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HomeMy WebLinkAboutPP23-063 s � N N N N N N w " o O k a � H O � o o4-4 � W . co H w . w Q z W p 00 x O 0�7 O w W uz o `n , � z 0�% CA PLO AF 00 _ H z .z A a 08 1-4 w ° O w �' © z xI1 u O a Vy " x z H �4 o �' LO o w z cq H w 04 x � _ate �::, JUN 2 2 2023 BUILDING DEPARTMENT VILLAGE OF RYE BRQUK VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KIN69TRf;I:'l RYF}IR ,NY 10573 ,(914)93.9- , www.r� d ory PLUMBING PERMIT APPLICATION // FOR OFFICE USE ONLY BP#: PP#: �3—OCy,3 Approval Date: W/ —2 Z_ 0 Permit Fee: $ Approval Signature: - Other: Disapproved: (fees are non-refundabuc) Application dated,& -3 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 57 HILLANDALE RD, Rye Brook NY, 10573 SBL: 130, 17-1-4 Zone-X?3-!;' 2.Proposed work: To excavate in property and repair approx. 10'of 4"cast iron pipe. 3.Property Owner: Margode Grossberg Address: 57 HILLANDALE RD, Rye Brook NY, 10573 Phone#: 9176967929 Cell#: N/A email: Grossberg@aol.com 4.Master Plumber: Milkjor Shilaku Address: 1178 E 180th Street Bronx NY 10460 Lie.#: 1372 Phone#: 718-231-3663 Cell#: 347-538-4621 email: office@expressplbg.com Company Name:Express Plumbing Sewer&water Main contracting Corp.Address: 1178 E t 80th Street,Bronx NY 10460 INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary I Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 31d Floor 4's Floor 5"�Floor Exterior � t 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 313/2Q23 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as; Milklor Shilaku ,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 Master Plumber for the legal owner and is duly authorized to make and file this application. 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 day of /�, ,20Z day of 20 � Signature of Property Own r Signatur of Kpplicant Print Name of Property Owner 0 Print Name of Applicant keL�- &��= �n'kA. Notary bl% (GORY M.RIVERA Notary> I MEULLO Public,State of Now Netary Public,State of New York Notary Public, OIME61BOO63 York No.01RIS441398 Qualified In VJestehester Countyr�' m Qualified in Westchester County Commission Expires January 29,20?- Co nission Expires September 26, 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. -z- 3/3/2023 BUIqET :4 - VILLAGE MENT VIL OOK 938 KINGBit ,NY 10573 j U N 2 2 2023 ID 0 OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE 216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR 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: ` I 3J, 700—� �4�5 , residing at, I� 1 1� 1(;t jd k C04 (Print mane) (Address where you live) being duly sworn, deposes and states t at(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; ' dCA , Rye Brook,NY. tJob Address) Further that all statements contained herein 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 stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property (hr nc r1 S)) (Print Name of Property Owner(s)) Sworn to before me this day of U ri L , 20 31'mJAA1M ( otary P lic) GREGORY M.RNERA Notary Public,State of New York No.OI RI6441398 3 Qualified in Westchester County Commission Expires September 26,7 8)12/2021 BRC�� Village of Rye Brook Public Works and Engineering Department JJ °� 938 KING STREET•RYE BROOK,NY 10573 (914)939-0753 Fax(914)939-0242 INSPECTION REPORT Address: r ��//i Date: ,c Name: ! ��� ��1 �(//'�/� / Location: Permit#: Phone: Email: Work being Inspected: Work Inspected is: Ad Rejected Re-Inspection Required Violation Noted Code Section Code Section: Action Taken Code Section: Action Taken 118 Erosion Sediment Pass Fail Violation 210 Storm Water Pass Fail Violation 135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation 213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation 216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation Other: Pass Fail Violation Notes: Alo 7 ' �� /lam Diagram: Signature/ �!�,