HomeMy WebLinkAboutMP26-016 I
FEB 3 2026 BUILD DAP'. MENT
VIL OF RY` OOK
VILLAGE OF RYE BROOK 38 KING ET.RYE B1t:' ,NY 10573
BUILDING DEPARTMENT `$ .4) 939-
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11'Qe71
Application for Permit to Install Fuel Storage Tank
(*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester)
FOR OFFICE USE ONLY: PERMIT#: 1,..t,r Z C�, (D J
FEB 4 2025 Permit Fee: S 22
Approval Date: -
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: Installation: $225.00 per Tank.
5.Dig Safely New York#(dial 811):
6. Inspection by Building Department for installation.
7. Submit all Manifests & Reports(if applicable,after work has been completed).
8.Certificate of Compliance will be provided when all requirements are fulfilled.
Application dated, ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to
install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)
will be installed in conformance with all applicable Village,County, State&Federal laws,codes,rules and regulations.
Indicate Permit 7'N pe: Above Ground ( ) • Buried in Ground (,0 Z iJ
a 379 North Rid Street
1. Address: g SBL: Zone: R —l
2. Property Owner&Address: Michael Lyons 379 North Ridge Street, Rye Brook NY 10573
Phone#: Cell#: 914-441-2330 email: michael29joseph@gmail.com
3. Contractor&Address: Halstead Quinn Petroleum 33 Hubbells Drive, Mount Kisco NY 10549
Phone#: 914-666-3200 ext 109 Cell#: email: Jerry ,hgpetroleum.com
4. Applicant. Halstead Quinn Petroleum
Phone#: 914-666-3200 ext 109 Cell#: email: ierry(cDhgpetroleum.com
5. Indicate Fuel Type: Fuel Oil ( )•L.P. Gas()o •Gasoline( )•Other( ):
6. Number and Capacity of each Tank: 1-500 Gallon Underground Propane Tank
7. Exact Location(s)of each Tank: side yard
t
ST Tea OF NI-.W YIJRK,('()I;NTY ter W1:STCIII;S7l.R ) as:
being duly%warn,deposes and states that he/she is the applicant alxlve named,
Ipmm name M,edivid 0 tig"mt at the applecaml
and further stairs that(s)he is the Tank Installation Contrat:hzr for the legal owner and rs duly
authonzcd to make and file this application
That all statements contained herein are true to the beat of his/her knowledge and belief,and that any work perfortned,or use
conducted at the above captioned property will he in conformance with the details as set forth and contained in thLs
application and in any accompanying appro%ed plans and specifications,as well as in accordance with the New York State
Uniform Fire Prevention Rt Building(;ode,the Code of the Village of Rye Brook and ail other applicable laws,ordinances
and regulations.
n
Swam to before roc this - Sworn to before me this
day of r lam'[' 20 day of
X
Signature of Pro y Owner Signature of Applicant
Michael Lyons
Print Name of Property Owner Print Name of Applicant
� i/ �/.tom✓, ,
Notary Public Mohammad Rahinan Notary Public
CommissioM OIRA0032973
Notary Public State of New yolk
My Commission Expvttion:O1/1712029
This application must be properly completed in its entirety and must include the notanzed
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.
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