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HomeMy WebLinkAboutMP19-012 (.�yC DR w G C VILLAGE OF RYE BROOK MAYOR 938 Ring Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E.Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 30,2025 484 North Ridge St Realty LLC 484 North Ridge Street Rye Brook,New York 10573 Re: 484 North Ridge Street, Rye Brook,New York 10573 Parcel ID#: 129.60-1-39 This document certifies that the work done under Mechanical Permit #19-012 issued on 2/5/2019 for the installation of two above-ground propane tanks have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �Qy_E aknvk w � w c /�• 1932 BUILDING DEPARTMENT VILDING INSPECTOR SISTANT BUILDING INSPECTORZ VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 DING STREET • RYE BROOK,NY 10573 (9197) 939-0668 FAX (914) 939-5801 www.rvebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 4 9 0 %okAJ DATE: PERMI'r# / � "Z ISSUED: saw -I SECT: /Z BLOCK: 1 LOT: LOCATION: oat OCCUPANCY: ❑ VIOLATION No,rvi) THE WORK IS... is ACCEPTED ❑ R iJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ >ATURAL GAS .,8'L.P. 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ASME.•..,.•,•.._._ ..a.. _:............. k •MAWP=Maximum Alloy ble Working Pressure WORTHINGTON CYLINDERS A VAAhmgton Indwstries Comp>ny .....,:n,,:.vk}n<tbi}'-'• J,`-`ti`M'ritJls7>?i.C:-S::;.. 200 Old Wilson Bridge Road - Columbus,Ohio 43085 Toll-free:866.WCTANKS(866.928-2657) Phone:614-438.3013 Fax:614.4383083 :,i%:Z:i Cylinders@1M1lorthingtonlndusV :ies.com ,,,.�!;_; Worthi ngtonCylinders.com e I0o4 wartM.�Am 4a.een A wa.rNiny�m Mvmk,Con Wm•U90s i>yi,:::: Side 2 .. •. ... ......:....::.:.: r..:n,.r:.,..r.w wr:www:w „n..:r r.., rw:,::,:,.::...:. _ _ ...... ........:.. : - .. :w , ...n::•:ti:{ Yri{:.}i}::v:.w.r•::Y:i-i.{•ii"'SYn•ii::i-:J:i:F:i:. ,.:,a,.,...,, x}„ t(r. rr,hs.,..?d:3 s ,S3tR•., ;r:•sS••2'•f •:s.•.tci>.Yr wn,.aC«Yxr,.• .,•!r.•.' s ktzr ac?•r fl "3' 9}•Y0-0fix.. x4 h n. %�u t -} S :,�.;..Y'-t'�.'r✓'i.'X•:..: :^;Y:Y� ;errs'-i".XF?.R•xY.R20' .2¢�';` .. .K2vY•` ..� ",`,:222:::Z:^v ���++!! q>, ��>{ ��p( }>ti .{ {s:.}:"•;:a .•\k.•`-: F?, :^n4K ... :$.. S,:d?n::.:::.i"rG:i.•S.. v' T'•v,''• + rlr$ii}:w:+ri:: FiS.�x::>i:8r Y.vr .�.•+•t�� h::+ .4..x .: 9 .ii ,,{ tom• vFtt:..rz.: ::a^F:: ^;•sr'm ;r.�:zc:?-}: .{.. ..t . ...,r..x...f,.•,Y.n..x:ttii:`. >'?#F•:r�,Fzwr`siii.,....:..,... ..,.w::st:•.Y.. .w„r x...... Tp� .......... C14 E CD E VA 03 Qo , ui CV) 1 LU p > X U) C4 AN 0 LU UJ z 0 CO 0 LLI LU to < Cd CZ P 41. 0 ce) CV) ri ACO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/01/2018 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 Marsh USA,Inc. NAME:PHONE 1166 Avenue of the Americas (A/c.No.E)M: New York,NY 10036 E-MAIL Attn:NewYork.certs@Marsh.com ADDRESS: INSURE S AFFORDING COVERAGE NAICI! CN101414839-MEENA-ALL-18-19 INSURER A:National Union Fire Ins.Co.of Pittsburgh,PA 19445 INSURED MEENAN OIL CO.,LP INSURER B:New Hampshire Insurance CO 23841 DB/A BURKE HEAT AND BURKE FUEL OIL CO INSURER C:Lexington Insurance Company 19437 475 COMMERCE STREET INSURER D:Illinois National Insurance Company 23817 HAWTHORNE,NY 10532 - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-009222598-67 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 ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY M LIMITS A X COMMERCIAL GENERAL LIABILITY GL7032336 10/01/2018 10/01/2019 EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED__ CLAIMS-MADE FXI OCCUR PREMISES Ea occurrence $ 100,000 X XCU MED EXP(Any one person) $ 5,000 X Contractual PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY[fl ECT LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHERS SIR $ 1,000,000 A AUTOMOBILE LIABILITY CA 7269847(AOS) 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident A X ANY AUTO CA 7269846(MA) 10/01/2018 10/01/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) E HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB X OCCUR 021430599 10/01/2018 10/0112019 EACH OCCURRENCE a 5,000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE f 5,000,000 DED X RETENTION E 10,000 $ B WORKERS COMPENSATION WC 031132295(MA,ND,OH,WA,WY) 0/0 11/2619 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WC 031132294(NC,NH,NJ,PA,VA) 10I01I2018 10/01/2019 1000 000 D OFFICER/MEMBEREXCLUDED? ❑N NIA E.L.EACH ACCIDENT $ (Mandatory In NH) WC 031132297(FL) 10/01/2018 10101/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1�'� DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B WORKERS'COMPENSATION WC 031132293(CT,DC,DE,DC,GA,MD 10/01/201B 10/01/2019 SEE ABOVE CONTINUED ME,MI,NY,RI,SC,TN,WV) DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) THE CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE NAMED INSUREDS OPERATIONS CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYEBROOK,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. David A.Cobleigh ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORKWorkers' CERTIFICATE OF INSURANCE COVERAGE Compensation STATE Board under the NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier Ia. Legal Name&Address of Insured (use street address only) lb.Business Telephone Number of Insured Meenan Oil Company,L.P. 1000 Woodbury Road Suite 110 Woodbury,NY 11787 1 c.Federal Employer Identification Number of Insured or Work Location of Insured (Only required ifcoverage is specifically Social Security Number limited to certain locations in New York State, i.e., Wrap-Up Policy) 11-3083408 Meenan Oil Company,L.P.dba Burke Heat and Burke Fuel Oil Co. 475 Commerce Street Hawthorne,NY 10532 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) CIGNA LIFE INSURANCE COMPANY OF NEW YORK Village of Ryebrook 938 King St 3b.Policy Number of Entity Listed in Box"la" Ryebrook,NY 10573 NYD074787 3c. Policy effective period 1/1/2019 to 1/l/2020 4.Policy provides the following benefits: ®A.Both disability and paid family leave benefits. ❑B.Disability benefits only. ❑C.Paid family leave benefits only. 5. Policy covers: ® A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employer's employees: 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 NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed December 14, 2018 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number_1-866-761-4236 Name and Title Underwriting Director IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 513 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers' Compensation Board (Only if Box 4C or 511 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this ormL DB-120.1 (10.17) NEW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured MEENAN OIL CO.,LP 914-769-5050 DBA BURKE HEAT AND BURKE FUEL OIL CO. 475 COMMERCE STREET 1c.NYS Unemployment Insurance Employer Registration Number of HAWTHORNE,NY 10532 Insured 8311425-2 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 113083408 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Insurance Company Village of Ryebrook 938 King Street 3b.Policy Number of Entity Listed in Box"l a" Ryebrook,NY 10573 WC 031132293 3c.Policy effective period 10/01/2018 to 10/01/2019 3d.The Proprietor,Partners or Executive Officers are ✓❑ included.(Only check box if all partnerslofficers 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"l 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 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,1 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: Dan Beaudry Print name of authorized representative or licensed agent of insurance carrier) �^—Approved by: ""� 9/18/2018 (Signature) (Date) RMG Executive Title: Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 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