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HomeMy WebLinkAboutRB25-0073 *-o c ❑� *ti4+ N c " O v i _ �•; N o „ w a, a� Q E a v c -a c Q) mLL 4-j v Y •y •� C > � KJ °1aa3 L (n m s E m W m H C a� 1n E a d w m w L (u � X H (v > °' > u i W N i L a a c Q) L_ O O > (U > a �+ aJ r- (n •� 1 W L U � "O +j W F- L �c MC ° w +� = N 3 $ -v N �e O v ~ Z 11 3 ` ao ° a>, NvUi w Z -Fo° O U 11 oEc -o W a o o x o Lmy CoCO N 0 0 ° ° r' OW � a > 3 � = Z � � — o >- am oa, g �, ° a, m � �� ,�, z �•' 3 � L c a -i W i O = J N o o f o } 3 c i in O N p ai a c o ' m 3 0 T >,cc ON -= ° a �a Xw — W a, Eo N � Z o O W 00 O D p N U Q Q Q E ro 2 a WO� V U = Z W i - O O -co Z M N C O W s u a, Y � W U v o E 4-5c •°' It WO � U O -00 > O Cl) os U co 0 m O w a1 E L W Ol " 0 Q 0 M f- d yZL - m0 Q O ° 00 >U> W O UQ 00 aci J U D i �_ _ c� LL o L > _ > Imo (N a) m +�� L � y N v v b0 L ,C @ •U C Ln L C M o E � a� a ° E < y Ems° m � � 'c V) cn0 ao a, � c It N n O 0 i- U F- Q w (A > m Q ll� 00 J r-j CV O O O r r1\ CN a+ E O �n 0 � co i O "O 0 ry I O O a p, N E L W o o a 0 m o omo � � � 2 (R cEa, p�NEW YpR� N p N a,1 > E c p W W W O O Q Y a Z yb �� W Q Q `= .a °r yp�9d1� a Q a a = V) � v 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 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 Roth Tank Concrete pad at rear of home Fuel Storage Tank Permit Application,page 1/1 BRnv� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 � W � Q Phone:(914)939-06681 www.ryebrook.gov ��• b2•`i Building Department Fuel Tank/Above Ground(Installation) Permit Permit Set 140 BRUSH HOLLOW CRES P#RB25-0073 R#129.76-1-120 PERMIT INFORMATION Address Permit number Date issued 140 BRUSH HOLLOW CRES RB25-0073 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 Site plan 5 Property Owner/Homeowner Government ID,and/or Proof of Ownership 6 Contractor's Liability Insurance 7-10 Mechanical Equipment Specifications pages 11-12 Contractor's Workers Compensation Insurance(Showing Rye Brook Cert Holder 13-14 Westchester Home Improvement License 15 Fuel Storage Tank Permit Application 16 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BRnu� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W � Q Y Phone:(914)939-0668 1 www.ryebrook.gov > �O ��• 02• t 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 ❑�y 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) i i I v � A a r� 40 Q<L o a i �s cr-- c� Part#2335101862 Submittal Data Information FZ=4+i Roth DWT 1000L YOUR ENVIRONMENT IS OUR BUSINESS. Effective.September 2007 Supercedes 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 i 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 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 UL® 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 UL®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 2614a1 wITH RRJEfS(NOT RODEO) 32 ,..a) J 25� 2.98 rW 3�(w nowc�o.wra) ueu 2915� 20 ifi.79 27.t4 2 21 lac ncs stow uo smaY) �7 1 97 5 HANDLE IS FASTENED TO FACE OF TANK WITH FOUR RIVETS. 47.13 Awemtled -------------27,3 Z MW—) 33(YA PO 341� 3512• 32-1-- Pn 36«T�. /III mYl MAlmr YA��Hl 6 N1Q®. BUTYL SEPIJNG GASKET IS COMPRESSED BETWEEN THE TOP OF THE CONTAINMENT TANK AND ESCUTCHEON POCKET. _ Vok ® 6RN y;25 5.51 19.67 5.51 39rM}d (TYPICAL) ROLLED EDGE sEv.1 WITH sExANr IN THE JOINT. LEAK TESTINO OF THE FINISHED SEAM IS WITH THE'ALL7EC—LEAN FINDER'METHOD. TEST CRITERIA CAN BE FOUND IN THE TEST PROTOCOL(HOT 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-amenca.corn Copyright 2007 1 1 1 04 co N /. . 00 oco �j cn Of F— LU O U J ch U co AN 'tection Q •� Q W U 7° y O D O ol� ,; N LT. j U— Z (� o00 _ f .: =' L W £i 4 w N r tilt U M ej r SJ t '/J •�+ ,ice /`• '�� S / Y •• A 4 r ��`�_-�\_•_,�'�__�./'�__!•�—=_=� __/�_-mil Ac"R" CERTIFICATE OF LIABILITY INSURANCE DATE(M 21/ YYV) 04/22/2022025 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 NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PH FAX HOME OFFICE: P.O. BOX 328 (A/C,No,E1ce►:888333-1949 (A/c,No):507 446�664 OWATONNA, MN 55060 AIL ADDRESS:CLIENTCONTACTCENTERQFEDINS.COM INSURERS AFFORDING COVERAGE NAIC k 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 MMIDD/YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES $100,000 (Ea occurrence) MED EXP(Any one person) $5,000 A N N 9062818 06/01/2025 06/01/2026 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000 000 X POLICY CEO- ❑LOC PRODUCTS&COMPIOP ACC $2,000,000 OTHER: ff���}}Y" AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 000,000 (Ea accidenq X ANY AUTO BODILY INJURY(Per Person) B OWNED AUTOS ONLY SCHEDULED N N 9062815 06/01/2025 06/01/2026 BODILY INJURY(Per Accident) AUTOS HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per Acdden X UMBRELLA LIAR 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 ETHER ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? N/A N 9917566 06/01/2025 06/01/2026 E.L EACH ACCIDENT $� �,000 (Mandatory In NH) E.L 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,AddiOonal 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 © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Yo K Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured 203-531-6800 Westmore Fuel Company Incorporated 86 N Water St Greenwich,CT 06830-5886 1 c.NYS Unemployment Insurance Employer Registration Number of 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 #35 938 King St 3b. Policy Number of Entity Listed in Box"la"Rye Brook NY 10573-1226 9917566 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) QX 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"l a"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 (Prin�ntt name of authorized representative or licensed agent of insurance carrier) Approved by: Y,�`"w 04/22/2025 (Signature) (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