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HomeMy WebLinkAboutMP25-067 z = � oy 0 N N w ■ p O W v N cV \ �a� ■ rA Lt7 L 0 R. GL 0-4 1�1 , F, � as ' •� p ;� � I' a 1� Ix y v v J L 1 o 7 W d O Q w ONdQ V ca clt 61 Ln fQyi ao H 00 0 ! � U a Z cC a g � Acc a F V A c 5 \O col a U W a a 00 ('� W7 cy 0 ,5 -0 + u u z a F A O zzb M o '� vnoC) goo x a w F H- .6 v o w a 4. V Q U O 00 a cn � a.•'. .B ° a a a w b = a a z BUILD MENTD CIEWL VIL F OF RY OOK 938 KING ET RvE BR cj ,NY 10573 MAY 13 2025 l <c 939.-0$G�$ e- ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Install Fuel Storaize Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: /�/' —©� / Approval Date: 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: Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 811): 6. Inspection by Building Department for installation. 7. Submit all Manifests&Reports (if applicable, after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, t> is hereby made to the Building Inspector of the Village of Rye Brook for a permit to install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s) will be installed in conformance with all applicable Village,County, State& Federal laws,codes,rules and regulations. Indicate Permit Type: Above Ground • Buried in Ground { } 1. Address: SBL: Zone: . 2. Property Owner&Address: Phone#:Q\y .J JS -Lf Cell#: y email: 3. Contractorr'&IA'ddress: �e�l n _ t l , �,�[ , - ? , [,t,)a�' Phone#: �1 �1 1 • >` 0 0 Cell#:a5S email: 4. Applicant: ' _ ni: �J ' , P , t Phone#q�q . .)yQ--) Cell#. email: 5. Indicate Fuel Type:Fuel Oil N•L.P. Gas( ) ••Gasoline( )•Other( ): 6. Number and Capacity of each Tank: ti t �� O(1.��fa t V-"ff— —Ql2_,C4 -,�CTnf-► , 0( \ /1, 7. Exact Location(s)of each Tank: T�1 � C-P�C C1�(' C .� ( `�(JT` CLc�4/C t 6/l/2024 STg,TE OF NBi-'tf$ K,COUNTY OF ) as: Z'�,n 11 k(e-F4f'^. ,being duly sworn,deposes and states that he/she is the applicant above named, m(pr name of in f idual signing as the applicant) and further states that(s)hc is the Tank Installation 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 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. Swum to before me this [� Sworn to before me this day of 01 20 ZC day of 9 ,20 5 S(gnatke of Proper Owner Signature of Applicant Print Name of Prop weer _ Print Nam lie Notary Public Mohammad Rtuaan otary ublic CommissionN OIRA0032973 SEAM LYTLE Notary Public State of New York NOT"rpU frix My Commission Expiration:01/17/2029 My CQtnm111110n Expires Aug.31,20,);- 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 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 fs/1/2024