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Home My WebLink AboutPP21-174 _ s o ocli M 99 a W O Ica O a x FO pJ Q = o � > _ a mg W C G�� l c z O F--1 '—' urn # Z C�, gz *Oft/ ►� pp _ }� •� M ICI F ° w a a Q � o r" A a .. � w � _ BUILDING DEPARTMENT DIECIEMED VILLAGE OF RYE']kOOK NOV -9 2021 938 KING STREET RYE Btt w NY 10573 VILLAGE OF RYE BROOK (914)"9-0668 BUILDING DEPARTMENT www.i'3+ ook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: 7 Approval Date: NOV ZQ Permit Fee//:,,$ l�Approval Signature: Other: _ 'b/VE' i ICY(q Disapproved: (fees are non-refundable) Application dated, js 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. 7 1.Address: / r,(J M AA) / /�Y� �""'SBL: Zone T 2.Proposed Work: 3.Property Owner: �1 /�%/ � J� r'. /✓'�<'� Address: Phone#: I' 91641 Cell#: email: _ 4.Master Plumber: \ /I �) �i A �Cq.SD4) Address: 332 /1 �G e y 6 Lic.#: Phon9 (,0 —�5 3�o Cell#: 11-t ?lq 1 Sig email: / Company Name: G/YlL3l�fi� CL� 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 41 Floor 5*Floor Exterior 5.*List Other Equipment/Provide Details: (5 ry (Notarized Signatures Required Next 2 Pages) -1- V12 021 ST TE OF NEW YORK,/COUNTY OF WESTCHESTER ) as: � " R , 6" �S 41,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 l2G L' In kl�v� 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 8411 Sworn to before me this day of /l,/,s wb,-r ,20 day of Y"�,J -e r, 2T ,20 Signature of Property Owner S atur of Applican Print Name of Property Owner Print Name of Applicant ILLU Publi AC NORA H.MARSHALL Notary ' P4otary Public,State of New York Notary Public, State of New York No.OiFR6363711 No. 011-.IE616n^63 Quailfied in Westchester County Q-.ialified in Westchester County 'ommission Expires August 28,20 Commission Expires January 29. ?_0 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- sit 2i2o21 BUILDING DEPARTMENT VILiLAGE OF RYE BROOK 938 KING�TWET RYE BR90Y.,NY 10573 NOV -9 2021 4� VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 )Fas: 3, ('�hv�z 5c_-� Q �`G residing at, � � v✓!r y' (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; &_'�W , 'L q ,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. 0;�p/w4'/ JAJA&�' (Signature of Property O);ner(s)) r (Pant Name of Property Owner(s)) Sworn to before me this day of N,;9�P1 � , 20r&l otary Public) ALEXANDRA H.MARSHALL Notary Public,State of New York _3_ No.01FR63637U Qualified In Westchester Cou►►1;�tf commission Expires August 28,2n_-Z. 8r12/2021 AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF X� COUNTY OF �G�/ ` �'Z :7: %&/ p U /(' 60�A<Ok, insert name), being duly sworn, deposes and says 1. I am the applicant fora Building Permit/Certificate of Occupancy /Demolition Permit Electrical Permit lambing Permit Fence & Wall Permit Mechanical Permit Po ermrt (circle all that apply) 2. I am the legal owner of property located at 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 ,( LC� /`�/ l/�-J � , Rye Brook, New York Aj and I am duly authorized by property owner C� ` l 1zS/ri(/�� 6�71xv' )"Crv(' 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: 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 Day of PA)q r , 20KAeu,'nj-L�' Notary Public SHARI MELILLO D �� E (Votary Public, State of New York U 11 f'Jo. 01 r,1ir EIS =:3 0,!n1?,lad in westche�;ier County NOV —9 2021 Commission Expires January 29,2t7 VILLAGE OF RYE BROOK BUILDING DEPARTMENT E BRC�u� BUILDING DEPARTMENT ❑BUILDING INSPECTOR 0-ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK (�f❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www r ebrook.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - ADDRESS : � `� DATE: 4 � 1-2,�2 022 PERMIT# W' `� �� ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: '`s 11 VIOLATION NOTED THE WORK IS... ❑I 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 SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER QyC DRcb F 0 1932 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: PERMIT# ISSUED: ct LT: BLOCK: LOT: LOCATION: E N� �r � �(lo )�` - OCCUPANCY: Z ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ( REJECTED/ REINSPECTION ❑ SITE INSPECTION J REQUIRED ❑ FOOTING u �rr, 0 FOOTING DRAINAGE V� ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑.,"L.E GAS FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER li