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HomeMy WebLinkAboutMP23-182 DR (G LG�VVyy / . 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 January 23,2024 Jeffrey Goodman&Tracey Goodman 28 Talcott Road Rye Brook,New York 10573 Re: 28 Talcott Road, Rye Brook, New York 10573 Parcel ID#: 135.50-1-3 As per the Certification letter from Hudson Valley Petroleum&Environmental Corp.dated January 15,2024, the removal of an above-ground oil tank and installation of a new above-ground oil tank under Mechanical Permit#23-182 issued on 12/27/2023 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BRC�k, • �9a2 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 : L 9 I L co 7 / E')O q t� DATE: 2 O Z V PERMIT# /'IP 2 .3 -132i ISSUED: /2-Z7 ECT: /-,3J,.Sa BLOCK: LOT: `3 LOCATION: 1`PCLA �G„/L C Yu E' C '` OCCUPANCY: 2�y ❑ 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 _ P e n-)y ye d 14 d o tle 6 �T 0 u w�f /_o,,k ❑ L.P. Gas U,V fps C r P C lC. ❑ FUEL TANK ❑ FIRE SPRINKLER G G k ❑ FINAL PLUMBING CROSS CONNECTION // /r �� G, /e-'ixP c/ ❑ �l (�'�(. f G,�T- /[/� -7 ❑ FINAL (� C(/L 0 / C9Z f /� �/ 1 Ue . ❑ OTHER �E BRC�k• cu � ,,/�' �9a2 •'��O 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: 2 U 7i9 6 if O / / - �{ D/i DATE: PERMIT# /"19 R 2 .3 -10°Z- ISSUED: I2-1?7'z3SECT: BLOCK: LOT: 3 LOCATION: (lC C� / �L� yI ��C�A cl Pc OCCUPANCY: 2 �U ❑ Violation Noted THE WORK IS... Er PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / / ❑ Natural Gas %�ti S f 6 �P c /y l-t.l ��1 ,�Z 0 yc ❑ L.P. Gas /�G a-FUEL TANK _ ti � !�"✓ Pam. �PCIti/ /�"�e/ ❑ FIRE SPRINKLER L Av&,k Gam, [ C' 62. A �Ll ❑ FINAL PLUMBING ❑ CROSS CONNECTION - ❑ FINAL ❑ OTHER / a 70, eq 0-0 z o - oa � w3 104 � v � vo wanW 42 O ono H 04 aen 0 ,d c z o � C p I..� Z o �-t W q � H i V,14 cn Q00 cn ' W W Q A O a o �' UO - H0�l CIS ~~ �' Z (h O Ud W U O ? o ho u p r/ `u "-' Ali Q., M..� oo Mil Z V © z cy 43 a - 0 ZL _ W z C7 Q O b O F.f.� O I zo Oa wv vw W = " � mow-► Uvo ?R � a" • U ►o • zF Q O -.0 • Op z W O A 0 �+ .� � P Ae~ ��..� = N w d 9 1I o � = b �-I go 0-0 O U _ BUILD MENT VIL OF RY OK SEC 2 7 20J 938 KING �` ET RYE BAR ,NY 10573 _ D 4 _0 -c VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove Abandon and/or Install Fuel Stora a Tank (*Storage Tanks in excess of 1,100 gallons require registration ' the County \\ofWestchester) FOR OFFICE USE ONLY: PERMIT#: �d�� y C�st Approval Date: DEC Permit Fee: $ _R / Approval Signature: Other: Disapproved: (fees are non-refundable) ,r,�********,r�*�r,r*,ter***,�*�r,�**,r*,�*******�******#******�r***,►,�***�*,a*,r********�***************,r****t*****�x,r 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$750.00 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: $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. Application dated, It;)—a7--Q 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 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 Tyye: Installation 00•Removal(X)•Abandonment( )/Above Ground OK) •Buried in Ground( ) 1. Address: 28 TALCOTT ROAD RYE BROOK NY SBL:/35 t SO Zone: —/ 2. Property Owner&Address: JEFF GOODMAN 28 TALCOTT ROAD RYE BROOK NY 10573 Phone#: 917-673-8154 Cell#: email: JEFFGOODMANHOME@GMAIL.COM 3. Contractor&Address: HUDSON VALLEY PETROLEUM&ENV.CORP.DON DESANDRE PO BOX 364 YORKTOWN BY-1 0598 Phone#: 914-302-2320 Cell#: 914-980-9513 emailOFFICE@HUDSONVALLEYFUELOIL.COM 4. Applicant: JEFF GOODMAN 28 TALCOTT ROAD RYE BROOK NY10573 Phone#: 917-673-8154 Cell#: email: JEFFGOODMANHOME0GMAIL.COM 5. Indicate Fuel Type:Fuel Oil(X)•L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: REMOVING A 330 ABOVE GROUND FUEL OIL STORAGE TANK. INSTALLING A NEW GRANBY 275 ABOVE GROUND FUEL OIL STORAGE TANK. 7. Exact Location(s)of each Tank: BOTH INSTALL AND REMOVAL OR IN THE SAME LOCATION UNDER THE DECK. 1 10/30/2023 STAM OF NEW YORK,COUNTY Or WFSTCHESTER JEFF GOODMAN ,being duly swum,deposes and states that he/she is the applicant above named, (print nanic orindivitlual signing as the applicant) and further states that(s lic is the legal owner of the property to which this application pertains,or that(s)hc is the 28 TALCOTf ROAD R E BROOK NY 10573 for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor,agent,cuaracy,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 f Sworn to before me this day of 1 ,20 day of ,20 Signaatu a o P / perty Owner Signature of Applicant Print ame of Property Owner Print Name of Applicant r 'A Notary P46c Notary Public 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. GREGORY M.RNERA Netwy Public,State of New York No,0111I6441398 Qualifted in Westchester County cotttmtsslw Expires September 26,2�( z 10/30/2023 r JAN 17 2024 � VIL :-:_ L.I RYE BROOK .�1jl�otlmen Corp. _.����r�r���NT DBA 1ranUo&&jw AMR PO BOX 364 Putnam License # 794-12 Yorktown Heights,NY 10598 Westchester License #WG33112-H2O 914-352-0500 914-980-9513 cell 01/15/24 Mr.Jeff Goodman 28 Talcott Road Ryebrook NY 10573 917-673-8154 Jeffgoodmanhome@gmail.com Dear Mr. Goodman, We have completed the removal of your 330-gallon aboveground fuel oil storage tank from underthe deck of the home. All waste oil and tank bottoms were transferred to Crown Petroleum Waste Services 986 RTE 6 Mahopac New York 10541, the AST was recycled at Expressway Recycling Cold Spring New York. We also complcted the installation of your new Granby 275 above ground fuel oil storage tank under the deck of the home on existing concrete slab. Sin ely, Don DeSandre PAYMENT RECEIPT E RRESSWAY AM 845-80,9-5f>33 d 3455 RT 9 Cold Spring N.Y. Receipt: 117967 Date:1/5/2024 Customer:101489 Time:8:40:59 AM TONY OSTRANDER 32 VAN WYCK DR POUGHKEEPSIE, NY 12601 ID Number: 123475665 Ticket: 119556 BOL: `— Opewtor.Admin PO. Weigh In: 1/5=4 8:36:50 AM jeer; Weigh Out: 1/5/2024 8:4018 AM _.. '�' _? are In pounds Lriess omerwise notes Commodity Gress Tare Net Price TOTAL$ N1` ': ` .-prep 21.740 18,360 3,380 0.0 ,�B 304.20 ------------------------------------------- ------ Ticket Total: 304.20 No.of Tickets:1 Pay.*no';t N16thod:Cash Total Paid: $304:20 I hereby state that I'm the lawful c•mer of the mat scobed heron.ttl I have a right to sell s--me and tha*. x paymen!rece,.cj in fill,hereby aclinovAedged.I sp'and convey t••.a of same to: ExPresway Recycling Inc. Thank you for your business, EVressway Recycling,Inc. r r. .•I.Y 1(7�T t 6TANpgRO COLLl_CT10N ORDER FORNf 936 Route 6 ° ft `�6 DM,NY IM41 ° �!� �5.8®3:8253 T 3otf, 5�' P ro1�u +El�vrra���1�.s lti e. IN&L ZTA- ce p NAME �nR&`3°2Lc.�ee ATt e`d L-Ald ion (Y C, ETA t,;i t STAM ONE- CITY Pam.-I,�ur,,, 4 ie SIN: PO STD -nmE OUL- ® ��T$!ffi!ft 1lE�I19�S SggE IWATERWORKS I TISTtWARrAUE Amman NEUVSURBR NY 12$5o j 845,581.gT T7 O LORCO PErHOLEUM SUS 450 S. 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P'�'i?,�'f _ a •Y r,^l•• "4Al AC'R® CERTIFIC ATE OF LIABILITY INSURANCE DATE(MM DD/YYYV) LHIERCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS/04/2023 DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. f the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. FRODUCER UBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT An ela all&Sterling,!nc. NAM 9 Nmi ain Street PHONE (g45 4 A/C,No Ext: ) `�-0800 FAX E-MAIL anacrl m A/C,No (845)454-0880 ADDRESS: @ afshall Sterling.COm Poughkeepsie INSURER(S)AFFORDING COVERAGE NAIC# NY 12601 Union Insurance Company INSURED INSURERA: 25844 Hudson Valley Petroleum&Environmental Corp INSURER B: Acadia Ins Company 31325 PO Box 364 INSURER C: GuideOne National Insurance Company 14167 INSURER D: Yorktown Hgts NY 10598 INSURER E COVERAGES INSURER F: CERTIFICATE NUMBER: CL2372044005 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED INSU NAME BELOW HAVE BEEN ISSUED TO THE RED D A OVEOR REVISION NE MO CRY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 LTR TYPE OF INSURANCE XM INSD WVO POLICY NUMBER POLICY EFF POLICY EXP COMMERCIAL GENERAL LIABILITY MM/DDYYYY MM/DD LIMITS CLAIMS-MADE F OCCUR EACH OCCURRENCE S 1,000,000 DAMAGE 0 RENT D A PREMISES Ea occurrence g 300,000 Y CPA551984611 07/20/2023 07/20/2024 ME EXP(Any one person) g 10,000 GENT AGGREGATE LIMIT APPLIES PER: PERSONAL BADV INJURY $ 1,000,000 POLICY ❑PRO- JECT ❑LOC GENERAL AGGREGATE S 2,000,000 OTHER: PRODUCTS-COMP/OPAGG g 2,000,000 AUTOMOBILE LIABILITY Employee Benefits S 2,000,000 ANYAUTO Ea accl iNdeDt SINGLE LIMIT g 1,000,000 A OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS ONLY AUTOS CAA551984711 HIRED NON-OWNED 07/20/2023 07/20/2024 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident S UMBRELLA LIAB X OCCUR S B EXCESS LIAB CLAIMS-MADE CUA551984811 EACH OCCURRENCE $ 5,000,000 07/20/2023 07/20/2024 AGGREGATE S 5,000,000 DED RETENTION$ 10,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY S Y/N PER ANY PROPRIETOR/PARTNER/EXECUTIVE STATUTE ER ER OFFICER/MEMBER EXCLUDED? N/A (Mandatory In Htl) E.L.EACH ACCIDENT 5 "'es describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE S Pollution E.L.DISEASE-POLICY LIMIT S C Pollution Liability Per Occ $1,000.000 ENV56201104301 07/20/2023 07/20/2024 Pollution Liabili A tY 99 $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Contractors Professional S2,000,000 Village Of Rye Brook is an additional insured if required by written contract,per endorsement number CLCG04931018. CERTIFICATE HOLDER CANCELLATION SHOULD ANY O;DATE BOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO THEREOF,NOTICE WILL BE DELIVERED IN Village Of Rye Brook938 King StreetACCORDANCE E POLICY PROVISIONS. AUTHORIZED REPREVE Rye Brook NY 10573 '1r V ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 S ACORD CORPORATION. All rights reserved. NYSIF ,New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE """A^^ 421749379 FRIEDLANDER GROUP, INC. 2500 WESTCHESTER AVE-#400A PURCHASE NY 10577 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER HUDSON VALLEY PETROLEUM CERTIFICATE HOLDER &ENVIRONMENTAL CORP VILLAGE OF RYE BROOK PO Box 364 938 KING STREET Yorktown Hgts NY 10598 RYE BROOK NY 10573 =G2574 MBER CERT�72T2 [NUMBIiR 66-8 POLICY PERIOD DATE 07/01/2023 TO 07/01/2024 10/4/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2574 766-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND 4 J-26.3 VALIDATION NUMBER:392420922 DIRECTOR,INSURANCE FUND UNDERWRITING