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HomeMy WebLinkAboutMP25-068 xi 00 0 � wyy ell 54 - o W �O a c, � y ~ 0 u 4 3 a ri � W , p © o `� O no Q� ` WN0 10 p : � :3 v o v `�` V w cn .., v c _ ^W 00 W V z O U1 11 " H M W I G7 cn � b � a�a00 `� ,. (U y -A .3 � too I� wA zz .001u y w p Vi � YI a l r O F C/) F. z O C FU V U v j w u. o W O v 0 �' C " O O o og 14 00 A W z F" OQ � o � 0 � � dab Mot E C E NED BUILD MEN'F VIL t)F Ry OOK MAY 15 2025 938 KING 4 •FT RvE OR .NV 10573 ^g Y VILLAGE OF RYE BROOK .90v BUILDING DEPARTMENT -- APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#:— ,),5—o ? Approval Date: MAY 2 Permit Ice:S Approval Signature: Other: Disapproved: (fees arc non•rcfundabtc) aaaaaarraaaaraaaaaaaraarrrrrraaa*aaaaa**,rust*+rii*a*a*a*ta**ata�*a**a,*ataa*iraaa**,t*r*ta**ta*taaatatata,ra DO NOT START A'ORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDIN(; INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRE FD OR CON11PLFTED WITHOUT A PFRNHT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 RF. U1REMFNTS FOR ItEI.F:ASt:OF I'F.RNIIT&CFRTIFICATE OF COMPI.IAN( I. 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 lined as certificate hold«)& Workers Compensation Insurance on a NYS Board form(Form 0 C105.2 or Form p U26.3/or NY State workers Compensation waiver) 4. Payment of I-ccs/Unit: RESIDENTIAL=S 150.00/unit•COMMERCIAL-$450.00/unit. S. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation.(48 dour notice required) 7. Electrical work requires a separate Electrical Permit& Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. tt,rs'taw,ttrrrt,r,ra***t***\r*,r*,t,t*r,r.r*****�***a*wtrra*******ir,tfat**rat*t**arrastr*«*ww*areae*ataafa*mow*ia� Application dated, �[7�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 confonnance with all applicable Local,County,State&Federal laws, codes,rules and regulations. r�� [�� ,,`` Q�, �/ f I. Address:q tdLMDD M. 04 �1� y__ SBL: 12S 1 —J-3 /Zone: - 2. Property Owner: U0 Address: q VAU(/LV ftJ) M• F^1L tVC04 Phone 8: Cell M 4�f a��(/,U I K JJ email 3. Contractor: Address: SZ F A064 4 Ste, 9-1 < <Aftlk Mai✓ Phone M Z� 1rrOlf Cell#. - O t� email: 'c.o4CCe � e"41�ld0 ' 4. Scope of Work: New Installation Q�•Replacement( )•Rem oval( )•Other( ): CO 5. List Equipment: '-�`� j- �/4 S A I t �Jt,41�S 3 6. Location of Equipment: I►� _ UN 1 j 1�� 1�i WIN S fOd M f Oo rl�,� �3•!� faoM _ 7. Method of Insuallation/Rernoval(lists all equifinem needed to performjob): a I a C,)+ C% L7 N>r o e 9.Q2b - a STATE F NEW YOM COUNTY OF WESTCI ESTER ) as: Tr-� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing&A the applicant) and further states that Whe is the licating,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 Ryc Brook and all other applicable laws,ordinances and regulations. Sworn to before me this& T+3 day of Sworn to before me this 20-2:c day of wwyy 20 Z5 NE Rl r.4r����,,, Signatur o Pro sr ,oiCU6367294�( Pp ca _: QUALIFIED IN ;O Print Flame ( �,Ow =U DUTCHESS COUNTY: _ COMM.ExP. cEPr@t NameVIAIt PU rr' 11-13 2025 Notary Public .�9 eL� �1 OtFI !V:y `\ Notary Public Mntwtnmad Ttahman Commtssx)rA OtRAO032973 Notary Public Stile of I*.Yort M•Comtniutoe BgV11!ion 0T/172029 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 and will be returned to the applicant. provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void 2 &A no24 -•�-,..-.,---ter Val