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Home My WebLink AboutPP23-028 s ■ e s 00 N N s ■ � N N W s N w000wtLO rq �•�, �� ■ "It k _ rp VD en R. a � v a O Zo *4 w 0 a A � w N �✓ a AFiy O r✓ �r z _ N r w x 00 co OW "o z I : N Z _ N Cn y. m ■ A zC� V r wcc v o -+ � s U W Ln W v � (a w � s U W 0 F, BUILDING DEPARTMENT FEB 2 1 2023 VIL � E OF RJBR , OK 938 KIN ET RYE NY 1057 VILLAGE OF RYE BROOK BUILDING DEPARTMENT W PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: 1'" PP#: Q3r 04< Approval Date: FEB i Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) :k�kkkk*kkkkk-kkK:kkK-Kk3K=kkkkkkkk**+k*kk�*Kkk*kkkk*k**kkk+k*kkk*k####*kkk#Kkkk3k*k#**k*k#*kkk#kkkkkk*kkk Application dated, - is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance c a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner, by signing thi document agree that said plumbing work will be in conformance with all applicable Federal, State,County and Local Codes. I.Address: I �eS�u 1.ei2� C-w f� SBL:f 3,' W— Zone 4e 1 c� 2.Proposed Work: C cL, t n-�e a r i j h es� 3.Property Owner: i- P c. i- C x rerl-e 1 r to LD( Address: J ,0e,7 4-6c Le,�jL Cyv+'Phone#: 'q 1y- F1 3y -02q:( Cell#: 77,) -9?jq- y?7.2 email: fr-e".rol- k) oplonti►�f.lVer 4.Master Plumber: Address:I La kt Uj-ew Lie. #: .26'7 Phone#: Cell#: ;If-) email: l u��ll;cti� .p�rYrc�o Q Purucc �r'►C�c�i Company Name: i h t}¢..S,t-r'► C�r ce j Address: �D e s �rl k �-A ��^euy S n INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natur Other* Total Closets Fountains Tubs Tubs Service Service Sewer LPG s Basement 1 st Floor 2nd Floor 3,d Floor 4"Floor 5'"Floor Exterior 5.* List Other Equipment/Pro 'de Details: C c (Notarized Signatures Required Next 2 Pages) 8/12/202 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 9- day of ,20 day of 20 Signature of Property Owner Signature o pplicant W 1 6 / " G rn_.. IC,Tr '�-Cn Print Name of Property Owner Print Name of Applicant— Notary Public NoMGhi ,t V&UU.O votary Public,State of New York NO.01MMIX1063 Qualified In Westchester County 1 mmission Expires January 29,20 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- ai 1212021 TI,U Y'A nol(an Ki v-(1 STATE ORK,COUNTY+ OF ) as: -RA(l I ek 5 T�-iA lbY,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the a licant) and further states thhat,(s)he is the legal owner of the property to which this application pertains,or that(s)he is the �()W LY 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 a this 6-0 K- Sworn to be me this '�o day of ,20i day of , 20 Signature of Property Owner�T Signature of Applicant Print Name of Property Owner Print Name of Applicant 9"cri—eu Q G otary Public otary Public 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. E=] �,rovr�e -2- 8/[2,2021 HIE BUILD MENT VIL OF RY OOK I FEB 2 1 2023 938 K NC, ET RYE BR ,NY 10573 1 VILLAGE OF RYE BROOK BUILDING DEPARTMENT rod 9 t«trr«r«rr«trrr«tAiiiiiiiiAiwr«tattrr««fiiiAi«««r«r«r««trot*rttrtrrr#««««rrtrrt«r«««r««r«r«r*rest«#tr« AFFIDAVIT OF COMPLIANCE VILLAGE CODE 216 r STORM SEWERS AND SANITARY SEWERS THIS AFrIDAVIT MUST SEAR 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: residing at, �r wes�t�l� i t .► (Print name) (,4ddre,s hcre 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; I ar Id_ � f" °�I l °- 1 ( ✓) e is e r /t� a >r , Rye Brook, NY. Further that all statements containedherein 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 stormwatcr or groundwater connections or sourcer, of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State County and Village Codes. r (Signature of Property Owner(s)) 1 Print Name of Property Owner(s)) Sworn to before me this C�V day f , zo Z3 ;� MS `� DtP�tES F4nx ry 4.2027 rNo ary Public) -3- QyE BRaj IEE cu � 1932 BUILDING DEPARTMENT QtUILDING 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.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:— Y DATE: PERMIT# ISSUED: (I SECT: `. BLOCK: LOT: LOCATION: 1 ` w�` `-�� j' ` `� �"" OCCUPANCY: 2--�O ❑ VIOLATION NOTED THE WORK IS... ❑,ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION 1 REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ FUEL TANK U-Q Cox ❑ FIRE SPRINKLER ❑ FINAL PLUMBING 7-1 CROSS CONNECTION U ( u v INAL �c \ V- l C� OTHER * o u co Co Qj * 3 , * OJr c � * a u v L Q W en * b y �' J * ... a (/1 0-4 aW * E� U as r y V � -- 0z-4 GW7 a o oN * J., co * ' i cl `' * O V is on In. z :J