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HomeMy WebLinkAboutMP25-092 yE D <c�Gta.°o jaw . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.ryebrooknygov TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE September 17,2025 Scott Waxenberg&Alyssa Kaplan 7 Jacqueline Lane Rye Brook,New York 10573 Re: 7 Jacqueline Lane, Rye Brook,New York 10573 Parcel ID#: 135.36-1-6 This document certifies that the work done under Mechanical Permit#25-092 issued on 6/13/2025 for the installation of an above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to O ti� QR w � '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR JKASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 7 Or` L V DATE: ` ^ ` - ZoZJ PERMITS MP 2,� 092_ Issul 1): -1 •IrSECT: I3S. JLBLOCK: LO'I':__�_ LOCATION: ►G IdT S ( CIA • OCCUPANCY: ❑ Violation Noted THE WORK IS... 9-1ASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas Ne O '-ram I ,j g ❑ L.P. Gas �a wa. FUEL TANK gA ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINALwjog-r- Cow, ❑ OTHER / Y� a a s : ' N ' W � • � W - � z Q. to. c G+ A , o "d ob IS x O V z N O �I 0 O � � � � ° d c'' D" � 44 d O04 W � E- � O � 0 ei p a� ' G a z o H \ rA Z 0041 Y o 0v � cn l-- CN a w o a zz � h U Z O O ; b w O 0-4 W O Q U o ° 01 = -- 0-0 a CY ZO Qoo9LA H U U O V o ° -° A Z o = _ z O A Od :1 a Z o9 n b W a cu a I *41 a w x � b a 4;4;414;4;4;Q414;4;4;4;4144a4;4;A44144;4046—9aa a49Q4141641414149414a449 BUILD :DEPARTMENT Im VIL E OF RYE BROOK 938 KING ET RYE BROo7i,NY 10573 4 -061G8k.Ora :Application for Permit to Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT #: 1' QS— C�j 0 ! Approval Date: J U N l 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. xxxxx**xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*xx***xxxxxxxxxx Application dated, 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. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*xxxxxxxxxxxxxxx Indicate Permit Type: Above Ground W*Buried in Ground ( ) 1. Address: 7 Jacqueline Lane SBI : 135.36-1-6 Zone: 2. Property Owner&Address: Alyssa Waxenberg 7 Jacqueline Ln Rye Brook Phone#: 917-626-5070 Cell#: email: alyssawax@gmail.eom 3. Contractor&Address: Innov8tive Environmental 392 Columbus Ave Valhalla, NY 10595 Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com 4. Applicant: Innov8tive Environmental - Donald Feeney Phone#: 914-449-6608 Cell#: email: service@ innov8enviro.eom 5. Indicate Fuel Type:Fuel Oil *L.P. Gas( ).Gasoline( )•Other( ): 6. Number and Capacity of each Tank: (1) 275 Gal AST 7. Exact Location(s)of each Tank: at the rear of the home i 10/30/2023 ST TE OF NEW Y RK.COUNTY OF WESTMESTER ) as: Ll" 1 - .being duly sworn,deposes and states that he/she is the applicant above named, (print ridne of individual signing as thJ 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 Contractor for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor,agent,attomey,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 of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn t before me this A Sworn to before me this day of 20 f ,20 Signatur of Property Own Si ature of ;ppanDonald Fee t ame of Property ner t Name o, of NewYork Otary bliCNORIN ERUc.No.OIME6130833 ary Public, tat of New York 33 Qualified In Westchester Cou Lic.No.0 E t C tL Commission Expires July 25, alified in Wes ter Co Commission Expires July 25,200-52 This application must be properly completed in its entirety and must include the notanze 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 10/30/2023 0 p co �A 0 C: 0 Y 2 00 cu 00 0 a cr Q) Gl co lit 0 > M .�= < Ln > C) C Z3 UJ -0 in cu E >- 0*0' > U 0 > Standard n Standard oil tank with strong welded lap joints SAFETY Bottom outlet configuration allows for natural elimination of water build. up from condensation DURA•Ilm Electrostatic powder-coated paint Made of robust material PEACE Of MIND 10 years against manufacturing defects('See warranty certificate for detalls) Contractor-friendly,trouble-free Installation 209101 120 Vertical 12 47"/23"/30" 170 208101 138 Vertical 12 44'/27"/30" 160 208601 138 Horizontal 12 27'/44"/30" 160 207101 220 Stubbies/Vertical 12 44'/27"148" 220 203201 G 230 Thin I Vertical grey 12 44"/22"160" 235 203701 G 230 Thin/Horizontal grey 12 22'i 44"160" 235 202201 240 Narrow/Vertical 12 47"123"/60" 265 202701 240 Narrow/Horizontal 12 23"/47"160" 265 204201 275 Vertical 12 44'/27"/60' 255 Horizonte 12 27"/44"/60" 255 Verticd� 10 44"127"160" 330 Horizonte 10 27"/44"/60" 330 Vertical 12 44"/27"/72' 290 Horizontal 12 27"/44"/72' 290 11 r 07"o. ej 1 C �� NO !: �, •a O C7 U Uhow c *, 4 ,T�. > a �' w w `n c ° action w Z) Z `� G ¢AC o V Z W N a) o F- M ] 0 0 r > w .,fir. �1 III 00 Z Q c ?; <co» C Hr t( ! E Mco .. 1/ j} f� u 'O Lam-'•. -} i a H cn rp o yVLi ILL j f �' tom. ► ► 1flit 1111 /1111►►i' i � $� '�►s1/►11�►''Ov- ►j ANlW l�►1(I/1�►� � D A A ♦♦ ♦I,y £•AA S A ^? y` i .+: ri .��t ��'�jylGei � �{•,r vKEt�.`�' � : IM'..t .3 ,.. v f,6 'j�.. r7�y\b lry 'l/! 6 •1t� ''Y"i` tA`V I A��y DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/19/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: EVlta Grande Mt Pleasant Capacity PHONE FAx P.O. Box 1689 •914-205-7682 A/c No:914-205-7682 Pearl River NY 10965 ADDRESS: Evita.Grande@mtpcap.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:Century Surety Company 36951 _ INSURED INNOENVI INSURER B:Selective Way Insurance Company 26301 Innov8tive Environmental Services Inc. 392 Columbus Ave INSURERC: Valhalla NY 10595 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:284037213 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDYYYY MMIDD YYYY LIMITS LTRWVD A X COMMERCIAL GENERAL LIABILITY CCP1289339 2/14/2025 2/14/2026 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X ECOT- LOC PRODUCTS-COMP/OP AGG $3,000,000 POLICY❑ PRO OTHER: $ B AUTO MOBILELIABILITY S264364200 1/15/2025 1/15/2026 COMBINED SINGLE LIMIT $1,000,000 Es accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A 4DED UMBRELLA LIAB X OCCUR CCP1289340 2/14/2025 2/14/2026 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 RETENTION S $ WORKERS COMPENSATION PER T AND EMPLOYERS'LIABILITY YIN STATUTE I ERH ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED9 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability CCP1289339 2/14/2025 2/14/2026 Each claim 2,000.000 Professional Liability Aggregate 2,000,000 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 ; I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^ ^A^^ A 8247038084 4�� jl MT PLEASANT CAPACITY AGENCY1 BLUE HILL PLAZA STE 1689PEARL RIVER NY 10965 i SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER INNOV8TIVE ENVIRONMENTAL VILLAGE OF RYE BROOK SERVICES INC 938 KING STREET 392 COLUMBUS AVENUE RYE BROOK NY 10573 VALHALLA NY 10595 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE —] W2455 047-7 51245 10/02/2024 TO 10/02/2025 10/2/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2455 047-7, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK. EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DONALD FEENEY VICE PRESIDENT FRANK MORACO INNOV8TIVE ENVIRONMENTAL SERVICES 20F2 THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND T �/ DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER 676702696 U-26.3