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HomeMy WebLinkAboutMP25-088 , 00 o _ _ 00w © Ln N c W s Ncq ' QO H w y xCA Gw a _ Mcu = mw H W a ; v rA z a brp- o >14 F" � h"■1 � � Ow � uc `v � A ■ � 1 ►aG p L~ ~ A per F to � � � q�.� �67 0 , Q 4-4 CA d v o d -r a � Qi 0.4 v � fzc A C w -• w z s W �, ,� , W `" �, zo � v ° j �.I ° F+■I F� p ICI M O w U' uw . w � Ac0ro , o o a U W = `= N 000 p s zx a o 1-4 F A o w z zQ c a. a w 01, E� o z „ d x z ° N [--� cq = ° o o W " b { BUILD MENT 938 KING t J ET RYES BR ONY 10573 oK JUN - 9 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT A lication for Permit t Remove bandon and/or Install Fuel Stora a Tank (*Storage Tanks in excess o ons require registration with the County of Westchester) FOR OFFICE USE ONLY: ' PERMIT#: ,ID��+ 000? Approval Date: 1. etmit PP Fee: $ C;)Cp Approval Signature: Other: Disapproved: (fees are non-refundable) 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, Abandonment,or Installation: $195.00 per Tank. 5. Dig Safely New York#(dial 811): CAS 251,'- c5p1— L((J' 6. Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, S 3 d ZZ,Z-�,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or instalt 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,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and regulations, Indicate Permit Tvve: Installation •Removal Abandonment( )/Above Ground ( )• Buried in Ground 1. Address: 17 W<s4vic,.jo- SBL: one: 2. Property Owner&Address:CeS 1 1 M i(In U C c,s Phone#: Cell#: i email:faAe�ga..rj l ltt,;,&„�, 3. Contractor&Address: cr Phone#: l -Z^I te- b Cell#:Q (14 qo(n-'L741,( email: 5 C Lit,In 4. Applicant: 3Z6 c r� Phone#: Cell#: email: T-c:M"PrSajI o e 5. Indicate Fuel Type: Fuel Oil V.L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: Q9 Y_sy U S-r- 1r.S&I l (2)vs­ 6-6-T 7. Exact Location(s)of each Tank: .5-CO V ST ti�r t �,� Le_�r hV/ oXis t 8/I 2/2021 It STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: cTb e ran l L�M tx�c� ,being duly sworn,deposes and states that he/she is the applicant above named, (Print aanie of iixiitiidual signing as tlae appncant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C D om£ Ul" 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 upplication and in any accompanying approved plans and specifications,as well as in accordance with the Now 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 O 0 Sworn to before me this '?d day of k)i~ 20 ZS day of .20 2`� Sigi atur of rope: Owner r O Sig uefl'i'`�olicant CeSA Re-- a`Y I as � -FOrYtCz-SuA Print Name of Pr erty Owper Print Name of pp icant a L r SANTIAGO J BALBIN Nntary Public Notary Public Not& is Qoorglanne M.aorta Connecticut Notary Publlc,State of New Yolk My Commission Expires May 31,2029 No.02BE4875234 Cklatilied in Wusichester county. This application must be properly completed in its entirety and must include then'o'�a ec�tptres Oct 6,20 2S� 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 he deemed null and void and will be returned to the applicant. e z 8/12/2021