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BUIL E MENT
VIL E OF RYE OK DEC 2 2 2022
938 KIN ET RYE B ,NY 10573
4 VILLAGE OF RYE BROOK
.or
BUILDING DEPARTMENT
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#:
Approval Date: ) Permit Fee: $ '
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated,J �' �''it 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: C SBL: I351 7�►i "�r J Zone:h_/0
2.Proposed Work: a�A�ti Si�L�-✓� Z.4s?4 5 �o.J C: (�e/ �' l/ 1_ V i i�j„yl
3.Property Owner: /3l-i n G P1 E 0 Address: C�'-q ey r 1'1 AC e /3yc BrCOA
Phone#: 91 y 37—.3�416 Cell#: email: A
4.Master Plumber: Ls �tiv �� Address: f /�7"7( A"`'� -1 Ile-vO 12-t+ A'"j it,
Lic.#: A 3 Phone#: 7l F Ltfi 6,RO Cell#: 1/ 9 6e1 09 3? email: Qe./U 4- C-o,
Company Name:Ale*j '10&ff-,O�tj.o;-fit 1k �vaUj Address: F7 7I MGJU'tf IJ A 6!:j W-ft
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
1 st Floor
2nd Floor
31d Floor
41 Floor
5di Floor
Exterior
5,* List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
8/12/2021
BUItET
T' R1
VILOF RYE BROOK DEC 2 2 2022 DD
938 KING RYE BROOK,NY 10573
939-066$j` VILLAGE OF RYE BROOK
_o 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:
.3, I r1.1ee- , ,Ftr►o t ,-,� , residing at,
(Print name) (Address where you li e)
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;
, 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.
( 'ma •e ofProperty Owner(s))
(Print Name of Property Owner(s))
Sworn to before me this
day of � , 20� LINDA BRO fMAN
NOTARY PUBLIC,STATE OF NEW YORK
Registration No. 01 BR6433920
Qualified in Suffolk County
( of ry PL1i i11 Cnmmirzsion Fxnlrres May 31, 2026
-3-
8/12/2021
STATE OF NEW YOM COUNTY OF WESTCHESTER ) as:
lCaM4'r aAlff7Jr - -LL— ,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)be is the
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 Sworn to before me this p
day of ,20 day of �E ,20 ?-
signature of Property Owner tgnature of Applicant
L�tu rc t� �rrl G-i a P 6-14"
Print Name of Property Owner Print Name of Applicant
1-
Notary Public Notary Publr
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.
.__. LINDA BROTZMAN
NOTARY PUBLIC,STATE OF NEW YORK
Registration No. 01 BR6433920
Qualified in Suffolk County
^^^ ^^ Fxnires May 31, 2026
-2-
8/1 212 0 2 1
BR(�uk Village of Rye Brook
Public Works and Engineering Department
9J&.KING STREET•RYE BROOK,NY 10573
1982''�` (914)939-0753 FAx(914)939-0242
INSPECTION REPORT
Address: Date:
Name: }r_A / 1
Location:
Permit#: Phone: Email:
Work being Inspected:
r
Work Inspected is: Acc ted Rejected Re-Inspection Required
Violation Noted Code Section
Code Section: Action Taken Code Section: Action Taken
118 Erosion Sediment Pass Fail Violation 210 Storm Water Pass Fail Violation
135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation
213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation
216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation
Other: Pass Fail Violation
Notes:
r
Diagram:
Signature
Laura Petersen
From: Mike Izzo
Sent: Thursday, December 22, 2022 9:09 AM
To: Laura Petersen; Steven Fews;Tara Orlando
Subject: FW: Message from UDig NY
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Thursday, December 22, 2022 9:08:24 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: 12/22/2022 09:08
To: VIL RYE BROOK PRIMARY Transmitted: 12/22/2022 09:08 00001
Ticket: 12222-000-220-00 Type: Emergency Previous Ticket:
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State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 7 To: Name: CONCORD PL
Cross: From: To: Name:
Offset:
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Locate: WORKING AT THE FRONT AND LEFT SIDE OF THE HOUSE
NearSt: ARLINGTON PL
Means of Excavation: HAND TOOLS, BACKHOE Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: Y
Work Type: SEWER REPAIR
Estimated Work Complete Date: 12/26/2022 Depth of excavation: 4 FEET Site dimensions:
Length 15 FEET Width 6 FEET Start Date and Time: 12/22/2022 09:06 Must Start By:
01/09/2023
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Contact Name: RICH DESTEFANO
Company: NEW YORK PLUMBING
Addrl: 8771 LEFFERTS BLVD Addr2:
City: RICHMOND HILL State: NY Zip: 11418
Phone: 718-441-6800 x129 Fax:
Email: richardd@nyplumbing.com
Field Contact: WAYNE
Alt Phone: 646-342-8406
i
Working for: CONSOLIDATED EDISON COMPANY OF NEW YORK
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Comments: EMERGENCY, CREW IS ON WAY TO SITE NOW, THIS IS A THREAT TO
LIFE/PROPERTY/VITAL UTILITY.
Lookup Type: PARCEL
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Members: ALTICE USA CONED
SUEZ WTR WESTCHESTER VIL RYE BROOK
WESTCHESTER CTY SWR
2