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VILLAGE OF RYE BROOK
MAYOR 938 Ding Street, Rve Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J.Bradbury
wmw.ryebrook.org
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Michael J. Izzo
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
April 13,2022
Joshua Escott
34 Rock Ridge Drive
Rye Brook,New York 10573
Re: 34 Rock Ridge Drive, Rye Brook,New York 10573
Parcel ID#: 135.35-1-24
This document certifies that the work done under Mechanical Permit #10-17 issued on 4/29/2010 for the
installation of an above-ground propane tank has been satisfactorily completed.
Sincerely,
0� 7�_
Michael J. Izzo
Building&Fire Inspector
/to
BR
1982 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: - � \ �=�j DATE: �1 2- 2-
1
PERMIT# ` �7 ISSUED:�I SECT: BLOCK: LOT:
LOCATION: OCCUPANCY: Z( J
❑ 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
❑ ATURAL GAS
d FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
LPG CYLINDERS
CYLINDER DIMENSIONAL INFORMATION
CAPACITY OUTSIDE OVERALL COLLAR FOOTRING TARE QUANTITY IN
LPG in Ibs. DIAMETER HEIGHT Outside Diameter Outside Diameter WEIGHT FULL LOAD
200 lbs. 24" 31- 7" 1'- 2 5/8" 1' - 6 3/8" 155 lbs. 192
90.7 kg. 609.6 mm 1092.2 mm 369.9 mm 466.7 mm 70.3 kg.
420 lbs. 30" 4' - 6 1/2" 1' - 2 5/8" 2' - 0 3/8" 285 lbs. 99
190.5 kg. 762.0 mm 1384.3 mm 396.9 mm 619.1 mm 129.3 kg.
OPENING OPTIONS
CAPACITY SIZE & SERVICE OF HANDLE
NUMBER OF OPENINGS COLLAR LID
OPENINGS
200lb. 3/4" - - - - - - - - - - - - - -Multi Valve
LIFTING ------ -
2 Openings 1" - - - - - - - - - - - - - - -Float Gauge LUGS O
420lb. 1" - - - - - - - - - - - - - - -Multi Valve
2Openings 1" - - - - - - - - - - - - - - -Float Gauge
420 lb. 3/4-- - - - - - - - - - - - - - -Service Valve
3/4" - - - - - - - - - - - - - -FiIlValve w
3 Openings 1" - - - - - - - - - -Relief Valve x
OUTSIDE a
3/4" - - - - - - - - - - - - - -Service Valve
4201b. DIAMETER w
1" - - - - - - - - - - - - - - -Float Gauge
4Openings 4" - - - - - - - - - - - - - -Fill Valve O
1" - - - - - - - - - - - - - - -Relief Valve
420lb. 34- - - - - - - - - - - - - - -Service Valve
4Openings 1" - - - - - - - - - - - - - - -FloatGau e
1 1/4 - - - - - - - - - - - - -FiIlValve —
1" - - - - - - - - - - - - - - -Relief Valve
FOOTRING
General Soecificafions
Conforms to the latest edition of the Department of Transportation section 178.61 specification 4BW for Liquid
Petroleum Gas (LPG).
Rated at 240 psig at 700 F per the Code of Federal Regulations Title 49 173.301 (e), 178.61 (a). All tanks are
good for full (14.7 psi) vacuum.
Vessels are delivered with a pre-purge vacuum that is in compliance with the National Propane Gas Association
#133-89 (a) Alternative Purge. r I
Vessel Finish: Coated with TGIC powder.
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AC RO o® CERTIFICATE OF LIABILITY INSURANCE OP ID AV DATE(MMfOD/YYYY)
PRODUCE PARAC-1 12 31 09
CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT
Fairfield Cty. Bank Ins. Svcs. ONILY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 0
401 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 969 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Ridgefield CT 06877
Phone:203-438-0404 Fax:203-431-8789 INSURERS AFFORDING COVERAGE NAIC#
INSURED - ----- -
INSURERA: Liberty Mutual Ins. Group 23043
INSURER B: Everest National Ins.__Co. 10120
Paraco Gas Corporation INSURERC:
800 WestchestQ r Avenue, S604 INSURERD:
Rye Brook NY 10573
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS --- ULICY E FFECTW
LTR INSIRE TYPE OF INSURANCE POLICY NUMBER DATE MMlDD/YYYY DATE(MMjDDfYyyyj LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1 00O 000
A X COMMERCIALGENERALLIABILITY TB164G435685030 01/01/10 01/01/11 _PREMISES Eaoccvrence $50 000
CLAIMS MADE n OCCUR MED EXP(Any one person) $5 r 0 OO
PERSONAL&ADV INJURY $1 000 000
GENERAL AGGREGATE $2 0 O O 0 OO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,()00
X POLICY PRO-
JECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT 1 OOO 000
A X ANY AUTO AS164G435685040 01/01/10 01/01/1, (Ea accident) $ r
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS - -
X NON-OWNEDAUTOS BODILY INJURY $
(Par accident)
X COMP/COLLISION $1,000 PPT DED PROPERTY DAMAGE
X COMP/COLLISION 5 000 TRUCK DED (Per accident) $
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGO $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000
B X OCCUR �CLAIMSMADE 71G4000088-101 01/01/10 01/01/11 AGGREGATE - $51000,000
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION _
AND EMPLOYERS'LIABILITY Y/N X TORY LIMrIS
A WORKERS
WC264G435685050 01/01/10 01/01/11 F.L.EACHACCIDENT $I 1 000 000
OFFX;ER/MF.MBER EXCLUDED? r
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1 000 000
1PEs,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1 r 000 r 00 0
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
VILLRYE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Village of Rye Brook REPRESENTATIVES.
938 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE
I
ACORD 25(2009101) PORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
04/27/2010 13:29 FAX 314 251 9444 PARACO GAS CORP 2 002/004
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
914-250-3700
Paraco Gas Corp.
800 Westchester Avenue,S604 Ic.NYS Unemployment Insurance Employer
Rye Brook,NY 10571 Registration Number of Insured
67-109415
Work Location of Insured(On(y required lfcoveragelsspecolcally Id.Federal Employer Identification Number of Insured
limited to certain locations In New York State, i.e., a Wrap-Up or Social Security Number
Policy) 13-3149941
2. Name and Address of the Entity Requesting Proof of 3n. Name of Insurance Carrier
Coverage(Entity Being Listed as the Certificate Holder) Liberty Mutual Fire Insurance Company
Village of Rye Brook 3b.Policy Number of entity listed in box"la"
938 King Street WC264G435685050
Rye Brook, NY 10573
3c. Policy effective period
1/1/10 to t/1/11
3d. The Proprietor,Partners or Executive Officers are
X included. (Only check box if ail parturn/afficers ineludcd)
~1 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 "I 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 will also notify the above eertifreate 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 maybe sent by regular mail.) Otherwise,this Certificate is valldfor 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 ix
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: _Robert E.Spadaccia
(Print nunlu ofuutllorizod reprc.4cntouvc or licomaed agent ol'insurance carrier)
Approved by: 4/27/10
(SI�Palure) (Date)
Title: President—Carnal) Insurance,LLC.
Telephone Number of authorized representative or licensed agent of insurance carrier: 203-894-3145
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.