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HomeMy WebLinkAboutMP25-011 t t� ' 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 April 3,2025 Luigi Ferraro 11 Whittemore Place Rye Brook,New York 10573 Re: 11 Whittemore Place, Rye Brook,New York 10573 Parcel ID#: 135.76-1-18 This document certifies that the work done under Mechanical Permit #25-011 issued on 2/3/2025 for the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BR(�v� o`` tim 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 ' ! z �� ���, i Y �-j F� DATE' / - PERMIT# P ISSUED: SECT: BLOCK: LOT: LOCATION: ►C \ ��� S t OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 2- ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION � ( 1 \ - 4- ❑ NATURAL GAS `1 1'1.I�1• �y( ) U=�J ❑ L.P. GAS f p O FUEL TANK ❑ FIRE SPRINKLER ALA 1� ❑ FINAL PLUMBING ❑ CROSS CONNECTION 0--'FINAL ❑ CI- OTHER J 5 i , 00 37blDs p �.�V7d .7ly0"-71j/y/;f 0 1� 0 At,/Fo 0/S 10 .a 66ay w oN .•and p�ra/pooY 01 0"0S/- ; £55161'8G -AbW"AW `b�1s N7 ldo� O pas�a��7 "1".2 T '40,< •o, �i�rioicncJ af;1 auroH� (� I i , .5 �vvg�v�v��vy�aYsay�{cagy /sii�04 pay.lj- � y 278 '01V LY VW '0 'b' 0-7714 c 10 NM 01 Y H1 Al '9/7,S' FH O W-71 o A o o -99 9.9 5 AP 0,09 N,/I,0/S 0 OS o60pz-M i Part k 2335101862 Submittal Data Information Rom Roth DWT 1000E YOUR ENVIRONMENT IS OUR BUSINESS. Effective:September 2007 Su ercedes: Job: Engineer: Contractor: Rep: ITEM PART NO. ITEM DESCRIPTION MANUFACTURER #2335101862 275 Gal.(1000 Liter)Double Wall Tank Roth comes with a detached saddle base which the tank is placed on at the time of installation. s The tank shall be placed into service in accordance with local codes and the listed use(indoor or outdoor) on a flat, level and stable surface, away from heat sources, corrosive atmospheres or fluids, potential mechanical damage or rapid temperature changes. The final location must have the tank label visible after installation. A minimum of 2"(50 mm)from all walls or obstructions is recommended for normal tank expansion and visual inspection. The integral ! base support shall not be removed and raising the tank _ height is not allowed except on a continuous concrete platform at least 6"(150 mm)wider than the tank base at all sides. All local fire code set-backs for fuel The Roth Double Wall Safety Fuel Oil Storage Tank oil storage tanks must be observed. (DWT) is made with a seamless blow-molded polyethylene inner tank and a 19 ga. galvanized outer Tanks installed indoors shall not be exposed to direct tank. The outer tank is formed by joining cold rolled sunlight on any plastic parts. Tanks installed outdoors sheet steel, used to form the sides and bottom from a shall be assembled with the required cover, Roth single piece,with two stamped metal end pieces. The #2335100747 for the 1000L. All tanks must be edges between the sides and ends have sealant applied installed with an approved vent alarm (Roth Vent to them and are then rolled to create leak-proof seams. Alarm 4235000999, or equivalent sized UL listed A stamped top is then pressed and riveted into place to whistle vent) in order to maintain warranty complete the assembly of the DWT. The DWT is UL® requirements. listed in the United States and Canada under SU2258 and approved under NFPA 31 (2001)and CSA B-139- Tank Model DWT 1000L 04 as non-metallic fuel oil storage tanks. Nom.Capacity US gal(liters) 275(1000) Length inches(cm) 43(110) Width inches(cm) 28(72) Both inner and outer tanks are pressure tested at the Height Inches(cm) 61 (155) factory during assembly according to ULO standards Min Height Req'd inches(cm) 66(168) and do not require further field testing. The DWT also Tank Weight lbs.(kg) 167(76) Shipping Weight lbs.(kg) 185(84) Your Environment is Our Business.® ROTH Industries,Inc,268 Bellew Avenue South,Watertown,NY 13601 Telephone:(315)755-1011 Fax:(315)755-1013 ROTH Industries,Inc, 1607 rue de I'Industrie,Beloeil,QC J3G 4S5 Telephone:(800)969-7684 Fax:(450)464-7950 Visit our website at:www.roth-america.com Copyright 2007 6.v12 TANK Ton PIECE Is FASIEMEo 26— WM RNETs(NM ROUED) 32 am--Am 25 � 2.96 3 1 m 2 fRc3fh 29 20 o. 56.79 97.14 2 21 on fa[m ro slap PwU 1.97 5-- HNLOLE IS F/SnM To FKE or TANI(WM FOUR RNM 43.13 A—M 27.33 33 � 34 w-M 35'r^..�^—M 32°°°'°°"""."' 36M- BUrn SENINO OASHEr IS COMPFCM BETWEEN THE MP OF 7W CONTAINMENT TMW NO ESCUTCHEON POCKET. 011 ® 0— 25 — S.Sf 19.67 S.SI — 39--m (Tm4x) RouEB EDGE SEAM WTtx SENAHr N 7IE JOM. n TESIIHG OF THE F*MM SEAM 6 WTTN TIE•LLTEC-LEAK FBOEH•MMM. TEST CRMPA CM BE FiXM IN TIE TEST PROMM(Nor A7T*0 ) Your Environment is Our Business.® ROTH Industries,Inc,268 Bellew Avenue South,Watertown,NY 13601 Telephone:(315)755-1011 Fax:(315)755-1013 ROTH Industries,Inc, 1607 rue de I'Industrie,Beloeil,QC J3G 4S5 Telephone:(800)969-7684 Fax:(450)464-7950 Visit our website at:www.roth-amedca.com Copyright 2007 ■ � 1w N a N O N p+ 11,•a a ■ N .r ■ a " 4L O , a 00 w O bIO p WLn en4 cc do 0 w cc L� ai o 5 � 2 O = .0 -0 U , a °° O ° 0 Q M \ Uzc v o cn ao 8oil O - o eo , o oc 10 w A14 u W O O cn Z z �. E �: A•� W a O v �4' oa � - ■ Lei O E v .a U ■ � � W F � O z � � �� yQ ,�.�' ~z "w � H S w a o r-4 w n > � o c7 A z A 0 >, .4 a �, o 0 w a �I M a a a BUILD 4) MENT p V i VIL OF RY ©OK 938 KING 'ET RYF-BRO' ,NY 10573 JAN 3 0 2025 � 1.4 , �-ilb68_, xu ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: �i -A) D l l Approval Date: 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#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, 1 `� f�� ,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 Buried in Ground ( ) 1. Address: 0 )AA r_(f rp, V x r 1 SBL:1 `c��-, �(g- } i�, Zone: I E 2. Property Owner&Address:L-X,Ql VPt'�i' -� — 1 '.r�41 `e1Y`C�'�1'1. a ��v���ra- �M(A 105-72, Phone#: Cell#+ '�1�� 01— �� email: 3. Contractor&Address: Phone#: Go'A ?J (M Cell#; email:. PVacerlPrr.r ��b)C5 tl.Ctxv� 4. Applicant: L Qi CT- l) Phone#:G,iy .—y Cell email: Pry ilpxr�r,nerr{F�v.�?S r �i ,Cpr,,, 5. Indicate Fuel Type:Fuel Oil •L.P. Gas O •Gasoline( )•Other( ): 6. Number and Capacity of each Tank: A- ,� 1'� Q O }Rmu d OLD sAOS`nQgArnL 7. Exact Location(s)of each Tank: C r-Ac cjadd f,n L 41 + 's.I Ae-- cr - �o-n e- 1 6/1/2024 STA, OF NEW PORK,COUNTY OF WESTCHESTER ) as: rn.t-�`or.� IC��,,,,, ,being duly sworn,deposes and states that he/site is the applicant above named, (print name of indiv' ual signing as the applicant) and further states that(s)he is the Tank Removal/Abandonment 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. 1 Sworn to before me this k 4 Sworn to before me this 1 day of M-h V`J� 20 2 day of J 0.0^ko,r ,20 a f �'AA Q S a A 1It X e 45 e-Af AW'11�1 �ignatutf of roperty O ner Signature of Applicant q% r-4 v-qv-%11;:C 10 5f r V' acun-'* AA+hD11V K)P-MM Print Na e o roperty Owner Print Name of Ainibcont bliC SON GARCIA Commission#HH 111010 Notary Public l qe Expires July 30,2025 r' ��,Srr E'� L� 1� 9rFp �Qp BondedThruBudgelNuUrySarvices +� :TOT./!RyP'&_J'CJ My COMM18310n l'X06;Aug,3 1,101 T is appl cation must be properly completed in its entirety and must include the notarized sig o) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. z 6/l/2024 ( �)� +ii► Oi+,� �- :4V1iR+ ,r• 4i +•i+.r �.:4h ►D .:�..�i1 ii��'�s �.�::+�hl+►i+-�• a ���yiiil�i'i++.`_,� •.� li! `, • ; o > \ co Ix Y G ' d G b �• ( )1� VY/ k � � a � � ,� � ice'•, cn 00 ULU ao a, v,�� � • � �✓��` V� ,.+ a, �'"' = aNi � PG y� � (.7 � : „gip�a�; •��`�� nW .Jai "IM LL z j M0O cn ¢ � ;�_ • � � C� w LL, = � µ= Ch _ I • rA .r-.1 3 a R t "� •�i Ems-, � �:���',�\ "• FaA'a`i'�1 ►i')' xT a.: + 11+, -., +fi1►1+ y F`-y:;lli►1i1 s 1 auk 1►►+ s- 8a,r(ii1 4 K as Ltd ! E,Y i) ►ii +y� ci+ ►<<icti+ i++iicj, ii�►+i+ii +►i+►+ici► r � vnj A�^�� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/10/2024 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 have ADDITIONAL INSURED provisions or 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 NAME:CONTACT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE I FAX HOME OFFICE: P.O. BOX 328 (AIC,No,Ext):888-333-4949 (A/C,No):507-446-4664 OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 330-130-6 INSURER B: WESTMORE FUEL COMPANY INCORPORATED INSURER C: 86 N WATER ST GREENWICH,CT 06830-5886 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0 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 INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS AMIDDIYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE FX-1 OCCUR DAMAGE TO RENTED PREMISESirrencel $100,000 MED EXP(Any one person) $5,000 A N N 9062815 06/01/2024 06/01/2025 PERSONAL s ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY �ECT ❑LOC PRODUCTS&COMPIOP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY ISCHEDULED N N 9062815 06/01/2024 06/01/2025 BODILY INJURY(Per Accident) AUTOHIRED AUTOS ONLY NON-O ONLDY PROPERTY DAMAGE AUTOS (Per Accd..0 X UMBRELLA LIAB tAIMS-MADE CUR EACH OCCURRENCE $7,000,000 A EXCESSLIAB N N 9062816 06/01/2024 06/01/2025 AGGREGATE $7,000,000 DED I RETENTION WORKERS COMPENSATION X I PER STATUTE I OTHER AND EMPLOYERS'LIABILITY N ANY PROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $500,000 A OFFICER/MEMBER EXCLUDED? N/A N 9917566 06/01/2024 06/01/2025 (Mandatory in NH) E.L DISEASE EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION VILLA 0-6 35 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 938 KING ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD vORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a. Legal Name 8 Address of Insured(use street address only) 1b. Business Telephone Number of Insured 203-531-6800 Westmore Fuel Company Incorporated 330-130-6 86 N Water St 1 c.NYS Unemployment Insurance Employer Registration Number of Greenwich,CT 06830-5886 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 06-0739367 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company Village Of Rye Brook #35 938 King St 3b.Policy Number of Entity Listed in Box"1 a" 9917566 Rye Brook NY 10573-1226 3c. Policy effective period 06/01/2024 to 06/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) X� 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"1 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 must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums 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. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon 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: Erin K Christensen (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 2 / ` 05/10/2024 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 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. C-105.2 (9-17) www.wcb.ny.gov