook as Certificate Holder) 3. Fee per Tank: Removal or Abandonment: $150.00; Installation: $150.00 4. Dig Safely New York#(dial 811): )UZ)1�'— Q!W—O/ro 5. Inspection by Building Department for removal/abandonment& installation 6. Submit all Manifests&Reports(after work has been completed) 7. Certificate of Compliance will be provided when all requirements are fulfilled. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the removal,abandonment and/or installation of a Fuel Tank(s)herein described.The applicant,by signing this document agrees that said Fuel Tank(s)will be installed,abandoned and/or removed in conformance with all applicable Local, County,State&Federal laws,codes,rules&regulations. Indicate either above ground tank or buried in-ground tank. 1. Property Owner's Name: MPS, IAC*►l Phone#: q�9P- 2. Job Address: Z l k&}}r_m&r_ Pj_ L L udt.I1/Y Phone#: 3. Parcel I.D.#: Zone: 4. Contractor: 14, �sm &*Ak*th&j Phone#: 5. Contractor's Address: kvL fA 6 I'h M7rFax#: 114-J47-1h� 6. Exact location of tank to be Installed: above ground in ground ❑ %,,&C,W r 7. Exact location of tank to be Removed: above ground❑ in ground L7 F/tir�-�� 8. Exact location of tank to be Abandoned: in ground only 9. Distance of Tank from Structure: 10. Distance of Tank fro�ropane: rty Line: 11. Type of Fuel: Oil: ❑; Gasoline:[]: Other: 12. Number&Capacity of Ea Tank: (j) 67 CK l Jcw - 1 c� Signature ofApplic Date: I G Z/1) Printed Name of Applicant: ))AM �w e&04h Phone#: �/'397-f rl jzZ e 'dOHVEC Hudson Valley Environmental & Construction 462 Lakeview Ave.Valhalla,NY 10595 1-877-811-HVEC L1 (,,,I, IRMM FL f yL BrDai A/Y z� l� K 'V GS U-�a`�c✓ Ud/dam /�L Standard Granby Industries Page 3 of 4 J General characteristics Always a tough tank. Welded lap joint: the strongest one. Handles on each head for easy handling. Easy to install. 10-Year Warranty. Models General Characteristics Technical Specifications • Steel ASTM A-1011 • Female threaded openings • Pressure tested at 5 to 7 PSIG • UL 80 label • Operation at atmospheric pressure only • UL 142 label also available on 275 & 330 US gal (including a 3" diameter emergency vent opening) • External surface: washed and phosphated • External finish: black or grey electrostatic powder paint Technical drawinis Documentation http://www.ganby industries.com/en-us/products/residenti al_tanks/1/standard/24 11/8/2012 l E z • (o N \ W N co 3 _ < » Vot c �'+ Z L ° v otectiop . w p yt • « " Z W V ' c / f W 3 ✓a , E � ll a• V Z a Lw 440 O t .» Z C40 F ~ w \ W o w . Vl ' Q •ram V a y OD s i d N r. a+ � AMU M q 41�1 y 4NNWITT - • DATE I Aco CERTIFICATE OF LIABILITY INSURANCE 0/2"MID 015 10/20/2015 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 Maria Plasencia NAME: Strategic Insurance Partners PHONE (973)667-2600 A/C Ilo:(973)667-5842 492 Franklin Avenue ADDRESS::mplasencia@siprisk.com INSURERS)AFFORDING COVERAGE NAIC 8 Nutley NJ 07110 INSURER A:Great Divide Insurance Co. 25224 INSURED INSURER B Harle sville Insurance CO 23582 Hudson Valley Environmental 6 Construction INSURERC: 462 Lakeview Avenue INSURERD: INSURER E: Valhalla NY 10595 INSURERF: COVERAGES CERTIFICATE NUMBER:Certs for 2015-2016 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 Y POLICY NUMBER MM/DD MEFF M/L ICY EXP LTR DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE To RENT X COMMERCIAL GENERAL LIABILITY PR MISE Ea occunence $ 100,000 A CLAIMS-MADE I-XI OCCUR ECP200195214 /1/2015 /1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO_ RO LOC Professional/PollutionLimit $ 1,000,000 AUTOMOBILE LIABILITY Ea acccidentSlN LE LIMIT 1,000,000 B X ANY AUTO BODILY INJURY(Per penmen) $ ALL OWNED SCHEDULED BA 00000052518V /20/2015 /20/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Law Enforcement Fee $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Coverages are subject to terms, conditions and exclusions on the above policies. 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 Mark Grossbard/SAN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgmnn,,i m Thu Annpn nnmu nnri Innn nru rrania+nrorl mnrkc of Ar npn New York State Insurance Fund Workers'Compensation& Disability Benefits Specialists Since 1914 105 CORPORATE PARK DRIVE SUITE 200,WHITE PLAINS,NEW YORK 10604-3814 Phone:(914)253-4861 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAA AAA 271014843 HUDSON VALLEY ENVIRONMENTAL&CONSTRUCTION CORP 462 LAKEVIEW AVENUE VALHALLA NY 10595 POLICYHOLDER CERTIFICATE HOLDER HUDSON VALLEY VILLAGE OF RYE BROOK ENVIRONMENTAL&CONSTRUCTION CORP 938 KING STREET 462 LAKEVIEW AVENUE RYE BROOK NY 10573 VALHALLA NY 10595 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE W2097 383-0 62325 04/05/2015 TO 04/05/2016 10/20/2015 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2097 383-0 UNTIL 04/05/2016, 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 SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 04/05/2016 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. JAIME COLEMAN-PRESIDENT DAMIEN COLEMAN-VICE PRESIDENT OF HUDSON VALLEY ENVIRONMENTAL& CONSTRUCTION CORP THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888)875-5790 VALIDATION NUMBER: 546746868 U-26.3 Spill Incidents Database Search Page 1 of 1 IEWYORK Department of- TATE OF OPPORTUNITY Environmental Conservation Spill Incidents Database Search Details Spill Record Administrative Information DEC Region: 3 Spill Number: 1506898 Spill Date/Time Spill Date: 09/30/2015 Spill Time: 11:41:00 AM Call Received Date: 09/30/2015 Call Received Time: 11:41:00 AM Location Spill Name: FORTUNA - TTF Address: 21 WHITTEMORE PLACE City: RYE BROOK County: Westchester Spill Description Material Spilled Amount Spilled Resource Affected #2 fuel oil UNKNOWN Unknown Cause: Tank Test Failure Source: Private Dwelling Waterbody: Record Close Date Spill Closed: 12/02/2015 "Date Spill Closed" means the date the spill case was closed by the case manager in the Department of Environmental Conservation (the Department). The spill case was closed because either; a) the records and data submitted indicate that the necessary cleanup and removal actions have been completed and no further remedial activities are necessary, or b) the case was closed for administrative reasons (e.g., multiple reports of a single spill consolidated into a single spill number). The Department however reserves the right to require additional remedial work in relation to the spill, if in the future it determines that further action is necessary. If you have questions about this reported incident, please contact the Regional Office where the incident occurred. Return To Results Refine This Search http://www.dee.ny.gov/cfmx/extapps/derextemal/spills/details.cfm 8/15/2016