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A4 w a x r BUILI�)�NG DEPARTMENT RNOV 18 2024 ID VIL{.a E OF RYE 1WOK VILLAGE OF RYE BROOK 938 KiNG,STREET RYE B ,NY 10573 BUILDING DEPARTMENT I `-f9} - -- - - _ wwwh� U idly-uov PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP# PP Approval Date: Permit Fee: S Approval Signature: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION tINTIL 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 Application dated, /�%��' 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. 1.Address: r+ l/NCB-S�p WJAfj 1 eJ_1t C eal SBL: f�J�,'7�._�—� p Zone: —/0 2.Proposed Work: 3.Property Owner:i/4 C Cal�� j c" Address: Phone#: Cell#q 14 k- 5,73 email: lC 4.Master Plumber: f 0 LAil n G(� Address: me� Lic.#: Phone 4A4,42, 4jfcell#: email Company Name: ddress: e i e� C' I �62� INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Se�%er LP Gas Basement Ist Floor 2nd Floor 31d Floor 4'Floor 5's Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) ,LCg 2_ L t I '`"I- e'�� O! \ t( �' ` 6/1/2024 c C� � 7 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print naive of individual signing as the applicant) and further states that(s)he is the Master Plumber 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 thi h--' Sworn to before me this day of l�I 'v f'tn, '20 _ day of ,20 Signa re of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant v)-s'�J s L Notary Publia;l Al MEULLO Notary Public ...ti,r y PUblle,State of New York Nc.OVAE6160063 Qualffled In Westchester County r}� i s:;5ireJ ;29,�20G' f 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. -2- 6nn02a STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 Master Plumber 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 Sworn to before me this day of WIy et`n� 20 c day of ' o _ i &i/gria6r of Property a Si66ature scant C1�1�1 L Zf Property Owner Rr t Name of Applicant 'k -Ary - No�Qjtlic State of New York No*XAPMWLLO No.01VIE6160063 Notary Public,State of New York . Qualified in Westchester County No.01ME6160063 Commission Expires January 29,2( Z Qualified In Westchester County Commission Expires January 29,201-1 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. -2- 6/1/2024 ! LI Ll L� BUILDING D&&TMENT ]D IE VILLAGE OF RYE BROOK � NOV � $ Z02(1 JD 938 KING iTREET RYE BRodk,NY 10573 (914)939-0668 �___�__� VlLLAGF OF RYE BROOK ww�vx eh^> T BUILDNG DEPARTMENT 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: residing at, , 13To (Print name) (Address where)ou lip e) 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; 0 c( Rye Brook,NY. (Job 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. (Signature of Property Owner(s)) /'Vic-dj/f (Print Name of Property Owner(s)) Sworn to before me this d t\/0 20 O l (Notary Public) SHARI MELILLO Notary Public,State of New York No.OWEU60063 Quilifir.cl In Westchester County .3- Co,nn1is�si,m Expires J, . /29,20� 6/l/2024 QyE BR(�j� O� Zm 1982 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 : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: r� it �� w"�- OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ` fit L�4 U� ❑ L.P. GAS 1 , / ❑ FUEL TANK t� 1 Y�/� V.? " ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER r _ �I `-.' fy �.. �` , 1. L � ' f•� Jp 17*416 t-N . � �`' 'k��f.}_. �. raj 14�� `,,� Ct •- � R 1�