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HomeMy WebLinkAboutMP22-005 40A QnZ,iZU;wm[x1# VILLAGE OF RYE BROOD MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.or� TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 11,2022 Danielle R.iverso&Jodi Riverso 210 Ivy Hill Lane Rye Brook,New York 10573 Re: 210 Ivy Hill Lane, Rye Brook,New York 10573 Parcel ID#: 129.76-1-3 As per the Certification letter from Envirostar Innovation Corporation dated April 6,2022, the removal of an underground oil tank and installation of a new aboveground oil tank under Mechanical Permit #22-005 issued on 1/11/2022 has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �yE 4RCbk_ O� ym Q,,/� F 0� • 1982 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' -,7ko ( �) LA-r-� — DATE: -:�> -Z,71 PERMIT# 01M_ Q,0_'> ISSUED: ZZ$ECT: f v BLOCK: LOT: LOCATION: 1j A OCCUPANCY: 2-1 I �j ❑ VIOLATION NOTED THE WORK IS... ,L]_,ACCEPTED ❑ R /RE* ❑ SITE INSPECTION ' RE:S�PETION ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION _ ❑ NATURAL GAS ❑ L.P.GAS , O C C ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING L_L qz ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ •n o tlN 3 O w � _ N N N W e � 00 0-4 W " Is 14 o O o W Ln 0 a o o ao � aa V1 .x w oo Ln o a.... M � F x eq co �ov00 ov ° r/ W I_' I O O p a�i aCi V �I W omaq G1 ~ M A cW7 uo Q a ++ Q � c '� cz x o , . O z � z 04 0 ;.4 �00 cn E.y A Oo z ® � � � � d w p Hgw en ng N A d a z a ° � b V O w w � a . �I � � a a w x � � �� -� p ECENED0 BUIL DEPARTMENT VIL E OF RYE OOK JAN 1 1 2022 938 KING ET RYE BR, ,NY 10573 (914)9, 914}9 39-5801 VILLAGE OF RYE BROOK w / 6C BUILDING DEPARTMENT Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester)( FOR OFFICE USE ONLY: PERMIT#: 1`�1 p _-06 im LApproval Date: Permit Fee:$ -70 Approval Signature: Other: Disapproved: (fees are non-refundable) REOUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 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 81 1): 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, 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 PermitjyM Installation (v�• Removal(v✓ •Abandonment( )!Above Ground )• Buried in Ground 1. Address: 1 ^V M SBL: 1s;P. 7(p 1-3 Zone: PU D 2. Property Owner&Address: Q,�{ 2,o -T\ ) (� 11 Phone#: Cell#: 9 ILA �} email:, J I 1 Ol ca� 1 ram-PfY) 3. Contractor&l Address: n S r 1' l 0S V1 l `� Phone#: "t � �`"1� Cell#: email 4. Applicants,l �\Y�S �v I nc" �rn Phone#: mot- �n'A SS Cell#: email: 5. Indicate Fuel Type: Fuel Oil(4•L.P.Gas( )•Gasoline( )•Other 6. Number and Capacity of each Tank: 7. Exact Location(s)of each Tank: 1 6/l/2020 STATE OF NEW YORK COUNTY OF WESTCHESTER ) as: ��Le 1,l C 1 W 11 being duly sworn,deposes and states that he/she is the applicant above named, (print name ofindiv ual signing as a 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 C IZInt(Q� 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 belies;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 —3-0+ Sworn to before me this day of 2 0 day of ,20 Sign o Property 0 r Sig&ture of Applicant , Print Name of Property Ow4 am Appli " d otary Publ c Notary Pub is 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. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Robin DiN'apoli Notary Public, State of New York Reg. No. 01 DI6377279 JUDY PUBLIC, ATE OFT Qual�ed in Westchester County NOTARY tratio STATE OF NEW YORK (+pMMISslon Expires July 2,2022 Registration No.01Bt150713532 Qualifled in Westchester County Commission Expires May 27,2023 2 3/21/l9 0 E 0 m U Q) �- 0 � � L CD- 0 0 - o L E `n W o r 4— O �N— U L. F - z m 0 w • LL O ui °' J a. F- in = LL J N i f^ V, � z > m w � z Y \ O r LL w N O Q) _ C fn 9s2 cn m � �N _ • � y oyff vim` c0 � N L U 0 L > L 0 Q� o — N j Residential oil tanks / UL 80 Product# Capacity Model Gauge Dimensions Weight (US gal.) thickness (lb.) H W L 209101 120 vert. 12 47' 23' 30' 170 208101 138 vert. 12 44" 27" 30" 160 208601 138 horiz. 12 27" 44" 30' 160 207101 220 stubbies/vert. 12 44' 27' 48' 220 203201G 230 thin/vert.grey 12 44' 22' 60" 235 3701G 230 thin/horiz.grey 12 22' 44' 60' 235 202201 240 narrow/vert. 12 47' 23' 60" 265 240 narrow/horiz. 12 23' 47" 60' 265 204201 275 vert. 12 44' 27' 60" 255 204701 275 horiz. 12 27' 44" 60" 255 211201 275 vert. 10 44' 27' 60' 330 211701 275 horiz. 10 27' 44' 60' 330 205201 330 vert. 12 44' 27' 72' 290 205701 330 horiz. 1 12 1 27' 44" 72" 1 290 External finish:BLACK or GREY electrostatic powder paint Warranty*: 10 years Touch up paint: PE0030C"BLACK" PE0032C"GREY" Cylindrical models horizontal Product# Capacity Model Gauge cover Dimensions Weight (US gal.) thickness Shell Dia. Height (lb.) 3005224 138 horiz. 12 12 26" 60' 165 External finish:BLACK electrostatic paint Warranty*: 3 years 'Consult warranty documents for details. 173'/z Ivy Hill Crescent Rye Brook, NY 10573 6!1 04 914-939-2440 D !� January 5, 2022 JA ���� N r � 2 022 Jodi Riverso pN D pyFeR p p 210 Ivy Hill Lane ARTMENT Rye Brook, NY 10573 Re: Oil Tank Replacement Dear Jodi Riverso, The Architecture and Grounds Committee (A&G) has reviewed your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G for final review and consideration. Work on the project may not begin until you receive written notice of acceptance from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Interim Property Manager Tara Gerardi From: Mike Izzo Sent: Tuesday,April 5,2022 9:13 A:NI To: Jodi Riverso Cc: Tara Gerardi;Laura Petersen;Steven Fews Subject: RE:210 Ivy Hill Lane COMPLETION OIL TANK REMOVAL/INSTALLATION Attachments: Color0316.pdf Dear Ms. Riverso, Thank you for the email. Here's a copy of my inspection report from the tank removal. To close the permit soil sample testing results must be provided to the Building Department by Envirostar for review. Once we receive information that the soil isn't contaminated, we will close out the permit with a Certificate of Compliance and provide you a copy of same. Thank you. Ahd(7, /zzo Building& Fire Inspector Village of Rye Brook, NY (914) 939-0668 From:Jodi Riverso<jodiriv63@gmail.com> Sent: Monday,April 4, 2022 4:42 PM To: Mike Izzo<Mlzzo@ryebrook.org> Subject:COMPLETION OIL TANK REMOVAL/INSTALLATION Hi Mr. Izzo, I recently had my in ground oil tank removed and above ground tank installed by Envirostar. They did mention to me that an inspector came by and gave approval. Can I assume that means a letter of completion will automatically be sent to me? Or do I still need to file the appropriate application for completion with the Village. Please advise. Thanks, Jodi Riverso 210 Ivy Hill Lane 1 D ID N vi�0 S T 1 APR - 7 2022 r ,,,...�.,..,��......A..��-...& VILLAGE OF RYE BROOK BUILDING DEPARTMENT fAf'�n.� Ir films?O�ti Apnl 6.2022 Villa.,e oi'Ryc Brook Kld&. DeTt. 938 Kink tit_ Rvc Hmok.\N' I07's Re- 410 Ivy I I i I I Late Rye Bock. NY 10573 1 o Whom It\Iav Comem. On ti(an:h'�_'_U2?i�sirost.�fnrynt�ti��n C'arF+. rcmoti�-�! (I)55(�_,sllan l'�I' Ervin the near of the hook Lind ir.t:dled t 1)240-pallon AST in the T%=of the house in the sCgvwc ,hcd,a( the Avve-mentiencJ location. Emvi".tar cut man titiav info the tnP of the tank.dispiwtl of the twA bottoms any) lwnd eleawd inside tank %tialIs- '1 he tank vms removed from the gmLmd and itu}<%:ted for holca- No Ix-ofes wL-re found in the tanL. A soil sample vas dra%Nn itoin the h1sc of the ctcavafion. Thc tank %%as disrw�~xi of. Ewloscd. please find copies of the fiollo%ing a«untentc- 1) Soil SampIc Results 2) Liquid Pr-ptsal Manifest 3) Tank Di%po%il Receipt 4) CUP? u!`itrt9fl it At thL%time.,aL ask that the permit be cloud. If.uu have wq q=56ons.plc%c do not heatate io contact us at 8-1 S-2 79-95{5. 1 hnnk )nu. 1 L \liehellc Rcr» Fn%irl-n-tar trtnUtiatit+n C��n+_ cc. Rnvrrui AWL PHOEVIT r.= ! ;rrrannlrr.rdl Laboraror;r.:- Irrc Friday,April 01,2022 Attn: Qrog DiNapoll EnviroStar innovation 50 Fields Lano Brewster NY 10509 Project ID: RIVERSO 210 IVY HILL LANE RYE BROOK SDG tQ. GCKS7515 Sample ID#s: CK97515 This laboratory is in compliance with the NELAC requirements of procedures used except where indicated- This report contains results for the parameters tested, under the sampling conditions described on the Chain Of Custody, as recaivW by the, laboratory. This report Is Incomplete unless all pages indicaled In tho pagination at the bottom of the page are incl udecl- A11 soils, solids and sludges are reported on a dry weight basis unless otherwise noted In the sample comments. A scanned version of the COC form accompanies tho analytical report and is an exact duplicate of the original. If you are the client above and have any questions concerning this testing, please do not hesitate to contact Phoenix Client Services at ext.200. The Contents of this report cannot bu discussed with anyone other than tho cllant listed above without their written consent. Sincerely yours, I AUL Pholl hiller Laboratory Director NJ Lab Registration VCT-003 NELAC -fl'NY11301 NY Lab Registralfon ##11301 CT Lab Registration ePH-0618 PA Lab Rogistration 9"-03530 MA Lab Registration SIM.CT007 RI Lab Roglstratlon 063 ME Lab Registration OCT-007 UT Lab Registration CCT00007 NH Lab Registration#213693-ALB VT Lab Registration WT11301 Sit East Ft4ov Tumpw.P,Q.Uft 170,ttanehnhrr,CT QGW T�kd+a+�cep,IiaS110? Fa�c petal scsau� 1 Aft PHOMt!" Environmental Laboratories, Inc. to r r 11301 5"Emu Moew Tu n.&A.P oho.370,uvw% a w.CT ow4s T&JWj E,aS1 t oQ re.(NO 645-am Sample Id Cross Reference April 01, 2D22 SDG LID.,. GCK97515 Project ID: RIVER.SO 210 IVY HILL LANE RYE BROOK Client Id Lab Id Matrix (BASE CK97515 SOIL Fgpa 2 aft PH0ENM'--1— Environmental L2boratones, Inc. 'W L"Malik%mrake,P4.Dow 37[, uxxwo",CT OC445 NY 0 113131 Tri_IVA1(4!5.11ty rw•;!wjw-oa—,3 Analysis Report r-oR. attn-Greg ati3pcii Envy oSty Innovator Apnl 01. 2022 50 F44%Lana crewfaff NY 10509 Samrae Information Custody Informatm Date Time Ittala_ SOIL Calm by. GREG OMAM Losaaaan Ccrx LWOROS Recelved by. LQ 0350W 1600 I2uth R"'Jest SLanurd 'Ana"' -d by: V--e 1W wow P,O_» Laboratory Data SDG ID- GCK97515 Phoerix ID: GK97515 Project ID: RIVERSO 211?IVY}FILL LANE RYA E W. K CIKnt ID: BASE Pa-Ameter Resutt POL Unite 010cr oxw Iome By Referer4e Pen-ne:t Solid 40 -. Ea 22 H MY34&7 SOW E)&=n or NY UPH [atitetea 4sxv.1 •.R 5tivai+e TPH ORO(C1 p-C2B1 O+essf KjFVc or;ancs IcI3.=? SO `A S6144 i 601e QAMC SurrooaCes %CM{surrJ GH % 1 u At,R2 JRB 50-15G% %Tavtienyl l s.'r 1 64 % 1 WJt,71 JPB 5Q-1a-2% RLiP0LaPaP A.e-WPr:%cbc 10W.1 aW Levol 41EmAwdanl W NE LAC LOG,urnrt d oum111m4w, r+ir)-m. d 0rhlLcW#At RLfFQL 6RL•B*Ww ReOpA"L"vI L-b*tt-rd Low QA<X SumoFom:5urrtsil e!!raeelpc3undz{precctsded wih w'K)J ied bYthe m deer--.no an2dr%n etfld� Surtppam ML113 4 Ii.11W fn the report are naL'de:ectee COerpoonda Comments: The TPH JC10-Ua8 Is uua-ti4lrid u�';13n akww=ndard AA iota.Wfd►s Q alutJy.-*WV IWPV-491 un•U►y rel91`14 LOS"tnk'l0 C+r0W5n r+aen In 1ho wiae oW-M"vnu,. 11 ymA arm-the de-a 3bp.9 am]ral.o My q-eums eatiarrq Its h-j?WV.pleaM 00 nd h&Lrz.to mrAac M06Mia C104 SoMw"sr eat 7M T po orrtnrrs of r.s��aR tax[�d+vssea r1e+xy�rta oihcr t-st Cte ciert(hntit�bi+ra.■a'nat ttrr+rtvt cvsrt phyl4s hiller,latatory Direetar npru 01,20n Reviewed and Releasud by.Rm rni 11.iko1,Pn*d MatnaWr Y�f t Page L..+6 to PIMIOENIX'D'�� , - �.co,►,. EnWonmentat laboratories, Inc. 5v uAt w-Arse Twro6m,PA Dam:1N,tldnehrater-CT=45 NY 0 11301 1'eL►E%:r 4{t 1172 Fia(Dd0}d4'�G1:1 QA QC Report April 01. 2022 QAlQC Data. SDG 1_n_ GCK97515 ti w mur 1 CS L c.a LCS u5 IM;,.-4 MU pit APrI P�r.�mtter 6Lro 141 % y► MD % 1< nDD L-- to UnaU QkQC Batch 557974{mp.XW,QC sar ow No.C xW616 tpt97515a TPH UGC(Extr c1ab1^PrrQd )-SCM1 EaLFWPOICtrnNC K7 50 !2] !a'. 67.7 9) 0 42.5 U-130 30 � %COOIsunl 62 ` !a 1s 121,f 11 23 IOLt 56-sm 20 Uer %Temwryl(c4,n1 61 w Vi I M. 50 s) 21A K-150 30 1v Itit7�ocnai a nople!Crdf'rii LC5 nrra+fraQ rsape a f.41:D11 I.LS tlttr(�in�rbr�e SL17SW,' The E--PKDRO LG5 Pie(M W rOMM L-M7 t> -W m CO ab=*talata.IM 1-T*ra rommeola A cuUde WO VM='=D 1pe:4*J r4G4Mv/imitm to-7M givwr.ir&ou Wo bimratorr fA&V50 tj recomep b-vb. r e 1 res paramrts•cWabe t 11 m w ry RP'O 1M,t+0 Memery Y-twL I 1hae arc nr f v&o IOr4 eCigardIng 13vs dare.picau to It ettmxv.lx Ctwr+I Servacitm A axlensw 200 >IUV-Ftelntive Parcare 1a vv"Ce LGS-Laboratamy Convol Sarrtale LCSG-L nbwr--.ry Convv1 Sam*Du'Kate MS-Ma1rix'Sprite Phy � 16 Oup-MID=Slate NOC3to Apri( ,7022�5?li l3borato!'yr Dtrdctor NC-Nu Curti--# at�r0 17 lets.tnuhrf r:re,nce RAW! ! ■ 4 C L u 4 q R u Tp r 4 QE J � Y � A T OCL c t � N = ; X ,s • L11 r, an � X � b �ry A �4c L w 1 E R e �c q 't - Evg h r z i V7 6 PHOENH J Environmental Laboratories, Inc. =IT East MWkde Tumpiks,P.0-9ox 37E.UxKhv~,CT""I NY; 1130, tet(b&*)tdS-1 tiCI f u CUDI 645-aM Analysis Comments AprO 01, 2022 SDG LD.: CCK97515 The loaowng anafysh:corrr►cnts arc nado regard Ing excaptiom to ailrxaz rrA already noted in the Analym Repon or DA OC Rupw, Nwo. 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BASS a SON, INS. 9-11 Carleton Avenue Mount Vemon. NY 10550 Phone (914)697-1442 * Fax (914)667.9647 1bassandsonCl�ao1_cam CERTIFICATE OF DESTRUCTION Custaffer ENVIROSTAR Job Location, 50 FIELDS LANE BREMTER, NY 105D9 Tvae' 0 2 UNP STEEL O NK Total Weight 10 BS. . Date_ 300W2022 DISPOSf110�I TRANSPORTER COMPANY NAME AND ADDRESS,. J. BASS&SON, INC. 9-11 CARD T_iQN AVENUE yA[T VERNON. NY 1 d55Q I, THE UNDERSIGN . CERTIFY THAT THE MATERIAL DESCRIBED ABOVE W.LL ONLY BE DELIVERED TO A FACILITY FOR DESTRUCTION „ r 3lQNATURt_.t�'A=-r., ,f: '�. .J 0"a b &M, Inc CATC. 3rJW20" I, THE UNDERSIGNED, CERTTFY THAT THE MATERIAL WILL 13E PROCESSED FOR RE AELTING ONLY THIS MATERIAI. WILL NOT 13E SOLD AS USABLE IN ANY SHAPE. FORM OR MANNER S*NATURF-/ f"�lle4/ _J Bass&Son, lnc DATE: 300rM g� 4 d / w tn x 5 k 7 t. 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Jy'k'S•� o¢. r ,1 k 't.+•'lIL.V14y °l. v'\`•Il�� ;::: '?.,: valtlr/. \ i V\1ii r/, �+le7f V `1v +''� ,; v �ti s.' : \lliii� `y` -�y/,�' i:'�%yr' Pll+�y{�.•5,�}+.T..'�i�yl�..(4� .�`�4r.Sa'�: ti 'yyVM��s - •-4�'~a�i` �"`rJ�'� �1 ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `./ 1 12/22/2021 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(les)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 NAMEn Allan Twitty _T FAX The Allan Twitty Insurance Agency,LLC A/CNtO. ,* (845)278-6160 ,pog (845)278-6537 E-MAIL allan wi rlsurance.com P.O.Box 419 ADOR�ss; at INSIIRERISI AFFORDING COVERAGE _ NAIC A Patterson NY 12563 INSURERA: Westchester Surplus Lines Insurance Company INSURED INSURER B: Liberty Mutual Insurance Co Envirostar Innovation Carp INSURERC 50 Fields Lane INSURERD: INSURER E: Brewster NY 10509 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._ INSR LTn TYPE OF INSURANCE ADDL SU9 Wen POLICY MUIBIPJt POLICY EFF POLICY EXP artym LIMITS l X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE 1XI OCCUR PREMISES(Ea occurrence S 50.000 - )( Professional Liability MED EXP(Any one orrsrn) 3 10,000 A I Pollution Liability G46854408 005 1229/2021 12/29/2022 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _S 2, 0,000 X POLICY 1-1JECT )^I LOC PRODUCTS-COMP/OP AGG S 2A00,000 OTHER Professional/Poflutlon 1 $ $1,000.000 AUTOMOBILE LIABILITY COMBINED,SINGLE LIMITMe $ 1,000,000 ANY AUTO BODILY INJURY(Per person) S �( OWNED SCHEDULED BODILY INJURY(Per soddanl) $ B �` AUTOS ONLY AUTOS BAS 5B 50 04 14 01/04/2021 031052022 __ _ XHIRFD NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per micl nl X UMBRELLALIAB X OCCUR EACHOCCLIRRENCE S 1,000.000 A EXCESS UAB >E G72514774-002 12rM02i 12292022 AGGREGATE S 1,000,000 DED RETENTION S $ WORKERS COMPENSATION PTR AND EMPLOYERS'LIABILITY - JUL— ANY PROPRIETORIPARTNERIEX ECU TIVE Y❑ N 1 A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED 9 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ Inland Marine Scheduled Equip $250,748 B BMO 58 48 44 33 01/01/2022 01/012023 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space to required) Evidence of Insurance 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 Dept. AUTHORIZED REPRESENTATIVE 938 King Street Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 17--0l;*k*\- NYSIF New York State Insurance Fund WESTCHESTER ONE.44 SOUTH BROADWAY. 10TH FLOOR,WHITE PLAINS,NY 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE kix-m ^^^^^^ 823325897 ALLAN TWITTY INSURANCE AGENCYPO BOX 419 PATTERSON NY 12563 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ENVIROSTAR INNOVATION CORP. VILLAGE OF RYE BROOK 50 FIELDS LANE BUILDING DEPT. BREWSTER NY 10509 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2549 055-8 747351 06/29/2021 TO 06/29/2022 8/4/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2549 055-8, 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. AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. 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. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT GREGORY DINAPOLI ENVIROSTAR INNOVATION CORP(1 OF 1) 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 690620147 U-26.3 Laura Petersen From: Mike Izzo Sent: Monday, March 21, 2022 1:49 PM To: Tara Gerardi; Laura Petersen Subject: FW: Message from UDig NY Michael J. Izzo Building & Fire Inspector Village of Rye Brook, NY (914) 939-0668 -----Original Message----- From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, March 17, 2022 2:10 PM To: Mike Izzo <MIzzo@ryebrook.org> Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/17/2022 14:08 To: VIL RYE BROOK PRIMARY Transmitted: 03/17/2022 14:10 00001 Ticket: 03172-001-520-00 Type: Regular Previous Ticket: 01062-000-713-00 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 210 To: Name: IVY HILL LN Cross: From: To: Name: Offset ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY NearSt: ARBOR DR & IVY HILL CRES Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 03/22/2022 Depth of excavation: 15 FEET Site dimensions- Length 15 FEET Width 15 FEET Start Date and Time: 03/22/2022 07:00 Must Start By: 04/05/2022 ------------------------------------------------------------------------------ Contact Name: ROBIN DINAPOLI Company: ENVIROSTAR CORP Addrl: 50 FIELDS LN Addr2: City: BREWSTER State: NY Zip: 10509 i ICI' Phone: 845-279-9555 Fax: Email: info@tankremovalservices.com Field Contact: ROBIN DINAPOLI Alt Phone: 845-279-9555 Email: info@tankremovalservices.com Working for: RIVERSO ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 Tara Gerardi From: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> Sent: Thursday, January 6, 2022 1:15 PM To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for:VIL RYE BROOK Taken:O1/06/2022 13:14 To:VIL RYE BROOK PRIMARY Transmitted:01/06/202213:15 00005 Ticket:01062-000-713-00 Type:Regular Previous Ticket: ---------------------------------------------------------------------------- State:NY County.WESTCHESTER Place:RYE BROOK Addr: From:210 To: Name: IVY HILL IN Cross: From: To: Name: Offset: ---------------------------------------------------------------------------- Locate:REAR OF PROPERTY NearSt:ARBOR DR&IVY HILL CRES Means of Excavation:EXCAVATOR Blasting.N Site marked with white:N Boring/Directional Drilling N Within 25ft of Edge of Road: U Work Type:OIL TANK REMOVAL Estimated Work Complete Date: O1/19/2022 Depth of excavation: 15 FEET Site dimensions:Length 15 FEET Width 15 FEET Start Date and Time:01/19/2022 07:00 Must Start By:02/02/2022 ------------------------------------------------------------------------ Contact Name:ROBIN DINAPOLI Company: ENVIROSTAR CORP Addr1: 50 FIELDS IN Addr2: City.BREWSTER State:NY Zip: 10509 Phone: 845-279-9555 Fax: Email:info@tankremovalservices.com Field Contact:ROBIN DINAPOLI Alt Phone: 845-279-9555 Email:info@tankremovalservices.com Working for.RIVERSO ----------------------------------------------------------------------------- Comments:Lookup Type:MANUAL ----------------------------------------------------------------------- Members:ALTICE USA BELL-VAL HALLA /WSCHSTR CON-ED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 Laura Petersen From: Mike Izzo Sent: Friday, March 18, 2022 9:24 AM To: Laura Petersen; Tara Gerardi Subject: Fwd: Message from UDig NY Sent from my iPhone Begin forwarded message: From: UDig NY Exactix<tickets@exactix.udigny.org> Date: March 17, 2022 at 2:10:08 PM EDT To: Mike Izzo <Mlzzo@ryebrook.org> Subject: Message from UDig NY Reply-To: Dig Safely New York Exactix <tickets@exactix.udigny.org> ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/17/2022 14:08 To: VIL RYE BROOK PRIMARY Transmitted: 03/17/2022 14:10 00001 Ticket: 03172-001-520-00 Type: Regular Previous Ticket: 01062-000-713-00 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 210 To: Name: IVY HILL LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY NearSt: ARBOR DR & IVY HILL CRIES Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 03/22/2022 Depth of excavation: 15 FEET Site dimensions: Length 15 FEET Width 15 FEET Start Date and Time: 03/22/2022 07:00 Must Start By: 04/05/2022 ------------------------------------------------------------------------------ Contact Name: ROBIN DINAPOLI Company: ENVIROSTAR CORP Addr1: 50 FIELDS LN Addr2: City: BREWSTER State: NY Zip: 10509 Phone: 845-279-9555 Fax: Email: info@tankremovaIservices.com Field Contact: ROBIN DINAPOLI 1 Alt Phone: 845-279-9555 Email: info@tankremovalservices.com Working for: RIVERSO ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/WSCHSTR CON-ED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2