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E C 1E �WEE LD�
BUILDING DEPARTMENT DEC 1 � 2�24
VILLAGE OF RYE. BROOK
938 Ki\C, STREET RYE BROOK.NY 10573 -
(914 -0668 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
w ww.ryehroo kmv.goy
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP
Approval Date: 1� , Permit Fee: S
Approval Signature: 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
Application dated, 12/13/2024 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.
I.Address: 229 S Ridge St, Rye Brook, NY 10573 SBL: 141.35-2-42 Zone:
2.Proposed work: replace existing natural gas water heater in same location
3.Property Owner:04P SW'I+ QIUr:,Pradeep Pereira Address: 229 S Ridge St, Rye Brook, NY 10573
Phone#: 914-356-3995 Cell#: email: b'nanangela@yahoo.com
4.Master Plumber: Gary Kroell (Burke Energy) Address: 22 Brookdale Rd, Mahopac, NY 10541
Lic. #: 596 Phone#: 845-628-3333 Cell a: email: burkepermits@meenanlp.com
Company Name: John & Kroell & Son Address: 22 Brookdale Rd, Mahopac, NY 10541
INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Water Urinals prinking Sinks Showers Bath LaundrN Domestic Fire Sanitary Natural/ Other* Total
Closets Fountains Tubs Tubs Sen ice Service Set%cr LP Gas
Basement
water healer tt l
1 st Floor
2nd Floor
311 Floor
41'Floor
51 Floor
Exterior
5.* List Other Equipment/Provide Details: connect to domestic water
(Notarized Signatures Required Next 2 Pages)
STATE OF NEW YORK. COUNTY OF WESTCHESTER ) as:
Gary Kroell /Prgd& )F&,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing A 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 o before me this Sworn to before me this (q�
day of l° lm,,� day of De,-en'>be_ ZO ot1
is 6�&Ov
Signa a'of Owner Signature o Applicant
rka P 8r��rt} f�I - a�� soa!, 21�{� C Gary Kroell
Pri Name of Property Owner L.LG Print Name of Applicant
Notary Public (2oary PubBLIZABETH SABLES
KAREN M aAMSTA NOTARY PUBLIC,STATE OF NEW YORK
Notary Public.State of New York Registration No. 01 SA6392045
NO.171estchosa60 Qualified in Putnam Count
Qualified in Westchester County y
My Commission Expires Dec 11. 2o2s Commission Expires May 20,2027
This applicatrd c ) � c t c e 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 property completed in its entirety andlor not properly signed shall be deemed null and void and will be
returned to the applicant.
6r 1;20?J
BUILDING DEPARTMENT
VILLOE OF RYE'BROOK FOIEC 19 2024
938 KING St kEET RYE BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
www.r�-ebrookny.Env mBUILDIIVG 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 WI STCHESTE'R ) as:
31, { > P 9?4M &Aq I9 - , residing at. 277 9ENS11 )O 1J RZAD A SCA P-OA 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,
2;�q 6044T-++ TLIDG E sT2CE1_, (Z_Y(E' XkDK) ICY 1 b M , Rye Brook, NY.
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.
PAW 69ft PEE► 60 Z%ATA- I'ZI D�t� ��~✓
+9'riu� '�,rn: gel i'�ni,.rii t�ti�� .ii•,�1 ii,, rr�� - —
Sworn to before me this IYo
pill
day ofjg'CMW J- 20
KAREN M BA7-nSTA
Notary Public-State of New York
NO.01 BA6029060
- — — Qualified in Westchester County
My Commission Expires Dec 11, 2025
3_
61112024