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Home My WebLink AboutBP25-089 a a 0 LCI o ■ p eq qj v a _ W Q = O H � � s H g 72 C a o vIf - - a Q H - .:� w z `n Z o,x o c o 00 VO i 8 i A C E Z Q O O m0 o PQ 1. V GQ . w�A E 2 ICI W F o z cu W Z pSo° a'dvw CH V Z " 18 - u z V w „ . w �t C7 A Z O C) CA > v _ w � � �� .. R W A: 09 Y / BUILD PARTMENT D _ VIL 'E OF RYE BOOK 938 KING ET RYE BROOK,NY 10573 APR ' 9 2025 4�99- ' 0668 L_._ W4iXMMDok ov VILLAC INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Q V9 Approval Date: OLer ;t#;APR 1 6 2025 PP A lication Fee:$ k)0 Approval Signature: _ Permit Fees:$ `4�� Jbo e- SDDisapproved: Other: w _ Application dated: "-� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building, or for a change in use,as per detailed statement described below. 1. Job Address:•J d(k W f'Acl ' c Ait SBL: /SSi —/'S3Lone: 2. Proposed Improvement.(Describe in detail): Q—I -_ ��- __ I P--- . - - 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER l: TIER U: TIER IIi: 4. Will the proposed project require the installation of a new,or an"tension/modification to an existpig automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (if yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: 2 l,'� After Construction: 6. N.Y State Constru tion Classification: N.Y.State Use,C(lktfication: 7. Property Owner f l E k,t Address: ^� U P.11(, -0. Pi= Phone#04_Tk6ct-3 b Ci Cell# email: 8. Applicant: &V't I, Address: Phone# Cell# email: ,,(�,, 9. Architect:�(��A/ Gt. f to S Address: 2iY�-rr! I(N� 1 I r_� oy d (�1 ��3► Phone#TI�,Aki - Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor:, ��7 �'�S dd ess: C' Phone# Cell# email: 12. Estimated cost of construction $ Qo 0 _00 (NOTE:The estimated cost shall include all labor material,scatioldmg,fixed equipment,professional fees,and material and labor which may be donated gratis.) d 13. Job Timetable: Start: 1 Finish: O �` (1) 6/1/2024 D BUILDING TIEPAR MENT VIL " o�Rl; ooK APR 0 9 2025 938 KING ET RYE BR ,NY 10573 4 -0 VILLAGE OF RYE BROOK ww ov BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE V16 • 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 . STATEIOF NEW YO K, COUNTY OF WESTCHESTER ) as: If 1 ,residing at, =StL wes�Ap[e�, Ar (Print name) (Address\\here yo i 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; --sk w�CA 4(': me- , 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. mAu (Signature of Property Owner(s)) I (Print Name of Property Ovvner(s)) Sworn to before me this day of n <<( 20,l<11' RANDYLJACKSON NOTARY PUBLIC STATE OF NEW YORK otary PubliC) V WESTCHESTER COUNTY LIC.#01JA6377198 COMM. EXP.09/27/2026 (2) 6/l/2024 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. Please note that application fees are non-refundable. STATE OF NFW YORK,COUNTY OF WESTCHESTER ) as: ._ �, __ _ , being duly sworn,deposes and states that he/she is the applicant above named, (print name of individ al signing as the applicant) and further Itateybat (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this a of Apt 20 i day f �<' , 202y' all_m' ru� k a ature of PropAcyfp Si ature o App Jr i ant y r . yl Print Name of Pro rty wrier mt Name of Applicant` ary Public �OPLbh�cd RANDY L JACKSON NOTARY PUBLIC STATE OF NEW YORK RANDY L JACKSON WESTCHESTER COUNTY NOTARY PUBLIC STATE OF NEW YORK LIC. #01JA6377198 WESTCHESTER COUNTY COMM. EXP.09/27/2026 LIC•#01JA6377198 COMM. EXP. 09/27/2026 (4) 6/1/2024