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HomeMy WebLinkAboutMP24-088 m s a a s n �.�/.� 4, a W M s 00 w F, : � z a .� a � p � ■ *k vi a v ~7 N H Q o s 1'� Q F-+-1 \ �i O o 0 ,0 V� �0 et C) i a " a wz � � � � � W a U H � 5 N a a a O a Ol J W H Fr N O p �J Q � � � ,� a d ^ F-1 I = V r�rr�� �/ rO� N d m z V U W A VM S w ° �� T o 00 ch lyl U' p+ Oda ° U F' � w � o U z a a� O OF a U r�.i l � � W ©. Q 0 � •m ,� ,� Q. A w Z 02 G p7�G o a W a2 a A a a O Ww O � � c v . m x � - mZ -a : BUILDI - ARTMENT �D VILLA E OF RYL ROOK JUL 202A 938 KING STREET RYE BOON,NY 10573 014)-939-0668 VILLAGE OF RYE BROOKwv(yy:>< _U/_ knv.t ov BfJILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ON Y: PERMIT#: � r Approval Date: � Permit Fee:$�� Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERNIFF HAS BEEN ISSUED BY TIIE BUILDING INSPECTOR,THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WIT11OUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: l. 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#C105.2 or Form 4 U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL =$150.00/unit• COMMERCIAL=$450.00/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, t 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. / —7 p 1. Address: � _3_ �I�G��S4,�aT SBL: /3�r CO I/I—c)— Zon /C— 7 2. Property Owner: Address: j� (' �(��i�tTj LC • Phone 4: : `7 3 Cell#: email: (•- 3. Contractor: X[ �P t'-V�C L<-, 1.-�.0 Address: vcr �] s Phone#: Cell#: email: Id c5l Uk, 4. Scope of Work:New Installation( )• Replacement( )•Removal( )•Other( ): cm 5. List Equipment: ! c " 6. Location of Equipment: G 7. Method of Installation/Removal(list all equipment needed to perform job): �• � � I 611I2024 STATE OF N W YO kno COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individua signing as the applicant) and further states t(s)he is the Mechanical Equipment 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 af) day of ''k ,20_ day of —auv_ ,20--,'�A Signature of Property Owner Signature of Applicant C�Gv -e6u h to w t¢ 5IZ- S(*V'CP4 W-I Print me of Properly �,A Owner Print Name of App 'ccannttt NOW Mrran a Bucei Amanda 13ucci Notary Public-Connecticut Notary Public-ConneMvCommisglonExpires yCommisionEcticu t FebwarY Z8 202S piresebrudr� Z8.20 25 _ i l}; L'1}plical.i6n t►ntst be properly completed in its entirety and must include t e it c{s}of the le-gai 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 6/I/2A24