The URL can be used to link to this page

Home My WebLink AboutPP23-017 g g g g g . [� M N ■ � 00 r\i M Ln CLO w s 00 r /l� O i � ' ,'� • rT p a CO 0 CA � .N' z z �"i r-+ d w o V a W � 17 u z ON CA w i Z i x � A zcn w V 00 SN dr cn ' l s (A 1.0 x w Q � � Uao Ln 0 BUIL11 G DEPARTMENT JAI 3 0 2023 VILLA, E OF RYE BkOOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK ( 14) 939-0668 BUILDING DEPARTMENT w�w-iwnebraok.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP PP#: _�� 7 ON3 � � Approval Date: Permit Fee: $ /S= Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, �� 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 Address: Sop W rya,, A jt Ry,e VcgoK NY 109;f 3 SBL:LkM adQ --l—c� Zonej 2.Proposed Work:&I epom>P +.u6 Oin wi a CG f loue i ♦ uj,4 h R eGw) Kiy% S h ow er 3.Property Owner: rk t 1;a f✓S D�5gr, Address: nnt,n Phone#: Cell#:(y!`t/-CIO f�c�mail:�ht,1j0 GnL5r�5 �►r�Seu(jaly rtry 4.Master Plumber:�41-on SG�iGtJt7n f . Address: SY WwMkq N-11G V%Y eWiek (,473, t Lic.#:2 i Phone#: Cell#: Gf/�� 4 y(2 6�lQ�f email: ill �,'1�1, n�- `� yu�iG• L4W7- Company Name: 4 S6hl otyz}np D �G Address: Ave r k tvr INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: rv$'ZJ Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement I st Floor 2nd Floor Yd Floor 4'h Floor 5`h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) R/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Gr ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indiv dual 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 (eo Ct a 4 jIft_S ,1 q liar N,A i w G f n G 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 120 Sworn to before me this & day of .n 0 12013 day of �nc� r ,20 XS �,i' �h FS ni noSG Signature o roperty Owner Signature of Applicant e n%Z co Cewp i"0;a A(t't'1c".'i (0-5"x6)t 050L.' Print Name of Property Owner Print Name of Applicarh ANA M SALAZAR Notary Pub NOTARY PUBLIC.STATE OF NEW YORK Notary Pu t iLIC.STATE OF NEW YORK Registration No.01 SA6163173 RCctstratian No,01SA6365173 Qualified in Westchester County Qualified in Westchester County Commission Expires 10-02-2025 Commission Expires 10-02-2025 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- 8/1 212 02 1 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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)he 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 J V day of 20 day of,}E ,20 aTA iJ r, Signature of Property Owner Signs e f Applicant Print Name of Property Owner PY&Name df Applicant Notary Public Notary Public SHARI MELILLO votary Public,State of New York No.01ME6160063 Quaiifled In Westchester County This application trust be properly completed in its entirety anc muss ii��'l �r i �S� ature(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- 8/12/202P R EC� ENE BUILD MENT VIL OF RY OOK JAN 3 0 2023 ID 938 KnNG ET RYE BR ,NY 10573 Q -c VILLAGE OF RYE BROOK 4 � BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §21 G • 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, SS aiai nv5C, ,residing at, 6'Q 1p"MAn hQZ (Zy a 61CVK N�_112_C12 (Pritlt name) (Address where you 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; Sao 'cJw mcA n l,v f-• ,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 V' Codes. (Signature of Property Uwner(s)) C.MIiRO C&piy%oz0. (Print Name of Property t wner(s)) Sworn to before me this 21D day of ct v+txt ry , 20 .2 3 (Notary Pub' ANA M SALAZAR NOTARY PUBLIC,STATE OF NEW YORK Registration No.OISA6363173 Qualified in Westchester County Commission Expires 10-02-2025 8l12/2021 QyE BRC�v� cu � 198,2 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 Uebrook.org - - - - - - - - - -- - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :_ DATE: j PERMIT# v� ISSUED: , �4T: ' 1 I. BLOCK:_LOT: LOCATION: \ \jy) �O\3�Qs �-o c) ' OCCUPANCY: z2(�) ❑ VIOLATION NOTED THE WORK IS... lj�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 i FINAL ❑ OTHER