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HomeMy WebLinkAboutMP10-17 Li 19 404 annftwmaW 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. 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'� I MiuJill IN K CN NIS �f� LU ' O eetiOn Q ►7 w Y > L O y : / w.p U W Y ' z ♦oo O O V I � •CD •— gip• +c �i �- CO CA tin Vp oj M f v: \ (0)>� ;-•+• •��. �e ser,.4� ; . . . ...�s•0•/• •1 s h. . ��Y. . `S:: . . . .��• '`s"iii` ,'x, � r�<(Ors)> DMA +1c/11�++++11�N+ / A t•. :11• A, `N• ei A€!" N• A. h ♦♦ ti i A ♦11 V$ A •♦ i A /N A`{44(( '\ A tom �.;PYVOi" +� ,• O�t/ ' �, �. $-�'rr$a''"�t....r✓i. .r7`y yam.� 7j+�-v��/„ti; ,�,.v �,�yw sl;�vtY -,,,1� .;�+�Y, :.��, �.rl,�v �.Vit r . 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.