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HomeMy WebLinkAboutMP24-162 N o " ILn 10 N N D „ v _ 0-4 OR z a vi a .b ■ a w O , � Z ' , © � z W g `� •Cam. p � " .c �' , � rT� � � ~ � � WF4f1 � V � 'n •bN '� C r-1 i w � � a Imo+ 00 Oc00 .� U, F O 5 1 N o o � a � '� cr Z en rO z 1-1 CN �-, WW. at mo 00 t� cn r� U O v x a"4i w ' a vovvo. w A F� ICI d z Z w cn O z cn x p a ' oov j U U � a F-, war P4 w o W O O Fy04 t • BUILD MEN`I' VIL OF R OOK DEC - 6 2024 938 KING ET RYE BR NY 10573 4 4 _0 -r . ov APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT //&FOR OFFICE USE ONLY: PERMIT#:/ A c Z/i Approval Date: Permit Fee: $ ,3 oo `)p 6 Approval Signature: Other: Disapproved: (fees are non-refundable) it�rirk*ik itit�kYr5r9r9r�tik*7r,tk�rYt9r�ir*ir�r9r,etri4**�49r**tr*�kie*ie*9eirir,r****:t:k*kk****:a it:F:t:t ie:F it:F kk:k:k*jt***iF************i:**�F at**iF**ie 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 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. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, 'a / is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the I-IVAC 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. c p 1. Address: -7- W i nd I no wl)od "Road No C11 SBL:��/i CI a '��� Zone: 2. Property Owner: ASk(Ar D\(AbbArkhDdiAfm Address: I Windialwond ROQd NDl'-tb Phone#: Cell#: ?H* - q 33 - 3*:*1- email: gst u r. d j Olh'd1ma i). r.0 h1 3. Contractor: 511 a 5k KY i U 5 LL G f ,45+n r-i o Address: 16 V00- "P60- 5iYfA+# Phone#: Cell#: email: OQ.CY A55)QSV060nWJ ,irl J. COW 4. Scope of Work:New Installation( )•Replacement Q0•Removal O•Other( ): 5. List Equipment:Emkffi ?Y1&,A api(A(.QYV1Lyl+ 11i k-jyi lz-NNOY• con dul5tr- (M I - Qqa-a3i coil ( U-NNOx cH35- 42 -aF) rind LJFNNQA RArna(L (ML1b0U"090vug13) 6. Location of Equipment: f3C45M9,11f- OVA ©u td our(Gor)&J nst r ) 7. Method of Installation/Removal(list all equipment needed to perform job): t 6n/2024 r STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly swom,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 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 Df,(t M b�I' Sworn to before me this D e Y M vkl-t 1- day of 20 Qq day of 20_ IV 0 Signatur of Property Owner Signat kif licant / p6V)arkhod�u2� 511a Goal c.s LL.C - Prm me of Property Owner Pri7,7 e of Applicant y4v > ,4 otary Public Nfdtary Public �,mapda gucci Amatlda l3ucci [Notary Public-ConnecticutNotary Public-ConnecticutMy Comn}i�sion ExpiresFr�bruorv28,2025 My Commission ExpiresFPbrvarry28,2025- 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. 2 10/30/2023