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B[JIL E �� MI
VIL E OF RYI, K APR 1 0 2024
938 KIN .ET RYE B K,NY 10573 VILLAGE OF RYE BROOK
�-0668 BUILDING_DEPARTMENT
or k. _..... . - -
PLUMBING PERMIT A LICATION 2
FOR OFFICE USE ONLY 31' #: PP#: ! r o S-3
`�\\
Approval Date: Permit Fee: $ /
Approval Signature: Disapproved:
(fees are non-refundable)
DO NOT START N'ORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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
Application dated, Y `/0 ' 2"Y 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.
I.Address: i tS RL LL E M 4 90 1G YL- W - W I D S-?-3 SBL: Zone:/AU,6
2.Proposed Work: e r n-•'o 7 �-r.� v� Ge. r e K � - �!��� ,,
3.Property Owner: FH EU1 CCU- Address: guu TPl K 01 R (; Ito 6 N Y
Phone#: G ba 32�1' C4 Cell#: 615-3 Fig email: FAI eCM S . � -'A f 6/ L'/` 4L bM
4.Master Plumber. /1 f/,r G>✓t Address: 7/�y,C�vlf�r �/l�yG 2i,r131 b l� A15r
Lic.#: Phone M Cell#: email:
Company Name: Address: .r/91VA, If eP4,C,
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 Senn ice Service Sewer LP Gas
Basement
1st Floor
2nd Floor
31 Floor
4"Floor
5°i Floor
Exterior FT
5.* List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
4-
BUILDMRYEBR
MENT DEPCE ]WE
VIL OK I APR 10 2024 ID
938 KING ,NY 10573
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE 4216 • 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: ,,��,
�> >�Q�KI�Y► ��s ,residing at, 1 7611r�Z,'�•%' t.'/ •!J Y/d r7 j
(Prinz nanie) (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;
,r�Cs�%r `V1i10.'4 d f 3 , Rye Brook, NY.
(Job 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.
L�
I,Z
(tilt urcol'i'roperlyOwner(s))
(Print Narne of Property Ownegs))
Sworn to before me this "I
day of r 20�
(Notary Pti/17.
GREGORY M.RNERA
Notary Public,State of New York
No.01RI644139B _
Ouallfied In Westchester County n i
Commission Expires September 26,ZG
8!12/2021
3/3r2023
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 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 efore me this Sworn to be re this ram,
day of h .20 day of (1A 20 aC 1
' .✓
Si a roperty Owner Sif, aturc of Applicant
Nr � M QLSA � A�larZeO,
Print Name of Property Owner Prin Name of Applicant
Notary P tc mliY M.RNERA NotNo �ry p
Notary public,State of New Yolk tI MELILLO
ary Public,State of New York
No.01R16441396 No.d1ME6164063
Qu3111ied In westehestercounty 14 QuOlifled in Westchester County
Commission Expires September 26,20 Commission Expires January 29,202
This application must be properly completed in its entirety and must include the notarized stgn�ture(s) of
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
Laura Petersen
From: UDig NY Exactix <tickets@exactix.0 dig ny.org>
Sent: Thursday, April 11, 2024 9:00 AM
To: Steven Fews
Subject: Message from UDig NY
****LATE****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 04/11/2024 09:00
To: VIL RYE BROOK PRIMARY Transmitted: 04/11/2024 09:00 00001
Ticket: 04084-000-696-01 Type: Late Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 18 To: Name: BELLEFAIR RD
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: FRONT OF PROPERTY
NearSt: FELLOWSHIP LN
Means of Excavation: SHOVEL Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: Y
Work Type: PIPELINE MAINTENANCE / REPAIR Estimated Work Complete Date: 04/11/2024
Depth of excavation: 4 FEET Site dimensions: Length 10 FEET Width 1 FEET Start Date and
Time: 04/11/2024 09:00 Must Start By: 04/25/2024
------------------------------------------------------------------------------
Contact Name: FAHEEM DESAI
Company:
Addrl: 18 BELLEFAIR RD Addr2:
City: RYE BROOK State: NY Zip: 10573
Phone: 607-379-5466 Fax:
Email: faheem.s.desai@gmail.com
Field Contact: FAHEEM DESAI
Alt Phone: 607-379-5466
Working for: WORK TO BE PERFORMED BY: SALCEDOS LANDSCAPING
------------------------------------------------------------------------------
Comments: NEED TO REPAIR A LEAK IN THE UNDERGROUND MAIN WATER LINE THAT
CONNECTS TO THE HOUSE.
CALLER ADVISED TO HAVE CONTRACTOR CALL UDIG NY
Lookup Type: ADDRESS
------------------------------------------------------------------------------
Members: ALTICE USA CONED
SUEZ WTR WESTCHESTER VIL RYE BROOK
1
WESTCHESTER CTY SWR
i
�yE DRC��.
1982 BUILDING DEPARTMENT
❑BU LDING 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 :- ' � 1,1z., E L 1-C` r 14 I (7 1` yA � DATE: '7 - // - 2 Q Z 7
PERMIT# -?P Z `I - 0S3 ISSUED: �% zy SECT: !Z T BLOCK: / LOT: S-s'
LOCATION: �2 O L F V` �.A OCCUPANCY:
❑ Violation Noted THE WORK IS... Q,/PASSED ❑ FAILED /REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION ' / ^ _
❑ Natural Gas Vl//4 T le -5 tl� C L R E 1"A'
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
OTHER Mk
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