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HomeMy WebLinkAboutPP25-073 qm tn N c O0 6d O N w � O � tn ~ ICI � z A W tua a ao cn � CD cJ CQ jj z © A w o a a z r-1 a o cn = rT� ~ U w oo ^2 00 A Q A C'� A zce) v aA � 00 z � ww Wax e ZZ ocn p cn N a o o � D a w Le) V aLn _ 00 z w w o � a W hl O 01 W 0 d a Br DEPARTMENT APR 2 9 2025 of RYE$Izoolt 938 KING{ RY1v B1 ,NY 10573 , VILLAGE OF RYE BROOK (914 -0668% BUILDING DEPARTMENT m�%�.1)�ChtooknXP� PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY - PP#: 'c 73 Approval Date: — Permit Fee: S Approval Signature: Disapproved: (lees are nowrefundabte) DO NOT START WORK or CONSTRUCTION UN1 IL 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 S750.00 Application dated, 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: 72 6 ft' SBL: c� — —C�o Zone/--)a 6 2.Proposed Work: 3.Property Owner: r, Address: Phone#: G�AA. !'' 1&(D (4 cell#: / email: 4.Master Plumber: Aho��'1l�rd. r�l'►1�ol /t'1 Address: I I p 00 Lic. #: 11p:7,, Phone#: 611 q,L qq 7*7gp Cell#: email: Company Name: jXACQ1,iL MaLr►&ohCPdl Address: �y b'm6i acv� Jb �rs(kfQis,, 4 , .nC INDICATE FIXTURES&LINES TO HE 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 3d Floor 46 Floor 51h Floor Exterior 5,*List Other Equipment/Provide Details_ o P Cl (Notarized Signatures Required Next 2 Pagers) STATE OF NEW WRK,COUNTY OF WESTCHESTER ) as: ) I _/,being duly sworn,deposes and states that he/she is the applicant above named, (print namc 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 Sworn to before me this v' Sworn to before me this da of <-\\ 20 day of. 20 C�J i aturc of rope caner Signature of Applicant t st*lame of roperty owner Print Name of Applicant ILL Nol*yft6lEdsllc,State of Notary Public No.01ME6160063 Qualified In Westchester County Kubli L Wate of DYork Notary Public-State of Commission Expires Jenuafy 29,2 No.01 WI529518Qualified in Putnam CMy Commission Expires De This application must be property completed in its entirety and must include the nota I 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. -z- 6/1l2024 'DID BU11,DING DEPARTMENT VILLAGE OF RYE'Bj�OOK APR 2 9 2025 938 KING STREET RYE 8RQ0Ik,NY 10573(914)939-066k./ VILLAGE OF RYE BROOK %vw"v.ryebrooki v rov , BUILDING DEPARTMENT #.#i*#rt#ti*t#i*ttiiii#iitr##it#it#*###iti#i#**#t#iitii#tts iiit#*t#ii####i#i##i##iiii#i#**#tttt*#t*#i*t 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 PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 3J> 10 1�1 _ � �IT��, residing at, V t9 niu n.un 11,1+11�,.yr Irrr ,,Irc,l 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; } n 01"ose Rye Brook,NY 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 ail State, County and Village Codes. �na1u!:n I'rulkil. Iu nrlf�U ('1117lri Nall/,.'11 PI+, 1 I\ I t\ 11iII,i11 Swom to before me this a f ,1��� , 20 `a ILI 1\„ran I'uhlt�l SHARI MEULLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County �'� Commtssion Expires JenUaty 29,20� -3-