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HomeMy WebLinkAboutMP23-015 ■ ■ e S ■ m ■ � w � a P.0 r y u y W ' N N M lyR ■ � � z CA o og cc A � w � v r. to � v [� W CN� O Wh E-4 w ■ M c) t w � a H $ �03a. 0 , Q Ocn Z H p p p x " ��vo 00 a ooz v z 04% rA 4e 3 v 1� c!3 G1 v escoo 0 it 00 -0 -'a 0 4 Uw y � Q ' vo � ^a � E� o .� v _ a o " o o Zo © a °4 '� V3 c O y " � o C Z © W 0 >0 .4 a, z a o �■ U y O W �, vv a w x° � � �� � BUILDING D ►RTMENT D [E C IE ��i1�- VILL'A'�E OF RYk,BkOOK 938 KING STREET RYE BRdCi ,NY 10573 FEB - 7 2023 4 _0 VILLAGE OF RYE BROOK L BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, 'VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE. ONI 1�: I'I I:AlI I Alp 0JV Approval Date: D23 Permit Fee: $ � `���-� Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (VillaLc of R\c Rroo, 111Lw i),� ti;i, :i,r,�rniic otr hnlctei) & Workers Compensation Insurance on a NYS Board form (i rni ( l(l;.1 or l onn :: ( fir.; or\) ti(u(r \\orkers Cor I') 4. Payment ofFees/Unit: Rl-SIUf.N I IAA_ = 5I00.UU!unit • CONINIFRCIAL, = ti3)50.00 ut(il. 5. Inspection by the Building Department for removal and/or installation. (48 hour notice required) 6. Electrical work requires a separate Electrical Permit & Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. Application dated,cD— /rc'�-3 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below. The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes, rules and regulations. > I. Address: / �I�'6 CJ Y SBL: rj � " ' ��'/ Zone: % 15 2. Property Owner: t Address: 4, Phone#: 91 14( Cell email: 3. Contracto _ c t Address: J50W A-!� 19LPz�- �C �r u• Phone#: ��7 � fj �p Cell#:q I"_�J y'31Z email:j�P pc+-14 r_ 4. Applicant: !L Address: !39cu G� _ r ' � (y�2�i'�'✓�Jr' Phone#: 1 Cell#:����y� �� ' email.'13,vn I atcYv ����Jv�t �Tl 5. Scope of Work: New Installation( )• Replacement( )• Removal( )•Other( ): 6. List Equipment: !� 6 (C- t Q4 r 7. Location of Equipment: -Ur 8. Method of Install do /Removal(list al]equ meat needed t perform job): /4 L e, -rr�� 8/12/2021 .15 de—b/J STAU OF NEW ORK,f � OUNTY OF WESTCHESTER ) as:_ rA2r I 15 ,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 3 Sworn to bef re me this day of ie L4 20 A 3 day of 0 Yl Signature of Property Owner re of Applicant Print Name of Property Owner Print%rrrWf Applicant Not*Public ANNA LEE NOWIERSKI Notary.lithlic NOTARY PUBLIC,STATE OF NEW YORK GREGORY M.RNERA Registration No. 01 N060'70443 %e1M public,State of New York Qualified in New York Nassau County No.(11 MU1Z98 Commission Expires March 4, 2026 0uatli W in weetchester County Cpmmtssion Expires September 26,2 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. Any application 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/t V2021