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BUILDING DEPARTMENT RFSP
E 15 2025
VIL .� E OF RYE'BROOK VILLAGE OF RYE BROOK
938 KING S.: ET RYE BROOK,NY 10573 BUILDING DEPARTMENT
(914)939-0668 '
wWw.p4rookny.eov
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 ONL PERMIT#: �c 5' �Y vC
Approval Date:
`,\k J\2 Permit Fee: $ O
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
«,r«*«*««*«*,r,t,►+r,r«««,vw*«*a*****+***+t*««*,r*««r«««*�**«*****«******««*«««««**,r***«,ex*�«x*,r*,r,c++r�«««***+�**
DO NOT START WORK or CONSTRUCTION IINTII A PFRNIFI IIAS BEEN 1SMIED BY TIIE BUILDING
?'v 1�V• l•l1n
INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WI THOU I A PER,ITT IS
120/6 OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$7;;0.00
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: Removal or Abandonment$185.00 per Tank.
5.Dig Safely New York#(dial 811):
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.
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Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to
remove or abandon a Auel 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 •Abandonment( )/Above Ground(Buried in Ground( )
1. Address: 58 Taleott Road SBL: 135-50-1-19 Zone: Jam— 12
2. Property Owner&Address: Tatyana Tatarskaya, 58 Talcott Rd., Rye Brook, NY
Phone#: 347-409-3853 Cell#: email: STATARSKAYA@GMAIL.COM
3. Contractor&Address: Meenan Oil Co LP 1 Gateway Plaza 4th fir. Port Chester, NY 10573
Phone#: 914-847-0295 Cell#: _ email: iweirOlrobisonoil.com
4. Applicant: Same as contractor
Phone#: Cell#: _ _email:
5. Indicate Fuel Type:Fuel Oil( •L.P.Gas( )•Gasoline( )•Other( ):
6. Number and Capacity of each Tank: Removal and replacement of 275 gallon above ground oil tank.
7. Exact Location(s)of each Tank: Under deck crawl area
6/l/2024
ST 'E F EW ORK C iTY F- ESTCHESTER ) as:
ing duly sworn,deposes and states that he/she is the applicant above named,
(pnnt ramqff individual sitning as the applica
and fitrthr 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. JENNIFER CINGUtNA"Mq►u01ic,Stott of IMw YaA O l L
Sworn�to�or met No.01C1002 e nle this
Sworn me t `
Qw1iRe4 in Westches C
day of 20 � COt ► K 209
Signature of Property(),.N ner gnature of Applicant
Td
Print Name of PropertyO r�r Print Name of A icant '
tary Public ESjHER�4.ROD 1 EZ RAMOS tary Public
NOTARY PUBLIC. rate of New York
NO.o t RO0036946
Quaiified in Kings,County 2
This applicati6n�iffiBZ$r�i'peld,c replete 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/l/2024