HomeMy WebLinkAboutMP24-126 a
a s
s
G v n n
: N N N
s \ a,, FiL•� � C a C� m
� U
Cl) H U
1-4
CID
Ln
= a i"i W 1 w C4� to !3. a� �j ✓� � Q =
a I//1�1. � � � ►� � �i ° Lc� 3 Ou Imo., y � � a
C �
� r o 3 a V1 °
O ~
x Q � ram-+ � w ►, rn
a.
Lnx Fy gu ^C m
z Z pyz p � i+ 0
O L' Cn vs o v `" U
00
QCa
-] �' oO
co
05
rLl p 'J 0 m a
v
CN
Qn
Ova, vO
C.'7 a3 A u s 0
� ,^ co� vo �
a
O E+ C � V r.w
° °'H C) V � Sw U
Cn r,,a O U
ar" ° � o
o .ti m
UU u -
�I
BUILD � �:�- .TMENT SEP 2 0 2024 DD
VML JtCE OF RYEtiB1�00K VILLAGE OF RYE BROOD
938 KING 9i; t I1rRv>;B ��o ,NY 10573 BUILDING DEPARTMENT
1M�41t� d'�. ov
APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING VENTILATION AND/OR AIR CONDITIONING E UIPMENT
FOR OFFICE USE ONLY: PERMIT#: r62
1
Approval Date: 6 2U24
f
Permit Fee:
Approval Signature: Other:
Disapproved:
i(fees
are
non-rfundabl*)�r,tfe��*,t
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 S750.00
RE UIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF OMPLIANCE:
1. Properly completed& Signed Application.
2. Site/Staging Plan if Required by the Building lnspector.
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#C 105.2 or Form#U26.3/or NY State Alorkers 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.
A t Ai.*.F.L i.h*********..*+. �********r.**w*********i.*ft********************************x**7*****A******)fit
Application dated, 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.
1. Address: 170 S. Ridge St. Ray Brook NY 10573 SBL:S 14I.35 B 2 L36 Zone:Cl-P
2. Property Owner: Win Ridge Realty LLC -Address: Itye Ridge Plaza.STE.200 Rve Brook NY
Phone#:9 4-701-4005 Cell#: einail: A*N;No)I,1;}.tt��
3. Contractor:A&K GC CONSTRUCTION INC. Address: 202-16 45T"AVE BAYSIDE NY 11361
Phone#: 17-515-88 4 Cell#:917-515-8894 ^_ email- akcon.incPgrnaJl.com
4. Scope of Work:New Installation(X)• Replacement( }• Removal{ }• Other( ):
5. List Equipment: . r�zn CFM / ARI,
6. Location of Equipment:
7. Method of Installation/Removal(list atl equipment needed to perform job):
rNSTALLATON OF VENTILATION SYSTEMS
1
STATE OF NEW YORK, COU CH
NTY OF wESTESTER ) as:
i-L46- /G.L WrC being duly sworn,deposes and states that Ile/she is the applicant above named,
(print name of individual 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 e th' _�� Sworn to before me this
day of 20 day of 20 Z-V
61
4u-t
q_i,W-nCture of troperty Owmr4 fir Signature of Applic nt
C A N U S f k5R Lull✓S
PriAAN64 of Prope ' �rfir,,,� Print Name of A plic�nt ,
1
Notary Public Notary Pub ,'li
f
ALENA HAKANJIN Msea A, SartoWe
NOTARY PUBLIC.STATE OF NEW PORK H,�tary Purlic. °`,Wte of me- York
Registration No.01 HA0013545 Np ol&607F5 3?
Qualified in Westchester Countyy pUpllAed !n aueens countt,.� f
My Commission Expires 511912021 ti, 2p _
Comrnisston FYn5.- s .'une
This application must be properly completed in its entirety and must include the notarized signatures) 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 mdI and void
and will be returned to the applicant.
2