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HomeMy WebLinkAboutMP14-075 �yE DRCi c tCc`P" �v CC`�u�t,C�u�vJ u� 1913 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 12,2024 David Lowenstein&Myra Lowenstein 802 King Street Rye Brook,New York 10573 Re: 802 King Street, Rye Brook,New York 10573 Parcel ID#: 136.21-1-12 This document certifies that the work done under Mechanical Permit #14-075 issued on 6/24/2014 for the removal of an above-ground propane tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE BR(��. • 1932• BUILDING DEPARTMENT ❑BUILDING INSPECTOR [a'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:- Aj G S / DATE: / v Z OZ 1 PERMIT# !'jI ! 7 � �-� ISSUED:�G"Z/ //SECT: BLOCK: LOT: 1 Z LOCATION: S/ c e �yzzt� OCCUPANCY: Z �U ❑ Violation Noted THE WORK IS... B�' PASSED ❑ FAILED REINSPECTION 0-SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas _��9 �� /il/,� S /(P w/U zle 0 4'vc� ❑ L.P. Gas - ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Q''FINAL ❑ OTHER Alfredo DiVitto From: Alfredo DiVitto Sent: Wednesday, January 10, 2024 8:24 AM To: myraloew@gmail.com Subject: 2014 propane tank removal permit Good morning Mrs. Loewenstein there is an open propane tank permit still open from 2014 looks like the tank was going to be removed from your property by suburban propane can you please verify if the tank has been removed and the gas line capped and safe. If by any chance I can stop by this week and just confirm the tank was removed that will be great, please call me so we can set up an appointment to do so. Thank you, Alfredo (Freddy) DiVitto Assistant Building Inspector Village of Rye Brook 938 King St. Rye Brook,N.Y. 10573 Office: 914-939-0668 1 s s Ln r- z 0 14 O a O e} � y •.� a °° Ct ►ut h+� >s- W, Oo ol a �j 1 � W � 1 a � y •� o t/1 a W a UQQ w . a y ayi Ey W OC -SA b U O O ~cs3 c U o � w � oa :Y � � � � A � a w w o a s F W Z d b a�i abi a W a o 0 U O U w d� m ao a" w x � � tL VILLAGE OF RYE BROOK JUN 2 4 2014 BUILDING DEPARTMENT 938 KING STREET,RYE BROOK,NY 10573 1 VILLAGE OF RYE BROOK (914)939-0668 FAX: (914)939-5801 www. ebroo UILDING DEPARTMENT APPLICATION FOR PERMIT TO REMOVE, ABANDON AND/OR INSTALL FUEL STORAGE TANK UP TO 1100 GALLON CAPACITY (*Storage tanks in excess of 1 100 gallons require registration with the County of Westchester) Permit #: H r ILI —M15 Building Inspector: Fee Paid: Date of Approval: JUN 2014 (fees are non-refun able) *�k9c�k*4e9e4e�Y9e9e**�e�ede4t�'e3e�Y*9c�k�k�Y9c�k9exxx9e�c�cx9c�Yicic�Fir*9c9e**9e*9e9e9e4e9c�Fx�F**de9e9e9t�c�r**,t9t*de�fr�4e4e�de�t REQUIREMENTS FOR RELEASE OF PERMIT& CERTIFICATE OF COMPLIANCE: 1. Application Completed by Bonded, Licensed Contractor 2. Copy of Licensed Contractor's Liability & Workers Compensation Insurance (naming the Village of Rye Brook as Certificate Holder) 3. Fee per Tank: Removal or Abandonment: S175.00; Installation: $175.00 4. Dig Safely New York#(dial 811): 5. Inspection by Building Department for removal/abandonment& installation 6. Submit all Manifests& Reports(after work has been completed) 7. Certificate of Compliance will be provided when all requirements are fulfilled. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the removal,abandonment and/or installation of a Fuel Tank(s)herein described.The applicant,by signing this document agrees that said Fuel Tank(s)will be installed,abandoned and/or removed in conformance with all applicable Local,County,State &Federal laws,codes,rules&regulations. Indicate either above,,round tank or buried in-ground tank. 1. Property Owner's Name: Phone #: q l `1 - "1`t Vt� J 2. Job Address: fn, _13-9 wle- Phone #: 3. Parcel I.D. #: Zone: 4. Contractor: s '"-��"' �� Phone #: `l'l`t e`�-t�4,6- 5. Contractor's Address: ZS k�-s��- t:" �' Fax#: a�`t - `' `° "$ -7`' 6. Exact location of tank to be Installed: above ground ❑ in groundEl r _ 7. Exact location of tank to be Removed: above ground�n ground ❑ 8. Exact location of tank to be Abandoned: in ground only 9. Distance of Tank from Structure: 10. Distance of Tank from Property Line: 11. Type of Fuel: Oil:❑; Propane:Fri Gasoline:❑: Other: 12. Number& Capacity of Each Tank: 12-� -ram--Ir- Signature of Applicant. Date: -o%�o (z3 l t-1 Printed Name of Applicant: ry 0_0L a- e 4e-P C-2 Phone #: 1`� e`� ��612014 '�, Y�.. .r5wr• �y�'.` � i >, .` i � ��1;'2 5 ..•w r��k)1��+5,, � a) y�. y, ,,��/t� A�! r�,y''T. s �y*a—`4�' ,bsZ;,.y��, iey,�!r , kr / ! '�^ ,,y S's R Mr �x `•'ti#i�. "K �. 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Vr ♦♦ k 1 M M' ,y «, Y 1 f �'r ,{ V 1 t , 4 rFx �, l •# • '� �y •'�� `dtY�a�j(Y�aY'" ' �_•{:Y YrK� d��' '•p!;�•�y.3 Siy>�y'yh`✓��.�'p k � 1 Y lc.�Sy� L�, _ <��G STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured 973-887-0500 Suburban Propane Partners L.P. 1c.NYS Unemployment Insurance Employer 240 Route 10 West Registration Number of Insured Whippany,NJ 07981 892-18602 ld.Federal Employer Identification Number of Insured Work Location of Insured(Only required ifcoverage isspeciftcally or Social Security Number limited to certain locations in New York State, i.e., a Wrap-Up 22-3410353 Policy) 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Indemnity Insurance Company of North America 3b.Policy Number of entity listed in box"la" Village of Rye Brook WLR C47886247 938 King Street Rye Brook,NY 10583 3c. Policy effective period 3/1/2014 to 3/l/2015 3d. The Proprietor,Partners or Executive Officers are X included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "la" 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"T'. The Insurance Carrier will also note the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums 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. Please Note: Upon the 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: Z>/�// e ed ve tic carrier) ens�d agent of tnstuance caer) - _ -- -- Approved by: Ol ( ) ( ) Title: _/�71f -_._. -- - -- — -- - Telephone Number of authorized representative or licensed agent of insurance carrier. Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-I05.2. Insurance brokers are NOT authorized to issue it. ® CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) ACORO 06103/201412014 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 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 CONTACT MARSH USA,INC. NAME: 445 SOUTH STREET PHONE A/C No: MORRISTOWN,NJ 07962 EMAIL PHONE: 973-401-5000 ADDRESS: INSURERS AFFORDING COVERAGE NAIC M J08990-ALL-GAW-14-15 SP LP CLIE INSURER A:ACE American Insurance Company 22667 INSURED SUBURBAN PROPANE PARTNERS,L.P. INSURER B:Indemnity Ins Go Of North America 43575 240 ROUTE 10 WEST INSURER C: WHIPPANY,NJ 07981 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: NYC-005492803-25 REVISION NUMBER:2 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYW A GENERAL LIABILITY HDO G27331403 03/01/2014 03/01/2015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 250,000 CLAIMS-MADE M OCCUR MED EXP(Arty one person) $ 10,000 PERSONAL&ADV INJURY S 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2.000,000 X POLICY 7 PRO- LOC 1 $ A AUTOMOBILE LIABILITY ISA H08819488 03/01/2014 03/01/2015 Ea acBINED SINGLE LIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED I SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTYDAMAGEPer accident S XHIRED AUTOS AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WLR C47886247(ADS) 03/01/2014 03/01/2015 X WC STATU- OTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECUTIVE Y/N WLR C47886235(CA,MA) 03I01/2014 03101I2015 1,000,000 A OFFICER/MEMBER EXCLUDED? a N/A SCF C47886259 WI 03/01/2014 03/01/2015 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) ( ) E.L.DISEASE-EA EMPLOYE $ H yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:WORK PERFORMED AT:LOEWENSTEIN 802 KING ST RYE BROOK,NY 10573 VILLAGE OF RYEBROOK IS SHOWN AS AN ADDITIONAL INSURED SOLELY WITH RESPECT TO GENERAL LIABILITY COVERAGE AS SHOWN HEREIN AND SOLELY IN THE EVENT THIS STATUS IS REQUIRED BY WRITTEN CONTRACT BETWEEN SUBURBAN PROPANE,L.P.OR ITS SUBSIDIARIES OR AFFILIATES AND CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYEBROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 KING STREET ACCORDANCE WITH THE POLICY PROVISIONS. RYEBROOK,NY 10573 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _MaLuvo►u �+4.�ec_w ice ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD