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Home My WebLink AboutPP23-096 6 t t i i s N � A y s F+~ 4-4 co o p H ca � pq x s x rq U o o V) P 03 co �l as z t �z CO ci w � w00 o c to zWz 00 a MM ,•� A w z pp a F� w z va v, W a C O s x w �o W w w w o a H P-4 p � O Q n H x W � N o � N A a a ° a �Q P-4 0 441 s e } D IEC E' Ll '// LEA ;�` BUILDING DEPA.YMENT SEP 13 2023 Uj VILLAGE OF RYE Rt OK VILLAGE OF RYE BROOK 938 KING SMETRYE BAWK,NY 10573 BUILDING DEPARTMENT (914)439-4668 www.jydg,aok.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: C Approval Date: a Permit Fee: $ JJ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described 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 Local Codes. I.Address: Q2.5 (00A'r'1Q C� �21 VC SBL: �� /i �c�' �� Zone: f ! 2.Proposed Work: CA S T�F_S i F-y/k- e0o L ff-Lrrt7-Le-A 3.Property Owner: W G✓C. C.5IC01 (1C✓ Address:a„ZS 91LSIC,D►Oc�k. —3 Phone#: Cl Cell#: email: !VI i can[�L ��c✓ts►-(� G��.l'Cti d✓1 4.Master Plumber: 6iZ c Via. S Address: 3 S r*1 A(L-C AVa- 7,o Lic.#: '7 72 Phone#: 9 / Y- 9G `'��4"Cell#: `7/y - 7`a 311a email: 6 �P c-d 'a- J`G R 6 m AK . c 0,�.% Company Name:A''t- f !bgrt ie - PE Address: A �yoI_1X4rA r f D 7 0 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 1st Floor 2nd Floor 3`d Floor 4'"Floor 50,Floor Exterior 5.*List Other EquipmenV?rovide Details: tr A—E T S T e'' &g-_6 �✓L C V 0 4- ht-ArAT 6/1 vt co 67n iQ IL rs D ,r✓ (Notarized Signatures Required Next 2 Pages) A- 3/3/2023 ` 1 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 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 s r Sworn to before me this day of / l ,20 day of ,20 Signs a of Prope Owner Signature of Applicant J0 Print Name of Property Owner Print Name of Applicant 9f lx' m V Notary K RNVM Notary Public Notary Pubk,State of Now Yo* No.01 R"1398 Qualified in westchestet City Commission Eapfies September 26,2d 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- 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 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 `2 Sworn to before me this day of � M, -20__�L day of ! ,20 t CW U tk16\V\ , ignature of Property Owner Signs a of plicant Print Name of Property Owner Print Name of Applic I�-'AU—Lt r { LL Notary Public SHARI MELILLO NouSRPM9iALLO Notary Public,State of New York Notary Public,State of New York No.OIME6160063 No.01ME6160063 Qualifies!in Westchester County Qualified in Westchester County, Commission Expires January 29,20Z-i Commission Expires January 29,20 � 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- 3/3/2023 r BUILDING DEPARTMENT R JD VILLAGE OF RYE BROOK ' SEP 15 2023 938 KING S'1 UET RYE BRo * NY 10573 -- -- �y: OK (914) -1�68$_; VILLAGE OF R E BUILDING nEPARTMPN-' AFFIDAVIT OF COMPLIANNCE 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: 31, ,residing at, (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; �� c�Gt�17�✓� GG cj'L� ,��/1��- ,Rye Brook,NY. (Job 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. r (Si a of operty er(s)) H6 LVAh;1 2�:7/5�0v! (Print Name of Property Owner(s)I) Sworn to before me this 4 5 day of C''M �,20 (Notary c) GREGORY K WERA New PuW,Stab of New York 3 No.Of Rtfr1413l8 owdMed to Westthester County Cogs %@10n Expire+September 26,20 8/t2/2021 QyE BRC�� cu � t7 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 ryebrook.org - - - - - - - - - - -- - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : l )xy ( DATE: `1 PERMIT# ISSUED: f 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 ❑ CROSS CONNECTION FINAL ❑ OTHER * o * O * •u x * o (�+ * * cd v >, co C * V Cl. z x O� * u _ W o M * v oz °` * H c ol �. W a �x 0.4 cz W w w C . A W4 x a O ao L. Z W w _ M * v * * Q X. * a 1 3 O * on O U on ¢' d a, r a. a