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HomeMy WebLinkAboutMP25-025 - a N L i N pZ •d m cq a N \ \ v QI N N v \ \ rn cwa O ' N 044 C di w rn 140 0 � 3 � Yvy O/ °a W ° -� 4 o W � „ 14 w ' PLO ...� Ln o . w W x � �, � � � o g w F � � �, � a•� .� O rI o w W o _ u ° w W C� w O W H A o v 4) a WrV N z z UzU (u N V U Sao Q G1 � O(� ; d w o . W..f U � x © ° Q a 00 .E cn a 'C y o •a ,� � Yam+ N 1 W z a © F jO� z ": .a qu a � F h—� p �, o HSW E E"r V O (7N wvs � s� ;, o as o � 51 P-, R D F�) FEB 2 1 2025 BUILDJIY+- k-3t-TMFNT VILLAGE OE RYE BROOK ti . .. c7 � BUILDING DEPARTMENTVIL E� OF RYES � OOK R 938 KING T ET AYE I3R ',NY 10573 APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE IDEATING 'VENTILATION AND/OR AIR CONDITIONING E UIPMENT FOR OFFICE USE O PERMIT Approval Date: _ 1�- Permit Fee: rr $ Approval Signature: Other: ➢isapprovcd; (fees are non-refundable) DO NOT START WORK or CONSTRUCTION IIN'1TI,A PERMIT RAS BEEN ISSUM BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT Is 12%OF TIIE TOTAL,COST OF CONSTRUCTION ION WFFH A MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMTr&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 bolder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U263/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$150.00/unit•COMMERCIAL=$450.00hrnit_ 5. Complete specifications for each twit 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 1.9} 2_S is hereby made to the Building Inspector of the Village of Rye Brook:for a permit for the installation and or re ovarh ltof the HVAC equipment os 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, -�,fin / \ �7 /�/ l. Address: 1 y�� RAR;A, ,5U 1 I C;t tfT Z SBL: / ��,``''c /pp..,,�i�Yy`,--7 Zone: `�f_/D 2. Property Owner. WA � �� 4 a C, Address° Z6r t.`1t, VIM r Phone#:9I1+� —i_M-4-ODS r Cell#: T email:M� M— �}Q ownwtto 3. Contractor:�.ws,q wMa '(t 5w�Iff-'r,li t Address'4D_ HA MY �.,' S M,CT Phone#: Z03' q4'3'535 Cell#: email:TANI;5 CM 4. Scope of Work:New Installation( } Replacement( )•Removal( )•Other( ): 5. List Equipment: 1 'bc_S+} TLA\J Y)V LT LIJP-5 S 6. Location of Equipment: COY�00 OIL CIF U1'k/1T A"%)wTf---D SPWCic— INS Uvyk—C , T 7. Method of InstallanoruRemoval(list all equipment needed to perform job): I 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)hc 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. Swam to before me 0' C Sworn to before me this oe Q day of r v i" 20 day of J Q n OO 2p a� lure of Pr erty awser h Signature of Applicant Pri t of o e Char * Print Name of Applicant JC���'Q'ZLK (If Notary Public Notary Public ALENA NAKANJIN t)at NOTARY PUBLIC,STATE OF NEW YORK Reylstrstlon No.01HAO013545 Ouslified in Westchester County My Commission Expires W1912027 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