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HomeMy WebLinkAboutPP19-171 : s o � � w _ t;,o qj ZZ a CN w 7 qt o oc 0-4 w7 qlr _ Lra f1i Gz7 Q.arc= r� F� � o Q D LSISUM� BUILDING .QEPAIMENT I'llVILLAGE OF RYE' AG t p . RYE BRoLKJ1LalNG GE�fiR V , 7938 Krmi S RETT RYF B NY 10573 (914)93," A(0 939-5801 Ook .or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: _1�1- 71 Approval Date: SEP202019 Permit Fee: S Approval Signature: vim, 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: 1 r G n V—I t r t-J a"y - SBL: i 24 ` r Ll Zone: 2.Proposed Work: (416 el Fr_c,n 4c, tit S k [ •�1L {j t t G I N ( U S 7-7 3.Property Owner: E U 5 U'r Address: fjY F r\V_l r" 5+ Phone#: Cell#: (`� — `t I U5 email: p r�,�n&f �y 3 ► ,.Ct; 4.Master Prlum`ber: ELF Pc4 c c. Address: f ' M C- S rr'k Pole- j rjV\Vt t Lic.#: { �! 6 Phone#. f C4)33 -70 2ell#: (q VUq`\i 6 email: —T0,\I ?�s-Q C,oMG C-e'h Company Name:E-Tp,1 P k �-1�'Ir+Lq Address:1�] �h,QLr, Jr N Q e• V\V t�S , iy`� 4 0-7 09 St r v.C.ZS -.�LtiC . J INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Shoxiers Bath Laundry Doinestic Fire Sanitar} Natural Other` Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement Ist Floor 2nd Floor 3`a Floor 4 Floor 5'h Floor FXterlor 1 5.* List Other Equipment/Provide Det ils: �"S S Ir 1 t (- a � � ��� YA e-�r ,�7Y 0 Vnr` ©1�k�r�c -cry J Cy d'. Y�.Q A-0 "G /t Ua-j . (Notarised Signatures Required Next 2 Pages) 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: FLA Its T.being duly sworn,deposes and states that he/she is the applicant above named, (print name of ind victual 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 C0\1\V P C c/ 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 Sworn to Aefore me this 0 day of 20 day of .20 + Signature of Property Owner Signature of ApWicKint F-L-1 A+ ' gac� Print Name of Property Owner Print Name of pplicant Notary Public Notary Pub tic 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. µ KAR.EN DISALY0 v�TARY PUBLIC,STATE OF NEW YORK lie istration Nv.01D14749642 Qualified in Putnam Co MY Zo My Cornmission Expires: 3-2t/ISM r BUILDOG DEPARTMENT DD VILLAGE OF RYE BROOK SEP 19 '209 938 KING S-rRFET Ri-i,-. BizooK,NY 10573 (914)939-0668 FAx (914)939-5801 VILLAGE OF RYE BROOK BUILD!NG DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 ESTORM 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: 111(34 � orkct-jo ------, residing at, I hint lmin'�J (Address wheic wu h\L,) being duty 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; �I 61 �--&(\V_\ *' t'� �, dob Addresq Rye Brook, NY. 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. (Signature(41'roperti, (Y%nert s 04 Si 1 r (Print Mum of Prop+ owncn m�- Sworn to before me this day of '" vL 'Y20 KAREN DiSALVO NOTARY PUBLIC,STATE OF NEW YORK o. I L N 0 D1�7 49642 t arn ou V M ounty 0 Registration No.0 1 DI 4749642 Commission d n Putnam '0 My Conunission Expires: 3/21/19 QyE BRC�k 198,2. 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 : C� DATE: PERMIT# , 1 l- '� ( ISSUED: SECT: BLOCK: LOT: LOCATION: ! C�� 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 �l ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER . \ { t � ƒ cl d § c ® 2 m � � cl \ \ gcr 2c % o = § q ƒ A en 2 \ z \ 2 � / Q 0 u 0 Q Q f op > � 2 w � - 9 k � � a22 ' cu y � . � > Ste / 7T \ § k § \ § © ° o � q2 Q 4 a 5 E E