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HomeMy WebLinkAboutMP23-139 CV N N o .c \ 00 d H !ticr, Cp U z o d v r x w w u �; L v av W = W 04 0 00 0 _ (T� © � � �--i �, � may. � GQ �d] � o Q -C a � ■ Z co r 11 W00 UOlN CIN v � a a � E O z � � 'B - v c 0ov x o � w 00 G O WAS a V� U 0 a w oa v � p a Ln v I1 CA H .. N u mu _ U hfi i/ Ica q wc O .0� W o a ° 0 � w N V � , Ono x a A z ava � a'va [� H o .b �il � 14 � W x yob VILLAGE OF RYE BROOK BUILDING DEPARTMENT R I JUL 2 5 2023 938 KING STREET,RYE BROOK,NY 10573 (914)939-0668 www.ryebrook.org VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL, MODIFY AND/OR REMOVE MECHANICAL EQUIPMENT OFFICE USE ONL : 1-����� CX ti,ogu, ov Permit#: /- �-3 " 39 Building Inspector: n-AK 2 1 2023 Application Fee: ,& c �Q' Date of Approval: Permit Fee: 4, Bldg/Use Class: Res. Comm. ( ); REQUIREMENTS FOR RELEASE OF PERMIT: (A CERTIFICATE OF COMPLIANCE Is REQUIRED TO CLOSE OUT THIS PERMIT) 1. Properly Completed& Signed Application. 2. Payment of Application Fee: Residential =$100.00, Commercial =$250.00 (fees are non-refundahre) 3. Site/Staging Plan as required by the Building Inspector. 4. Sealed Construction/Installation Documents& Specifications as required by the Building Inspector. 5. 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#Cl 05.2 or Form#U26.3/or NY State Workers Compensation Waiver) 6. Payment of Permit Fee: Residential=$15.0011000.00 of Construction/Materials Cost with a minimum five of$100.00.. Commercial= $25.00/1000.00 of Construction/Materials Cost with a minimum fee of$275.00. 7. Inspection by Building Department for removal and/or installation. (48 hour notice required) 8. Any electrical work requires a separate Electrical Permit and Electrical Inspection. 9. Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection. Application dated, 7- cis-d is hereby made to the Building Inspector of the Village of Rye Brook,NY, for a permit for the installation,modification,and/or removal of the specific Mechanical 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 the approved plans, �and with all applicable Local,County, State&Federal laws,codes,rules and regulations. ].Ad d- 1`L (��,�} J� SBL:111i 36 ��5 V,` Zone: f��- - 2.Property Owner: // "1J�11 L-�,4- Address:llVJa(��y T 0-1 f"DA & ,b Phone#: 1�1 "4` b Cell#: email: r lJ P4 d It bw-� _ 3. Contractor: r�J �(-e C IJPr Address: Sf �LI ,�1 U' Uf Phone#: 0 cell #:� _ email:g�er�V�� 1` �� t e�Uk�Iv�•LDh 4,Applicant- �� � ►if P(Atu I - - air +off 6A)Address:%a, OV_t f , �j)V C-�---- - --- Phone#: 0\,1�'`- b - �D Cell: _ _ - email: ti �`(� --` k4,%rt, 5. Scope of Work. New Installation( )•Replacement( ) •Removal( )• Other O m AL k�A lJ - (,OCl l b-tixQ 6.Type of Equipment: _m�, U0 -6 d` On I 7. Location of Equipment: I(- 8.Cost of Equipment including Installation Cost: 1 8/12/2021 STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: ,(4,So U1 I-e ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as th pplicant) and rurther st spat Whe is the legal o ner of the property to which this application pertains,or that(s)he is the 1 ti 4 e `1 'e C! for the legal`owner and is duly authorized to make and file this application. (indicate architect racto,a ent,attorney,etc.) � That all statements c d herein are true to the best o is r 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 efore me this Sworn to before me this 0154 day of 20 090 day of_! ,20_cn_ Signature o*Property wncr Si ature of Applicant 1))4 6/9(�) --Ya So Y1 u 11e %am Print Name of Applicant "ako Notary is SEIIAMA F EDwARDS Notary Public,State of New York Notary�u�lic State�i HeW yank No.01ME6160063 NO,otElia3a559 Qualified in Westchester County qualified in westcmostsr County Gafilm"lon Expires January 29,20 � My Commission Expires hurt i, 2o2i This application trust be properly completed in its entirety and must inc ude 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 8i1212021