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HomeMy WebLinkAboutMP25-064 ■ 4 = ■ N cv ` �a� _ ■ OG pQ,,, cq d W ■ rA a Ln - '-' W 3 N V a o ° B °� � \ v ~O w CLn s : O O � � w 3 U � a v A ■ 04 yj a o V a tV 0. r h A z � � � � W W �q � to � � � � W ■ rg U ■ Fes+ �a y N U P L W W C) O � z 0 o o a E.c,-9 ;.Z:W L Zo � 06 0 w 00 - � z a• W © � wd � � o -° cLA �J`I h+� N p ^' �I W cd 'a0 ■ BUILD_kNG DEPARTMENT [E C E ll V E VIL ' OF RYE OOK 938 KING T ET RYE BRO, ,NY 10573 MAY - 5 2025 ,rlalku'' . 0v VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Install Fuel Storame Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: Approval Date: j - / V + 2 O ZSJ Permit Fee: $ l � Approval Signature: � Nlt�, 4z) 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: 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, y 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 Ke Buried in Ground ( ) 1. Address: r:�','-1`12- SBL:IL}�•%rzl Zone: a� 2. Property Owner 8c Address: 1 Phone#:q M •0�D- I U lqt Cell : email: QxT",I't A UiA �{��+7�n•�L4_t' 3. Contractor&Address: w��S '(`C1Q9CC� a Q�\5��1��L_ �i (�.�k�e1�wP1'�� Cam),Of".CTUWD Phone#:N Q • Cell#: email:�,M ,(�k1n� 4. Applicant: 1 Phone#: 30Q Cell#: email:^P1V;tP �i'�C49�,Cd� 5. Indicate Fuel Type: uel Oi ,�Q•L.P. Gas( ) • Gasoline( )(•,Other 6. Number and Capacity of each Tank: �p1 (>� Q�(�� F-1 .S� • [�� ( i"�r, ��� T Exact Location(s)of each Tank.'- C" j— t 6/1/2024 STATE OF I ENVM M OUNTY OF ZE T 44ESTEA ) as: elt2,9 being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Tank Installation Contractor for the Iegal 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 _znaucted 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 Uniforni Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to e this Sworn to before me this bef day of m 20 day of /V 4- 120 Signature of Property Owner Stgnatui of Aonlicam Print Name of Property O er HOPE B. VESPIA Print Na Applicant Notary Public, State of New York No. 01 VE5084028 otary ublic Qualified in Westchester County otary Publi Commission Expires August 25,20 SCAN LYTLlE NO DMI YPUBLIC My Commisslon Explres Aug.31,2021, this application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the space: 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. -