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Home My WebLink AboutFire Inspection Certificate 2023-2026 A � � O azxz w A w pa a H > oA o W Z zwzxH w n W Z OHA a aa > o � z 0-4 � .-+ w v A p a 04 � wwo • � � w w � x � � � N N N F F �" Q N N N ►� � � AW Z � � F w A A ~ M N H w x :t QyE BRC�k O� Zm l7 c BUILDING DEPARTMENT ❑BBUILDING INSPECTOR 6 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 :- I / E41- A ✓Q DATE: 12- L-02,3 PERMIT# 7,n, ISSUED:&/CIVII,LSECT: Z .23 BLOCK: LOT: LOCATION: S C CCU a n OCCUPANCY: 2-3*0 ❑ Violation Noted THE WORK IS... S PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ;� we A I (\,\ J '� � LL ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 6/rINAL ❑ OTHER �E BR(�k, cu � • 1982 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:— ` DATE: PERMIT# � �Y�� SSUED: SECT: BLOCK: LOT: l � AIS//� LOCATION: �` "1 ` �.�\ �y-y" OCCUPANCY: - 3 0 i 115 Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION SITE INSPECTION W\ \eSt' REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING❑ INSULATION❑ Natural GasC� � ❑ L.P. Gas ' `c ❑ FUEL TANK ❑ FIRE SPRINKLER 6 C C t 1 c 1 s� ❑ FINAL PLUMBING ❑ CROSS CONNECTION V ❑ FINAL ❑ OTHER V Ir �v� QyE BR(��, t7 ,,/�' �9b2•��O BUILDING DEPARTMENT 3UILDING 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: �q5 DATE: PERMIT# , C I` .i(!f7 USUED: SECT: BLOCK: LOT: LOCATION: `j 0 \(-A 'f 'C �� ,� � OCCUPANCY' 2 ❑ Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING C-'% ❑ INSULATION ❑ Natural Gas � �G TS - �r( �L ❑ L.P. Gas N Q �C t f�C c��C�t o' ❑ FUEL TANK 1 ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CRO CONNECTION ❑ JNAL OTHER MEMBER N.F.P.A., MEMBER I.K.E.C.A.,MEMBER N.F.S.A.,MEMBER N.A.F.E.D. INTERSTATE FIRE & SAFETY EQUIPMENT COMPANY, INC. 188322 Remit to: P.O.Box 502 Correspondence to: P.O.Box 4165 Harrison NY 10528 Greenwich CT 06831 (914) 937-6100 • (203) 531-1333 • (914) 937-9723-FAX http://Www.interstatefireandsftv.net NASSAU-AEL01260 NYC-81754822 FIRE EXTINGUISHERS/FIRE SUPPRESSION SYSTEMS/RESTAURANT NASSAU-969977428 NYC-P01 NASSAUHOOD INSTALLATIONS/RESTAURANT VENTILATION CLEANING SUFFOL -1200004780 NJ-P01090 SUFFOLK-122 CT-F30002 SALES&SERVICE HUNTINGTON-F015927 CT-SM5-5598 MA-CR4622 CUSTOMER NAME: TECH ID: DATE: An, icx C �c,( es we is _J 3 PHYSICAL ADDRESS: PHYSICAL CITY,STATE,ZIP: PHONE: 'l 1 .5 E11e,)dolt Ave- J'yc �100t . N. w 3 71y- 737- Y4 BILLING ADDRESS: BILLING CITY,STATE,ZIP: FAX: KITCHEN SERVICE INFORMATION CHECK IN: CHECK OUT. 1 Fans working properly? OYES ❑NO ❑N/ 1 Fans working ro erl ? ❑YES ❑NO ❑N/A 2 Defects in fan wiring? ❑YES ❑NO 2 Hood wiped down? ❑YES [-]NO ❑N/A 3 Hood lights working? ❑YES ❑ N/A 3 Kitchen floor mopped? [-]YES []NO ❑N/ 4 Hood globes resent? ❑Y NO ❑N/A 4 Outside area clean? ❑YES ❑N /A 5 Hood globes undamaged? ES LINO ❑N/A 5 Hood lights working? ❑Y O ❑N/A 6 All filters in hood? ❑YES ❑NO ❑N/A 6 All filters in hood? ES ❑NO ❑N/A 7 Filters conform to code? ❑YES ❑NO ❑N/A 7 Do inaccessible areas exist? ❑YES ❑NO ❑N/A 8 Grease build-up o 8 Frequency of clean in ❑YES ❑NO ❑N/A 9 Grease bu' around fan 9 Pilots lit? ❑YES ❑NO [-]N/A 10 Grea uild-up in ducts 10 Photos n? ❑YES ❑NO ❑N/A 11 ase build-upin hood 11 F' s stem within service interval? ❑YES ❑NO [:]N/A Grease build-up on filters Fire extin uishers within service interval? ❑YES ❑NO ❑N/A COMMENTS: / ) 1 ( e 1 ....��........ NON I�JO:K'1��..W.�S..��tt.l(!�(.�...Ill{..... ....}.L....�.�T7:.Sr:� �Lrj.�71Z...C!�L/...... �n ..}.`.... ...... s.7C�..Lc��. '.�.Ar"�'�J..7 CJ51�Y??t�............................................. ......................................................../............................................................ SYSTEM SERVICE CYCLE REFERENCE PER N.F.P.A.STANDARDS NOTE:CUSTOMER IS RESPONSIBLE FOR ENSURING SERICES ARE COMPLETED AS REQUIRED.FOR MORE INFORMATION,PLEASE CONTACT THE N.F.P.A.AT 617 770-3000 Hoods stems serving solid fuel operations-Inspected every month Hoods stems serving moderate operations-Inspected semi-annual) Hoods stems serving hi h volume wok,char broiler -Inspected quarterly Hoods stems serving low-volume operations church,etc. -Inspected annual) Kitchen fire suppression systems-Inspected&serviced semi-annual) Fire Extinguishers-Inspected&serviced annual) QTY DESCRIPTION PRICE EXTENDED 1, 1 0 ICJ, cr h 14 if 2 c 3 A/C MJ C 1;-* q sal F6-E= 1 5 E -5Ice• c[ 6 7 7 C C.�L 8 9 SALES TAX — RATE: % (TAX EXEMPT#: ) 14b ;2 TOTAL DUE CLAIMS OF UNSATISFACTORY WORKMANSHIP MUST BE MADE WITHIN 48 HOURS OF SERVICE.INVOICES ARE SUBJECT TO AN INTEREST RATE OF THE GREAVR OF 1.5%PER MONTH (18%PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY UNPAID INVOICES THAT ARE NOT PAID WITHIN 15 DAYS.IN THE EVENT OF DEFAULT,INT STATE FIRE&SAFETY EQUIPMENT CO.INC.SHALL BE ENTITILED TO RECOVER COSTS OF COLLECTION,INCLUDING REASONABLE ATTORNEY FEES.INTERSTATE FIRE&SAFETY EQUIP O.INC.IS NOT AN INSURER,OUR LIABILITY ON DAMAGES,NEGLIGENT OR OTHERWISE ARE LIMITED PER THE TERMS LISTED ON THE REVERSE SIDE OF THIS DOCUMENT.THE CUSTOMER CAW- REFUSE TO AGREE TO ALL TERMS BY CANCELLING THEIR SERVICE 48 HOURS PRIOR TO SERVICE.THE CUSTOMER IS RESPONSIBLE FOR ENSURING THAT FIRE PREVENTION EQUIPMENT AND KITCHEN HOOD SYSTEM SERVICE CYCLES ARE FOLLOWED. CUSTOMER PRINTED NAME: TITLE: DATE: �;,.. 0-0- 2 CUSTOMER SIGNATURE: TEgHNl AN SIGNATURE: AM YOUR SIGNATURE ABOVE INDICATES THAT YOU HAVE READ,UNDERSTOOD AND AGREED TO THE TERMS ON BOTH SIDES OF THIS DOCUMENT. WHITE-OFFICE COPY PINK-CUSTOMER COPY YELLOW-ACCOUNTING COPY BUIOOFRY ENT VIOK OCT 21 2023 938 KINGNY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FIRE INSPECTION / OPERATING PERMIT APPLICATION FOR OFFICE USE ONLY: /wQ- 3o,�om Fee Paid: $ Inspection Date&Time: /`7c�-�ta�4y �V, 1p� '.O43 FEE SCHEDULE: Re-inspection Date&Time: Triennial & Private School Annual Inspection: =$450.00 Public Assembly Annual Inspection: <100 People= $525.00/>100 People=$775.00 Application,dated: is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting that a Fire Inspection be conducted at the building and premises listed below for the purpose of issuing a Permit to Operate the business, private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform Fire Prevention & Building Code, Title 19 NYCRR Part 1201, and all other applicable local, County, State & Federal laws, rules & regulations,as per detailed statement described below. 1. Address: �7Jta 4L2k/ri 4k ,4? -e i4je SBL: Zone:,�� 2. Business/Occupancy Name: / NYS Use Class: 3. Property Owner: —,�i " 9X �h�r1WOe/l Address: V a C�ho%✓t �t/C� �� i27Blf Phone# `//y. 931-114 97 Cell# email: 5. Business Owner: Address: Phone# Cell# email: 6. Emergency Contact: /�u55t/I i4j�rrJe✓L Address: 11_iod b /�d Y✓�,�2 NOW /Yr/ /010oI Phone# Cell# 9��/'�� '�p/,3(p email: 7. Inspection Escort: Title: Phone#: Cell#: email: 8. Provide a brief description outlining the current and/or intended use of the property: 9. List all Hazardous Materials: 10. Occupant Load: Existing: Proposed: Other: �� 11. Date&Disposition of Previous Fire Inspection: t �/tip L/Pass ❑ Fail i 8/12%20'_1 This application must include the notarized signature(s) of the legal owner(s) of the above mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. 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 application) and further states that he/she is the legal owner of the property to which this application pertains, or that he/she is the , for the legal owner and is duly authorized to make and file this application. That all (indicate architect,business owner,attorney,agent,etc.) 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 o f 0(fA Ae r- 2 7, , 20 e-:' 3 day of , 20 Notary Public Notary Public C-hz-c �, Signature of Property Owner Signature of Applicant �q? •-/at e w-r14-'s Print Name of Property Owner Print Name of Applicant 2 sn 2/2021