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HomeMy WebLinkAboutPP25-055 � � N N C rl a O N � 0.0 M �+ .. z u cn 0-4 e H x O U G� �.T.t Lin o � (Z,' w � � o "co) A = oW y � rq CNxPLO O ^�' uz ■ 00CY o?j Z W ■ �4 C � U O All, � 4 � � a � � a w O F' 0 w H d oRn�� BUILDING IJi.CA MENT APR - 4 2025 VILLAGE OF RYE OK 938 K1N6 ST1cT RYE B ,NY 10513 VILLAGE ©F RYE BROOK (9 BUILDING DEPARTMENT ov PLUMBING PERMIT APPLICATION FOR OFFTCF. USE ONLY BP#: PP#: _ Approval Date: AP Permit Fee: $ Approval Signature: �m M Disapproved: (tees are non-refundable) DQ N01 S'1AR'1' N�OR_K or IONSTRI-C"F1O` L1"i IL A PL;RNIFF 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, '1— 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 that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 2 W J, 9.9 1) SBL: .l a 9 r Q-3 —/—!1 Zone: f 2.Proposed Work: i t}e�rtti 3.Property Owner: S�ni S+' �c�I�/AJ Address: 2- W(,,,b Eu �2 (v Phone#: ,( Y - 9�z- Cell#: email:SA.>4a • 3f h'N G,+t . �rry 4.Master Plumber: 6 /n42 Address: Lic.#4 1 Phone#: 91( 3 O L _ Cell#: email: Company Name: {-t�Cc�1c- /f/A c�t,��v(C --e Address: /6 fl1�fAiN O�C /Uc7 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 2nd Floor 31 Floor 40,Floor 5`s Floor Exterior 5.*List Other Equipment/Provide Details: '�"" / ►! (Notarized Signatures Required Next 2 Pages) -I- 6/1/2024 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)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. vl Sworn to before me this Sworn to before me this 3 day of ,20 day of ,20,2!:�:: i "''llll ,Signature of Piropei4y Owner Signature of Applicant -31,S-n"17 st 3��1 IU6V111,14u Print Name of Property Owner Print N f Applicant J - Notary ORY M.RIVERA otary Public UNA WHAL.EN New York o State Notary Public,Staf Notary Public'State of New York 6 No.01WH6394580 No.OtRI ate of OuaTfied in Westchester County Qualified In Westchester County Cominil;Wn July 8,2027 mm Coission Expires September 26,2a5 its application mu r , , y 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. -2- 6/1/2024 BUI N i MENT Ec [E �w [� OD LD VIL 'GE OF RY OOK APR - 4 2025 938 KIN ET RYE BR' ,NY 10573 . 4) 4 VILLAGE OF RYE BROOK wryly, gel' ov BUILDING DEPARTMENT F*:l-**t*k**Aaex*ksl*i:t*k**ir kk**+Y aF F of at***ir:F*:tk*t Ir:t;t is k Yc:ir!**ic***ir at is*t:ki***at***+F sk*ic':°k VC Y::k kYr*aF 4:iFA**k:kkk l:k#i:**t**ic AFFIDAVIT OF COMPLIANCE VILLAGE CODE §21 C • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMiT'TED 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: Sr_ 'a, , residing at, 2 w,„d.:� ,,,,off �'. N �„� B��f Avy, /6S-;3 (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; 5, -.1 ,Rye Brook, NY. (.lob 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. (Signature Property O er(s)) (Print Name of Property Owner(s)) Sworn to before me this day qf 120 _4X P11:We7 J,/M, (Notary P tcl GREGORY M.RIVERA Notary Public,State of New York No.01 RI6441398 3_ Qualified In Westchester County Commission Expires September 26,2U2� 6/1/2024