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HomeMy WebLinkAboutBP21-322 s s s - N ■ N ■ s N N N � _ ° � ■ C6 s rn a�i S Ew.i k 3 ai0.'d tON� ram. rr a fsr ~ O o _R N Ls i 96 cd lil a� O W d o0. 01 0 oe WTI ■ W w H 4 3 9 A 00 00 7 4- " O r- z co Zu � o �oo ° L"7 wtip O �; M czr� � � � w W _ ,n .•, o o > , N I••I F 01 F+�I cti .�—� ON U Ate ' N per °o Q w r o • con OC o_ R en 0 0-0 A 7 rU F �b �1 Izi fYi w w �• A, h 6� �.., ° g a .o a, v� cc a9 o> >0 I 7 ai w o � a• a a BUILDING DEPARTMENT VILLAGE OF RYE BROOK NOV 3 0 2021 938 KING SMET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.org BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: NOV 3 2 Permit#: �'� �' pplication Fee: S Approval Signature: Permit Fees: Disapproved: Other: IV 61 r �� /*',r,rrr�+r**,rrr—,r1+x*,+rr,e*�,e Application dated:! 30- Ci is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address:TpS/Z,4 O le Ld ow E. SBL: /35. 73 -/-9 Zone: -�0 2. Proposed Improvement.(Describe in detail): /7Lazt-e (% /eiz 4 J/z 12/7--1 G46 rZ dp!^/ f- Ln6 /L C ,§Lr�-Lf-Z_ r 4eCk-' C A.2F_-e/.4 Gi,644t'/T 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER If: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy-,(1 fam.,2 fam.,comm.,etc...)Prior to Construction: I r� M After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:MNULJ Ir L 1)R!POAZ r 7 Address: 9 a I20 0 lc L tit Phone# Cell#(21 1) Z -7 R I/Z email:/10.4/4 41 E 4 . p TZ j�;, tqr-ZwJJ :NI1>I(. 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: Finish: (1) 8/1212021 BUILDING DEPARTMENT NOV 3 0 202� 'ED VILLAGE OF RYE BROOK �� 938 KING STREET RYE BROox,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT v 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: 3, 11 AW1 L R D D A/E 2_ , residing at, ir&nd k Llil RYE e&V o/l I !L0.573 (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; — Tf f� n 0 V LC ,_ !6,z , 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. (Signa e f Property Owner( (Print Name of Property Owner(s)) Sworn to before me this 20Q (Notary Public) SHARI MELILLO Notary Public, State of New York No. 0VI t=616,1''33 Gt.ialified in Wcstchcster County Commission Expires January 29.20'�-'? (2) 8/12/2021 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. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: t4 ©#%/d! lk-r �D D N,C Z ,being duly sworn,deposes and states that he/she is the applicant above named, (kint 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. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this J D Swom to before me this day of�Q J`;��1 `_ ,20j3AL _ day of , 20 z S' aufi of Property Q er Signature of Applicant Jog DOV ` �z t Name of Property Owner Print Name of Applicant VN&A� Notaty Public Notary Public SHARI MELILLO Notary Public, State of New York No. 01 t1,E616r4C63 a_iatified in Westchester County .� Commission Expires January 29.20—� >_ (4) 8/12/2021 AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF ME , r COUNTY OF C!�,E !T E rL /�/J N,�/� ►� �,P�p ,p�,r'�2 (insert name), being duly sworn, deposes and says 1. 1 am the applicant for a Building Permit/Certificate of Occupancy /Demolition Permit Electrical Permit/Plumbing Permit/Fence &, Wall Permit Mechanical Permit/Pod Permit (circle all that apply) 2. I am the legal owner of property located at 9 f32DpK L„ct N£ Rye Brook, New York (insert street address) OR I am the (Architect/Contractor/Engineer/Attorney) (circle one) for the legal owner of property located at , Rye Brook, New York and I am duly authorized by property owner to make and file the accompanying application. 3. The following is a description of(1) the work to be performed under the permit for which I am applying; and (2) how the work arose as a direct result of Hurricane Ida: t u /V 13 T-ra.� (102s Si T d Gse L-4 cZ ,,7i 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. Sworn to before me this mot' O j ay of NN,,,4 , 20�_ Notary Public r,� E j C`�J17 3 0 2021 �J"tv VILLAGE OF RYE BROOK r- ":,,un r-A '111 BUILDING DEPARTMEN I �