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HomeMy WebLinkAboutMP24-165 a ,•, s w W V cn a. a v c�, 00 > �"'� C 1� F4 rl M G ate• "V. => *�' s Ln \O 8 o O z00 00 a� z g g ma Ln w A H w d Z wzo ou we ow "', � �- Z A M OW Z u U i..4 My r Od A, w =1 a MMr 00 ,� mod, ,d N_ "�'� •x :. �"w a o � � ° " oo �' ° ,U v ey W c� � 6. a 'Z � w �•„ p o O � z � Zvi x z c o pen o . ,, �" w � Ca N g w z a o a.-v �� a a .41 w x �.m71 BUILDG DEPARTMENT VIL �E OF RYL\ftOOK 21 DEC 1 7 2024 938 KING �� ET RYE BRO",NY 10573 _( l4_)939�0668 VILLAGE OF RYE BROOK . ov BUILDING DEPARTMENT i4 "* APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: �1-\ Permit Fee: $ 3 — /��7 Other: Approval Signature: 5 Q Disapproved: t (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: i. 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 must 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. $. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, - ;Iis 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. n I. Address: I�U A � � � K r rj aft- SBL: j�� ti'1_ I-� I Zone: 2. Property Owner: Address: 11411 f7r Y Phone#: -Q t y —Cell#: email: j4 C'� Z 3. Contractor: /7 n 61 /1 Address: gO a 4 /a.G� Phone#: I Cell#: email: 4. Scope of Work:New Installation{ )• Replacement V,Removal( )•Other( ): 5. List Equipment: FUr /la - oilL Co ell S n Vola IG 6. Location of Equipment:Ja G f ©f �U� 7. Method of Installation/Removal(list all equipment needed to perform job): —! �"pl? �i �l Lr S�'a 3 3�% t 6/1no24 STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: Thomas Monahan ,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 Mechanical Equipment 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. Swom to before me this Ae Sworn to before me this A0 day of 11 C -)o01 day of U bt-'' ,20Z-1 Amold Handwerger Thomas Monahan Sii n�ature„oyf Pro rty O ner Signature al pplicant Print Name of Property Owner Print Name of plicant Notary Public "Notary 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. 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. t ISA FITZGERALD Notary Public, State of New York LISA FrrZGERALD Reg. No. 01 F16402089 Notary Public, State of New York Qualified in Putnam County Reg. No. 01FI6402089 Commission Fxpires 12/23/20 Qualified in Putnam County Commission Expires 12/23/20. G/t/2024