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HomeMy WebLinkAboutMP25-022 a a U i O, C, 1 4 fq Ln N C ° Q h===I N 0000rq W WWl o U zy y _ ^ W c`1 (� O O w y w C V op V CN ow 7 Ga rn Q x wa ` a 1 ( 1 p� Fa O till u W �J O 0-4 a w � z O 'n R. O a x z oa � Iba U U w V � G y p � a+ W w p o 0 0 �,� Y v fJr OO EsOw � •� V U O °' � o z F G p R pr o ti 04 a - �I � 0. � •� w x � � � a -o BUILD MENT VIL E oIa RY OOx R1 FEB 1 9 2025 938 KING ET RYE BRo , ,NY 1 Q573 ` `L'"4)939-0668 VILLAGE OF RYE BROOK XY • °v BUILDING DEPARTMENT Application for Permit to Remove or Abandon Fuel Storage Tank. (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: -1'� � 'C� Approval Date: FEB 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#C 105.2 or Form #U26.3 /or NY State Workers Compensation Waiver) 4.Fee per Tank: Removal or Abandonment$185.00 per Tank, 5. Dig Safely New York# (dial 81 ]):©_2`2rz -COD 6. Inspection by Building Department for removal or abandonment. 7. Submit all Manifests& Reports (after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon 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 or abandoned in conformance with all applicable Village,County,State& Federal laws,codes, rules and regulations. Indicate Permit Tvnt': Removal (J)•Abandonment ( )!Above Ground( )•Buried in Ground{✓) 1. Address: —1 I 4 SBL: c��i / — --�^ Zone: 2. Property Owner& Address: J l X' k� A%&Afl�I�, 2-9\ } V0R- (�I ce-( * Phone#: �1— ��fl" I#: email: .(—ro 3. Contractor& Address: Envirostar Innovation Corp., 50 Fields Lane, Brewster, NY 10509 Phone#: 845-279-9555 Cell#: email: info@tankremovalservices.com 4. Applicant: Envirostar Innovation Corp. Phone#: 845-279-9555 cell#: email: info@tankremovalservices.com 5. Indicate Fuel Type: Fuel Oil •L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: G QJIJI 7. Exact Location(s)of each Tank: Y,�Cor C Y-0 1 6/l/2024 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: C1 WG�t1 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indjAdual signing as&c applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C,3nlCY G�-C.trjX( for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this -3 Sworn to before me this day of l n 20 J day of ,20 Si of Propedy Owner ` Signature of p icant , �lZC�1 19 e2-5,-, C� `` LJlrrrrrrrrr Y CA) r Nam�Property O O$` amgbf pl' t STATE I L O r' :'OFNER+YO , o A0 A No.O1ME6160063 ;NOTARY P[T$L1Q1Pubiic Qualified In Westchester County ? " �• commission Expires tenuity 29,202-7 D101637r279 .' This application;,Host be properly completed in its e �l� include the notarized signature(s) of the legal owner s of subjectproperty,g ( ) and the app scant 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. 2 3/21/19