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BUILDING DEPARTMENT
❑I11IJ1.UlN(: INSPECTOR
tiSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFOR(TMENT OFFICER 938 King Street • Rye Brook, NY 10573
(914) 939-0668 FAx (914) 939-5801
www.ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS: y� I aG£ .?LA ZA DATE:�O- 2 q- Z= '
PERMIT# v 11-A KL /�6pfi._GF 1 a-� ISSUED:_.... SEC'r:..I..!Y -I7_.. BLOCK:.._ LOT:�?_....
LOCATION: .da............ � cam,. _ _._..._. _ OCCUPANCY:_.._..-------
❑ Violation Noted THE WORK IS... MASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ .INSULATION /❑ Natural Gas1/0^6-- (/-LG/
❑ L.P. Gas /
❑ FUEL TANK —
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL.
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1932 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAX (914) 939-5801
www.ryebrook.ore
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : �-Q� i�1 AkA= Pt Al 2-v r DATE: 1[I - 1 S0- 2-Q45-
PERMIT# Z%�Lt Ric- I�vS��C.�iJ J ISSUED: SECT: L7 BLOCK: l LOT:�j
LOCATION: VXGI,- 20,a a OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/ REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
r
❑ NATURAL GAS ft' - sJ ��
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER s��.7 -T,>e ^ ,7- '1. )'--I �� rJ %.k
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
OTHER
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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK initial Inspection Date: CI1Pass
STEVEN E.FEWS 938 KING STREET,RYE BROOK,NEW YORK 10573 1- 24- 15-f I' rail
BUILDING&FIRE INSPECTOR (914)939-0668 -wWW.ryebrookny,goV Re-Inspection Date: [I Pau
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FIRE INSPECTION REPQRT, NOTICE 01F VIOLATION & ORDER TO REMEDY SAME,
Site Address: I R ye 9 1 jo. i " Zo. Zone:Cj-P SBL: 27
Occupancy: SSA AA_�,a AS 10..J 6,1S�ro State Use Classification: A -L,
Business Owner: S t-ie ll..>'—� Phone: 417- y 80 6 y/s
Building Owner: H/1 N ( Z►e,R L ,! Phone: q I L/ '70 1 - y Q OS
Emergency Contact: Phone:
Building Representative in Attendance:
----------------------------------------------------------------------------------------------
Take notice that the following violations of the New York State Uniform Fire Prevention&Building Code and/or the Code of the
Village of Rye Brook were found to exist at, I R-1E pe i'JAIA 40ka-La in the Village of
Rye Brook,NY on, SAN W46 iN 2.44 20 Z.S .Th person or entity served with this Order to Remedy shall
immediately commence to correct all li ed violations and shall completely cure each violation described herein by no later than
FC-&(zu,an.% 21 Z,o ZS' ,which is thirty(30)days after the date of this Order to Remedy.Furthermore,
upon curing any list violation(s),you shall immediately contact the Building Department during normal business hours to schedule
a re-inspection of the premises to confirm full compliance with all applicable codes,laws,rules®ulations.
BE ADVISFI)THAT YOUR FAILURE TO CORRECT ALL VIOLATIONS IS A CRIME PUNISHABLE BY FINE,IMPRISONMENT Olt mi'I'11.
1.PORTABLE FIRE EXTINGUISHERS (PFE's) NO 1'i?s N/A
a.906.1. Are PFE's installed throughout the space&on the premises as required by code. a.Z(
b.906.3.L Is the maximum travel distance to a PFE 75 feet or less. b.
c.906.5.Are PFE's conspicuously located&readily accessible. C. �(
d.906.6.Are PFE's unobstructed/unobscured from view. d.— -v--'
e.906.7.Are PFE's properly mounted as per the manufacturers instructions. e._
f.906.9.Are PFE's properly installed:<40 lbs.max.5'above floor;>40 lbs.max.3.5'above floor. f.
2.FIRE ALARM SYSTEM&SMOKE DETECTORS
a.901.6.1.Is the fire alarm system inspected,tested&maintained in accordance with NFPA 72. a.
b.907.4.2.1.Are manual pull stations located within 5 feet of exits&within 200 feet of each other. b._ ,/ _
c.907.4.2.2. Is the height of the pull station handle located between 42&48 inches above the floor. C.
d.907.3.Is a fire alarm system provided in existing buildings as per section 907.3.1 &907.3.2. d.
3.FIRE,.SUPPRESSION SPRINKLER SYSTEM&FIRE HYDRANTS
a.901.6.1. Is the sprinkler system inspected,tested&maintained in accordance with NFPA 25-13. a._ r/ _
b.901.6.1.Are the main valves secured against tampering in the open position. b.
c.901.6.1.Are sufficient clearances maintained from fire sprinkler heads to fixtures or materials. C._ Vol _
d.901.6.1. Is a supply of six spare heads&a wrench maintained on the premises. d._ ✓
e.901.6.1.Are sprinkler heads&cover plates unfinished or of factory applied finish only. e._
f.901.6.3.Are records of all system inspections,tests&maintenance reports maintained on the premises. f.
g.913.5.Is the fire pump inspected,tested&maintained in accordance with this section&NFPA 25. g._ ✓ _
h.507.5.2.is the fire hydrant system properly maintained,operational,compatible w/NST&tested annually. h._ ✓
i.507.5.4.Are fire hydrants&fire protection equipment unobstructed. i.
j.507.5.5.Is a clear space of not less that 3 feet maintained around all hydrants. j._
k.901.8.Are all fire protection systems in place and maintained untampered. k.
INSPECTOR: , DATE: 1— 2- 9— Z a2,9-
-I-
ReNised 6/12024
NO YES N/A
4.STANDPIPE,CABINETS&FIRE DEPARTMENT CONNECTIONS
a.901.6.1.Is the standpipe system inspected,tested&maintained in accordance with NFPA 25-14. a. _ ✓ _
b.901.6.1.Has the required flow test been performed within the past 5 years as per NFPA 25-14. b. _ ✓' _
c.912.2.3 Are standpipe FDC threads compatible with fire department standards. C.
d.905.7.Are cabinets containing fire fighting equipment unobstructed/unobscured. d.
e.905.7.1.Are cabinets containing fire fighting equipment properly identified&labeled. e.
f 912.2.1.Are exterior FDC's fully visible&recognizable from the point of fire department access. f. _
g.912.4.Are all FDC's unobstructed and available for immediate access by the fire department. g.
5.ExITS,MEANS OF EGRESS&OCCUPANCY /
a. 1031.2.Are exits&exit enclosures continuously maintained free from obstructions or impediments. a. ✓' —
b. 1031.3.Is the means of egress free from obstructions including accumulated ice&snow. b.
c. 1031.6.Are exits maintained unobstructed by furnishings,decorations,draperies,mirrors,etc... C.
d. 1031.7.Are existing emergency escape&rescue openings maintained as per this section. d. _✓ _
e. 1010.1.Are egress doors provided and maintained as required by this section. e. _ _✓ _
f. 1004.9.Are all spaces having an assembly occupancy posted with an approved occupant load sign. f
g. 1013.1.Are exits marked by a properly located,approved&readily visible exit sign. g.
h. 1013.1.1s the maximum travel distance to any exit sign in an exit access corridor 100 feet or less. h. _ ✓ _
i. 1013.4.Are tactile exit signs complying with ICC/ANSI 117.1.provided as required by code. i. _ ✓
j. 1013.3.Are all exit signs illuminated at all times. j. _✓
k.1008.1.Are the means of egress&exit discharge illuminated at all times the building is occupied. k. _ _✓
1. 1018.3.Are public aisles in group B&M occupancies maintained at least 36"wide where fixtures I. _✓ _
are placed on one side of the aisle&at 44"wide where fixtures are placed on both sides.
in. 1018.3.Are non-public/non-accessible aisles serving less than 50 people maintained at least
28"wide,or at least 36"wide where serving 50 or more people.
6.COMBUSTIBLE STORAGE&WASTE MATERIALS
a.304.1.is the building(s)and premises maintained free from accumulated combustible waste material. a.
b.304.1.2.Is property free from weeds,grass,vines or other growth capable of being ignited. b.
c.304.2.Is combustible rubbish stored so as not to create a nuisance or hazard to the public. C.
d.315.3.Are combustible materials properly stored&separated from ignition sources. d. _✓ _
e.315.3.1.Is storage maintained 24"or more below the ceiling in nonsprinklered buildings, e.
and 18"or more below sprinkler head deflectors in sprinklered buildings.
f.315.3.2.Are exits&exit enclosures maintained free from stored combustible materials. f. _ ✓ _
g.315.3.3.Are boiler,mechanical&electrical rooms maintained free from stored combustible material. g.
h.313.1. Is building maintained free from stored fueled equipment.(motorcycles,mopeds,mowers,etc...) h.
7.ELECTRICAL
a.604.1.Is the building free from modified/damaged wiring,devices,appliances,equipment a.�C _
and maintained free from electrical hazards.
b.604.2.Are electrical service equipment areas properly illuminated. b.
c.604.3.Are proper working space clearances provided&maintained for electrical service equipment. C.
d.604.3.Are electrical service equipment working spaces free from any stored materials. d.
e.604.3.1.Are all electrical control panel room doors,panel boards&disconnects properly labeled. e.
f.604.4.is the building free from unfused multi-plug electrical adapters. f
g.604.5.Are electrical extension cords being used in a safe manner as per code. g. _
h.604.6.Are all junction,switch&outlet boxes fitted with approved covers or plates. h.
i.604.6. Is the building free from open-wiring spliced electrical connections. i. _
j.604.8.Are electrical motors maintained free from accumulated oil,dirt&debris. j.
k.915.1.Are Carbon Monoxide Detectors installed&maintained as required by this section and by 1103.9. k.-
INSPECTOR: DATE: "' Z
-2-
Rwised r/inuza
No YES N/A
8.ELEVATORS.DUMBWAITERS&ESCALATORS
a.[PM]603.1.Are elevators properly maintained,and is the current certificate of inspection on the premises. a.
b.606.3.Are approved standardized,pictorial signs posted adjacent to each elevator call station on all b. fR'
floors reading; IN FIRM.EMEItGFNCV.Do No'I'l ISI�E1.14VA'I'OR.UsF Exl'1'S'I'AIItS
c.606.7.Are keys for elevator car doors&fire department service kept in an approved location. C. 1�
d.315.3.3.Are elevator machine rooms maintained free from stored combustible material. d. _ _ ,<
e.[B]3005.1.Are elevator machine room doors maintained unobstructed at all times. e. p(
9.COMMERCIAL KITCHENS
a.906.1. Are portable Class K fire extinguishers installed within 30 feet of cooking equipment. a. _
b.904.12.5.Is the fire protection equipment inspected,tested&maintained as per Section 901.6. b. _
c.904.12.5.2.Are automatic fire extinguishing systems serviced at least every 6 months. C.
d.904.12.5.3.Are fusible links&automatic sprinkler heads replaced annually. d.
e.[RB]122-5.13.Are grease traps provided and installed as required by Village Code. e. _
f.[PC] 1003.10.[RB] 122-6.Are grease traps properly maintained as per State and Village Code. f.
g.[RB] 122-6.C., 122-9.Are all service,maintenance,&repair records for grease traps and related
plumbing maintained on the premises as required by Village Code. g.
10.HFATING SYSTEMS
a.[PMl 603.1.Are all heating appliances properly installed&maintained in a safe working condition. a.
b.[PM]603.2.Are all fuel-burning appliances&equipment connected to an approved chimney or vent. b. ✓'
c.[PM]603.3.Are heating appliances maintained with proper clearances from combustible material. C.
d.[PM]603.4.Are safety controls for fuel-burning equipment maintained in effective operation. d. _ V
e.[PM]603.5.Is the fuel-burning equipment provided with adequate combustion&ventilation air. e.
11.MOTOR FUF,L-DISPF,NSING FACILITIES&REPAIR GARAGES
a.2303.2.Is an approved,labeled&readily accessible emergency disconnect switch provided a. _ _ Ix
in an approved location within 100'of,but not less than 20'from fuel dispensers.
b.2304.3.4.Are dispenser operating instructions conspicuously posted on every fuel dispenser. b. _ X
c.2304.2.4.Are fuel-dispensers unobstructed&in clear view of the attendant at all times. C. _ _ X
d.2305.5.Are approved portable fire extinguishers complying with Section 906 with a minimum rating of d. _ X
2-A:20-B:C provided&located not more than 75' from pumps,dispensers&fill-pipe openings.
e.2305.6.Are warning signs provided&posted within sight of each dispenser as per this section. e.
f.2305.7.Are weeds and other combustible materials kept at least 10' from fuel-handling equipment. f.
g.2306.4.Are above-ground tanks provided with vehicle impact protection. g.
h.2306.5.Are above-ground tanks provided with secondary spill containment. h.
12.HAZARDOUS MATFRIAI.S Q-IA7.-MATS)
a.407.2.Are S.D.S.Sheets for all haz-mats readily available on the premises. a.
b.407.3.Are spaces and individual containers containing haz-mats properly labeled&identified. b.
c.5004.2.Are stored haz-mats provided with approved secondary spill containment. C.
d.5003.7.1.Are proper No SMOKING:signs provided as per this section. d.
13.MISCELLANEOUS
a.403.1. is an approved fire safety&evacuation plan prepared&maintained for the building/occupancy. a. _
b.405.1.Are emergency evacuation drills conducted at the intervals as specified in Table 405.2. b.
c.405.5.Are records of emergency evacuation drills kept&maintained on the premises. C. _
d.505.I.Are approved address&building numbers properly placed&plainly visible from the street. d. _ ►� _
e.506.1.Are approved key boxes(knox boxes)provided,properly located&equipped with the proper keys. e.
f.703.1.Is all required fire-resistance rated construction properly maintained as per code. f. _
g.703.1.Are openings through fire-resistance rated assemblies properly protected&maintained. g. _
h.5303.5.Are compressed gas cylinders&systems secured&safeguarded against damage&access. h.
i.5303.6.1.Are compressed gas cylinder caps or collars in place at all times except when tanks are in use. i.
14.GENERAL HOU sKF,EPING
a.Good
b.Fair
c. Inadequate _
d.Poor INSPECTOR: DATE: y Z D
-3-
Revised 6/1/2024
1'fF,M Numm-,.Ii REMARKS
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INSPECTOR: 7 � I 4,�) DATE: � - 2 7 - 1io ZS�
-4-
Revised 6/1/2024
NRL Fire Protection Services, Inc.
P.O. Box 194
�RL Monroe, Connecticut 06468
Fire Protection Services,Inc. 845-278-4333 888-99GONRL
TO DATE
ADDRESS I co �� �Q PHONE NO.
pq A �l #� y- yal - ds/
qP ^ r00)� ,N� I f� I^S -7 3 JOB LOCATION
ATTENTION: rj '1 c/
VP LA DESCRIPTION OF WORK
OTY. MATERIAL UNIT AMOUNT
8 Y50 or
t .Ua g
Odic � 2 /76 Ov
MISCELLANEOUS CHARGES
(y�
-5 f ;�,
LABOR HRS. RATE AMOUNT
TOTAL LABOR
TOTAL MATERIALS #3/5' no
TOTAL MISCELLANEOUS
SUBTOTAL 00, OU
CUST.APPROVAL
SIGNATURE TAX S
PRINT NAME GRAND TOTAL (,50, S
CLAIMS OF UNSATISFACTORY WORKMANSHIP MUST BE MADE WITHIN 48 HOURS. INVOICES ARE SUBJECT TO AN INTEREST CHARGE OF THE LESSOR
OF 1.5%PER MONTH(18%PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY UNPAID INVOICES THAT ARE NOT PAID WITHIN 30 DAYS.
IN THE EVENT OF DEFAULT NRL FIRE PROTECTION SERVICES SHALL BE ENTITLED TO RECOVER COSTS OF COLLECTION, INCLUDING REASONABLE
ATTORNEY'S FEES.
visit our website www.nrlfirepro.com
NRL Fire Protection Services, Inc.
P.O. Box 194
Monroe, Connecticut 06468
Fire Protect ion 5ervkes,inc. 845-278-4333 888-99GONRL
TO 8uDATE
d�f�c�
ADDRESS PHONE NO.
9/yIJ -
�!�/ JOB LOCATION
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ATTENTION: DESCRIPTION � �
RK
�Jr'vP� Z19,0�Pr
QTY. MATERIAL UNIT AMOUNT
V79'77/179
MISCELLANEOUS CHARGES
ep qj u U cuts D� _ 1�5'4 1
I Ov
r;o � qD 000
3 0 Vl -04 � ,o r LABOR HRS. RATE AMOUNT
TOTAL LABOR
l_
TOTAL MATERIALS
TOTAL MISCELLANEOUS AbO01 00
SUBTOTAL #12 Z S! 00
CUST.APPROVAL TAX
SIGNATURE
PRINT NAME GRAND TOTAL
CLAIMS OF UNSATISFACTORY WORKMANSHIP MUST BE MADE WITHIN 48 HOURS. INVOICES ARE SUBJECT TO AN INTEREST CHARGE OFTR LESSOR
OF 1.5%PER MONTH(18%PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY UNPAID INVOICES THAT ARE NOT PAID WITHIN 30 DAYS.
IN THE EVENT OF DEFAULT NRL FIRE PROTECTION SERVICES SHALL BE ENTITLED TO RECOVER COSTS OF COLLECTION, INCLUDING REASONABLE
ATTORNEY'S FEES.
visit our website www.nrifirepro.com
F,j DAVID ZUIDEMA INC .
COMPLETE SEPTIC SERVICE
ESTABLISHED 1919
90 Midland Avenue • Midland Park, NJ 07432
Tel: 201-445-3188 • 888-901-7392 • www.DavidZuidema.com
Invoice: Tech_ s Date:
CUSTOMER INFORMATION Time on site:
Name: >. , Phone:
Address: f cF ��
City: '`' 1,n Stater Zip: County:
BILLING INFORMATION
Service Description Charge
Pumping Gallons -
Inspection
Treatment
Riser/Extension
Labor/Digging
Cover/Lid
Jetting/Snaking
Camera
Service Call
Baffles
O Check# O MasterCard O Visa O Amex O Discover�� Subtotal
O Cash C.C. # Exp. Permit/Tax
O CC Name on CC: Sec. Code Total
ASSESSMENT
Depth to Top of Tank
Type of Tank Cesspool Steel Concrete Fiberglass Other
Tank Condition Any visible sign of Cracking Root Decay Other
Effluent Level Below Outlet Operational Level Above Outlet
Baffle (Inlet) Intact Missing Damaged I INiot Applicable
Baffle (Outlet) Intact Missing Damaged I lNot Applicable
Flow From Tank No Run Back Notedi I Run Back Noted
Tank Location Front Yard Back Yardl I Side Yard (L/R Other
Comments:
Work Completed to Customer Satisfaction Signature:
Interest 18%per year Not responsible for sprinklers, driveways or underground wiring.
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914)939-0668 Christopher J. Bradbury
wwH,.r)•cb rooknX►guy
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. l=ews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
September 23,2024
Via 1,1 Class Certified Mail
Buddha Asian Bistro& I libachi
c/o Peter Lin
1 Rye Ridge Plaza
Rye Brook,New York 10573
Re: 1 Rye Ridge Plaza, Rve Brook,New York 10573
Dear Mr. Peter I.in.
It has come to the attention of the Building Department that it has been over one year since you applied to renew your
Operating Permit for the subject Place of Public- .\sscmbl•,and as such your Operating Permit is now expired.Please note
that the Code of the Village of Rye Brook roqutres that your Place of Public Assembly hold an Operating Permit,and that
such permit be renewed by you annually. Please note that in order to renew your Operating Permit,you are required by Rye
Brook Village Code§91-4.13,to undergo and successfully complete a Fire Inspection for this location at least every twelve(12)
months.
In order to avoid a violation,please complete and submit the attached Dire Inspection/Operaung Permit Application form,
remit the correct application fee,and schedule your annual Dire Inspection with the Building Department by no later than,
October 23,2024 which is thirty(30)days after the date of this notice. Please note that the property owners notarized
signature,as well as the business owners notarized signature must appear on the application form in the appropriate spaces.
Upon successful completion of the Dire Inspection,you will be issued a renewed Operating Permit valid for one year.
Please remember that you must renew your Operating Permit even,year by tiling a Fire Inspection/Operating Permit
Application,remitting the applicable fee,and scheduling your Dire Inspection with the Building Department at least thirty(30)
days prior to the expiration date listed on your Operating Permit.
Thank you. �^
Steven E. Fews
Building& Fire Inspector
sfews®q•e br o,•nX.gu •
cc: Alfredo DiVitto,Assistant Building& I-tre Inspector
l.aura Petersen,Office Assistant
Alena I lakanjin, Property Manager
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VILLAGE OF RYE BROOK
MAYOR 938 Kind;Street, Rye Brook,N.Y. 10573
Jason A. Klein ADMINISTRATOR
(914) 939-0668 Christopher J. Bradbury
w%v%v.rycbrookn)igQv
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David Nl. Heiser
Salvatore W. Niorlino
September 23,2024
Buddha:\sian Bistro& I libachi Via 1'1 Class Mtul
c/o Peter Lin
1 Rye Ridge Plaza
Rye Brook,New York 10573
Re: 1 Rye Ridge Plaza, Rye Brook,New York 10573
Dear Nit. Peter I,in,
It has come to the attention of the Building Department that it has been over one year since you applied to renew your
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Operating Permit for the subject Place of Public ssemhl\,and as such your Operating Pernut is now expired. Please note
that the Code of the Village of Rve Brook requires that tour Place of Public;\ssembIv hold an Operating Permit,and that
such permit be renewed by you annually. Please note that in order to renew your Operating Permit,you are required by Rye
Brook Village Code§91-4.B, to undergo and successfully complete a Dire Inspection for this location at least every twelve(12)
months.
In order to avoid a violation,please complete and submit the attached Dire Inspection/Operating Permit Application form,
remit the correct application fee, and schedule your annual hire Inspection with the Building Department by no later than,
October 23,2024 which is thirty (.30)days after the date of this notice. Please note that the property owners notarized
signature,as well as the business owners notarized signature must appear on the application form in the appropriate spaces.
Upon successful completion of the Fire Inspection,you will be issued a renewed Operating Permit valid for one year.
Please remember that you must renew your Operating Permit every year by filing a Dire Inspection/Operating Permit
Application,remitting the applicable fee,and scheduling your Dire Inspection with the Building Department at least thirty(30)
days prior to the expiration date listed ou your Operating Permit,
Thank you.
Steven E. Dews
Building& Fire Inspector
sfews ,c br kny.gov
cc: .\Ifredo DiVitto, ;\ssistant Building& Dire Inspector
Laura Petersen,Office:\ssistant
\Icna I lakanjin, Property Manager
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BUIL ,MENT D �� � ��n
V l`-01- R OK V
ED
938 KING Q E r RYt:Bit, NY 10573 OCT 2 3 2024
"k ov VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FIRE INSPECTION / OPERATING PERMIT APPLICACT�I Q,
FOR OFFICE USE ONLY:
Fee jai • $ Inspection Date&Time: )6�1 p1Q q - a/ 4 i off-/ 4w s
FEE SCHEDULE: Re-inspection Date&Time:
Triennial&Private School Annual Inspection: =$450.00
Public Assembly Annual Inspection: <100 People= S525,00/>100 People=$775.00
Application,dated: /O-A33-Q' ,is hereby made to the Building Inspector of the Village of Rye Brook NY,requesting
that a Fire Inspection be conducted at the building and premises fisted below for the purpose of issuing a Permit to Operate the business,
private school and/or place of public assembly in conformance with the Code of the Village of Rye Brook,the New York State Uniform
Fire Prevention& Building Code, Title 19 NYCRR Part 1201, and all other applicable local, County, State & Federal laws, rules &
regulations,as per detailed statement
described below.
1. Address: I e li. (,A7-A SBL: 1y1, c)7 -1- rio Zone:
2. Business/Occupancy Name:Wd"AS'NG^I \S f VD NYS Use Class: A- Z
3. Property Owner: VJ, H C:kC-)e k eon I -1-� L L CAddress: 2VI lk*OJ',re MCI Z'01
Phone#9(4 1 p ( - `(00 S. Cell# email: a�, '1h [��,..�r e'i�S !a►y
5. Business Owner: Qv p,-,J L ZsJ Address: I HE V'40-e P(A Z .A r4el�t+Y 14 P
Phone# Cell# 1*7-4 8>- ((�j '� email: r1�g 17 Si�o p j `l a�i�y• l0"H
6. Emergency Contact: ev Qi,l U, LZ -4 Address: I V-4e&,dSP 0AJ..'
Phone# Cell# gemail: � �e�4 •!��
7. Inspection Escort: 5- JQ I itle: 1 �/
Phone#: Cell#:q 1'1, V - 6 (4 57email: /lbg "1 SL JJI IG`'�• +r00
8. Provide a brief description outlining the current and/or intended use of the property: f PV1.A
9. List all Hazardous Materials:
10. Occupant Load: Existing: 2 Proposed: Z Other: _
11. Date& Disposition of Previous Fire Inspection: 2 Pass ❑ Fail
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This application must include the notarized signature(s) of the legal owner(s) of
the above mentioned property, in the space provided below. Any application not
bearing the legal property owner's notarized signature(s) shall be deemed null
and void, and will be returned to the applicant.
************************ir cxx kirxic is is*ii iexuixxie it it**iei,ie i is is ir,Fxic'r it r ie is it ie icxicxxit is x:ci,xzir it is xie******ixx iie ixic ix ie it*Kir*ix it it
STATE OF NEW YORK >
COUNTY OA W F ESTCHESTER ) as:
S�V�,�V11 L-1 N ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing application)
and further states that he/she is the legal owner of the property to which this application pertains,or that he/she is the
bU�WXSS OINi,%a�-� � for the legal owner and is duly authorized to make and file this application. That all
(indicate architect,business owner,attorney,agent,etc.)
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.
Swom to before me this L 7 Sworn to before me this L
day of � � ?0 day of AQ—t— , 20 _
w
a 1' Notary Public
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a of PropertyKri 1er Signature of Applicant
&A, o S-+e J rA (�;it
Print Name of Property OvrffF Print Name of Applicant
RICHARD A.YARMY 11
NOTARY PUBLIC,STATE OF NEW YORK Nota(y11
1 ICY.
Registration No.01 YA0013323 waltio 6 westct�er 1i0` 20_.tQ
Qualified in Westchester County commtsat l E> Pob.2S
Commission Expires September 08,2027
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