Loading...
HomeMy WebLinkAboutMP25-095 x a = s a m Ln Cl% ,o � in N PG N s LAG W v a "Q a eq H N W y cs A d w a a s con fn a v ►�} �' W r� � y N a 3 W CA Gzl OO M © L4 V) C a z z Wo m zo 4 - g ¢ o F O W C., W 00 y o °g Cjo H i 7 dJ O a 4-4O W C _ o a _ V p ° � Cw 000-0 Ln z x w - CC 4 a oo GiE- �' � c . -D � PQ ZW. cn CD w c owe "N W v O v � (:F �Q Z a M A W z F O L� 2 O b MM� ^^Ri�� �I W h- �4. w x .0 m a 469494;4;4;4 4 4 4 4 a 4 a a 4 a 4 46 6 6 0 0 46.0 0 a 9 4 a 4;a4;a414194141419a44 BUILD �., 'MENT VEL of R, OOK JUN 16 2025 938 KING LT RV Eftl NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING E WMENT _ FOR OFFICE USE ONLY: PERMIT#: Approval Date: �� Permit Fee: $ --- Approval Signature: Other. Disapproved �r*x,t*,a**tt*+►*9r*,ees arnon-refundable) *r****s**#** DO NOT START WORK or CONST UCTIONUNTILAPERMIT HAS BEEN ISSUED BY TH BUILDING INSPEC OR.THE A 1INI V FEE FOR W RO RESSED O OMP WITHOUT A T IS 12"/o F THE TAL COT N TRU I N WITH A MINT $750.00 REmmu1VIENTs 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 COMpensatlon Insurance On a NYS Board form(Form#C105.2 or Form#U263/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL—$200.00/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 reguired) 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, (- t L- I 29 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. I. Address: f SBL:L35�,,j�'-(f,� one: 2. Property Owner: Address: Phone#: I 5r+' Cell - 3. Contracto . r � ��,1 a q,. ►�.��Address: {s '� fa Phone#:(ti �r�.y .-o a- Cell#: �" " f 4. Soape of Work:Now Inetxllation( )-Re itacemcrit i-I{em®va]( )•OtilE,7( ): 5. List Equipment t,�o - +GZ 11 c( 6. Location of Equipment: j 7. Method of Installation/Removal(list all equipment needed to perform job): I 6/1/2025 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as- being duly sworm,deposes and states that befshe is the applicant above named, (print name of individual signing as the apppcano and fiuther states that(s)be is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and fife ttm applicanon. 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 wrll be in conformance witb the details as set forth and contained in this application and to any accompanying approved plans and specifications,as well as in accordance with the New York State Unifnnn Fire Prevention&BmIding Code,the Code of the Village of Rye Brook and all other appLicable laws,ordinances and regulations. Sworn to before me this_ I Sworn to before me this day of-�:7V ,20 _ day of affProp Signattrre of Applicant Print Name of Property Owner Print Name of Applicant N _ Ptrblio No ublic This application must be properly completed in its entirety and must include the notarized signatum(s)of the.legal ownerfs)of the subject property,and the applicant of record in the spaces provided. Any application not properly completed bi its entirety and/or not properly signed shall be deemed-null and void and will be tetumed to the applicant. z 6/1/2025