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BUIL1 NEPA. MENT
VIL E OF RYE* OK JAN 15 2025 Di
938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
. ov
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#: J
� --Approval Date: 6 � •—_ � Permit Fee: $ �
Approval Signature: Disapproved:
(tees 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
PEHA IT IS ��
12°o OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF 750.00
Application dated, /"/J` 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.
1.Address: ` '''� W`' !Jtdt tv _ SBL: /35/4G J—��Q Zone:/1e_/E7
2.Proposed Work: r o ► A L�
3.Property Owner: A 1?4&4 Co 92 Al Address:_'qd iV 1 N wv4 d 1' 1U
Phone#: _�Wp -5 Cell#: J email: 48 i i a 1411.3 I(0'1,"
4.Master Plumber: _.,4 3aoA(.._ /1-g w p Address: `,7�G N 9�'� 5�
iv
Lic.#: -Phone#:3—Ly-9 3V 01 —Cell#: email:PAej-pAhT c 'c
Company Name: A 2 i i t m t cA A.-1/r.( Address:y(� o yU �1✓ S i lhr.y i�.r /Y"l
INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural! Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement
1 st Floor
2nd Floor
3'd Floor
4'h Floor
51 Floor
Exterior
5.*List Other Equipment/Provide Details: J00S
(Notarized Signatures Required Next 2 Pages)
A- �u�a
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 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 to before me this Sworn to before me this
day of ,20oV day 20 s-
ignature of Property Owner Signature of Applicant
L6VVC-ems coketi ?"z "6'/"7nC'
Print Name of Property Owner Print Name Applicant
6
Notary Publiel i�tELILLO Nor MW
ubublic,State of Now York
State of New York No.01 WH6394580
-!f,7E6160063 fhsalified in Westchester Counttl
Westchester County Commission Expires July 8,2027
Expires JZriL*;y 29,20_
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. Applications
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/l/2024
BUILD NG D>E P MEN D v
VIL E OF RYE`' OOK
938 KING 4 ET RYE ID
BR ,NY 10573 JAN 15 2025
_0
kri:'„o�, VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
*****9e%*k�:***:k:Y*:hYe:t4;rP***•k:P*%•*ky:**k***sFkd•***t*:kx�r*i::kk**•k*k�e:Fxrk****:Fk*ki:***i**kk********ki#****ie**t**:t dF:F*
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 FORK WILL BE RETURNED TO THE AePLTCANT .
STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: / !
J, [�w�e � �r)j �� , residing at, ub � ),"'d (^1rl yee� F-d N
(Print name) (Address where you live)
being duly swom, 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;
Rye Brook,NY.
(Job Address)
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 storrawater 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.
i
(Si o Propery uwner(s))
LQ'VV r e/1-
(Print Name of Property 0%vnut i 1
Sworn to before me this
20c,)�
(Notary 1'uhliu)
SHARI MELILLO
-„t ai y Public,State of New York
No.OIME6160063
flied in Westchester County
in ExpiresJ.rit.r-.y 29,20�_1 -3-
6/1/2024