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HomeMy WebLinkAboutMP23-122 N � � a CV N N Q a + �1 00 \ 00 ` b 000 00 cn y Oa+ O M'al a low ca r^ A y `•: . Eo- Ch _ � W o low , Q h"'1 O Ca p to o V] w _ 4-4 r-+ M n if' � oo © ° ,.0/ as �C�..,1) ❑ M .�. .� O � � .ti Cam,-o a �'s �"'i _ y� a 0.4 co © OZ OZ 00 Vzo. e M 0.0 OC Mai C/) G1 w V x w cp 0 �D � W w A z �J' Wl O C W 1�1 �� F" © U Z o a n ti c v � � W o ° a � v CI) a O O V 2g 'bINu U O V (Alf w � � - o � z A o p � y, -4� E� N Q z 4 Ra a 4) W W OF aa,ae .� Q'I as w a w x cub BUILD EPA MENT R F.C IE Q V LE VIL E OF RY OOK 938 KING ET RYE BR ,NY 10573 JUL 13 2023 I4 , -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING 'VENTILATION AND/OR AIR CONDITIONING E UIPMEN S FOR OFFICE USE ONLY: PERMIT#: /'" _/��c� ti� Approval Date: Permit Fee:.$ / r4 Approval Signature: / ' Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT: CERTIFICATE OF COMPLIAN£k: 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 required) 7. Electrical work requires a separate Electrical Permit& Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. Application dated, /.3—�13 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.I. Address: 0- SBL: /,, /,3 / zone: 08- S 2. Property Owner: ddress: Phone#: 9J'� "' 9--•�!(a�„ Cell k email: 3. Contractor: Address: Phone#: L 4 540 7 Cell#: email: 4. Scope of Work:New Installation( )• Replacement( )•Removal( )•Other( ): 5. List Equipment: 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): i 3/3/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that be/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor 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 Zq*42 Sworn to before me this day of ,20 day of ,20 Signature of Property Ow er Signature of Applicant /bAg1mq 415r74%-4 twe/2 c ;; Property Owner Print Name of Applicant v�"-- N f Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.O1ME6160063 Qualified In Westchester County Commission Expires January 29,241 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. L 2 3/3/2023 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) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor 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 ,20 _ day of l l�� ,20 1 Signature of Property Owner ature of App 'c Print Name of Property Owner Print Name of Applicant Notary Public gotary blic GREGORY M.RIVERA Nabn Public,State of New York No.DIR16441398 r oualltied in Westchester County Comsrttssbn Expires Uptamber 26,2t1 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. 2 3/3/2023