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HomeMy WebLinkAboutBP25-164 a ��„� N N .. .O ❑ a � � v � 1©-1 a � cpa•`� O W e F v v U W W � `J A. Qj Nu MITI � v o f C v U 00 � 11 Q� 1`--1 W 1~1 a O a �• p x '� � � M W � o � � a.• cfi `J 0 M .aN W " w•° 3 V W ooCIA cr 0.4 V--4 A 4 z T ,°o aka Get �h �Cj7 a O U3Q M o a W O v � VU lul Z M W C7 o � � o �. A w a a � c. o,v e a BUILD 1VIENT r V11L E OF R QOK D 938 KING ET RYE Bllz ,NY 1057 jUN 2 6 2025 4 -0 ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPL FOR OFFICE USE ONLY: ``1 � t Approval Date: JUL ' erm pplication Fee:$ Approval Signature: 4 Permit Fees:S Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit forthe interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address:3 ,"ix a/..&1i� SBL:,,�N. — l Zone: 2. Proposed Improvement.(Describe in detail): 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER 1I: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes. (If yes,please submit a separate Automatic Fire Suppression System Permit a plication&2 sets of detailed engineered laps) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: l -After Construction: a 6. N.Y State Construction Classification: N.X.State Use Classification: 7. Property Owner: 1100 Phone# ell# 8. Applicant: Address: Phone# AA Cell# email: r 9. Architect:m rlk Address: Phone# 0_6 ` L/:�7-3 9 Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (1) 6/l/2024 BUILD MENT VIL E OF RY OOK 938 KING ET RYE BR NY 10573 w ov AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE j�OF NEW YORK,COUNTY OF WESTCHESTER ) as: Q I, •�.!�t IC I&4w ,residing at, {Print name) l:4Jtir. i, lien) being duly sworn,deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 3 )wp:R+►wy*A. : gig &W ?3 , Rye Brook,NY. Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. 12& Cc,S � (Signatureo rol7crty(Av, (s)) w• qS cp 6-ct& (Print Name of Pngperth O�%n.,,- Sworn to before me this�( day of , 20 r TAWiA SUtr1 M t4OTMY PUBLIC STATE CHEM Y021K tN ,i:e, Puhi LIC 2W:214 (2) 6/1/2024 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. ,S �OF NEW YW�� TY OF WEST ) as: lL��( 1 being ing duly y sworn,deposes and states that he/she is the applicant above named, (print name of individu sagmng as a applicant and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the _&v,Fr _ for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. 4 4dayof o b fore me this Sworn to before me this Cl1 © day of , 20�rCJ- �U` of erty Owner Signature o Iicant WSYLo&� 4TJMA 6cs UV• :S Gc s 44-C Print Name of Property Owner Print Name of Applicant Notary Pub is Notary Publ c _... ._�_TA4Y A SUMA N07,ARY PlJB_IC cgATE 0 ,?,jcU'!yC.q WESTC HEATER CoLl")"i1Y LIC. P, 3U 2214 CCU(UP (a) 6/l/202a