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Home My WebLink AboutPP22-061 a V.14 s N N Ln ' a ►\n Ln a• a ►� N a. w n o [h] s ^ = a w z ,`�'�' z A = o zLr) F o o � w = o w �z cis o V co u z 04 ON � s 00 � z a ' Z w.44 P4 04 w o y 1� A O H w a U z o Ln Fg orA W. p ECENE BUILDING DEPARTMENT MAY 10 2022 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.Kyebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: " Cj Approval Date: MAY 1 1 22 Permit Fee: $ Approval Signature:_ Other: Disapproved: (fees are non-refundable) Application dated,// /C2 rs 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: SBL: to?&• 0 /7— I S 7zone: 15 2.Proposed Work: �v�c�= GiNF �A.�iQe 3of�: 3.Property Owner:,L (9�A1��Q�LS4:2W 1 Address: 1 Phone#: q14 U 1w1 k Cell#: email: / 4.Master Plumber: �S�h't4—W 6W'Q J0/U Address: .3 3 a 1657t Y S 72, Lic.#: Phone#:9/,1-y6D-,65-36 Cell#: V II — ?7I—/-5 Company Name: 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 4'h Floor 5'h Floor Exterio 5.*List Other Equipment/Provide Details: ��L G 'T /l��/� �i'iIT��'L KJ O JcT) (Notarized Signatures Required Next 2 Pages) 4- 8/12no21 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .5��P/4ElJ R- 616)�5 oA) ,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 lj;L!/M ISrX) 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 before me this 1 d day of ,20 day of ,20 as Signature of Property Owner Signature of App icant Print Name of Property Owner C N e of Appl Notary Public State of New York No. 01 LI,E6160063 Qualified in Westchester County Commission Expires January 29,20 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 STATE OF NEW``,,��YOM COUNTY OF WESTCHESTER ) as: / , 6&e545 OA) ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing u 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 architw%cwtrwtor,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 before me this ' b day of 20 day of 20 'aa Sign Property Q Signature of Applicant Print Name of Property Owner N e of Appli Notary Public tilr I Si t c'New York 791JZ�/a'� 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. e�t�rmat D t1MAY NE 0 2022 BUILDING D> pARTVILLAGE OF RYE BROOK lvl�rrr BUILDING DEPARTMENT VILLAGE OF RYE,BROOK 938 KING 9TREET RYE BROoK,NY 10573 '(914)939-06681 i AFFIDAVIT OF COMPLIANCE VILLAGE CODE 6216►STORM SEWERS AND SANITARY SEWERS TaIs AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMING PERMIT APPLICATION. ANY BUILDING OR PLUMB G PERMIT IN APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �0A Lk-?J }e1Cn . ,residingat, ( �, (Pratt name) beingdal sworn d (s)he pp (Address wHdre you live) Y deposes and states that 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; Luw� �a� � r �v-� V(Job Address) 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 of property Owner($),)( II l c o T— �&k'1d S. (Print Name of Property Owner(s)) Sworn to before me this day of ,20 (Notary Public) -3- 8/I IR021 BR(�uk BUILDING DEPARTMENT ,IJ BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ A( ('I:P 1 F1: ❑ REJECTED/REINSPECTION 0 SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS 0 FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ FINAL ❑ OTHER QyE BRC��. cu � 1982 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: �v DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: 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.P.GAS 00 FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING µ UV� C �` L L 1 1( 1 re - ❑ CROSS CONNECTION ❑ FINAL C 1.1QZ N-cXL�x ❑ OTHER