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HomeMy WebLinkAboutMP25-057 3 `n N a a , a *, W w 0-4Q, d a cr m a o C s r-d U q o •� o � y fs, `� � r�-I C v u C.y 06 w Q 4-4 a A w z w Q 000 Q (, z QO pO ^O ayui F1 V z °Y b a o U� a ~ 00 a � Q I� o a o 'A E� V � v . � 0 - x z x wA EMS W W � Ucn a z w r, ZO OOb CJ Vll V �* O w T.r ° � , � 8W w a, � p W Z H � od � •� o � T � Apr,' � O W � � •" �,v '�' :. $UILDIfq""cRT MEN T D VIL AGE: OF RYE BROOK APR 2 3 2025 938 KING E;"I' RYE BROOK,NY 10573 1� -04b�3 VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING,VENTILATION AND/OR AIR CONDITIONINGnEQUIPMENT FOR OFFICE USE ONLY: PERMIT#: 1" ' 057 Approval Date: APR 2 Z5X-t Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. 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 holder) &Workers Compensation Insurance on a NYS Board form(Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL =$150.00/unit • COMMERCIAL=$450.00/unit. 5. Complete specifications for each unit 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, is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as 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. 1. Address: -T M,©r�14�1Pgw L_a'ne SBL: /3Jri 40—1—c�(v Zone: -I�- 2. Property Owner: F x\1� 5, c�D1 Address: LA — C1(� W\Q_ Phone#: ( ((7 � �-L12��} Cell#: email: C 6C-- UCKADi c'GB0Ckr CAI •COf'll 3. Contractor: '�f1(`� k` (C .t1 Address: A Q k1 Q_e Lac_\ R\je-M Phone#: C(iq- bqD`Icx)C) Cell#: email: COM 4. Scope of Work:New Installation{Jj•Replacement( )•Removal( )•Other( ): 5. List Equipment: A QTA-1 2 Cj::)1 Ss leQ� 6. Location of Equipment: 7. Method of Installation/Removal(list all equipment needed to perform job): t 6/1/2024 STATV wO_F NEW YORK,COUNTY OF WESTCHESTER ) as: —) 1 ,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 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. Sworn to before me this rmrd Sworn to before me this 239:A day of -1i ` ,20 2r day of 1 20 Signat of property Owner gnature of Applicant it l � ��'�.. Sin � �S ,r-l. ✓\ Print Name of Property O ner Print Name of Applicant Notary Pu c Notary Pub JENNIFER RIVERA Notary Public-State of New York JENNIFER RIVERA NO.01RI6388056 Notary Public-State of New York Qualified in Bronx County NO.01R16388056 My Commission Expires Feb 25,2027 Qualified in Bronx County My Commission Eryires Feb 25, 2027 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 6/1/2024