Loading...
HomeMy WebLinkAboutMP25-098 00 cs �o \ \ m a a /\ . N N 6 C On ►� L~� �4 ~ Okr VJ A. Ci �4 •" p U A o ° 3 � [s, � � a C; s r^, W o p Z d p � F' -- oz �N g � o W N Q C rn C © W oo w °° � o ° a.'E V�1 Ln W en W � 1-'L-I LI r/� �I �/ � VJ W \ a. M tCL• � a r' Zo o p y '+_s G == 0 � U F� W Q x z Z Uz � � ° o Z V ✓� CT U �., d ° aA Q p Qy0, . � U � w � i4T W a MM� 00 G1 u - \ wz E W p x A z o ° 'o v H z � BUILD NG.DEP'` MENT VIL4ET OF RYE. OOK 938 KING RvE BR ,N Y 1057 E 01Y i -0 `� . ov JUN 2 3 2025 APPLICATION FOR PERMIT TO INSTALL AN / I BROOK TMENTT HEATING, VENTILATION AND/OR AIR CONDITIONING Q p FOR OFFICE USE ONLY: PERMIT JUN 2 5. 025 Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: Bees 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 PER;ti11T 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 NVS Board form (Form a C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL = $200.00/unit • COMMERCIAL =S450.00/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 requires a separate Plumbing Permit& Plumbing Inspection. Application dated,to 195126 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. 1 1. Address: I f1 e SBL: j!' 4//10 Zone: ✓ 2. Property Owner [ r s Address: t+ ilf 1 n4-e� P C4. Phone#: a �. 2-1 Cell#: email: 11r11� -N er ' (' Lll`il,(I.a 3. Contractor: Pirche !glee ban i ems. l Address: y410 'N• rnQ-1 N Ls4 . f ,, Phone#: Cell#: 1. 4 I-). 3j1 Ir email: , Ir rneC r K�fll cal 4. Scope of Work: New Installation{ }• Replacement( • Removal( )•Otther( 5. List Equipment: - t h - C���Il,�i�V- (���-tj.i—l1Q��l� 6. Location of Equipment: e 7. Method of Installation/Removal (list all equipment needed to perform job): 1 611/2025 STATE O NEW Y RK,C�O�UNTY OF WESTC14ESTER ) as: or I A- ,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 before me this L-1 day of ,20 OS day of 20 Z 1�ed� S at of Pro erty Own e of plicant F.-, J ri �eL ;!S)AA, 7Na of Property Owner P ' •me of Applicant 1 Notary Public SHAAI MEULLO NotarySAAWfAEULL0 Notary Public,State of New York Notary Public,State of New York No.01ME6160063 No.01ME6160063 Qualified In Westchester County Qualified In Westchester County•� Commission Expires January 29.20 Z-7 Commission Expires Januaty 29,201 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 6/112025