Loading...
HomeMy WebLinkAboutMP20-082 �.� DR 19 40 annkwmaW VILLAGE OF RYE BROOK MAYOR 938 Ding Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 3,2022 Carmine Sala&Angela Croce 952 King Street Rye Brook,New York 10573 Re: 952 King Street,Rye Brook,New York 10573 Parcel ID#: 129.60-1-46 This document certifies that the work done under Mechanical Permit #20-082 issued on 7/7/2020 for the removal of an aboveground oil thank and the installation of a new aboveground oil tank has been satisfactorily completed. Sincerely, Michael]. Izzo Building&Fire Inspector /to QyE 4RC�v�, Q 1932 BUILDING DEPARTMENT BUILDING 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 : �� kt , 04 DATE: -9h 1 2 PERMIT# 1 �-� C/�J ISSUED Z� SECT: BLOCK: l LOT: LOCATION: � T OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... �CCEPTED ❑ 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 Z o ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Z C F[EC� EW J A N - 4 2022 LINK&Slip RI�' VILLAGE OF RYE BROOK Motmt Vernon, N NY 9-11 Carleton e BUILDING DEPARTMENT Y 10550 Phone(914)867-1442 o Fox(914)567-9647 Y Jbassandson(Maol,com CERTIFICATE OF DESTRUCTION 7';, Lek. �a Job Locatton: well Welaht: A, Date Z, /z c DISPOSITIOnI TRANSPORTER COMPANY NAME AND ADDRESS: J. BASS&SON INC. 9-11 CARLEfON AVENUE iUIOUMT VERNON niv 10550 I,THE UNDERSIGNED,CERTIFY THAT THE MA IAL DESCRIBED ABOVE WAS DELIVERED TO A FACILITY FOR DESTRUCTIO SIGNATURE= Bess&Son,Inc.. DATE I, THE UNDERSIGNED, CERTIFY THAT THE MATERIAL WA8 PROCESSED FOR REMELTING ONLY. THIS MATE IAL LL T BF SOLD AS USABLE IN ANY SHAPE, FORM OR fAMN SIGNATURE J.Bass&Son, Inc DATE IHlbbl-lII l INUUHULH must be legibly filled in.in Ink,inlMaliWSPenCR.orin Carbon,and retained by the Agent Shipper's No Carrier's Name: Carrier's No. RECEIVED,subject to the classifications,and talNls In effect on the date of the isaUo of this Bill of ladling, at (Date) FROM do I>IWcnY Ansrlbcd brim w ryT,ren ri—II e�W,, —m4 ., owed . • aA ..Wwnn d aumran of N•+{<, doom. muW NILt� and AWrb1 ,Mn hek+ r Idh ud cm4 114 wW nevapaq ben# �mmnd NrouyA l Pu wa nvbcl a.l_Sul ,a I" -.rt r-P-- m p n..m �A 1h > undo dw •mrV apes. w wn w n. wul P.— of hhner u uW deYurm d w -11," a h- palen IrsbeaY ..�r) sK tE,I apcmmn,, rN,nv"e In ,kL,ar m a„otllsr Be a lu iW 4u,r.vwe. II mMuYll aped a 6 d JI a r1Y N -a e• JI {av� ! .aIJ s n w bdrnallua mJ , w 6 Prr} m Y Wet Ielrrcgcd is all 1 1 .vJ W� m .ef.xe to h Pnl—d ii—d, ",�pI,�4,e1emblrtl , ab e4 , tW —4— m de,In/ms DalevK Svrlal sill I LWm# r, faeM II w Ibe l;nlarm Fmllll Cla.,lfica,un ,s ene.l on rise due I'ol I , a dxprrt. 121 m ds 1 nnan, fmler c1a,wRulm unR d IbI, n a mw ,►p+,eM SWyper Mrtb) c,nl�, au M n t+mbv n,P W rermt N .uil,uw Pc uW 1,41 n aJlnd. Ir lodlaa a—•mom d,e b.-I, IlKnel at I. 1 dr d—r>al,co a wM •IueA #mvm rk vnoipo,am d du, .hpv� :uJ ,�e .vd Iemn aeW evw. , att sicbl ansad w hY Pe +h• ,sl en ed Ia bm,rll u h" .n141b1 a avant aft—Iw wvpblal nl"ofif alisll Mr 1 SuhYnel w S.—)of anedrnnu,d Ib,b4+m Consigned TO w"da—W w W 04"`w4—"� On Cabo on oil • dre sea IM .< f— Owl ,yrl ds mny Shill—r s.ae lanaa'COD'—odpeor belan)CONQIwO'l Mm1 a N aMM,N wa'Idsd n Mtn UD.Sac 1 l.U-"tom Its risen male Jth,M of IM, Destination. Sheet City ^g` land fi a Wild sd all nlm hap, Route County State Zip e Ivery Address* (tTd bo rsd m avy wtsrl an+ppar dlwq a1M s^n'e,„'M waa wane br dlbisry ela.#11 Islprn,+n a rtne+v,a•1 Delivering Carrier Car or Vehicle Initials and No. C.0.D.Charges to be Paid by Collect on Delivery$ And Remit to o shipper ❑Consignee Street y Ci State No H IA w CanKIM�I or CMmin Psrdug#1 hu,dq Packpa DalcrbhelYaI MICYa SpKhIWM.rWEadplanl 0.e.e•„d 1 w a1Ple a wapylnnl M IM c6ssc+ m Ibe (n�enY Jrarnh•A I•naaw aa.n a faahrn M Ills u#Wu,r lyre nlrwtMR,mil rM nnnnlll wrP,a 1 S )'Ts Rhre c uN rn d,n ,h,Pannl mImm w the.Ralf nrrn .eI lo- m'N An) mean',mllllaa rlvre.n,d all„Me mprlemteta ,d sWe rl „( IM l'—..n 1'syM lL„dlam and R"M ) :/ w UlMwul Mwa 1)aeM 'a ,Mp�m w.b nu p,n,M1,,,ens.In w,r,the I,w rgrvrt,rk,I ra NI:of Idm/dun,ram,W HIM M H t.,nM,n,bIPPn',w<IlM '1mn14all•,I' NOTE--t11erc IY rue.4Paideel.m,Jr..b�e,a,<ny„I,ed I,•uw rlw.l<Jh m wnrmP Ih M•ml drt'<nJ„lie M ae Ir,�1) Mr • IM,ar in hn M nary ,n • ryn M Nil nl I,fml ,pwtn.,l a Pr lenura Tar nQnd r desYM)able M ee pe..pertY 1.kerth,ryerinc,ly oared b)Ile,blppr In be net nseWln[ famn,ena C,a„nra.rn aaY.� Agent must detach and retain Shipper,Per this Shipping Order and must sign Pertnonenl poet aff,ce the Original Bill of Lading. address of slipper LJ Aco vi) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODYYYY) 11 1 6/29/2020 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 CONTNAME: RICK J McCLATCHIE _ Wm. E. Morrell, Inc. P( "No.E 914 949-0904 ac No: 914 428-8999 128 Court St A DRIESS: info morrell-insurance.com White Plains, NY 10601 INSURERS AFFORDING COVERAGE NAIC0 INSURER A: Main Street America Assurance Company INSURED INSURERB: NGM insurance Com an VM Transportation, Inc. INSURER C INSURER D: _ 791 Lake Street INSURERE: West Harrison NY 10604 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAIAED ABOVE FOR THE POLIGY 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 SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER Y MWDD YYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED Lp CLAIMS-MADE a OCCUR PREMISES Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A I MPU4648Z 14/24/2020 4/24/2021 PERSONAL dADVINJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY J JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY OMBINEDISINGLE LIMIT $ 11000,000 (Ea accidenANY AUTO BODILY INJURY(Per person) $ OWNED B AUTOS ONLY X AUTOSULED 61 U8904Z 7/10/2019 7/10/2020 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DIED RETENTION$ $ WORKERS COMPENSATION PTER AT TE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED' N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/LOCATIONS,VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) VILLAGE OF RYE BROOK IS NAMED AS ADDL INSUREDS IN REGARD TO GENERAL LIABILITY-SUBJECT TO WRITTEN CONTRACT, TERMS, CONDITIONS 8r EXCLUSIONS OF THEORIGINAL POLICY AT THE TIME OF ISSUANCE BY THE INSURANCE COMPANY. 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 RYE BROOK, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTH?EID AAREPRESENTATIVE ©1988-2 15 ACOkO CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name&Address of Insured(Use street address only) lb. Business Telephone Number of Insured (914)686-7958 VM Transportation,Inc. 791 Lake Street lc. NYS Unemployment Insurance Employer West Harrison,NY 10604 Registration Number of Insured Work Location of Insured(Only required ifcoverageisspecifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, Le., a Wrap-Up or Social Security Number Policy) 27-3050300 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) NGM Insurance Company 3b. Policy Number of entity listed in box"la" VILLAGE OF RYE BROOK WCU4648Z 938 KING STREET RYE BROOK,NY 10573 3c. Policy effective period 04/15/2020 to 04/15/2021 3d. The Proprietor,Partners or Executive Officers are ❑ included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' insures the business referenced above in box "la" 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"T'. The Insurance Carrier will also notify the above certificate holder 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. Please Note: Upon the 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. ed Approved by: ( C V NA (i (Print name of authorized represent ' e tensed agent of insurance carrier) Approved by: , � ZV!/ zf (Signature) (Date) Title: Telephone Number of authorized representative or licensed agent of insurance carrier: I�— _U�0� 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(9-07) www.wcb.state.ny.us