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HomeMy WebLinkAboutBP25-109 e s i O w a e _ Ln N \ v C s s ^ \ N p»a a L • w > h,Yy a j a .b r� q. v v5 U o 0 CA a•�y = O CtT 94 � v O a O h—i w 3 v h�i � � W Z � p W W � � ° � � • � 14 Z w42 ° � . WE V x O (� 0�0 Q Z O p U z .a v Z x W a w w \Q � 6 � W PZ �i 00 CIS 0�4 lu � H� Zn �, z a v, y c,•° N z N w © d' q W � d � o � � •� ob = .. aa.... G4 v i e a BUILDING DEPARTMENT D �C, VIUACM OF RYE BROOK 938 KING STREET RvE BROOK,NY 105 MAY 2 n 2025 (914)939-0668 www.rye! okay gov VILLAGE OF RYE BROOK � BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL. FOR OFFICE USE ONLY: 1 25 ` APPROVAL DATE: P IT#: 6-/ 0/ APPLICATIO1N FEE: APPROVAL SIGNATURE. PERMIT FEES: bu ( _ H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: is hereby made to the Building inspector ofthe Village of Rye Brook,NY,for the issuance ofa Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. I. Job Address: , '2i Qd �; 2. Parcel ID#: f QL9 i 6 7 '' / Zone: 3. Propose Improvement(Describe in detail): IN t 4. Property Owner: Address: Phone# Cell# e-mail List All Other Properties Owned in Rye \Brook: c Applicant:Address: Phone Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: Address: Phone# Cell# e-mail (i) 6/I/2024 BUILDING DEPARTMENT VILLAE OF RYI' BROOK 938 KING S t T Rti F:RR00K.NY 10573 (k4l)939-4166H W"� ',chr(ioI.nN.Lo r:rr+•rr+►+rrr♦rraraarrrararrrarrrra+r++arrrrarra rrrrtrarraraarra►rrrr+rrrrrr••a+rar►rrrarrrrrrw+aa+ara i AFFIDAVIT OF COMPLIANCE A VILLAGE CODE 4216 r STORM 'SEWERS AND SANITARY SEWERS THIS ATPIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLuNBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT , STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as: I Yusuke Hayashi, property manager ,residing at_ 1 13ronxville Rd Apt 3A, Bronxville, NY 10708 4PT11:1 n,unc) (%Jdic»uhrrc I,w In:i 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: 424 N. Ridge St ,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 stornwater 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 VMage Codes. Isignatureofl'ropertti O+cncrlsll Yusuke Hayastd d1rintNamcofPropcm ONcncrts)) Sworn to before me this day of &1 / .20 Joseph cmicoio Notary Public.State of New York Reg.No.01 C10027568 (3n Qualified in Westchester County Commission Emires August 5 2028 612024 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also 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 NEW YORK.COUNTY OF WESTCHESTER ) as' Yusuke Hayashi ,bein%duly sworn.deposes and states that he/she is the applicant above named, Ipnnt name of uidrvidua[signing as the aMhcwtl and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the Properly MAnager for the legal owner and is duly authorized to make and file this application. /indicate wch[tcci,contractor.agent,unomcy,ctc I 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 orthe Village of Rye Brook and all other applicable laws,ordinances and regulations. B) 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 stomtwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 1,479 Sworn to before the this r day of ,20 ZS' day of `� 20 a> Signa[urcafPropert}Owner sign try I icant Yusuke Hayashiilf',( 4' "� Print Namc af Nopem nc Punt\,un�ui' 11+nliian: ti n 1' lie \,+[ar+ I'uhl Joseph Cintcolo MARYANN NIELSEN Notary Public.Stele of New York 't Notary Public,State of Newyork Reg.No.01CIO027568 No.01 N16030813 Qualified in Westchester County Qualified in Westchester County Commission Expires Auaust 5.202P Commission Expires Sept.20,20� i��