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HomeMy WebLinkAboutMP23-036 s e = _ k4D h 'I 0 C ' H O H � . o 0-4 cn Z O $ r _ O Z Q O W M ® O 00 W g � w w x L00 c W O �y N`-' U 0� ❑d " W z 'n y a. Uu CO + a z O C 0 G a 00 \40 � V W v z v sa, c AN 0 P., Q 0 c`� ZO E � as c pwq M W W i � � Fi W F1 F Z z .0 —F p 2 r � - 'gi p x .8 o .� v QH O p V z °" °aca.tiv a 8 $ g � W O W a � v W w v v `n O a tz0 .5 v " i o ow 'A" > CGS Q a W a ° ai x © 1-4 _ a a a a w � E, � x ICE MWF, BUIL MENT � �, VIL OF R OOK MAR 2 Q 2023 938 KING ' r Ri,L 8 NY 10573 VILLAGE OF R`r'E BROOK . , BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION /FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Approval Date:W 2 # MP#: pplication Fee: $ ­� 6 Approval Signature: Permit Fees: S C;�Ss 0— 4SU Disapproved: Other: t,rY*dFkaF**Y:***:F:F***:F**F i;**i:ak*M�k*•k sY�**3F F:k x�:k*ktF*:k:kx kk***W;Y**�k�:4:Fx Yr��***�Ys*�Yc*fit 1k 7F�c:F*at rY:k 9:*#*******s4�&�M F**t*tic Application dated: ]. p 3 is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: `T�J� I1GQ,�Son '� C 9�OQ� f�(�C L7f4© b� ivy 2. Parcel I.D.: / / Zane: 3. Proposed Work(Describe system in detail including suppression agent): UQn VP�j tale`�•( ')'d� A., `� r 4. Number&Types of Fire Sprinkler Heads: 5. N.Y State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job: $-�t, 600 *0 (Value shall include all labor.materials,fixed equipment,professional fees,and materials and ldex,.r,, bor which may be donated gratis.) 7. Property Owner: ew"', 1�� -tee 6-4.t�Tess: -6p Illµ 1� I (000) Phone P jq 1 1 7-- r 2-3 Sl __Cell# 91 IS— email: "o A2.r 8. Architect/Engineer: Address: Phone# Cell# email: 9. Sprinkler Contractor:i 'J S rn 1.NCAddress: f"�' 'd A 7 Phone# 3d f 3 Cell# �f)t( email, 3r3/2023 '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 andior not propt"'fly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATOOF EW FORK,COUNTY OF WESTCHESTER ) as: Da. .9-- - ,being duly sworn,deposes and.states that he/she is the applicantov abe named, , (Print name of individual signing ms the appitcart) and further states that Csj40 is the Sprinkler Contractor for the legal owner and is duly authorized to make and filc this application. Iliat all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,aruse 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 bcforc nic this �6L Sworn to before me rhis /5'5 day ol- �LO' 20 day of fi? -C ,;;,plature, 010P -CM-rxer Signatv4 of Appliml d-=" PrII)II, e a' rop rty Owncr Print Name ol'Applicanl >9 1 '9 0 1�211 1 N'vtery"Puhfie Votary hihh,� SERANA F EDWARDS MADELINE G', CITRONE Notary Public-State of New York pioa Notary Public.State of New York NO. OIED6434559 (Qualified to Westchester County No. UI MAeO3O446 My Co-mission Expires Jun 6, 2026 Qualified in Westchester Count, E Commission Expira6 Sept. 13, ?-n.'