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BUILDING DEPARTMENT
VIL E OF RYF BROOK
938 KING ET RYE BROOK,NY 10573 JAN - 5 2024
(914)9 914)939-5801 j
o re VILLAGE Ur K`�es 6ROOK
BUILDING DEPARTI IT
Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank
(*Storage Tanks in excess of 1,100 gallons require registration with the/Coounty of Westchester)
FOR OFFICE USE ONLY: PERMIT#: a"''/j' ,W —0c)3
p 9 202
Approval Date: '�f�N Permit Fee: $
Approval Signature: I Other:
Disapproved:
(fees are non-refundable)
x�FxxxxnxxRx;x�x;,*x��xxx*x*��x*xxx, �*xx�, xxxxt�xx*x�xxxxxxx�, x�xx: *x, xxx*��***,t,t****�*,x, �x**x*xxx****
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: $185.00 per Tank.
5. Dig Safely New York# (dial 811): 01054-000-466
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, 1/512024 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 Tyne: Installation euyoval +Abandonment{ )/Above Ground,&yRuried in Oroundl,,,�
I. Address: 46 Rock Ridge Drive SPA: 135.28-1-16 ► Zone: to
2. Property Owner&Address: Nick Caputo
Phone#: 917-682-4414 Cell#: email: nickcaputo@gmail.com
3. Contractor&Address: Innov8tive Environmental
Phone#: 914-449-6608 Cell#: email: service@innov8enviro.ccom
4. Applicant: Innov8tive Environmental
Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com
5. Indicate Fuel Type:Fuel Oil i ' L.P. Gas( )•Gasoline( )•Other( }:
6. Number and Capacity of each Tank: Removal of(1) 550 and Installation of(1) 275
7. Exact Location(s)of each Tank: Removal from right side of home and installation at right side of home
t
6/1/2020
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
Donnie Feenie ,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
Contractor for the legal owner and is duly authorized to make and file this
application.(indicate architect,contractor,agent,attomey,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 5 Sworn to before me this
day of 0OLVA, . 20 M day of Aavlvowk 20 Zq
Signature of Property O er Signature of Applicant
Nick Caputo Donnie Feeney `
P 'qNae oft'ropert Owner r' t Name ohAppli t
Noblic NORINE M17ER o g MNotary Public,State ofNe Y rk Notsry Public.State of New`tb&
Lic.No.01ME6130833 Lic.No,p1ME6130833Ousllfied in Westchester Coun(y OuaIMW In Westchester Cou
ommission Expires July 25.2045 Commission Expires July 25,20
This application must be properly completed in its entirety and must include iFe notarize 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.
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6/1/2020