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LbBUIR
LDING DEPARTMENT
VILLAGE OF RYE BROOK
SEP � 6 2Q22
938 KING STREET RYE BROOK,NY 10573
(914) 939-0668 VILLAGE OF RYE BROOK
www.ryebrook.org BUILDING DEPARTMENT
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: � PP#:
Approval Date: SEP 1 Permit Fee: $ ,4%6
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated, /(r 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: Zig A Z? Z SBL: /3,�;_,315—///!43 Zone:t4- v i
c " D
2-Proposed Work: .0 �.• 2 /'/�.� �.cse91+L •`nL �$I e�C of h tC
3.Property Owner: Zjj9[e-151 Address:
Phone#: Cell#: �Q 3 .7e /-71/y email: if U /t/ 1 + /.
4.Master Plumber: /chi c11 AZD 5 F�f/ZGT Address: 371 5- w#Vyf'1LY
Lic.#: /%d 5 Phone#: `-/e/ 777 / '7 Cell#: AW V0.3 Xail: /tte/l 5'/c rj/LL/ Ap L �y
Company Name: ��J J�//VDr s' /1!//GfS e l dress: !-1 ZAO£/2'�Y/3tUF' /0
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 V/
1 st Floor
2nd Floor
3`d Floor
41 Floor
5`h Floor
Exterior
5.* List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
-I-
8/12/2021
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
11/t1ih4W 51c(t"f/dGf ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further stat s that(s a is the legal owner of the property to which this application pertains,or that(s)he is the
d4o , - 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 161*11 Sworn to before me this 0-1,
day of S= f tf-t6.c- , 202, day of 120 Z"L
ir..Bu
Signatuii FIR' Owner S' re pplicant
Z U zv
Print Name of Property Owner Print Name of Applicant
JANE` TE SANCHEZ
Notary Pub 'c -Y PUBLIC,STATE OF NEW YORK Notary Pu is
Registration No.OISA638787
Qualified in Westchester Co ty
kly Commission Expires.
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-
sit2/202t
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING�TREET RYE BROOK,NY 10573 SEP 16 202
(914)939-0668
a
w wwxy broo e
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::
It Z- o.5 Lr 1') Z l.��l/ ft' 'residing at, / 7 AVC,-le' OZ IIP PIZ
(Print name) (Adds c�• where you five)
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;
/2l.U15-Y "w
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.
('Sign Property Owner{s))
d#//I o,S G v z
(Prise Name ul'Property Uwncr(s))
Sworn to before me this V�
day of , 20 JANETTE SANCHEZ
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.01 SA638787
(Notary Public) "
� Qualified in Westchester County
��D6 } vt. ^_otnmission Expires:
-3-
8/12/202 t
�yE BRC�uk
o`` tim
1932 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
O ❑CODE ENFORCEMENT OFFICER �938 KING STREET • RYE BROOK NY 10573
�
(914) 939-0668 FAx (914) 939-5801
www ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS: I �1 (A DATE:
PERMIT# 5
1 a2. ISSUED: I r) Z SEC '-35 BLOCK: LOT:��
LOCATION: ��� V OCCUPANCY:
rr��11'
❑ (J VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
-, ❑ UNDERGROUND PLUMBING (LV1Ci(¢ NOTES ON INSPECTION:
❑ ROUGH PLUMBING / /1 n C
❑ ROUGH FRAMING (v\ V=
❑ INSULATION
❑ NATURAL GAS 1
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
Laura Petersen
From: Mike Izzo
Sent: Monday, September 19, 2022 8:14 AM
To: Laura Petersen; Steven Fews; Tara Orlando
Subject: FW: Message from UDig NY
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Monday, September 19, 2022 8:13:31 AM (UTC-05:00) Eastern Time (US & Canada)
To: Mike Izzo
Subject: Message from UDig NY
****EMERGENCY****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 09/19/2022 08:13
To: VIL RYE BROOK PRIMARY Transmitted: 09/19/2022 08:13 00005
Ticket: 09192-000-286-00 Type: Emergency Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 17 To: Name: ROCK RIDGE DR
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: RIGHT SIDE OF HOUSE
NearSt: BOBBIE LN
Means of Excavation: EXCAVATOR, HAND TOOLS Blasting: N
Site marked with white: Y
Boring/Directional Drilling: N
Within 25ft of Edge of Road: Y
Work Type: SEWER
Estimated Work Complete Date: 09/23/2022 Depth of excavation: 6 FEET Site dimensions:
Length 60 FEET Width 3 FEET Start Date and Time: 09/19/2022 08:10 Must Start By:
10/03/2022
------------------------------------------------------------------------------
Contact Name: OSWALDO INTERIANO
Company: ROTO ROOTER, MAMARONECK
Addrl: 525 WAVERLY AVE Addr2:
City: MAMARONECK State: NY Zip: 10543
Phone: 914-447-3528 Fax:
Email: firielsalvador@gmail.com
Field Contact: OSWALDO INTERIANO
Alt Phone: 914-447-3528 Email: firielsalvador@gmail.com
1
• Working for: CARLOS
------------------------------------------------------------------------------
Comments: EMERGENCY, CREW IS ON SITE NOW, THIS IS A THREAT TO
LIFE/PROPERTY/VITAL UTILITY.
Lookup Type: PARCEL
------------------------------------------------------------------------------
Members: ALTICE USA CONED
SUEZ WTR WESTCHESTER VIL RYE BROOK
WESTCHESTER CTY SWR
2