HomeMy WebLinkAboutMP23-142 : r
■
N a
L Ln Ln
p O rA
y
a Mo.
o T^� a
H CO) W Q00
V M Zzo
to
ca o S a .. w �3 ` ■
Ok
� ICI � O :� y� � �4�+' •r ..r
o o U
v �
j
~
0
i -a W M d o
pQ� b c� v
�i � 1 FBI F'�i z
C 'o" N 0 1 o r
Ham, ti a; �o ° o � Ws V ■
O W ra M U
W � Uc
ON
Lo
CA
LO
Ln
0 o a � �d ■
~ v H A p�q W X "o f
d W �0CN
V w 9y 0 rJ C7�
o44
� bo
z o c a. v
v � V
.4 O C14 a
O
BUILDING DEPARTMENT OCT - 5 2023
VILLAGE OF RYE BROOK
938 Kiwi STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
j4V-&./" (914)939-0668 BUILDING DEPARTMENT ,
x w% .ryebrook.org
ERMIT APPLICATION
OCT � � 102
Approval Date: Permit Fee: S
Approval Signature: Other:
Disapproved:
(fees are non-refundabir)
Application dated, 10 , is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of
a Permit to install and/o?ren6ove 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.
_ II
1.Address: ' ( SBL: l '!' �
�ne:
2.Proposed Work:
3.Property Owner: Address: (�
Phone#: Cell#: email:
4.Master Plumber: Ch S I oo Address:
Lie.#: 1,SSS Phone#: Cell#: email: V R bl -C
Company Name: Address: AC
INDICATE FIXTURES& LINES TO BE INSTALLED AS Pl-:R THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Naturay Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP
Basement
1 st Floor
2nd Floor
3'd Floor
4'h Floor
5'h Floor
Exterior
5.*List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
4-
3r3r=
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 Sworn to before me this
day of d i ,20 Z day of >r 20 (�r
Signature of Property Own Si a of A plicant
14AA4�4'0 4 kk 30 -'�In M
Print Name of Property Owner Print ame of0plicant
l
Notary Public Notary Public
SHARI MELII L0
Notary Public,State of New York
No.OIME6160063
Qualified In Westchester County --t
Commission Expires January 29,20Zi f
3l3/2023
BUILDING DEPARTMENT E C E � V E
VILLAGE OF RYE BROOK R OCT _ 5 2023
938 KING S`I'Rf FT Rvx.BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
NrwA.r4ehrook.or,-, BUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VI1,I,AGE COI)I; &216 - STORM SEWERS AND SANITARY SEWERS
STATE
�fOF,NEW
YORK,,�JCOUNTY OF WESTCHESTER ) as:
residing at,
H'III IV naIIICI t.Wdrc ,AMery li'tI li%ci
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,
Rye Brook, NY.
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.
(Signature of Property 0%%aer(.tiI)
(Print Name of Property Ovrner(s))
Sworn to before me this
day of 0CA*�Ar , 20 �
(Notary Public)
SHARI MELILLO
Notary Public,state of New York
No.01ME6160063 _3_
Qualified In Westchester County
Commi I n Expires January 29, _
fll, artz zozi