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HomeMy WebLinkAboutMP24-152 a s m LO _ � N N N N v N i a 0 W �"+ r°n W a � t � W by cn x g g a bI5 vi 0.3 'O r. a o " Qj ■ �G p r"� r� w O �, d o o � � o QI a (T1 ( h �•+ N W w F oq ed Gd T4 �./ p L p r 1 .�-� H h r y ca p. w A Q ,noo cn 3 vw O U E i P�" � QW W j. o ata© 00 14 H � Q V 2 C) t o H p v • �a E" O ZImw v _ i BUILDING DEPARTMENT VIL�VGE OF RYE BROOK 14 938 KING STREET RYE BRO0K,NY 10573 NOV2024 VILLAGE OF RYE_ BROOK r -fro i ov gal_III-i yli'•i^ DEPARTNIENT Application for Permit to Install Fuel Stora;!e Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: Approval Date: N Permit Fee: $ / Approval Signature: Other: Disapproved: (Pecs 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: I.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#C105.2 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 811): 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, 10/24/2024 ,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 Type: Above Ground(X)-Buried in Ground( ) I. Address: 124 BRUSH HOLLOW CRESENT SBL: A) , 76—/ /3&zone: IOU6 2. Property Owner&Address: IRENE STAMM 124 BRUSH HOLLOW CRESENT RYE BROOK NY 10573 Phone#: 914-261-8396 Cell#: email: 3. Contractor&Address: HUDSON VALLEY PETROLEUM&ENVIR PO BOX 364 YORKTOWN HEIGHTS NY 10598 Phone#: 914-302-2320 Cell#: email:OFFICE@HUDSONVALLEYFUELOIL.COM 4. Applicant: DONALD DESANDRE-OWNER/PRESIDENT HUDSON VALLEY PETROLEUM&ENVIRONMENTAL CORP. Phone#: 914-302-2320 Cell#: email: OFFICE@HUDSONVALLEYFUELOIL.COM 5. Indicate Fuel Type:Fuel Oil 0(,)•L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 1-ROTH DWT 1000L 275 GALLON ABOVE GROUND FUEL OIL STORAGE TANK 7. Exact Location(s)of each Tank: REAR OF HOME ON A 4-INCH CONCRETE PAD AGAINST SHED 6/1/2024 STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: 0©NALn nFRANURE ,being duty 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 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 be rc Me this � �� <, Sworn to before me this day of 20 �`� day o ,202.4 i � r G ,.=.-- Signature of Property Owner Sig Lure of Applicant / Print Name of Property Owner P--bt Name of Applicant ,4�`� (� L 1r E C sirs Notary Public N Pub c' : F o Fq o,L'. fit/ 264L!F0�9i 0 'U rcHESS�ED 1N This application must be properly completed in its entirety and must include the notarized N cofV1} 06125 Za x COU P. signature(s)of the legal owuer(s)of the subject property, and the applicant of record in.the spaces��=.,AVs 2 t provided Any application not properly completed in its entirety an&or not properly signed Shall b��,� ....... y© ,• deemed null and void and will be returned to the applicant. ���,,! 2 b/1/2024