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HomeMy WebLinkAboutMP25-106 � o Q n W C A n G © No � c Jp >A CZ qj ■ `r' arken F/-'I (w� M O gg• ''. ° E-� ■ f—j �+ C) v r/ ;J-I O ch \./ W 00 f--� (� W O - aoi u G, . W � t-+ O M�"� V� A � � � W� w � •tea '� �j � ° Z Qu ux o V 00 04 ITI �' � fir � � O z Z � � " � � ■ ■ ( W A F cn m u a+ y H z O z zoc sk a � w W z o o o O F `+•a ,c •�, u W z H W A O '�' •" �.� H R; W of a BUILDING: RTMENT 3 2025 VILLAGE OF RYE BROOK VILLAGG'OF RYA-BROOK BUILDING DEPARTMENT 938 KING STREt,T BOOK, NY 1057.3 ---- (9f 06b8 ww-w.rsebtlo_o -ny.gov APPLICATION TO SERVICE/CLEAN TYPE I HOOD AND/OR EXHAUST DUCTWORK FOR OFFICE USE ONLY: e� Approval Signature ^�.a �``l��© Date_ 2 0 z S� Permit Fee.S50.00,Kcaid: due AIM9r o�o ............I................../........ ..................,...............,.....................,.......�....,....................,..... ............................ / Application dated: ` ais hereby made to the Building Inspector of the Village of R)c Brook NY fur the issuance ur a Mechanical Permit to service and/or clean'Type I Commercial Cooking Equipment Fehaust IIeads and/or Ducths ork as per detailed statement described beloiti.I. aob,Address: 1 Rye Ridge Plazza (6CW')efy''S SB1.: f"I��� c�—7— 6 Zone:C/—/p 2. Date&Time of Service: 1 3. Proposed Work(Describe system & methodology in detail)- Y 424 L*' r � . / 4. Cost of Service: S (L.,:: di:'I in, de all lobar.matLriak r:w.? :gm;)mew.rn+lcs.i.�nal k2�.:.and ina:criaL and latar lshich 111.0 I'c duaatrd_rails.) S. Property RMINi Address: Pwn 6 j Phone# ~� � - Cell# email: G. applicant: Address: U 4vf—it !hh 0 1 Phone# , - -o CeIJL# email: 7. Service Contractor: -e G Address: r 7 vkvc �Jk / a Phone#_p 7�—!"773~ / c,)L - Celli$ �� — �O �j�1 enuril: Olr eyN(/11 ► ie 8. Name& Phone of Field Technician(s): U Ve Q+ c Q7 (,, - a,59_ M , 9. Date&Time of\ext Scheduled Service: (Eiteh scrt iec require,a c p::ratc Iknnit.11crinit applic•atiow;arc available on lire:u.s��s�c.ncbrnn4m'.eus M I blt)2024 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. Please note that application fees are non-refundable. STATE OF NEW YOR�. CIOL:NTY'OF WESTCHE•STER ) as: CA ) V� �`a ,being duly s% orn.deposes and states thatl q she is ih applicant above named. (print name of individual signing as t;:applicant i nrid further slates that (s)lye is the ! al ow9er of the property to which this application pertains, or that (s)he is the �� . rke_ �r� G1 UTU-�c it i^t Y} t'Chrr'.,,Ifor the legal on,ner and is duly authorized to make and file this application. (indicate architect."onttactor a;ent.ahomc%.eic 1 That al statements contained herein are true to the best of his her knoXvIedge and belief.and that any work perfonned.system installed or use conducted at the abo%a captioned property%N it I be in conformance with the details as set forth and contained in this application and in am accompan}ing approved plans and specifications.as%veil as in accordance with the New York State Uniform Fire Prevention R Building Code.the applicable sections of the N.F.P.A.,the N.E.C.and with the Code ofthe Village of Rye Brook.as well as all other applicable Federal. State or County lams.ordinances and regulations. Scorn to before me this ?)V 0 SNtoni to fxfore me this - 1 1 dad of V U� _. �() �/ da) of � .20 .'gnat of rop y( %Tlrty ri7 (t~ .`gnature of applicant P int.' me of Propetn 0wrter — Print Nana of Ap ,wru, tiJa;grYFubA4L9*A MAKAN�IN t Notar)•Pu is o", BIEAITATE OF WN Y L- . 0,... . •'g i 01 D1s;� I en No.01NA0013M - Red In Woeteholgr Count -+='�� � S fllr cMwheiOlf Ea tf10f200� =�-.��B�s0 '(D D() \OT START 1VORK or CON*STRUcT!()1 UNTIL A PER.N-11'1' HAS REEK issur1) By THE o INSPECTOR. TIIE ADMINISTRATIVE FEE FOR WORK PROGRESSED Oil COti1PLGTEp Y'ti ' ,,f,N PERMIT IS 12% OF THE TOTAL COST OF CntitiTRUCTIQN NN ITH .A M I N IM U.M FEE Ol z 6/f/X124