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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK NOV 12 2025
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
www.ryebrookny.l;ov 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#: m
Approval Date: Permit Fee: $ e�
Approval Signature: 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#C 105.2 or Form#U26.3 /or NY State Workers Compensation Waiver)
4. Fee per Tank: Removal or Abandonment S4<.00 per Tank.
5. Dig Safely New York#(dial 811): .gas
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, I/)"Z L S 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(v�•Abandonment( )/Above Ground (v�Buried m Ground ( )
1. Address: 58 Greenway Circle SBL: 129.84-2-47 Zone:
2. Property Owner&Address: Linda Bucci, 58 Greenway Circle, Rye Brook, NY
Phone#: 914-937-2618 Cell#: email: lindan7ll@verizon.net
3. Contractor&Address: Meenan Oil Co LP, 1 Gateway Plaza, 4th flr., Port Chester, NY 10573
Phone#: 914-847-0295 Cell#: email:permits@Rob&sonoil.com
4. Applicant: Same as contractor
Phone#: Cell#: email:
5. Indicate Fuel Type:Fuel Oil(X•L.P.Gas( )•Gasoline( )•Other( ):
6. Number and Capacity of each Tank: Removal of 275 gallon above ground oil tank in outdoor mechanical room
7. Exact Location(s)of each Tank: Outdoor mechanical room.
t
6/1/2024
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. l
Sworn to before me this ✓ Sworn to before�me this
day f 20_°1 S day o V V ,2Q aS,
\ gnature of roperty Owner S' nature of Applicant
Print Name o rope er Print N e of App ' t
AMANDA K OLMSTEAD AMANDA K OLMSTEAD
Notary Pu lic NOTARY Pl BUC,STATE OF NEW yoiM No PuuucTPuRJ( STATE OF NEW YO
Rc6is a No.01 OL6417632 �daa No.01OL6417632
Qttadfied is Westchma wary Q-ified a Wastciala�7
Commmioo Egim W362M 24 C--maa EW=Otr3a MZ
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
6/1/2024