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Home My WebLink AboutMP25-065 ■ x s a � w �j N c 7E.1� PLO 72 m(\ x Ln L H p a N a o W �k � a W �Ln -+ D F- '�--i U Q ►-� O H d a p» a, cc p s s C ob No3a' v o m CA � 0 � Q � bu � tv p� ' 00 cc o � U W oc ON W fy. U c/n CY d z z "o m d I w L U PLO 0 vo Ln z o A 0 >4 . � � � � o U y. BUILD MENT CEME r . VIL OF RY OOK 938 KING ET RYE BR ,NY 10573 E - 7 2025 `t 4 . -0. . ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EoMPM�/ENT FOR OFFICE USE ONLY: PERMIT#: J (.CL)-� Approval Date: MAY I Permit Fee: $ 1�� Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL 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$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 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 listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C 105.2 or Forin#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 requites a separate Plumbing Permit&Plumbing Inspection. Application dated, `�' 7-�sis 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 andregulations. 1. Address: ZS Q A D cQ I Aet, 9Q:PjJ72 SBL:f.35 I cW��—' Zone: 2. Property Owner: N I C K 7A- N)C,P-�F-D 1 Address: 2..j!; �e 44'�0iA )(- ,P Phone#:q l4-(.,'2,j --I (1Z. Cell#: email: 4MT U k 3. Contractor: S t t�( ��a r7y t. tr U C� ., Address: "70 K 7- Phone#: 114 A(.6 • O V00 Cell#: email: 4. Scope of Work:New Installation O Replacement )•Removal( )•Other( }: VIp�YrC3 S. List Equipment, 0 O r\PzL I� _ PAt i4 r-, T _u_Q , CMA 6. Location of Equipment: !Ole 7. Method of Installation/Removal(list all equipment needed to perform'ob): ReSi IL r 6/112024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 � Sworn to befforew me this day of ,20'oL1 day of ��?�,20'� Signature of/Property Ok ner Signature ,�r�of Applicant 00 ] tt ;Pr&intameof Property Owner Print N me of A plicant ic o ary Public AMANDA BUCC1 AMANDA BUCC1 SO TAR Y PUBLIC-C0&?,R'77CUP NOTARY PUBLIC.CONNEC17CUF MY COMMISSION EXPIRES FEB.28,2030 MY COMMISSION EXPIRES FEB.28,2030 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. 2 611/2024