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HomeMy WebLinkAboutMP25-136 s s ° y L N N a x u� Ln y N N W yyRyy 00 0004 N M d a N aTo a S W v + ►��y Cn � y3 � •G �" 0.4 11 ~ ~ mm: Linen P-4 z g u ° b Ln o a o � g CUL � q ►r O/ W o Z H 04 ° ^o b W O °d D " 2 a � zo v vw 8 V Cn i z av � � vv .� lu a z bo V c� 1.4 �o o a � v W .- v H .4 W W O oz V W z W C7 o z zo °aab .: W z ,b w ►� cn d � •� c .n N A W z R� ° -o .. w W z vv � A a04' O W � � �v o xC, � � � b BUILD MENT D ( V (� VIL 1? X, OOK v E 938 KING t" i�RE8�12 ,NY 10573 AUG 2 5 ZOZS . 0V VILLAGE OF RYE BROOK BUIL©ING [DEPARTMENT Application for Permit to Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: M 194:;?5` 13(4! Approval Date: 8 - -2 — 2 O L S— Permit Fee: Approval Signature: \Vccl L► 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$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# C105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Installation: $225.00 per Tank. 5. Dig Safely New York# (dial 811): 6. Inspection by Building Department for installation. 7. Submit all Manifests& Reports(if applicable, after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, Pi is hereby made to the Building Inspector of the Village of Rye Brook for a permit to install a Fuel Tank ash ein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s) will be installed in conformance with all applicable Village,County, State&Federal laws, codes, rules and regulations. ****************************************************************************************************** Indicate Permit Type: Above Ground • Buried in Ground ( ) 1. Address:2kLA 9,CT�, R,Awl_� I �(�..©}- SBL:QED•-Nra Zone: l� I ID 2. Property Owner&Address � �VYia2Na'n� '�i I- Phone#: 14• ( T3 - ldba I Cell#: email:kQ 3. Contractor&Address: aAmcce-Y�21 Co.t e, 24p N. 6-r 8+ Gmnn ),11e-3^ C'C bb83h n Phone#:"�Mq. `` �y� Cell#:203 . 531 • (Q _email:Sery;GcA4CQ A-0ttc1•C0y- 4. Applicant:�QS'tirrfY. UO� C-n,Inc, Phone#:q1q u%9 •3400 Cell #:Db3 531 lgQ(DC email:Sol-ve CA e,,:.�rJM1A Q lf�}fxxe 10 ,C�•,� 5. Indicate Fuel Type: Fuel Oil'W L.P. Gas( )•Gasoline( ) •Other( ): 6. Number and Capacity of each Tank: n"m o-, i�ST 7. Exact Location(s)of each Tank: 1 6/I/2025 L STARE X O NE--V RK COUNTY OF ) as: n o q�(�n+�-� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indi idual signing as the applicant) and further states that(s)he is the Tank Installation 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 C;)(:) FI.— day of 20 _ day of 20 _ Signatt re 1of Property Owner L,,J Signature of Applicant �O �►IK �K��4 �� Print Property O wne Print Name6f A plicant Notary Public No ublic SEAN LYTLE SEAN LYTLE NOTARY PUBLIC NOTARY PUBLIC STATE.OF CONNECTICUT STATE OF CONNECTICUT i his.aPTIWXMKAWRA"-c bb rry m completed in its entirety and must include t%tCfidWHWxP1R[S Au&3i,2030 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. z 6/1/2025