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Home My WebLink AboutMP25-133 ■ r M oy w � t4i !1 N Le) C, w � � °' ■ 0 EI CV N CV N a ate,1 G. . W � O 3 0 � a� CN W ON � F c` 1-1-1-. z a ,° 9 1 b o b p M s 14 Lr p z pp O W z 00 4 0 oa eM-a O Z a c " � O v o ■ W W � ~" x u v q v V Fri ;L4 i7 '-' 1 � WVH WO ; op v w z " W � v U Ua o wUza� V ~ M5. V � acEm , W 00 A a W z z o ZZO -- s O F� A O Uo80u QI z V U O w0 rq 4.'. y O C7 >4 A z W" cn w 0 A � daa W V Waa?? a BUILD NG D'EO . MENT D VIL E OF RY OOK 938 KING ET RYE B R ,NY 10573 A U G 2 2 2025 -13 _0 '� . Ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: - 2 7 - 2 O Z," Permit Fee: $ Approval Signature: Other: 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$750.00 REOUIREMENTS 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 Contractor's Westchester County Home Improvement License,Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#Cl 05.2 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, c�5 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal bf 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. Address: l r C_p SBL: �`�`"/'/ e: OQ—/,5— 2. Property Owner: v le Address: I(4 o TT1��1�1Q(� 9A, Phone#:q u _e(�Q-\?)G Q Cell#q� - Db'g®\ email: C1 ® \�.Wm 3. Contractor: �j�l�tJ� ccm ?(s1 Address: 00 Phone#: Q(,-A 'q LA(b- 555 Q) Cell#: emailyh\,\,1�(�(bl I0 brUCGtfI In 4. Scope of Work:New Installation( )•Replacement( •Removal( )•Other 5. List Equipment: 6. Location of Equipment 7. Method of Installation/Removal(list all equipment needed to perform job): I 7/1/2025 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 21 (') Rga1 1 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indivi ual 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. nn Sworn to before me this Sworn to efore me this '!L day of AkAAWT 20 '2S- _ day of .r ,20 2-5- Signature of Property Owner ire of Applicant Print Name of Property Owner_ Print Name of Xp_pfic nt Notary Public Notary Public DEOUNA BARON-DANIEL j DEOUNA BARON-DANIEL NOTARY PUBLIC,STATE OF NEW YORK I NOTARY PUBLIC,STATE OF NEW YORK Registration No.0 1 BA0032946 Registration No.01BA0032946 Qualified in Westche5trr C ( Qualified in Westchester unt My Commission Expires s unty?� My Commission Expires G • F 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 7/1/2025