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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 : (4 `9� N ` \ �n DATE:
PERMIT# 1y�y C ISSUED':` ,SECT: 1�
`� LOCK' � LOT:
LOCATION: C / \ - �V
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
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
FINAL
��] OTHER
�yE � BUII.,DING DEPARTMENT ,;
VILLAGE OF RYE BROOK MAY 19 2022
938 KING STREET RYE BROOK,NY 10573
1902- (914)939-0668 FAX(914)939-5801 VILLAGE OF RYE BROOK
www.ryebrook-org BUILDING DEPARTMENT
FOR OFFICE USE ONLY: : Original Building Permit Number. Date:
Certificate of OCCUnancv Number: Date:
Approval Date: Permit ; Permit Fee: + + Date:
Approval Signature: ; Renewal Fee.4•3` 0 — of renewal Sling: f cl—ate
Disapproved ak: Date: = Renewal Fes: Date of renewal filing:
: Renewal Fee: Date of renewal filing:
Renewal Fee:: Date of renewal filing:
RENEWAL APPLICATION
FOR HOME OCCUPATION PERMIT
Application dated- ,/y - 2 c 4 Z is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a
Renewal Permit to conduct a Home Occupation in accordance with Section 250-38 of the Code of the Village of Rye Brook,as described
below.
1. Address:
492 North Ridge Street, Rye Brook, NY
'
2. Parcel ID# Section 129.60, Block 1, Lot 41 Zone: R-15
3. Property Owner. 0/ANE SCHwa2T7- E S rtgTE TqX 5HELF�5gEp TiggSF
Address: 492 North Ridge Street, Rye Brock, NY
Phone it 914-939-0558 Cell', 914-420-1892 Fax 914-729-1068
Applicant: Dr. Samuel Schwartz
Address- Sam
Phone# 914-939-0558 Cell 914-420-1892 Fax# 914-729-1068
4. PROPOSED HOME OCCUPATION: (Full disclosure detailing the exact nature of the-proposed home occupation,hours of
operation,number of visits per week,number of employees,etc...is required by law.)[use additional sheets if necessary]
Chiropractic services. For the speciacs of the use to rAuch the premises is put;
reference is respectfully made to the Resolution on Appel of the Z=ng Board of Appeals
for Case No. W366.
5. Occupancy(I-family,2-family,etc...)Prior to improvement: 1 family After improvement: 1 family, 1 R�Qf-
6. Proposed Home Occupation(check one): Tier I: Tier II: Tier III:X—per_ ZBA Res.04
CHAPTER 250-38 OF THE CODE OF THE VILLAGE OF RYE BROOK CONTAINS INFORMATION VITAL TO THE
PROPER COMPLETION OF THIS APPLICATION. PLEASE CONSULT THIS SECTION OF CODE PRIOR TO APPLYING
FOR ANY HOME OCCUPATION PERMIT.
LAST REVISED:6AD6
Please note that this application must include the notarized signature(s) of the
legal owners) 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:
5AM N EL s c N vy A FtT Z ,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
5 r t A Nt✓vR ct n j 4 e v i 5 c e c F fwthe 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,IIthe Code of the Village of Rye Brook and all other applicable laws,ordinances
``and regulations.
Sworn to/before me this JV Sworn to before me this 0xd
day of /"` , 20L!�2_ day of _,20 22.
Notary P lic Notary P blic _
Signature of Property Owner Signa re of Applicant
.�tit� S, i 2
Print Name of Property Owner Print Name of Applicant
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LAST REVISED:6.6.06