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1932 BUILDING DEPARTMENT
❑$UILDING 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 : 4J '�-+�11� K I (A DATE: L loz-�
PERMIT# ISSUED: SECT:_13S Al BLOCK: LOT: �a3
LOCATION: Z-2 J 0+ k =- OCCUPANCY: 0 C/
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION
.SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS M S
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
,]` OTHER F��
BUILDRTMENT3D
VIL OF R OOK JUN 1 3 2024
938 KING ET RYE BR ,NY 10573
4)939-06 � VILLAGE OF RYE BROOK
ov BUILDING DEPARTMENT
?9£�)
FOR OFFICE USE ONLY: 10 �
Inspection Date&Time _ Z l?e
Approval Date: Re-Inspection:
Approval Signature: Original BP#: Date: .7 C 3
Disapproved a/c: Date: Renewal Fee: J � Due: ❑ /Paid:.
ANNUAL RENEWAL APPLICATION
FOR EJ/XISTING HOME OCCUPATION PERMIT
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,to renew a lawfully
existing Tier 1I or Tier III Home Occupation in accordance with§250-38 of the Code of the Village of Rye Brook,as described below.All
Home Occupation Permits must be renewed by no later than June 15°i of each year.Please consult the above captioned section of Village
Code at,www.ryebrooknny.gov for furthers information prior to filing this application.
1. Address: b3 I''�r0 (ap�► cX
2. Parcel ID#: ^ G 3 Zone:
3. Property Use: ❑ One Family; ❑ Two Family; ❑ Multi-Family; ❑Other: Tl Pl 3
4. Property Ownev
Address: S . 1121011— Jt_ ivzel ell-L ta-)
Phone# r/�y cs Cell# 3C OT t/ email:
Applicant: Sq ►I
Address: S a V_�,P
Phone# Cell# e
5. EXISTING HOME OCCUPATION:check one:Tier II( ) Tier III( ull disclosure detailing the exact nature of the
proposed home occupation,hours of operation,number of visits per week,number and names of employees,etc... or any
other changes in the nature of the home business since the original approval is required by law.)
[use additional sheets if necessary]
i
6/1/2024
Please note that 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 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
for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc.)
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 3 Sworn to before me this
day of , 20�± day of , 20
�^ 1
Signature of Property Owner Signature of Applicant
JUI-11 _T 1-4-1.11
Print Name of Property Owner Print Name of Applicant
Notary P w Notary Public
GREGORY M.RIVERA
Notary Public,State of New York
No.01 RI6441398
Qualified In Westchester County
Commission Expires September 26,20
6/I/2024