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HomeMy WebLinkAboutMP23-069 �yE DR t tt� r7 19 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 Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 18,2024 Dania Cruz-Ponce 1A Wyman Street North Rye Brook,New York 10573 Re: 1A Wyman Street North, Rye Brook,New York 10573 Parcel ID#: 141.35-1-3 This document certifies that the work done under Mechanical Permit #23-069 issued on 5/3/2023 for the removal of the above-ground temporary oil tank and the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to J-� B,aR(b, - �2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q"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 : Z,4 WX1;m^j / A,C/� DATE: /- Z / - Z0 Z y PERMIT# l / P ? 3 -L,6 / ISSUED: S "2_3 SECT: �/� BLOCK: / LOT:�� LOCATION: G tA I 5 c,, OCCUPANCY: ❑ Violation Noted THE WORK IS... 3 PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas �� L�J ti r L7 ❑ FUEL TANK / ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL _ ❑ OTHER .,i j l S i � �E BRC�k, tim cu � 04 1962 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: DATE: 202 PERMIT# M/ 2� I R3 ISSUED: 12-7-22 SECT: 33 BLOCK: / LOT: 3 LOCATION: �i (z W I S 11 o 7 1 u u S-, • OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas c v ErIFUEL TANK ` I f ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION l A J ° { (� (' I �''1/<�V t� C S�0 ❑ FINAL C0 � CNl l G L c G. �kD 1 ❑ OTHER -;7-L �u � �Qy6 BR�� O Zm cu � l7 1982 BUILDING DEPARTMENT tissiSTANT UILDING INSPECTOR 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 M v��1JA 0TE: PERMIT# ISSUED: �i SECT: BLOCK: LOT. LOCATION: C OCCU ANC : Ck ❑ Violation Noted HE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION QC' REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ LP. Gas FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER DR o ti� BUILDING DEPARTMENT ❑BUILDING INSPFCTOR 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.or� - - - - - - - - - - - - - - - - -- - - INSPECTION REPORT - - - - - - - - --- - --- - - - -- ADDRESS: ] ��`y DATE: V2 PERMIT# 1 ISSUED: SECT: BLOCK: LOT: LOCATION: r-t L l l c OCCUPANCY: -2` ) ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REIECTED/ REINSPECTION Q' SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION \ �� ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING �><J ❑ INSULATION \ ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION \ CDC v , 1 ❑ FINAL 4- ❑ OTHER r c. J N w N 0 Cr � E fln ¢" w +1 s 3 w Q4 E W ►. rU 0 L0. L v `O E : ►-+ M fL cn a «Ln d r to > i O 04 2 � � E W sr Cc v ,-,'4 .4 p s O a .V V� cc Ir E (� °oaco E \-O UO Z t 0*4 21 Il^/1 '1 `V Fi ate-- v M z = I1 V) G1 M ,..� — t7 W o 0 Z M �" a0 Q Q E ° o w = C1 N..r �! A W x E � � as c M1 � 4 . CY d 3a o 5 o R, 24 uu r c a !p PLO W o0o en G as �-Ab BUILD,�' � �'MENTEM Ell'IOK 938 KING S�r�t ET RYE BROok, NY 10573 914)93 -W. ro6lEor �/ 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: MAY Q '2023 PERMIT#: 1 l ID_-3—a& G Approval Date: Is permit Fee: $ Z 7-aryl Approval Signature: Other: Disapproved: (fees are non-refundable) *,�ww,x*wwww*w*w****ww*ww**,t*w**r*w,tww*w*******w,r*w,rw*w****r*www*wwwwwww*w*wwwww*www,rw,tw**,+,rw***,rwwww*t* 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: S 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. wwwwwwwwwwwww**w*,rww**w***w*wwwwwwww****ww*,rwtwwwwwww**tw*wwt**wwwwww:wwwwww*r+�w,r•rwwwwwwwwwww*wwww*a*w Application dated, 51 L 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. w,c**w****,tww*w**,rw*wwwwwwwwwwww*ww,t **w***w*wwwwww wwwwww*ww*ww*wwww*www*wwwwww**,r*www,r*,�w*wwwwwwwww* Indieate Permit Type: Installation )•Removal( Abandonment( )/Above Ground V�• Buried in Ground ( ) 1. Address: I-A ` r Ito SBL: 11-4--,5 - 1`3 _Zone:��'� 2. Property Owner&Address: I-`� 1Q.11f,%11 � C)A,.r�4 �•t�y Phone#: q IL4 -ZI i —q1=k, Cell#: email: 3. Contractor&Address: /1/1 Lr_t u �aaJ� �1�� 1-7O w+-M-re r;' C�n�J(�,JR_�, CT' 06,Z iO Phone#: ?--} Q, -LI s-1-7 Cell#: email: Sln; sti 'r D M.It"xqr•.,v ,i.+')!!- 4. Applicant: Cyr±M ' (r)A. P-cA:ick PQrM+`A . Phone -`j lti %q(-I o Cell#: email: b t ttavi C'6 5kr;,'cx�.��w? 5. Indicate Fuel Type: Fuel Oil�,f-L.P. Gas( }•Gasoline( }•Other( ): 6. Number and Capacity of each Tank: .I },"V,.. a,►^ . ' crJ r,4.f LP 7. Exact Location(s)of each Tank: Sn-E AS EvsSTi*� t 8/12/2021 STATE OF NEW ORK,COUNTY OF WESTCHESTER ) as: s r ok 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. rr�� Sworn to before me this Sworn to before me this day of A f lZ 1 L ,20 day of 20 na a of Property O�er Si na of Applicant Print Name of Prnpe Owner t me of Applicant eA SCOTT W. CRAIG /l�Qil AA Notary Public NOTARY PUBLIC Notary Public STATE OF NEW YORK REG. NO. 01CR6390567 !2_07-� COMMISSION EXPIRES APRIL 15,20M 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. _=HMI"S CORE3 NotConry Commtsslon 2 8/12/2021 f sg I _ -I I� 1 1- Fill COPY GROUP, LLC Dania Cruz March 08, 2023 1A Wyman St Rye Brook NY 10573 Scope of Work: Install 1 Granby Ecogard 275 V Double bottom oil tank on existing pad. Oil.tank installation includes new fill-vent piping, oil filter and oil line. New tank will be attached to the pad with floor flanges and lag bolts to keep attached to the pad. The Granby Ecogard tank has a 25 year manufactures warrantee. Proposed Pricing: Three Thousand Nine Hundred Dollars.........,.. $3,900.00 Plus Permit Fees Terms: 1/2 deposit 1/2 upon completion a3 Please contact me with any questions. Thank you, Ty J. Cole General Manager Milro Group 203-515-9000 S 1- 0402470 170 Whlte Street,Danbury,CT 06810 Telephone:203.743.6902= Fax:203.794.8013•CT Ucense S1-0402470 Milro Group, LLC 170 White Street, Danbury, CT 06810 6W I L10 Telephone: (203) 855-4377 GROUP, LLC Municipality: 6f. Date: This letter serves as written authorization for CT Permit Services LLC agent to represent me in the procurement of the permit described below. Project Details: O-Aluor 6.1 Homeowner: bc ^�- C.ry 2 Street Address: 1 A W 1n Sa••�1 �'�� City, State,Zip: �US� Licensee Signature: Licensee Name HEATING,PIPING is COOLING VNI WITF."CONTRACTAF TY J COLE 13 PARK t N t1i?' } NEW Nift.FORD,C1' 06716-2372 H"TG.040 70-SI 09/01/2022 08/31/202:3 .. 17 e _ -- .�'''•q� .'S�£` ir `� 5 �. � ` "� i3J' 4^_i.. `R-_.`„ t�`t�M'S!•'Sr .F ` lw�c' r e4f` Y� is't '.�; GNP .n+,\SI ♦ 1'}'' ! \�,!l�' - � '[ F'1`,•• {' -� / �i�1• �i� - ��. '�y�i`:M,��'" i. 1 rY��f� r '.',}��. �`+�'���YlA1`� �� �I�hn�-��lr' '71 � ^w �^'�.p�r' �i�aia��r�s� �14 '��'#� ,li��f►�`'.��' �''�:+ .r�LL����1� .q�9 ��-'�� 4��9'���`: - li`�rd�+<P '' 4 .. o. \ W CD 1J1�Rv9 01. CD `� (J r����� � >✓._..u�7i;Jd�'d r-' �. �. a - z r _ - M„1 ....p,� _ s f I tK-_� s[ �\ Al AN; ifs.C ? 1 ♦1� -� - 'l1 O G IPIR, t 0IISSIA� pi�< �y" 'gp!.1�I.I �Y` ,��- � �, I.1 h�4 . 2 �`•i17��!'�"'., i; -y -'"aG, 1 1�' 'r�-� ` '�^��yt[���d.,y.lL� 1+.FS}v�._.^:-��+"�t.i;Yrj_ -,1�,..7'yy� y}tr. ^'�-i-ei,, 1 .�te•14. 7{yr ;'+`.�+•+.1` f tt��w,�* �Y� 1�., yr , vL-s,D,.JJ�F t�K•,ti;:r ,v .v. r'Fp,�l�,k:��'e ,�� .c � `1 `�' •�a �f1�J�' •'N � �•:':'t,� F'>� .r-• �1 ncoizv F—ATE CERTIFICATE OF LIABILITY INSURANCE D03109I2023Dn 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(les)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 LONIACI Max Gomes Marsh USA,Inc. NAME, 1166 Avenue of the Americas ac No_Elii 212 345-0415 Putie Na New York,NY 10036 MAIL Ann:NewYork.cerls@Marsh.com ADD,E max.gomes@marsh.com --- INBIIRER S AFFORDING COVERAGE MAID a _ CN 101414839-PETRO-ACORD-22- GV INSURER A:National Union Fire Ins Co Pi Lojh PA 1114115 INSURED INSURER B:AIU Insurance Co 193" Milro Group,LLC -- - 170 White Street _NSURER C:Lexington Insurance Co_M__— 19137 Danbury,CT 06810 INSURER D. _ INSURER E NSURERF• COVERAGES CERTIFICATE NUMBER: NYC-OD9222598-88 REVISION NUMBER:8 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 - -- - - - ADtWS - - - -- POLICY El* POLICY EXP ITR TYPE OF INSURANCE 1 POLICY NUMBER MMIDD MMR10 LIMITS X COMMERCIAL GENERAL LIABILITY GL7032451 10/01/2022 10/01/2023 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X ;OCCUR DAMAGE IO HEN I ED PREMISES(Ea gccurren S _ 500.000 X )CiU _ MED EXP(Annone Boon S _ 10,000 X Contractual PERSONAL 8 ADV INJURY s 1.000,000 l GEN'L AGGREGATE LIMB APPLIES PER GENERAL AGGREGATE S 5,000,000 X POLICY a PO- JET LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER SIR g 1,000,000 r AUTOMOBILE LIABILITY 8682566(AOS1 1010//2022 W101/2023 3 0 LIMIT S 5,000.000 � 1 U X ANY AUTO 8682567(MA) 1010112022 10/01/2023 BODILY INJURY(Per person) S A AUTO DONLY _ AUTOSLED 8682568(VA) 10101/2022 10/01/2023 BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTYDA AGE AUTOS ONLY .- AUTOS ONLY jeers—ftal)_ _ _ S S X UMBRELLA UAB X OCCUR 021430599 10/01/2022 10101/2023 EACH OCCURRENCE S 5,000,000 EXCESS L1A 3 CLAIMS-MADE AGGREGATE S 5,000,000 DED II X I RETENTIONS 10,000 S B WORKERS COMPENSATION WC 063850976(CT,DE,MA,MD,MI,NH, 1/2022 1 1WO112023 X ; o - ANDEMPLOYFRS'LIABILITY VIN 4T_>z...1—�.€R_ ANYPROPRIETOR/PARTNERIEXECUTIVE NJ,NY,PA,RI,VA,WV) I 11000,000 OFFICERIMEMBEREXCLUOED? ❑N NIA E.L.EACH ACCIDENT S (Mandetory In NH) E.L.DISEASE-EAEMPLOYEE 5 1.0m.000 If yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Cerfificate holler is additional Insured CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 King Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE of Marsh USA Inc. --// ;W!4,C¢GL IYS �/Tt ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ro.. Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a,Legal Name 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Milro Group,LLC 203-325-5400 170 White Street Danbury,CT 06810 1c NYS Unemployment Insurance Employer Registration Number of Insured 8311425-2 Work Location of Insured(Only required d coverage is specifically limited to 1d Federal Employer Identification Number of Insured or Social Security certain locations in New York State.i e a Wrap-Up Policy) Number 74-1810078 2.Name and Address of Entity Requesting Proof of Coverage 3a Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) AIU Insurance Company 31b Policy Number of Entity Listed in Box"la" Village of Rye Brook WC 063850976 936 King Street Rye Brook,NY 10573 3c Policy effective period 10/01/2022 to 10/01/2023 I 3d The Proprietor,Partners or Executive Officers are Oincluded (Only check box if all partners/officers included) all excluded or certain parbners/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". 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 premiums 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 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: Michael Price (Print�naame of authorized representative or licensed agent of insurance carrier) Approved by: 4 f — s March 20,2023 (Signature) (Date) Title: C.E.O.North America Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb ny.gov