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HomeMy WebLinkAboutMP25-028 ■ s � a � a N W a N N N61 p. o IV Or. i 6 �■O/ O � � � N � � c a a Q ■ z a , a `o ono o W 0 3 ,5' V� No • O z Q Q o V v oU (,� 10, -� °° O © z z v X F- �-+ a3 3 x U QN � V W x cc� rV Q U � o L V w o U 0E H c z � ¢ x o op ob _ BUILDZC DEPARTMENTRVIL OF RYE BROOK FEB 2 B 2025 938 KING ET RYE BROc ,NY 10573 _ qL- 9-%0 VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: MAR 3 ZO Permit Fee: $ d� Approval Signature: Other: S 767C) Disapproved: (fees are non-refundable) r•�,r******,rw**:r*******,k,t,k******************,r*************�*:�********,t*se**,kat**,k**r,r*,r****vrr*,x*w,�*�******� 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 REQUIREMENTS 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#C 105.2 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. ****tk'k*4e de do tF*#9e ti*tk9:sk kt'*A'*#•*'kktk***k tk�fc*ttnklF*'k*dF tt'k**tk*eF t49F 1F ek 4t eF dr*'k**yk"ktY*k nk k*F itr:F*k*:F:F:E eF:F e4:4�t at ie*F�*Y it et kkic�:x Application dated, —<W—3 Sis 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. 1. Address: 2-4 17e • SBL: IQ Zone: 2. Property Owner: re ;�Qt:r � Address: 2_�- _ZCX04tP� D( Phone#: C111 - Cell#: email: ( 11M LJ 3. Contractor: t d��'LC'►���.s�I�LC� Address: 2b ti1te2xxe11Pl.k gAlM4�__-A k� Phone#: C�1 N—C.iS ! CUL) Cell#: email: VX)e 0 e(x 4 ec m 4. Scope of Work:New Installatio�on^^(4•Replacement( )•Removal( )•Other( ): 5. List Equipment: '[\VcA WM9 Io 'A'�tCU.):30 VDA.,P5 Rg- `V•,`E.( bod G fir, -,-Pr 6. Location of Equipment: 0YfNQCl l( R rc, o4c on U►n"rJ1 0r po fr 7. Method of Installation/Removal(fist all equipment needed to perform job): t 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: � (l �IIS,' 1( 1) ,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 Keating,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 before me this Sworn to before me this day of ,20 2 day of RM)a 20 Signature of Property Owner nature of Applicant Ar► Poss©'n tN31 Print Name of Property Owner Print Name of Applicant Notary Pub *- Notary Pub ' :T;�—' JENNIFER RIVERA JENNIFER RIVERA Notary Public.State of Now York Notary Public-Stat•of Now York NO.01 R1630SO56 N0.09116311110116 QwIIMad In Bronx County Qu&IIM*d In Oronit County [my Commf111"101`00 Fob 2d,2027 µy tunimi3sir�n Cz�16irps Mrb 22, 2017 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 6/1/2024