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Home My WebLink AboutMP21-171 t4♦ JJ 1 . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopherj. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 23,2021 Richard Dayan&Betty Dayan 53 Talcott Road Rye Brook,New York 10573 Re: 53 Talcott Road,Rye Brook,New York 10573 Parcel ID#: 135.58-1-26 This document certifies that the work done under Mechanical Permit #21-171 issued on 11/5/2021 for the removal of an above-ground oil tank and the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, 1- Michael J. Izzo Building&Fire Inspector /tg 4E BRCS , w 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR DASSISTANT 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` kv ISSUED: SECT: BLOCK: LOT: LOCATION: 2 `�11 � Y OCCUPANCY: -2 0 i ❑ VIOLATION NOTED THE WORK IS... D"ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS L r X ❑ L.P. GAS FUEL TANK � �� J FIRE SPRINKLER C 1 r-j�'( C'r, ❑ FINAL PLUMBING ❑ CROSS CONNECTION �f ❑ FINAL ❑ OTHER rl r-I N N N 0-4 rot l rl 1q � � �,,, T ° O � •� Q s O O Z •r O Q 0 r o O w •x � � O C > > : o� rA 'I,- -o as - co O woo 3 b �00 OF > .s E a e ham! Q ��j_� /Q� O - �Z � R.•'C � 'J4' I� �I o �b� Q C W C 0 � iaV [...i c a � u„ Q co as A Q a Z Q � V .. w aa� > > _ a. O. a. a a a x � � $UIL �)R ;, MENT �-; :. NOV - 3 2021 VIL tA'��E OF RYOOK `$ NY 10573 938 KING ET RYE B(914)9 -5801 Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the �County ^o�f/Westchester) FOR OFFICE USE ONLY: PERMIT#: Approval Date: N O 5 202 Permit Fee: $ t !" Approval Signature: Other: Disapproved: (fees are non-refundable) *kkk*R*n kit-t is*k td*ki:ik i :�k�ir*k 71*il-k Yc k :*kt9:t**'k kF k:F k�*�k�x'J•':F�•4 kxxilfi�kk,�A•F�kki:9Fk*kiFkkkick*at*•k�>k Aar is*At*-k is Y*:A REOUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF CONIPLIANCE: 1.Application Completed by Bonded,Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 811): 6.Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports (after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, 3-d ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and regulations. Indicate PermitlyM Installation { ) • Removal( )•Abandonment( )/Above Ground( )•Buried in Ground( ) I. Address: 53 Talcott Road SBL: 135.58-1-26 Zone: k7/c`� 2. Property Owner&Address: Richard Dayan, 53 Talcott Road, Rye Brook, NY 10573 Phone#: 917-797-4703 Cell#: email: RICHARD@CACTUSTRADING.COM 3. Contractor&Address: Robison Oil 1 Gateway Plaza,4th FL, Port Chester, NY 10573 Phone#: 914-847-0286 cell#: email: aolmstead@robisonoil.eom 4. Applicant: Robison Oil Phone#: 914-847-0286 Ceti#: email: aolmstead@robisonoil.com 5. Indicate Fuel Type:Fuel Oil( •L.P.Gas( )•Gasoline{ )»Other( ): 6. Number and Capacity of each Tank: Removal of (2) 275 gal oil tanks in basement and Installation of(1) 275 gal oil tank in same location 7. Exact Location(s)of each Tank: basement l 6/1/2020 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: .being duly sworn,deposes and states that he/she is the applicant above named, tprint name ofindividual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Contractor 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. r V- �-- -'' Sworn to before me this Sworn to before me this day of ,20 `�� day of .20 �=�ature&'P--ropertyOwner Sign •e of Applic 4 Pir Prop wne Print Nam Applic 1!r taryPu Notary Pu 1 anan ,Instead NOTARY PUBLIC.STAi'E uF NhW YORK Registration No.010L6417632 Qualified in WF.STCHRSTER County Commission Expires 0813012025 This application must be properly completed in its entirety and must include t e notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety f#M!q�pVroperly signed shall be deemed null and void and will be returned to the applicant. ��XP C � ;F 11200 op .s �•0� �G h E 0 ;'P pU8`- do LP ;° o`t;do • � Vry 1/6/16 .kF . ' C I j 73{SE I i i+C7 M i l31-]r / 4 / t i f i i a e 6 s i 1 V Residential Oil Tanks ! UL 80 Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge H W L (pounds) . _ 209101 120 ver±. 12 47' 23' 30" 170 208101 138 vert. 12 44' 27' 30" 1 160 208601 138 110rz. 12 27" 44' 30' 160 t 207101 220 stubbwe$'4ert 12 44' 27" 48" 220 i ` 207601 220 stubbies horz 12 27' 44' 48" 220 203201G 230 thinivert grey 12 44" 22' 60" 235 203701G 230 thin horz grey 12 22' 44" 60" 235 202201 240 narrow vert. 12 47" 23" 60" 265 1 240 narrow:horz. 12 23" 47" 60' 265 - I 275 vert. 12 ';44' _ 2-7' ' 60' 255, _ 275 horz. 12 27' 44" 60' 255 211201 275 vert. 10 44' 27' 60' 330 ' 211701 275 horz. I 10 27' 44" 60' 330 205201 330 vert. 12 44' 27" 72' 290 ��. 205701 330 horz. 12 27' 44" 72' 290 External finish:SLACK or GREY electrostatic powder paint Cylindnc Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge Cover Shell Dia. Height (pounds) 3006622 150 0CV 560 11 12 30" 65" 200 3007622 I 185 DCV 690 11 12 30' 77" 225 3008622 220 DCV 825 11 12 30' 88" 255 u■rin�ir External finish: WHITE polyurethane pa!:,,* F Cylindrical HOrizont ! Capacity Thickness Dimensions Weight PrPr=-ct# I (US gals) Model Gauge Cover Shell Dia. Length I (pounds) 3005224 138 Horz. 12 12 26" 60" 165 Externalfinisn:Black electrostatic paint I rL 10 , a h._ If ' i,. =� I°If141°f , �� f 11 - `�i°I f11°° ! 1°�fl�ll { I�f1�t f1 4 �1ff�A. • j igs) % Hli+_ i �H°t d I+`►° ayt: °N°9r a ��I�S s .4h �� , - : !1`I} late 3R r� >t vw C3 cv _ K s: as W N :ru � c cm I + G no ' M ^ ,. w p (U €G r r z ell, 4' F Ef ,,�, .fit, n ` ao Lo LU O z �' .. +• L Ti7 6. "�/S�• 47 V� U i� co co U 0) / L Z N ' E o rn cn N r!+ a LD r ,-s��a 1d11�1►°° - �I°tilliti°+ (� ° I r � 'as1f1�� °i1/1 z Illfil} � }q IIII�rr 3 f1111 # 1 14�° j liffl ��qy joy, 1f1AfY � ♦� `,tA �1 Sr w `<'r. Mi , S w^�� i i♦ 13'w��E1f r f A`oRV CERTIFICATE OF LIABILITY INSURANCE DAT1/ar202,rrY) 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: Tammie Pattanite Arthur J. Gallagher Risk Management Services, Inc. P"�"E .888-273-8155 ac No:856-273-3663 4000 Midlantic Drive Suite 200 E-MAIL Mount Laurel NJ 08054 AODRESS: tammie attanit a' .corn INSURERS AFFORDING COVERAGE NAIL 0 License#:BR-724491 INSURER A:New York Marine And General Insurance Company 16608 INSURED SINGHOLZ2 INSURER B: Singer Holding Corporation dlbla Robison Oil One Gateway Plaza,4th Floor INSURERC: Port Chester NY 10573 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:945532112 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. ICY EXP LTR TYPE OF INSURANCE INSD DL V POLICY NUMBER MMIDDfYYYY MPOLICY EFF M DD YYY LIMITS A X COMMERCIAL GENERAL LIABILITY PK202000020101 12/31/2020 /2/3112021 EACH OCCURRENCE $1,000,000 -DAMAGE TO CLAIMS-MADE FTI OCCUR PREMISES Ea rrence $100,000 MED EXP(Any one person) $5,000 PERSONAL E ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JEPO- CT LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AU20200001752S 12131/2020 12/31/2021 COMBINED SINGLE LIMIT $1,000,000 Ea accident IX ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED Ix NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident _ $ A UMBRELLALIAB N OCCUR EX202000001405 12/31/2020 12/3112021 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5.000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE I I ER ANYPROPRIETORIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED') NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ if yyes,describe under DESGRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Village of Rye Brook Building Department is named as an additional insured with respect to the above General Liability Policy,if required by a written contract executed prior to services performed. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook Building Department 938 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE �J O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD a NEWYORK , Workers' STTA E Compensation CERTIFICATE OF �4— Board NVS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ADP TotaiSource FL XVtI,Inc. 9143455700 10200 Sunset Drive Miami,FL 33173 L1C/F 1 c-NYS Unemployment Insurance Employer Registration Number of Singer Holding Corporation DBA Robison Oil Insured 1 Gateway Plaza 4th Floor 45045108 Port Chester,NY 10573 1 d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 133121491 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Ins Co Village of Rye Brook Building Department 3b. Policy Number of Entity Listed in Box 1 a" 938 King Street WC 038381464 NY Rye Brook,NY 10573 I worksite employees working for Singer Holding Corporation paid under ADP TOTALSOURCE.INC's payroll,are covered under the above stated policy. 3c.Policy effective period 7/1/2021 to 7/1/2Q22 3d.The Proprietor,Partners or Executive Officers are 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"I 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,I certify that I am an authorized representative.olieensed ene.,.Of the'R Pronee carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Adf IBna Sanchez (Print name of authorized rep alive;u6/30/2021 f insurance carrier) Approved by: r �iuraiurc (DateI Title: Account Specialist II Telephone Number of authorized representative or lieensed agent of insarmee800-743-8130 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.