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HomeMy WebLinkAboutMP24-112 = 00 00 � w •� a� a W cn 0 Old W z , O o C $ 0, 0 O r © ► M M W °� 'O V� W �O W cN MON d $ o w9 a o H rn W W x Wo � ov � o U w oes 1 uz z o H Av f uU w � v � '� A a, z v � vo v� gib ❑ z _ a o . V � 4 w MCN ��T�T V� u p y ■ a s a�i O Q ■ A [1 N 0-0 - �, O zo go o o a� � U z a d x o4. _ V V W `I � A z a vi p' w o icy o -0 - a - �I G� P r--1 W xu�i � v BUILD DEPTMENT VIL 'E OF RYE. OOK AUG 2 2 2024 938 KING ET RYE BRA ,NY 10573 ..0 . ov APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: " 2 Permit Fee: $!Z_JC_.J Approval Signature: Other: 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 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. 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 roust be listed as certificate holder) &Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#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,kiq. c1 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or rem val 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.. _ 1. Address: ESA 1y[�, 1, _Nye- SBL: I' -Ic-' - �]� Zone: 2. Property Owner: E.�AQt - T� Address:�ANArn►p6ra a- NX r A - Phone#: f 4- CEI .' F) Cell#: email:F PUNU+,'�L\ I P (tX� 3. Contractor: 1,� mcx'P. l ca1 Co, .I r,{, . _!Address:An is\— �;N . .62gnw,c- ) CT Phone#:'�VA Wn •`x -AM) Cell#:2X53•!:-ak • kj2M email:.ert cAd tYuh1G"l t. .ee9� 4. Scope of Work: New Installation( }• Replacement*Removal( )• Other( ): 5. List Equipment: �% , UlK- 1 L7)t\ Z -C �0*�, arch 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): 'AO -} p�-y,��Q{ Amk cc, 1 6/112024 �rtinQe�i�4.t- 'Fa,r,;a(CD STATE OF NEWA�63N{,COUNTY OF R ) as: 0!\, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of inbividual signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning 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 .2( Sworn to before me this 46r- day of �g,�sk 20 Z�-11, day of 1 ' 20 CvYtJ7 Ci� tgnature of Property Owner Signature of Applicant EItaIn0r 06rC.aik An+hmv Kleem Print Name of Property Owner Print Na licant Notary Public Notary Public SEAN L.YTLE SEAN LYTLE NO2AAyPUBLIC Y NOTA.RYPUBLIC YCOMMIUlan EXPIreo Aug.31,"of COMMI slen Expires Aug,31 �3 Tli1s application mast be properly completed in its entirety and must include the notarized signature(s) of the legal owners) 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. z 611/2024