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MEN
ECENEDD
BUILD , OK JUL - g 2015
VIL tl L OF RY
938 KrNG Titl:r'r RYI�: BRO' ,NY 10573 VILLAGE OF RYE e?ooK
4 0f)4$ BUILDING DEPARTMENT
ov
INTERIOR B ILDING PERMIT APPLICATION
FOR OFFICE USE ONLY:, '']
Approval Date: JULWO ' `7 Permit#: / c)� / ,Application Fee: 1
Approval Signature: Permit Fees: S }
Disapproved: Other: It
Application dated: aD 5 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below. ,,rr /
1. Job Address: 14 OLD ORC1�P&O 2-2 SBL: J:� , !�6—/—W Zone: 'r
2. Proposed Improvement.(Describe in detail):— kAl I bAT t 9-rA 1 '441f-bg gRft).
k •?meµJJ aW .-_'i 7 W64Q VVI000 a C I RI-L PEW �TN i 000c
Nt-?V /MZDwo0P 4voeipi . NEW S'1,9 tNe 1UE i t= tN All -r 7HRMS
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 1: "PIER II: 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: v" Yes:
(If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: I FAIL t I w After Construction: Fa M t C
6. NX State Construction Classification: N.Y. State Use Classification:
7. Property Owner: 114 OLD OR C14AR O L L C Address: 14 OLD RC►}tARD 'R O
Phone# 9 1 T 905• 9594 Cell# SA.MS.- email:SFBN?t cl? ®FA LA%.J. C-Drr`t
8. Applicant: ' ,OSf-Q IE LAG RAND Address: b W1 IrJKV6 -Ly AVE. MArnflR7r13cGK.
Phone# Cell# 914. 31q- a (. -ar) email:SM6 LXGt—Al-)0 GrnA'% Co
9. Architect: i N riE it6EL 1'ESJ" G tb o P Address: 2 $E¢C A Qi:. W hA I I A I WV
Phone# Cell# 911 4. email: G L E i fEN I �O 7 Cr M
10. Engineer: Address:
Phone# Cell# email:
11. General Contractor: 1"&ELkGRP.xzgb �'�Address: -A WA L P'of-, 1wlkMI�RO G tJ 10'S43
Phone# Cell# 914. 3l9 email:-3M�-LAGRAM0aGfoAll. CoM
12. Estimated cost of construction $ 100 1 000 . 0 o
(NOTE:The estimated cost shall include all labor.material.scaffolding,fixed equipment,professional fees,and material and labor which may be donated
gratis.)
h
s Sbo►0 NS YMPAr t,S Finish:
is : L
I3. Job Timetable: Start: D s
P�
(I}
6/1/2024
V�'[EEBUILDIN - I&-ARTMENT
VILJ.A E OF RYk,$PgOK ` 9 22025
938 KINGMla
NY 10573
LAGE OF RYE BROOK
DEPARTMENT
v
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:
T, Joseph A. Fonti ,residing at,10 Oxford Road, Larchmont. NY 10538
(Print name) (Address where you live)
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;
14 Old Orchard Road , 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.
1
(Signature.7
Prop Owner(s))
14 Old rchard LLC
Joseph A. Fonti, Member
(Print Name of Property Owner(s))
?�v
Sworn to before me this
day of 5U 14 20 a.5
(No
JASON ROBERT GIALANELLA
Notary Public-State of New York
NO. 01G16262662 (2)
Qualified in Westchester ou ty
My Commissijn Expires
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.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
_ Joseph Mefaarano, Jr. ,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 legal owner of the property to which this application pertains, or that (s)he is the
Contractor 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.
Swom to before me this Sworn to before me this
day of -3vk 4 20 a s, day of , 20
Si OfAtoperty Owner i at=of Applicant
14 1 Orchard LLC
Joseph A. Fonti, Member
Print N e of Properly Owner Print Name of A licant
—
is No btic
JASON ROBERT GIALANELLA JC�HIV DIONISIO
NGtary Public- State of New York Notary Public State of New York
NO. 01G16262662
Qualified in Westchester gour>,ty Qualified - Westchester County
My commiss")n Expires 47 4 g # OIDI4804045 Exp. 9/30/26
(4)
611/2024