HomeMy WebLinkAboutPP5917 This Permit Must Be Kept on Premises While Work Is Under Way
PLUMBING DEPARTMENT
rtA 5917
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
938 KING STREET, RYE BROOK, N.Y. 10573
PERMIT TO INSTALL PLUMBING
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This is to Certify That c—A- �L—o
has permission to install (Sewer Connection) (Plumbing) (Oil Burners) (HVAC) (Storm Drains) (Water Lines)
located on Section 1 Block t Map of Street No. 'sue
Street or Avenue in accordance with application No. and the
statements of the work on file in this office, and subject to the provisions of all State laws, by-laws and ordinances
of the Village of Rye Brook, and rules, regulations and orders of any board, body or department, so far as the same
may be pertinent.
The right is reserved to examine the premises as often as may be necessary while such work Is being installed
and to order anything necessary to be done to insure safety.
VILLAGE OF RYE BROOK BUILDING DEPARTMENT
Fee: $ 7
Building Inspector of V e f Rye Brook Building Department
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�RC�V� BUILDING DEPARTMENT r ,
VILLAGE OF RYE BROOK Fill W AUG 2 3 2007r �.
938 KING STREET RYE BROOK,NY 1057q ,
(914)939-0668 FAx(914) 939-5801 ( - .--
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PLUMBING PERMIT APPLICATION
*MUST BE FILED B Y A LICENSED MASTER PLUMBER ONLY*
Date: - Z ?— D ���,��L tf� Building Permit.#:
Fee� 7J' � � ?� �� Approval Signature:
Application is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit
to install Plumbing as per detailed statement described below, and in accordance with all applicable Federal,State,
County and Local Codes, at the following location:
Address: - �' Phone#: ` - j 5�
Owner: Xv k-L-1,4 j (?-c• Address &Phone: /o 4 v
Use/Occupancy: d reel I.D.#: Zone:
LICENSED MASTER PLUMBER'S INFORMATION:
�P print): �� \ Ci Phone#:
Name lease tint : .�. -�-- '�
Signature: .. 'Westchester County License#: :�Z Z_
Company Name:
Company Address: /I"l G r s // f�l/ �� �/-� City/Town: J3 X
State:'-Zip Code: ��' / Phone#: �y
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FIXTURES &LINES ARE TO BE INSTALLED ACCORDING TO THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement
1 st Floor
2nd Floor
Outside 1
*Other: •� Er � �� �
Detailed Description of Appliances etc...:
Village of Rye Brook
BUILDING DEPARTMENT
938 King Street, Rye Brook, New York 10573
TeL (914) 939-0668 Fax(914) 939-5801
CERTIFICATION
THIS CERTIFIES THAT THE GAS PIPING WORK IN THE BUILDING BELOW HAS
SUCCESSFULLY PASSED A LEAKAGE TEST:
v� (1 6 V4-1�
NAME
cA1.5!7"
ADDRESS
SECTION 1 U BLOCK I LOT
DATED: �1 >
BUILDING INS ECTOR
DATED: 7 5?1
PLUMBER
PLUMBING CONTRACTOR:
1