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ECENED
APR - 4 2025
BUILDING DEPARTMENT VILLAGE OF RYE BROOK
-'i
VILL' ,OF RYE BROOK BUILDING DEPARTMENT
938 KiNG,S STREET RYE BRQOK,NY 10573
www:t t b- 606y.gov
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: PP#: c) --J c S—
Approval Date: APR 7 025 Permit Fee: $
Approval Signature: Ot Disapproved:
(fees are non-refundable)
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
Application dated, '2- is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of
a Permit to install and/brl rem ve Plumbing as per detailed statement described below.The applicant&property owner,by signing this
document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes.
I.Address: 112 S Ridge Street, Rye Brook, NY 10573 SBL: 7_/-(p Zone:
2.Proposed Work: Cal2 Gas line that is not in use
3.Property Owner: Win Ridge Realty Address: 24 Rye Ridge Plaza, Rye Brook, NY
Phone#: Cell#: email: A "IN�l�srvI'11ih(. a�'(Y�
4.Master Plumber: Luis Santiago Address: 717 Union Valley Road, Mahopac, NY 10541
Lic.#: 1333 Phone#: 914-241-0968 Cell#: 914-329-6525 email: service@thruwayplumbing.com
Company Name: Thru Way Plumbing & Heating, InC Address: 717 Union Valley Road, Mahopac, NY 10541
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
1 st Floor
X
2nd Floor
3,"Floor
4"Floor
5'Floor
Exterior
5.*List Other Equipment/Provide Details: Cap Gas line that is not in use for salamander equipment
(Notarized Signatures Required Next 2 Pages)
1- 611/2024
STATE OF NEW,Y,ORK,COUNTY OF WESTCHESTER ) as:
�1 1� ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signin 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.
Sworn to before me this 3 Sworn to before me this
day of Pt�- 20 !'r day of ,20
I � _
Si titre ofproperty Qwfter 4CVN Signature ofApplic
41Pr*ntN7a=me ofProperty Os�er�/ I ant me of Applic t
ylic Notary FUD11C0IN?HENG
NAIIANJIN NOTARY PUBLIC,STATE OF NEW YORK
NOTr::
STATEOFNQtIV0111t Registration No, OIZH5237977
IlNo.01MA0013"S
Oabh„n oa Qualified in VY TCIiI= TER County
Cote iG`ion Ex. hers � C 28 . �7
Elm in 90*M
I ust De properly completed in its entirety and must
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 mull and void and will be
returned to the applicant.
-2-
6/1/2024
R
L C IE""
BUILDMG"biPARTMENT APR - 4 2025
VILLAGE OF RYE'BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 ' BUILDING DEPARTMENT
www, ebr'ookriy"o
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t e6
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:, �! �-;Y� tw p
-3� (
(Print name) (address%Shoe cou lice)
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;
1�_r , 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.
(. agnautrc of I'roPu l> t-?+4ri<rf il) �--
(Print Name of ilroperty(3+mer(s))
Sworn to before me this
d 9 1(., ..,20
(Notiffy Public)
ALENA HAKANJIN
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.OIHAO013645 -3-
QusliOad In Westchester Count
Yy CtmtmisWn Espirst 011W2021
6/1/2024
QyE BRCZ: .
cu �
1982 BUILDING DEPARTMENT
❑,,BuILDING INSPECTOR
��ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAx (914) 939-5801
www.ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : , %Z �2ti..0 ,� C DATE: I Z Z - Z ue
PERMIT# QT �O �� ISSUED:' *f�'Z- SECT:/V/. Z 7 BLOCK:_LOT:
LOCATION: ( `F�_.�`�- 1 �� OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION /l
0 NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
,o FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL ci ! i'"IX.10 c ct
❑ OTHER