HomeMy WebLinkAboutThe Kingfield Community Clubhouse Operating Certificate 2023-2024 ■
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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 ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS: t DATE:
J
PERMIT# �C N A 1( ISSUED:C�6v-w JECT: BLOCK: LOT:
LOCATION: ���6� tJ �"`�� OCCUPANCY: Z U
❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION i REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING \ t
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas C
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
p FINAL
❑ OTHER
BUILD NC DE MENT
VI cr Oi, Rvi- BE OK MAR 2 0 2023
938 KING a:r R�'E:: 111u4 NY 10573
14 939-06 ' '� VILLAGE OF RYE BROOK
CUNLDING DEPARTMENT
FIRE INSPECTION / OPERATING PERMIT APPLICATION
FOR OFFICE USE ONLY: / �' 30/0IV7
Fee Paid: $ 'f�Q __ Inspection Date&Time: e�7
FEE SCHEDULE: Re-inspection Date&Time:
Triennial & Private School Annual Inspection: =$450.00
Public Assembly Annual Inspection: <100 People=$525.00/>100 People=$775.00
Application,dated: januacy 16, 2023 ,is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting
that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business,
private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform
Fire Prevention & Building Code, Title 19 NYCRR Part 1201, and all other applicable local, County, State &Federal laws, rules&
regulations,as per detailed statement described below.1. Address: 1 Rose Lane, Rye Brook, NY 10573 SBL:/o)9it).5 �'-�— ��A Zone: P466
2. Business/Occupancy Name: Kingfield Lot Owners Association NYS Use Class:
3. Property Owner: Kingfield Lot Owners Association Address: 1 Rose Lane, Rye Brook, NY 10573
Phone# 203-653-6542 Cell# email: Cbaldwin@plazarealtymgmt.com
5. Business Owner: Address:
Phone# Cell# email:
6. Emergency Contact: Courtney Baldwin Address: 1 Rose Lane, Rye Brook, NY 10573
Phone# 203-653-6542 Cell# email: Cbaldwin@plazarealtymgmt.com
7. Inspection Escort: Title:
Phone#: Cell#: email:
8. Provide a brief description outlining the current and/or intended use of the property:
Community Clubhouse
9. List all Hazardous Materials:
10. Occupant Load: Existing: Proposed: Other:
11. Date&Disposition of Previous Fire Inspection: 5.12.22 Pass ❑ Fail
i
8 12 2021
This application must include the notarized signature(s) of the legal owner(s) of
the above mentioned property, in the space provided below. Any application not
bearing the legal property owner's notarized signature(s) shall be deemed null
and void, and will be returned to the applicant.
S 19F NEW-YOBonrCoGNhe 1v.� >SS: S�a`nn Four
Gylv lvw 1 r1 ,being duly sworn, deposes and states that he/she is the applicant above named,
(print name of indiv dua signing application)
and further states that he/she is the legal owner of the property to which this application pertains, or that he/she is the
R&rnt ,for the legal owner and is duly authorized to make and file this application. That all
(indicatk architect,business owner,attorney,agent,etc.)
statements contained herein are true to the best of his/her knowledge and belief,and that any work perfonned 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 11�1111 Sworn to before me this 5 iv,
day of A Ow LO , 202 5 day of M(fit C c 0 120 z 3
Notary Public Notary Public
Signature of roperty Owner pp Signature of-Applicant
C114 �13 W_\
Print Name of Zroprty Owner Print Name of App 'ca t
CNo
LE PACHEC0
�. blic,State of Connecticut NICOLE PACHECO
'
31 y028 Notary Public,State of Connecticut
ion Expires January
My Commission Expires January 31,2028
2
8/12/2021