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HomeMy WebLinkAboutMP19-028 DR 19 tC 4.j aJ V �� i � G •��Dui; VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.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 August 12,2024 Michele Toll 203 Ivy Hill Crescent Rye Brook,New York 10573 Re: 203 Ivy Hill Crescent,Rye Brook,New York 10573 Parcel ID#: 129.76-1-10 This document certifies that the work done under Mechanical Permit #19-028 issued on 3/5/2019 for the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRC�v�. 1982 BUILDING DEPARTMENT ❑,,BUILDING INSPECTOR eASSISTANT 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 H ( L DATE: / " 2-0 L/ PERMIT# !- Z ISSUED: SECT: BLOCK: LOT:. LOCATION: IP a A 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 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�k w � 1932 BUILDING DEPARTMENT ❑ UILDING 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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: PERMIT# � ISSUED: 1 SECT: BLOCK: LOT: LOCATION: OCCUPANCY: Z\6 ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING �P ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS S�rll U Un b2\k C)1 , ❑ L.P. GAS E] FUEL TANK + N,5 \ ❑ FIRE SPRINKLER \\ � ❑ FINAL PLUMBING Cam' „ ,C ❑ CROSS CONNECTION 15�LS8 ❑ FINAL ❑ OTHER uc aw - ► W c (cS N f nnm L' � im Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge H W L (pounds) 209101 120 vert. 12 47" 23" 30" 170 208101 138 vert. 12 44" 27" 30" 160 208601 138 horz. 12 27" 44' 30" 160 207101 220 stubbies/vert 12 44" 27" 48" 220 207601 220 stubbies/horz 12 27" 44" 48" 220 203201G 230 thin/vert grey 12 44" 22" 60" 235 203701G i; 230 itiin/horz grey i 12 = 22' 44' 60' i 235 202201 240 narrow/vert. 12 47" 23" 60" 265 r 202701 240 narrow/horz. 12 23" 47" 60" 265 ` PEST 204201 275 vert. 12 44" 27" 60" 255 � 204701 275 horz. 12 27" 44" 60" 255 211201 275 vert. 10 44" 27" 60" 330 211701 275 horz. 10 27" 44" 60" 330 205201 330 vert. 12 44" 27" 72" 290 J 205701 330 horz. 12 27" 44" 72" 290 External finish:BLACK or GREY electrostatic powder paint Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge Cover Shell Dia. Height (pounds) 3006622 150 DCV 560 11 12 30" 65" 200 3007622 185 DCV 690 11 12 30" 77" 225 3008622 220 DCV 825 11 12 30" 88" 255 External finish: WHITE polyurethane paint Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge Cover Shell Dia. Length (pounds) 3005224 138 Horz. 12 12 26" 60' 165 Extemal finish:Black electrostatic paint Ait • W 4� A-" J0, . ........... o4 2*7 1.4 C) Jq 0 m ............ 'A _r_ CIS (u z 0 LD r. Cd < > 0 L) kection Cl- _j CO C) cr ui 0 0 4-J co w 0 LL 2:1 A 0 LLI U) 0 cc Lo -2 Lli cz `�71 V, Ell u aj Pi V) co E Ell) Cb tan W C'4 Q V C) Ri ,Iffy, 11.6Pf•9 "AW1 ViVio Wn. NO Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Singer Holding Corp. (914)345-5700 dba Robison Oil 500 Executive Blvd 1 c.NYS Unemployment Insurance Employer Registration Number of Elmsford NY 10523 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 13-3121491 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Employers Insurance Company of Wausau Village of Rye Brook Building Dept. 3b.Policy Number of Entity Listed In Box"1 a" 938 King Street WCC-641445127-038 Rye Brook,NY 10573 3c.Policy effective period 11/1/18 to 11/1/19 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"Ill 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". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? x❑YES ❑NO 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 i 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: Salvatore Sorce (Print na me of uthori d r resenlative or licensed agent of insurance c rrier)Approved by: /10 gnalure) (Date) Title:Vice President/Team Leader Telephone Number of authorized representative or licensed agent of insurance carrier: 203-337-181 S Please Note:Only Insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are N_QZ authorized to issue it. C-105.2(9-15) www wcb ny.gov ,acoRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYVV) 11/1/2018 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 NAME: Hub International Northeast Ltd. PHONE — FAX 777 Commerce Drive A/C.No.Eat:203-337-1815 (A/C,No): - Fairfield CT 06825 ADDRESS: Salvatore.Sorce@Hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Liberty Insurance Underwriters,Inc 19917 INSURED INSURERS:Evanston Insurance Company 35378 Singer Holding Corp. dba Robison Oil INSURER C:Libe5y Mutual Fire Insurance Company 23035 500 Executive Blvd INSURER D:Employers Insurance Com any__ Wausau 21458 Elmsford NY 10523 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1018880021 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 INSRLTR TYPE OF INSURANCE Y NSp SUER POLICY NUMBER MM/DDlYYYYI IMMIDDIYYYYILIMITS C X COMMERCIAL GENERAL LIABILITY Y Y TB2-641-445127-028 11/12018 11/12019 EACH OCCURRENCE S2.000.000 C DAMAGE TO REN LAIMS-MADE a OCCUR PREMISES Ea occurrence S 100,000 MED EXP(Any one person) S 10.DDO jPERSONAL 8 ADV INJURY S 2,000,000 GEII'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 4.000.000 POLICY a JE LOC PRODUCTS-COMP/OP AGG S 4,000,000 OTHER. deductible S 50,000 C AUTOMOBILE LIABILITY Y AS2-641-045127-016 11/1I2018 11/12019 COMBINED SINGLE LIMI S2000000 Ea accident X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED (Per accent AUTOS ONLY AUTOS )BODILY INJURYYAMAGE id S X HIRED X NON-OWNED PROPERTY D S IAUTOS ONLY AUTOS ONLY Per acc I I Auto Pollution S CA99481013 A X UMBRELLA LIAR X OCCUR Y 100027683"1 11/12018 11/12019 EACH OCCURRENCE S10.000,ODO EXCESS LIAR CLAIMS-MADE AGGREGATE S 10.000.000 DED RETENTIONS Follow Form S D WORKERS COMPENSATION VYCC-641-445127-038 11/12018 11112019 X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANVPROPRIETORPARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS belay I E.L.DISEASE-POLICY LIMIT S 1,W0,WO B Property Y MKLV10XP002780 9/12018 91112019 BPP Lm1d 1110,000 Deductible 2.500 E L DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured with respect to General Liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village Of Ryebrook Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Ryebrook NY 10573 AUTHORIZED REPRESENTATIVE USA `� V` ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD CHECK REQUEST FORM-FILINGSIFEES TO: ACCOUNTING DEPT. FROM: DATE: 2/27/2019 RE: HVAC PERMIT FEE--$75 MECHANICAL APPLICATION FEE—$75 MECHANICAL PERMIT FEE--$15 PER $1,000 OF COST OF WORK TANK REMOVAL PERMIT FEE --$175 PER TANK TANK INSTALLATION PERMIT FEE --$175 PER TANK $175.00 TOTAL: PAYABLE TO VILLAGE OF RYE BROOK BUILDING DEPT $175.00 938 KING ST., RYE BROOK NY 10573 VENDOR: VILLAGO15 CORP 429 ACCT: FOLIV FOLLICK r -- - -�- --- '- • - -_- - 2477 � SINGER ENERGY GROUP LLC PERMIT ACCOUNT 50-7044.-2210 500 EXECUTIVE BLVD. ELMSFORD,NY 10523 _ - DATE ! ' idCHECK ARGWR TO THEORDER OFi�,�, If ✓ '� r �� ` ,� �P q PAY + + r -� Il' ►,�('1 �C� �i �ir� f ��'I � lX Y DOLLARS 5.r. I � STERLING ' NATIONAL BANK :i FOR Ali -L't 411 In 1. I•: u•002�. 77i1• 1: 22L970443s. 6700b548all _-- _ -- -