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Home My WebLink AboutPP20-050 BUILDING DEPARTMENT MAY 2 6 2020 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 FAX(914)939-5801 BUILDING DEPARTMENT www.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: D — /Approval Date: $ Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, s hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbi g as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformancewith all applicable Federal,State,,,C,ounty and Local Codes. 1.Address: � 3 W i �1 lJ( - SBL: I35 .t(/-&/ -�•-�Zone:�-1 D 2.Proposed Work: co-q ,p, `[� t vt(� -t"e S� �r- �(e d3�(�f 3.Property Owner: Address: ,2 3 1411 A:l R yQ Phone#: Cell#: �f/y -2 1'2 7 7 email: / L 4.Master Plumber: - I4W 'F=,S -ZR(&C5' Address: Ah -� F7r Lic.#: '9�3 Phone#:y3 9I ? Cell#: ,` email: /lj6Db Company Name: &!n ,tCs P��ZLL Address: Z Acr-A'Pr 14v- INDICATE FIXTURES& LINES TO BE INSTALLED AS PER 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 and Floor 4N Floor 5"Floor Exterior 5.* List Other Equipment/Provide Details: r Q 5 Car (Notarized Signatures Required Next 2 Pages) 3/21/19 BUILDING DEPARTMENT `MAY 2 6 2020 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 !BUILDING LAGE OF RYE BROOK (914)939-0668 FAx(914)939-5801 DEPARTMENT www.ryebrook.oru AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216 NORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: � 3J, eo-t Sind L, , residing at, Z 3 l�i�7"�^� (44b U'rint nantCi \vhCrC uoo Ii\Ci being duly sworn, deposes and states that(s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 2 3 Gy i (Z o A'> , Rye Brook, NY. (Job AddrC>�) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief; that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Propert} O Nnerr,)i SCot S"C(IoL (Print Name of PmpertN 0%%ner(s)l Sworn to before me this S� day of , 20 A DEBORAH J PIZZELLA NOTARY PUBLIC,STATE OF NEW YORK Registration No.01PI6033288 WESTCHESTER COUNTY t�utan I'i_ihliL Commission Expires NOV. 15.202) -3- 3/21/19 MAY 2 6 2020 VILLAGE OF RYE BROOK BUILDING DEPARTMENT STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: JA Vet F-5 --t3R( being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the 666:! z� r for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. 7 Sworn to be ore me this /1.0- Sworn to bef e me this day of 2026 day of ,20 GY d _ S�'S ., Signature of Property Owner Signa a of Applicant S�ofi S�,d�V J ca w� 5 ire, GLS Print Name of Property Own Print Name of Applicant L ot� H J P ELLA otar�l— JRAH I E NOTARY PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 P16033288 Registration No.01 PI6033288 WESTCHESTER COUNTY WESTCHESTER COUNTY Commission Expires NOV. 15,20� Commission Expires NOV. 15,202_( This application must be properly completed in its entirety and must include the notarized 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. 2 3/21/19 �E BRC�k, 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 0 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 : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: 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 ❑ NATURAL GAS ❑ L.P. GASH L ❑ FUEL TANK ' ❑ FIRE SPRINKLER 1 f7 -�1= jQ ❑ FINAL PLUMBING ❑ CROSS CONNECTION / ❑ FINAL n �J OTHER ' �C C 7D� 1 � - o o-Z Q�E 4R(��• tiM w I Q�i� ��O•c '982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑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: ✓ DATE: �� L PERMIT# �2 "(5 ISSUED: QECT:)'� ffcLOCK: ` LOT: 5; LOCATION: r �� 7 l c OCCUPANCY: �-l ❑ 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 [� NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ` ❑ FIRE SPRINKLERCS ❑ FINAL PLUMBING ❑ CROSS CONNECTION \ ❑ FINAL ❑ OTHER cn v� y N * O U .b * * cd U te) cd Q Q 64 61 COD * O * It aCd ,-4 * �e o o cz a� * * 4, * rZ bo p Ur. 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