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BUILDING DEPARTMENT
❑BUILDING INSPECTOR
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.ryebrook.org
- - - - - - - - - - -- - - - - - - - - INSPECTION REPORT - - - - - - - - -- - - - - - - - - - -
ADDRESS : �+" 1 f I�A3' : )_2o2_!
t� r�
PERMIT# L C� �- , 4 ISSUED: SECT. BLOCK: LOT:
LOCATION: OCCUPANCY: `
❑ VIOLATION NOTED THE WORK IS... CCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION 'r 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
BUILDING DEPARTMENTDi
VILLA CA OF RYE;ROOK JAN 2 6 2022
938 KING S,'T EET RYE ftgoK,NY 10573
- 4)939,06 VILLAGE OF RYE BROOK
_ BUILDING DEPARTMENT
FOR OFFICE USE ONLY: --��' C U,10M JJ
Inspection Date&Time:/�G'✓/Cl��
Approval Date: L Re-Inspection:
Approval Signature: Original BP#: /6-00 Date: I als ao/
Disapproved a/c: ate: Renewal Fee: Due: ❑ /Paid:A
ANNUAL RENEWAL APPLICATION
FOR EXISTING HOME OCCUPATION PERMIT
Application dated: 01&G 161CAd ,is hereby made to the Building Inspector of the Village of Rye Brook,NY,to renew a lawfully
existing Tier II or Tier III Home Occupation in accordance with§250-38 of the Code of the Village of Rye Brook,as described below.All
Home Occupation Permits must be renewed by no later than June 151 of each year.Please consult the above captioned section of Village
Code at,www.rvebrook.pM.for further information prior to filing this application.
1. Address: 5N tk0CV- P,1 DG t D KI V E
2. Parcel ID#: 13 S ..3 G - d - I Z Zone: t`- <D
3. Property Use: M One Family; ❑Two Family; ❑Multi-Family; ❑ Other:
4. Property Owner: 4 NA PA U L#A (-. 9 if L L I N
Address: S)-1 R,G C V- R-I DG E 3_*) P-i V E
Phone# Cell#9 1�(-9 I.l 3 -q G a+ email:
Applicant: SOX h•-.e-_
Address:
Phone# Cell# email:
5. EXISTING HOME OCCUPATION: check one:Tier 11( ) Tier III!�q(Full disclosure detailing the exact nature of the
proposed home occupation,hours of operation,number of visits per week,number and names of employees,etc... or any
other changes in the nature of the home business since the original approval is required by law.)
[use additional sheets if necessary]
i
8/12/2021
Pease note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,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 `�e Sworn to before me this
day of , 20 day of , 20
gnature f Property Owner Signature of Applicant
p 4U 1 A B tZ__L.1. I t
Plint Name of Property Owner Print Name of Applicant
'A., 'VN'u�_
Notary Public Notary Public
SHAFT MELILLO
Notary Public, State of New York
Qualified in west&.ester County ss��
Commission Exoires Januery 2.9,2019S
2
8/12/2021