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• 1982 • BUILDING DEPARTMENT
UILDING 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 : J Ir\ DATE: t Z 1 -1 v
PERMIT# (: ` (- ISSUED: SECT: BLOCK: LOT:
LOCATION: { U �cic �(A v`l~ 1 OCCUPANCY:
❑ Violation Noted THE WORK IS... tj PASSED ❑ FAILED 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
❑ eROSS CONNECTION
,Y FINAL
f'❑ OTHER
BUILDING DEPARTMENT D D
VIL#A'GE OF RYE OOK RMAY 3 0 2023
938 KING GE
RYE BR ,NY 105
{ LBULILDING
GE OF RYE BROOK
(914)93,9-0668 FAX(914)939-5801 GEF RYE.DEPARTMENT
vim .ryebrook.org
FOR OFFICE USE ONLY: �' �}�
Inspection Date
Approval Date: Re-Inspection:
Approval Signature: Original BP#: Date:
Disapproved a/c: Date: Renewal Fee: 5P
2 --.
J 11_jk_j Due: ❑ Paid
ra,t�«*,r,t,t*,r�,r*,r*,t*,r************************,r***��******,r*,t*,t**,tr**,►,t,t*,t*w*,r***,w*r*,►***********,r************
ANNUAL RENEWAL APPLICATION
FOR EXISTING HOME OCCUPATION PERMIT
Application dated: 5'�30--,—)�,is hereby made to the Building Inspector of the Village of Rye Brook,NY,to renew a lawfullyexisting
Tier II or Tier III Home Occupation in accordance with§250-38 of the Code of the Village of Rye Brook,as described below.All Home
Occupation Permits must be renewed by no later than June 15'of each year.Please consult the above captioned section of Village Code at,
www.ryebrook.org.for fiirther information prior to filing this application.
1. Address: 492 North Ridge Street, Rye Brook, NY
2. Parcel ID#: 12,9/.60-1-41 Zone: R-15
N7 3. Property Use: One Family; ❑Two Family, ❑ Multi-Family, ❑Other:
4. Property owner: Diane Schwartz Estate Tax Sheltered Trust
Address: 492 North Ridge Street, Rye Brook, NY
Phone# 914-939-0558 Cell# 914-420-1892 email:
Applicant: Dr. Samuel Schwartz
Address: Same
Phone# 914-939-0558 Cell# 914-420-1892 email:
5. EXISTING HOME OCCUPATION:check one:Tier II( ) Tier III W(Full disclosure detailing the exact nature of the
proposed home occupation,hours of operation,number of visits per week,number and names of employees,etc... or any other
changes in the nature of the home business since the original approval is required by law.)
[use additional sheets if necessary]
Chiropractic Services. For the specifics of the use to which the premise is put;
reference is respectfully made to the Resolution on Appeal of the Zoning Board of Appeals.
3121119
Please note that 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.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
SgM t4 t:L S c 14 VV A Q-rZ ,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
u A d►fa R a r,c( 0_1Z.V t S r e e-F fvIi;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.
Swom to before me this �� Sworn to before me this S
day of day of /' —. j
20
)-,)ij
N �ublrc Notary Public
Sig �e of Property Own ignature of Applicant
Print Name oyf Property erG2� / Print N f Applicant
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LAST REVISED:6.6.06