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BUILDING DEPARTMENT D C E M
VILLAGE OF RYE BROOK FEB 2 3 2023
1 ID
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
,www.ryebrook.orm BUILDING DEPARTMENT
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY 131" #: _ PP
Approval Date: Permit Fee: $ / —7
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated C is hereby made to!the Buil¢ing� Spector of the Village of Rye Brook NY, for the issuance of
a Permit to install an or remove Plumbing as per detailedtemetilt des 'bed 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 L(o�cal Codes.
���'4' �1.Address: b, $ i L SBL: _` YSt � /
7"�`3 Zone:
2.Proposed Work: �' Il-e g �— / AJ �r 7 eYll�
3.Property Owner: e &1 //✓ Address:
Phone#: '?/L/ Aly3 fL 0 Cell#: 9/7 g 73 y�r^-x/email: AeXd o Cd � �/ G/!!/g•�• Ca.
4.Master Plumber: geeZe Zq fW4,1_ Address: ' •� e
Lic.#: �7 d Phone#:ft 71-1/79'1 Cell#:�����7 �-1/email: _ Ale - :5
Company Name:WIIIIP 1Vw'G St%*iieXr Address:
INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement
I st Floor
2nd Floor
311 Floor
4"Floor
5'Floor
Exterior
5.*List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
A-
8/I2P2021
STATE OF NEW YOM COUNTY OF WESTCHESTER ) as:
�1L �!5IcCTJ; L;t ,being duly swom,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and furtther states that(s a is the legal owner of the property to which this application pertains,or that(s)he is the
(iow Ar4G t/L 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.
Sworn to before me this All sworn to before me this c3
day ofL ,20�'L day ofC�
Signature XProperty Owner Sign2ife of Ap ant
du CaAI�, rt,�� Sr�� �r
rint Name or Property Owner Print Name of Applicant
JANEM SANCHEZ
Notary Pub NOTARY PUBLIC,STATE OF NEW YORK Notary Pub i
Registration No.OISA638787
Qualified in Westchester C unt
My Commission Expires:
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.
-2-
8/r 2/2021
BUILDING DEPARTMENT
VIL AGE OF RYE 91tOOK
938 KING STREET RYE BROOK,NY 10573
1 (914)939-0668
"'yv'NN- rN ehrook.org
.AFFIDAVIT OF COMPLIANCE
VILLAGE CODE 4216 - 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 .
STAVE OF NEW YORK, COUNTY OF WESTCHESTER ) as:
Cdr13 , residing at, f /�G��'S fZ f /20raf>%
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;
7 T 'GG5 2?z Rye Brook,NY.
(.lob 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.
(Print Name of opcay Owner{sI
Sworn to before me this
day of ,B1j , 20
JANETTE SANCHEZ
NOTARY PUBLIC.STATE OF NEW YORK
Registration No.OISA638787
Qualified in Westchester C my
My Commission Expires: 8/12/2021
Laura Petersen
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Thursday, February 23, 2023 8:29 AM
To: Steven Fews
Subject: Message from UDig NY
****EMERGENCY****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 02/23/2023 08:28
To: VIL RYE BROOK PRIMARY Transmitted: 02/23/2023 08:28 00004
Ticket: 02233-000-154-00 Type: Emergency Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 5 To: Name: EAGLES BLF
Cross: From: To: Name
Offset:
------------------------------------------------------------------------------
Locate: LOCATE THE FRONT OF PROP
NearSt: MEADOWLARK RD & CUL DE SAC
Means of Excavation: EXCAVATOR Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: Y
Work Type: SEWER LINE REPLACEMENT
Estimated Work Complete Date: 02/25/2023 Depth of excavation: 6 FEET Site dimensions:
Length 10 FEET Width 32 INCHES Start Date and Time: 02/23/2023 08:25 Must Start By:
03/09/2023
------------------------------------------------------------------------------
Contact Name: MOISES MONSANTO
Company: ROTO ROOTER, MAMARONECK
Addr1: 525 WAVERLY AVE Addr2:
City: MAMARONECK State: NY Zip: 10543
Phone: 914-216-3720 Fax:
Email: moises.monsanto1311@gmail.com
Field Contact: MOISES MONSANTO
Alt Phone: 914-216-3720 Email: moises.monsanto1311@gmail.com
Working for: H/O PETER CORBIN
------------------------------------------------------------------------------
Comments: EMERGENCY, CREW IS ON WAY TO SITE NOW, THIS IS A THREAT TO
LIFE/PROPERTY/VITAL UTILITY.
Lookup Type: PARCEL
------------------------------------------------------------------------------
Members: ALTICE USA CONED
SUEZ WTR WESTCHESTER VIL RYE BROOK
1
QyE BRC��.
O� Zm
�1• 19a2.�' BUILDING DEPARTMENT
❑'BUILDING INSPECTOR
❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573
(914) 939-0668 FAx (914) 939-5801
www acbrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - -- -
ADDRESS :_ DATE:
PERMIT# ', ISSUED: SECT: BLOCK: LOT:
LOCATION: OCCUPANCY:
❑ Violation Noted THE WORK IS... []/PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ GROSS CONNECTION
FINAL
/ ❑ OTHER