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BP24-180
■ 7 00 ■ CV CCC Ngr a M�yr� 00 00 v � s h+�l rT ,4 c~a p N py x _ w C/) 040.4 a s vs W O Z N U v 0. � W cn y o � � w � x A � a Q z � � p ° s flQ � a� A PLO s-r V W n � {d� u °u ° a w `°1cn ` 'n 44 AW I�tw O o+zvwGw W Z ti A oo ° W a V o � [ U en Q O � � xv 0.4 My V/ N x 00 � w o uz = 00 ""a rr © V U U a ►--� U a Z O 5 W p o a � b � ° U x � � 01-4 _ O � W Q z O "� �o ` d ■ o .. ,� A. ---AV - {�J r i BUILDING DEPARTMENT �� VILLAGE OF RYE OOK 938 KING STREET RYI;BR6 ,NY 10573 AUG 152024 HD � VILLAGE OF RYE BROOK wwwXyebrookn.8ov BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: AUG 1 i ' rmi #: 61b AYOApplication Fee:$ V Approval Signature: Permit Fees:$ ��.,�'[ Disapproved: ' Other:e� - -3 D ]. Application dated: L3 `�, f� ! is hereby made to the Building Inspectorofthe Village ofRye Brook.NY.for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: 5 AV( n Cox (1` 0vi l V SBL:/35i 2. Proposed Improvement.(Describe in detail): ff Ockeny) ->Qw C"inth, Puuf 0410Cf 5faJ-, &tzkykrl� , C'�, r r 0 A 1,*,,,eef 40. � ✓ WP 1 It 'Plo,r k.t. /lam. �ti i /1Py �i►+e7f-�I't 3. Does theSproposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: V Yes: If yes,indicate: TIER l: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an exis6n automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No:VYes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: I 7. Property Owner: Fle^vr muci t Address: Q35 5d {-^ICI re). {�2 4s cruet t1($, �CJ�/ Phone# q I LI —�41-3L1 oS_ Celll# email: _ 1 Y}u (U 19 ko'tma i .C/Ulf) 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# L_ Cell# email: � y 11. General Contractor: 1� 04c Address:: d7v& 0eP( ,SJf ee 1 4-ke k// ioSc/I Phone# Cell# 34 1 49 4- %K email: �e.C• rQ/`t�+� '^f �l Cf�,nu-.t. C 41.1 12. Estimated cost of construction $ 15, 000 (NOTE:"The estimated cost shall include all labor.material,scal7olding,fixed equipment.professional ices,and mutenal and labor which may be donated gratis.) 13. Job Timetable: Start: S f�1 ��" 1 _v_ Finish: ! t/ (I) 6/1/2024 BUILDING DEPARTMENT VILLAGE OF RYE]$ROOK AUG 15 2024 938 KING A4FET RvE ftd'&�,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wwwlryebrookny.gov _ BUILDING DEPARTIL PN 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 YORK,COUNTY OF WESTCHESTER ) as: I,F J Cki)1,. r <<4.. _ residing at, 35 f "- () C E rc-kt- un� t— (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; 3S A ,u-) ( �Fsk c U In �- ,Rye Brook,NY. (Joh 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. C rc of Prop"m, ()wncr(s)) f t' C,(01U(' C1 , (Print Name of Proper( Owner(s)) Sworn to before me this day of , 20 0N(11:11\ P ire) GREGORY M.RIVERA Notary Public,State of New York No.OI R16441398 ! Qualified In Westchester County `� / Caftrftslon Expires September 26,20�r 6/l/2024 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal 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. Please note that application fees are non-refundable. STATE /NEW YOP COUNTY OF WESTCHESTER ) as: ff Hyo•. _ ,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 `AtAy -T�l• 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. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 15 y� Sworn to before me this day , 20 ]C.♦I day of . 20 JV_ G�� Signatu Property Owner Signature of Applicant FJe4 w� L&L.<tA(6'._ )"Ire"L- Print ame of Property Owner Print ame of Appl icant if! &Dyk— otary Pu notary PfYi GREGORY M.RIVERA GREGORY M.RIVERA Nary Public,State of New York M"Public,State of New York No,01RI8441398 No,G1RI6441398 Qual1 Qualified In Westchester county , fled In Westchester County Conm►fssk Ires Co^TM""an Expires September �P �Pternber 2(I,2t P tuber 26,2 ill 6 1,2024