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HomeMy WebLinkAboutPP22-093 ! S en CNrq N N a 0000 W N � � � W � � H Q+ a o �--+ a cnCA w x O = �' oc CN w z O a w o 1.0 � 00a c o F rh� W co °O j-� z z w U 1-o U Z rn C� Acnoc O w Q zc U LL O O x V9 x DECEHE BUIL n"?, E A,P'FMENT JUL 1 $ 2Q22 VILI4 E OF RYE"BROOK VILLAGE OF RYE BROOK 938 KING ET RYE Blur ,NY 10573 BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY 13P#: PP#: Approval Date: JUL .1 a2O22 Permit Fee: $ Approval Signature: VAA Other: Disapproved: (fees are non-refundable) Application dated, 1 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. l,� �r�`�'�Y�1.Address: 3 SBL:/ Zone: r-5 2.Proposed Work: 'Vo ' bou."bu) y:e�ly kry: fy'S47el-t_ 3.Property Owner:-Imb K ARAIn Address:I I/A4 It t.,62-; LAT Phone#: X3_3 71P'&&1D Cell#: e,�m_�ail:�, 4.Master Plumber: ' �, il Address: T1�� / TgT jm *V1" Kq Lic.#: I S-!r Phone#: / ` a'l Cell#: email: fDtbW Company Name: t?g0AA-"6 f mki?l Address: Or 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 Ist Floor 2nd Floor 3,d Floor 4d'Floor 5°i Floor Exterior 5.* List Other Equipment/Provide Details: Vf':1t( (Notarized Signatures Required Next 2 Pages) $1122021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: x "TOD D kAPL/4W ,being duly sworn,deposes and states that he/she is the applicant above named, 4 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 MAil�_� legal owner and is duly authorized to make and file this application. (indicate architect, ontractor)agent,attomey,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 day of V_U ,2012q-427— day of 20 Signature afPrope Owner Sign ure of Applicant Tops k KIIAI '1�J N( .�Print a of Pro Owner Print N e of Applicant V 1 otary Public Nota ublic Lynda Derenzis Notary Public-Connecticut My Commission Expires ALGA CASARELLA November 30,2©24 NOTARY PU LI ,STgjawe properly completed in its entirety a d mLg� i of the legal owner(s)of the subject property, and the applicant f re� �lICO �eetadQ�ultp�plic ions Commission Ex Aires 26 02 not properly completed in its entirety and/or not properly sig 11 be returned to the applicant. -2- sn 2r2o21 BUIqET MENT VILOOK JUL 1 $ 2022 938 KING ,NY 10573 � VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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'WESTCHESTER ) as: '1, ., oyi) kAPI A-N ,residing at,_r�, ch,,Jts utne, Ry[_ R,wLi, N1 10673 (Print name) (Address where voi 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; a� �h4 !-4nf . Qy� e_S1V0k j NY 10673 , Rye Brook,NY. �I ilob 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. r � (Signature ul Prupem Owner(si) ©I� (Print Name ufPropert} Owner(s)) Sworn to before me this day cJ GJL �" PV117n'Public) Lynda DerenZls Notary Public-Connecticut My Commission Ex¢ires November30,2024 B/12/2021 �E BR(�� cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR J-54SSISTANT 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 : � ���� Q� n-Z DATE: PERMIT# P a — 2-Z v 1 ISSUED:—j I SECT: LOCK: LO'L LOCATION: '` ��T' } OCCUPANCY: 2� U ❑ 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 YTINAL ❑ OTHER