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HomeMy WebLinkAboutBP23-131 z s M _ \ cl, W .o O° a, � CY Q � � 7 o On � W Ey o a w x • (, o 64 O © Ln � o � $ ou TT 2 "2 W V eMt (W 8 � o r .r 7 T wo � „ � � W = Naae o " eke W W U ti9 z W A. co 00 L"r 0 U oo O w a°� o M _ j•� © T-+ F eq eq W w os Alfte s a�i d 00 H py z E• o _ � y un p4 a H o zb �w � _ ] ' os � � °W o ff po = A z 1 w 9) U p ZO � U O O U g o o b a a w � u IUA `. BUILDING DEPARTMENT R I C IE R VILLAGE OF RYE,BROOK J U L - 7 2023 DD 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.orz BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:Approval Date: AUG Q 3 IOU) hermit#,A6103_ '3r/ Application Fee:$ Q5iaAb Approval Signature: Permit Fees:$ /' DCOJ bUE Disapproved: Other: Application dated: / is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: Co 9 91 W IES-1 C.A E g'77 I , L SBL: 13S •+A - I- R Zone: _ 2. Proposed Improvement.(Describe in detail): E f -A9C1 }2,c'X`*A 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: 12( Yes: If yes,indicate: TIER I: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No:->S,—Ycs: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comet.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: p 7. Property Owner kt thW0- LI C Address: LoglCL Phone# q ti A- q Z 2 . 4 64S Cell# email: 8. Applicant: Address: Phone# Cell# email: 9. Architect: ��(`�1►1C.�J Address: .5:S2— W, 4a 4 eg tk Phone#747-&'4.E852 Celi# AENNIEX>--((zz:1 rt F(kA?-A-�ACN1v.+=2 l�Rc`l- 1TECTS, c.o�y 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: I I Address: I R,--, kk\Af('C- N4 N�4 Phone# 4.14. 4-% .1 S'1 Cell# email: I ob43 12. Estimated cost of construction $ y Qtonc:t ) (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: /`T Finish: 1 k-uA (1) 6/l/2Q23 ME BUILDING DEPARTMENT E C E VILLAGE OF RYE BROOK JUL - 7 2023 938 KING STMET RYE BRooK,NY 10573 (%4)939-0668 VILLAGE OF RYE BROOK wwW,ryi�ook:org 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: residing at, cL{1 Ulf(�, TC�L�SlL`- p� I=71�U L. (Print name) (Address where you live) being duly sworn, deposes and states that(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; Rye Brook,NY. {Job Address) - � Y 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. IS AL-t- SZ, L erty O s)) C��4 L'4 kx \_Mut� or� &A6.tf4 LW (Pint Name of Property Owner(s)) l Sworn to before me this 1 da f ,1 20� (Notary Public) SHARI MEULLO Notary Pubilc,State of New York No.01ME6160063 (2) Quallfled In Westchester county commission Expires January 29,201 8/12/2021 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. Please note that application fees are non-refundable. TE OF NEW YgJM COUNTY OF WESTCHESTER ) as: F t >�"4 _ 1 Ono t� —,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and furt4er states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the = C for 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. By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this �-° Sworn to before me this day ofS1 )U L,J , 20 Z,.3 day of V Lq 20 9 L.L c e of rty Owner f e App i t 4 �u Name of Property Owner ~ameofApplicant .V-\JL�L— ��-I �Jl Notary Public Notary Public SHARI MELILLO SHARI MELILLO 'Votary Public,State of New York votary Public,State of New York No.01ME6i60063 No.01ME6i60063 Quallfled In Westchester Coun --] Qaallfled In Westchester county-2-7, ,ommission Expires lsnuary 29,20 1 ,rnfssion Expires January 29,20G (4) 8/1212021