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HomeMy WebLinkAboutMP22-150 LL�`{y Y Ji7 i 4c . 19 401A annr'uzr m* 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 Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE October 19,2022 The Estate of Lois Balfe 38 Windsor Road Rye Brook,New York 10573 Re: 38 Windsor Road, Rye Brook,New York 10573 Parcel I D#: 135.60-1-43 This document certifies that the work done under Mechanical Perrr it #22-150 issued on 10/3/2022 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 �yE BR(�k• cu � 19132 BUILDING DEPARTMENT ❑BUILDING INSPECTOR XSSISTANT 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 : \l 1 JOCL DATE: 1()t1-� 1.�- 2�? yj PERMIT# ISSUED: 1`J �sicT: \ � BLOCK: ' LOT: �� LOCATION: Y >��5� d� ��!� 1-c= 1 OCCUPANCY: `' r i ❑ 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 1I_ -.S �V -2"[ �, X ❑ L.P. GAS FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ tn ° N N H a y a� O F1 3 v � W L a acd °� h �N n G1 03 4 .. N Gz. A o a ti W Z g v Lo O �3 w o «0 o p Q = 1 i 'b = o r--t W 00 W � � c - 1-40 ONO W Q f" � A Jz 00 M—( Q W �' W �j � x N � zz zz U b aw � O V � = y W S C, O p ozo H a wc � v � Iv W Z o O O D� U V `i o " © � Z � a � y a"•v o oo z o ►� v BUILDING DEPARTMENT R `_� " F, DD VILLAGE OF RYF, OOK SEP 2 8 2022 938 KING STREFF RYE BR' ,NY 10573 (9I4), VILLAGE OF RYE BROOK s-.. 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) 1 ()R (*TR l ("SF (YNI 1 i s �Q� /. Q Approval Date: OCT - 3 Z�ZZ Permit Fee: $ 3 7©—/` ,6 Approval Signature: Other: Disapproved: (fees are noon-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: $185.00 per Tank. 5. Dig Safely New York# (dial 81 1): IV i+ 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, 9/30122 , 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 Type: Installation • Removal (X) • Abandonment( )/Above Ground (X) • Buried in Ground ( ) I. Address: 38 Windsor Rd. SBL: 135160—Jl 7(=-)Zone:� 2. Property Owner&Address: Susan Balfe (executor) 38 Windsor Rd. Rye Brooke, NY Phone#: (914) 229-1945 Cell#: email: mbalfel953@gmail.com 3. Contractor& Address: Advanced Environmental Phone#: (914) 761-8020 Cell #: (914) 906-8878 email: info@thetankspecialists.com 4. Applicant: Advanced Environmental Phone#: (914) 761-8020 cell#: (914) 906-8878 email: info@thetankspecialists.com 5. Indicate Fuel Type:Fuel Oil►}O•L.P. Gas( )• Gasoline( )• Other( ): 6. Number and Capacity of each Tank: Remove an old 275-gallon aboveground fuel oil tank from basement; cut & clean; dispose of tank--- Install new 275-gallon aboveground fuel oil tank in basement 7. Exact Location(s)of each Tank: basement ► 8/12/202 t ST E OF NEW YOM COUNTY OF WESTCE]rSTPR ) as: yf� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual si tng as the applicant) and fur* r states 1hat(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 r! _ Sworn t eforeL � day of 20 ?� day of — of PropertyIr Signatturo pplicant — Susan i3alfe 1. ,t f�,1+ Ad ed Environmental Print Name o Property wn P mt a of Ap ,icant JOHN B.COLAN©ELO It I N ota u rc 'I!'Public,State of New York No.4708504 N Qualified in Westchester County / BARBARA LEVY Commission Expires My 31,2C NOTARY PUBLIC,STATE OF NEW YORK Registration No. 01 LE6392102 This application must be properly completed in its entirety and must 'nclu0e�fltemlattiti:aigt�atutly of the legal owner(s) of the subject property, and the applicant of re tdhimjdsWta sprovidddaAZ(y 2023 application not properly completed in its entirety and/or not properly stgtit s a e eemearld void and will be returned to the applicant. 2 6/1/18 17171] 17� i v - L• way Residential oil tanks / UL 80 Product# Capacity Model Gauge Dimensions Weight (US gal.) thickness H W L (lb.) 209101 120 vert. 12 47" 23" 30" 170 208101 138 vert 12 44" 27" 30' 160 208601 138 horiz. 12 27' 44" 30" 160 207101 220 stubbies/vert. 12 44" 27" 48" 220 203201G 230 thiNvert.grey 12 44" 22" 60" 235 203701G 230 thin/horiz.grey 12 22" 44" 60" 235 202201 240 narrow/vert. 12 47' 23" 60' 265 202701 240 narrow/horiz. 12 23" 47" 60" 265 204201 275 vert. 12 44" 27" 60" 255 204701 27" 211201 275 vert, in 44" 27" 60' 330 211701 275 horiz. 10 27" 44" 60" 330 205201 330 vert. 12 44" 27" 72" 290 _- 205701 330 horiz. 12 27" 44" 72" 290 External finish:BLACK or GREY electrostatic powder paint Warranty*: 10 years Touch up paint: PE0030C"BLACK" PE0032C "GREY" Cylindrical models horizontal Product# Capacity Model Gauge cover Dimensions Weight (US gal.) thickness Shell Dia. Height (lb.) 3005224 138 horiz. 12 12 26' 60' 165 External finish:BLACK electrostatic paint Warranty*: 3 years 'Consult warranty documents for details. \ ,y" v. t' v r� t tt`�t�• �J"'3(`� � t tl� ff t,y r ig'tJ f1 1r► c tl. ff .21` 4� ♦♦ �1 '� :�• �, /;, - 11 1 1}I { .�\11 1 7-,. tyll I t s It1�//1�+?: s ss•.':;+Il�llt�l<,�,a s F.�l {�11 ;�_` c f /1 / y rA Ch �� } �` ... O `w - .• 0 Poo ci cs _ \ fix: l! Vl W Z N j � ction .��.� � � � to � .� = � � o • „ ,��� , jl' f'- Z U p W h =Wit► U iI(f ) " W c \ / ( G � W Q 0 LL 1 a W = � 04 t W Z W `��.A �1 Q ►� W Q Q -E CA CD tA)) [ N O y N t z • L O ,�Y OF / � •to ¢ 1 :. i A! °+ �+a',' !1 +)..ems sxs• y� 11_• t s s `1}`ill m ,Oty, .�� . 1 � +t'!1 11111-���: •tr`II{I1111}y ,,� - 14/+�+1+1 Ij{}+}/�l 11}11`1y1 /� 11h11~rIf}/11/jh1 f ►i+i1 A 11111 A� ♦♦ . , >A � f♦ ws f A �1♦ A ♦1ti(A� tM ^ ( it n` �p 11 �4 � ,,gy�pp •�e,• i _ 'Mi'.r - vi f ADVAENV-01 CNADEL ACORO CERTIFICATE OF LIABILITY INSURANCE DATE /28120 1028/20 1 21 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. PHONE 989 Main Street (A/C,No,Ext):(845)896-6727 SAC No):(845)896-6877 Fishkill,NY 12524 ADDRE : INSURERS AFFORDING COVERAGE NAIC 0 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 INSURERD: 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 LT A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE X OCCUR ECP2004113-20 11/7/2021 11/7/2022 DAMAGE TO RENTED 100,000 X P I ES Ea occurrence $ X Contractors Poll MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY F_x]ipra LOC PRODUCTS-COMP/OP AGG $ 2,000,000' OTHER EACH POLLUTION $ 1,000,000 B AUTOMOBILE LIABILITY (CEOMBINED, S ccidentINGLE LIMIT $ 1,000,000 ANY AUTO BAP 7971105 11/7/2021 11/7/2022 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILYBODILY INJURY Per accident $ X AUTOS ONLY X AUTOS ONLY PPeOaR DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ?DED XCESS LIAB CLAIMS-MADE AGGREGATE $ I I RETENTION$ $ C WORKERS COMPENSATION PET LITEERH AND EMPLOYERS'LIABILITY YIN WC 7972682 11/26/2021 11/25/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE F N/A E.L.EACH ACCIDENT $ OFF ICERWEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 600,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I 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 9 King Street .Ryy e Brook.NY 10573 ACORD 25(2016103) ©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) lb. Business Telephone Number of Insured (914)761-8020 Japanese Import Specialists, LTD dba Advanced Environmental 33 Hayes Street ic.NYS Unemployment Insurance Employer Registration Number of Insured Elmsford,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(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"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,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 or licensed agent of insurance carrier) Approved by: a C 12/47/2021 (Signature) (Date) Title: President&Chief Operating Officer Telephone Number of authorized representative or licensed agent of insurance carrier:(845)896-6727