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BUIL DE MENT
VIL E OF RYE OK FEB 1 4 2024 ID
938 KIN , ET RYE B ,NY 10573 L
VILLAGE OF RYE BROOK
or BUILDING DEPARTMENT
PLUMBING PERMIT APPLICATION f
FOR OFFICE USE ONLY 13P #: PP#: 1 �
Approval Date: 1. - I U — Z og L y Permit Fee: $ `
Approval Signature: C' ,�, .�� Disapproved:
(fees are non-refundable)
DO NOT START WORK or CONSTRUCTION UN"I'I I I'EWNII HAS BEE\ ISSUED BY THE BUILDING
INSPECTOR. THE ADMINISTRATIVE FEE FOR \1 ORK PROGRESSED Old COMPLETED WITHOUT A
PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00
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.
1.Address: �.3 P t Aa t t 7&L ,4vr "6 6✓o p SBL: Zone:,��
2.Proposed Work: !`� Ln /'�^<� 54���'ha -re- DA,r 34 �
3.Property Owner: a C_C-o C of p{fb�' Address: $L Ae*W d A-0, 6,ra e o wIG G 06 Ell
Phone#: 91 g 37-O85r'U Cell#: 6 YS- 046'r cmail: (( /rP�fi✓�CAL�'f}5 �Q�
4.Master Plumber. ;Qt? C,,'tiY Address:$? 71 Le-Fla" Al" At-1 iv7
Lic.#: a7 0 3 Phone#: -71,49 't4{- 600 Cell#: 9/7 68/-0 S 3-3 email: 6,0-C-+4 P N r f1w+-✓3�+-G•fir.
Company Name: &W Y 4- P4,A,i.r, r. *i5l 11 f'o� Address: 11-71 10lt1.� �!"� /1 W ! e�
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
1 st Floor
2nd Floor
Yd Floor
4'h Floor
5's Floor
Exterior
5.*List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
3/3/2023
STATE OF NEW�}YORK,COUNTY OF WESTCI ESTER ) as:
�EG,a( �y4fi)4+— 411— ,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 H 14 Sworn to before me this /1-1/
day of ,20 day of f eA A-!!!) ,20 d Y
Signature of Property O er S ggnat=of Applicant
a 4e-a (�p 624-6 J, r (LOVA�1AI--"p—
Pruq Name of Property OvIner Print Name of Applicant /
N tary Public Notary Pub]'
L N110 NI ULLINS x
Notary Public, State.of New York L M ULLINS
Flo 01ML16114168 Notary public, State of New York
Qualified ill Queens County fro.01 MU6114168
► �i u ust 09 2 Qualitied in(queens County
This appl' r entirety and must incl cct�9rttiji,i$ r (s�gq¢0 '`�
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-
10/30/2023
BUILDQRVE
MENT D (;
VILOOK
938 KING ,NY 10573 FEB 94 20244
Ly VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
:k#:t**tt**esri*:k*:'r*:k•k:k}yk�•,k*ie**:kick;k irxi::M sN�:ie**;�•*;t*•k*9t�t**;4******irt**tick**i:**:F******•k:Fi:ie***k*k*ir•k***•k 9:k****9:**
AFFIDAVIT OF COMPLIANCE
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.
:0, 2oeco ' —A JtO ,residing at, 6,1 4 C 0 F_0 tiA !LA, &e&?ww�# cT 06,0JI
(Print namc) I (,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;
5;—.3 c,V"VC4)W-A AmOO- , Rye Brook, NY.
-- (.lob.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.
(5ignatt e of Property Owner(s))
"20
utv LAA�42
(Pant Namc tit Prupert) U�tncr(s)I
Sworn to before me this
day f' A � ,20 d`f
Vfi W
(No ary Public)
-4, 4- 0-
LINDA N1 MULLINSM ,
Notary Public, State of Ne,v Yor;
No.0 1 MU6114168
Qualified it)Queens County
`, Comrnission Expires August 09,20 > 8/12/2021
�yE BRC8,
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 : UJ c.),+C.ke/, F VF DATE: Z - Z / - Z OZ -�
PERMIT# 2�1- C7 2 �- ISSUED: SECT: /3s O�l BLOCK: LOT: j
LOCATION: e C�V Tom" 2CY—(4 . OCCUPANCY: 1 u
❑ Violation Noted THE WORK IS... R PASSED ❑ FAILED /REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION /
❑ Natural Gas 0 eA PC)
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
OTHER
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♦_� _
Laura Petersen
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Thursday, February 15, 2024 7:33 AM
To: Steven Fews
Subject: Message from UDig NY
****EMERGENCY****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 02/15/2024 07:33
To: VIL RYE BROOK PRIMARY Transmitted: 02/15/2024 07:33 00001
Ticket: 02154-000-104-00 Type: Emergency Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 538 To: Name: WESTCHESTER AVE
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: FRONT OF PROPERTY, WIDTH OF THE LOT.
NearSt: DIVISION ST & MONROE PL
Means of Excavation: BACKHOE, HAND TOOLS, AIR COMPRESSOR Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: Y
Work Type: SANITARY SEWER REPAIR
Estimated Work Complete Date: 02/15/2024 Depth of excavation: 5 FEET Site dimensions:
Start Date and Time: 02/15/2024 07:30
Must Start By: 03/01/2024
------------------------------------------------------------------------------
Contact Name: RICH DESTEFANO
Company: NEW YORK PLUMBING
Addrl: 8771 LEFFERTS BLVD Addr2:
City: RICHMOND HILL State: NY Zip: 11418
Phone: 718-441-6800 x129 Fax:
Email: richardd@nyplumbing.com
Field Contact: RICH DESTEFANO
Alt Phone: 718-441-6800 x129 Email: richardd@nyplumbing.com
Working for: CONSOLIDATED EDISON COMPANY OF NEW YORK
------------------------------------------------------------------------------
Comments: WORKING ON BOTH SIDES OF THE STREET.
EMERGENCY, CREW IS ON WAY TO SITE NOW, THIS IS A THREAT TO
LIFE/PROPERTY/VITAL UTILITY.
Lookup Type: PARCEL
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Members: ALTICE USA AT&T
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