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HomeMy WebLinkAboutMP24-151 yE a etc,. . 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.ryebrookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 20,2025 William Stamm&Irene Stamm 124 Brush Hollow Crescent Rye Brook,New York 10573 Re: 124 Brush Hollow Crescent,Rye Brook,New York 10573 Parcel ID#: 129.76-1-136 As per the Certification letter from Hudson Valley Petroleum&Environmental Corp. dated February 3,2025, the removal of an underground oil tank under Mechanical Permit #24-151 issued on 11/14/2024 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE 4Rnuk. 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 : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: 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��. BUILDING DEPARTMENT ❑B DING 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 : Z S`"� L L J �� . DATE: `� Z J PERMIT# 1VNP 2.(4 ISSUED: 1) `SECT: BLOCK: � LOT: � J L LOCATION: P C OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... D 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 0" FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING Ll--k n C ❑ CROSS CONNECTION {�(' ❑ FINAL ❑ OTHER `� r ���� : .� ��. � �- _ (� �. ;- r, i:. .. - . l . =� . .tip >. a b e / �� r f•M I �� :� 'l �� � ✓ 1 '� �.. 'r+. r yk � V. ,r' �' �, .''v - �. ��. �� .� �� � � �� a �1 � �l � r ��, � �r-� c C � �, / � V'I� a \ r u.W Zo � c r i r I� rl # � Y :4 y «� � // y A �/p ♦� .c � �. TO•!I.�1 �Wi7 y' 3�i _ ��r, 1 �' .. V �• r. ��, r � ,��: �,� �r �., '�#e�` ■ L W _ N N �••! '�'+ '�" '" y cacp O N w � ■ rn CA °:PA a o Cc O j~i 9 C Oa � e � o U W 10, u cn W 66 En O © W M (dA� " © c ' y2 Q..� 00 1.0 O W a CO CE ' E 0 rul U a � � � 1 - 0 V W ono o '0 - " W a. ■ (� cn � � W � W � � � � o ;� Q ,� O uz A z ^ a w w � e - 1� 1••�r00 cu c N MM O QI d zz y 0 U U 0 z yQ W � O z11 � � ab � ,,,,, W O O O E a,� � � i••i cn o 0. x o � ., 00 � � p4 00 U 6f- av� Q — O w OZ > A O � ° N �0-4 U WA �. O O �I � aa U a a t BUILD MENT NOV 1 4 2024 1 —PJ VIL E OF RY . OOK II 938 KING ET RYE BR ,NY 10573 VILLAGE GF R T BP,Qp;< 93 BUILDING DEPARTMENT ov �1% 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 ONL 1 PERMIT Approval Date: �5\ Permit Fee: $ / Approval Signature: 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$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, a 0 is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon a F el T c 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 Type: Removal()o•Abandonment( }!Above Ground ( )•Buried in Ground M 1. Address: 124 BRUSH HOLLOW CRESCENT SBL: a?t7b—/l3& Zone: 2. Property Owner&Address: IRENE STAMM 124 BRUSH HOLLOW CRES, RYE BROOK NY 10573 Phone#: 914-261-8396 Cell#: email: IRENEBILL710@GMAIL.COM 3. Contractor&Address: HUDSON VALLEY PETROLEUM & ENVIR. PO BOX 364, YORKTOWN NY 10598 Phone#: 914-302-2320 Cell#: email: OFFICE@HUDSONVALLEYFUELOIL.COM 4. Applicant: DONALD DESANDRE-OWNER/PRESI DENT HUDSON VALLEY PETROLEUM&ENVIRONMENTAL CORP Phone#: 914-302-2320 Cell#: email:OFFIC ta.HUDSONVALLEYFtJR Oil .COM 5. Indicate Fuel Type:Fuel Oil(X)•L.P.Gas( )•Gasoline( •Other( ): 6. Number and Capacity of each Tank: 1-300 GALLON UNDERGROUND FUEL OIL STORAGE TANK 7. Exact Location(s)of each Tank: UNDER REAR DECK OF THE HOME i 6/I/2024 • � R STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: DO ALD DESANDRE ,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 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 m 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 be re this �X Sworn to before me this day of a 20_ day o 4 e/- 20;Z- I Signature of Property Owner Si lure of Applicant Pript Name of Property Owner Pint Name of Applicant fGµ L E& t, NutaizY. iic,State of New York N Pub c F 0 , Rio.01h1F6160063 O T g SiUrl In Westchester County 1u:' QU�L,D626 a,9.. O rru-san Expires January 29,1.?-L� L. F1EaiN r - This application must be properly completed in its entiretyand must include the notarized = to ' Cppy�Ms COCN�:' < signature(s)of the le al ovine syof the subject roe and the applicant of record in the s aces�v F�r25'zo g � } 1 property, pP p UBLI ' Q provided. Any application not properly completed in its entirety and/or not properly signed shall b' FO •C..'yo deemed null and void and will be returned to the applicant. ''•,rrFt111'E'1tt,.*` 2 6/1/2024 j I 3 o D72 pa4 + o or- The Arbors Homeowners' Association 173 '/2 Ivy Hill Crescent Rye Brook, NY 10573 October 18, 2024 NOV 14 2024 Irene & William Stamm VILLAGE OF RYE BROOK RUIt ;D10111C IDEPARTMEN_I 124 Brush Hollow Crescent ~ - ------ — Rye Brook, NY 10573 Re.- Above Ground Oil Tank Dear Irene and Bill The Architecture and Grounds Committee (A&G) and the Board has reviewed your application for the above-named work. The approval requires that you screen off or paint your tank. The paint color would match the house color. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Nicholas Salzarulo Property Manager Z-�_,- �-' -��� ��- _ r . ' .�. �� - ... ���� ��..i �� ____r r, ____.� _ � �,�. ..�. �� --- _:��;:. -=� ,. _.-� ..�..•. ::�. ::=�� - - - RDECIENE FEB - 7 2025 -Y) Hudson Valley Petroleum 49TVILLAGE OF RYE BROOK BUILDING DEPARTMENT Environmental Corp. DBA ITanksoilutions Website: www.tanksoilutions.com Email: office(atanksoilutions.com PO BOX 364 Westchester License WC-33112-H2O Yorktown Heights,NY 10598 Putnam License #794-12 914-352-0500 (office) Yonkers License #7963 914-980-9513 (cell) Yonkers Fire Dept. #5960 New Rochelle License #22-102 Mt. Vernon Fire Dept #8811 City of Poughkeepsie #193 City Of Rye #23-OHE-01 NYSDEC Waste Hauler #3A-1350 US-EPA NYR000266924 February 3, 2025 Irene Stamm 124 Brush Hollow Cresent Rye Brook,NY 10573 914-261-8396 Irenebill710@gmail.com Permit#MP 24-151 and#MP 24-152 Dear Ms. Stamm, We have completed the removal of your 330-gallon underground fuel oil storage tank from under the rear deck of the home. All waste oil and tank bottoms were transferred to Waterworks, 77 Stewart Ave, Newburgh, NY 12550 and the oil tank that was removed was recycled at Expressway Recycling, Cold Springs,NY. Our visual inspection showed no perforations or leaks of the tank. We also installed a Roth DWT 10001, 275-gallon tank at the rear of home against the shed. "erely, Donald De S NON-HAZARDOUS WASTE MANIFEST Please print or type (Form designed for use on elite(12 pitch)typewriter) NON-HAZARDOUS 1.Generator's US EPA ID No. Man test 2 Page 1 WASTE MANIFEST CESQG UITTZ 09 et 3.Generator's Name and Mailing Address 2,9 I'3rcksh C-re_SCe_ni- 4.Generator's Pnone( ) C - O a� 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transorter's ID 3A-1350 TANK SOILUTIONS i NYR000266924 B.Transporter 1 Phone 914-352-0500 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID D.Transporter 2 Phone 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID WATER WORKS 3-3346-00020/00003 77 STEWART AVENUE NYR000236349 F Facility's Phone NEWBURGH, NY 12550 1845-803-1519 11.WASTE DESCRIPTION 12. Containers 13, 14. Total Unit .� � No. Type Quantity Wt.Nol. a PETROLEUM CONTAMINATED OILY WATER AND SLUDGE, NOT 001 DM i1 G REGULATED, NOT US DOT HAZARDOUS MATERIAL, N/A, NONE, CJ NONE G b. E N E R A T O R d. W (A QG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above N5 O 13 cc Q a15.Special Handling Instructions and Additional Information Z O Z AULL-11, AL 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects In proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. Date Pnnted7yped Name Signature Month Day Year Donald DeSandre For Generator Above ( 1 a R17 Transporter 1 Acknowledgement of Receipt of Materials Date Y Pnnted,"fyped Name Signature Month Da Year p Ryan Connolly p 4 o� O 18.Transporter 2 Acknowledgement of Receipt of Materials Date R T Printed Typed Name Signature Month Day tiear E R IF19.Discrepancy Indication Space A C L20 Facility Owner or Operator:Certification of receipt of the waste materials covered by this maifest.except as noted in item 19. Date T Printed.?yped Name Signature Month Dav Year Y PAYMENT RECEIPT E PRESSWAY 845-80g-5633 m 3455 RT 9 Cold spring N.Y. Receipt: 133909 ®ate:1/21/2025 istomer:100729 Time:2:12:31 PM nk Solutions =VIN MCGEE �FIELDSTONE LN DRTLANDT MNR, NY 10567 Number: 762006793 Ticket: 136710 BOL:p0: Operator: Admin Ref: Weigh in: 1/21/2025 2:09:24 PM deigh Out: 1/21/2025 2:12:12 PM AJI tiveignts are in pounds unless otherwise noted Gross Tare Net Price TOTALS unmodity 336.30 Seel/Pip 38,360 34,820 3,540 0.0950/LB ---------------------------- --------- Ticket Total: 336.30 No.of Tickets:l payment Method:Cash Total Paid: $336.30 hereby state that I'm the lawful owner of the material described heron,that I have a right to sell same and that'e oropfayme same oreceived in full,hereby acknowledged.I sell and corNeYr Expresway Recyding Inc- Thank YOU for your business,Expressway Recycling,Inc. BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www UebrooLorg - - - - - - - - -- - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - -- - - ADDRESS : 1 L y 9--ne V1S�\ Y n LLoc..j A.& DATE: i PERMIT# m l 2,q - 1 J 2- ISSUED: I I'N-2- SECT:_1 Z9._� BLOCK: ! LOT: 136 LOCATION: Rgq� Li O-'J OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ NATURAL GAS " NI?4 } Po 1- 46 D �C ❑ L.P.GAS ,FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING N��s .� ❑ CROSS CONNECTION Aj [� e PA,^ ~ ❑ FINAL /YL ❑ OTHER ROA A4, _ '.� �` '�'�• �!••^R'11.• WO: ` � �•�_ ��pv1u a4� Fs.•. ,. :, '7Ty� � ( :.J! - � 'ntwti 'YE raw .'I+�t •ti,yy Y, it�rJ• , /' '• '� -�:o.,i�,'r�al• "Y.-'.'"a,'� A i° _ �, 8� �v a��•�{�"r�,.-. �' -;� ��, {' �.ti :i'..y y".- �•'�'� •� 7'�''�. 5 •. �.�i.::' -. ..?� '�-- d5 yn'/�s.> ;?e c,('+ ' �1' r "e l f®90♦ 9 !l1 : ` 8," !1 gt�'R't� r. i +W»r!/ •d �' :� t•.c, �' ?r & i�g:-: r+a6+f$Ml 3F _v a (flri)► ,./ f �.+c' f OII_ =C`c.i %G•.(F If1f' wi f ryll)♦ ff{' -- �f �lj, �R & s` /`. . j� •fit' � f -s` �♦ O'er � , rk CN 1 ��` to `� ,_ ' �'. �„� Z3.•y � „t p n : V. ; • cs I 06 ;. ,\ 1• � _�.• � Rol •- -�-, �.a� �3c CO J ra ,Vy., ).y "E 'rfsl ' f" - fl{Qf�r •';Gt,. . . %tz. .f. .f.- 0 777 j'` c4i t } s f+�f)1f • .' rtyG/flcQr tt d `'`+r'�4O�f,r a 3```: 'off !t /�� rr.r. . . . .,v @ 1 - :s .�_ a.:% �, �}��,. �},� A:A. ,,{%;'•�N•tO•"�. �4 .,.,�•:ia+ i a�'�'dwl�,.. +®p+ :���4�i�1,� 1i+) +t Cy�'fag :e0�0�t ?iE2�1 *f'rala r6fOf/4drrtl�`�', - f�1 r � 'r�`'. `fib %tb �,ir. n •..t}e iw; n !{i,.fy.,w�. `� !:^r\�! � q`��._ 0 •,i..,�� + rl ,� �'G 'S 6�4. y ''ii/'/+ .'Y'•.G"� l.^Y 1 ''� x• ...Lt.." q !ti; a r `... .i A 5�:•fir.,\. �a-_q p A \y.� L- 8 i '��.• T?•' �,reltl��• ' `'�H��,'.r"?'"t{�Y;;..-. _'°�;;� '1'? •�;i;:: _:.tr.j�y�- ti. '>`' �'`- �.N: 0a6 .`�w�f�.,, f: !�o�,!lh r, '�.?'y'••...:�_ '�5' .•.. $ -"'", :Y�•'... •1•il•5:0�'�''•• Sy�i,iati}•'CC' •.•C y ti4 n yr'•?'.lT�' ' q �:fi� 1 •:� �":: fQ�;'i:- is rf ., .i":_ - 1' �.,. _:: s �fh.,A �' qG�® CERTIFICATE OF LIABILITY IN URANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NOR HTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER T COVERAGE AFFORDED BY THE POLICIES 07/19/2024 BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(es) If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain polic es may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s) DDITIONAL INSURED provisions or be endorsed. PRODUCER Marshall&Sterlinc,Inc, CONTACT NAME, Angel NAME: Nacri 110 Main Street PHONE (845 454 0800 A/C No Ext: FAX E-MAIL (g45)454-0880 ADDRESS: anach marshallste ding.com ac,No Poughkeepsie INSURER($)AFFORDING COVERAGE INSURED NY 12601 INSURER AUnion Insurance Company NAIL# 25844 Hudson Valley Petroleum$Environmental Corp INSURER e: Acadi Ins Company 31325 PO Box 364 INSURER c: Guide ne National Insurance Company 14167 INSURER D: Yorktown Heights INSURER E: COVERAGES NY 10598 CERTIFICATE NUMBER: CL24719685231NsuRERF: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN URED NAMED A OVEREVI'I THE POLICY INDICATED. NOTWITHSTANDING ANY REQ Y PERIOD UIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTH R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRI ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID LAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY MM/DD MM/DD LIMITS CLAIMS-MADE OCCUR EACH OCCURRENCE $ 1,000,000 A PREMIS S Ea occurrence $ 300,000 Y CPA551984612 MED ECP(Any one person) g 10,000 GEN'LAGGREGATE LIMITAPPLIES PER: 07/20/202 07/20/2025 PERSONAL BADV INJURY g 1,000,000 POLICY ©JE T ❑LOC GENERAL AGGREGATE g 2,000,000 OTHER: PRODUCT S-COMP/OPAGG g 2,000,000 AUTOMOBILE LIABILrrY Employee Benefits $ 2.000,000 X ANY AUTO COMBINED SINGLE LIMIT A OWNED Eaacddent $ 1,000,000 AUTOS ONLY SCHEDULED CAA551984712 BODILY INJURY(Per person) g HIRED AUTOS 07/20/2024 07/20/2025 BODILY INJURY(Per accident) $ AUTOS ONLY NON"", ON S ON LY AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR $ B EXCESS LJAB EACH OCCURRENCE 5,000,000 CLAIMS MADE CUA551984812 07/20/2024 07/20/2025 $DED RETENTION$ 10,CO0 AGGREGATE $ 5,000,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY $ ECUTIVE ANY PROPRIETOR/P YIN PER STATUTE ER ER OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L.EACH ACCIDENT If yes,describe untler g DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ C Pollution E.L.DISEASE-POLICY LIMIT $ ENV56201104302 Pollution Liability Per Occ $1,000,000 07/20/2024 07/20/2025 Pollution Liability Agg $2,000,000 Village Of Rye Brook is an additional insured if required by Written contract DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more ace Is required) Contractors Professional $2,000,000 See page 3 of Certificate of Insurance for applicable forms based on the coverage reflected above CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION ATE THEREOF,NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WI H THE POLICY PROVISIONS. AUTHORIZED REPRESE TATIVE Rye Brook NY 10573 41,14 C� ACORD 25(2016/03) The ACORD name and logo are registered marks f ACORDI S ACORD CORPORATION. All rights reserved. NYSIF Now York State Insurance Fund PO Box 66699,Albany,NY 12206 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 421749379 FRIEDLANDER GROUP, INC. D 2500 WESTCHESTER AVE-#400A PURCHASE NY 10577 a., " 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 [�!GL�2574 MBER �CERTIFICATE NUMBER 6-8 POLICY PERIOD DATE 4798 07101/2024 TO 07/01/2025 ---------------- 07/08/2024 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/ CERTVALASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN NOTIFICATIONS. THE EVENT OF FAILURE TO GIVE SUCH 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 /' 4VALIDATION NUMBER: 918032693 DIRECTOR,I SURANCE FUND UNDERWRITING 14 000000000®2g3g7982�§1u1 Form WC-CERT-NOPR(NT Version 3(OW9/2019)(WC Policy-25747668] (000000000001293979823(0001-000025747668 #BG 16425-05 U-26.3 1f 7( 1(�e2NOP{ERT_I](01-00001] Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, November 18, 2024 6:15 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 11/18/2024 06:14 To: VIL RYE BROOK PRIMARY Transmitted: 11/18/2024 06:14 00001 Ticket: 11184-000-035-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 124 To: Name: BRUSH HOLLOW CRES Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR YARD NearSt: BRUSH HOLLOW LN Means of Excavation: MINI EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 12/30/2024 Depth of excavation: 5 FEET Site dimensions: Length 6 FEET Width 6 FEET Start Date and Time: 11/30/2024 07:00 Must Start By: 12/16/2024 ------------------------------------------------------------------------------ Contact Name: DON DESANDRE Company: HUDSON VALLEY PETROLEUM & ENVIRONMENTAL CORP Addr1: 32 BUTTERFLY LN Addr2: City: PUTNAM VALLEY State: NY Zip: 10579-2906 Phone: 914-980-9513 Fax: Email: office@tanksoilutions.com Field Contact: DON DESANDRE Alt Phone: 914-980-9513 Email: office@tanksoilutions.com Working for: HOME OWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER = VIL RYE BROOK WESTCHESTER CTY SWR 1