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HomeMy WebLinkAboutMP23-152 _ N o y b _ M N N =72 A , V r a °~ OG p a Ln a o � a4 v o v c o 3 u ° ag•o W a O w � 'o Vol ^ va oz CA . w CC) -C 0 0 r�1 lei s. v ,� V "S '6 C�% a z U Vo- oo 5 , T 1 • o ! + pp f 1 ,� GNON a > al A © C7 e ly W 5 V o Z A w 2 9 W © z U o� ° v x o15 � v� W F O ot-I p z oo t/� z © a O „ +. C� O V V $ ° � N � x w i o LO V Cl' am v o rn z a � . �l V H o W c V BUILD - MENT ViIL OF RY OOK OCT 17 2023 938 KING ET RYE BR ,NY 10573 4 �} .0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT r FOR OFFICE USE ONLY: PERMIT#: OCT 2023 Approval Date: Permit Fee: $ /0 cZ Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: L Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. 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#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL = $100.00/unit • COMMERCIAL =$350.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice required) 7. Electrical work requires a separate Electrical Permit& Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated,/0—/7-;.� is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC 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 all applicable Local,County,State&Federal laws, codes,rules and regulations. ,? i. Address: /.95- C3n4& f/c /16" Cry;c e n f SBL: 149, —/;//S' Zone: 2. Property Owner: _Alanct4 a+cle r Address: / /5� &1-viA. ////I u CFeSCe,-,f Phone#: 91 H" 8UG ' 3 / Cell#: email: `� 3. Contractor: 604arran leed /7_I0tt / j>/Yvli/ 19 Address: h40 /c� &3 cZf Tt0,0,1, �/��nY+tom IIY43 Phone#: //i-SO7-GOAD Cell#: g email: V�n,ero(f4 4rth P.(.��/1i�rNl.,, 4. Scope of Work:New Installation(vf•Replacement( )• Removal( )•Other( ): •/ 5. List Equipment: [JL I/i/ed 51-ambss SlAel hH+*u S%Jlmt 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): 1 3/3/2023 i STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: NN C- AAA OM ,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 Heating,Ventilation and/or Air Conditioning Contractor 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 bef re me this Sworn t befo e me:is y yl ,20 a day of uL 20 day of - Vam M Signature of Pr rty Owner tg11 e of Applicant Print Name of operty Owner Print Name of Applicant Notary Pfiblic Notary Public GREGORY M.RIVERA MARIA TRAmoNTANA M"Public,State of New York Wary public,State of New York No.01RIS441398 No.Q1T-,6251263 OuaNf[ed In Westchester County Qualified In s Cot Commission Expires September 26,20 ires N-v^" 14, 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. 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. z 3/3/2023