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HomeMy WebLinkAboutMP22-121 d�4 b�✓d AM anniveomiq VILLAGE OF RYE BROOD MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher).Bradbury www.iyebr(>ok.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michaela. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 16,2022 Cohen Purchase Building Company LLC 975 Anderson Hill Road Rye Brook,New York 10573 Re: 975 Anderson Hill Road, Rye Brook,New York 10573 Parcel ID#: 129.34-1-42 This document certifies that the work done under Mechanical Permit #22-121 issued on 7/28/2022 for the removal of a 1,000 gallon above-ground gasoline tank and a 500 gallon above-ground diesel tank has been satisfactorily completed. Sincerely, Steven E. Fews Assistant Building&Fire Inspector /to �E aR(b, F0 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 :— PERMIT# �1 �2- , ISSUED: 2.�SECT: BLOCK:LOT: C� LOCATION: l v t�l�� C� C'0"�L- OCCUPANCY: 107 ❑ 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 ❑ L.P. GAs � �O r FUEL TANK y� FIRE SPRINKLER G ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER s _ N N g ■ N C 000 w N N g _ 1 ► � � n a 4-4 rA ' 0 O 0 ~ Lw p p 'u -E O bA s u0 cl _ Q7 O Gv0 Q �QC o p CA 11 a w r' to © z © - a o � a An t~O00 � F-I z V A z u r—a IU4 x A g oa (, : ^O ,O � t G a w w A u � o . b H Oa,� v a Ln 04 CA y 0 v 0 i BUILD � � MENT VIL E OF RY OOK JUL 2 6 2Q22 938 KING � ET RYE BR �,NY 10573 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#: ,/�/�o1+d I Approval Date: AUG 1 �QZZ Permit Fee: $ 7o—I 1.J 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#C 105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal, Abandonment,or Installation: 8185.00 per Tank. 5. Dig Safely New York#(dial 8 l 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 Permit Tvae: Installation ( )•Removal 4�•Abandonment( )/Above Ground (Y". Buried in Ground 1. Address: 7 761 l i'0 f/ ,�r, SBL:/ 4 7�.J J `I 7 4 Zone: /01'�p r, 2. Property Owner&pAddress/' P,& �U,[ �� ��y�, Phone#: ` l4`0 lq-c>74 Cell#: email:rn QYW . 40*1 3. Contractor&Address: U� Phone#: Cell#: email:�Qj, V1YQ�O�CLWY.!'rtsf 4. Applicant, p Phone#:d'7�7y/, -(?o1O'.P0 Cell#: email: Dt F�;b7Vt1y OD t't 5. Indicate Fuel Type:Fuel Oil( )•L.P.Gass(M( )•Gasoline(v=Other(V DIESPI l 6. Number and C pacify of each T : iJ��[/ V l -4' o l QIID� ✓ vI 7. Exact Location(s)of each Tank: SO t 8/12/2021 STATE,OF NEW XOM COUNTY OF WESTCHESTER ) as: ,K44�—rhxrph ,being duly sworn,deposes and states that he/she is the applicant above named, (punt name of individual signing as the applicant) and further her 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 be ore me this o2oZ MD Sworn Ctobebefore me this a1� day of � ,20 ACL. day of JU Signature of Property Owner Signa plicant rin N e of Property O ner Print Name of Ap74' E C.CITRONE C Notary blic dt ry ubHa,Stets of New York Notary Public PATRtC17�C1 W15 No.01 MA6030446 NOTARY PUBLIC-STATE OF NEW YORK Qualified In Westchester County No.01 LEg277606 Commission Expires Sept, I3,JD Qualified in Putnam County This application must be properly completed in its entirety and must include A&ri i ,n Expires03-11-2025 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. z 8/12/2021 Licensed Contractor 936 Route 6 Westchester Co. #WC-13721-1-103 and M8h008C,NOW York 10541 Roc PutnamoCo.#PC2299 A 0-00 60 TEL M51626-3610tl* N.Y.S.D.E.C. #3A-491 E.P.A. #000047506 BBB Wadls/te.• mm..dutchessenr/iio.coni Proposal MM dutchesseae/ie-dc®atcastnet go Date Phone Submitted to: 6/13/22 Westchester Building Job Location Email Company ALICHT cohenbrothers.com 975 Anderson Hill Road Cell 333 Westchester Ave. Rye Brook,NY 914-997-1235 White Plains, NY We hereby submit specifications and estimates for. Removal of a 500 gallon aboveground diesel storage tank. Dutchess Environmental Construction will supply the labor,materials,and equipment to perform the following: • File any applicable permits—WCDOH Tank ID#6 NEW. • Cut open top of tank. • Vac-Truck to remove and dispose of remaining product(liquid disposal additional$1.25 per gallon,sludge and tank bottoms @$4.00 per gallon). • Enter and clean tank(confined space entry personnel). • Remove and dispose of old fill and vent pipes. • Disconnect& Remove fuel dispenser unit. • Inspect inside of tank. • Remove and dispose of tank. • Set-up inspection with the WCDOH. • Issue tank certificate(if no leakage is found)and remove tank ID#6 NEW from WCDOH PBS Registration. Total: $3,115.00 (Plus tax if applicable) Options/Notes: Laboratory analysis soil sample(s)@$375 per sample. Concrete core boring for soil sample collection @ $200. Not included in this estimate: Any and all permit fees,including local permit fees. Any and all labor,material,equipment,testing, permits and trucking for the removal and/or disposal of contaminated soils and/or water. Payment: We propose to furnish material and labor,complete,in accordance with above specifications,for the sum of.• Three thousand one hundred fifteen and 00/100 Dollars($3,115.00) (options excluded). To be paid as follows: One third upon signing of contract,one third upon start of work,one third upon completion of project. All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders, and will be an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents, and delays beyond our control. NOT responsible for utilities not marked out by U Dig NY. Our workers are fully covered by Workmen's Compensation Insurance. Any costs incurred in the collection of any amounts due Dutchess Environmental Construction will be paid by the customer. Returned checks will be subject to a$45.00 handling fee.Dutchess Environmental Construction will not be liable for damage to any underground utilities that do not have their locations adequately marked out or the existence of which is unknown to Dutchess. Note: This proposal may withdrawn by Dutchess Environmental Construction if not accepted within 30 days. Acceptance of Proposal: The above prices,specifications,and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: Date: Page 1 of 1 —Office/Customer Copy Licensed Contractor 936 Boole 6 Westchester Co. #WC-13721-H03 Rockland Co.#H-09869-10-00-00 Whom,New York 10541 Putnam Co.#PC2299-A TEL[8451628-3610t1w N.Y.S.D.E.C. #3A-491 E.P.A. #000047506 BBB WB4SNO.' www.dutcUssenulrucem Proposal Ehlt8/k du[c/tessend/ieQcomcastnet IM submitted to: Date Phone 6/13/22 Westchester Building Job Location Email Company ALICHT@cohenbrothers.com 975 Anderson Hill Road Cell 333 Westchester Ave. Rye Brook,NY 914-997-1235 White Plains, NY We hereby submit specifications and estimates for: Removal of a 1,000 gallon aboveground gasoline storage tank. Dutchess Environmental Construction will supply the labor,materials,and equipment to perform the following: • File any applicable permits—WCDOH Tank ID#4 NEW. • Neutralize and vent to below LEL. • Cut open top of tank. • Vac-Truck to remove and dispose of remaining product(liquid disposal additional$1.25 per gallon,sludge and tank bottoms @$4.00 per gallon,gasoline disposal(g$5.25 per gallon). • Enter and clean tank(confined space entry personnel). • Remove and dispose of old piping. • Disconnect& remove gas pump dispenser unit. • Inspect inside of tank. • Remove and dispose of tank. • Set-up inspection with the WCDOH. • Issue tank certificate(if no leakage is found)and remove tank ID#4 NEW from WCDOH PBS Registration. Total: $4,645.00 (Plus tax if applicable) Options/Notes: Laboratory analysis soil sample(s)@$375 per sample. Concrete core boring for soil sample collection @ $200. Not included in this estimate: Any and all permit fees, including local permit fees. Any and all labor,material,equipment,testing, permits and trucking for the removal and/or disposal of contaminated soils and/or water. Payment: We propose to furnish material and labor,complete,in accordance with above specifications,for the sum of Four thousand six hundred forty-five and 00/100 Dollars($4,645.00) (options excluded). To be paid as follows: One third upon signing of contract,one third upon start of work,one third upon completion of project. All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders, and will be an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents, and delays beyond our control. NOT responsible for utilities not marked out by U Dig NY. Our workers are fully covered by Workmen's Compensation Insurance. Any costs incurred in the collection of any amounts due Dutchess Environmental Construction will be paid by the customer. Returned checks will be subject to a$45.00 handling fee.Dutchess Environmental Construction will not be liable for damage to any underground utilities that do not have their locations adequately marked out or the existence of which is unknown to Dutchess. Note: This proposal may be withdrawn by Dutchess Environmental Construction if not accepted within 30 days. Acceptance of Proposal: The above prices,spec ffcadons,and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified Payment will be made as outlined above. Signature: Date: Page 1 of 1 —Office/Customer Copy All • `w s U �h,h'` � � ''hT;�'�'' --�D� ;{o�i �,ep�b(n .0�� `;.�C�t ,.5'4 f •gip ; ���p�./ . �,, p .. 7 Fti r;!�t ����'-�1�� r y,. 'r. ���� h �L' �,;.....�1♦ .,r •i';� '.:.-�1♦ ' ." a 'f ���� r .y ;,-��� ,r �� .. ♦�� �Jr 4 ;.��1(l/l(lil N VP �' '. �+' +'�• o ill - � •:�+ h 4" � W N tom, i Y �. V 0 •�� RS L' \ (0) a z F U y O co� , ♦ y Ir orb �n ray �s:' � V � O +�•� � jl�. �l *long . w N LLJ O U t� - o y� r- p • w 4 wTiP aQ d > O `Z i 1��y1 AA,, w % 6} ,tidy �I � In •.+ a, g� .•-•` ' W i Yg VIP. cu J o � y f' •"� : w � "� to •� f �^`, + 1 eC cc y� < a -S' _ �� x Gn rA i, • °' N -W cam dN -011 I -a 1 1II :III III Illlly ... ,�IIIIIIl�II '1'�I�lill' ''►'OOiI, 'llib�i�l' �illlill' , ''I'�l�li+l+; '1'4�I�h' , ,'' .: i y Y V ri •.•} py v y r •y J V .i y 'y r.J' ' V DUTCENV-01 BERM11 A�RD CERTIFICATE OF LIABILITY INSURANCE F E DATUM/2DIYYYY) 6/14/2022 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). CONTACT PRODUCER NAME: Emery 8r Webb,Inc. PHONE 896-6727 FAX 989 Main Street (A/C,No.Ext): (845) (A/C,No):(845) 896-6877 Fishkill, NY 12524 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER As Great Divide Insurance Company 25224 INSURED INSURER B:Ohio CasualtyGroup 24074 Dutchess Environmental Construction,Inc. JNSURER C:Technology Insurance Company 936 Route 6 INSURER D Mahopac,NY 10541 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 MMLDDY EFF MMLIC EXP LIMITS LTR 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE �OCCUR X ECP2003674520 9/2/2021 9/2/2022 DAMAGE TO RENTED 100,000 PR occurrent X Pollution MED EXP(Any oneperson) 5,000 X Professional Liab PERSONAL BADVINJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT X I OTHER Limited Contractual $ B AUTOMOBILE LIABILITY EOMBIcNdeDtSINGLE LIMIT $ 1,000,000 X ANY AUTO BA058545341 5/20/2022 5/20/2023 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ 1 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED I I RETENTIONS $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N TWC4113969 5/20/2022 5/20/2023 STATUT ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? FW] 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured with respect to General Liability,as required by written contract or written agreement,subject to the language of the policy. 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 AUTHORIZED REPRESENTATIVE Bldg Dept 938 King Street R e Brook NY 10573 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS'COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (845)628-3610 Dutchess Environmental Construction Inc. 936 Route 6 lc.NYS Unemployment Insurance Employer Registration Number of Insured Mahopac,NY 10541 Work Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State,Le,a Wrap-Up Policy) or Social Security Number 16-1533676 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Company Village Of Rye Brook 3b.Policy Number of entity listed in box"la" Bldg.Dept. TWC4113969 938 King St. Rye Brook,NY 10573 3c. Policy effective period 5/20/2022 to 5/20/2023 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"1 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 premium 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"30,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 the 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 on this form. Approved by: John C.Webb III (Print name of authorized representative e or lice ed agent of insurance carrier) Approved by: � (�• 5/19/2022 (Signature) (Date) Title: President&Chief Operating Officer Telephone Number of authorized representative or licensed agent of insurance carrier:(845)896-6727