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BUILD �G DI_PA MENT d [E C E � V E
VIL E OF RY> OOK
938 KING ET RYE BRO '�,NY 10573 NOV 2 1 2024
'MW0668"
ookn ov VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT
FOR OFFICE USE ONLY: PERMIT#: / z) -7 —/6-4/__
Approval Date: NO 5 2 Permit Fee: $ / _5— —ID6
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 CONSTRUCTION WITH A MINIMUM FEE OF$750.00
REOI"1 REMENTS 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.
8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection.
Application dated, 1 112012 0 2a 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.
I. Address: 17 Highview Avenue SBL: 141.35-2-10 zone:
2. Property Owner: Maxima Moran Address: 17 Highview Ave., Rye Brook, NY
Phone#: 914-479-8790 Cell#: email: normaliza.p@g,mail.eom
3. Contractor: Meenan Oil Co LP Address: 1 Gateway Plaza 4th flr, Port Chester, N`
Phone#: 914-847-0295 Cell#: email: iweir@robisonoil.com
4. Scope of Work:New Installation( )•Replacement( )•Removal( )•Other( ): Boiler replacement
5. List Equipment: Installation of Navien combination boiler for heat and hot water.
6. Location of Equipment: Basement
7. Method of Installation/Removal(list all equipment needed toperformjob): Removal of oil fired boiler. Installation of
new Navien propane fired boiler model NCB-190/080H.
t
6n/2024
STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as:
k&( m'c C i ,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 legal owner of the property to which this application pertains,or that(s)he is the
(indicate architect,contractor,agent,attorney,etc.) for the legal owner and is duly authorized to[Hake 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
I Prevention&_ Building Code,the Code of the Village of Rye Brook and all other applicable laws„ordinances and regulations.
1 �,
Sevotn to before me this _ _ Sworn to before me this ✓Q
day of 11 20 _ day of 20
i Si nature of Pry crty Owner Si�-naturc of Apf licant
Print Narnq of Property Owner Print ame orL pplicant
� ,
N SIERF[4
Notary Public ivo,aiy Public-State of i-ow York „ Notary Pubic Nc ?uhlle-Stag of A1ew'c,r1;
h10.01510280J99 if0.01SIfi2E30;98
Qualified In Ylestchest� rounh F 0ualified in'Nestehester Cour":
h Ecmrmission Expires3y I y My Commis tan Expires }
This application mus=be proper yy complete in I's entirety and trust 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.
i
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