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HomeMy WebLinkAboutMP24-068 e y�y/�� , OC) O y V �. N N a� p 'v _ o = F" A x a tea, luk r , cV y p• , W acn to N Q A a zLnlZ 00 a oa w W M Z 7�z ° w w _ a /h1W00 C7� zA � oW � � O W H p4 p z Uz � b a � a C11 i Cn G'� cn -o a M Q � o 4 a h O 0EO r 1 a U 00 � �' y ° � H WO p o ,u U cn E� o z z z 0 opo U V C � z i o w p A a vi a'v o c"1+ z pG C A q W z E+ CA o � x � � �� - , BUILDING DEPARTMENT D V E VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 RAY 3 0 2024 (914)939-0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/ VE HEATING VENTILATION AND/OR AIR CONDITIONING E i11PMENT /�Xlj 1-/-06 � Approval Date: Permit Fee: $ 62c6pld_ 01 Approval Signatt.0 e. Other. Disapproved: (fees are non-refundable) #*#**********#**ir irAAi4*Rt*,k**akh#fit.h::i ht.:':d�trti::t:ti,:Fkiefe*k*at irki:lkR*al F f,Rh k*A**:FAR{kf,i,lrltak*,4Ads4d*ie is�AAtik*:t to fY Ye 9e ie ft REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: . Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector, 3. Copy of Licensed Contractor's Liability Insurance. & Workers Compensation Insurance on a NYS Board form 4. Payment of Fees/Unit: 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (4x/lurrr notice required) 7. Electrical work requires a separate Electrical Permit& Electrical Inspection. 8. Plumbing/Gas work requires a separate Pltmtbing Permit& Plumbing Inspection. Application dated,/¢ J0 oh is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or renoN al 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.Count,,State&Federal laws. codes, rules and regulations. / 1. Address �ai✓k/i �` 'J �t/Raa/� SBL: ���.�r�a ��'ulie: r 3. Property Owmer:A/A/eL Cd��S1�.�/� Address: "e Phone Cell #: g��.l�.t 3�G�� email:/4//f2G. C®M��L 3. Contractors 0 t Ci D L Address: rGI h C�s - 4 Phone* Z Z Cell* 114 email: 4. Scope of Work: New Installation( }•Replacement( }•Removal ( }•Othe O: 5. List Equipment: +3OG}'1 aoyA r 36Pf)r-►)a © �U1i �W ►"t 2 6. Location of Equipment: w 7. Method of Instal lation/Removal(list all equipment needed needed to perfonn job): 1Q� e,;nd e}� f e'6oL e,rrrar,-� ice_ j DC A.P Vk Ytc.w tQ HIA . ' Pe I .. tnt�, ��� •77 p,n ✓1q iG l I n,'30/202 3 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: H,44C Coe-w7tif 1 ,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 Wtie is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to snake 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 iti accordance with the New York State Uniforni Fire Prevention R Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and re, ilations. Sworn to before me this ;20 7?14 Sworn to before me this � �P day of / y 20 ;24' day of 2o2-4 5i�;u ure of Property Owner Signature of Applicant r Print Name of Property Oxivner Pr me of Applicant Notary Public qotary Public �'t''AN PATRICIA KALBA QOMPAGE GAYA vITHANAGE NOTARY PUBLIC,STATE OF NEW YORIC r4mary Pudic-State of New YorK NO.Q1vt6424207 Registration Na 01KA6080158 Qua(:fied in Westchester County Qualified in Westchester County My Commission Expires Oct 25,2025 = Commission Expires SEPTENTRER 09.20 200 2