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BUILDING DEPARTMENT MAY - 3 2012
° y VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 BUILDING DEPARTMENT
�, a • �� (914)939-0668 FAX(914)939-5801
www.ryebrook.org
PLUMBING PERMIT APPLICATION
*MUST BE FILED B Y A LICENSED MASTER PL UMBER ONL Y*
Date: /c;�— Plumbing Permit# Building PeriniM•�
Fee: Approval Signature:
(fees are non-refun(fable)
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: �1 0 I Rd,-v r Si IYY /05-73 Phone#: /1 Y—( 90
Owner: J&--7R f L/�t/y Address& Phone: 9v lrr'l�+1rS� �E' v/� y /v 73 q/y
Use/Occupancy: PFS e . z Parcel I.D.#: t one: LSD -/vU
LICENSED MASTER PLUMBER'S INFORiyIATION:
Name(please print): Phone M S i/' S Vl6 STT-��-
Signature: Westchester County License#: L
Company Name: �j�✓rl r C7v�. S i
Company Address: j 55 R. City/Town: I'7(rz�lL,)
State: `/ Zip Code: /d S'Z 3 Phone#: S i y S y6 S—T1—T
......................................................................................
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
Ist Floor
2nd Floor /
Outside
*Other:
Detailed Description of Appliances etc...:
QyCC,BRC>v,�
BUILDING DEPARTMENT
rn❑BUILDING INSPECTOR
L 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 : 1 � v��j �� DATE:
PERMIT# 1 U 21, ISSUED: SECT: 1• ' BLOCK: LOT: J J
LOCATION: 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 1
❑ NATURAL GAS C. z>
❑ L.P. GAS k �J (f E �C
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER