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BUILDING ICE MENT MAR 17 2022
VIL AGE OF RYE OK
938 KIN f EET RYE B> NY 10573 VILLAGE OF RYE BROOK
939-0668 BUILDING DEPARTMENT
w.ryebrook.org
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#: 5-.DiQ
r-� r
Approval Date: MAR 1 7 Permit Fee: $
Approval Signature: Other:.
Disapproved:
(fees are non-refundable)
Application dated, Y 1-1 =Ds 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: FA. Put 10 SBL: 35,5,;t3'lo? Zone:)e 7
2.Proposed Work: -k e- at,_ Y-P_ oLsif S d -eG(
3.Property Owner:V2bP CCa o} e,r,,CA n .S(.1ffll O�t Address:Lk- w Qua-PBrook-
Phone#: Cf q : q /S'1 Cell#: email: SCklrnl t^ �t �O pt Cl ,OYc}
4.Master Plumber: �(,LV �, %7�V.nf�ll� Address: J
Lic.#: y 1 (7 Phone#(p. f 1 N `sCell#:�I q L'R_j `O(Y—n email:S ��n�}�C ,yn
Company Name:_QnkW_\'C 16 YY1 ,Yt(j,_ Address: )LfA ockawcka
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
1
1st Floor
2nd Floor
31 Floor
41 Floor
5ei Floor
Exterior
5.*List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
9/12/2021
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
b'ko 1(b —JZ0 b-NDU ,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
Coot`°Jky A-e-'-'b✓ 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.
Swom to before me this Swo t before me this
day of 4 ,20 day of 20__2 �
Signaturf of Pr eriy Owner ftnature of A plicant
I�0-fte„)1do
Print Naffic of Property Owner Print Name of Applicant
No ublie Notary Public
TRA JEAN TAMUCCI
TRACY JEAN TAMUCCI NOTARY PUBLIC,STATE OF NEW YORK
NOTARY PUBLIC,STATE OF NEW YORK Registration No.01TA6425615
Registration No.01 TA6425615 Qualified in Westchester County Z�
Qualified in Westchester County .L Commission Ex Tres November 22.20_
Th eted in its entirety and must inclu e e 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_
8/1 212 02 1
FE3
BUILDI-N, r MENTMAR 7VIL EOFRYE OOK2OZZ
938 KING ETRYEBR NY 10573 GE OF RYE BROOK
- �Y ING DEPARTMENT
ww .
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:
Sc k #1 Jf
, residing at, I rl I 6
(Print name) &dress where you live)
being duly sworn, deposes and states that(s)hc 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;
31 Arm t LefirrA V/. 10Y?� , Rye Brook,NY.
(,l(eh.gddi'C")
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.
%A"Iu'01
(Signature of aperty ,w tcrM)
(Print Name of Ri p,!n% Owner(s))
Sworn to before me this TfiAGY J TAMUGCI
NOTARY PUBLIC.STATE OF NEW YORK
day of ,20 Registration No.01TA642561a
ouaiitied in Westchester County ,
Commission Ex Tres November 22,2Q
(Notary ublic)
8l12'2021
QyE BR(��•
O�` tim
• 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 :— 0J DATE: ^�":�:' � V
PERMIT# _ ISSUED: 111 , SECT: BLOCK: LOT:
LOCATION: GaS `- Vim" �\ OCCUPANCY: '2 A0
❑ VIOLATION NOTED THE WORK IS... L] 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
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