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HomeMy WebLinkAboutPP22-003 ■ _ N M s � � N x V a W � W o W U w rC'�',- _ O o Q = tj 4-4 O w + 0.4 can M.. Ln =� W o � O w � w . .� � H G� w 00 z W U ON 00 CY _ � A = H a 114 � o ° _ O � cc c1� BUItDor ENT C(CIE Q 1�l E VILOK 938 KIN NY 10573R JAN - 6 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP Approval Date: JAN — Q Permit Fee: J P(.L Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 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. 1.Address: QZd U-pl_ SBL: /,3Si Y3 /-51 H Zone: rw 2.Proposed Work: 1 1 3.Property Owner: -t Address: 7 Phone#: ! Cell#: email: 4.Master Plumber: I ' Address: Lic.#:� Phone#: '-! 2 Cell#: email: Company Name: Address: 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 4"Floor 5'h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) I- 8/12/2021 STATE FNE "N"OX,COtNTY()F,'WT-I..qTCHESTER I as- �01 -i that hc:,,he is the applicar.tabove natncd WI)S duly sworn,dap arcs and slaiv spriranhmw< it vi ta�'siong as tb--Appliemu wid further statics that lisjiheim the tel nwwTof the proptmy to Which*i--appikation Pertains,t)rljta*,($.)he is the (of Ilk lepl owner imd ii duly authmized to n-wkc and tilt this application. I indk-alt-tmhvwt�"ftwwr'Wv,womey,W.I That all stout wnts ei-inisined heroin are true to the beat of hislIer knowtet%,e A114 he fief;and that an', W-wk twAlfawd,or U84 wnducwd at dw above capfiencid pmpery wil I be in ounfomanuc with the dtiaik-as wt forth and contained in this a0kicarkm and in my aLvonipnying apf"ved plain and specifications.as wc[l as in at cordaw with the New-York S4ate Unirom fire Prevention& Building Code.the C-cmk of the Village of Rye Brook znd ail lother applicable laws,ordinameN and regula6i:tna. SWOM14404ve ruc this Sworn to befim area this day of .20 day of Signature of Propmy Owftv Y mm Signalltrr 0 ppliml 'Print Nww of Property Owner Print NaTc waiAppli6LA ­jj�tjb�jc.. CLAUDIAUVALDID Notary CLAUDI NOTARY PUBLIC,STATE OF NEW YORK oil NO-01 UV6107856 QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES APRIL 12,2024 4q5l Thii appfi :non mu-st be pj-(,)perIN complewid In its enfirety and ij-.ust, ujc]LOc the wtarized Ripailereus) Of the lep) o**ncri(s) of the slkjecl property, ano ihe apph ant ofret:(.Ird In the spam pmvided. Appillcation* rKA property campteted In Its entirety aild?or nut mspefly signed 41all be deer null and volid-vul Will IV retumed to the appfi�:arit_ NE M.GARCIA CIA Notary Public,State' New York 170f N York No.OIGA6198912 W� 0 8912 M Ouallfied In Westchester Counly y C ,ter Co �jan 0 Y Commission Expires Jan.05,20 it 0.5' Or R , BROOK J A N - 6 2022 01 9-18 KIN(;;Srli�FET RY'E Rko4jk,NY 10573 4) I[t668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Y 11 kVi�AlFAr#A'R1F#M*irfF84��#lrrg4•iLrilkt4k#�l1e 9tlF**�*#�sfr.YkrYr•i��4 ,.:-+1,:-eoa��•�-i..t^.!t*M#ithfsrt lt'k#�'k*'itsR;44M1►Md+r it�'RA'�^#it.*,+ef1t AFFIDAVIT OF COMPLIANCE Tsi AFFIT V T x M WYMUM S1=ATEM OF TO OWMAEF A=, ATZNG WTTIII ANY WILDIM ['1R P"JVMTNG PEPUlt APPE,Ps A.TIMW . ANY BFa:LDRtiS OR Fl_tte = !'-KHTT APPLr ATZC'IN 1.1"TOD WT HOTJT THIS ':r�P1.kST0 AND NOTAF?ZED MRM WI .I:. IM R1TLTRN= T�~ THE A,;9LZ+IAb r . STATF OF NEW 'YORK,COUNTY OF WESTCHESTER � as tl n► f /�Ub , residing at, P t� r 0 I f 7-.,>, being duty sWOM, deposes and states that:(k}he is the applicant above named, and further states that(s)he is Ib lcgal owner of the pm rty� to which this .Affida °it ofCompliance pertains at; ✓ ' /�LG� v Iiil" ,tj/ mot_ �1 [ �fCrl� � ©� Rye Brook,NY, Further that all s>Gate MIs contained herein are,true, and that to the hest of hi ier knowledge and belie€; that there are no krrujwn illegal cross-connections conceming either the storm suer or sanitary sewer, and further that there are no roof dmin&, stimp pumps, or other prohibited ston-numter or groundwater c nrtections or snurcesk of inflow or infiltration of any kind into the sanitary sewer from the stlbieet propemt in accordance with all State, County and Village Codes. tr YAtur cif Itv paty cmgwjg t t IRril N&f: +`fF't3 etZti Ft:�EfE�ri Sworn M rue this -� CLAUDIA UVALDO —� NOTARY PUBLIC,STATE OF NEW YORK day NO.01 UV61078-56 QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES APRIL 12,2024 .j, 1932 BUILDING DEPARTMENT QBUILDING 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: !1 ` : 177,DATE: PERMIT# �� ' D� / _ ISSUED: Z�SECT: /I� BLOCK: t LOT: -211 I LOCATION: 1� E ** 1�- - OCCUPANCY: 4 9 ❑ 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 r ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK _ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL �--� ❑ OTHER