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HomeMy WebLinkAboutMP22-135 t;; L`y"O A" CnuuumaW 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..or TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie j. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE December 5,2022 GEOLIF LLC 48 Rock Ridge Drive Rye Brook,New York 10573 Re: 48 Rock Ridge Drive,Rye Brook,New York 10573 Parcel ID#: 1.35.28-1-17 This document certifies that the work done under Mechanical Permit #22-135 issued on 9/1/2022 for the removal of two above-ground oil tanks have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to QyE BRO 1932 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: �" 1 l DATE: L V PERMIT# ( �.C�' 1 � ISSUED SECT: L BLOCK: ' L07 LOCATION: `�� - C=\� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... [ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION ` REQUIRED ❑ FOOTING w1� ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING _ ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS -© FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION l ❑ FINAL ❑ OTHER m , M w N Qeq — _ PL4 D O PC qq ® - n.i y W u`ni W Cn a \ o CA � OG � v y � O 4�J �'" E„y ■ a W ►n H � @ � ���++ � w Lin � Q ■ I..� O 00 W W ° C o H '� � U 00 W \ V z a O en e� N 0 o � a � � w oc CY VvU .2 z W V O Ho a $' �zo AO W A 4J H w z od91o � V W o F .v) 7° ' BUILD MENT D � `�' ��W VIL OF RY OOK AUG 3 0 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) FOR OFFICE USE ONLY: PERMIT SEP - 12022 Approval Date: Permit Fee: $ 04 2S Approval Signature: Other: Disapproved: lees 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, 8/30/22 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 Tvpe: Installation ( ) • Removal(x)- Abandonment( )!Above Ground (X)•Buried in Ground ( ) 1. Address: 48 Rock Ridge Dr. SBL: 3-5�r -- —/lane: -)0 2. Property owner&Address: Gesthimani Kouloukis 1 Nikki Dr., White Plains, NY 10605 Phone#: 646-261-7166 Cell#: email: gessie@geoliflle.com 3. Contractor&Address: Advanced Environmental Phone#: (914) 761-8020 Cell#: (914) 906-8878 ;;: info�7a thetankspecialists.com 4. Applicant: Advanced Environmental Phone#: (914) 761-8020 Cell#: (914) 906-8878 email: info@thetankspecialists.eom 5. Indicate Fuel Type: Fuel Oil 00-L.P. Gas( )-Gasoline( )-Other( ): 6. Number and Capacity of each Tank: Remove two (2) 275-gallon aboveground fuel oil tanks from basement; cut & clean; dispose of tanks 7. Exact Location(s)of each Tank: basement 8/12/2021 STA�F 1��RK,COUNTY OF WESTCHESTER ) as: ►'halfr+ ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and fiplher states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C;5r*(&r AQ I 1(O"LW 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 'Se314A Sworn to before me this 13 0-M day of A-a6UJT- 20,9A day of !;'j ,20 e Signature of Property Owner Signa re of Applicant 665NIMAW Kot1t_OLkL-S 5�-- —t�'�� hart Print Name of Prop% Owner int a pAo tl c RENATA PRENDERGAST '00" /*4440 Notary Public-State of New York] otary Public No.01PR6430969 otary Public Qualified in Dutchess County My Commission Expires 03/2812026 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. z 8/12/2021 �� �— c � � J L a �. � '�� �" � �, �-, � it � � � � � = � � � � j C,�.J � i � ' _.. � . -�t� s �� ,, � �- � r`�.� r � � �._ i advances advanced 33 hayes st elmsford. ny 10523 environmental telephone: 914/761-8020 facsimile: 914/761-8260 info(oMetankspecialists com Proposal/Contract August 30, 2022 Gesthimani Kouloukis Site: 48 Rock Ridge Dr. Rye, NY 10538 (646)261-7166 Bessie ,geolifllc.com Advanced Environmental proposes to perform the Removal of an aboveground oil storage tank. For this project, Advanced Environmental will supply labor, materials and equipment to perform the following services. Job Description: ❖ Removal of two(2)aboveground oil tanks($1,500.00) ❖ Disposal of all in-tank sludge as per code ❖ Disposal of old tank as per code ❖ Dispose of any old piping as per code ❖ Rye Brook permit fee($370.00) ***Contaminated soil and/or water removal, disposal & transportation, labor and any occurrences having to do with an environmental incident will be an additional charge and a separate contract will be issued for that proposed work. The remediation contract described will be separate and non- contingent on the obligation of this Proposal/Contract. Any Change from the above specifications involving extra costs found during or after the job will he made upon written agreement and will become an extra charge above the Proposal/Contract. THIS PROPOSAL F,aPIRF.S IN 60 DA ITS. Advanced Environmental proposes to perform the work as stated in this Proposal/Contract in a workman- like manner for the sum of: One Thousand, Eight Hundred & Seventy Dollars ($1,870.00). Payment terms are % down and the balance due upon completion. Late fees apply. All official documents from the Town, Fire Dept, DEC, Westchester County and Advanced Environmental will be furnished only after full payment is received. Advanced Environmental will take all necessary precautions to ensure that there will be no damages to the property. We will not assume liability for personal injury or property damages beyond the curb line which are unforeseen or NOT properly marked out. (i.e. easement, masonry, asphalt, concrete sidewalks, retaining walls, walkways, patios, a/c units, fencing, trees, any subsurface conditions, electric,water or sprinkler lines.) .4cceptance clf ProposalCwntract: The above price, specifications, terms and conditions are hereby accepted. You are authorized to do the work specified. Payments will be made as outlined above. Please sign and return this Proposal/Contract with the deposit and print one for your records. Please feel free to call with any questions. Thank you for your consideration and we look forward to working with you. DATED: SIGNED: (property owner) • \ �`i►'P 't9• �� 'nt^7A.A' a.. °A 'a.,/�. sQ�f �Si s A 3ifs A A+F l �f '?S^ _ ')i" � A�v..`t-�•......: s' A K}K�'s.- ... "�1yj�� - A'!�AYJN�f• ,. - A- ` J u�yy -"�C1 YtQ4R i ���3'�•'$My ��� �i..-,♦1• YOr I� •• .• � 4 s:•��� �Ss 6 ,iYatl .:�� , v hi�. •�+� � Q•-•4'�'�, A M. � ,f+•+•+! _.�i � yf;+�i'�'1't ._, , ''+'i!'i'tl ,: I++tl1►,+k .�,�!!t I� 1 �°, �� ;;�h 1111'�;�-< 1 t_,.;���-•f If,�=s.�*�:•<..:�INtI',>�,�,,��;,�.,:�3.M 1/_r3:.�. �*�..fllh .....�: s�' /ld � 4c ) r vt M : S. N y iC O :-• 7 ` w•� ). N ciL J _ t(b)1 ti Y . to Q 2 91, W o x 4r, Z Lij �+" U L section <�►• �" U 7 � �R• Wit, v/ > OC-11 `�V ��~ Nli� ••`/ s� w o _ �? LE CIO W Q W o " L :tw `1 • ' a 4� 1; 3 At w �l C33 1; ;,: LO N .3 cn r� y ►` ' i s rj V LY+ P , V'¢. KO)> (b)►. "� s-c•-,r^-- -r-**� t:. , ss'^�i " k.:r 4 11 •Sz,a•3 _ `�3'_ 1 11 �k -,4) ( t! 1 t ` .•-.. `, f 1+114 t t t ? pN +i�i( i► it.. '•'•'1 . )�!�( i► •14 1 ti► 1••1 a ^r 1+. ,1 A ', - •• ^'¢4f•�iH�^ :t' •n .r< •'�`I � w }7 ii �A . Yi.r '' � f-<., �;r[4,SR �` �J" Yr�•b .� r�iri4�E:" 1P�S. �4:a,`:+. v ADVAENV-01 CNADEL DATE(MMIDD/YYYY) `4�o�zo CERTIFICATE OF LIABILITY INSURANCE 10/28/2021 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(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 NAME: Emery&Webb,Inc. PHONE 989 Main Street (A/C,No,Ext):(845)896-6727 (� No):(845)896-6877 Fishkill.NY 12524 E-MAIL INSURERS AFFORDING COVERAGE NAIC k INSURER A:Great Divide Insurance Company 25224 INSURED INSURER B:All America Insurance Company 20222 Japanese Import Specialists, LTD INSURER C:Central Mutual Insurance Company 20230 dba Advanced Environmental 33 Hayes Street INSURER D: Elmsford. NY 10523 INSURERE: 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 EXP LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FXJ OCCUR ECP2004113-20 11/7/2021 11/7/2022 DAMAGE TO RENTED 100,000 X PREMISES Ea occurrence $ X Contractors Poll MED EXP(Any oneperson) $ 5,000 1 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F PEe7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER EACH POLLUTION $ 1,000,000 B AUTOMOBILE LIABILITY EOMaccdeD SINGLE LIMIT $ 1,000,000 ANY AUTO BAP 7971105 11/7/2021 11/7/2022 BODILY INJURY Per arson $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-AWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accdent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ _ _ $ C WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y WC 7972682 1,/25/2021 11/25/2022 TAT T, ER 500,0001 ANY PROPRIETORIPARTNER/EXECUTIVE a NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured with respects 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. AUTHORIZED REPRESENTATIVE Village of Rye Brook 938 King Street IRye 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 Ia. Legal Name& Address of Insured(Use street address only) Ib. Business Telephone Number of Insured (914)761-8020 Japanese Import Specialists, LTD dba Advanced Environmental 33 Hayes Street le. NYS Unemployment Insurance Employer Registration Number of Insured Flmsford,NY 10523-1827 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 13-3602461 2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Central Mutual Insurance Company 3b. Policy Number of entity listed in box"la" WC 7972682 Village of Rye Brook 938 King Street 3c. Policy effective period 11/25/2021 to 11/25/2022 Rye Brook, NY 10573 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"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NV)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"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 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,1 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 repr,,—)esejntatiiv/ve►�or licensed agent of insurance carrier) Approved by: �/^' F• GAS 12/17/2021 (Signature) (Date) Title: President& Chief Operating Officer Telephone Number of authorized representative or licensed agent of insurance carrier:(845)896-6727 advanced advanced 33 hayes st elmsford, ny 10523 environmental telephone: 914/761-8020 facsimile: 914/761-8260 i n fo(cDth eta n ks pec is I i sts.co m D [EC(2C DV1E October 5, 2021 NOV - 4 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT j Village of Rye Brook 938 King Street Rye Brook,NY 10573 Building Dept. RE: permit# MP 22-135 Site: 48 Rock Ridge Dr. Dear Inspector: On September 28, 2022, Advanced Environmental performed the removal procedure of two (2) 275-gallon aboveground oil tanks at 48 Rock Ridge Dr. in Rye Brook,NY. Enclosed please find all manifests needed for closure of the Rye Brook permit. Thank you and please do not hesitate to contact me if you need any further information. Sincere , Stuart F e man Advanced Environmental Enc. i 2 Pere 7 a( S. Kin. ,nc ., jow ST ~ ROG VILLAGE OF RYE BROOK _y4 -ems Ry; A t� $ BUILDING DEPARTMENT — NYRO`0?0904 3 Trr 6r r 2�* sir?Aizrte U.S.EPA M INari; ' P T U.S.EPA!B t�oft, ENVIRC JVAS.E 279 RT. 6 NY00444825E34e N!AH0PACC, NY 105 A J s !6 erld 4}3S Ort 5.�Wjftm '1.Tc 12.vri: Tye - PETROLEUM CONTAMINATED SLUDGE. NON 0,9.T, NON RCRA i 7 ! PETROLEUM CONTAMWATED WATER,NON D.Q.T.,NON RCRA ' I TT G 1 I t II ~� e b M � 61,nc%t"7ro �. Ait4+:!: �Lj t�` 9t+':FiPI;` "L'✓w 5 r. pg 1 d'r �"��I"`t,�,�3F�+ {. � eY`�+��G'�;�` .� ....s � �!P`•°'�y=�1itr1A'J�k"3&^a:9.q�,Y�J.Tc-?�`^�'!212�iE.["..c. 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