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BUIL DEP MENT FEB 2 5 2025 3D]
VIL E OF RYE OK
1° >938 KIN �T ET RvE B ,NY 10573 VILLAGE OF RYE BROOK
.> BUILDING DEPARTMENT
w+�u�,� � n.Y_l��
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP #: PP#: 30
Approval Date: FEB 8 25 Permit Fee: S Q00 10NJ
�`�
Approval Signature: Disapproved:
(fees are non-refundahle)
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 XITH A MINIMUM FEE OF$750.00
Application dated, 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 thatsaid plumbing work will be in conformance with all appli able Federal,State,County and Local Codes.
1.Address: (O r-/0 Z a(e,g& t!10L �Wt0 SBL: Zone:�u
2.Proposed Work: r /1�
3.Property Owner: I-f Ot4 Address:
Phone#: /� / Cell#: email: +�' ,/
4.Master Plumbery'tC [�.,,� cell/. � .�� Address: � ? �o(r"� pT,-t Gil
Lic.#: 205: Phone#:�?Z&C?Z X;'d� Cell#: email:
Company Name:7Z Address: 94
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
1st Floor
2nd Fioor
3`d Floor
4'h Floor
5"Floor
Exterior
5.*List Other E ipment/Provide Details: 'Tb C\R - �
(Notarized Signatures Required Next 2 Pages)
-1- 6/1/2024
BUILD C DEP MENT [ECEPYED ,
v
VIL E OF RYE � OOK FEB 2 5 2025
938 KING ET RYE BRo ,NY 10573
`� 4 939-0669 V VILLAGE OF RYE BROOK
brookny.2ov BUILDING 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 WESTCHESTER ) as: i 1
3, AAxA<c711 , residing at, 1 b<)rk`l & �_ �-nx W
(Print name) (Address where you live)
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;
`CV 'bo rc�- V y �-�vi& , 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 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.
kao A4V)
(Signature of Property Owner(s))
'�,K�Lih ?b_(co_& AX&YKC 1
(Print Name of Property Owner(:;))
r
Sworn to before me this F vlvl_
day of /Cl tt , 20
s EUZABETH A. HUTHWArrE
Notary Public,State of New York
fiz-
otal ublic) No.01 HU4625967
Qualified in Westchester Cou 9
OOMMI"lon expir"FobruMry>:0,
-3-
6/1/2024
STATE OF NEW YO {,COUNTY OF WESTCHESTER ) as:
j� 31
O� C ,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.
Swom to before me this Fib(-Wwr Sworn to before me this "')
day of Z q ,20 S day of ,20
<,O MAR1A CEtILIA DEPINH6
Signature of Property Owner Notary Public,State of New York N0.01DE6313737 Signatur of pplicant
Qualified in Westchester County
0'( ,A q �e11 Commission Expires 10/27/2026
Print Name of Property Owner Prin Name of Applicant
E ILIZABETH A.HUTHWAfTE &'49�
_ Notary Public,State of New York
; I
5NaAryPu4Wc Qualified°j01 y� ester County Notary Public
Commleslon Noires February 28,
This application trust 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.
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b/I/2D24