HomeMy WebLinkAboutMP25-029 ■
■
N
b �q
c,q N CV CL
/-. �
'h
a� O W ■
qj
■ qj u
Y■■I
�S cr a a:
c >
N O cl -v tuo-.'3 " ■
■ O ■ry n Z a y > H ■
M W N
as U �..� ■
O ^ -, z 3 0 o v C f!1 �Q
• `� > O p is p v p ,� ■
00Cop V,
00,
vo
z 0 + C O
�j '
W rj a F W Zb a c
Z CA
o
00
oa °
U O U C) � a
C7 A Z y v
pw P4 u 0 G
O W 0 �
BUILDING DEPARTMENT
VILLAIGE OF RYE BROOK 4 2fl25
938 KING SET RYE BROOK,NY 10573
-0668 VILLAGE OF RYE BROOK
• °y BUILDING DEPARTMENT
Application for Permit to Remove or Abandon Flues Storage Tank
(*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester)
FOR OFFICE USE ONLY: PERMIT#:
Approval Date: _MAR 5 2 Permit Fee: $
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
*,rw***,rt*,r�*t*w*,r**t********,t,t,trtrtw****wwwwwwww***x***w*+rww*wwxwwwwwwwwwwwwwwwww*wwwwwww*wwwww�wwwwwwwww
DO NOT START WORK or CONSTRUCTION UNTQ,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: Removal or Abandonment $185.00 per Tank.
5. Dig Safely New York#(dial 811):
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.
rww*w**r*r*ra**w***�rwr******r,r**wx*wr,rw+rww*ww*wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww*wwwwwwww
Application dated,(11 cz rch 3;:1C%1!21S ,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.
wwwwwwwwwwwwwwwwwwwwwwwwwwww,rwww*wwtwwwwwwwwwww#wwww*wwwwwwwwww**ww*wwwwwwwwwww*wwwwwwww*wwwwwwwwwww**
Indicate Permit Tvue: Removal 04•Abandonment( )l Above Ground( )•Buried in Ground
1. Address: �V-VA lJdu, �� 2�F �� k—SBL: /351 Zone: �J
2. Property Owner&Address: �QIJ� -1Jw 0211 n
Phone#: qN- 5S7-�)o2--TS Cell#: email: Opp' �rxt��. 00✓�
3. Contractocr�&Address: Lu,--,�G n (1 V I f O n >ryl e YTS 3e c y ,c e 3
Phone#: U t�`J't'( tS C}5 1^Cell#:_r email:
4. Applicant:
,?c,-i ,,\
Phone#: 4 W— G5�f`'6 of:T-S Cell#: email:
5. Indicate Fuel Type:Fuel Oil( )•L.P. Gas( )•Gasoline( )•Other{)c}: a uB 0_I I
6. Number and Capacity of each Tank:— 500 q ci` USA— 4 Qej
r`?
7. Exact Location(s)of each Tank: U .
e—
1
6/l/2024
S• ,ATE OF NEW YORK,COUNTY OF WESTCHESTER ) as.
0,�,o k b i vl being duly swom,deposes and states that helshe is the applicant above named,
(print name of individual signing as the applicant)
and further states that(s)he is the Tank Remo vaI/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 hisiher knowledge and belief,and that any work perfortned.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 It Sworn to before me this-�?r
day of MC��C� �,20 7C day of_�g�h_��_,20 96
Si ritAre of Prop"Owner Si'.,tiature of APPlii ant
:Print N e of Property Owner Print Name of Applicant
�FctrSr v Public Notary Public IV
ly t led it ty ITIC11. a th
ignature(s) of the legs uwner(sI )f the subject property, and the applicant of record In the
l roviaed. Any app icalton nol andlo not properly signed sha tx
be OnNnIIE FAY GtJLICK
ND plCil}E.uk432,
JARED PHQ►NG .Ouolitied in Sul+iv:, aunty
NOTARYaPUBUC t..,rry m i s 91 on L b U•)-1.•-'i'J�
STATE OF COLORAI)O
NOT4IRY ID 20244003346
MY COMMISSION EXPIRES 0112412028
z
6/l/2024