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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 NOV 2 0 2023
(914)939-_0668
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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 #: Wt—�) _ 7�
Approval Date: 08--�/* Permit Fce: $ �,�0
Approval Signature: W Other:
Disapproved:
(fees are non-refundable)
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING
INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS
12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF w750.00
REOUIREMENTS 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. ($185 x 6 =$1,110)
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.
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Application dated, ��o)(D—d ,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,
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Indicate Permit Type: Installation ( ) • Removal ()o • Abandonment ( )/Above Ground 00•Buried in Ground 00
1. Address: 975 Anderson Hill Road SBL: Zone: P14.6
2. Property Owner&Address: Cohen Purchase Building Company. LLC 750 Lexington Ave NY, NY 10022
Phone#: 212-838-1800 Cell #: email: ccohen@cohenbrothers.com
3. Contractor&Address: VM Transportation, Inc. 791 Lake St West Harrison, NY 10604
Phone#: 914-804-3296 Cell#: 914-804-3296 email: marcvmtransportation@email.com
4. Applicant: Marc Tschantre (Pres, VM Transportation, Inc.)
Phone#: 914-804-3296 Cell#: 914-804-3296 email: marcvmtransportation ,gmail•com
5. Indicate Fuel Type:Fuel Oil(x)•L.P. Gas( )•Gasoline( )•Other(x): Diesel, Used Oil
6. Number and Capacity of each Tank: (1)20,000 Gal Fuel Oil; (1) 10,000 Gal Fuel Oil; (1) 500 Gal Diesel,
(1) 500 Gal Fuel Oil; (1)275 Gal Used Oil; (1) 50 Gal Diesel (6 tanks total)
7. Exact Location(s)of each Tank: See attached site ma
10/30/2023
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
Marc Tschantre ,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
tank removal contractor 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. l
Sworn to before me this �y✓ Sworn to b fa e t is /
day of Ak I' 20 q 3 day of ,20
jS nature of P opetty Owner Signature of Applicant
C es Cohen Marc schantre
' t am f Property Owne Print ne f lica
otary Pu tc t
This application must he properly completed in its, entirety and ltIlt,, include the imiarized
si�-)nature(s)of the legal owner(s) cif the subject property.and the apptWant of rccord in the spaces
provided. Any application not properly completed in its entirety and/or not pioperl.v s1t2ned Shall he
deeined ttull and void and twit] be returned to the applicam.
MADELINE C. CITRONE AVALLA
Notary Public, State of New York i�otary ublic, State of NY
No. 01 MA6030446 No,01CA6022369
Qualified in Westchester County n�
Commission Expires Sept. 13, 20__O.</ Qualified in Westchester C unty
r;c;aim. Expires March 29,
2
10/30/2023