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V ° 0-4 W v od as A p" W - � � ° a � t BUILDING DEPARTMENT Hum VILLAGE OF RYAROOK 938 KING STREET RYE BROOK,NY 10573(91.4) 9-0668 www.Y rooknY•gov INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: N©V ZQVrinit#: tea+ Application Fee:$ rA .., Approval Signature: Permit Fees: Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration o4an. ting uilding.or for a change in use,as per detailed statement described below. 1. Job Address: t' PBVXK t`r'� 105--B SBLJ 6 J r 5 '1—'7 Zone: K t 2. Proposed Improvement.(Describe in detail):3$ffii2"J 2k*J..LATi OTC I Nru-p-i ,• A41 Nr IlUi H►5fil F L DOQ G.� 2r�1-es'e C r S \ art eon - t -ec rr 1 1Q)C-0 r10� . '�—. ►1 iS 3. Does the proposed improvement involve aHome-Occupation as per§250-3$of the Code of the Village of Rye Brook? No: ✓ Yes: If yes,indicate: TIER 1: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existiV automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: V Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I faro.,2 fam.,comm.,etc...)Prior to Construction: + VAI. After Construction: I fAq• 6. N.Y State Construction Classification: N.Y.State Use Classification: . 51 lt� 1"j�t{�!'105 8b0 �A0+ iC-T, Obl - 7, Property Owner: �—Address: i Rt1T�1L"1�„T cT 069�Z Phone# Cell# 9i1 3 I email: S. Applicant: Address: Phone# Cell# email: 9. Architect:t:V-V rJL H LI WO 5tl 0 Address: L. 1� t-D VE n© Phone# (914)SW-2241 Cell# email: ly e.MaG.rq Ai •eA+•+� 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Jiggi HAMAL —Address:-�3b tM4 1 AIE-PU11N5 r4l. 10bQ3 Phone# Cell# y N 4 t�7 email:'3 1 corny 1100 L%@W CVP� WV0 12. Estimated cost of construction W ��5,000 (NOTE-The estimated cost shall include all labor,material,scallirlding,fixed equipment,professional tees,cord material and labor which may be donated gratis.) 13. Job Timetable: Start:611Kf tb 15 ATLJ� A? Finish: I'lk-t Lb (1) 6/1r2024 i kOCT E d V E RY )OK 16 2024 *A KIIvt,$ RT HYR 08 NY 10!173 ���� i VILLAGE OF RYE BROOK BUILDING nF=PA,RTMENT ••AsaaaaaAaaaaataaliaai!lifiliiiiiftaffNtff#affa#ffliflf�lFffiii#flFff#lfifiiflNf!#!flfiiliilftfaAAN AFFIDAVIT OF COMPLIANCE Vit i.AGt C.`om. §210 - S'LF0RNI SEWERS AND SANITARY SFWFRS ANIS AFFIDAVIT ?MUST BEAR THE NOTARIZED SIQ4ATURE or THE LEGAL PROPERTY OWNER AND BE SVBMITTYb AID WITH AM BUIi.DIItG OR PLUNDINC VKRHIT APPLICATION. ANY BUILDING OR PLow-MING PEM41T APTLICATIOt SUMI-I D, WITHOUT THIS COMPLETED AND NOTARIZED rom WILL BE RETUI0rED To THY APPLICANT, STAFF OF NEW YORK,COUNTY OF WESTCHESTER ) as 1, Sv13 t"l m✓1 ,residing at.IS70 P f:t' a �Amfo,-, 0-06 � (Nwil M) (Addres4N -)(w %o 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 A flidavit of Compliance pertains at; ys cgmAL:a: .ill ;g4z nR% �('04, my_ —f -7 Rye Brook,NY. 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. ��3���, 1�1 •HAS f t'nnt Sam W PuIXn) nerls)) Sworn to before me this J sf k _ day of 20. t?:ary Public) Mohan. D. Buxam !Votary public, State of New York 12f Registration No. OIBU6266896 Qualified In New York County a)�odt Commission Expires August 06, 2028 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. fJPIE OF NEW Y RK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, ame of indivi ual signing as th ap icant) rther sta s that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the _ 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 o/� Sworn to before me this d day of Si4XOA'►Z,r , 20 *Z 5 day` f 201cr�,Z�N� r C, WiLITe o6gKo—perTy Owner igd to of Applicant Print Name o rope P nt I lame oiA licant Notary blic Notary Pu c 1 Joseph Cinicolo Notary Public, State of New York Joseph Cinicolo Reg. No. 01 C10027568 Notary Public, State of New York Qualified in Westchester County Reg. No. OIC10027568 Commission Expires August 5, 2028 Qualified in Westchester County Commission Expires August 5,2028 (4) 6/U2024