The URL can be used to link to this page

Home My WebLink AboutPP22-090 II ■ t O t N N N � � ■ 0, W = N : � a WX PQ rq Lp 0*4 � z � L G o W Z ■ cn R N .a 4 ip Q C oo ~ W w ■ �� w ce Z o 94 1-4 z S L I� w a a D BUILDING DEPARTMENT JUL 13 2022 VILLACE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914) 939-0668 BUILDING DEPARTMENT www.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP #: PP#: C;)t)r 090 Approval Date: Permit Fee: $ Z* 5_ f4L.J Approval Signature: Other: Disapproved: ' (fees are non-refundable) Application dated, ?—/3—cD� 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: 5 t1 i e SAQnea�,ZII __ SBL: �v�7r&Y—/—7/ 7 Zone: /n 4/� 2.Proposed Work: YN%J M } t 3.Property Owner: WQ?f Address: e)e. ` n'!A _ .,e �. k j� aS 3• Phone#: (91:1) � - IqO� _Cell#: email: Cho � ,: c� 12Qe�w,a,�- c o..-, 4.Master Plumber:--VAS-1 L F- JV f LAfA Address: 239 �ew:n�n Lic.#: 22t4 Phone#: (Rly);10 -92141 Cell#: email: Company Name: �/Q�7`, _P G V AATIW Address:23R L aliinC Jo.1 4UL IO U ,� 1'—"4 4WI./ IQS�rQ 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 "Pubs Service Service Sewer LP Gas Basement I st Floor 2nd Floor 3'd Floor 4'Floor 5'Floor Exterior ` 1 5.*List Other Equipment/Provide Details: Ig „n Q z c. in C z, h o uv -4 Q o nP ( ') CL (Notarized Signatures Required Next 2 Pages) -a- BUILDING DEPARTMENT VILLAGE or, RYE BROOK JUL 1 3 2022 G �� 938 KING STREET RYE BROOK,NY 10573 �--------••-• (914)939-0668 VILLAGE OF €',YE BROOK BUILDING DEPARTMENT www.ryebrook.ore 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: pp �1, �� G_r I+� � ,residingat, g H i I�S�n{ ILCJ brcot N (Prins nansf fAddress%%here you lice) NJ I 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; S-�o O 0.A , Rye Brook, NY. (Joh Addrrss) 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. - —140 (Signature of`Pruperty Owncits1) I I y C`-1 (Print Name of*f'r�y Owncrls)) Sworn to before me this day of �V ,24 _ MARIBEL PEREZ Notary PubliC-State of New York No DIPE6246496 (Notary ublic) Qualified in Bronx County My Commission Expires August B,2GZ`5- -3- W1212021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ► as: JJQ J2� C-TY t C k k- ,being duly sworn,deposes and states lhnt he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)hc is the legal owner of the property to which this application pertains,or that(s)hc is the \/Q S7 L E V r,,,F—&A for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,atlomey,etc.) That all statements contained herein are true to the best of his/hcr 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 1� Sworn to before me this k` day of , 20Z day of �` 20_2) _ Signature Property Owner Si nature of Appl t +6:�e V r l' ct VA5:[L r Print Namc of Property Owner Print Name of Applicant Q .!!/ MARIBEL PEREZ Notary ublic u Notary �,biic.State of New York No Public No.01 PE6246496 MARIBEL PEREZ qualified In Bronx County Notary PLb1ic-State of New Yak My Commission Expires August 8,201c> No 01 PE6246496 Cuai Aed in Bronx County My Commission Expires August 8,29 This application must be properly completed in its entirety and must include the notafized 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 retumed to the applicant. -2- tU1212021 Qye Bkj� 2m 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 : , ` ATE' PERMIT# ISSUED: 'SECT: BLOCK: LOT: LOCATION: r"-� `,e r OCCUPANCY: Z ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE % ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING / Cl ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS / ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER / ❑ FINAL PLUMBING ❑ CROSS CONNECTION rV�ii C Cl �l ❑ FINAL \ C42 ❑ OTHER