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HomeMy WebLinkAboutMP22-058 �yE DR 4 s i7. 19 A(" Ca nnftwmaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebro©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 27,2022 Kevin McNamara&Lillian McNamara 6 Tamarack Road Rye Brook,New York 10573 Re: 6 Tamarack Road, Rye Brook,New York 10573 Parcel ID#: 135.67-2-42 This document certifies that the work done under Mechanical Permit #22-058 issued on 4/8/2022 for the removal of an above-ground oil tank has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to BUILDING DEPARTMENT ILDING INSPECTOR [](ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : !M�AC ` ' i DATE: ` j `- Z PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: � �� OCCUPANCY: 6-1- ❑ 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 ❑ .P.GAs FUEL TANK f FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a = e 00 w •• U) w a N N W y s N N N a cr—cl,•2 s ^. ■ F+'1 GO 40 a N 0 ~ ■ cd G+ +-+ GIB U N oo q o . B +� ti � 04 c' 0 ,i ui Cc ° p O � O O � p �-. EQ., � © O C Mo O W a o O z A P4 5 � i '° 00 O V W qVb vV ■ O o 0o a Z O bA v U -! 0 O s N d F w z ■ Z o z � . U W z U 0 -o v - v M� z BE Ln V o O V 1309. y x = o ��cn �I a w x � � b BUIgar MENT VILOOK Lu 1 APR — 7 ��Zz 938 KING ,NY 10573 I (914)939-5801 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 Approval Date: APR ,1 Permit Fee: $, Approval Signature: Other: Disapproved: frees 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): _N/A Aboveground Tank 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, I(I IM-11 ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and�nsiall 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 ( ) •RemovalD'•Abandonment{ }/Above GroundJ',t*N'• Buried in Ground( ) 1. Address: 6 Tamarack Road SBL: 135.67-242 Zone: 2. Property Owner&Address:Kevin McNamara 6 Tamarack Road Rye Brook,NY 10573 Phone#: 917-577-4304 Cell#: email: K1998@aol.com 3. Contractor&Address: Innov8tive Environmental Services 392 Columbus Avenue Valhalla,NY 10595 Phone#: 914-449-6608 Cell#: email: servicenu.innov8enviro.com 4. Applicant: Innov8tive Environmental Services Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com 5. Indicate Fuel Type: Fuel Oil ( •L.P. Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: Removal of(1)330 Gal AST 7. Exact Location(s)of each Tank: Basement of the home t 6/1/2020 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual 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 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 ` A& Sworn t before me this day of 20 ZZ— day of ,20 'ZZ L i�Jt'iLv. Signature of Property Owner Signature of A icant ^z-tll„/ M e q p� Donald Feeney in ame of Prypert Ir jIN me of ApRlican AAAMQ� 161r- NQRINE M YEA NORINublicNotary Public,State of New York oary Public, W YorkUc.No_01ME6130633 Lic.No. CQualified In Westchester Goon pualtfled in WCo2076<Commission ices July_este 5,20 commission Ex5,20 must be properly completed in its entire y an 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. 2 6/1/2020 } Z Y U Y O co O E m c0 N F- >1 cD d' I ! V1 0 I I � U 00 .° ca ,� c1 0 \ > a G c 'c ]J 0 I V i ? — >) v CU � c o > 0) 3 rain 1N3WiH 3a ONIaiine cu E o w r NMI9 3A l 30 3Obllin 00 0 - ZZOZ L - ddd 0 N m L + = > i 4 6 INNOVt, TIVE ENVIRONMENTAL SERVICES INC . May 2, 2022 Village of Rye Brook Building Department D [C IEUVLF 938 King Street v — Rye Brook, NY 10573 MAY - 2 2022 RE: Kevin McNamara VILLAGE - RYE BRGGK 6 Tamarack Road BUILDING DEPARTMENT Rye Brook MP-22-058 To Whom It May Concern, This letter is regarding the work performed at 6 Tamarack Road, Rye Brook, New York in accordance with permit#MP 22-058. Innov8tive Environmental Services (IES)was contracted by Kevin McNamara to remove (1) 330 Gal Aboveground Storage Tank(AST) from the basement of the home. IES began the removal process April 6, 2022. IES pumped 16 gallons of waste oil and sludge out of the aboveground tank. A liquid waste manifest is attached for your viewing.The AST was then cut and cleaned in accordance with DEC regulations.The tank was found to be free of any breaches or contaminants. An inspection was performed by the Village of Rye Brook building inspector, where it was determined that the scope of work was completed in accordance with the current regulations.The tank was then removed from the premises and recycled at M. Miller's Scrap Iron & Metal Co., Inc., Portchester, NY. A scrap tank ticket is attached for your viewing. At this time, IES is requesting closure of permit#MP 22-058. Please advise if any additional information is required. Thank you, v j7/�1 Donnie Feeney Innov8tive Environmental Services Innov8tive Environmental Services Inc. 392 Columbus Avenue, Valhalla NY 10595 serviceCcDinnov8enviro.com 1 (914) 449-6608 www.innov8enviro.com NON-HAZARDOUS WASTE MANIFEST Please print or type (Form designed for use on elite(12 pitch'typewriter) NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest WASTE MANIFEST 2.Page Document Na. 1 of 1 3.Generator's Name and Mailing Address �.kIMQ+f�- �Tawlo�racl�- 4.Generators Phone 5.Transporter 1 Company Name 6. US EPA IA Number InnOv8tive Environmental Services N Y R 0 0 0 2 3 g 2 1 0 A.Transportte r1 Phone ID B.TransporieriPhane 914-449-6608 7.Transporter 2 Company Name B. US EPA ID Number C.State Transporter's ID D.Transporter 2 Phone 9,Designated Facility Name and Sile Address 10. US EPA tD Number Water Works E.State Facility's ID N Y 0 9 $ 6 9 0 8 0 8 5 77 Stewart Ave Newburgh, NY F.Facility's Phone 645-561-4111 11.WASTE DESCRIPTION 12. Containers 13. 14. Total Unit a No. Type Quantity Wt.Ival. Non RCRA, Non DOT liquid (Oily Water) 1 T T Gallon G b• E N E R c. A T O W R d F- U) G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above O In Ix a 15.Special Handling Instructions and Additional Information Z Approval a z 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects in proper condition for transport.The matenals described on this manifest are not subject to federal hazardous waste regulations. PrintedFTyped Name Date Donald Feeney - As Agent forinr� month ,7Day Year TR 17.Transporter 1 Acknowledgement of Receipt of Materials N Printed/Typed Name Signature Date Month flay Year S Sean Fenelle P Q 18.Transporter 2 Acknowledgement of Receipt of Materials R ( Printed/Typed Name Date E Signature R 19.Discrepancy Indication Space Month Day Year F A C 1 20A Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in it 19. I T PrintedfTyped Name Date Signature Y Month Day Year M.Miller's Scrap Iron & Metal Co., Inc. 69 Traverse Ave. * Portchester, NY 10573 Phone: (91 4) 939-1357 COPPER COPPER BRASS LEAD ALUM SS BATT , STEEL CAST LT IRON MAX I _ TARE R NET " iY�51� �flf V �1� V ��. '�• �l V 1'a 1 Mull<n 11 1��4 e34Yr,.11 �. "s o3'.11 �... � �� •. .. .1. ,�(0)>I E O EL N if ca z � U .C:�" • /�L v w y �.. y w = o section '14 Z Cn z 2F Goo 1 r 'I � w � ri c L �yLLJ N C WNW w � > �. I a� 00 r�z� CC Myl Z y t� i d.t�,'': fir• = � � r 00 rA aj IS Vol DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 2/15/2022 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 Mt Pleasant Capacity NAME: EVlta DermanisPHONE FAx P.O. Box 1689 914-205-7682 A/c No):914-205-7682 Pearl River NY 10965 ADDRESS: Evita.Dermanis m ca .com INSURE 8 AFFORDING COVERAGE NAIC 0 INSURER A:Century Surety Company 36951 INSURED INNOENVI INSURERS:Progressive Casualty Insurance Company 24260 Innov8tive Environmental Services Inc. 392 Columbus Ave INSURERC: Valhalla NY 10595 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:903137522 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 ADDL SUER - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CCP1039913 2/14/2022 2/14/2023 EACH OCCURRENCE $1,000,000 _ �OCCUR DAMAGE T RENTED CLAIMS-MADE PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000.000 X POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ B AUTOMOBILE LIABILITY 016663982 1/15/2022 1/15/2023 COMBINED SINGLE LIMIT $1,000.000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPER DAMAGE $ AUTOS ONLY AUTOS ONLY Per aoddTY t $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED 1 RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability CCP1039913 2/14/2022 2/14/2023 Each Claim 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 938 King Street UTHORIZED REPRESENTATIVE Rye Brook, NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, LOTH FLOOR,WHITE PLAINS, NY 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^ ^^^^^ 824703808 = �P-b ti•��+., t M. MT PLEASANT CAPACITY AGENCY 1 BLUE HILL PLAZA STE 1689 PEARL RIVER NY 10965 O i SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER INNOV8TIVE ENVIRONMENTAL VILLAGE OF RYE BROOK SERVICES INC 938 KING STREET 392 COLUMBUS AVENUE RYE BROOK NY 10573 VALHALLA NY 10595 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2455 047-7 990590 10/02/2021 TO 10/02/2022 10/6/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2455 047-7, 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 DONALD FEENEY VICE PRESIDENT FRANK MORACO INNOV8TIVE ENVIRONMENTAL SERVICES 20F2 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: 452625305 U-26.3