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HomeMy WebLinkAboutMP25-085 4R, C cOC4'°u�J j ��` L� y�o vuYi . 1q VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 11,2025 Mary Dillon&Nancy Echausse 245 Tree Top Crescent Rye Brook,New York 10573 Re: 245 Tree Top Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-76 As per the Certification letter from Optima Environmental Services Inc. received July 9,2025,the removal of an underground oil tank under Mechanical Permit #25-085 issued on 6/5/2025 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to J�f�• 79�rJ•��0 BUILDING DEPA'Wr.MENT ❑BUILDING INSPEc."root ,0 ASS1.41-ANT BVILRIN4.INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KiwG S')'IZ)M'F-.RYI1 BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 w-wwj.T-g Ook.org - - - - - - - - - - - - - - - - - --- INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - AX)DRESS: 2 T�2 �rj� P •—�.1 _ - z�_ -- __ _ --DATE: o� PLILMIT MP Z S" p $5— Issur,D:�S-_1.�'SECT: 2 - 7 BLOCK: _LOT: 7!o LOCATION: _ _ OCCUPANCY: ❑ VIOLATION NOTED 1.1I13 WORK IS... U-<CCFPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ TOOTING ❑ U00TING DRAINAGE ❑ FOI.INDA.TION ❑ UNDERGROUND PLUMBING NO TFS ON IN;SP.ECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION r ' ❑ L.P. GAS ❑ FIRI3 SPRINKLER Zg ' _��cS_4 �_ � po�L�t '7— ❑ FINAL PLUMBING r ❑ CROSS CONNECTION 13 FINAL ALL ❑ OTHER - /PAL. 4). IL �v !JCS LL _ � n1 �E 4ROv�. w � BUILDING DEPARTMENT W❑I3U LDNNG INSPECTOR +ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 DING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAQ► (914) 939-5801 www.ryebrook.or�; - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS 2 ���^ R'm -n f ` w 1 qj DATE: l / (D c2arz� PERMIT# IV? L2J �y �'1� ISSUED: -j~-ZY SECT: ly?f-Aw BLOCK: LOT' LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... /ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION �.q��I REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS I+J' 4) �• ❑ L.P. GAS FUEL TANK , ❑ FIRE SPRINKLER ❑ FINAL PLUMBING `r r ❑ CROSS CONNECTION ? woock f B'FINAL f& l k*" 9j ` / • w/ gve ❑ OTHER r� 't j o \ r !�1 � 4 W i ;: �" I�IR -"�"'� �- -f�k � .x - . . .. � r x t. a j s ��<( ' � , .. � �_` x s s a � w � 0 C N W 9A .8 s N N a s a QI a `n y °' El � D A T� �H Qp.� a v a a ^ ON U N "d V ip sr C1 aU � =� , -V o x � o � a. - �, x M Ln a �Cf Cw.7 w r- y b V a Lil W A o H w " cn � � � M , wE U00 a w Q I O � z Uzw � � � C ICI C1 �i ~ M VW Ulu 00 CA o -v a O fx AG ° . n..r W � � • v � �, V W H x U o p" y Ln N p w z a ° V b O u, C) w � ag § a a �° w x � � b BUILD MENT ® E C IE N IE VIL OF RY OOK 938 KING ET RYE DR ,NY 10573 MAY 2 9 2025 PV. . ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove or Abandon Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: > � ®� Approval Date: JUN 0 9 20 Permit Fee: $ Approval Signature: Other: Disapproved: (fees an non-refundable) wwwwwwwwwwwwwwwwwwwwwwwwwwwwww+++++++++www*www*+++++++++www**:r:r**wwww+wwww,k**++++++++*+*w++w+++www***ww 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: Removal or Abandonment $185.00 per Tank. 5. Dig Safely New York#(dial 811): (J CZ I C` - V O( - 9 6. Inspection by Building Department for removal or abandonment. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. +++++++++++++++++w++++++++++++w++++ww+wwwwwwwwwwwwwwwww+wwwwwww+++w++++++w+++++++www++++++wwwwwwwwwwww Application dated, _,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed or abandoned in conformance with all applicable Village,County,State&Federal laws,codes, rules and regulations. +++++++++++++++++++w++wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww+++++++*ww:�rw**ww*w*w+++++++++ww+ww+wwwwwwwwww+w Indicate Permit Type: Removal(1�}•Abandonment( )/Above Ground( )•Buried in Ground 1. Address: 9Y�- :fct e-4,q C/e5C P_A. - SBL: /a /i 7 J- /14 Zone: AWb 2. Property Owner&Address: f(NC_ t'C tff�U-SSA rye C/ Gam - N !c /v5`73 Phone#: Cell#: (5�-19)S-3 Z-4'/o/_ email: /lan eq CC k4LIze lggA&N.4:3, 3. Contractor&Address: Phone#: Cell#: email: d kt-ea e,1 t/- Co,-1 4. Applicant: Plum q Fe-�. 1 JSC� Phone#: Cell#:t$i 6 .S-3.2 -L(1 a I email: /1aitc N e e k a uZe-:4 9,9w(44 1 -4-ti 5. Indicate Fuel Type:Fuel Oil Q/.L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: - 30 U S f 7. Exact Location(s)of each Tank: Q ack U r 06 &' Io Ai A-n LLOJ Q6 90 o e,,-/"O0A4 t 6/1/2024 STAVE F NEW YOB C UNTY OF WESTCHESTER ) as: -2 r c,--, �,�?C��c 5�,being duly sworn,deposes and states that he/she is the applicant above named, (print name of ipervidual signing as the applicant) and further states that(s)he is the Tank Removal/Abandonment 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 13niform 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 7 2 Sworn to before me this -Z L day of IW y,20 ZS__ day of ,20 2 f igrrture of operty Owner Signatur f Applicant Print Naxqb of Property Owner Print Name of Ap cant G"I Arit)T Notary Public Notary ubl WMPAULDFGENHARDT rotaryPu . Slate 4997135�lewYork Notary Public,State of Now York No. No.499']135 Qualified in West c t Count" Qualified in Westch t Co my Term Explrfts / 2 This i ltiest m ornpleted in its entirety and must include the notarized signature(s) of the legs owners) 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. z 6/1/2024 Z G 0 Imo` a w Rl o � O c O 1 � n rl z CA 0 A & G APPLICATION FORM Page 2 of 2 �! � , r Homeowner Name(printltype): (.� A Address: �� �d cal(� Phone: i Email: N l Date: Print or type a detailed explanation of your proposed project: Oeu,c) 'V,LS I 4A & ^ ofd C � , 4� Lwl Owl a AA r 4 Ad �,�at-'e- -S;M z 7z Ho iwner Signature Date Arbors Homeowners Association The Clubhouse 173 %Ivy Hill Crescent Rye Brook,New York 10573 _ IN Oil Tank Repair/ Removal/ Abandonment/ Replacement Before any oil tank can be repaired, removed, abandoned and/or replaced, the Homeowner and the Arbors HOA must enter into an agreement concerning such activity. 1. Oil tanks and the installations thereof must conform to all Village of Rye Brook, Westchester County, New York State and Federal law and regulations. 2. All required permits from the Village of Rye Brook must be obtained before any work is begun. 3. Above ground oil tanks can be installed in sheds only, and only when there is enough room available to meet all federal, state and local regulations. 4. The HOA strongly recommends the use of double-walled tanks. 5. Ap-proval for any alterations to the landscaping on or near any oil tank must be obtained from the A&G Committee before any work is begun. 6. Any and all damage to common and/or private property from the Repair /Removal /Abandonment /Replacement of an oil tank is the sole responsibility of the Homeowner and the Homeowner agrees to indemnify and hold harmless the Association with respect to any such damage. 7. No excavation equipment may be used to expose the tank. However, if contamination is found, excavation equipment may be permitted only with written permission from the Arbors Property Manager. 8. The NYS Department of Environmental Conservation sets the regulations for clean up remediation. The responsibility for proper removal and/or remediation lies with the tank removal company and ultimately with the Homeowner. The Village does not sign off on any in-ground fuel tank removal or abandonment unless all the proper documents, manifests, and DEC Spill Close-out letters are submitted by the removal company. Homeowners who do not follow-up to ensure that fuel tank removal/abandonment permits are properly filed and closed out are assuming a risk that they may encounter problems with insurance companies, buyers and/or financial institutions when selling or re-financing their homes. In addition, failing to report a fuel spill or to initiate the proper remediation may constitute a crime or violation under New York State or federal law. 9. The HOA strongly recommends the purchase of a supplemental Oil Tank Insurance policy. Company Doing Works Address C �� � � '1 TZ) Co. License # to L - z 7 LF /-f/S - Co. Proof of Insurance 7 / Contact Person )"0". ����nea Phone# t Expected Start Date IywLt Homeowner of unit and Arbors Home hers ociation make this binding agreement that I am legally responsible for any and all damage caused by the Repair/ moval/Abandonment/Replacement of my oil tank. I further agree to hold harmless and indemnify the Association for any and all damage, costs and expenses, including legal fees, arising from, connected with, or related to such Repair/Removal/Abandonment/Replacement, including, but not limited to,damage to lawn areas, trees, shrubs, walkways, curbs, fences, underground drainage, coaxial cable, telephone, cable, internet service, electrical power lines, water lines, and any other landscape, utility or property. In addition, failure to comply with any part of this agreement will subject me to a $600 fine imposed by the Arbors Homeowners Association. 1 ave read, understand, and agree to abide by the entire contents of this document. l Homeowner 6ate Arbors Property Manager Date Page 1 of 1 Revised September 2017 A & G APPLICATION FORM Page 1 of 2 ❑ Review A&G Guidelines, AHOA Declarations and By-Laws pertaining to your project. ❑ Consult with the Property Manager for any clarification of pertinent A&G Guidelines. ❑ Include in Request Section: a) Exact measurements of affected area& materials to be used b) Detailed description of project c) For fences and patios: exact location to be marked with stones, stakes, and/or paint, preferably done by installer ❑ Submit with Application: a) A"Before" picture b) Contractor's license & insurance (if applicable) c) Permit from VRB (if applicable) d) Plot plan (if applicable) e) Architectural drawings(if applicable) f) Oil Tanks, Fencing and Painting: requires an additional form to be filled out and submitted with this application (consult with Property Manager) ❑ If any information is missing, the Property Manager can NOT accept the application. ❑ AHOA and A&G are not liable for the cost of any plans, regardless of approval or denial. ❑ Once A&G receives the complete application, the area will be inspected and A&G will respond to the request in a timely manner. ❑ If approved, Homeowner is then responsible to notify the Property Manager when work Begins and Finishes. ❑ Once the project is complete, an "After" picture must be submitted to the Property Manager to be kept on file.A&G and/or the Property Manager will then inspect the work done for adherence to the approved application. ❑ If work is not in compliance with the approved application, Homeowner is subject to fines and/or assessments and/or restoration of the property according to A&G Guidelines and the original approved application. J Note:Any work done without proper Prior authorization is also subject to fines Wor assessments, as well as possible removal and/or restoration. Please check each box as read, and then sign and date this page. eowner Signature Unit# Date 94 Stewart Avenue, Newburgh, NY 12550 tI (845)561 - 1512 1 Fax:(845)561 - 1204 OPTI'iNA p O timaenv.com ENVIRONMENTAL SERVICES Nancy Echausse 245 treetop Crescent May 12th, 2025 Port Chester, NY 10573 SUBJECT-30OG UST removal/installation Dear Nancy, Optima Environmental Services Inc, is pleased to present you with this proposal to Remove a 330g oil Tank @ 245 Treetop Crescent, Portchester NY10573. Upon receipt of an executed copy of this proposal, as well as the Initial Payment (described below), Optima will schedule and proceed with work as outlined below: Project Scope: • On-Site Work: • DAY1: o UST removal o Hand Dig to top of existing tank o Cut and clean tank o Drum up sludge into 55-gallon drums o Remove tank o Collect soil sample (If required by Inspector) o Back Fill tank grave to grade o Pour concrete pad • DAY2: o Install 275g Roth Tank with Hood. o Run new oil lines to boiler o Fire up boiler check for proper operation Closing Items: o Close permit by providing requisite documentation to customer and the appropriate authorities or 9FAM e�Rv=c� sic. 86 6toWaZt AVOXLUS Newbumffla, NY 16660 p [EC� MVE DID O! JUL - 9 2025 Wank Removal VILLAGE OF RYE BROOK BUILDING DEPARTMENT The above service provider(Optima Environmental Services)does certify that 1-300 Gallon Underground Fuel Oil Tank located at 245 Tree Top Crescent Rv ebrook NY 10573 have been legally removed on June 16, 2025. Visual and olfactory inspection of the tank and excavation did not indicate spillage or contamination from the tanks. Optima Environmental personnel field screened the excavation soils utilizing a photo-ionization detector(PID). No positive petroleum impacts were found within the excavation. Corporate Representative �'— Declan McEneany Environmental Project Manager OPTI 11A ENVIRONMENTAL SERVICES *2 swam Avanm m ewbuxrgl%9 1-ow Yorft 12 25SO OPTIMA ENVIRONMENTAL SERVICES CERTIFICATION OF TANK CLEANING & DISPOSAL OWNER LOCATION I Nancy Echausse 245 Tree Top Crescent 245 Tree Top Crescent Ryebrook, NY 10573 Ryebrook NY 10573 FACILITY TANK REG. #: � N/A — THIS CERTIFICATE IS TO VERIFY THAT THE TANK(S) ORIGINATING FROM THE LOCATION STATED ABOVE HAVE BEEN CLEANED BY OPTIMA ENVIRONMENTAL SERVICES INC. IN ACCORDANCE WITH UNITED STATES ENVIRONMENTAL PROTECTION AGENCY REGULATIONS. TANK(S) SIZE TYPE PRODUCT 1 300 Gallon UST Steel #2 Fuel Oil CLEANING TECHNICIAN George Prekas 6/16/25 FINAL DISPOSAL OF THE CLEANED TANKS: ASAP Recycling DISPOSAL LOCATION 2780 Route 208 Walden, NY 12586 94 Stewart Avenue Tel: 845-561-1512 Newburgh, NY 12550 Fax: 845-561-1204 www.optimaenv.com A A$AP Scrap Recyclin /-� 2780 NY-208 Walden, NY 12586 Purchase Ticket #40924 PAID Operator: Nikki Time of Arrival: 11:07 AM,06/24/2025 PAID: 11:07 AM, 06/24/2025 Customer: Optima Environmental Address: 94 STEWART AVE Newburgh, NY 130953 License Plate; -- Drivers License#: 196 639 311 Payment Type: Cash NOTES Materials G T Adj Net Valu 1. SHEARING-unprep ($135.001GT) 11,680 10,280 --- 1,400 $84.3; Total 11,680 10,280 --- 1,400 $84.31 Truck Total 0 0 0 Accepted [ ) Disclaimer Seller warrants full title to or authority to listed materials,represents that listed materials are not,and are free from all hazardous wastes(as defined in Federal and state regulations),and acknowledges receipt of stated fynds JV1A 'j C C lfW v SSG 4 e -Fop fZILs bi C L-)k �� NON-HAZARDOUS 1.Generator ID Number 2.Page i of 3.Emergency Response Phone 4.Waste Tracking Number WASTE MANIFEST 2-4ro 4(,D 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 'A41s•c 24 5' 1404P G1.0r-aat�or's Pho e S'A'/ AGA /O'573 6.Transporter 1 Company Name U.S.EPA TD Number S Nvc-, /1 V r1 J t✓ C L5A — 7.Transport 2 Company Name U.S.EPA 1D Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 77 FacilitVs Pho `fV Unit U l 12 t Toa . n Contai 9.Waste Stopping Name and Description 10. ners 11. I No. Type Ouantiry WUVoI. LU 2' t7 3. 4. 13.Special Handling Instructions and Additional Information _ ApQ,c,c. 1 * 2so 0301 Qv# is LM 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations. Gen erator's/Offeror's Printed/Typed Name Signature +� Month Day Year 15.International Shipments T—. ❑Import to U.S. ❑Export from U.S. Port entry/exit,Transporter Si nature(for exports only): /f)ate�eaving U.S.: W 16.Transporter Acknowledgment of Receipt of Materials T er 1 PrintedrTyped Name / Signature Month Day Year Div - -- - - � f Z'•, ¢t tiansponer 2 PdV/fyped Narrne -- — Signature „ Month Day Year F 17.Discrepancy -- 17a.Discrepancy Indication Space ❑ Rejection Quantity Type Residue Partial(iejetxion ❑Full _ Manifest Reference Number. 17b.Alternate Facility(or Generator) _ U.S.EPA ID Number u LLFaditys Phone: 17c.Signature of Altemate Facility(or Generator) m Month Day Year Z —� fA W C 18.Designated Facility Owner or Operator.Certifx.ation of receipt of materiels covered by the manifest except as noted in hem 17a /Printedrryped Name / Signature Month Day`/ Year 169-BLS-C 5 11979(Rev.9/09) ) DESIGNATED FACILITY'S COPY .. 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A�� DATE(MM/DD/YYYY) �`�`� CERTIFICATE OF LIABILITY INSURANCE 05/20/2025 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 Caren Malthaner NAME: C&H Agency HCONNo Ext: (973)890-0900 FAX, No. (973)812-9860 55 Lane Road,Suite 210 E-MAIL cmalthaner@chagency.com ADDRESS: P.O.Box 10003 INSURER(S)AFFORDING COVERAGE NAIC# Fairfield NJ 07004 INSURERA: Great Divide Insurance Company 25224 INSURED INSURER B: Key Risk Insurance Company 10885 Optima Environmental Services,Inc. INSURER C: 92-94 Stewart Avenue INSURER D: Newburgh,NY 12550 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25-26 GL,A,U,WC 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGEN 300,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ X XCU Included MED EXP(Any one person) $ 5,000 A X Contractual Liability ECP01536097-23 04/01/2025 04/01/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 JECT POLICY PRO- ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Pollution Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BAP1536099-23 04/01/2025 04/01/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE FFX1536098-23 04/01/2025 04/01/2026 AGGREGATE $ 5,000,000 DEC I I RETENTION$ $ WORKERS COMPENSATION PER/� STATUTE EORH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA WCA2011314-21 04/01/2025 04/01/2026 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Permits. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE%�JJvJ�/���/ Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers' YORK CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name 8 Address of Insured(use street address only) 1 b Business Telephone Number of Insured 845-561-1512 Optima Environmental Services, Inc. 1c. NYS Unemployment Insurance Employer Registration Number of 92-94 Stewart Avenue Insured Newburgh, NY 12550 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations In New York State, re,a Wrap-Up Policy) Number 47-4028616 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Great Divide Insurance Co. Building Department Village of Rye Brook 3b. Policy Number of Entity Listed in Box"la" 938 King Street Rye Brook, NY 10573 WCA2011314-21 3c Policy effective period 04/01/2025 to 04/01/2026 3d The Proprietor,Partners or Executive Officers are QX included (Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"3" insures the business referenced above in box"la"for workers' compensation under the New York State Workers' Compensation Law (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder ill box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail ) Otherwise,this Certificate Is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c", whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Care aner (Pn name of authonz epr senor licensed agent of insurance carrier) Approved b : u'/Y.[��- e ��J�J 5/20/2025 r" (SignaluFe) (Date) Title: Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier: 973-890-0900 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny gov Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, May 21, 2025 12:37 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 05/21/2025 12:37 To: VIL RYE BROOK PRIMARY Transmitted: 05/21/2025 12:37 00002 Ticket: 05215-001-592-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 245 To: Name: TREETOP CRES Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF BLDG NearSt: BRUSH HOLLOW LN Means of Excavation: HANDTOOL Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: U/G STORAGE TANK REMOVAL Estimated Work Complete Date: 06/03/2025 Depth of excavation: 2 FEET Site dimensions: Length 5 FEET Width 4 FEET Start Date and Time: 06/03/2025 07:00 Must Start By: 06/17/2025 ------------------------------------------------------------------------------ Contact Name: DECLAN MCENEANY Company: OPTIMA ENVIRONMENTAL SERVICES Addrl: 92 STEWART AVE Addr2: City: NEWBURGH State: NY Zip: 12550 Phone: 845-779-6476 Fax: Email: dmceneany@optimaenv com Field Contact: DECLAN MCENEANY Alt Phone: 845-779-6476 Working for: NANCY ECHAUSSE ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR i