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BUIL E MENT
VIL E OF RYE , OK AIN 2 3
938 KIN ET RYE B ,NY 10573
Y.gov
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#:
Approval Date: Permit Fee: $ _/ r
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, Z aZy 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.
l.Address: 3 ( ot-�-� ( o SBL: Zone: I
2.Proposed Work: ' ` L1 r
3.Property O er: �►�,br.a 0.1�+AY1 Address:_qll 39 -411;�... ��rk .
_�� �RSI�
Phone#: — ZZ Cell#: email: b I�f1`rn,-1 Iw av loo • c4m
4.Master Plumber: . Address: 13 6 S �6 9 1 Ce lt� �q .^-. VJ Li �OS
Lic.#: Phone#: S "Z6 -14be Cell#: email:-Tac-w�f �]! 1 we' tr- by%'
Company Name: wa6k&T Address:33'er U IQLC�
INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary NaturaU Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement I
l st Floor
2nd Floor
31 Floor
41 Floor
5'h Floor
Exterior
5.*List Other Equipment/Provide Details: • e ya ue- s: _ 4...Acr
(Notarized Signatures Required Next 2 Pages)
-I- 6/I/2024
STATE OF NEW Y,QJM COUNTY OF WESTCHESTER ) as:
_ ses
,being duty sworn,dep and states that he/she is the applicant above named,
(Print Dam of- as the --- sai)
and further states that(s)he is the Master Plumber far the legal owner and is duly authvrizod to make and file this application.
That all statements contained bavin are true to the beat or his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in confbrammm with the details as set froth and contained in this application
and in any accompanying approved plans Wrd specifications,as well as in wxordance with the New York State Uniform Fire
Prevention&Building Code,the Cade of the Village of Rye Brack and A other applicable laws,ordmances and regulations.
SwOM W befiore rite this Sworn to before me this 1
day of v ,24 Z day of 20q
Signature of Property Owner of Applicant
lr 1 Q✓I'�� ��r�Q Y' ��f� ( ��Tsl?�n�
Print Name of Property Owner Print"Name of ppiilicant
No lic Public
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. 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.
Deadd R C&Vuoto
Notary Public, State of New York
Reg. No. OI CA0025396
W1L.=ALCAMTARA Qualified in Dutchess County
MMMY public-SW&or Mew Ywk Commission Expires May 31, 2028
M0,WAL6449415
QUA11hed 4n Wnlcho*gr Cou+ny
MY ComrnVssimr[spirts.Jul 6,2025
_2,_
611fM24
BUILD NT
ViLL I E OF OOK
938 KING$ ET RvE Bit NY 10573 Al 2 3
'A't4'tt'tt't!!tllttA�rt"A'�!f!!�!t*4�1 '!f'!'�fflllHit�#�1tR**41!'!*�1`!►tf►t!'f"f'�t*A71'��`�'#'!!#f*4tf'Rf1'4'A t*�t*'i*'k
AFFIDAVIT OF COMPLIANCE
VaI ALGE CODE 4216- STURM SEWERS AND SANITARY SEWERS
THIS AMDAVIT MIST BEAR THE NOTAIMED SIG ATDRE OF THE LEGAL PROP13 Y OWSM AND BE ZTTED
ALONG NTTA ANY WILDrM OR PLUMBING YX MIT APPLICATION. ANY BUILDIM OR PLUMIM PZRMIT
APPLICATION SUBMITTIE) WITHOUT THIS COMPLWM AND NOTARIZZD FM WILL BE RZ'P TO M APPLICANT .
STATE OF NEW YOM COUNTY OF WESTCHESTER ) as;
1, 9f 6nKia �u o ,residing at, 62 A
(Address when yOu l i%c`
being duly sworn, deposes and states that(s)re is the applicant above named,and funnier states that(s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
M0rA1%N>'i WL.' Sr e'*- ' , Rye Brook,NY.
t[ob Address)
Further that all statements contained herein are true,and that to the best of hialher knowledge and belief,that
there are no known illegal crossconnections 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.
tL:1�lTt5ture o: ropt y t .l Tll:r(41'r
Sworn to before role this Z-
day of
E
LCANTAKA
Shale of Newyor6LN19415
strinamer County
xpires Jul i.2025
�E BRC�k,
1932 BUILDING DEPARTMENT
❑BUILDING 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 : 3 I �� O e �tc-.�I DATE:
PERMIT# t n L ISSUED: SECT: 1 G 1•&b BLOCK: LOT: 1 L.
LOCATION: ( , CI S Q p o rq OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... [3 ACCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS C7
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER