HomeMy WebLinkAboutPP25-160 o N N =
o
� Ccn
In w W
ri U A
00
^/ Ln
4-4
a o w W wo cn
wLn00
rq
z �
cn
Cf
Q x zz
z w
W x p cr
U �1
*
w u. O
� z ;
W c z
o v�
c
ate'
o
�C� � O��
B�Uffi MENT 0 C T 14 2025
IL Fi OK
938 KIN ;
.�.:..�3:r ,NY 105 3 VILLAGE OF RYE BROOK
j BUILDING U,_PARTMENT
do Y.gov
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#:--- PP
Approval Date: OCT 4 -uL Permit Fee: $
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 FF,E 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, 10/6/2025 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: — �dlQ,�_ .� �_ SBL: r-6. ..7 — \ —a-7 Zone: — 1 C)
2.Proposed Work: Replace water main from the curb line to the meter.
3.Property Owner: -4; Y ' Address:
Phone#: 7nk-t Cell#:_ __ email:
4.Master Plumber:Steven A. Sallerno Address:635 Old White P sins Rd.. Tarrytown. 91
Lic.#: 1160 Phone M 914-713-3040 Cell#: 914-374-3242
email:archerplumbing@gmail.com
Company Name:Archer Plumbing & Heating, Inc. Address:635 Old White Plains Rd., Tarrytown, NY 10591
INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Watcr Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natura Othcr; Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement
1 st Floor
2nd Floor —-
3rd Floor
4'h Floor
5'Floor — ---
Exterior - - — -- -- - -- —
1 1
5.*List Other Equipment/Provide Details: Replace water main from the curb line to the meter.
(Notarized Signatures Required Next 2 Pages)
4- 611R024
BUILD, - 1VIENT FE
VIL ' ' OOKOCT 2025
938 KING Q tR; ,NY 10573
4.: 0 VILLAGr OF kYE BROOK
e o 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:
A<A41rt ; (__ ------ residing at, L1_7
(Print name) (Address where you
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;
L-k-T -v-,4�.`c-- fir: e_ -- ,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.
(Signalurc of Property Owner(s))
(Print Name of Property Owner(s))
S o efo n e this t
,20 L1_
lN( 'c)
MARK H GUERRERO~
Notary Public-State of '.e:� rk
NO 01GU62122 7
Oualified in KingS3C
My Commission Expir
0/2024
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
S kvv1 S0.0 i C+rr✓16 ,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 b fore me ais Sworn to before me this
day of ,2� day of QC,6 20_s.2 _—
Signatbke of Property Owner Signature of Applicant
Pn Name of Pro wner Print Name of t
- ----
a MAFIK H GUERRERO Notary P lic
Notary Public-State of N, ;yokan
NO. 01 GU62122 S' TANYA BASALYGA
LRegistration
RY PUBLIC;STATE OF NEW YORK
0ua!Ified in Kin s No.01BA6290293
My Commission Expires
ali sedIn Westchester County ,
This a on must be properly completed in its a tiremust include
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.
MARK H GUERRERO
Notary Public-State of New York
No.OIGU6212297
Oua'tee in'
My comma;,.
-2-
6/1/2024