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HomeMy WebLinkAboutMP25-091 S ON W �l O N O W u H - N L - s W x 3UD v u W tus 0 `0 O C F" u C v a. W `-" o � a a " b A l bIJ F o u O a A 2 W '74 W d © W W rn -a� 7,, o o � '0' d -o g cis W W r u � •y �" � � :4 'n Ono z `n v' w � F' d ZO o v �° �} (,� w oo C� z W F a a W o 0 d z � o _ ~ M O W � � z ( � C/) F-••1 t7 �n b O von. z O W --_j a W 00 -on O ~ W W Q 0-4 H A a o _ F U U -do y `° a _ o ° v �' u En W F C z �` a� v d x a O � o ~ a p go v U V 0 U � z a � � avo i—, Z A A W z F ~ P. U W � � a a w = � � �10 -n BUILD DEPARTMENT a VILJET OF RYVNBROOK 938 DING RYE Bltbb'I�,NY 10573 J U N , ���� 4 -0 $_ wor VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove or Abandon Fuel oraae an (*Storage Tanks in excess of 1,100 gallons require registration with the Countyy of Westchester)( FOR OFFICE USE ONLY: PERMIT #-. `� 1 Approval Date: ��N 6 �4 Permit Fee: S 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 S750.00 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 811): 06025-001-485 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. l ltRit F**1t7kltlRltlt7t7[it 9M t 1t7t1[st at itlt itx RitR RtRR7t 9r7t![itlt*it 717R 1tR*It 9kRi!ltkR![rtfMlP7t1tlelk itR*7t7lRlkltftt7tf1it71t 7k 1t ik********************fP9tf 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 Type: Removal•Abandonment( )/Above Ground( )• Buried in Ground 1. Address. 7 Jacqueline Lane SBL: 135.36-1-6 Zone: 2. Property Owner& Address: Alyssa Waxenberg 7 Jacqueline Lane Rye Brook, NY 10573 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@ innoy8enyiro.com 5. Indicate Fuel Type:Fuel Oil;I 0•L.P. Gas( )•Gasoline( )•Other( ): & Number and Capacity of each Tank: (1) 550 Gal Underground Storage Tank 7. Exact Location(s)of each Tank: from under the pavers at the rear of the patio t _/21/2O24 STATE SOF NEW SA �� RKY OF WESTCHESTFR ) as: being duly swots,deposes and states that he/she is the applicant above named, (print Aame of individual signing as the 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,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 of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of ,20 da of ,20 Z Signature df Property Owner Signature of Applicant A"SSA WMo4 l Donald Feeney nt Name of Property caner P ' t Name of Applicant Nary u bi New York Notary Pub NOMINt M!Y Lic.No.01 MF6130833 Notary Public,State A NA.,York Qualhied in Westchester C PnO� Lic.No.01 ME613 Commission Expires July Qualified in Westchester oun ty Commission'Expires July 25, This application must be properly completed in its entirety and must includ no adze 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. /21/2024