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HomeMy WebLinkAboutMP25-079 BRy . 19 S� 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.Jgoov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 1,2025 JoAnn Barrett 28 Hillcrest Avenue Rye Brook,New York 10573 Re: 28 Hillcrest Avenue, Rye Brook,New York 10573 Parcel ID#: 135.76-1-4 This document certifies that the work done under Mechanical Permit #25-079 issued on 6/4/2025 for the removal of an above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE DRC�k, cu � • 1982• BUILDING DEPARTMENT 7 ILDING INSPLCTOR AssISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT Orr10ER 938 King Street • Rye Brook, NY 10573 (914)939-06681nx (914) 939-5801 www Uebrookjq - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : L! f 3_9A1.L—C►Z EST A 1/if-: DATE:-1 — Z O Z.S PERMIT'_M? 0-2_( ISSU1?1): �2.�tiI;C7'. S+• 7 BLOCK: --- --- - �- --- 'ram---� r LOT: LOCATION: /�Q _ _ OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ^1 1 J n- I ❑ Natural Gas ve—C- -� ly�� 1�Po2rtTbrL ❑ L.P.Gas TANK.,QrFUEL T Ih o (/Ane� 0 P a 7.5 AY-i /�V ❑ FIRE SPRINKLER �/ /Y��T• _ _ ❑ FINAL PLUMBING ❑ CROSS CONNECTION a 1l` �- FINAL � Ale- /yd Q t- Co � &k /c vi Go ❑ OTHER I•u� ^^- J 1 c MCA, IA-1. 1989-• BUILDING DEPARTMENT D BUILDING lN8PJlC-J.'0Xt Rofl-9818TAMF BUILDING INSPECTOR VILLAGE 0.13 RYE BROOK D Com,EM40RCI,?Ml,?N. r 03malit 938 KING STPE?ET - RYE BROOK,NY 10573 (914) 939-06081:1AX (914) 939-5801 ,kwwxV-cbr0oLUr( - - - - - - - - - - - - - -- - - - - - - INSPECTI.ONREPORT - - - - - - - - - - - - - - - - - - - - PERMIT,#jw,P ISSUED: SECT: 216 8;1,0CIc.: LOC.AJJ0N: OCCUPANCY: 0 V101ATION Nwrm) 14-TE WORK IS... jd/ACCEPTED El Rulm-ria)/ REINSPEC'.CION 0 SITE INSPECTION Rt,(2uwja) 0 *FOO'fING 0 1100,11INGI)RAINAGE 11 VOUND.A.TYON 0 'UNDERGROUND PLUM.11ING NOTES ON INSPECTION: 0 ROUGH PLUMBING 0 ROUGH FRAMING 0 INSULATION 0 Nmrmm,GAS 0 1-It Gms FUEL 1 - 77 ULILTANK ❑ Fmal 'imu-Niux..u. 0 FINAL PLUMBING A D CROSS CON I.L CltL C-0 +I go NECTION LIU 13 FINAL 2* cell e L] 0.rHEM /Z �,� � F � .silt ,.j ..._ _. _.__ vfI ,F t ,�,.. w% iit' ��� M1 V� ��_ n-; ' .. i t . Y7 - .'��, �4: � ,.� - �.,; ,i -- r '�► r'` . , �a - �_ � . , F { __ . ��_ ._. - � r �^'� ���� _ C o p N s s � � � C t W En Kr 26 C OFlo w/ ►� ►� � � f�j W �, °3 0 � � Vl� Ln 'A Woyoa ° Q V W Z 0 V p o v V A� � Z V Z v v a � .. C4 .500 v fro x � cy zzbo � ►� C'7 W H o � v °Jw np F" V V � y � � v x H O O z zoCa".� � !« W U w O v Q V O o ~ z 00 F © Wa S V o V O 40* _ N W Z E+1 © � '8 0 �� � a a BUILDING. AItTMENT R � VILLAGtE of RY> N OOK MAY 2 77 2025 l 938 KING STET RYE BROW,NY 10573 ��w�� ¢� -OG68 ' VILLAGE OF RYE BROOK wr�yw rx col uy.eov BUILDING DEPARTMENT Aualication 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#: �-o7 cT Approval Date: J UN- Pertm9t Fee:$ / 00S!r —A Approval Signature: y Other: Disapproved: ` (fees are non-refundablc) PO NO S 1A1t I NN ORK or CO S I RUC PION t,N I IL A PLRMT1 HA.�, itLLN IS�t I.D B1 I IJL BUIT.1)I N(. INSPECTOR. THL AWN11INISTRATIVL FEE FOR WORK PROGRESSED Olt C'OMPLL IED"I l'HOUT A Pt,RMIT IS 1.2%OF THE TOTAL COST OF CONS l lt1`('T1ON WTTIt A !MINIMUM FEE.OF 57500) 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 ti l 85.00 per Tank. 5.Dig Safely New York#(d i;,1 81 1): 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. Application dated, 5/09/2025 ,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 Tyne: Removal 64•Abandonment( )/Above Ground(�•Buried in Ground( ) 1 Address: 28 HILLCREST AVENUE, RYE BROOK, NY 10573 SBL: J�, 7ta —�—y Zone: 2. Property Owner&Address: ;::Jr0a/I/I go r Phone#: 914-844-7040 Cell#: email: ioannb28@hotmail.com 3. Contractor&Address: C2G ENVIRONMENTAL-83 S PUTT CORNERS RD, NEW PALTZ, NY 12561 Phone#: 845-255-4900 Cell#: email: quotesQcc2g.us 4. Applicant: Phone#: Cell#: email: 5. Indicate Fuel Type:Fuel Oil> •L.P.Gas( )•Gasoline( )•Other( ): 6. Number and capacity of each Tank: (1) 275 gal heating oil tank 7. Exact Location(s)of each Tank: BASEMENT 1 6/l/2024 V1Sr, , STATE OF NEW YOM COUNTY OF VIE-S ) as: Samantha Aprea ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual 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 Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Toni LHokanson �� ptl� NOTARY PUBLIC,STATE OF NEW YOR to before me this Sworn to before me this I Registration No,01 H06294662om day of U. 20 ZS Qualified in Ulster County of � 20A6 Commission Expires December 23,20 ature of Pro Owner lgnature of pplican'!` Ja Ck W 5k 41 11401 ' Na �efPrope er Print Name of fican Joni Lamaj �� Commission#O1 LA0025681 Pu rc Notary Public,State ofNew York Notary Public My Commission Expires June 07,2028 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 6/1/2(124 C2G Environmental Consultants, LLC 7 Skvline Drive Suite 32(1 Tel. (914)357-8275 Hawthorne, NY 10532 Fax (845) 255-4909 May 20, 2025 Joann Barrett 28 Hillcrest Avenue Rye Brook, NV 10573 Scope of work: Cut, clean, and remove (1) 275 gallon ahoveground oil tank from the basement. Install (1) 275 Granby aboveground oil tank in basement.To include; fill/vent piping, alarm, and gauge. )C) Install (1) 275 gallon aboveground tank in basement Remove(1) 275 gallon oil tank from basement Lrri, 17. L V L I I Gttdlvl No. 4456 P. 1 I 11,61slad by,r.J,hbtf fAAA!6S0utATEA,lw;,,O,Ntr,r.wr, VA•US.t•,aOp)321 WJ66,J%GNer s k,, Nrhrbd M JUL 21 VILLAGE OF RYE BROOK NON•HAWDOUS L Gomwala ID Number ^— �,Pago 1 of S.Emergency Response Pho A.Weela TreekNgNUeltMf WASTE MANIFEST 5.Ganaretola Nerve and MO&I Address �'� ti ,r C! neraafs Site Address R difforent than ma g address) '�o� ►1 LcrY es� k 0 ratoya Phono: 8.Transporter i Company Name U.S.EPA Ig Number u ro 7,Transpoder 2 Company Name US.EPA ID Wxnber 8.11e4lgn064 Fadflly Name and SNe Address 1.1.EPA 10 Number LZ. Dk �a�e FaeM I A Phone: fp N Q.Woele Shipping Name and Descilpllon 10,Con olnere 11.Total 12.Unt _No. Type Otrenllly M.NoL n' t Y1-'7 O, 3. 11 Special Handing Inalruciions and Addiand Informellan r � a.GENERATOR'Sl FFEROR'S CERTIFICATION:I hereby declare 141 One comenls of IN$consignment are fully and accur4ly described above by IM proper shOping rwm,-and are daalgad,paclraged, milked and labetedlplacarded,and are In all respects In proper condlllon for Iranspod aeoondng to applicable tnleme national govenv,wnlal regulations. Genemise pforZkNTyped Name Signature Momh Day Year •`. 5.Inlemellond Shipmome f-1 Z Nrpottto U.S. ❑Eupal from U. . Pod of emrylealt: Tro 9 fa o Date leavingU.S.: 16 Tranepprler Adrrgwledgmmi of Recelpl of Molerlols Transporter 1 Pdnfedrfyped Name Signeiure March • Day Year Transporter 2 Pr nled/Typed Nerve Signowle Mash Day ear 17.Dleerapancy 17L Discrepancy Ind(cellon Space ❑ouantiy ❑rypa ❑Residue ❑Pend Neation ❑F.W Rafeation Manilest Relerence Number, r 17b,Alternate Facility(a Generator) U.S.EPA ID%mbw. 'u •• r�i FacNkys PMne: y9Q 170,3lgnaluro 01 Allefnale PadM1y(a Ge110fa1a►) Month Day Year . Q Q 1 _D (CEE F J U L 2 1 2025 VILLAGE OF RYE BROOK BUI D N,DEPARTMENT S D,r! V 710`0145CP C2G C rIJV:iIC�# 214�18 to Cash P!.rchast: DiaTE/TINE- 6/27/2025 11 :C5 1 AM CA D-IT ER: 100101 STATION: 01 Customer info Cusiomer: C2G CD #1 57E L (Un,3rapar-ed)-021 --- !I`:a2Ci $C.09 $`.i 32.80 '3tabfotal.___ .------ --_..-------$532.80 Gf7A"@ (rTal. 9�)180 C,as'i 3!-332.80 Mon-Fri 7:30<iiri u"m �at 7am-2pm Wl) TAX ON 3Cf,AP METAL X _. 01 rfiUTURF P - � C2GENVI-01 LGRYCZYNSK ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDY)YY) 12/11/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such en_d_orsement(s). PRODUCER CONTACT Craig Ceara NAME World Insurance Associates,LLC PHONE 732 228-8236 1805 FAX 225 Madison Ave (A/C No.Eat) ( ) (A/C.No); Morristown,NJ 07960 ADDRESS CraigCecere@worldinsurance.com INSURER(S)AFFORDING COVERAGE - NAIC I$ INSURER A Admiral Insurance Company 24856 INSURED INSURER 8 Selective Insurance Company of the SE 39926 C2G Environmental Consultants,LLC INSURER C 83 South Putt Corners Rd INSURER D New Paltz,NY 12561 - INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: _ 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 BR TYPE OF INSURANCE ADDL SU pOLH:V NUMBER POLICY EFF POLICY EXP LIMITS LTIRIN 0 __ IMMMQWfyYL-LMMtD0NYYY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE X OCCUR FEI-ECC-3628"0 12/12/2024 12/12/2025 DAMAGE TO RENTED - 50,000 PREMISES(Eanccurrencel .S MED EXP(Any-one person) .S 10,000 PERSONAL AADVINJURY .$ 5,000,0001 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 5,0001000' POLICY PELT LOC PRODUCTS-COMPIOPAGG 5 5,000,000 X" OTHER Pollution Liability _ POLLUTION LIABI $ 5,000,000 B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY tEa acadenq S X ANY AUTO S 2307223 4/29/2024 4/29/2025 BODII Y INJURY{Per person) .$ i OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INA RY IPer accident).$ RED Np1J.pWN P{�OPERTY MAGE X .AUTOS ONLY X I A17T05 ONE Y I iPet_acGdent� $ - $ UMBRELLA LIAR OCCUR Y EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION — PER OTH- AND EMPLOYERS'LIABILITY YIN STMUTE _ ER ANY PROPRIETORIPARTNERIEXECUTWE - E L EACH ACCIDENT $ QQF�aFlCER,A1E"Wl EXCLUDED? 'N I A IMhdatwY In NN) E L DISEASE-EA EMPLOYE"} If Yes describe under DESCRIPTION OF OPERATIONS belo« _ E L DIS E-POLICY LIMIT A Professional Liabili FEI-ECC-36284-00 12/1212024 12/12/2025 ProfessionaLiability 5,000.000 A Transport.Poll.Liabi FEI-ECC-36284-00 1211212024 12/12/2025 Transport.Poll.Liabi 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additio"Ramarks Schedule,may be attached if more space is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 - AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1986-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N Y S I F PO Box 66699 Albany,NY 12206 New York State Insurance FIInJ nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^A^^^^ 200882662 , 0 LOVELL SAFETY MGMT CO.LLC 22 CORTLANDT STREET 33RD FLR NEW YORK NY 10007 4 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER C2G ENVIRONMENTAL CONSULTANTS LLC VILLAGE OF RYE BROOK 83 S PUTT CORNERS ROAD 938 KING STREET NEW PALTZ NY 12561 RYE BROOK NY 10573 POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE Z 1412 798 9 894279 04/01/2025 TO 04/01/2026 02/28/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1412 798-9, 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 IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS:/IWWW.NYSIF.COMICERTI 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 THE SOLE PROPRIETOR, PARTNERS ANDIOR MEMBERS OF A LIMITED LIABILITY COMPANY 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 ANDiOR 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 INSURANCE FUND 4 DIRECTOR 1 SURANCE FUND UNDERWRITING VALIDATION NUMBER 572364289 iir o00000 1377087-�ili R.rm M'f-FEAT-JIOPRINT Vernon tlOS'_9?IIIVIINIP,h. l n]'+Fil I 'i,i 213