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Home My WebLink AboutMP19-136 R`� 6 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rve Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R Epstein INSPECTOR Stephanie J.Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 23,2021 Benjamin Sheer&Carlen Sheer 4 Concord Place Rye Brook,New York 10573 Re: 4 Concord Place, Rye Brook,New York 10573 Parcel ID#: 135.44-1-51 This document certifies that the work done under Mechanical Permit #19-136 issued on 8/6/2019 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 /tg BR��r 1982• BUILDING DEPARTMENT ❑BUILDING INSPECTOR *ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK f ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.aebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 't DATE.. C7 PERMIT# ISSUED. SECT: BLOCK: LOT: ys lQo :. LOCATION: r ' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED 0 REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS f FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING CROSS CONNECTION ❑ FINAL ❑ OTHER Benjamin Sheer 4 Concord Place Aye Brook,NY I0573 f' Residential Oil Tanks / UL 80 Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge H W L (pounds) 209101 120 1 vert. 12 47' 23' 30" 170 208101 138 vert. 12 44' 27' 30' 160 208601 138 horz. 12 27" 44' 30' 160 207101 220 stubbier/vert 12 44' 27' 48" 220 207601 220 stubbies/horz; 12 27' 44' 48" 220 203201G 230 thinlvert grey 12 44' 22' 60' 235 203701G 230 thinihorz grey 12 22" 44" 60' 235 202201 240 narrow/vert. 12 47" 23' 60" 265 202701 240 narrow/horz. 12 23" 47" 60" 265 -t 204201 275 vert. 12 44' 27" 60" 255 204701 275 horz. 12 27- 44' 60" 255 _ 211201 275 vert. 10 44' 27' 60" 330 t ' 211701 275 horz. 10 27' 44' 60' 330 4 205201 330 vert. 12 44' 27' 72' 290 - 205701 330 horz. 12 27' 44' 72" 290 External finish:BLACK or GREY electrostatic powder paint Cylindrical Models Vertical r Capacity Thickness Dimensions Weight Product# (US gals) Model saw carer Shell Dia. Height (pounds) 3006622 150 DCV 560 11 12 30' 65" 200 3007622 185 DCV 690 11 12 30' 77" 225 3008622 220 DCV 825 11 12 30' 88" 255 External finish: WHITE polyurethane paint Cylindrical Models Horizontal Capacity Thickness Dimensions Weight Product# (US gals) Model Gauge Cover Shell Dia. Length (pounds) 3005224 138 Horz. 12 j 12 26" 60" 165 External finish: Black electrostatic paint - -�I I .�� w L,�•_� / -?: • 4 a ,,..y e, /�^ t� �` .. Z., r'.i7 ri. YY,►l,''] -°sj,; 'IY++111,ISY Sil? afl 'j fottlll,,r;t17`'" dY 1Y1 + !!t? dj, 1 r �3�ems, t • t 9± ,Y F .f'' 1!•y,.. K •,� .._!YI Yr. !� � 4 b..��y..hlillk�,.!��r � .Y ° r:c a -:h1r11!{''�.La.: O � o Q RCS C-4 y Y r ss u p, CD M E x C+9 - rw Y . a ' cV p it�ls�i e�a�pction'�N. ZrL (<t�s �".I Ga C7 Z) LL UJ 0 W T! ; Ak- c Q tu 0 r ' x U .e Y 841- O • Tj °1 co CD ° i. �.� .. ,IY9rr/ f �1° "-�� +: I k s<a. '_'T'�'T'r bpi'ti. "T1 J'-�-•-•�Tr--rT`"'f-. fis.--°—<--� 4YIj�111Yf�ej g YII 41 ± ri1 -s.a PY►'Y ee• °�G�':� -..Y�r1.-.•- Y f -.J,� w �,H�.,rr�'LJ�.. .,.. rye.+. � a�^9nT Ats.+�'e � �{j,�' -'f3lIPUsy V�, e ...�ti . _ - „yam,. � .�• --' u M,� ` T DATE 1MMIDDNYYYI AC Ro CERTIFICATE OF LIABILITY INSURANCE 11/1/2018 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: Hub International Northeast Ltd. ENE 203337-1815 ac Na: 777 Commerce Drive E-MAIL Fairfield CT 06825 ADDRE s: Salvatore,Sorce HubintemationaLcom INSURE �AFFORDINGCOVER_AGE NAICA INSURERAi Uberly Insurance Underwriters,Inc 19917 INSURED INSURER B:Evanston Insurance Company 35378 Singer Holding Corp. INSURER C: mr Libe Mutual Fire Insurance Coma 23035 dba Robison Oil — 500 Executive Blvd INSURER D:Employers Insurance Company of Wausau 21458 Elmsford NY 10523 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1018880021 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. I NSR' TYPE OF INSURANCE ADDL BR POLICY POCY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM1D01YYYY MMIDD/YYYY C X J COMMERCIAL GENERAL LIABILITY Y Y T62-04I-W127-028 1111/2018 11112019 EACH OCCURRENCE S20DD000 DAMAGET CLAIMS-MADE FRI OCCUR PREMISES Ea occurterlce S1DD,000 MED EXP(Any one person) S 10.0w PERSONAL B ADV INJURY $2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 POLICY 111 PE0 LOC PRODLICTS-COMPIOP AGG S 4,000,DD0 OTHER; I deductible S 5D,OOD C AUTOMOBILE IABILITY Y AS2E41445127-018 1111r2018 11112019 COMBINED SINGLE LIMIT I - $2 000 000 Ea acbd. X ANY AUTO BODILY INJURY(Par person) 5 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S X HIRED X NONZ NJE❑ PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per ecctdert Auto Pollution S CA99481013 A X UMBRELLAUAB X OCCUR Y 1000278838M 11/1/2018 11112oi9 LACHOCCURRENCE S10.ODD.000 EXCESS LIAR CLAIMS-MADE AGGREGATE S 10,000,000 DED RETENTIONS Fokw Form S D WORKERS COMPENSATION W1CCS41 r45127-038 11I1201s tU120 119 X I PT AND EMPLOYERS*LIABILM YIN STATUTE ERA ANYPROPRIETRI OPARTNERIEXECUTIVE E.L.EACH ACCIDENT 5 1,0D0,0D0 OFFICERlMEMeER EXCLUDED) ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYF 51.0D0,D00 It yyes.oescnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1.000,0D0 8 Property Y MKLV10XP002780 912018 91112019 UPP I-MI 100,D00 Deductible 2,5w I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddlUonal Remarks Schedule.,may he attached it more space m required) Certificate Holder is included as Additional Insured with respect to General Liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Ryebrook Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Ryebrook NY 1 0573 AUTHORIZED REPRESENTATIVE USA (NA l� I 9)1908-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD " Workers' CERTIFICATE OF 11—' STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE Be 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Singer Holding Corp. (914)345-5700 dba Robison Oil 500 Executive Blvd 1c.NY5 Unemployment Insurance Employer Registral ion Number of Elmsford NY 10523 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d Federal Employer klentification Number of insured or Social Security certain locations in New York Stale,i.e.,a Wrap-Up Policy) Number 13.3121491 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Employers insurance Company of Wausau Village of Rye Brook Building Dept. 3b,Policy Number of Entity Listed in Box"1 a' 938 King Street Rye Brook,NY 10573 WCC-641 445127-038 3c.Policy effective period 1111118 to 1111/19 3d.The Proprietor,Partners or Executive Officers are ® included.(Only check box if all pannerstofficers 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"1a'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'. Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? EYES (-]NO 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 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: Salvatore Sorce (Print name of ulhori `d r resenmve or licensed agent of insurance c uteri Approved /�O Approved by: gnarure) {Date) Title:Vice President/Team Leader Telephone Number of authorized representative or licensed agent of insurance carrier: 203-337-1 B 15 Please Note:Only Insurance carriers and their licensed agents are authorized to Issue Form C-105.2.Insurance brokers are N_QJ authorized to issue it. C-105.2 (9.15) www wcb ny.gov