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BULL, E RTMENT FEB 122025
VIL E OF RYE OOK
938 KIN( ET RYE B -.'.NY 10573 VILLAGE OF RYE BROOK
(914)9 939-5801 BUILDING DEPARTMENT
w n T d or
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#:
Approval Date: FEB 14 Permit Fee: S / 1_1S_®
Approval Signature: Other:
Disapproved:
(fees are non-refunetaMe)
Application dated. is hereby made to the Building Inspector of the Villacue of Rye Brook NY. for the issuance of
a Pen-nit to install and/or rem ve Plumbing as per detailed statement described below. The applicant& propertN owner. b\ si��ning this
document agree that said plumbing work will be in conformance with all applicable Federal.State.County and Local Codes.
1.Address: 12A Rye Ridge Plaza, Rye brook, NY 10573 SBL: _ Lone 'I0
2.Proposed Work:Remove sink cabinets and cut and cap plumbing for 2 sinks _
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3.Property Owner: tl Address:_Z* M e fit 6c
Phone#: Cell#:
4.Master Plumber: Ken McCabe Address: P.O. Box 650 BriarcIIff NY 10510
Lic.#: 983 Phone#: Cell#: 914-80 _ 412 email: _
Company Name: VFR CONTRACTING Address: P.O. BOX 650 BRIARCLI FF NY 10510
INDICATE FIXTURES& LANES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks ShoNNers Bath LaundrN Domestic 1 ire Sanitar, Natural! Other* Total
Closets Fountains Tubs Tubs Seri icc scr%ice tic%%er 1.1'(Jas
Basement
I st Floor
2nd Floor
3' Floor
-t`h'Floor
5` Floor
Exterior
5.• List Other Equipment/Provide Details: Cut and cap plumbing to existing sinks /t-eM D✓f( 4444;3,-
(Notarized Signatures Required Next 2 Pages)
_r_
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
Ken McCabe ,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 legal owner of the property to which this application pertains.or that(s)he is the
Contractor for the legal owner and is duly authorized to make and file this application.
(indicate architec►,contrac►or.agent.attorney.etc.)
That all statements contained herein are true to the best of his!her knowledge and beliel'. and that anN 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 la%%s. or,linances and regulations
Sworn to before me this ID Sworn to before me this
day of8 20 day of •20;5`7 _..
S(, atrc u c�DSiure ( n ep
�Av tD N46t l s-vt E'en MJ'ahe
I'ri it Name of Prop4 rty Qm tr—. J� Print (tame of Al►pl icant
_ L, ura Smith
Notary Public NotlaN#1961k, State of New York
ALENA NAKANJIN Reg. No. 01 SM6387739
WTARy pUWX.STATE OF NEW YORK Qualified in Westchester County
Re Istratlon No.01NA0013645 Commission Expires02/25/27
pyalified in Westchester CountY
my Commission Expires 9It9! :
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.
]1 1 �
BUILII KG 99PART,VIENT D3D
V14;WE OF Rv"% ROOK FEB 12 2025
938 KING STAEET RYE HR00K,NV 1US73
(914ji 939-0668 (9I-11939-SSUI VILLAGE OF RYE BROOK
�`��w l�• nl;�,l BUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE �216 STORM SEWERS AND SANITARY SEWERS
THIS AFFIDAVIT MUST BEAR THE NOTARIZED si=xTuRE 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 13E RETURNED TO THE APPLICANT.
STATE OF NEW YORK. COUNTY OF WESTCHESTER ) as:
3I, � I`��;Ll , residing at. —
Wri,nl mane) IAddre>s%tihere you 11%c1
being duly swom, deposes and states that (s)he is the applicant above named. and further states that oche is the
legal owner of the property to which this Affidavit of Compliance pertains at:
JZA FCA-M Rve Brook. NY.
Doh Addue'si
Further that all statements contained herein are true, and that to the best of his!her knom 1,doe and bcliel: that
there are no known illegal cross-connections concerning either the storm scx%er or saintan sewer. and lurther that
there are no roof drains. sump pumps, or other prohibited storm-water or ground\\titer connections or sources of
inflow or infiltration of any kind into the sanitary sewer from the subject propcm in accordance %\ith all State.
County and Village Codes.
tiignau „� I'rn •�,� llauw��,1
l Nrinl Name A'PrOr rt\ t hvwe M-
Sworn to before me this io
day if '1 24
ALENA NAKAN 00
NOTARY NK C.STATE OF NEW YORK
ANe�islrsllon No.GIHAO013NS
GUMMMd In Westchester Coup�
CewissMon Es 9HNZOYT