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HomeMy WebLinkAboutPP25-116 : Ln �10 LcnqN N N �4 p ICI U z A Z Q V5 _ a w H A 4 W bjO 09 _ M N oo o cry W �i a s fq �o °° d w00 ° U = © T \0 o W Z a WI F� CN Acn POO J-a r� W A oZ _ _ a � c U 'r _ � W ° o m W N z a Q N Q O � s ,. F z e _ _ _ BUILDING DEPARTMENT VILLAGE OF RYE BROOK RIECENE 938 KING STREET RYE BRfm,NY 10573 JUL 16 2025 %_,gov VILLAGE OF RYE BROOK PLUMBING PERMIT APPLICATION BUILDING DEPARTMENT FOR OFFICE USE ONLY BP #: PP#: C� ` I Approval Date: JUL 1 025 - Permit Fee:$ Approval Signature: Disapproved: (kxs are satrsOmdable) 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 Application dated, - -t)J is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. I.Address: Z3 () l je 0 L Q a&_SBL:--129 -5 2 - f- I7 Zone: 2.Proposed Work: O 0_f3 Co 9 3.Property Owner: Address: 2 Cn r., �P Phone#: M1 Y na 0 Cell#: email: V 1 rlo i .S IN Ua(a)�` ,,1, 4.Master Plumber: � n �i.-ICA Address: 1 f Lie.#: k3oj_Phone#: 914 2 W-7 7' f C� Cell#: 9 UL/?Q entail: r �.COO Company Name: ' Address: Qa l R40C4'�)_-On Inc INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 3'd Floor 4t'Floor 51'Floor Exterior 5.*List Other Equipment/Provide Details: an"`)GU O U ! T -2 ? bait .eI. (Notarized Signatures Required Next 2 Pages) _I- 6/112024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Mohamad Salameh ,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 Master Plumber 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 o-2 S Sworn to before me this 16 day of J A ri e 20 S day of July 20 25 0�1 h96� — Signature of Property Owner " Signature of Applicant M;SAke! Ae1II,'kctrq Mohamad Salameh Print Name of Property Owner ! Print lV of Applicant Notarized online using audio-video communication Lee Presser Note b Online Notary Public STEVEN COOPER l Notary Public State of New York :RT mi s ion ster#:0 county eyititr8lion No.0 C05016298 Commission Jl:01PR0000217 uelifad in WastcRester Count Commission Expires:02/02/2027 Carn'r`esbn Ex ryes 819120 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. Applications 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- b/I/2024 BUILDING DEPARTMENT R [E C � V VILLAGE OF RYE BROOK JUL 1 6 2025 938 KING STREET RYE BROOK,NY 10573 (914�-0668 VILLAGE OF RYE BROOK www,ry okny.p.ov BUILDING DEPARTMENT 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 OF NEW YORK, COUNTY OF WESTCHESTER ) as; Mishuka Adhikary , residing at, 23 Country Ridge Drive, Rye Brook,. NY (Print name) (Address where you live) being duly swom, 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; 23 Country Ridge Drive , Rye Brook,NY. (Job Address) 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. ,/m , , AdLdz::��� (Signature of Property O er(sw Mishuka Adhikary (Print Name of Property Owner(s)) Sworn to before me this day of n , 20 (Notary Public) STEVEN COOPER NOTARY R OUC STATE OF NEW YOW Registration NO 02COW6298 Qualified in Westchester County tj Cortrr>a.m Expires Wn 6 i 2n2a