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HomeMy WebLinkAboutPP22-020 a ■ = a m _ ■ O N N M w 1-4 O ■ � O O +-+ s n ■ � w W = a rA cn . � W rwl Ley F ■ � Z o W � ■ e O o 1 fTl a xwi 0co r ■ A F 1—� wvINj o V ■ V U � 00 1-4 P-4 14 A z a W o z � ] � BUILDING DEPARTMENT FEB 16 2022 VILLAGE OF RYE BROOK 938 KING STREET RYE.BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT VVWXN.ryebruuk.org PLUMBING PERMIT APPLICATION FOR OFFICE [ISE ONLY 131, #k PP #: C=)c)_0Q)0_ .r Approval Date: Permit Fee: $_ / 75 i/ 6 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/ re ve 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: 1`S(� 5 • r�.i'D6E .�TtiALT SBL: /'��r v� rl done:01 t4 7— 'Zas 2.Proposed Work: Ile P Q 5 511 A)U ( N& 3.Property Owner: CA LN t L)I-C Address: 7-4- -T- nn , L, Phone#: 't(4- -��(4 j Cell#: email: S W-1�11Z1 'Yl/) 4.Master Plumber: Ir 1 Address: 116 OAK ING t<AAT 3 , �ga UW Lic.#: Phone#: Cell� 0'#: '1Z� {��email: f1� 1,L U1 P/,Vti,�c Company Name: �� ��'I� �T' �►�CAddress: 06 PA?T M' k*\T 3, �tW I UL K` 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 I st Floor 2nd Floor 31 Floor 4t'Floor 5'h Floor Exterior 5. *List Other Equipmen0rovide Details: (Notarized Signatures Required Next 2 Pages) i 8/1 212 02 1 STATE -pOFF,NEW Y, RRs�� O •K,,COUNTY OF WESTCHESTER ) as: IUO-,y Lp /T ►U 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 T wm for the legal owner and is duly authorized to make and file this application. (indicate architect contractor,agent,allomey,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any worm 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 I(OTIf Sword to before me this 1(9?l� day of U1 y ,20 ZZ day of F��+eLA KY ,20 Z2 aturc o4Property Ow / *Wr Signature of Applicant OW paw L-+)67L l 30 iC M,W Print Name of Property ftnei Print Name of Applicant IW N 9t Iy,u�!- o ►v Puhli N t Publ'c It - �York 327- 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- 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK FEB 16 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.rvebr©ok.c�r� 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 ) as: �/ .3, bA110 CGUSt , residing at, Z+ C' /—'ID66 Piff?-A {1'rin1 uamc) (Address%%hcrc,%ou li%o 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; � 'So S� �� 5��� , Rye Brook, NY. (oh Adkhcss 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. ti urcnCf'ro crh t)�lr2Ti;. ��j� WIAJ )QI&M— Pe-79&NI0_( _ (Print Name of Properh,( rr,0wrri. 'T_ W 11V A'fld )CC.iR_ I f 0—C Sworn to before me this UP74 day of 7 20 ZZ KPAY Notary P-1' k -3- COTIIMJ8Slon t plk«s lvlai('n h 0 * u * y � O -0 NO 0 at A * Oq N * �— �'' M4 '3 ¢, N * o y cc E-� Z c%s oOl uwo 00 a 00 Q 4Tr v * W P4 Z W � A a � M * v adz 06 Lo pq w * +� w r` i 9 o * � N oj � Z * w * kAc o p U v E �4 V� a4 0 'd O * o * y � � r 4- y 00 Z en c a � 0CS0 a = t w A -,� * H Q w x a, aS C7 O "4941 a i. oj a �J # O V a S a �. • o �. * v � v o on a 1 N * !C 4V y4 O 0 0-4 cn v �` ,°or a cd * Ch A � � o� * V •a� z ON * � c M * � O 0 * a CO an * 0 cN 3 0 * 0 NO O d U LS L1. h w a a �E QRc�� °4 tip, 1982 BUILDING DEPARTMENT UILDING 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.or -- - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - -- ADDRESS: � S ��r J� DATE: Z �ZS zZ PERMIT# Z ISSUED:Z IZ:ZSECT: iy Z BLOCK.: LOT: G LOCATION: IGFIa-a -®F I `�- '`- «'-�ram' OCCUPANCY: V t 1. ❑ 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 ❑, NATURAL GAS L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER � \J ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL � �Jr� c_5` L4�- El OTHER BRCZj'�, w � >>r�` '9f32•'1�O BUILDING DEPARTMENT ,9BUILDING 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: I J S. 1 I DATE: z lzz 122, PERMIT# 01 Z 2 - UZ"D ISSUED:Z SECT: 1--7 BLOCK: t LOT: LOCATION: ���— � c)V- �.'1 L`.Z'l N G7 OCCUPANCY: ❑ 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 ❑ NATURAL GAS _! �`—�� �� 1 •� ��i fV �J�[-. ` d L.P.GAS ❑ FUEL TANK _ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �I ❑ FINAL ❑ OTHER �1 �- L fy