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NOV 17 2022 BLrILDINODEPA.RT'VIENT rt-N+ kO'VILLAGE OF OF RYE`,BROOK C)7 S
VILLAGE OF RYE BROOK 938 KING STR>!trRYE BROOK,NY 10573
BUILDING DEPARTMENT (914)A39-0668 t N"rs 7-7-2D
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Approval Date: Permit#:�Vtl �? y��� Sp#: -7
Approval Signature- Permit Fee: Lam'47
Disapproved: Other:
Attached Resolutions: ( j B.O.T.; ( ) P.B.; ( )Other
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STOR1M ATER MANAGEMENT CONTROL PERMIT APPLICATION
Application dated: L I 2Z is herebv made to the Building Inspector of the Village of Rye Brook.N'Y,for:he issuance of a
Stormwater Management Control Permit for work,as per detailed statement described below.
1. Job Address: 30k Z�w_"tS
-- Parcel I.D.#;U��—�J 7
'Lone:
.1. Proposed Wotk(Dosonbr in detail): a�.�..a.o, e.���..
4. Property
se•Owner:
Addre n () {
Phone# — 1 Ceil# �'I I�i�0?7.5/��. email:LS)"1 h o 5 Ln I I-C��,-�
Applicant:
Address: -
Phone Cell 0 -- email: -
ArchitecvT;tagineer.
Address: -—
Phone 1 Ccl'.# 1'k- `k — S d �naiF:C�e+�,SC� �C•��e.ow.�iNt�,��
General Contractor:
Address: \\ 4„ S77 _
Phone # `� • email:
5. )estimated cost of site work $
(NO*I'L:The estimated cost shall include all labor,material.scaffolding,fixed equipaneat prvfessionw feral,baekfill,grading,site
restoration,cartin&�ripping fees and matc6al&labor which May be donated gm:is.)
1
Rr'12'2(r2l
MLD1106-jiEPARTMENT D
ViijA' GF, OF RYE BROOK
938 KiNc.STRIKE I RY1(BROOK,NY 105 '7 7-
(914)939-off ,, VILLAG OF RYE&W
�e,wwx ebra� BUILDING DEPARTMENT
A,Dprava; Date:- Permit Sp
Permit Fee:
Other.
Attached Rescluflons: B4O3.: P.B.; Cow.
STOR-MWATER MANAGEMENT CONTROL PERMIT APPLICATION
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook.Ny,for the issuance of a
StOrnlw3tct Management Contol Permit for work,as per detailed statement described below.
I. Job Address; ?SO*t tovevajN
2. Parcel -1 -,71- Zone:
3- Proposed Work(Describe in detail);
- 1110�
,ZkN Ck AA-e�
4. Property Owner:
Address: IS14 ?)YT,ix�
Phone# C'em# L114 lk-5-o I � 0rh
Applicant: j
Address:
Phone* CCU emaiL.
ArchitectiEngineer:
Address:
Phone#- Call ok\-%A- ZA cts S 0 culai 1:QV-4-Naca
ah
("ClIeTS1 COK&SCtM 1C-V%ft--4!,\X 4L ASAAMp,
Address: \k 1&jjM..N� ft .4L 4PCAA,� 4
Phone
..........!$16- 2.
5. Estirp=d cost of site work S
(NOTE:The estirnatad cost shall intludo all labor,mdeTilL scaffomia&fiend eqtnpnxm-,,pro&%%iaoal fees,bwJM,Vdin& it.
reswrabon,cwting?6pping few and materiel&labor which rmy be donMad gratis
p EC ENE
BUILDING ItTMENT NOV 17 2022
VILLA ol~RYiiRoojc
VILLAGE OF RYE BROOK
938 KING S` ET RYE 81t66K N1 Y 18573 BUILDING DEPARTMENT
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AFFIDAVIT OF COMPLIANCE
VILLAGE CODE§216!STORM SEWERS AND SANITARY SEWERS
TH3s A7710AVIT VMST BFJLA THE P+t"i'IAFUZZD 3-GWA11LJR: 'O T',?k. LE;'&L PRO STY Ci'*S--R i�eu BE 3'.,`Mwfi`1 D
ALONC WITH ANY 80'LDINCs OR PLtMING Pf3`OCIT Ar3G;,T£�".iC�a. t+SY Roil"DINO OF PrLT11z'011.Nc P 4ii
APPLICA`PTON STJSttITIMD WITHOUT TF:IS Ca"LE7RVI Avl''. %0Tr'LFLZ'zz:"1 FORM WILL BE To TEE t_I?L:_-k?z"
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
3, Six a�\ �)A.O f—q ,residing at, ��� E t_;.YA
I!,nni tee i Adt s.*whtxu you I: z:
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;
%YVI,a An 19,6' Rye Brook,NY.
tamdzt, i
Further that all statements contained herein are true,and that to the hest of his/her knowledge and belief,that
there are no known illegal cross-connections comceming 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 Cods.
ISkgwr.zb'k)f t m tX�F7
(Frith N=w of Pyupc f,{ wncr(s) .�
Sworn to before me this
day f OC'10164— ,20 ;�,I,
DANIEL D TARTAGLIA
Notary Public,State of New York
Registration No.02TA6323493 3
Qualified In Westchester County
Commission Expires April 20,2023
W121ML
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S TE OF NEW Y RY,COUNTY OF WESTCHESTER
'"t I^_ '. _ ,being duly sworn,deposes and states that he/she is the applicant above named,
{print acme of individual sitp ing ax the 'rant)
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.
(iadi�au araMGoct,aatsttaatar, .attmnar,ate.
That all-statements contained herein are true to the best of hiclhcr 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 m 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.
5wom to before me this Swom to before the this-��
.of 20. day of ( � ,20 �
'A-
Sir atrae of Appttcani
PMt Name 0(Ptopetty 0W0Cr Mama of Apptirant
Notuy Public Noun it
EL
TARTAGLIA
NotaryAPublicl DState of New York
Registration No.02TA63234g3
Qualified in Westchester County
Commission Expires April 20,2023
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