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Home My WebLink AboutPP21-178 CO I- I N N N N N a ` o � w p Gzl 00 MO Un fS b +y W-4 H ■ ■ W p �, oc CO '� ��' � ' C9 co 00 0 � w �c � � Oz � � o0 0*4% rj w w oo c � F � ze a o w CAROLYN MARIE CANNISTRARO Notary Public-State of New York BUILDING DEPARTMENT n No.01CA6177080 NOV 12 2 221 Qualifier)in Westchester County VILLAGE OF RYE BROOK My Commission Expires Nov.5.2023 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 L BUILDING DEPARTMENT \ kvw.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY —/ Approval Date: Permit Fee: $_I_D 5 1 Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, ��Q—c is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal, State,,,Comlly j � and Local Codes. (.mil I �Jj ^ � � 1.Address: n W �'1 SBL: Zone:Q-/�! 2.Proposed Work: o t A-0 sQ w Z ILJ c 3.Property Owner:_ K VL,1-a V\ Address: Phone#: t Z- G FsS Cell#: email: 4.Master Plumber: IM ,j5 Address: U.j4 Lic,#: �Phone#: 3rS -�by{)Cell#: email: _12 I5 2 r �G Company Name:"AP tX'k flgr�Pi A o' IAA I L. Address: l0"t.'C.�.g 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 1st Floor 2nd Floor 31 Floor 41h Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: t fL (Notarized Signatures Required Next 2 Pages) -I- 8/12/2021 STATE A NEW YO COUNTY OF WESTCHESTER ) as: M&- Q N ,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 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. Sworn to before me this M r— Sworn to before me this /"? `�— day of C ,20 day of iD VtA-"6W 20 jlignag,e.lperty Owner ature of Applicant XC 1l e-A l Le. 4 n w,. . Ida S z Print Name of Property Owner Nint Name of Applicant C�lII W—i n e c�ifyn,� 1r1�'�Cl Q Notary Notary Public LECA F. rRM �i0?A,RY PI" J M NI+ew York Oualifif:d idl County CUnur�issi�ri�xpi+es 3 �a�-�3 This application must be properly completed in its entirety and must include the notarized sig.natLI the Icual oxmer(s) of the subject property. and the applicant of record in the spaces pro,,ided. Applicati011" 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- 8/12/2021 BUILDING DEPARTMENT Q FNOV IE ��E VIi,6 GE OF RYE BROOK 12 2021 938 KING�TREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.n'ebrook.orV I BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE V16 • STORM 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: 1, Ws, 164 ( (4 l , residing at, ck ! (Prim min:. I-WdrC",vkhCr .ou li%. 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; 6 FA k(11 I�J 11 U k' U , Rye Brook,NY. .I011 %dd11 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. (SiL�[1:1turr,II'Pro I Merl mt_c� k 4A (Print Name of Propert% ncr(s)) Sworn to before me this of ! u � ,20 a - CAROLYN MARIE CANNISTRARr) Notary Public-State of New York No.Of CA617708CI Qualified in Westchester County My Commission Expires Nov.S, 023 -3- an2rzo21 QyE 4RC�k` O� y� w � 9a,2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK Q,00DE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.acbrook.org - - - - - - - - - -- - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �.�'l5 1 l��e DATE: PERMIT# I 1 " ISSUED:—LlA=NECT: BLOCK: LOT: LOCATION: OCCUPANCY: V ❑ 'VIOLATION NOTED THE WORK IS... Cy ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION 13-�UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATIONS ❑ NATURAL GAS � � ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER Q Q r Q\10 ❑ FINAL PLUMBING CROSS CONNECTION ❑ FINAL ❑ OTHER