HomeMy WebLinkAbout2 International Drive Fire Inspection Report 2021 BUILD TMENT
VILL OF RY OOK Initial Inspection Date: ❑ Pass
MICHAEL J.IzzO 938 KINGS ,RYE BROO EW YORK 10573 }Z^i!Z \ Fail
BUILDING&FIRE INSPECTOR (914)93 q 39-5801 Re-'-1!Ty tion Date: El Pass
mizzo(a)rvebrook.org FLO
❑ Fail
FIRE INSPECTION REPORT, NOTICE OF VIOLATION & ORDER TO REMEDY SAME
Site Address: N� /( Zone: SBL: y 2 i !
Occupancy. " State Use Classification:
Business Owner: - �(�C�� Phone:
Building Owner: I 0 Phone:
Emergency Contact: ( Phone: A T//11
Building Representative in Attendance:
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Take notice that the following violations of the New Yo State Unif Fire Prev lion&Building Code and/or the Code of the Village
of Rye Brook were found to exist at, r -) ,in the Village of Rye Brook,NY on,
20 .The person or entity served with this Order to Remedy must completely cure each
violation described in this Order to Remedy by ,which is thirty(30)days after the date of this Order to
Remedy.You are finther directed to contact the Building Department during normal business hours to schedule a re-inspection of the
premises to confirm fidl compliance with all applicable codes,laws,rules®ulations.
BE ADVISED THAT YOUR FAILURE TO CORRECT ALL VIOLATIONS IS A CRIME PUNISHABLE BY FINE,IMPRISONMENT OR BOTH.
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No YES N/A
1.PORTABLE FIRE EXTINGUISHERS (PFE's)
a.906.1 Are PFE's installed throughout the space&on the premises as required by code. a.
b.906.3.1 Is the maximum travel distance to a PFE 75 feet or less. b.
c.906.5 Are PFE's conspicuously located&readily accessible. C.
d.906.6 Are PFE's unobstructed/unobscured from view. d. _
e.906.7 Are PFE's properly mounted as per the manufacturers instructions. e.
f.906.9 Are PFE's properly installed:<40 lbs.max.5' above floor;>40 lbs.max.3.5'above floor. f.
2.FIRE ALARM SYSTEM&SMOKE DETECTORS
a.901.6.1 Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72. a.
b.907.4.1 Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b.
c.907.4.2 Is the height of the pull station handle located between 42&48 inches above the floor. C._ c/
d.907.3 Is a fire alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d.
3.FIRE SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS
a.901.6.1 Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a._ ✓
b.901.6.1 Are the main valves secured against tampering in the open position. b._
c.901.6.1 Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C._
d.901.6.1 Is a supply of six spare heads&a wrench maintained on the premises. d._ v'_
e.901.6.1 Are sprinkler heads&cover plates unfinished or of factory applied finish only. C._
f.901.6.2 Are records of all system inspections,tests&maintenance reports maintained on the premises. f _ Jl,
g.913.5 Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g.
h.507.5.2 Is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h.
i.507.5.4 Are fire hydrants&fire protection equipment unobstructed. i. _
j.507.5.5 Is a clear space of not less that 3 feet maintained around all hydrants. j.
k.901.8 Are all fire protection systems in place and maintained untampered. k.
l I`
INSPECTOR: "' DATE:
_I.
Rid Faun
No N/A
4.STANDPIPE.CABINETS&FIRE DEPARTMENT CONNECTIONS
a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. _
b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. —
c. 912.2.3 Are standpipe FDC threads compatible with fire department standards. C.
d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d.
e. 905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e. _
f.912.2.1. Are exterior FDC's fully visible&recognizable from the point of fire department access. f.
g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g. _ yl
5.EXITS,MEANS OF EGRESS&OCCUPANCY
a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. _
b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b. _ _
c. 1031.6. Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... C. _
d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. _ c/
e. 1010.1.Are egress doors provided and maintained as required by this section. e. _ _
f. 1004.3.Are all spaces having an assembly occupancy Posted with an approved occupant load sign. f.
— � —
g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g. _
h. 1013.1.Is the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h. _
i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1. provided as required by code. i. _
j. 1013.3. Are all exit signs illuminated at all times.
k.1008.1. Are the means of egress&exit discharge illuminated at all times the building is occupied. k.
1. 1018.3. Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures I. _
are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides.
m. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least M.
28"wide,or at least 36"wide where serving 50 or more people.
6.COMBUSTIBLE STORAGE&WASTE MATERIALS
a.304.1. Is the building(s)and premises maintained free from accumulated combustible waste material. a.
b. 304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b.
c. 304.2. Is combustible rubbish stored so as not to create a nuisance or hazard to the public. c.
d.315.3.Are combustible materials properly stored&separated from ignition sources. d.
e. 315.3.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e.
and 18"or more below sprinkler head deflectors in sprinklered buildings.
f. 315.2.2.Are exits&exit enclosures maintained free from stored combustible materials.
g. 315.2.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g. _ 1�
h. 313.1.Is building maintained free from stored fueled equipment.(motorcycles,mopeds,mowers,etc...) h.
7.ELECTRICAL
a.604.1. Are emergency&standby power systems properly maintained. a. _ v _
b. 605.1.Is the building free from modified/damaged wiring,devices,appliances,equipment and b. _
maintained free from electrical hazards.
c.605.2. Are electrical service equipment areas properly illuminated. C. _
d.605.3.Are proper working space clearances provided&maintained for electrical service equipment. d. _ ✓
e.605.3.Are electrical service equipment working spaces free from any stored materials. e. _ _✓
f. 605.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. f. _ _✓ _
g.605.4.Is the building free from unfused multi-plug electrical adapters. g.
h.605.5.Are electrical extension cords being used in a safe manner as per code. h.
i. 605.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. i..W
j. 605.6.Is the building free from open-wiring spliced electrical connections. j.
k.605.8.Are electrical motors maintained free from accumulated oil,dirt&debris. k.
1. 915.1.Are Carbon Monoxide Detectors installed&maintained as required by this section and by 1103.9. L
INSPECTOR: DATE:
Revised faun
-2-
No YES. N/A
8.ELEVATORS.DUMBWAITERS&ESCALATORS
a. [PM]606.1.Are elevators properly maintained,and is the current certificate of inspection on the premises.a.
b. 607.3. Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b. �[
floors reading; IN FIRE EMERGENCY,DO NOT USE ELEVATOR,USE EXIT STAIRS
c. 607.7.Are keys for elevator car doors&fire department service kept in an approved location. C.
d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. _
e.[B]3005.1.Are elevator machine room doors maintained unobstructed at all times. e.
9.COMMERCIAL KITCHENS
a.904.12.5.Are portable Class K fire extinguishers within 30 feet of cooking equipment. a.
b.904.12.6.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b.
c. 904.12.6.2.Are automatic fire extinguishing systems serviced at least every 6 months&after system C.
activation,and is the certificate of inspection forwarded to the code enforcement official.
d.904.12.6.3.Are fusible links&automatic sprinkler heads replaced annually. d. _
10.HEATING SYSTEMS
a.[PM]603.1. Are all heating appliances properly installed&maintained in a safe working condition. a.
b. [PM]603.2. Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b.
c. [PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C.
d. [PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d.
e. [PM]603.5. Is the fuel-burning equipment provided with adequate combustion&ventilation air. e.
11.MOTOR FUEL—DISPENSING FACILITIES&REPAIR GARAGES
a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a•
in an approved location within 100' of,but not less than 20' from fuel dispensers.
b. 2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. _
c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C.
d.2305.5. Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. _ _
2-A:20-B:C provided&located not more than 75'from pumps,dispensers&fill-pipe openings.
e. 2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e.
f.2305.7.Are combustible materials kept at least 10'from fuel-handling equipment. f.
g.2306.4.Are above-ground tanks provided with vehicle impact protection. g.
h.2306.5.Are above-ground tanks provided with secondary spill containment. h. _
12.HAZARDOUS MATERIALS(HAZ—MATS)
c. 407.2.Are M.S.D.S. for all haz-mats readily available on the premises. a. _ _
d. 407.3. Are spaces and individual containers containing haz-mats properly labeled&identified. b.
e. 5004.2.Are stored haz-mats provided with approved secondary spill containment. C.
d.5003.7.1.Are proper No SMOKING signs provided as per this section. d. _
13.MISCELLANEOUS
a.403.1. Is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. _ J�
b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b. _ —
c.405.5. Are records of emergency evacuation drills kept&maintained on the premises. C.
d. 505.1.Are approved address&building numbers properly placed&plainly visible from the street. d. — ✓ —
e. 506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e. _
f.703.1.Is all required fire-resistance rated construction properly maintained as per code.
g.703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g. _ _✓
h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h.
i. 5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. I.
14.GENERAL HOUSEKEEPING
a.Good
b. Fair
c. Inadequate
d.Poor
INSPECTOR: 4DATE:
Revised 10/4/17
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ITEM NUMBER RE ARKS
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INSPECTOR: DATE:
Revised 10/4/17
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Since ' Certified Elevator Inspections, Inc. Smed ince
420 Columbus Avenue, Ste. #510. Valhalla. NY 10595 • Phone: 914 428-3419 • johnceil`droptonhne.net
January 27,2022 p [E C V E � V (S
1100 King Street Associates L��
C/O George Comfort&Sons,Inc. J U N 2 9 2022
4 International Drive
Rye Brook,NY 10573
Attn:Larry Christ VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
Re: 1100 King Street,Annual Elevator Inspections-Rye Brook New York
Dear Sir.
On January 24&25 2022 I witnessed the code required annual no load hydraulic pressure and safety tests on twelve(12)
passenger elevators located at the above referenced address as performed by your elevator maintenance company Liberty
Elevator Corp.
The elevators were tested to ensure compliance with testing procedures required by ASME A17.1 Safety Code for Elevators and
Escalators as referenced by the 2020 NYS Building Cody Chapter30
The following violations were revealed that require correction to comply with code:
Building#1
Elevators#1&2
1.Fire recall Phase II does not work in the hold position.
1� R�missing car platen plate bolts(not done)
Building#2
Test satisfactory
Building#3
Lobby Phase I key switch does not work,unable to test recall system
Building#4
Test satisfactory
Building#5
Elevators#1&2
1.In—car emergency lights and alarm do not work
Building#6
Test satisfactory
The violations listed must be corrected in a timely manner as required by the Village of Rye Brook Building Inspector.
Elevators are deemed safe to operate,but compliance is mandatoryl
If you have any questions regarding this report,please feel free to contact my office.
Yours truly,21,fied `
Elevator Inspector
NAESA QEI Cent#G 875I NYS Inspectors Llc#132-21-01IS9
C.c.Michael J_Izzo Village of Rye Brook,Liberty Elevator Corp.
• �NA�SA ' j
Certified C-875 SA
Since 1993 Certified Elevator Inspections, Inc. CSi cee 199375
7.11 Legion Drive. Suite 103. Valhalla. NY 10595 • Phone: 914 428-5419 Fax: 914 428-3501 • johncei@optonline.net
January 26,2021 J AN 2 2021
1100 King Street Associates
C/O George Comfort& Sons, Inc.
4 International Drive
Rye Brook, NY 10573
Attn: Larry Christ
Re: 1100 King Street,Annual Elevator Inspections-Rye Brook New York
Dear Sir:
On January 22 &23 2021 I witnessed the code required annual no load hydraulic pressure and safety
tests on twelve(12)passenger elevators located at the above referenced address as performed by your
elevator maintenance company Liberty Elevator Corp.
The elevators were tested to ensure compliance with testing procedures required by ASME A17.1 Safety
Code for Elevators and Escalators as referenced by the NYS Building Code, ChapterM
The following violations were revealed that require correction to comply with code:
Building#I
Elevators# 1&2
1. When cars are on fire recall Phase I and return to lobby the fire buzzers must turn off.
2. Fire recall lights must remain on during Phase I and 11 operation.
Elevator#2
1. Replace 2 missing car platen plate bolts
Building#2
Elevator# 1
Fire recall lights must remain on during Phase I and II operation and buzzers must turn off.
Elevator#2
1.Car does not recall on Phase I
2. Control valve relief is set at 600psi; it must be set to approximately 450 Psi
3. Fire recall lights must remain on during Phase I and 11 operation.
Building#3
Elevators# 1 &2
1. When cars on fire recall phase I and return to lobby the fire buzzers must turn off and fire lights must
stay on.
Elevator#2
1. In-car emergency Phone does not work.
2. Replace broken emergency light lens.
A
Cenified C-875 VNAESA
Since 1993 Certified Elevator Inspections, Inc, Certified
199375
7-11 Legion Drive, Suite 103. Valhalla. NY 10595 • Phone: 914 428-3419 Fax: 914 428-3501 • johncei(4optonline.net
P¢.2
1100 King Street Associates
C/O George Comfort& Sons, Inc.
4 International Drive
Building#4
Elevators#1&2
1. When cars are on fire recall and return to lobby the fire buzzers must turn off and lights stay on.
Elevators#1
1. In—car emergency phone does not work.
Building#S
Elevators# 1 &2
1. In—car emergency lights and alarm do not work.
Building#6
Elevators# 1 &2
1. When cars are on fire recall and return to lobby,the fire buzzers must turn off, lights must remain on.
Elevator#2
In—car emergency lights and alarm do not work.
The violations listed must be corrected in a timely manner as required by the Village of Rye Brook
Building Inspector.
Elevators are deemed safe to operate, but compliance is mandatory!
Please notify this office when all violations have been complied with so that a reinspection can be made
and we can provide you with a compliance letter.
If you have any questions regarding this report,please feel free to contact my office.
Yours truly,
Qco;hhnGd. Boc--inis
Certified Elevator Inspections
NAESA QEI Cert. #C-875
Certified Since 1993
C.c.Michael J. Izzo Village of Rye Brook, Liberty Elevator Corp.
A aul
A
Certified C-875 Certified C-875
Sim 1"3 Certified Elevator Inspections, Inc. Since 1993
7-11 Legion Drive, Suite 105, Valhalla, NY 10595 • Phone: 914 428-5419 Fax: 914 428-5501 • johncei@optonline.net
February 21, 2020 VVILLAGE
�f1100 King Street Associates
C/O George Comfort& Sons, Inc. 3 2Q2Q4 International DriveRye Brook,NY 10573 RYE BROOKAttn: Larry Christ RARTMENT
Re: 1100 King Street, Annual Elevator Inspections-Rye Brook New York
Dear Sir:
On February 19,20,2020 1 witnessed the code required annual no load hydraulic pressure and
safety tests on twelve(12)passenger elevators located at the above referenced address as
performed by your elevator maintenance company Liberty Elevator Corp.
The elevators were tested to show compliance with testing procedures required by ASME A17.1
Safety Code for Elevators and Escalators as referenced by the International Building Code.
At the time of the inspections,the following violations were revealed that require correction to
comply with code:
BuiMWM # 1
Elevators# 1& 2
1. Replace two missing piston Platen plate bolts,requires four.
2. Emergency lighting and alarm does not work.
Elevator#2
1. Remove excessive oil from catch pan.
2. Does not recall on Phase 1
3. Emergency lighting and alarm does not work.
Buildin-e # 2
Elevators# 1 & 2
1. In-car emergency lights and alarms do not work.
2. Provide and install an engraved plaque on each car button station stating Elevator number.
Building # 3
Elevators# 1 & 2
1. Remove excessive oil from catch pans.
rru7CEl
Certified R75 Certified C-R75
Sincel99993 Certified Elevator Inspections, Inc. Since1993
7-11 Legion Drive, Suite 103, Valhalla, W 10595 • Phone: 914 428-3419 Fax: 914 428-3501 • johncei@optonline.net
Pg.2
1100 Kina Street
Buildine # 4
Elevator#1&2
1. In—car emergency phones do not work.
Building # S
Elevators# 1 &2
1. In—car emergency phones do not work.
2. In-car alarm bell does not work when stop switch is activated.
3. Provide and install an engraved plaque on each car button station stating Elevator number.
Building # 6
Elevators# 1 &2
1. Test Satisfactory
All Elevators
The type of elevator controls installed in these buildings predates the use of a call cancel
button when the elevators are on phase II operation.
The recent installation of new car button fixtures in all the elevators, Incorporate a call cancel
button. The call cancel button in each elevator must be removed and blanked off as to not
confuse the local fire fighters during an emergency.
The violations listed must be corrected in a timely manner as required by the Village of Rye Brook
Building Inspector.
Please notify this office when all violations have been complied with so that a reinspection can
be made and provide you with a compliance letter.
If you have any questions regarding this report,please feel free to contact my office.
Yours truly,
`
?J_o n G.Bochinis
Certified Elevator Inspections
NA ESA QE[CerG #C-875
Certified Since 1993
C.c.Michael J. Izzo Village of Rye Brook
Liberty Elevator Corp.
Aull
Certified Elevator InSpectionS, Inc.
100 Laurette.Avenue. White Plains. NY 1060 5 • Phone: 914 428-5419 Fax: 914 4-9f;-550l
January 24, 2018 l%
5 2018
Reckson/SL Green VILLAGE
360 White Plains. NYe1 BV Lp NC DEp'E br OOK
0601 �r�tENT
Attn: Tom Giantomidis
Re: 1100 King Street, Annual Elevator Inspections-Rye Brook New York
Dear Sir:
On January 16, 17, 18,2018 1 witnessed the code required annual no load hydraulic pressure and safety
tests on twelve(12)passenger elevators located at the above referenced address as performed by your
elevator maintenance company Liberty Elevator Corp.
The elevators were tested to show compliance with testing procedures required b\ ASME A 17.1 Safety
Code for Elevators and Escalators as referenced by the International Building Ctitle.
At the time of the inspections, the following violations were revealed that require correction to comply
with code:
Building # 1
Elevators# 1& 2
1. Render in car fire recall lights and buzzers operational.
2. The in-car fire recall and access door keys do not match the fire service
recall switch in the lobby.
3.No access to Fire Phase II due to wrong access door locks
4. Replace missing Platen plate bolts.
5. Render in-car phones operational.
Buildinz # 2
Elevators# 1 & 2
1. Render in car fire recall lights and buzzers operational.
2. In-car emergency lights and alarms do not work.
Elevator#1
1. Render in-car phone operational
t art
�A 11MA
m(chcd■%-
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Sc W ('cmfied•+;;
Certified Elevator Inspections, Inc. ,mrW
PQ.2 100 LntA>cttr .\Wnur. \\lute 1'Lun,. \l 10605 • Phone: 914 428-5419 Fax. 1414 428-5501
1100 King Street D ��
�'
Building # 3
Elevators# 1 & 2 — 2018 I
1. Render in car fire recall lights and buzzers operational. VILf3U AGE OF RYE 1
IDIN , pEP�Tn.1`
Building# QQ
Elevator#1&2
1. Render in car fire recall lights and buzzers operational.
Building# 55
Elevators# 1 & 2
1. Render in car fire recall lights and buzzers operational.
2. In-car alarm bell does not work when stop switch is activated.
Building# 66
Elevators# 1 & 2
1. Render in car fire recall lights and buzzers operational.
:Vote: All lobby and in-car fire recall switches must be keyed alike. FEO,255 or 2642 switches.
The violations listed must be corrected in a timely manner as required by the Village of Rye Brook
Building Inspector.
Please notifv this office when all violations have been complied with so that a reinspection can be made
and provide you with a compliance letter.
If you have any questions regarding this matter, please feel free to contact my office.
Yours truly,
4.2-,
John�. Boc ►ni�
Certified Elevator Inspections
NA ESA QE!Cert. #875
Certired Since 1993
C.c. Michael J. luo C.E.O. Village of Rye Brook
Liberty Elevator Corp.
` BUILDM11MENT pVI OK938 KING NY 10573 JAN 15 2021
(914)99-5801
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FIRE INSPECTION / OPERATING PERMIT APPLIC�QATION 1
FOR OFFICE USE ONLY: pl_dQy �v� A;6- !
o3� -
Fee Paid: $ '�,5�- Inspection Date& Time: -3p/4#'4
FEE SCHEDULE: Re-inspection Date &Time:
Triennial & Private School Annual Inspection: =$450.00
Public Assembly Annual Inspection: <100 People=$525.00/>100 People=$775.00
Application,dated: is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting
that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business,
private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform
Fire Prevention & Building Code, Title 19 NYCRR Part 1201, and all other applicable local, County, State & Federal laws, rules &
regulations,as per detailed statement described below.
1. Address: � {AM5pj.L)�2 L( SBL: Zone:
2. Business/Occupancy Name: lLb���,��X�(� NYS Use Class:
3. Property Owner: 1(00 <1M jC4_VS LLC Address: � Amjr¢rf;7rP��/L(��Q
Phone# ( Cell # 9/Lj-7�ty -�f(X�-� -email--T.-St
5. Business Owner: 5m _Q Address:
Phone# Cell# email:
6. Emergency Contact: 4::�y (-A/-(f2 f' Address:
Phone# Cell# email:
7. Inspection Escort: ""t OJO&(� Title: CA )e-�
Phone#:9/q_93�-���-W Cell#: J/�-4Q0-"SS(>� email: - (a�si ��pFA C—CW4
8. Provide a brief description outlining the current and/or intended use of the property:
9. List all Hazardous Materials:
10. Occupant Load: Existing: Proposed: Other:
11. Date&Disposition of Previous Fire Inspection: ❑ Pass ❑ Fail
i
6/1 2020
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:
being duly sworn, deposes and states that he/she is the applicant above named,
(print 64me of individual signing application)
and further states that he/she is the legal owner of the property to which this application pertains, or that he/she is the
AAFltpJ' j4 fk�,,An-; . , for the legal owner and is duly authorized to make and file this application. That all
(indicate architect,busiKess owner,attorney,agent,etc.)
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 Sf h Sworn to before me this
day of �e(1" , 20�_ day of , 20
otary Publi Notary Public
1111A XLZE.z�L.G�
Signature of Property Owner Signature of Applicant
Jl.vL?y1i1Gc
Print Name of Property Owner Print Name of Applicant
ALEXANDRA H.FRANK[M&17h�I�)
Notary Public,state of New York
No.01FR6363M
Qualified In Westchester County t
-ommission Expires August 28,20:2
2
6/1,2020