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HomeMy WebLinkAboutPP21-183 OD r-I -4 N pip WQ 96 a r. a - - C Zo w o ? � p eq en o - pO,� 33 oo w o co oc O a U 0 W O a V o z Z O Uz A A V 00 F oc F d U z W W w a w o LT. [� V a •• a a p � COVE BUILDING DEPARTMENT NOV 1 8 2021 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 BUILDING DEPARTMENT wwwhaA.org PLUMBING PERMIT APPLICATION 1 FOR OFFICE USE ONLY BP#: PP#: / /U NOV 1 Approval Date: Z 11 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, a_>/ 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,County and Local Codes. I.Address: �l re 1_5 441)C4.ecY1 Wit / A SBL: a9.3,A/,f—J/0 Zone:ab 2.Proposed Work: Zk-:567Z fD• erY Ate. Twa l3or/ 17�f Tjn� 3.Property Owner:A4(0C.l504 6411 M C4A Att LGC_ Address: ?So le—W44tbA >-✓&- Phone#:21-2 � $�-�1 `b b Cell#:V4$ 4'q_(47 -� ( email: /��y /� �C tIS�ObNet'l $Y'nt [J'3�Cd wt 4.Master Plumber: (�/ m I"'e -spg4C7 Address: 3S A? . U.COP PLOe te AJI, kq Lic.#: IF206 Phone Cell#: W7-453 J email:C4 o-4111<jLF041Y Suhc�t. h Company Name: rJ�ILJiGbL�X-t�7 Jolaw"Ow IJ Address: q4itC 5'L--Ace A,(y 1UfS-0 3 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 3'd Floor 4m Floor 5th Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -t- 8/12/2021 STATE OF O��F NEW YORK,COUNTY OF WESTCHESTER ) as: �.-ak-( 1 h'_ `" p,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 C-cpA4 (L 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. Y�— Sworn to before me this Sworn to before me this day of f��O�/t✓N�/�jG R ,20�2 day of /l(✓' ,20 1 21-1 Signa a of P erty Owner ,10s, 25— 4/ Signature 1ic t C�ffA r2 Zob of Property Owner Print Name of Applicant lic MAE)F_LINt b. MTRONE Notary Pub&JSq�j SUGAR Notary Public. State of New York Notar)'Pubk, No, qi MA6030446 State of Newyork ©uaMied in Westchester County No.OJSU49MI Commission Expires Sept. 13, 2N� QualfW In&M c Commission iExoiree /p,-5- Z S 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. Applications 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- si12i2o21 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BRoox,NY 10573 �rILLAGE OF R a K (914)939-OG6$ VILLAGE DE A T wv,ryelook;erQ - �_- AFFIDAVIT OF COMPLIANCE VILLAGE CODE $216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: �( (!fl k#- eS , residing at, 7X,7--� �iuh� 10� � Al,?I ✓ (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; q75 9L,(-- X04 , Rye Brook,NY. (Job Address) Further that all statements contained herein are true,and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (signature of Pr rry Owner(s)) C_L�4-6.s S ONe�I (Print Name of Property Owner(s)) Sworn to before me this MADELINE C. CITRONE day Notary Public, State of New York No. 01 MA6030446 Qualified in Westchester County `� Commission Expires Sept. 13, 20_. o b c -3- 6/12/2021 BR(�j�• Q 2� 198-2- �7 BUILDING DEPARTMENT BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT'OFFICER 938 KING STREET • RYE BROOK, NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrooLorg - - - - - -• - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :_ 1 7-'; 7' ":1- 2 50%0 �L4- DATE: t l PERMIT#-M 'z-ti — l '4:> ISSUED: 1$.Z1 SECT: r , _ BLOCK: I LOT: 14 Z LOCATION: IV 1 V a-AL- ( �S L lti' � A- 4 n"j!(' OCCUPANCY:Q ❑ VIOLATION NOTED THE WORK IS... ACCEPTED 0 REJECTED/REINSPECTION ❑ SITE INSPECTION j J REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING Lz! ❑ INSULATION NATURAL GAS �4,;rr,3 -dly L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET•RYE BRoolr,NY 10573 (914) 939-0668 . FAX (914) 939-580 1 www.ryebrook.org BLUE CARD CERTIFICATION This document certifies that the natural gas piping or as performed in accordance with Rye Brook Plumbing Permit ?1 14� ,issued: 1 is in compliance with the applicable sections of the Code of the Village of Rye Brook&the 1rTYSUFP&)1 ,and has successfully passed the leakage test. Address: `1 L- Parcel ID#: 12S Property Owner: o t Inspector: -Z 01 Dated: I 1 1Z i Plumber: Lic. #: .`"Z—2> Dated: Plumbing Contract '1 4 �� .� ✓v