HomeMy WebLinkAboutRB25-0099 6 P, .
0 �. VILLAGE OF RYE BROOK
Building Department-Inspections
938 King St Rye Brook,NY 10573 1 Phone:(914)939-0668 1 Fax:(914)939-5801
CERTIFICATE OF •
Compliance granted date: 12/08/2025 Permit Number: RB25-0099,Issued on 11/04/2025
Visit result: Granted and fully completed Date of inspection: 12/08/2025
Parcel number: 135.44-1-53 Municipal Address: 8 CONCORD PL
Legal Description:
This certificate does not in any way relieve the owners or any person or persons in possession or control of the
premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for
the uses or purposes for which the building or premises is designed or intended. Furthermore,it does not relieve such
owners or persons from complying with any lawful order issued with the object of maintaining the premises or building
in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit
facilities shall be made,and no enlargement,whether by extending on any side or by increasing in height shall be made,
nor shall the building be moved from one location to another until a permit to accomplish such change has been
obtained from the Building Inspector.
Additional
Compliance description:
ALL WORK COMPLETED OK TO ISSUE CERTIFICATE.
Outstanding matters:
•
Howard&/or Lori Levine
8 Concord PI,Rye Brook
+19149391324
loribl@aol.com
Inspected
Alfredo(Freddy)DiVitto
Building Inspector,Village of Rye Brook
+19149390668
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BRnv� VILLAGE OF RYE BROOK
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938 King St Rye Brook,NY 30573 .$
Q Y Phone:(914)939-06681 www.ryebrook.gov
�• 19b2 '� Building Department
Fuel Tank/Above Ground(Installation) Permit
Permit Set 8 CONCORD PL P#RB25-0099 R#135.44-1-53
PERMIT INFORMATION
Address Permit number Date issued
8 CONCORD PL RB25-0099 11/04/2025
REVIEWED BY
If you have any questions regarding the review of these drawings please contact:
Application in general
Alfredo(Freddy)DiVitto
adivitto@ryebrook.org
INSTRUCTION AND ATTENTION
It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection.
TABLE OF CONTENTS
Cover page 1
Building Permit 2
Required Inspections 3
Property Owner/Homeowner Government ID,and/or Proof of Ownership 4
Mechanical Equipment Specifications pages 5-6
Site plan 7
Application Materials 8
General Contractor's Home Improvement License-Westchester 9
Contractor's Liability Insurance,Contractor's Workers Compensation Insurance(Showing Rye Brook 10-13
Cert Holder
Fuel Storage Tank Permit Application 14
Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668
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BR(�uk VILLAGE OF RYE BROOK
938 King St Rye Brook,NY 10573
Q Phone:(914)939-0668 1 www.ryebrook.gov
>>��• 99b2 •��0 Building Department
INSTRUCTIONS
THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQUIRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT
THE PERMIT IS COMPLETE
%1 '
REQUIRED INSPECTIONS
Name Description
Final Inspection Completion of all required items under the permit including the site grading and the surveyor's final grading
certificate.
Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required)
Part#2335101862
Submittal Data Information 0
Roth DWT 1000L
YOUR ENVIRONMENT IS OUR BUSINESS.
Effective:September 2007 Su ercedes:
Job: Engineer: Contractor: Rep:
ITEM PART NO. ITEM DESCRIPTION MANUFACTURER
#2335101862 275 Gal.(1000 Liter)Double Wall Tank Roth
comes with a detached saddle base which the tank is
placed on at the time of installation.
_ The tank shall be placed into service in accordance
with local codes and the listed use(indoor or outdoor)
on a flat,level and stable surface,away from heat
sources,corrosive atmospheres or fluids,potential
mechanical damage or rapid temperature changes.
The final location must have the tank label visible
after installation. A minimum of 2"(50 mm) from
all walls or obstructions is recommended for normal
tank expansion and visual inspection.The integral
i base support shall not be removed and raising the tank
-- _ height is not allowed except on a continuous concrete
platform at least 6"(150 mm)wider than the tank
base at all sides.All local fire code set-backs for fuel
The Roth Double Wall Safety Fuel Oil Storage Tank oil storage tanks must be observed.
(DWT)is made with a seamless blow-molded
polyethylene inner tank and a 19 ga. galvanized outer Tanks installed indoors shall not be exposed to direct
tank.The outer tank is formed by joining cold rolled sunlight on any plastic parts.Tanks installed outdoors
sheet steel,used to form the sides and bottom from a shall be assembled with the required cover,Roth
single piece,with two stamped metal end pieces. The #2335100747 for the 1000L. All tanks must be
edges between the sides and ends have sealant applied installed with an approved vent alarm(Roth Vent
to them and are then rolled to create leak-proof seams. Alarm#235000999,or equivalent sized UL listed
A stamped top is then pressed and riveted into place to whistle vent)in order to maintain warranty
complete the assembly of the DWT. The DWT is W requirements.
listed in the United States and Canada under SU2258
and approved under NFPA 31 (2001)and CSA B-139- Tank Model DWT 1000L
04 as non-metallic fuel oil storage tanks. Nom.Capacity US gal(liters) 275(1000)
Length inches(cm) 43(110)
Width inches(cm) 28(72)
Both inner and outer tanks are pressure tested at the Height Inches(cm) 61 (155)
factory during assembly according to W standards Min Height Req'd inches(cm) 66(168)
and do not require further field testing. The DWT also Tank Weight lbs.(kg) 167(76)
Shipping Weight lbs.(kg) 185(84)
Your Environment is Our Business.®
ROTH Industries,Inc,268 Bellew Avenue South,Watertown,NY 13601 Telephone: (315)755-1011 Fax:(315)755-1013
ROTH Industries,Inc, 1607 rue de I'Industrie,Beloeil,QC J3G 4S5 Telephone:(800)969-7684 Fax:(450)464-7950
Visit our website at:www.roth-america.com Copyright 2007
M"2 TANK TOP PIECE IS FASTENED 26—
WITH RIVETS(NOT ROLLED) 32--Am
25- 1
1.98
2
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Sfi 79
/21 27.14
2
(a[�tt eRP Wo�onw) (WbA
1,997
I 5-- HANDLE IS FASTENED TO FACE
OF TANK WITH FOUR RIVETS.
43.13 AMMM
77.3
33—
34
35"'�.� ,
3 2 U MK.RO6K E..i.9Nq 3 B——,
BUTYL SEAUNG GASKET 15 COMPRESSED
?- BETWEEN THE TOP OF THE CONTAINMENT
TANK AND ESCUTCHEON POCKET.
—
j
S 51 19.67
if39
(TYPICAL) ROLLED EDGE SEAM WITH SEALANT
\ _ 1N THE DINE LEAK TESTING OF THE
nNISHFLD SEAM TS MIT11 THE'ALLTEC-LEAK
nNDER METHOD. TEST CRREHIA CAN BE
FOUND IN THE TEST PROTOCOL(NOT ATTACHED)
Your Environment is Our Business.®
ROTH Industries, Inc,268 Bellew Avenue South,Watertown,NY 13601 Telephone:(315)755-1011 Fax:(315)755-1013
ROTH Industries, Inc, 1607 rue de I'Industrie,Beloeil,QC J3G 4S5 Telephone:(800)969-7684 Fax:(450)464-7950
Visit our website at:www.roth-america.com Copyright 2007
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AcoRO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ Y)
04/22/20252025
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).
CONTAUT
PRODUCER NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE— - FAX
HOME OFFICE: P.O.BOX 328 (A/C,No,Ext):888-333-4949 (A/c,No):507-4464664
OWATONNA, MN 55060 ADDREs.CLIENTCONTACTCENTER FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024
WESTMORE FUEL COMPANY INCORPORATED
INSURER C:
86 N WATER ST
GREENWICH,CT 06830-5886 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0
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.
INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD MMIDDIYYYY MMIDDIYYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE a OCCUR AMAGE TO RENTED PREMISES $100,000
Ea ocarrehice)
MED EXP(Any one person) $5,000
A N N 9062818 06/01/2025 06/01/2026 PERSONAL a ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 ODO 000
X POLICY �JECT El PRODUCTSPRODUCTS&COMP/OP ACC $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Es secidenq
X ANY AUTO BODILY INJURY(Per Person)
ASUCYEE��
B OWNED AUTOS ONLY ULED N N 9062815 06/01/2025 06/01/2026 BODILY INJURY(Per Accldent)
HIRED AUTOS ONLY NON-OWNED ROPERTY DAMAGE
AUTOS ONLY Per Acdden
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000
B EXCESS LIAB CLAIMS-MADE N N 9062816 06/01/2025 06/01/2026 AGGREGATE $5,000,000
DED I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN X PER STATUTE THER
ANY PROPRIETORIPARTNERI EXECUTIVE El EACH ACCIDENT $500,000
B OFFICERIMEMBEREXCLUDED? N/A N 9917566 06/01/2025 06/01/2026
(Mandatory in NH) El DISEASE EA EMPLOYEE $500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
VILLAGE OF RYE BROOK 35 0 938 KING ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
RYE BROOK,NY 10573-1226 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
YORK Workers' CERTIFICATE OF
STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Board
1a.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured
203-531-6800
Westmore Fuel Company Incorporated
86 N Water St
Greenwich, CT 06830-5886 1c. NYS Unemployment Insurance Employer Registration Number of
Greenwich,
Insured
Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security
certain locations in New York State.i.e.,a Wrap-Up Policy) Number
06-0739367
2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company
Village Of Rye Brook #35 3b. Policy Number of Entity Listed in Box"la"
938 King St 9917566
Rye Brook NY 10573-1226
3c.Policy effective period
06/01/2025 to 06/01/2026
3d.The Proprietor, Partners or Executive Officers are
❑ included.(Only check box if all partners/officers included)
OX all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box"la"for workers'
compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY)must be listed under Item 3A
on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send
this Certificate of Insurance to the entity listed above as the certificate holder in box"2".
The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled
due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or
eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this
Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy
expiration date listed in box"3c",whichever is earlier.
This certificate Is Issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the
referenced policy.
This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect.
Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be
named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a
new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the
mandatory coverage requirements of the New York State Workers' Compensation Law.
Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced
above and that the named insured has the coverage as depicted on this form.
Approved by: Elizabeth Petersen
(Print name of authorized representative or licensed agent of insurance carrier)
Approved by 0"�`� 04/22/2025
(Signahire) (Date)
Title: Authorized Representative
Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949
Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT
authorized to issue it.
C-105.2 (9-17) www.wcb.ny.gov
Fuel Storage Tank Permit Application Village of Rye Brook
938 King St Rye Brook, NY 10573
Phone: (914)939-0668 1 www.ryebrook.gov
Building Department
Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester 7-71
Project Information
Permit Type Fuel Type
Above Ground Fuel Oil
#of Fuel Tanks Capacity of each Tank: Exact Location(s) of each Tank:
1 275 Gallon Garage
Fuel Storage Tank Permit Application,page 1/1