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HomeMy WebLinkAboutMP24-123 QyE aR �. p Gtu ti 19 tGG Gti VJJ V G GtiG(Go � VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morhno CERTIFICATE OF COMPLIANCE October 9,2024 Matthew Aronberg&Monica Mosquera 195 Neuton Avenue Rye Brook,New York 10573 Re: 195 Neuton Avenue, Rye Brook,New York 10573 Parcel ID#: 135.68-1-12 This document certifies that the work done under Mechanical Permit #24-123 issued on 9/20/2024 for the removal of a an above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRC��, 1932 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 : 1 i � IV E tit L a DATE: I O - 3 - Z(D Z PERMIT#met 1) - 12- 1 ISSUED: 'IJ-Z SECT: BLOCK: / LOT: �z LOCATION: &A-�p -n e:2A 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 d ❑ NATURAL GAS ,` J 1! �s ❑ L.P. GAS /1 �7 FUEL TANK 12 S P /Y1P C_ U Y ❑ FIRE SPRINKLER ❑ FINAL PLUMBING L ( J S I ' n �� ❑ CROSS CONNECTION W )W' 1 C 440 r� 4 - �C ❑ FINAL gP,(- -P t V UA-P 1 n 4 40L, ❑ OTHER M oN N �. � bOn U rA W r 14 - W � w �7 p $ r3 ++ � \ Ln v o w C Q r . r ' 04 2 72A x o ~ A V c P o o C n q rh w z z y H °' V C v° 00 AO p w v {� P, Of, V z v a-d o C/] H A Li o c q, „ F � v W F z O zz o -0 - = o z C G !C = U lot 0.0 O a � W W z o C) z a s o = A W Z Hrim p � cb U BUILD :l MENT © ECIEME ID VIL OF R, OOK ��� 1 9 ZQ24 938 KING ET R)'E BR ,NY 10573 l4 ,U �� VILLAGE OF RYE BROOK ®V BUILDING DEPARTMENT Application for Permit to Remove or Abandon Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: Approval Date: SEp a g 2g24 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are nun-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$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: Removal or Abandonment $185.00 per Tank. 5. Dig Safely New York# (dial 811): 6. Inspection by Building Department for removal or abandonment. 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 . , �i ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon 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 or abandoned in conformance with all applicable Village,County,State&Federal laws,codes, rules and regulations. Indicate Permit Tyne: Removal ( •Abandonment ( }/Above Ground •Buried in Ground ( } 1. Address: Prz_ Pla � I��� VP4 SBL: I`?�� (�i _ — Zone: '��F 2. Property Owner&Address: '[�j , Phone#:LS�n bb'aCj Cell#: email:' 1 3. Contractor&Address: C Phone .0`�� • � Cell#: email:���r�: Fr�•n.�-1 rrYt.� �, 'ltt,ac1+1,�i+•t` 4. Applicant: ', , •wrr�t^+C, co Phone#: j'4 T�9, .-COM Cell#: email:�yarvtr „�a. s} -cuy( ,cam_ 5. Indicate Fuel Type: Fuel Oil'X•L.P. Gas( )•Gasoliine( )•Other( ): 6. Number and Capacity of each Tank: �1�- oic�,llcrrti cirt� _��t-f��ts.r� 7. Exact Location(s)of each Tank:' ank' (1 - 1 6/1/2024 Cc,11`CCk—,.0�- F-It�l ('�-,-fL W STATE OF MEW-MRK,COUNTY OF W as: f1 A Y1\PMcf�, ,being duly swam,deposes and states that he/she is the applicant above named, (print name of ind' ' ual signing as the applicant) and further states that(s)he is the Tank Installation Contractor for the legal owner and is duly authorized to make and file this application. 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 Uni€orm 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 l Z.+� Sworn to before me this -1 day of_ adz ,20 2y day of 54)+t^_ber ,20 _ $ignaturc of Prope wner Signature of Applicant } Klemm Print Name ofpamrty Ow Joni Lamaj Print Name o Applic Commissic"W I LA0025681 Notary Public,State of Now York of ub tc MY Commission Expires:June 07,2028 ary Public MAN NOZARkPUBLIC 4y Commissiun'Explrea Auj,31,202f This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 6/1/2024 2 2 o � -1 T "3 Its 3 `� p r4 S IA r�G ;r i w� i R FYcr 3D �� OCT - 8 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT K.,_ ..„ ,, .....FUEL CO.,INC. 10/8/24 Village of Rye Brook Department of Buildings 938 King St. Rye Brook, NY 10573 RE: Matthew Aronberg 195 Neuton Ave Rye Brook, NY 10573 Permit# MP-24-123 To Whom it May Concern: On 10/3/24,Westmore Fuel Company, Inc. removed the existing 275-gallon steel oil storage tank from the above-referenced residence. The tank was pumped out,and transported to our yard, where it was cut in half, cleaned,and disposed of properly. The tank was brought to M. Millers Scrap Iron&Metal, Inc,and the hazardous waste was picked up at our yard by Moran Environmental Recovery. Sincerely yours, Rachelle-Marie Koenig Service/Installation Coordinator Westmore Fuel Company,Inc a e 86 North Water Street• Greenwich,CT 06830•(914)939.3400•(203)531-6800•(203)531-5783•www.westmorefuel.com CT State Contractor's License#308868 9 HOD 444 -- 6 / �z � �? r ; f 43 / g \ z k , cri k / k \ / \ C % 2 z0uƒ 2 % 0. CD .1 I` .b � 7 7\ \ / \ E E m 2 d R 0 w k < 2 � ± m « ccw m � / / < q m \ U 2 0! _ �OM'.� -fit�r� _ ^�.:'R.T_�. �.. .► •M�,.:; _�i~�- � w^r„� i..y � .... � l)/�1�111 � III/il�//i I�,�'�+'�* ,:/�/�h, � � ,N:/�tr�.��v ►Oic ,1A 1'�d![Na 110.11 e7{a$�" y�;�+I/•/•1 �,, g�i, � y• ..N1111111,r`I' � e:i:.11f':t?�- y3,,.1�/1�llil rtr��n°�41111V/,�Pa_y��li1�1.!�I;.r, '��,s.'.111/1/{1�1�,,��'�y�_111+11�11111.' s� <(o Y _ . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . 10 i )t, y 'd � cC N I ,Y(•o s O v " . CO ,irk y 7t' V00 ❑❑ I ' �`x:• s� 'O � Cd e' E Uuj �. 4x ►�. Q � V .�. '�+Yam: :�.,.I r Q 4-/ ti. ^�•+, /off En 00 LL rw ,.•o ,Ca+ <tRs)>> r l CO)W W „ Gam fey I 71) .) = UJ �i U s. as cq 16. I ,,• •� �C .F I_ 10 �• O is a �I�NI• :'s + 111�111' E,,F :••1�,1 i A . e1= 1 1 c `11 ( 1 �{i►s)> Fa- IIIj1/11111 1111/f1111 ICI I�QI `II�/�� 1�111� IIIH=1 1 '1 ' 1 1 111 111 1/1 rl,4: All I \ {4.v `�?' �'Y' •1YS�n^F�" '�• '"fib :.- :.. +.�.1►,.by" •.l�y►�1r."�. •c./tvj�:+' "w . DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/10/2024 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 NAME CT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE I FAX HOME OFFICE: P.O. BOX 328 (A/C,No,Ext):888-333-4949 ( No):507-446-4664 OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC a INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 330-130-6 INSURER B: WESTMORE FUEL COMPANY INCORPORATED INSURER C: 86 N WATER ST GREENWICH,CT 06830-5886 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXPyI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES $100,000 MED EXP(Any one person) $5,000 A N N 9062815 06/01/2024 06/01/2025 PERSONAL&ADV INJURY $1,000,000 GENI.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000 000 X POLICY �ECO- ❑LOC PRODUCTS&COMP/OP AGG $2,000,000 OTHER: INE AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT $1 000 000 Ea n X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY LULED N N 9062815 06/01/2024 06/01/2025 BODILY INJURY(Per Accident) HIRED AUTOS ONLYIAH8?SC UT ONED PROPERTY DAMAGE ALITLY X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $7,000,000 A I EXCESS LIAB CLAIMS-MADE N N 9062816 06/01/2024 06/01/2025 AGGREGATE $7,000,000 DED I RETENTION !WORKERS COMPENSATION X I PER STATUTE I OTHER AND EMPLOYERS'LIABILITY YIN I,ANY PROPRIETORIPARTNERI EXECUTIVE E.L EACH ACCIDENT $500,000 A OFFICERIMEMBEREXCLUDED? N/A N 9917566 06/01/2024 06/01/2025 (Mandatory in NH) E.L DISEASE CA EMPLOYEE $500,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION 0-6 35 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED VILLA 938 KING ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 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 NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name 8 Address of Insured(use street address only) 1 b. Business Telephone Number of Insured 203-531-6800 Westmore Fuel Company Incorporated 330-130-6 86 N Water St Greenwich,CT 06830-5886 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to 1 J.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 06-0739367 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company Village Of Rye Brook #35 938 King St 3b.Policy Number of Entity Listed in Box"1 a" Rye Brook NY 10573-1226 9917566 3c. Policy effective period 06/01/2024 to 06/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) �X 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 in 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: Erin K Christensen (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �4 L K�f 05/10/2024 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 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