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HomeMy WebLinkAboutMP26-002 -� BUILD ---------------- I MENT D VIL OF tOOK 938 K[NG d ET RYt,NY 10573JAN 0 8 2026 4 . ov VILLAGE O1 RYE BROOK BUILDIf�JG DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: �Ill C 2-1e —CDo�z_ Approval Date: Permit Fee: $ 'qCkQ.. oS k,, Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS SEEN 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 RE<)uREMENTS FOR RELEASE OF PERMIT&_CERTWICAITE 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. (Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form(Form#Cl05.2 or Form#U26,3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RF.SIDF.NTIAI,=$200.00/unit• COMMERCIAL =$450.00/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, is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of 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. �y 1. Address: Z3 1 1� r o inf xxsc4 N� SBL: 2. Property Owner: _:L.r,05I-OAri Sim Address: .7-31 '1A91W, Pf 0^5c+.�<__ Phone#: q!yd}/S (,o 54eJ Cell# 3. Contractor: Ale A&v•'-.d '1�'�Address: /y "074,;ly c Phone#: 9/y r p-3J YV c I Cell#: email:J-4+C,9 4. Scope of Work:New Installation( )•Replaccmcnt6?6•Removal( )•Other( ): 5. List Equipment:A 6. Location of Equipment: ©0 7. Method of Installation/Removal(list all equipment needed to perform job): A Pi i 1 7/t/2025 STATE OF NEW YOM COUNTY OF WESTCHESTER ,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 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. Sworn to before me this Sworn to before me this day of 20 day of �3pr\"Ol ,20 kW16� A /�b— — Sign a of Property Owner S' Ap icant j 0 mkpt?w S f t Name of Property Owner a of Ap licant r otary PgA�k MELILLO Notary Public NOTARY PUBLIC,STATE OF NEW YORK SRARI MELILLO NO.01 ME6160063 NOTARY PUBLIC,STATE OF NEW YORK QUALIFIED IN WESTCHESTER COUW)C NO.OIW:6160063 COA mw*N Dms imiARY 29,20 j��I QUALIFIED W WESTCHESTER COIJNP�, (PtRE "OA4IL115Si01V DS JANUARY 29,2O� 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/i/202S