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HomeMy WebLinkAboutMP25-024 BRCi it- VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradburyy www.ryebrookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE June 9,2025 Maxima Moran 17 Highview Avenue Rye Brook,New York 10573 Re: 17 Highview Avenue,Rye Brook,New York 10573 Parcel ID#: 141.35-2-10 This document certifies that the work done under Mechanical Permit #25-024 issued on 2/25/2025 for the installation of a new above-ground propane tank and the legalization of an existing above-ground propane has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to +r) _ ,�1���.�.11..kl..A��..���,.1��`�_Gi .��' /°'.Il'�r.�T'�I��rp�•��('fl�'{�,(r�•i 1•LX•1'I Nl A:)I I+I;iB^A A��gAWA!'. � � � . i i�. 1 T. r�A,�IUAhG;�{.N7anuVc'd1;13�:11 rfA'gN>"Nnn.A±ilt 4*�Pa,i )��,J1;1y1'Ar �'�II.'p,f.Jlti)I+,'.If' n IiO:iTTf.IIn.Q1:aR4All:4:n��ny II.AD�T,/:,� (nJlal.!11:� '.'h::i^1,.,tCDriDa,n9 ai.{ :'in: (":kN�•) ^h^hI, r ^ �7�6��,...n�ar^llnma nn t+ll��nplr�p� W l- l=1 VI/11,A'1'111N Navrr•u '.il.'rxr±.V�rinu^..ic:u:°:.^. �(�q;A;�;?�^%rl?:c;)ty I 1 ltc; II+<^rrtn R�:a1u�u,rr u r� il_� �C'tlbtfp'Il'xJy'riR 11.1J1t�,/�_tthf.�+In)1 jqq C:J ICT:c�i:nnnsu;„.)l ,c,+rrrt�rrh h:n)r•urr )ta1fn, atif�:h'If:'lf?, �i�l�l a(a�l :g ?Q I�I :D�a1�arAAxx C"r;AT:t`Va:n"�)il'+:fn•„ .,-_r .�, �_� ![S;AJ+QTr;•n:IFfl:�'A4�.1M[)[:I'q'Ai: T ,VI' Pau�r>i?)r•'II't�.ia)Fr .. :._...__���w_ ..___-- ��N 1 v I_-.I nrJf�f.n« �nx.�rt�:r:„lrc.�Ari •-� �..�1..__.._ . _/.�. .. _--�_,._ .. _.. __....�.. fir. AJON-h)_I;;a:'PIPUT'I QyC BRC�v�. 0 2m '9�2 BUILDING DEPARTMENT ❑yBUILDING INSPECTOR u 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 7 /-// 6,4/ V 1 f hJ DATE: PERMIT# -") ,"n ,5 - U Z f ISSUED: SECT: BLOCK: __ LOT: LOCATION: ' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED E REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER L N N N \ \ in N � s N N x 4Pw a p sk id I� A W � �+� vy.• � W Ucn ? p , a y O � � $., � a 3 •� � Q,' M a O •3cn U a © O � x 0 5 eo Q Qtwo S � � � � v pr : V � eel 00 CN v V o N x �. Ei 0 p o ogb � V i � o t� A z q O .4v n. [` Z1-4 o � 4 -0 4go4414;4aaa94NQ4941444;4&a444a9 cog 4a4;aaQQQQQQ994N41441 V E BUIL MENT FEB 2 4 2025 VIL n $OFAY. K 938 KING SET RYE BR ,NY 10573 VILLAGE OF RYE BROOK (914)9 39-5801 BUILDING DEPARTMENT w '� . r o. dr Amplication for Permit to Remove Abandon and/or Install Fuel Stora a Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) I.OR OFFICE USE ONLY: PERMIT#:_/-_/ C� Approval Date. 7 � Permit Fee:$ a /"� �J Apprt,.,.,,c�anature: A 10K Odwr: 0Je_ (feu are non-rcl'undable) AAAAAA#A#A#AAAAAAAAA##AtIiAAAAAAAA##AAAA •AieR*#►►ftkAAAAAAAAfii#iii####i/,A##A####AAAA###AAA#AAA###AAA#AA# RE UIREMENTS 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#C 105.2 or Form# U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tank. 5. Dig Safely New York N(dial 811): 6. Inspection by Building Department for removal/abandonment and/or installation. 7.Submit all Manifests& Reports(afler work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. #AAAAAAAiA#AA#A##AA #AAA ••••AA•AA•••••A••A•AAAAAAAAAA#AAAAAAAAiA#AAIAAAAAAAAAA##AA##AAAAAAAAA##kAAAAA Application dated, 1 °} ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to removc,abandon,and/or 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 removed,abandoned and/or installed in conformance with all applicable Village,County, State& Federal laws,codes,rules and regulations. A#}AAAAAAiAAAAAi AiAA###•AAAAA#AAAAiA##••••••i#AAAAiAAi AAw AAAAA#AAA#AAAAAAAAAAAA#AAA#kA A#AAA*AAAAAA Indicate Permit Tyne: Installation 4-Removal( )•Abandonment( )/Above Ground ( Buried in GrAAouAnd( ) 1. Address: SBL:111 3s Zone: ,)F 2. Property Owner&Adddress; r d Phone Ll l� -��-r•� U -- ry-#rf email:C Cr'�Z I JS yc��CXJ_ C�J'Rf 3. Contractor&Address: r �G 0`j I�r�n I -- r. INTA K, .r3 Phone#: 01 4 GG, 5 I l e Cell C. ck' email: e_P m 4. Applicant: tv tl t c p�JwlfP, Cal Phone#: Cell#:�a l C/-q-7Ct 81 cl o email: C_ V e/, z0S e l_Ia AL_A] (cw 5. Indicate Fuel Type:Fuel Oil L.P.Gas( )•Gasoline( )•1Other( ): 6. Number and Capacity of, VTaank: e 1 41 n I J 2,0 L W CA L ( I � I _0 `xZl1� f'�i �._ x Olt, as t - y la. &el r 7. Exact Location(s)ofeach Tank: qlt 0l Ll Qlcfs 6/1 i 2020 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 1i ,being duly sworn,deposes and states that he/she is the applicant above named, (print name or individual signing as the applicant) an further states that(s a is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor,agent,attomay,etcJ 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 before me this OA Sworn to before me this 144A day of ,20 day of 20 2 C— Signal of Property 04ner ftraWof Applicant Print Name of Property Owner Print Name f AprN t „r - DAVJD C SLOANota Publit State of New lhxkNotary Public Notary Publ' 6318303Qualified in Putnam County Commission Expires Feb 28,2027 I his plication must lie properly completed in its entirety and must include Itke t as gnaturesJ" �' of the legal owners?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. Joni Lamaj Commission#Ol LA0025681 Notary Public,State ofNew York My Commission Expires:Jtme 07,2028 2 6/1/2020 HEATING LL f } SPECIFICATIONS I 100 io, HEIGHT(INI 48 43 52 #r LPG CAPACITY(GAL) 1 _^ 13.d �- _ —' 47.2 -- - - 99.1 � WATER CAPACITY ILBS) 239 474 1.000 NOMINAL TARE WEIGHT ILBS) 48 142 271 CYLINDER DIAMETER(INI ;; — 14.7' - - _ 24 30 CYLINDER VOLUME ICU.IN) _6,616 -_ 13.120 27,680_ COLLAR DIAMETER(IN) 6.5 16 16 COLLAR HEIGHT(IN) �. 5.1 A 6.9 6.9 FOOTRING DIAMETER(IN) '" 14.5 19 22 VALVE CGA7 510 NO OPO CGA-510 NO OPO CGA-510 NO OPO �Q STANDARD SPECIFICATION GOT-48W240 �- — - 0OT-48W24o i DOT-48W240 METRIC MODEL/SIZE „ , HEIGHT(MMI _ 1.219 _ 1092 -_- 1,321 _ LPG CAPACITY(LI 86.7 172 360 WATER CAPACITY IKG). , 108.4 215 450 NOMINAL TARE WEIGHT(KGl 30.8 64.1. 122.9 CYLINDER DIAMETER IMMI 373 610 762 CYLINDER VOLUME(L) ? 108.4 215 450 COLLAR DIAMETER IMM) 165 40d 406 COLLAR HEIGHT(MMI I 130 �y- 175 175 FOOTRING DIAMETER(MM) J`t 368 �483 559 VALVE _ CGA-510 NO OPO - T CGA-510 NO OPO CGA-510 NO OPD STANDARD SPECIFICATION DOT-4BW240 007-48W240 O0T"48W240 00 OLD WILSON • • COLUMBUS.OHIO 43085 CUSTOMERSERVICE,@WURTHINGTONINOUSTRIES.COM1 1 WORT HI NGTONiND USTRIES.COM INDUSTRIES 614.436,3033 3 L=9D .frr.�y�� ..r 1 / 'tT '' .. r £ ,, + L.�.,tom-r�' - 1 ¢••r r ,� AGIA ,, ., -�.� ��` ' ors •' ,9Z. 1 ', ' l - `!.Z96Y`S�W`x��iasssW setiy. � '•' _ 1 . • t�"eupit�'�sM7�allblw�71iv�u p � '>= � • rvm ti�► oYVd if# MAW YALI All r 11�/r I� VO D v tiYr-1_ :1..'�}'4'.!•t" i ... - z, r 1� ... ... .... • arc- y t r � � ' Zrf t'' . k.. O�s.•� •doh. �4,wso r i•�.!,' +P •>i�i!y�!., r�r :•�4��•1�P all v tj LO • `o is O N � \ LLJ o o o S` (ss)> 43 o , ME/� •� cn W ull n I 9 1 i+i a V U pug W p � 2� <(MONO + : . � 4� i•+ Z W W O .o �gC110q ' • CL W LLJ = hr " 4-1 W Q U) a� a� m Z U 3 cL o `• .� ..J L y 4'" r m v O s = �iljp Vag n' M �/ vr i ��yl iy1O�: s u 'i'• \I .;Yf2 ` ♦�� � w a .r C O �: N :p`ar % Al �.. r . . . 4w � � ^ •• �NwiTM a •• m��+Ilw )ii• A� �+i� f^ • )+ A ++•� A� •`r �A f \ AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYYY) ��+2��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 CONTACT MARSH USA,L-C. NAME' - -- PHONE FAX 445 SOUTH STREET LAIC No.ExUr A/C No): MORRISTOWN,NJ 07960-6454 E-MAIL Attn:Morristown.CertRequest@marsh.com Fax:212.948.0979 ADDRESS: INSURERS AFFORDING COVERAGE NAIC N SP LP CLIE INsuRER A:Libert Mutual Fire Insurance Company 23035 INSURED INSURER B:LM Insurance ration 33600 SUBURBAN PROPANE PARTNERS,L.P. 240 ROUTE 10 WEST INSURER C:N/A N/A WHIPPANY,NJ 07981 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-009138921-52 REVISION NUMBER: 4 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDPOLICY/YYYY MMIDDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TB2-631-507975-084 10/01/2024 10/01/2025 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE FX1 OCCUR PREMISES Ea occurrence $ 250,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT PRO- FLOC PRODUCTS-COMP/OP AGG $ POLICY a 2,000,000 OTHER 1 $ A AUTOMOBILE LIABILITY AS2-631-507975-074 10/01/2024 10/01/2025 COMBINED SINGLE LIMIT $ 2,000.000 Ea acc dent ANY AUTO BODILY INJURY(Per person) $ X OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ XI HIRED X NON-OWNED PROPERTY DAMAGE $ XIAUTOS ONLY AUTOS ONLY Per acc dent b UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WA5-63D-507975-094(ADS) 1 0/01/2024 10/01/2025 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE YIN WC5-631-507975-114(WI) 10101/2024 10/01I2025 1000000 OFFICER/MEMBER EXCLUDED? ❑N NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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 LLCr�� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD w PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Suburban Propane Partners, L.P. 973-887-0500 240 Route 10 West Whippany NJ 07981 1 c.NYS Unemployment Insurance Employer Registration Number of Insured 892-18602 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 22-3410353 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) LM Insurance Corporation Village of Rye Brook 3b.Policy Number of Entity Listed in Box"I a" 938 King Street Rye Brook NY 10583 WA5-63D-507975-094 3c.Policy effective period 10/1/2024 to 10/1/2025 3d.The Proprietor,Partners or Executive Officers are 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"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: Susan Martinez-Dolman (Pri ' -__ _._...�__:-�,f _--y--._.:..- __'--}---/----•-"nsurance carrier) Approved by: z`tWlGt�tK�/-c.J (It'�d�✓ 9/20/2024 (Signature) (Date) Title: Client Service Coordinator II Telephone Number of authorized representative or licensed agent of insurance carrier: 1-914-606-5181 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 81983354 1 3-507975 1 10/24-10/25 C105.2 I Connie Myszka 1 9/20/2024 9:16:05 AM (CDT) i Page 1 of 2