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HomeMy WebLinkAboutPP22-084 ■ i ■ f ■ ■ N� © W s-i ■ c o N ° _ 00 0 ■ � A W V `� V � � o ■ w ■ a 0, p ■ a � w H � � � � � w : R Z O o W ■w 4-4 Qj O a W -q w ' col FAR KS r. G ad O Wo Q w0 u zu, w M w w A o 4ON w a MM� 00 � H h+■1 cn �" d d az z z o H 0 � � w �rj� o ° f+ O 2 C�J7 3 a � No v O w x z a 00 A w z � ° a .. a fWT � 04 F1, cn BUIL. 0 E MENT VIL E OF RYE K JUN 2 4 2022 OD 938 KIN ET Ry'E B ,NY 10573 (914)9 939-5801 VILLAGE OF RYE BROOK or BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION ^� FOR OFFICE USE ONLY BP#: PP#: -D Approval Date: � � n Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated j! pl? is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or reirdove 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: / — Zone: //S 2.Proposed Work: k 3.Property Owwner: T Address: Phone#: 71 0 3a Cell#: email: 4.Master Plumber:f�/l Address: , W Lic.#: hone#: �� —� Cell#: no] email; ISO Company Nam S i` A d d r e s . — G+ � INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: N fU��� Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement lst Floor � q 2nd Floor 3`d Floor 4"Floor 5`h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) BUILD )BRONY ENT V1 �E OF ROK JUN 2 y 2022 938 KING ET RA E 10573 (914)9 9-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST HEAR 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: I , 31, rI 1` , residing at, I (Print name) ( (Address ere you live) being duly sworn, deposes and states that (s)he is the applicant above name , and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; ( 1 , Rye Brook, NY. 55-L_ (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. (Signature ol Property Owner(s)) �" r k+ (Print Name of Property Own ) Sworn to before me this day of S'"e- , 20 L2— (Notary Public) NY. Aa °t 6 3/21/19 S ATE OF NE—W�^YORK,COUNTY OF�WESTCHESTER ) as: V1� tJ_. �JI�}� ///,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 CO i✓Z7&d ra4n 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 3 Sworn to beforeme this day of 3 hk.e- 20 2,7Y day of 1 LC/�it�: ,20 (] Signature of Property Owner Signature of Applicant )<(Lkw W1-('CAk-t' Vi�,"-Z- 4, ,-T.7 Print Name of Propert' O er Print Name of Applicant VVVA (� —';' -Z."Z/ Notary'llublic p1p� 2�V ARY t AN RANO Notary Public State of New York NO. 01AN6246783 �womhosw . ft�La Qualified in Westcheste o my My Commission ExpiresU This application must be properly completed in its entirety and must i s e o e s n e s o 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- 3/21119 �E Bkj� �m 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT 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:- 1 \ DATE: 22-E ?-qAPERMIT# ISSUED SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Lf ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION `^_ , `1�I REQUIRED ❑ FOOTING �J O ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ,,Q NATURAL GAS `'❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER r