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BUI0-'l
ENT
VILOK ,1AN 2 2 2025 '"UJ
938 KING ,NY 10573
VILLE OF RYE BROOK
ov BUILDING DEPARTMENT
APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING. VENTILATION AND/OR AIR CONDITIONING EQUIPMENT
FOR OFFICE USE NLY: PERMIT#:
Approval Date: 1 2 �� Permit Fee: $ Pp P6
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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:
4: 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)
A. 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, 1/13/2025 is hereby made to the Building Tnspector 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: 195 Ivy Hill Crescent, Rye Brook, NY 10573 SBL: 129.76-1-18 zone: uib
2. Property Owner: Louise Carrayone Address:195 Ivy Hill Crescent, Rye Brook, NY 10573
Phone#: 914-262-3305 Cell#: email: Icarravo@gmail.com
3. Contractor: Burke Energy Address:475 Commerce St, Hawthorne, NY 10532
Phone#: 914-919-3507 Cell#: email: burkepermits@meenanlp.com
4. Scope of Work:New Installation( )• Replacement(x)•Removal{ )•Other{ ):
5. List Equipment: Replace existing boiler with (1) new Burnham V8H-03 heat only oil-fired boiler with hot water coil
6. Location of Equipment same mechanical room at rear of building.
7. Method of Installation/Removal(list all equipment needed to perform job):
1
6/1 Q024
STATE OF NEW YORK COUNTY OF WESTCHESTER ) as:
Kelly Redlon/Burke tnergy ,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 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 efore me this /�� Sworn to before me this I l yt-l-,
day of t ,20 day of C�-�'ll,l(.'�.t� ,20
� ELiZABETH SARLES
>r NOTARY PUBLIC.STATE OF NEW YORK �`-�
Registration No 01 SA6392045 /
Signature of Property Owner Qualified in Putnam County Sign re of pli t '��
`LmfCe mmission Expires May 20,2027 Kelly Red n/Burke Energy
Print Name of Prop rty Owner Print Name of A t
Notary Oublic Notary Pu rc
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
611/2024