Loading...
HomeMy WebLinkAboutMP23-104 a i W J ea y r� U'1 Ow A . Lr) ,b s a Z O \ O A 00 W .i' o o o ob �I O � � M r/a � � � [� o O .� � •� r 01)0 If�T, ►-a E' u ^d v co Ln F N ;� QV ^G �? V0) ~ 0000 x U z v n 01% . o : W IQsloe aON C i Z O V .a 00 = 3 v e ON V v) .� v W 0 = V A0-4 w = M � ,, v3oa Rao Z Z zZ o � H V a a P-M z o ;4 0 0 W � .a -d D E C E� V BUILDING DEPARTMENT JUL - 6 2023 VIL AGE OF RYE BROOK 938 KING�ikEET RYE BRooK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.rye6rook.ar8 APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT #: 3 Approval Date: JUL Pr4 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CE_RTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder) & Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit-COMMERCIAL= $350.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice require,) 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing inspection. Application dated, 3 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations.v` � k 1. Address: �2 C. -roe Y ��-lr,` BK cO SBL: 13J/62 —1-6 Zone: 2. Property Owner: I,Gk V1 G1 E✓' a jVt 1���.� Address`:Z C o� ecie Phone#: It I,- 3 } - (DYE�q Cell#: Co7(o`1 email: G t 1'V PkAu 3. Contractor: F.CAA:k C Address: 1eVlq Phone#: `��y-{e�3�� �$fj Cell#: q 1q-'iQ email: ►nf%pelI ntCtcDIt._MULWAea��t (J 4. Scope of Work:New Installation(-j<Replacement( )•Removal( )•Other( ): ---)-D3 e-,o4,P)r--f7,1 Ck CQA 5. List Equipment: 7Tn Sin 1 \\!A P 6. Location of Equipment: jL1( � 7. Method of Installation/Removal(list all equipment needed to perform job): 1 3/3/2023 17 Fi-om: jennifer.martucci@plitnick.com Subject: Affidavit of Compliance Building Department of Rye Brook Date: Jun 27, 2023 at 1: 16:42 PM To: mlgiampino@yahoo.com Good afternoon, Attached you will find the Affidavit of Compliance for the Building Department of Rye Brook. Please sign and notarize this document per the instruction. ;` Kindest Regards, w Jenny BUILDING DErAR'rt11F.NT VILLAGE OF RYF..RROOK 938 KIN4r S'rRF.VT RYE BRrn)K,NY 10573 (914)93 9-11 6 6 8 Ir.e)l.nrbrnnk.urk . ....................................... AFFIDAVIT OF COMPLIANCE VILLAGE CODE 216- TO1tM SEWERS AND SANITARY SEWERS IRIS AFFIDAVIT/OUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND RE SUBMITTED ALONG WITH ANY RUILDING OR PLUMAING PERMIT APPLICATION• ANY BUILDING OR PI,UNW,, PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTAR12E0 FORM WILL RE RETURNF_O TO THE hPPLIcANT. S'r/ATE OF NEW YYORK,COUNTY 01"WESTCHESTER residing at. bein g dui swum,do b Y poses and states that($)he is the applicant above named,and further stales That(s)hc is 111V legal owner of the PrOPerY to which this Affidavit of Compliance pertains al; /�7 � ( .Rye Brook,NY Further that all statcmenls contained herein are true,and that Io the best oorhis/hcr knowledge and belief,that Ihcrc arc nn known iltegUl crlrss-conncctnlns concerning either the storm sewer or sanitary sewer,and further thal Iherc an•Iro roast drains,sump pump,,nr usher Prohibited stornwalcr or groundwater connections or sources of Int1o.Y Ill inAhration of any kind into :Intl the s.nry tita solver from the Subject pr©Pcrty in accordance with all State, {Oln11l' IllAge Codch, JOHN M SUOTZO /L1{ f2 r A CC'l Alec Pr Ajt (1107ARY PUBLIC,STATE Or NEW VW Reglstratkln No.01 SU6070919 DuWifled In WBstchestar County Sworn 10 before me this / MN Commlasion EAlbas March 11,20M 9 I OF WESTCHESTER as; he/she is the applicant above named, STATE OF NEW YORy,COUNTY ) being duly swom,deposes and states that ° ". (prim name of. vidue1 ur)hg`s the Heating, Contractor for the legal owner and is duly and[mother states that(s)he is the Hcati°g,Ventilation and/or Air Conditioning erformed,Or use authorized to make and file this application. That all statements contained herein arc true to the in st of his/her conformance with knowledge details belief, set forth and contained in this application conducted at the above captioned property 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. r; Sworn to before me this Swom to before we this �t -- day,of ZO,� day of--- 20 Signature of Applicant Signature of Prope Owner Print Name of Applicant t Name of Property e terry Public Notary Public SHARI MEt.ILL0 Notary Pubtle,State of New York No.01ME6160063 qualtMed In Westchester County. Commisslon Expires January 29,2V_( 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 and/or not properly signed shall be deemed null and void and will be returned to the applicant. a 3r312023 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 t 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 as 20'D3 _ day of 201} Signature of Property Owner Signature or Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public '9 uuj..0, RLA. o This application must be properly completed in its entirely and must include: the notarized sis;�t the legal owner(s) of the subject property, and the applicant of record in the spaces provided. 1)(s��'�9Vfg�g>)�tv��.•`' 4,,,unrurNr� not properly completed in its entirety and/or not properly signed shall be deemed null and void .Intl evils he returned to the applicant. -2- 3 3 2023