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Home My WebLink AboutMP22-034 Jl%` '� +•sue 4UIA anazim*3m* VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryeb ro o k.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 13,2022 Jane Botticelli 20 Valley Terrace Rye Brook,New York 10573 Re: 20 Valley Terrace, Rye Brook,New York 10573 Parcel ID#: 135.67-2-23 This document certifies that the work done under Mechanical Permit #22-034 issued on 3/7/2022 for the removal of an above-ground oil tank and the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to �E BRC��, cu � 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 : V DATE: PERMIT# h?-z7- 7 l ISSUED: SECT: BLOCK: LOOT: LOCATION: 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 `�"�✓�—' i ❑ P. GAS FUEL TANK (( _ FIRE SPRINKLER 2� J ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 2 a a : : a M P : N N N :.7 �p,•n : m y � MM ems"' A � � _• x v� � „*'', � F� s a PLO O Aglow m : o ° Q a x 1w, � x Ln Z o w v w a r R H ► o O V W a a7 b pv+ a = W O T 7 Vce 00 a P.4 z E-' E. v cn v W V 9 ru, w W w O 0H C '4 U w ° QW � . C z ZO H W A 0 �- � � s e BUILD MEN VIL OF RY 10 LIAR — 4 2022 938 KING ET RYE BR' ,NY 10573 `� 4 -0 VILLAGE OF RYE BROOK 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)V FOR OFFICE USE ONLY: PERMIT#: /'�� 3 Approval Date: MAR — 7 22 Permit Fee: S 3 7o`" Db Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS 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 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, c �. , is hereby made to the Building Inspector of the Village of Rye Brook for a pen-nit 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 Permit Type: Installation (4. Removal (0 • Abandonment( ) /Above Ground (7.Buried in Ground ( ) 1. Address: V , e SBL:L--ks-o Zone:P 7 2. Property Owner&Address: I t VG Phone#: �y •� � �1 Cell #: email: 3. Contractor&Address: Phone#: Cell#: email: ,(0 4. Applicant: Phone#:Q)q . NO_Cell#: email: ir4 e zSeA ccyk-� 5. Indicate Fuel Type: Fuel Oil(�(- L.P. Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: a DIA Z7S- n y (II 7. Exact Location(s)of each Tank: t 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: -h 0 I' Sri�1l[ 6�L t_.. I ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) rid furt r states that(s)he is the I gal owner of the property to which this application pertains,or that(s)he is the f1.i of IS for the legal owner and is duly authorized to make and file this application. (indicok architect,ceAractor,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 b ore me this c;2c/ Sworn to before me this a day of ,207-- day of r%.er ,20,fhl4�- /60 AJI- Signature of Property Ovmer ignature of Applicant q. AUK a �� ►C�Gt,.t _ Print Name of P operty Owner Print Name o pplicu LILLIAN SIERRA --- Notary Public-Slate of New York Notary Public/ NO. 01S16280398 Notary Public SEf N LYTLL Qualified In Wastchest ty 11'Of.4RP LG'LIC My Commission Expires My COmlcl55100 Expires Aug.31, 1rZS This application must be,1propeAy---@ampleted in its entirety and must include the notarized eJo�--( (W. - signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces 5k.. . of provided. Any application not properly completed in its entirety and/or not properly signed shal l bed deemed null and void and will be returned to the applicant. co r` 2 8/12/2021 �y ?I'll ��Lr YV 1 d j z § \�„■;; LL \o zo ) f Lo . ( _ , ; /■ G o - ! �! I! {2 / ( \ \ @ \ $ � ) § t / _ w\ / § M\53E/92 �EEEEee § \| | - , � ` ) ; § � % a 2 � 2 /\ \ ` I � I I C3 I I ` I . I . I I � D EGENE ffAPR 11 2022 e4& FUEL CO.,INC. VILLAGE OF RYE BROOK BUILDING DEPARTMENT 4/1/22 Village of Rye Brook Department of Buildings 938 King St Rye Brook, NY, NY 10573 RE: Jane Botticelli 20 Valley Terrace Port Chester, NY 10573 Permit# MP 22-034 To Whom it May Concern: On 3/31/22,Westmore Fuel Company, Inc. removed the existing 275 gallon steel oil storage tank from the above-referenced residence. The tank was pumped out, and transported to our yard, where it was cut in half, cleaned, and disposed of properly. The tanks were brought to Rubino Bros., Inc. and the hazardous waste was picked up at our yard by Moran Environmental Recovery. Sincerely yours, Rachelle-Marie Koenig Service/Installation Coordinator Westmore Fuel Company, Inc � t 86 North Water Street • Greenwich, CT 06830 • (914)939-3400 • (203) 531-6800 • (203) 531-5783 • www.westmorefuel.com CT State Contractor's License#308868 • HOD#44 RUBINO BROTHERS, INC. 5w Cana)Strut Stamford,Connecticut Telephone 323-3195 Customers Name..................... -! / G `j.............................................. ._. _ ..... Order No............................ Address..................................... : `/- 02 a2 aZ Date................... ...................... DES CRIPTI ON Delivered Empty Drums Delivered Empty Bins Issued by, RUBINO BROTHERS, INC., STAMFORD, CONK. Driven Received b Romariu, OK'd by. .......................................................................................... ' `• � . . 1'�'d . '0111 1 Ilihti l;. Itl'i�i'itil � y4'1'PIII Ih'ih� 1;4h'ijl co3 '�1 Id. �h 111. .1 111- ►111 t= N 11 �_ _Ih 11 <co>' t- �. ..Z u N 04 O = I N 00LU � 94 Co ILP : •,�``: � �A p �spy, j., F— Qj !} a Q /� V W F- 0 CA ICI •^y O w O u iC w : n` ection J.� Z tY v :: ' F , uj ca �O LLJ L•L. Z w U' 6 0 <(b) (Cgo =2 o O cz fO it CN CD M _ /�• • 1 • �_ � � y � � v � it -�� I y 1 .illl/1l/lhl- x 111111111111 t=�, >I:°Illl//�lllyl��- "�I lllllllh�.. .rllllllllllll i 5�11111�1/14 � 111111111.. 11111 � 11/11 11/11 � � 111 1/lli � 11 11 { �1//1 . • lib •.- `i;i�y ..N ....-- A� �TE(IJn CERTIFICATE OF LIABILITY INSURANCE OS06J10Q, 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 conditlons 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 CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT NTACT CENTER FX HOME OFFICE:P.O.BOX 328 (A CNNo Est):888-3334949 (A c No)!507-446-4664 OWATONNA,MN 55060 ADDResS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 330-130-6 INSURER B: WESTMORE FUEL COMPANY INCORPORATED INSURER C: 86 N WATER ST GREENWICH,CT 06830-5886 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0 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 TYPE OF INSURANCE DL SUBR pOUCY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDIYYYY MMIDOfV'/YY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1.000,000 CLAIMS-MADE ❑X OCCUR pR�MIGES Eeocarr0ienx $100,000 MED EXP(Any one person) $5,000 A N N 9062815 06/01/2021 06/01/2022 PERSONAL&ADV INJURY $1,000,000 O N'L AOOREG TE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X POLICY JECT ❑LOC PRODUCTS-COMPIOP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 a ao l en X ANY AUTO BODILY INJURY IPef pendn) Y OWNED AUTOS ONLY SCHEDULED A AUTOS N N 9062815 06/01/2021 06/01/2022 BODILY INJURY IPer aaidant) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per accldm X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $7.000,000 A EXCESS LIAR CLAIMS-MADE N N 9062816 06/01/2021 06/01/2022 AGGREGATE $7,000,000 DED RETENTION WORKERS COMPENSATION X PER STATUTE I GETRH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE E.L EACH ACCIDENT $500,000 A OFFICERIMEMBER EXCLUDED? NIA N 9917566 06/01/2021 06/01/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 It yes.describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Scladule,may he attorned it more spaee is required) CERTIFICATE HOLDER CANCELLATION 330-130-6 35 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD NEW Workers' YORK : CERTIFICATE OF sTa€1 i COfTtPEkrtsaSttaflBoard NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name 8 Address of Insured(use street address only) 1b Business Telephone Number of Insured WESTMORE FUEL COMPANY INCORPORATED 203-531-5656 86 N WATER ST GREENWICH,CT 06830-5886 1c.NYS Unemployment Insurance Employer Registration Number of Insurwl Work Location of Insured('Only rergtured If coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in Now York Staff?,i a,a Wrap-Up Policy) Number 06-0739367 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity tieing Listed as the Certificate Holder) Federated Mutual Insurance Company Q Village Of Rye Brook #35 3b.Policy Number of Entity Listed in Box"la' 938 King St Rye Brook,NY 10573-1226 9917566 3c.Policy effective period 06/0112021 to OW0112022 3d.The Proprietor,Partners or Executive Officers are included.(Only rheck box if all par netstnfllrers 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"1a"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 carver 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 or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted an this form. Approved by: April Myer (Pint name of auttndaed representative et licensed agent of insuience rattier) Approved by: 45Ltd2ff�%� !c,v gnature) 1,7 (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier. 888-333-4949 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(9-17) wvvw.wcb.ny.gov