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HomeMy WebLinkAboutMP25-024 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