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HomeMy WebLinkAboutMP24-158 _ M _ - L(� W GW = N N a � W . H A w O w v CA En H o w s y rn W � N a g ;� � � •�c w � [-��/ y . Oe _ a d' v +• CIl _ 'Oi Q W oo o v , v co x W Jl� Z CN � -� d 0-4 �oU ° CC °° Ln w CIOw V �` z zz V w 0Z� u a N W G° � '� � N ++ r Z © x S4o � -v a w =n z a .d x � � v s _ BUILD ��� ,TMENT b VIL OF RY OOK NOV 2 7 20214 938 KING ET RYE BA ,NY 10573 VILLAGE OF RYE BROOK .201 BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT 4: Approval Date: NOVJZJ 2024 Permit Fee: $ Approval Signature: Other: Disapproved: (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 CONSTRUCTIOti NVII'H A MINIMUM FEE OF$750.00 REOUIREMENTS 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. I 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=S 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, - 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. / fJ l. Address: I C 4A L pf o� L�pN Q __ (y ek NJ SBL: /3S, `/4—,rI/� S' zone: �I Q1- 2, Property Owner: Re 2 J� T (a M,53 Address: /O C.AR11-4,. L6►, "t, Phone#: `7.0 y Cell#: email: Q_t�_MJ•fr 3. Contractor: IQ t f C Address: 7(y /V A1A%ti _34— &C S �3 Phone#: /1 7-JVY3,31Cell#: email:. 4. Scope of Work:New Installation{ )•Replacement( •Removal ( )•Other T 5. List Equipment: t R eV A cL LZ 4.,A 1-4 .14' 6. Location of Equipment: &A 7. Method of Installation/Removal(list all equipmcnt ncedcd to perforn,job): LJ 2 N L.A �C 1 611/2024 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 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 performcd,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 j-7 day of i�G�/;,tirn S,- 20 L� day o V"J v v�� 20 nature of Property Owner e f Applicant Print Name of Property Owner rin ame of Applicant Notary Pul6lic Notary Public Emilykrth SHARI MELILLO Notary Public,State of New York Notary Public,State of New York Reg,No.01W00030559 No.01h1E616O063 Qualified in Westchester County Qualified In Westchester County,� Commission Expires November 01,2028 Commission Expires J:-u ,.y 29,20 ! This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owncr(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 6/1/2024