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HomeMy WebLinkAboutPP22-081 : s a a a N N 4-4 rn HN cnx C� Z w A -10 w $ Zz _ w a W r � e s YT 0 ~ a o q F' uz _ O z A z © H w Lo O _ oo � w _ tee.�.. .......� � P BUILDING DEPARTMENT � JUN 2 1 2022 i VILLAGE OF RYE BROOK L, -... - _..__ 938 KING STREET RYE BRoox,NY 10573 j VILLAGE 0= Rsr" BROOK BUILDING DEPARTMENT www.ryeirook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: C�;?Q Approval Date: JUN 2 1 202Z Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, —Qc)- 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: / rt SBL:�d/ (�a r�Y��' Zone ie 15- 2.Proposed Work: C 3.Property Owner: ess: �,,l, Phone#: Cell#: �� J email: ��j,I��v/f/ G 4.Master Plumber: Address: Z(�,�G;7C+-,1�C ���23- Lic.#:.5�Phone#: Cell �/ email:�j1./�,K&&,/ 1-� • Company Name: 1/�r Address: * ZO 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 I LP Gas Basement / 1st Floor 2nd Floor 31 Floor 4°i Floor 5te Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 4- 8/12/2021 STATE OF NJ YO COUNTY OF WESTCHESTER ) as: �/+/ ,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 for the legal owner and is duly authorized to make and file this application. (indicate archi corttractor,a ent,attorney,etc.) That all statemen 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 beforMme day of � �i�t//� 24 1' of i" ignature of Property Owner S ature of Applicant C--� 6% C'— Print Name of Property Owner / t N e of Appli t CIA N Public JOHN DIONIS'® tary l NNAR LL Notary Public State of New York of ryPu ic, StateofNewYork No.016A5085324 Qualified - Westchester County Qualified in Westchester County�Da r # 01DI4Pn,"04.5 EXP. 9/30/22 Commiss;on Expires September 22 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- sn2r2o21 BUILDING DEPARTMENT Q 1�`Jr E ° VILLAGE OF RYE BROOK 1 U N 2 1 2022 938 KING STREET RYE Mom,NY 10573 (914)939-0668 VILLAGE Or RYE BROOK wwyi�.r rll aok.crr� BUILDING EIEPARTMENT 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 WESTCHESTER11 ) as: 3, &aj\ 1r\a I a✓ ck V owAresiding at, I"� 1�/� (�I IV,Gr r(T��� " (Print name) (Address where you live) 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; "1 3 ) ,�,tr 1 � 3ToC?'� �l� R r0C)1_ Y Rye Brook,NY. (Job Address) 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. - z iA_� (Signa- 9 Y-1,a Y-1 Y-1 01, ture of Property Owners}) (Print Name of Property Owner(s)) Sworn to before me this day of 2 20 L y (Notary Public) JOHN DIONISIO Notary Public State of New York Qualified - Westchester county ty P1D14SO4045 Exp. / / snzrzozi �QyE BRC�k• O 2m cu � 1982 BUILDING DEPARTMENT ❑ UIi DING INSPECTOR SISTANT 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 : J, DATE: PERMIT# v ISSUED: k 1 5T: BLOCK: LOT: LOCATION: �. 'l 1 �1 �\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.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER FINAL PLUMBING / ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER