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HomeMy WebLinkAboutMP25-162 DR i� 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 January 5,2026 Yolanda Paulino 32 Roanoke Avenue Rye Brook,New York 10573 Re: 32 Roanoke Avenue, Rye Brook,New York 10573 Parcel ID#: 141.35-1-40 This document certifies that the work done under Mechanical Permit#25-162 issued on 11/18/2025 for the removal of an above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to O y Bk w 1982 BUILDING DEPARTMENT ILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914)939-0668 FAx (914)939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - -- - - - - - - - ADDRESS :_ A_Aer_ DATE: � Z �� L 40ZS PERMIT# 2 S 1 tp2 ISSUED: &2rSF.(;T:_��• 'BLOCK: LOT:!M LOCATION: } g4o� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION n ❑ NATURAL GAS ✓n O II�� 2 �� �,V•J S.�, ❑ L.P. GAS ^ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING La t ❑ CROSS CONNECTION J ❑ FINAL O'"OTHER Z 0 c BR O ❑BU )ING INSPECTUR BUILDING DEPARTMENT SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOD ❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 wwW.ryebrc►i_ ok_o -- - -- - - - -- - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - _ _ _ _ - - ADDRESS: 2 �4 d,F_ DATE• /� 2 /— ZO ZcS. PERMIT* _ISSUED: BLOCK:�•1J St CT: - .y! LOT:_L-= LOCATION: �. S l - OCCUPANCY: ❑ VIOLATION NoruU THE WORK IS... ACCEPTED ❑ REIECTEI)/ REINSPKCTION ❑ SITE INSPECTION ❑ FOOTING Ri.QuIRED ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS G� ( V� s Q� p 1� zr ❑ L.P. GAS ►UL r ,ej�UEL TANK _ ❑ FIRE SPRINKLER _A u Wy2 D- ❑ FINAL PLUMBING (� ❑ CROSS CONNECTION ';c J U4P C ❑ FINAL ❑ OTHER -- k�;+k.-I 36 '"rr,,� �•} •��t,�='tom. �'S�'•f _�5�.t�1w�r���IR�S�3' w.u`j�►�� `d' a/ �• _tom. t �,J ^ RJ :� y,}�r •yea _ _ S'.. WWI 1- N oN = �--I N GL s 0 O rl a W � . a U o �+ n W p 04CA 3 _ cn O M W z z ►ten L� � r � Ao ; o00 O O 1 N 0 � � Ca � A = W by H H 00 O W W 00 0 3 -; j v O a aO4 Q mow/ M�_I (n Ad U u 0 , W _ ¢ a C a ob A W V r. z C O "a WO � hov � o V = Woo �j r_I� r+ O F' o p c Uzen i b o z = 11 � �► � °00 a v U = CA 00 COS. co 0 44 V z 0 a ° v � � u � 00 o a v V V E „ ° ° U x cn F, o z d' O ZO w c� Hgw � .Nu [--i p Wm W q z > o M A W z Ey d ° A a �a � u. a Ltd❑pypp a � � W x h .;1 BUILDkN DIW IRTMENT VILLA E OF RYE rOK 938 KINGS ' ET RYE BR oie,NY 10573 �( 4) -0 8j 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) ,ll i mpaS i boa Approval Date: `� �\ Permit Fee:S �1 Approval Signature: Other: Disapproved: _ (fm arc non-is I undablc) DO NOT S'I ARTWORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED Bl TIIE BUILDING INSPECTOR, TIIE. ADMINISTRATIVE FETE FOR WORD PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF"HIE TOTAL COST OF CONti TRUCT10N WITII A \MIN I'%U NI FEE OF S750.00 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 i)i_ ,,,,k 5. Dig Safety New York#(:i l.d ',:i I): --- -- 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. *#*#*#*N#**k*kk*k#****#**#*************#***k*k***k*********+#*#*#**k***##*#*******#*****#*k##k*******# Application dated, 1%1 1171DS 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. *******#******#***k*********k**********k**k***#k*k*************#*++#*a+*a**+aaa##k##a*a+#«##a#*##**aA# Indicate Permit Type: Removal Abandonment( )/Above Ground Buried in Ground ( ) I. Address: 32 Roanoke Ave SBL: 141.35-1-40 Lone 2. property Owner&Address: Paulino Yolanda_32 Roanoke Ave Rye Brook, NY_10573_ Phone#: 914-830-2159 Cell a: email:yolandapaulino1011Qgrnail.eom 3. Contractor&Address:.0 - 83 S Putt Cure rs Rd, New Palt7, NY 12561 Phone#: 845-255-4900 Cell n: email: crhorles@c9g us 4. Apphcanr.C2G / 83 S Putt Corners Rd, New Paltz, NY 12561 Phone#: 845-255-4900 . _ Cell 4. email: erhodeSQc2g.us 5. Indicate Fuel Type: Fuel Oil O• L P.Gas( )-Gasoline( )-Other 1 )4 2 heating nil 6. Number and Capacity of each Tank: . i)_27� 7. Exact Locations)of each Tank. outsirlWunrierrieck t 6 1 '20?5 1/15 STATE OF NEW YORK,COUNTY OF WEA R ) as: ChrissV Rhodes/Agent C2G being duly sworn,deposes and states that he she is the applicant above named, (print tame 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 perforated,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 20 day of �c/aJ���,� ,20 _ C Signature of Property Owner Signature of Ap ' ant Chris lk-4-1 A- nt Print Name of Property Owner Print N e atlt =PUBLIC. okanson TATE OF Nt VU.01H0c2 466Notary Public Ulster County iota Publics Decernber 23,20 This application mast be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject propetly. and the applicant of record ill the spaces provided. Am application nol properly completed in its entirely andlor not properly sinned shall be decilled null :1nd %:yid and N\ill be returned to the applicant. i 611(2025 NON HAZARDOUS 1.Genera(cr ID Number 2.Paae,1 of 3.Emergency Response Pier, �4 N1a5(e.TraCkrng NurtlbCt WASTE MANIFEST t I1 rt 4i 5.Generator s Name and A4ailing A Generator's Site Address(if differ in lh ding eddre") - ' DEC � 2t02i GeneraiorsPhone: �(y.A�� ���- `. 6.Transporter 1 Company Name — — --- ---------- — ✓US,.EPQ.tD,Numb r 7.Transporter 2 Company Name ---�—- ----- — _ U.S.EPA ID t,umber I ; 8.Designated Facility Name and Site Add l U.S.EPA ID Number c�tvi'Yr�Yri�� Facili 's Phone: 9.Waste Shipping Name and Description to.Containers 11.Total 12.Unit No. Type Quantity Wt./Vol. 2:. r r'' " ,3� • i3''Special Handling Instructions and Addilfona+Information 14.GENERATOR'SIOFFEROR SCERTIFICATION.I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded.and are in ail respects in proper condition for transport according to applicable intemational and national v ' htal regulations. Generator's/Offeroes PrPted/Typed Name r Signature• ._ M• ._. Day Ysar Month 15.International Shipments ' ❑Import to U.S. ❑Export from U.S. Port otentry/exit: z Trans orter Signature for ex ores only): w Date leaving U.S,: 16.Transporter Acknowledgment of Receipt of Materials . F' Trans r�1-Phnled/Typed Naive Signature a - Month Day Year l �Transporter 2Printe ypedAame Signature Month Day Year F_ 17.Discrepancy 17a.Discrepancy Indication Space Elnn Quantity ❑Type ElResidue IJ Partial Rejection ❑Full Rejection 17b.Alternate Reference Number:ate Facility(or Generator) U.S.EPA ID Number J U t¢i Facifitys Phone: w 17c.Signature of Alternate Facility(or Generator) Month Day Year z O� -�.,�.gar. 18.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest except as noted in Item 17a Printed/Typed Name Signature Month Day Year 169-BLS-C 6 10497(Rev.9/09) COPY DEC 19 7079 IrST N;I�IGa uhl hEC`>DIG COOP 642 bee': .�._ I(i��'sta7 NY,12401 VILLAGE OF RYE BROOK I (81`i) :3:31-301'2 BUILDING DEPARTMENT E N.Y.IS O,Fi.V 710507=1SCf _ ... _ .._.� NuME:: CcG C 11W)IC.: 222240 I:�;�aed t0 �;3iI1 1-1.:rchase I)kTE:l*rIf,iE: 11J26i2025 8:22:30 AM 100 H) :i'iAT IOV: 01 Cmsiumer Irrfa ilustom r: (2-1 C211 .1 STE;-L (Uri?Drep,jred)-027--- ----- ' $0,09 $437.90 ;atibl ota 1 $4187.90 Gf PIO TCiT,ki, $187,g0 C<rsr� 1487.90 Mon-Fri 7:30dm-4,:30__ppOl S+3i 7dm-2pm NO 1'A; ON SCRAP ME'rAl. X___... .._._...- .......... SIGNATURE 5— kvc)" � c Ask " Y •+� • Y •+ K) • t' y •+ v • s AM �x.._. - �c•salt)>?'" . .a �. . . . . . . . . .... . . . . . . ... a BSc c . 06. LLJ CD y C 0 I^ram z w «t CD �. 4 Y r ; N b i-. ✓!r' V Q W O w LIJ N �� fi a ckion uj pui I (dais) ; W O w C� n w o ►- c+t�.> it � = N � c� .✓ (rj '9"� Q� CO Q �p W G > x o z CN c. •�r 4� ���11 z a� o I �� •�'" a w ca 'c� a� .— � I N Y 3 w c0 04 r � U `t k tT (� 9, f t! _-M e . yl,I4 �,xi 7 t y `r r f Tis. 4 1`n, 0 _. o ";'fit+1 rl )• y1t17�jr kd14�t t '�Pyr, '8,51 / n �.fl +i•1� Ii 1 11i i1/� 1/ Z N /i .�. Ik'}vJ .✓�� �� � ��. '� O'+ ay j�yy�Lr .ry�v�•! .Z1A(h'y.�=t A'' � }�?.:.�=I '^•t�J ¢ :,14 v�°'� 'f� ;~3 �+ !� � 4Y=" k��'UJJJQ J 4vly q��>(fi. 1 ..- C2GENVI-01 EMARTIN A`CO�RO CERTIFICATE OF LIABILITY INSURANCE DAT DYYYY) ___— 5/1 5/1/2/2025 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 CONTACT Elaine Martin NAME: World Insurance Associates,LLC AI°N o,EXt (973)871-15251813 225 Madison Ave I ,No: Morristown,NJ 07960 E-MAIL elainemartin orldinsurance.com ADDRESS; INSURE 1 AFFORDING COVERAGE _ NAIC i INSURER A:Admiral Insurance Company 2"68 INSURED INSURER 13:Selective Insurance Company of the SE 39926 C213 Environmental Consultants,LLC INSURERC: 83 South Putt Corners Rd INSURERD: 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. IN8R TYPE OF INSURANCE 'A SUER wftmPOLICY NUMBER POLICY EFF POLICY EXP LIMITS A I X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 5,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED FEI-ECC-36284-00 12H2/2024 12112/2026 50,000 MED EXP oneperson) 10,000 PERSONAL 8 ADV INJURY 9 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 X POLICY jpERFf LOC PRODUCTS-COMPIOPAGG 5,000,000 X]OTHER Pollution Liability POLLUTION LIABI 5,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ent) X ANY AUTO S 2307223 4/29/2028 4/29=26 BODILY INJURY Pet OWNED SCHEDULED AUTOS ONLY AUTOS yV E BODILY INJURY Per accldeM AUTOS ONLY AUTOS O ��Ee RRTTYnt AMAGE UMBRELLA LAB OCCUR EACH OCCURRENCE_ _ EXCESS LIAR CLAIMS-MADE AGGREGATE -_- DED RETENTION E WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN A LITE ANY PROPRIETOR/PARTNER/EXECUTIVE QFFICER/MEMSEREXCLUDED? ❑ NIA .L EACH ACCIDENT (Mandatory in NH) If yes,de—be under E.L.DISEASE-EA EMPLOYE DESCRIPTION OF OPERATIONS below L.DISEASE- MIT _ A (Professional Liabili FEI-ECC-36284-00 12/12/2024 12/12/2025!Prof Liability 5,000,000 A Transport Poll Liab FEI-ECC-36284-00 12/12/2024 12/12/2025'(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 Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD x^' Y ACORD 25(2016/03) ©1988-2015 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 Fund nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 200882662 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:/MIWW.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 SURANCE FUND UNDERWRITING VALIDATION NUMBER: 572364289 1100000000000137708753111 Form WC-CERT-NOPRINT Version 3(08/29/2019)1 WC Pohn-141279891 1,26 3 213