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Home My WebLink AboutBP26-002 BUILD MENT VIL E OF RY OOK DFC 3 , 702E 938 KING ET RYE BR NY 10573 � 44 -0 � w ov INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: TIPC - 6 Pe #: Application Fee: Approval Signature. Nk Permit Fees:$ J ' Disapproved Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1, Job Address: Z MEE77r/G1 900lZ" LAND SBL:1%c! . -7 —Zone: PU i 2, Proposed Improvement.(Describe in detail): Fl vi544 3A5ZeAE"T CC,FeD age �,eu,r� FI,✓I j r+ sr"r_,C +,9afan^ Arr'y V T►r_1 r 13.a+.en PkCl.4 A4 cA L 'ZmoJ-k 3. Does the proposed improvement involve a Horne-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: If yes,indicate: TIER 1: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: C Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: I FA AA After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: ! toy+ o Address: 2 1Ae-V11N6 th%_" 4-A^1 9' Phone# Cell# 'R)`1F-52Z-"Z 15 Z 7 email: PrMINkvl-!• VELC (2-617A44lr_.C., 8. Applicant: Address:. Phone# Cell# email: 9. Architect: 1—Ul PFA445 1 Address: ��$ 5M +� �UE�c�t; , /r"r k'tsco, ru f I a5" Phone# A1,4—Iv c0(vr3$56 Cell# email: LouQZD,,tASrA94,ti++TUIX'S.GJ,�► 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: f-6,6• Cps nir6 Address: l'� tG.b+' P4114.r Phone# IN ' 'S`�5 Cell# email: 12. Estimated cost of construction $ 01°"" (NOTE The estimated cost shall Include all labor,material,scatT sldme,fixed equipment.professional tees,and matenal and labor which may be donated gratis,) 13. Job Timetable: Start: FC'9Cw±qJ Finish: MA {1) 6112024 BUILD NT VIL E Off'RY OOK 938 KING ET RYE Btt ,NY 10573 ' DEC � a 2�� 4 9-0668 w Ikm.='tag x�xxxxxx*�,ax�xxx�xu�cxK�i��xx***xx*x,ti,�***��*�x�i*��**�t*��**��*��*f#ff,►*,t*#t*:s*****�k****�*ak**A* 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 SUBMITTE0 WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I, A N�� y'�L , residing at, Z M-15M JL ,4 n'' , 17Y6 N (Print name) (Address"here you live) 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.- 2 , 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. (Signature 'op rtN 0%%ner(s)) {f'rintNamcofl'roPc�i chtiner(s)) Sworn to before m�e, this day of 9 ' i 1 20 f Nat,r� Puxh c IV GREGORY M.RIVE; A NOTARY PUBLIC,STATE OF iiL N YORK NO.GIR16441398 (2) QUAL1FIE0 IN'WESTCHESTER NYI COIJN 03ISSION E)T RES SE 9 A 9ER 2$,20 6/I2024 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. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) asp _ --+!'T 'q Vat- _ ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indivVual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the 0G-1 A,�t_g_ for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc,) 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. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Swom to before me this day of , 20 day of , 20 Si of property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Pu I Notary Public GREGORY M. RNERA NOTARY PUBLIC,STATE OF NEWW YORK 40.01 R16441398 QUALIFIED IN W4ESTCHESTER COMpMOON EKES SE 7BRER 26,20 (d) 6/1/202a