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HomeMy WebLinkAboutPP25-130 , s = a Lin Ln LO , a OC °° qT _ = QI cn 6 O Il s U Za v a F A 04 P. 04 aXC) Lq M Ln a L— = Z o W w o W o W , _ o ' o �f = -- q;; o A w z Lc V0.0 _ 00 a A0 zx � Q ~ 00 zz _ oCA, oo _ U O P-+ Z W O A P. cn ►� w zc _ : BUILD'Il DEPAI yTMENT VILLA E OF RYE OK AUG 152025 938 K1Ndl ET RYE B ,NY 10573 VILLAGE OF RYE BROOK wv ny.gov BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: Approval Date: Permit Fee: $ 1—> Approval Signature: Disapproved: (fees 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 PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 Application dated, /S a� 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. 1.Address: .kg - `,661— - 1A !A-e 'b `(�20)�, s SBL: S�' r� _�_�, S' Zone:L— � 2.Proposed Work: ! U G 3.Property Owner: Address: (� Q t Phone#: y -- i Cell#: email: �-1, t r 4.Master Plumbor: M n k,-xmrA A Se, .1 W) -e, Address: Lie. #: Phone r o ell#: email: Company Name: a Addre s: L 1 �k IND&ICATE IXTOURES&LINES TO BE INSTALLED PER%QdA&"HAT') LE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement y 1st Floor I 2nd Floor 3,d Floor 4'Floor 5'h Floor Exterior O r 5.* ist Other Equipment/Provide Details: 1 e�' kC (Notarized Signatures Required Next 2 Pages) -i- 6/ll2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 , Sworn to before me this s �h day of ,20 0�`�` day of ok&Cl c—c+ ,20 ZL Signature of Property Owner Signaturc of Applicant Print Name of erty Owner inr nt Name of licant No Public N SIERRA Notary Public -State of New York Notary Joni Lama} NO, OIS16280398 Com Wio M JLA0025681 ` Qualified in Westchester n Notary Public,State of New York My Commission Expires 2 � My Commission Expires:Jane 07,2028 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- 6/l/202A BUILD MENT ff J � I VIL E OF RY OOK ll 938 KING Ei'RYE BR NY 10573 (914)939-0 AUG 20�� w °v VILLAGE OF RYE BROOK 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: ) � residing at, 11'6111 name) (Address where�( u li�e) 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; 40� - , Rye Brook,NY. (.rob 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. (,ignature oCYropeny Ovwner(s)) {print Name nd Property Owner(sl) 9' Sworn to before me this day of , 20 ] Notary Public-'State of New York NO. 01S1623©39" Qualified in %.V-itche'V (Nolan Ptiblicl -3- 61112024