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HomeMy WebLinkAboutMP24-015 s a a fl w C s © N N W a�v av s N © N a N N f V CA w W V 0 a v A ° H G W : ,n w p w en O p ° o °64 ` ° v� a-1 Q i u s W Yr z H y h+ l C O a�1 C O W z "10, ,"� W H V ° W id •G1 V1 t W Nb Y M I J CD 00Wp U � ,,., •• Q �..i � Q � OOb � w a CN � � � O to N cd �I ■ 00 w � � UP', W W adao '5 -0o. Wzz 11 F� C) Ca = U Ua © O -Z a y _ U z o O © w O w a O O w p A o �• .' °' °' ° �I CO P.41 a 0.41 x � a BUILDING DEPARTMENT R VILLAGE OF RYE BROOK FEB - 9 2024 DD 938 KING STREET RYE BROOk,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.orz BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING E UIPMENT FOR OFFICE USE ONLY: PERMIT Approval Date: Permit Fee: $,/ _Q Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U263/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$I00.00/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, L'R) 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. 1. Address: SBL: 2. Property Owner: Address: Zc), It l 1[aJ (4Uj Phone#: I4 25E70ma Cell#: email: A Q OYV\ 3. Contractor: S L t'A UNA k .Cal(\, t,T�.r��Address: Phone#: Cell#: email: C_N L S IL14 Ct 4. Scope of Work:New Installation( )•Replacements.Removal( )•Other( ): 5. List Equipment: 1,Q-E;-\11 M,C�I. CC AT� 6. Location of Equipment: Fk&ZaA D,X. 7. Method of Installation/Removal(list all equipment needed to perform job): 1 10/30/2023 STATE OF NEW YORK.,COUNTY OF WESTCHESTER ) as: SILA LLC DBA Astacio Plumbing ,being duly sworn,deposes and states that he/site is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the 4 for the legal owner and is duly authorized to stake and file this application. (indicate architect,contractor,ages ,attorney,etc.) That all statements contained herein are true to the best of Iris/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 plaits and specifications,as well as in accordance with the New York State Uniforin Fire Prevention& Building Code,the Code of the`tillage of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this "+ Sworn to before me this day of ,2CA day of �1GM ,20 �\ Signature of Property Owner Signature of Applicant Kett Peterson SILA LLC DBA Astacio Plumbing Print N I e of Propep Owner Print Nat of Applica Notary Public MM ccl ( ma Notarynecticut Amanda Buccl (Votary Public-'Connecticut xpires My Commission Expires 026 ebruery 28 26 _ completed in its entirety and must include th ltre(s) of the letgai owners; 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 atld will be returned to the�appiicatit. 2 10/30/2023