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Home My WebLink AboutMP23-097 tc4 w°a aQ V G 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 November 3,2023 Frederick Taylor& Carole Taylor 1 Westerleigh Court Rye Brook,New York 10573 Re: 1 Westerleigh Court, Rye Brook,New York 10573 Parcel ID#: 135.41-1-5 This document certifies that the work done under Mechanical Permit #23-097 issued on 6/30/2023 for the installation of an under-ground propane tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRC�v� • �9�2 BUILDING DEPARTMENT ILDING 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 - - - - - - - - --- - - - - - - - - - Ri ADDRESS : "� o DATE:- -7 k' o PERMIT# - ISSUED.. (0 SECT: BLOCK: LOT: i _ q LOCATION: Grp P ��\` OCCUPANCY: ❑ Violation Noted THE WORK IS., ZPASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION �/ REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas qAL.P. Gas � I' . i ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER s = M N rq O W -0 _ 04 W U p, ':� L w H ix a N o� + H O h�i A M 'Octu ' w A ww �, OZ U - 0�% C� M pq lu MM w d F� a zz _ Poo, y w z1, d a � v �I a a1 a1 w a m BUII, MENT ECM AIL ; � .; OOK 938 KING NY 10573 JUN 2 3 2023 r ur o 39-5801 VILLAGE OF RYE BROOK L 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#: �D3 '-0 / /' Approval Date: JUN 3 0 2023 Permit Fed: $ Approval Signature: Other: Disapproved- (fees are non-refundable) **#####*####**##*##*#**#***##**74 tk##�•#####,y*#:4#*tk**# *###***####ik 9r*i4 a4 ik>Y* ##*#:F#'k*#:4#s4*i•*irk**;4#:F*�:l Je��** REQUIREMENTS FOR RELEASE OF PERMIT& CERTIFICATE, )3+COMPLUANCE: I. Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as cedificate holder) 3. Your contractor's valid proof of workers compensation insurance (Form #C 105.2 or Form#U26.3 /or NY State Workers Compensation V Taiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tart 5. Dig Safely New York#(dial 81 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. ***########***#*#####*#***##AkA•sk:F r�A:lr###t4#t4#######F**##sM#*:F##*#*#*###*###* #########tk#i#####*#�4######a4 Application dated, 6 1/14 �-3 ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a Fuel Tonic 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 ill applicable Village,County, State& Federal laws,codes,rules and regulations. �4*##:k##t1,4*#k*k#*####*#*######fir#pc***it k+k�.ikk*****kt.k*:F*�.t:4Aks4�•de*+k*###****# #*##ok###de*ki�:k A*i:of#k*#*k#iF* Indicate Permit Tyne: Installat Above Ground O• Huriwi in Ground (L-1� 1. Address: , %f �; /�y/�17/`3'BL: �1 f �� Zone:je—J=N�- 2. Property Owner&Address: / e- ll l< /v Phone#: q/y- 935`-d 1t/Z Cell#: email: 3. Contractors&Address: S 6-Jr Phone#: )107`J'771 Cell#: &"-- 240 email: ��'n° i G s�4�j''dj •Cs+,w 4. Applicant: Phone#: Ce11#: email: 5. Indicate Fuel Type:Fuel Oil ( )•L. as(1,.-G asoline( )•Other{ ): 6. Number and Capacity of each Tanl. 0 DO . ,-//aN / rind f —I1A.--I T Exact Location(s)of each Tank: 6/l/2020 3 1 STATE OF NEW YORK,COUNTY OF WESTC14ESTER ) as; , being duly sworn,deposes and states thathe/she is the applicant above named, (prin(mine or individual signing es 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 a thorized 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 bet ief,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 ir 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 Swoni to before me this day of ,20 N� ,20 2-3 ignal)li0 f Property Owner Signa of Applicant Pri ame of Property Owner GINA L. CLEMENTS Print me of Ap licant NOTARY PUBLIC-STATE OF NEW YORK C� No.01CL6446278 Notary Public Qualified in putchess County tar Public My Commission Expires 01-17-2027 This application must be properly completed in its entirely and Must In dude the notarized signature(s) of thy; legal owner(s) ot'the subject property, and the; applicant of record in the spaces provided. Any application not properly completed in its entirety and/ear not properly si gned shall be deemed null and void and will be returned to the applicant. 2 i 6/1/2020 i STATE OF NEW YORK,COUNTY OF WESTCHESTER --- AW 11�r" _,being duty sworn,dpposaa and states that hMhe is the applicant above named, (WOO Onto of W0vkkW eianistg as the Wplicant) and Amer states that(s)he is the regal owner of the property to which this applicatic n pertains,or that(s#w is the for the legal owner and is duly a ithorized to make and file this appi cation,(tndketc mhiwA,contradcK rVMtt,atcrarnry,otc.) That all statements contained herein are true to the best of his/her knowledge and be[ef,and that any work performed,or use conducted at the above captioned property will he in conformance with the details asset forth and contained in this application and in any accompanying approved plans and specifications,as well as it accordance with the Now York State . Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook mu all other applicable laws,ordinances and regulations. Sworn to before the this i Li Swo to before me this day of ,20 day a Sl~of Prop"th"wr Fred Taylor ,� ��,L.�.-..✓ Print Nan f owner Print I ime of Applicant --71 Notary Pubi • Public n This applicatio ' lstFhe properly completed in its entirety and must in' lode the notarized signature(s) { of the legal owner(s)of the subject property, and the applicant of recont in the spaces provided. Any application not properly completed In its entirety and/or not properly si M ed shall be.deemed null and void and will be returned to the applicant. I F/trzo2o t a � m e� -- �-j EAST BRANCH BLIND BROOK - I u Ot¢ WESTERI EIGH a ROAD Rtrlflonf GENERATOR SITE PLAN �.NDEC•EF♦lC MllEt,f t fllt EItMNF Es v. .. YOR S-1 THE TAYLOR RESIDENCE tI � �� C RN0%MJ a Ho� P a 0 t q wg--4 o n fir ' a v s Q a � LL � a a m co LU Y ® N m ♦ N io 1� o Z aMA Lij SZR loll] s cHn i , ` ^ ` � DATE(MM/DDYYY) A`ORO® /Y CERTIFICATE OF LIABILITY INSURANCE 12r28/2022 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). PRODUCER CONTACT NAME: Thomas Helple Edgewood Partners Insurance Center PHOIAIC.NENo,E,ti 203 658-0506 FAXNo 1 American Lane E-MAIL Greenwich CT 06831-2560 ADDRESS: tom.heiple@epicbrokers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Casualty Co of Amer 25674 INSURED PARAGASC INSURER B:Lloyd's of London 25186 Paraco Gas Corp; Paraco Gas of CT Inc Paraco Gas of NJ LLC; Paraco Gas of NY Inc. INSURER C:The Charter Oak Fire Insurance Company 25615 800 Westchester Ave,Suite 604 INSURER D:Travelers Casualty and Surety Company 19038 Rye Brook NY 10573 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:212110147 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 ADOL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDO/YYYY C X COMMERCIAL GENERAL LIABILITY 6601POO9026 1/1/2023 1/1/2024 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTFU___ CLAIMS-MADE Fx_1 OCCUR PREMISES Es occurrence $300,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 POLICY❑PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 X OTHER $ A AUTOMOBILE LIABILITY TRJCAP7KO29970TIL23 1/1/2023 1/1/2024 CEaOMBI accNEident D SINGLE L MIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLA LIAB X OCCUR UKPCB2300025300808 1/1/2023 1/1/2024 EACH OCCURRENCE $5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DIED I I RETENTION$ $ C WORKERS COMPENSATION UB8N6879022351D 1/1/2023 1/1/2024 X PER OTH- D AND EMPLOYERS'LIABILITY Y/N UB8N6862232351 R 1/1/2023 1/1/2024 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/ME MBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached if more space is required) 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 938 King Street AUTH RIZED REPRESENTATIVE Rye Brook NY 10573 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured (use street address 1 b. Business Telephone Number of Insured only) 914-250-3700 PARACO GAS CORP 800 WESTCHESTER AVE 1c. NYS Unemployment Insurance Employer Registration 5TE 5604 Number of Insured RYE BROOK, NY 10573 Work Location of Insured(Only required if coverage is specifically 1 d. Federal Employer Identification Number of Insured or Social limited to certain locations in New York State,i.e.,a Wrap-Up Policy) Security Number 13-3149941 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) THE CHARTER OAK FIRE INSURANCE COMPANY village of Rye Brook 3b. Policy Number of entity listed in box"'Ia" 938 King Street UB-8N687902-23-51-D Rye Brook, NY 10573 3c. Policy effective period 01-01-2023 to 01-01-2024 3d. The Proprietor, Partners or Executive Officer 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 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 irl 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: Kim Owen (Print na uthorized representative or licensed agent of insurance carrier) Approved by: 12-21-2022 (S' nature) (Date) Title: Manager, Domestic Operations Telephone Number of authorized representative or licensed agent of insurance carrier: 804-527-4872 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 W31F3117