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HomeMy WebLinkAboutMP21-065 A" am iumaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.rycbrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan K Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE September 1,2022 Todd Kaplan&Laura Kaplan 2 Charles Lane Rye Brook,New York 10573 Re: 2 Charles Lane,Rye Brook,New York 10573 Parcel ID#: 135.33-1-8 This document certifies that the work done under Mechanical Permit #21-065 issued on 4/23/2021 for the installation of one above-ground 120 gallon propane tank has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �yE BRa? BUILDING DEPARTMENT I VILDING INSPECTOR SSISTANT 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 - - - - - - - - - - - z --�o) ADDRESS: 1 DATE: PERMIT# ISSUED: ECT: BLOCK: LOT: LOCATION: ) ��� �'l OCCUPANCY: �( ❑ VIOLATION NOTED THE WORK IS. . ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING L-o ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS 9L.P. GAS '-FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRaP. 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR JOASSISTANT 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:— DATE: PERMIT# j ISSUED:"t��nV�ECT: "OCCUPANCY: LOT: LOCATION: V°leSK -1�+(� V n ��I�C `� ,vOCCUPANCY: Z Ci ❑ VIOLATION NOTED THE WORK IS.../g' ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p- L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER SECT 10N -- y y/v .•, iC :�'� I iG (�l' `5r i '�� 0 0ur�G��c� �� I �u ftiG'�! � LG'8 Ca�o�uc7GJ t'G'6Il�flBIF�iG' '� DOT Cylinders -fi OLOR � G/T100ASME Tall 100#ASME Less Gauge `100 lbs. White 263468 GIT100ASME-G 100#Squat With Gauge 100 lbs. White 269529 I -�\_ GIT100 POL Service 100 lbs. Gray 185223 !, GIT100M Multivalve 100 lbs. Gray 1B5226 ! - j G1T100MW Multivalve 100 lbs. White 194259 It GIT200 Multivalve 200Ibs. White 185229 9 ] ; Gff200G Multivalve 200 lbs. Gray 192637 Gr100M MUltivalve 2001bs. Gray 185226 -�~ GIT420 Multivalve POL 420 Ibs. White 185243 G[T420G Multivalve POL 420 lbs. Gray 192638 0iA A G/T100ASIvlEG/fi100ASME-G sw` i ]/ swro awns Guu ,me•uoG s- 3/]x 1/8x-u Efu u dni Es ueo Go fill 16 En./407 mm /� ]nxye a /P ss• ,,m•art— o•on r E o e eosmu Ilrb ]N19G E5909] uem9e L..,w•uw Erma� �.uy �i•J SECTION AA SECTION M aff• qq Sd ASME Cylinders -- -- - 200 lbs. _IVIFR#__ VP3LVE .• ._ _ SIZE• COL,O_R• WEBB# GIT200ASME Multivalve 200 lbs. White 190984 e Grf200ASMEG Multivalve 200 lbs. Gray 193312 G/T420ASME Multivalve POL 420 lbs. White 185244 —d 61T420ASMEG Multivalve POL 420 lbs. Gray 193311 _ SIZE 100 LBS. 200 LBS. 420 LBS. SOW t0 Order a Ti`L1CkI®ad LPG Capacity 23.6 gal. 47.2 gal. 99.1 gal. 89.3 liters 178.5 liters 374.9 liters 11 bundles make up a 239.0 lb. 474 lbs. 10D0 lb. truckload.Special colors, Water Capacity 108.4 I(g. 215.0 kg. 453.6 kg. or plastic mesh protective 420 lbs. Tare Weight 71.0 lb. 158.0 lb. 272,0 lbs. coatings are available upon 32.2 kg. 71.7 kg. 123.4 kg. request.There is a quantity Duc ipd.n-dSIU of 410K 5.1 In, 6.6 in. 6.6 in. of 9-420's in a bundle,and Lp.G.CylmduOpenings Collar Height 130.2 mm 167.6 mm 167.6 mm 16-200's in a bundle.You A,Wery R.erV-1°e(1•)NPT 14.5 in. 19.0 in. 22.0 in. must specify DOT or ASME s:p,u vale(3/4'Nn Footring Dia.o/s c WTMoaGIA ge(1'�)NrT 368.3 mm 482.6 mm. 558.8 mm style tanks at time of order. D:Vapor Service Valve(314'NPT Minimum order of 3 bundles (Open Caf Q a fP is considered a partial truckload.No more than 3 - —- 100#Cylinders y different stops per truckload _ 1 IIIIFIZ# DESCRIPTION—WEBBY within a 150 mile radius. N. PIGME350A Multivalve 186562 TO ORDER, CALL: 800.243.9350 o CT: 660.722.2433 FAX: 800.274.2004 ECTO°R 93 e N MV U r.. p ✓ N_ rn OY(( Odik F �}I oz 03 LTO co z = r h r►; Q 1 � � � y � O oc Q Q E- z = j o i ° F a w o 96 _ a ° t% p �C� � �ML BUIL E MENT APR 11 2021 VIL E OF RYE OK 938 KIN ET B ,NY 10573 VILLAGE OF RYE BROOK (914)9 A' 939-5801 BUILDING_DEPARTMENT WW o .or PLUMBI�N,JG PERMITS"APPLICATION FOR OFFICE USE ONLY 131P0. /%�c���C��p�� PP#: pj1 /057 Approval Date: Permit Fee: $ 7, Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, !;'J QJ is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or remove Plumbing as per detailed statement described below. The applicant&property owner, by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. I.Address: 'X Ckay `Gc, L�r-c RV fb f)'C I SBL: l ��"�l_e Zone:,P—)� 2.Proposed Work:-,A— I�an a V)OU C C�rf>L111� y G��� A-S ke 01CO&Ke- `,Yl�L , a y A _ C 0 (O fQv�e v }tJ �r C Qd• S v� a n c� �O u fe 3.Property Owner:Tn C3 S 4 LA1 6— Vq p(Qr Address: a eS !acne QYe 6✓Oo k_ W ( SSA j Cell#:��I c�—.321- �3 4� email T���CC1D h nc e IA4&1,6044 4.Master Plumber: GV yaFh,._.__ Address: �� 1�oe'A 'L 1 LA`h � yV ST P_ Lic.#:�2.S Phone#: Cell#: email: Company Name: K/I'l1s P Address:"Z FgA OL) n)'E g WSTL �)y INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 5 ve 2nd Floor 3`d Floor 41 Floor 51 Floor Exterior 5.* List Other Equipment/Provide Details: { IE IQ f C vie i-£c L (4VJ Ur _ e_ gf3 (Notarized Signatures Required Next 2 Pages) 11/27/18 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: LA�tv-^ VAP1Av, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and fitrther states that(s)he is the (legal owner of the property to which this application pertains,or that(s)he is the 1) nn 1�G ,�lyV(_� for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all 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 Sworn to before me this day of ,20 day of 20 X- V"'"" �� ;rz '�I� Signature of Property Owner Si at e of Applicant Lau►-A k, �g P ZL, '`J Print Name of Property Owner Print Name of Applicant Y\0�- V-\'-�Je-d Notary Public Notary Public This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 11i27n a BUIL MENT VIL E OF RY OOK APR 2 i 2021 938 KING ET RYE BR O ,NY 10573 (914)9 9 39-5801 VILLAGE OF RYE BROOK W o F BUILDING DEQARTMENT ._ . ._.__.__. AFFIDAVIT OF COMPLIANCE VILLAGE CODE V16 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: f� LG%A� rae\AV , residing at, 2 C v1Gr��s La►til fi 8,00Ls, 1W 10S-73 (Print name) (Address where you live) being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 2 C W rL(S LA I_'c , Rye Brook, NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. X r-2" ��� (Signature of Property ner(s)) X LAtiv-7,�<q{ I,,VA (Print Name of Property Owner(s)) Sworn to before me this day of , 20 AUoE r«AgA (Notary Public) 11/27/18 .err' _ <4 •.`.1 A5. — �l LLj LLj _ Z W c z � I �11 d LIJ Li r 4 Ln Y =j 01 �L7 - Ll LL, C _ c' '4 1-7 `".- J LO so i51 IH��� 2 IL 1� - ALMEOIL-01 LKAZZI ,aco�n►� CERTIFICATE OF LIABILITY INSURANCE 1 DATDD/YYYY) 7/31 311/2020 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 endorsements. PRODUCER NAMTACT Lauren Kazzi People's United Insurance Agency,Inc. FHONE FAX 850 Main Street (A/C,No,Ext): (A/C,No): Bridgeport,CT 06604 E-MAIL Lauren.Kazzi@peoples.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:New York Marine&General Ins.Co. 16608 INSURED INSURER B: Halstead-Quinn Petroleum Co.,Inc. INSURER C: 33 Hubbells Drive INSURER D: Mount Kisco,NY 10549 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. ILTR NSR TYPE OF INSURANCE AGDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 'CLAIMS-MADE �X OCCUR PK201900018638 8/1/2020 8/1/2021 PREMDAMAGET EREENTEDn $ 100,000 MED EXP(Any one arson 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY PRO- ❑LOC 2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: A AUTOMO'ME LIABILITY COMaBIINED SINGLE LIMIT $ 1,000,000 X ANY AUTO U201900017114 8/1/2020 8/1/2021 OWNED SCHEDULED BODILY INJURY Perperson) AUTEOS ONLY AUpTOSS Ep BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY Pe�acEcident AMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,600 EXCESS LIAR I CLAIMS-MADE EX201900001337 8/1/2020 8/1/2021 AGGREGATE 5,000,000 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIADILITY Y I N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ GFFICER/MEMBEW EXCLUDED? N/A Mandatory In NH) E.L.DISEASE-EA EMPLOYE If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required Village of Rye Brook is included as Additional Insured where required by contract or agreement with regardto liability arising out of the Insured's operations per the terms and conditions of the referenced generalliability,auto,and umbrella policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 510423602 MAJ KEEVILY,SPERO-WHITELAW INC. I} . ��� 500 MAMARONECK AVENUE HARRISON NY 10528 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER HALSTEAD-QUINN PETROLEUM CO, INC. VILLAGE OF RYE BROOK 33 HUBBELLS DRIVE BUILDING DEPARTMENT MOUNT KISCO NY 10549 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G2090 374-6 972753 05/01/2020 TO 05/01/2021 4/19/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2090 374-6, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 VALIDATION NUMBER:432901926 U-26.3 i 2 � V � 'hg , d. r-� c� V� Q � .00 oz.rs s Mew tl o1� ; .ivs► /.wor t ,00.5Z M.00 AZ.f S N - Y Z oz � C� Y LJ c°� -(� M Q N CCV m V 0 uj N ilm Iuu1 g J � � LIB m ~ av� o m