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HomeMy WebLinkAboutMP22-047 DR VILLAGE OF RYE BROOK MAYOR 938 King 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 Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 21,2024 Samuel Ackerman&Hanna Ackerman 56 Talcott Road Rye Brook,New York 10573 Re: 56 Talcott Road, Rye Brook,New York 10573 Parcel ID#: 135.50-1-18 This document certifies that the work done under Mechanical Permit #22-047 issued on 3/29/2022 for the removal of an above-ground oil tank and the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE BRC�v� • 19t32• BUILDING DEPARTMENT ❑BUILDING INSPECTOR 0 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 :- / zq L4-0 r P0,41 DATE: L J ZOL'" PERMIT# 1 Z 7 / ISSUED: 3 Z 9-ZZSECT:1-�Y-0, BLOCK: / LOT: LOCATION: 1154 / OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑"'P ASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ,2'FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL !� ❑ OTHER QyE BRC�k, O� Zm cu � Q�i� ��O•c • 1982 BUILDING DEPARTMENT �❑BBUILDING INSPECTOR b 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 : S (a I A LC- o TT tC (D DATE: L 1 OZ�f PERMIT# A� / 72 - 0 7 7 ISSUED:. -Z 9-2Z- SECT: ���- i) BLOCK: LOT: /25 LOCATION: 9/q SL OCCUPANCY: v�� ❑ Violation Noted THE WORK IS... ff-PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas p� 7 S A s T . /�'C lV o z,2 41— . ❑ L.P. Gas E'-FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER N N N1 F a - .0 W r a a a O 0.0 r�l 00 ' Ln 0 o r W en HLr) O W O en 01 C o •o w M K,' 8 o (� O Z N o -�00 Ln aoi o p w O "' .°. IT�I �S i a -0 v 9 © 'S etaco Cj 00 O W 7 pV z O A U � 1�-I 0 Q N O a c QI U Z .d a � o 0 aw CJ� 00 z o 00 WC, o � tz F 4 a s \U z a a w Q O F, o *" .a D8 ^� W O U U � � y. o nJ un Ln ' W. u q a OIh-"�ti •• q � w w � � 9 90 .d �I 4 *41 P.C. a1 401x � BUILD MENT uN VIL E of RYE,,. OOK MAR 2 1 2022 938 KING ET RYE BRq ,NY 10573 -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) FOR OFFICE USE ONLY: PERMIT #: H10-X)--(D `y'' 7 Approval Date: MAR 2 9 202 Permit Fee: $ 3 76) /"d•� 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#C 105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal, Abandonment,or Installation: $195.00 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, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/ so n1r nlrsttall 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: tallaho moval •Abandonment( ClA ove Ground •Buried in Ground( ) 1. Address: C SBL: ��+ 40—J+� d Zone: 2. Property Owner&Address: T�1 C o � P Phone#:�f 1 �� 0Cell#: email: COU, c1.ckalno� [��rn "r�CM 3. Contractor&Address: ().(1 °- CO , - �2�� Phone#: )��-aU0-19 Z3 Cell#: email: }fin k Co--W C Qm 4. Applicant -T-Ck-n �,r�} ��,���fDC�X\k-�--- ` `�, Phone#: {`S /� l'7 Cell#: email: C+,I_ �'I Ic C( t! 5. Indicate Fuel Type: Fuel Oil( •L.P.Gas( )•Gasoline( )•Other 6. Number and Capacity of each Tank: 0 ' CA 7. Exact Location(s)of each Tank: S t 8/12/2021 n y N O �N e 7 N z�u° c O lofz d Q L W w.pw K0 a.z 4-77 m v 'cc N 1_1 i U. Q c y I �, � t�.� ~ � •ti � 5 (u C ..ti-n -o �yi a7 O ff. 9 CC U a) al � � �' aQL a. z < Cd 23 .fib a� � '3 � © o � � � •� Li o o .� a:moo ..S 9 W f . a .� ',.4 p O Q 0 t ^ 3 C T y cc 'J+ Epp mow. � P. .cc •� 3 C_-- I) vJZ F c CL m > E p CG� I NIE MAR 21 2022 I VILLAGE OF RYE BROOK BUILDING DEPARTMENT i 1 y U 7 AWN a JD TANK COMPANY "Oil tank services within your budget" 17 Manor Dr.Poughkeepsie NY 12603 W b i e•WWW..JDTANKCO.COM Email:JD_TANKCO@YAHOO.COM Line 1: 1-845-240-1923 Line 2: 1-845-240-1033 Fax: 1-845-240-1923 CERTIFICATION LETTER To whom it cnay concern: Date: This letter is to certify the JD Tank Company has followed all state and local laws concerning the work performed at 6(o l r Please reference invoice number for detarls on work performed at this address. JD Tank Company abided by the contract presented and the proper disposal of tanks as well as residuals left in tanks. JD Tank Company uses CHARLES EFFRON& SON,Inc for the proper disposal of steel tanks and we use either ALL STATE ORC in NJ or LUZON ENVIRONMENTAL SERVICE in NY for the disposal or VAC services of the tank bottoms. Both Tank Bottoms and Tanks are usually dropped off in bulk as to save costs of repeated trips. All information on amounts are available upon request if needed by client for their records. Feel free to call our office at anytime. Signed Jason Leisch(Owner pan ) VVIYIIYIGfI�►IML I IVf�GI -- - -- M.. � r�� ��` TRUCK#: THE IN: 04/09/22 08:19 AM .. , THE OUT: 04/09/22 08:30 AM l;, . -_ DESCRIP: STATUS: PAID i' `'. I I I. I i DRIVER: VENDOR: 42942 Baroni Scrap Metal, LLC JDTANKCO 20 Van Kleeck Drive 17 MANOR DR W Poughkeepsie,NY 12601 WEIGHER: TFLETCHER POUGHKEEPSIE,NY 12603 Phone 845 471-0820 Fax 845 471-8873 TOTAL $: $432.00 PHONE: FACILITY#7121961 TOTAL LBS: 2,700 FAX: Code Commodity Gross Tare Contamination Tare2 Net U Price Total 133 STEEL UNPREPARED 24,960 22,260 2,700 C 16.0000 432.00 24,960 22,260 2,700 432.00 These weights setforth herein are manually entered. Notes: N G JDTANKC-01 KPROPER ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DD/YYYY) 3/17/2022 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 Emery&Webb, Inc.-Fishkill Office aC'No,Exe: (845)896-6727 WC.No:(845)896-6877 989 Main Street E-MAIL Fishkill, NY 12524 ADDRESS INSURERS AFFORDING COVERAGE NAIC ft INSURERA:Ca Itol Specialty Insurance Corp INSURED INSURER B:Pro ressive Casualty Insurance Company 24260 JDTANKCO,Inc. INSURER C: 17 Manor Drive W INSURER D: Poughkeepsie,NY 12603 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE OCCUR EV20183624-03 10/8/2021 10/8/2022 DAMAGE TO RENTED 300,000 REMISES(E.MED EXP(Any one n 10,000 PERSONAL BADVINJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICYEl PRO- LOC PRODUCTS-COMPIOPAGG 2,000,000 OTHER JECT B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 ANY AUTO 01537516-2 12/18/2021 12/18/2022 BODILY INJURY Per person) _ OWNED X SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS AUTOS ONLY AUOTOS ONL� PROPERTY DAMAGE Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT (Mandatory in NHj EXCLUDED? N/A E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Professional Liab. EV20183624-03 1018/2021 10/8/2022 Aggregate 2,000,000 A Pollution Liability EV20183624-03 10/8/2021 10/112022 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I i 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. AUTHORIZED REPRESENTATIVE Village of Rye Brook 938 King StreetRye Brook.NY 10573 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i� NYSIF New York State Insurance Fund PO Box 66699.Albany. NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A^^^^^ 463840919 r �•. 71 EMERY&WEBB INC 989 MAIN ST FISHKILL NY 12524 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER JDTANKCO INC VILLAGE OF RYE BROOK 17 MANOR DRIVE 938 KING STREET POUGHKEEPSIE NY 12603 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2486190-8 626935 09/28/2021 TO 09/28/2022 3/17/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2486190-8.. 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 JASON LEISCH JDTANKCO INC- 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 SUR NCE FUND 7 �V DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 642188689 U-26.3