HomeMy WebLinkAboutMP24-102 tt 4.°JJj v
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VILLAGE OF RYE BROOK
MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914)939-0668 Christopher J. Bradbury-
www.ryebrooknygov
TRUSTEES BUILDING & FIRE INSPECTOR
Susan R Epstein Steven E. Fews
Stephanie J. Fischer
David M.Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
August 22,2024
Paul Silver&Amy Silver Trustees
of the Paul Silver and Amy Silver Joint Declaration of Trust
67 Rock Ridge Drive
Rye Brook,New York 10573
Re: 67 Rock Ridge Drive,Rye Brook,New York 10573
Parcel ID#: 135.36-1-2
This document certifies that the work done under Mechanical Permit #24-102 issued on 8/6/2024 for the
installation of a new above-ground tank has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
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1932 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
0 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:
PERMIT# ISSUED: SECT: BLOCK: LOT: 2-
LOCATION: OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS
FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
QyE BRC�k,
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 :—< ( .:�� �e- DATE:
PERMIT# ISSUED: SECT: /3 .3�, BLOCK: LOT: !i
LOCATION: ,\ �' �I C�� R PG-n O b T'um' OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... LJ ACCEFrED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION �� � 1 o _ REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
p L.P. GAS �� S
Q FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL S. �/ ) jf I
❑ OTHER �( V
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BUILDING DEPARTMENT v
VILLAGE OF RYE BROOK N �u Z��y
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 VILLAGE_ OF RYE BROOK
www.ryebrookny.F_ov BUILDING DEPARTMENT
Application for Permit to Install Fuel StoraLore Tank
(*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester)/
FOR OFFICE USE ONLY: PERMIT 4: �! � /`/ 0
Approval Date: � Permit Fee: $
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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
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: Installation: $185.00 per Tank.
5. Dig Safely New York#(dial 81 1): 08014-000-927
6. Inspection by Building Department for installation.
7. Submit all Manifests& Reports(if applicable,after work has been completed).
8.Certificate of Compliance will be provided when all requirements are fulfilled.
Application dated, 8/112024 is hereby made to the Building Inspector of the Village of Rye Brook for a permit to
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 installed in conformance with all applicable Village,County,State&Federal laws,codes,rules and regulations.
Indicate Permit Tyne: Above Ground M- Buried in Ground ( )
I. Address: 67 Rock Ridge Drive SBL: 135.36-1-2 Zone: R-10
2. Property Owner&Address: Paul Silver 67 Rock Ridge Drive, Rye Brook, NY 10573
Phone#: Cell#: 914-329-3110 email: asilverlady@aol.com
3. Contractor& Address: Envirostar Innovation Corp 50 Fields Lane, Brewster, NY 10509
Phone#: 845-279-9555 Cell#: email: info@tankremovalservices.com
4. Applicant:
Phone#: Cell #: email:
5. Indicate Fuel Type: Fuel Oil L.P.Gas( )•Gasoline( )•Other( ):
6, Number and Capacity of each Tank: 1 - 275 Gallon AST
7. Exact Location(s)of each Tank: Side Yard
t
6/1/2024
IVOV NF11' Y(YRK (()I' .VfYOl \\F,T(FIRSIER I u.
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\ r.`E�y 1-being duh y+,om.deposes and states that he+she is the applicant abo+e named.
�pnm n:+mr of Indn j1 vpn+nq as Q;c appi+ca,
and lunher states that 10he is the legal Lmncr of the properh to%�hich this application pertains,or that t s)hr is the
for the le--al wcner and is dul}autfwrired[o mai c and file this application.
+n.futr:ucNtn-+,�unnactux,afV",aMXM),0&1
That all statements contained herein are Inge to the hest of hi>her knKm ledge and belief,and that att\ xork pertonned,or use
conducted at the abv+e caplioncd prupem till he in contilrmance�%ith the details as set forth and contained in this application
and to am accompanying appro+ed plans and specifications,as-ell a5 in accordance%%A the\, e\+ }ork State l_niform f ire
Pre+cnlion K Building{:ode-the('tale ol'the Villay_e of RYr Brook and all other applicable laces,ordinances and regulatitm+-
S,+om to bef6re me this _
S++urn to ttefore me this_
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PLUS
°rodur,t u C.ipacrty Model Gauge Dimensions Weight
,. 'US gal . thickness H W L (lb.)
44" " 60
75/
44' 7 , 290
UL 142 also available(275 and 330 gal )
Warranty": 20 years
wo PLOgILCt or Capacity Model Gauge Dimensions Weight
(US gal t thickness H W L Ob.)
44'
44- ;34
,"irnf fi!_'(,i Warranty*: 25 years
P"
Rig Product M Capacity Model Gauge g Dimensions Weight
(US gal ) thickness H W L (lb.)
1� 44
Warranty*: 30 years
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CERTIFICATE OF LIABILITY INSURANCE
0 v0412024
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
CONCT
NAME Dominica Twrtty
The Allan Twrtty Insurance Agency LLC PHONE 8451 278-6160 FAX
P O Box 419 (AIC,No.Exp
E"MAIL (A/C,No) (845)278-6537
ADDRESS dominlca@atwittylnsurance corn
INSURER(S)AFFORDING COVERAGE NAIC a
Patterson NY 12563 INSURER AXIS Surplus Insurance Cc
INSURED
INSURER 8 C,tadel Life 8 Health Insurance Company 71897
Fnvoostar Innovation Corp INSURER C Ohio Casualty Insurance Company 24074
50 Fields Lane
INSURER D
INSURER E
Brewster NY 10509 INSURER F
COVERAGES CERTIFICATE NUMBER: 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
FEXCLUSIONS
DICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
RTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
POLICY EFF POLICY EXPSR
TYPE OF INSURANCE POLICY NUMBER MM/ DIYEFF M DY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY
X .a <_ t000.000
s=:. '-:.:•aGE r.`,aEN'EC
X Professional Llabddy 'REMISES Ea occurrence S 50 000
ME'_)E•a,:. pie pefs." c 10.000
A X Contractors Pollution Liability FPAP22001711 012 12i29i2023 12/29/2024 Ea:,•;
1.000000
2,000,000
vap�•.i_,-c __YoICIa a;G S 2.000.000
AUTOMOBILE LIABILITYProfessional;Pollution t S S1 000.000
Ea accaN-.•` - 1.000,000
3APB006221 03105/2023 03,05/2024 'e•aT:ae•• _
UMBRELLA IIAB X 5
1 - E. = c 1
A X EXCESSUA6 000000 G� 12.29i2023 12,29,2024
s 1 000.000
'
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y N -- - •q
E.""; PE^'_ _ N A
(Mandatory in NH)
,es ❑esc•ce.,-,e _ _-"elAav�EE F
Inland Manne Scheduled Equip S250 748
3R1(>58 51 15 00 L'1 04r2C24 01104.2025
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101 Additional Remarks Schedule.may be artached f more space is required)
Evidence of Insurance
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS
Building Dept AUTHORIZED REPRESENTATIVE
938 King Street
Rye Brook NY 10,71
c)1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
NY S I F PC Boa 66699 Albany.NY 12206
I nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
" 823325897 D ❑
ALLAN TWITTY INSURANCE AGENCY
PO BOX 419
PATTERSON NY 12563
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
ENVIROSTAR INNOVATION CORP VILLAGE OF RYE BROOK
50 FIELDS LANE BUILDING DEPT
BREWSTER NY 10509 938 KING STREET
RYE BROOK NY 10573
POLICY NUMBER �CERTIF"ICATENUMBER T POLICY PERIOD DATE
W 2549 055-8 I---- 06/29/2024 TO 06/29/2025 07�01/2024
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO 2549 055-8 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 AND WITH RFSPECT TO OPERATIONS OUTSIDE OF NEW YORK TO
THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF
CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS:/IWINW.NYSIF.COM/CERT/
NOTIFICATIONS.
CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF
THE INSURED CORPORATION
PRESIDENT
GREGORY DINAPOLI
ENVIROSTAR INNOVATION CORP 11 OF 1)
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 STATE INSURANCE FUND
/!/,� 4
VALIDATION NUMBER 891335243
DIRECTOR 1 SURANrE FUND UNDERWRITING
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