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BUIL R MENT
VIL E oP RYE OIi' MAY 2 8 2024
938 KIN ET RYE BRO ,NY 10573
VILLAGE OF RYEBROOK
BUILDING DEPARTMENT
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#:
Approval Date: Permit Fee: S P6
Approval Signature: - 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
Application dated, -5 ZS Z 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 r -EDGE WDDIJ !DRIVE SBL: 135- 3o"j - j Zone: d"
2.Proposed Work: Re-Re C51k� i 5 , t�i C 2 Dry } 5 (�_ +r s C3 ro,I rA-
GJ18 i h � 11 3.Property Owner: -'Sbay �.V?ro ) e- Address: ROM8 y 1l I I ry�d ,Ikr(n D/L*
Phone#: 502-115 a - 9 0 Cell email: 3,)IQ0e C CLh VD 00
4.Master Plumber: LU►�k Address:
Lie.#:�� _Phone#: Cell#: email:
�G�► ��' n•G,� ��.cti
Company Name: Address:1�
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 Service Service Sewer LP Gas
Basement
i st Floor
2nd Floor
3rd Floor
41 Floor
501 Floor
Exterior
5.* List Other Equipment/Provide Details: v1tA:),—j5 r e-[�z'
ext 2 Pages)
-I-
3/3/2023
STATE OF NEW YORK,COUNTY OF R ) as:
,being duly sworn,deposes and states that he/she is the applicant above named,
(grin 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.
r
Sworn to before me this Q Sworn to before me this S
day of 120 dAy of 20
-1f
Signa re Property Owner St nature bfApplicant
& LiAJ'td
Print Name of Property Owner Print Name o A plicant
SAUN.H HUTCHINGS SAUN H HUTCHINGS
Notary Public-State of New York Notary Public-State of New York
N0.-01HU6427835 NO.01HU6427835
Qualified in Dutchess County Qualified in Dutchess County
My Commission Expires Jan 3, 2026 My Commission Expires Jan 3, 2026
s app tcation must e properly completed in its entirety and must tnc u e (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
BUILD MENT
VIL E OF RY OOK MAY 21 2024
938 KING ET RYE 13 ,NY 10573
.9-066 ` VILLAGE OF RYE BROOK
ebrook.or-J BUILDING_DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE §216 - 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 YOR(K, COUNTY OF WESTCHESTErR� q) as: t
31, '(�( Zih/1 r lGC('1 e- , residing at, d1 1 ��(P'�� Ctit�
(Print name) (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;
I �7�w(�� d2�V - , 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.
4<a_A �
(Signature of Property Owner(s))
- 5�� ronY-�ojl� C,
(Print Name of Property Owner(s))
Sworn to before me this
day of kv-\ n- , 20 (V
(Notary Public)
SHARI MELILLO
Notary Public,State of New York
No.01ME6160063
Qualified In Westchester County _3_
Commission Expires January 29,20
8/12/2021
�,yE BR N
cu �
1.
1982 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
[3'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.ors
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : , C Q lA) J�� Ft ✓fo DATE: / - O
PERMIT# -?i Z `4 - L-)7 1 ISSUED: - 1 "Z` SECT: 13.0(o BLOCK: LOT: n
LOCATION: Z :J A 4 l y O^1 V` OCCUPANCY:
❑ 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
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
_ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
�Qy_E BRC��•
O Z�
uJ �
BUILDING DEPARTMENT
❑BUILDING INSPECTOR
[ZVASSISTANT 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 i 4` y� O� -A DATE:
o U
PERMIT# \ 1 I ' 01 ISSUED: SECT: BLOCK: LOT: v
LOCATION: T ^ R �.ti) OCCUPANCY:
❑ 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 F l /YJ1--
❑ L.P. GAS
❑ FUEL TANK n S _ N f
❑ FIRE SPRINKLER 1` ;) ✓f
❑ FINAL PLUMBING
❑ CROSS CONNECTION `J
❑ FINAL )se w
❑ OTHER
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