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Home My WebLink AboutMP24-037 a a � M 00 '- to v �j M M tlN' 0-0 CIS w w a to In 3 Y v wr, v 04 6J W gP ;av °a 0-4 4-4 Hj w 0v a0-4 Lin v " W W 00 �+p o 0 r a A U (% u Ss u ~I II 0 0 -0 cd M..� 00 W 0lu MCI Gti �/ U CY w � a 'a � zzb ocu p oo 15a a.d ,�io� � w c O ' y 'f Y um : BUILD MENT VIL OF RY OOK FEB 16 2024 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 E UIPMENT FOR OFFICE USE ONLY: PERMIT#:A/P(,—)-�/'r Q Approval Date: MAR 1 Permit Fee: $ / Cx�-,)%�06 r Approval Signature: Other: (DO �r 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#C 105.2 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, 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: 260 Betsy Brawn Rd, Rye Brook, NY 10573, USA SBL: 135.43-1-43 Zone: 2. Property Owner: Bruno Veras de Melo Address: 260 Betsy Brown Rd, Rye Brook, NY 10573, Phone#: 914 426 3101 Cell#: email: 3. Contractor: Dandelion Energy Address: Phone#: $456496073 Cell#: email: ldevore@dandelionenergy.com 4. Scope of Work:New Installation(X)•Replacement( )•Removal( )•Other( ): 5. List Equipment: Install closed loop geothermal heat pump system. 6. Location of Equipment: HVAC MECH ROOM 7. Method of Installation/Removal(list all equipment needed to perform job): l 10/30/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Bruno Veras de Melo ,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 before me this /— Sworn to before me this day of k) ,20 day of 20 a °nc°�N 99� ��`t�o� Stature of Property Owner ��Q 01�5ES lot Signature of Applicant Bruno De Melo a°�\�SON T Na Property Owner GOB Print Name of Applicant Nota r Not ublic This application niust be properly completed in its entirety and must include the notarized signatures) ol- the legal owner(s) of the subject property, and the applicant ol`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. 10/30/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Bruno Veras de Melo ,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 before me this Sworn to before me this 12th day of ,20 day of ''February 20 24 h a4, 16 k,.k kl' Signature of Property Owner Signature of Applicant Bruno Veras de Melo Hannah Kowalsi of Dandelion Energy Inc Print Name of Property Owner Print Name of Applicant nt Notary Public Notary Public \dp111111Nfr/�� Tlana L Tranowl- iD N—BFR 1 F\ 1]3u7S1T] COM3ISWN EXPMES UOOIBN April 25.2025 Electronically signed and notarized online using the Proof platform. 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. 2 10/30/2023