HomeMy WebLinkAboutMP25-134 DR
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. 190
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
September 30,2025
Edison Barros&Diana Barros
123 North Ridge Street
Rye Brook,New York 10573
Re: 123 North Ridge Street, Rye Brook,New York 10573
Parcel ID#: 135.59-1-34
This document certifies that the work done under Mechanical Permit #25-134 issued on 8/25/2025 for the
removal of an above-ground oil tank has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
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�932 BUILDING DEPARTMENT
❑BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573
0 ASSISTANT BUILDING INSPECTOR (914)939-0668 FAx(914) 939-5801
- - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - -- --- -I --- - -
ADDRESS. , �1 V , a_ DATE.
PERMIT# ISSUED: , SECT' ` BLOCK: LOT:
/ 1
LOCATION: ` OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION REQUIRED
0 FOOTING
❑ FOOTING DRAINAGE
0 FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
0 ROUGH FRAMING0 INSULATION
❑ NATURAL GAS
❑ L.P. GAS
0 FUEL TANK I
0 FINAL PLUMBING
0 FINAL
0 OTHER
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BUILDING DEPARTMENT E. 1EME
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 AUG 2 5 2025 L9D
(914)939-0668
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)
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Approval Date: Permit Fee: $ �
Approval Signature: Other:
Disapproved:
(Fecs are nun-retundahle�
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
5. Dig Safely New York#( ):
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, ,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 (x) • Abandonment ( )/Above Ground Buried in Ground ( )
1. Address. 123 North Ridge Street �131 135.59-1-34 Zone: _0
2. Property Owner&Address: Edison Barros/ 123 North Ridge St,Rye Brook,NY 10573
Phone#: 646-942-3264 Cell#: email: edison.barros09@gmail.com
3. Contractor&Address: C2G Environmental Cons.LLC 83 S Putt Comers Rd,New Paltz,NY 12561
Phone#: 845-255-4900 Cell#: email: erhodes@c2g.us
4. Applicant: Edison Banos
Phone#: 646-942-3264 Cell#: email: edison.barros09@gmail.com
5. Indicate Fuel Type:Fuel Oil(]o•L.P. Gas( )•Gasoline( )•Other( ):
6. Number and Capacity of each Tank: (1)275 gallon
7. Exact Location(s)of each Tank: basement
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,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.
Sworn to before me this CPS Sworn to before me this
day of�� � ,20 day of In ,20��
Signature of Property Owner Signature of Applicant
Edi Scat, aar t-OS
t Name of Property Owner �Te of Applicant
Notary Ptl MELILLO Notary Public
Notary Public,State of New York
No.O1ME6160063 SHARI MELILLO
Qualified in Westchester County Notary Public,State of New York
Commission Expires January 29,20
No.01ME6160063
Qualified in Westchester County
Commission Expires January 29,20��
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6112 Abeel :3T K ingston NY,1 •401
845) 331-3311
N.Y. , i XV 7105074SCF,
NAME: C2G C
INVOICE-4 217573
t;10.ied to Cash Purchase
DATE://TIME: 8/27/2025 2:47:20 PM
CASH ER: 100101
:STATION: 01
Customer Info
Customer: C213-C213
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GRE 101 1652.60
$552.60
Mon-Fri 7:30am-4:30pm Sat 7am-2pm
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WASTE MANIFEST
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5.Generators flame and Mailing Address Generator's Site Address(if different than mailing address)
Generators Phone: 4 _
6.Transporter 1 Company Name U.S.EPA ID Number
7.Transporter 2 Company Name U.S EPA ID Number
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B.Designated Facility Name and Site Address , Numb U.S.EPA a
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14.GENERATOR'VOFFEROR'S CERTIFICATION:I hereby declare t at the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed,packaged,
marked and labeled/placarded,and are in all respects in roper con itidri'or transport according to applicable international and nationalgovemmental regulations.
G erators/Offerors 'nted/T Name 1 / Si lute
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Printed/typed Name Signati re Month Day Year
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NONHAZARDOUS 1.Generator ID Number re 1 IJIEmergency Response Phone 4.Waste Tracking Number
WASTE MANIFEST
5.Generators Name and Mailing Address Generators Site Address(if different than mailing address)
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6.Transporter 1 Company Name I U.S.EPA'ill Number
7.Transporter 2 Company Name U.S.EPA ID Number
8.Designated Facility Name and Site Address ! -
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14.GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare t tat the contents of this consignment are fully and accurately described abo4e by the proper shipping name,and are classified,packaged,
marked and labeled/placarded,and are in all,respects in proper condition fortransport according to applicable international and national governmental regulations.
Generator's/Offeror's PrintecVTyped Name Signature Month Day Year
J 15.International Shipments
t— ❑Import to U.S. ❑Export from U.S. Port of entry/exit:
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>� 1932 BITLDING DEPARTMENT
UILDING INSPECTOR VILLAGE OF RYE BROOK
0 VVILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573
❑ASSISTANT BUILDING INSPECTOR (914)939-0668 FAX(914)939-5801
— — — - — — — — — — — - - — — — - - - - — INSPECTION REPORT — — — — — —
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ADDRESS: ' V c�� DAi E. J =
PERMIT# ' ISSUED: �\ SECT: - BLOCK: LOT:
LOCATION: OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING ,^(r `� 50
❑ ROUGH FRAMING
❑ INSULATION �^ c
❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING vC
❑ FINAL
❑ OTHER
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BUILDING DEPARTMENT D 1�C F� ir V LE
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK, NY 10573 AUG 2 5 2025
(914)939-0668
VILLAGE OF RYE BROOK
BUILDING DEPt`ARTMENT
Application for Permit to Remove or Abandon Fuel Storage Tank
(*Storage Tanks in excess of 1.100 gallons require registration with the Count} of Westchester)
Approval Date: — 2 7 Z O LS _ Permit Fee: S 4--11U
5
Approval Signature: �t � _ 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 or Abandonment
5. Dig Safely New York
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,4; is hereb% 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 Tvae: Removal W • Abandonment ( )/Above Ground Buried in Ground ( )
I. Address: 123 North Ridge Street SIR,: 135.59-1-34 Zone:
2. Property Owner& Address: Edison Banos/ 123 North Ridge St,Rye Brook,NY 10573
Phone#: 646-942-3264 Cell #: email: edison.banos09@gmail.com
3. Contractor& Address: C2G Environmental Cons. LLC 83 S Putt Corners Rd,New Paltz,NY 12561
Phone#: 845-255-4900 Cell#: email: erhodes@e2g us
4. Applicant: Edison Barros
Phone#: 646-942-3264 Cell # email: edison.barros09@gtnaii.com
5. Indicate Fuel Type: Fuel Oil(10• I.P (;as( )•Other i ).
6. Number and Capacity of each Tank: (1)275 gallon
7. Exact Location(s)of each Tank: basement
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,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 Whe 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.
Sworn to before me this Sworn to before me this
day of�L�Q � ,20 day of ,20�_
Signature of Property Owner Signature of Applicant
LAISo, &art- oS Ed,soh �avr�
t Name of Property Owner lame of Applicant
Notary Pt l MEULLO Notary Public
Notary Public,State of New York SHARI MEULLO
No.O1ME6160063 Notary Public,State of New York
Qualified In West� y ter Count
commission Expires January 29 20 No.OIME6160063
Qualified In Westchester County
Commission Expires January 29,207!�
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i� C2GENVI-01 EMARTIN
ACQRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
5/1/2025
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 MTAF.CT Elaine Marlin
World Insurance Associates,LLC PHONE
ac 973 8714 525 1813 FAX
226 Madison Ave ,No,
Morristown,NJ 07960 p I .elainenurtin@mmM!nsuranm.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Admiral Insurance Company T24856
INSURED INSURER B:SelOCtive Insurance ComRny of the SE 39926
C2G Environmental Consultants,LLC INWRERC:
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.
ISSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
ILTRA X COMMERCIAL GENERAL LuaLrrY EACH OCCURRENCE S 5,000,000
CLAIMS-MADE ❑X OCCUR EI-ECC-36284-00 12/12/2024 12/12/2025 DAMAGE TO RENTED 50r 000
MED EXP(Any oneperson) 10,000
PERSONAL&ADV INJURY 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5,000,000
X POLICY F7 PRO LOC PRODUCTS-COMPIOP AGG S 5,000,000
X OTHER:Pollution Liability POLLUTION LIABI 59000,000
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
amdr4 S
X ANY AUTO 2307223 4/29/2025 4/29/2026 BODILY INJURY Perperson)
OWNED SCHEDULED
AUTOS ONLY (A�UUpTry(OSyyyyNNEE BODILY INJURY Per
AUTOS ONLY AUTOSONL� AMAGE
UMBRELLA LIAR OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I RETENTION$
WORKERS COMPENSATIONS' PER OTH
AND EMPLOYER LIABILITY Y/N STATUTE 1 --
ANY PROPRIETOR/PARTNER/EXECUTIVE " EL EACH ACCIDENT
OFFICER/MEMBgEER EXCLUDED? u MIA -
(Mandatory m NH)
EL.DISEASE-EA EMPLOY
If yes,describe under -
DESCRIPTION OF OPERATIONS below I I EL.DISEASE-POLICY LIMIT
A 'Professional Liabili EI-ECC36284-00 12/12/2024 12112/2025 1Prof Liability 5.000,000
A Transport Poll Liab I-ECC36284-00 12/12/2024 12112/2026 Transport Poll Liab 5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/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
Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS.
938 King Street
Rye Brook.NY 10573
AUTHORIZED REPRESENTATIVE
NY S I F PO Box 66699,Albany,NY 12206
New York State Insurance Funa I nysd.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
A A A A A A ■ •� � �
200882662 � 1.t•: f
LOVELL SAFETY MGMT CO., LLC
22 CORTLANDT STREET 33RD FLR
NEW YORK NY 10007
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 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://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 THE SOLE PROPRIETOR, PARTNERS AND/OR 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 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 INSURANCE FUND
DIRECTOR, I(SURNCE FUND UNDERWRITING
VALIDATION NUMBER: 572364289
111()0000000000. 0875111