HomeMy WebLinkAboutMP25-166 D,
s : DEC 18 2025 e
BUI l.Dt4 ` R M ENT
/�,r VILLAGE OF RYE BROOK
VII voi- RYJ OOK BUILDING DEPARTMI'NT 1
938 KING r•.t:R):-F;BR ,NY 10573 — - �-
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APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING,VENTILATION AND/OR AIR CONDITIONING EQUIPMENT
FOR O1TIcE USE ONLY: PERMIT#:kP _Z;7 RA�
Approval Date: DEC ; 9 ` Permit Fee:$ ✓
Approval Signature: Other:
Disapproved:
(fees xrc non-rcfvndublc)
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V0 NOT START WORK at,CONSTRUCTION UNTIL A PERMIT HAS R'EEN ISSUED BY THE BUIUDING
INSPF.(7I'011.THF A1)MTNI91'RA'TIVF Fl:*L FOR%NORK PROGRESSED OR compI.I:'rED WI'I'HOU'T A PF RNMIT IS
12%OF THE TOTAL COST OF CONSTRUCTMON WITH A MINIMLT51 FEE OF$750.00
REQUIREMENTS FOR REI.FASE OF PFRMTT&CERTIFICATE OF COMPLIANCE:
1. 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. (villageorRyc Bmik must
be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form 4 C105.2 or Form tl U26.31 or
NY State Workers Compensation Waiver)
4. Payment of Fees/Unit:RESTDENTiAL=S200.00/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.
4*4########iF#4#4
Application ted da ,9 25 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the
installation and or ret&vat ot the HVAC equipment as listed below.The applicant and property owner,by signing tiffs document
agrees that said equipment will be installed and/or removed in conformance with all aEplicable Local,County,State&Federal laws,
codes,rules and regulations. IV �34NU
I. A ddress: ice` �-1 b P SBL 1 L p Zone
2. Property Owner. 0lo glow- -N U—C Address-1pt a►{ prAd.T I R1 AA d a%..I, l -.(C.yv�
Phonc#: � j t�� Ccll#: email:
3. Contractor. CC-k57r&r_ Imo'-C+{ SCX%VL0d;S TJtiC. Address:40 �- O Tyt%tA� 4w C)"_
Pbnnc#: Zr'l-_45?,._ '3-412 Cell#:7�23, _�7A3-5353 email:uuetm__a Co+trsCtRt -yµc-_c-- wo-K KL
4. Scope of Work:New Installation(*Replacement( )•Removal( )•Other( ):
5. List Equipmcnt: C 0 S Ftrt.'r .S y.5 T E_-0-, (S- -Tc4*Q C Ory tCt W ►.T"t-E I.hj 0UwL
6. Location of Equipment: C c+tt D CJ TJ n a a 4- C v%ov i T 'Z-N 'e5e W-CAQ
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7/1/2025
STATE OF NEW Y R U 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 slates that(s)hc 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.
q i�7, H
Sworn to before me this L Sworn to before me this
day of l 20 day of D$G��l+ a ,20 71;s-
Si re of perty O—le, A Signature of Applicant
lA �u<3h P4PvtD rNgr4
Pri t e of Prope 61mr, T Print Name of Applicant
Notes Public Notary P fy
weuc,STATE of MW rare
"RaplstraUon ifa:01MAGG13416
01Nfhf ed is Westchastor Cauxtty
Caasntla;l �l n, lJt1d20i1
This application must be properly completed it)its entirety and must include the notarized signature(s) of
the legal owner(s)of the si>hject 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.
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