HomeMy WebLinkAboutMP26-018 VILLAS `OF RYE BROOK
BUILDING DEPARTMENT JAN 2 6 2040
938 KING S " KNY573
(914)939- wifkv APPLICATION FOR PERMIT TO INSTALL MODIFY AND/OR
REMOVE MECHANICAL E UI N �
OFFICE USE ONLY:
Permit#:}-t P ZCO Building Inspector;
Application Fee: Date of Approval:
Permit Fee: Bldg/Use Class: Res. { );Comm. ( );
DO NOT START 1N ORK or CONSTRUCTION [ NTIL A PERMIT HAS BEEN ISSUED BY THE
Bt 1LDING INSPECTOR. THE ADS[INISTRATI E FEE FOR N%ORK PROGRESSED OR CONIPLE]ED
11 1 1 IIOUT A PERMIT IS 12% OF THE TO'I kL COST OF CONSTRUCTION WITH A MINIM N1 FEE
OF$750.00
REQUIREMENTS FOR RELEASE OF PERMIT: (A CERTIFICATE OF COMPLIANCE Is REQUIRED TO CLOSE OUT THIS PERMIT)
1. Properly Completed& Signed Application.
2. Payment of Application Fee: Residential—$100.00: Commercial=$250.00(fees are non-refundable)
3. Site/Staging Plan as required by the Building Inspector.
4. Sealed Construction/Installation Documents&Specifications as required by the Building Inspector.
5. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&
Workers Compensation Insurance on a NYS Board form
(Form#C105.2 or Form 0 U26.3 or NY State Workers Compensation Waiver)
6. Payment of Permit Fee:
Residential =$18.00r 1000.00 of Construction/Materials Cost with a minimum fee of S 150.00.
Commercial= S25.00/1000.00 of Construction,'Materiais Cost with a minimum fee of$275.00.
7. Inspection by Building Department for removal and/or installation. ras hour notice requiredf
8. Any electrical work requires a separate Electrical Permit and Electrical Inspection.
9. Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection.
Application dated, 1/1412026 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit
for the installation,modification,and/or removal of the specific Mechanical 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 the
approved plans,and with all applicable Local,County,State&Federal laws,codes,rules and regulations.
1.Address: 163 BRUSH HOLLOW CRESCENT SBL: 129.76-1-97 Zone: ?OD
2.Property Owner: REBECCA ZALTAS Address: 163 BRUSH HOLLOW CRESCENT
Phone#: 914-450-4123 Cell ft: email: RZALTAS@GMAIL.COM
3.Contractor: HOFFMAN ENERGY OF DANBURY Address: PO BOX 411, NEW HAVEN, CT 06502
Phone#: 203-974-6440 Cell#: email: ORDERS@CTPERMITSERVICES.COM
4.Scope of Work:New Installation{ )•Replacement( )•Removal( )•Other( )
5.Type of Equipment: REPLACE EXISTING BOILER IN SHED WITH BURNHAM PV8H3WEC-TBWN OIL FIRED BOILER
6.Location of Equipment: IN REAR OF HOME INSIDE SHED
7.Cost of Equipment including Installation Cost: S 13,690.00
l 6/l/2024
■
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
being duly swom,deposes and states that helshe is the applicant above named,
(print name of individual signing as the applicant}
and further states that(s)he is the Mechanical Equipment 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.
�t++nn tr h�lrrr u14 Ilm 1,�,,1-' - r
_ 1_ .)urrllt•,h;l,Menttihl. 1. t
t1.1\ +I e 11 } —
�,.,-r�lfi��__.�•
Siuttalurc ol'I'rurCtt} t)WIM' 4rs+l.ltttrl+l lrplit;nu f
? r
Ili iniNaniC
�-
k+tan Public gMANt7A 1° IEITNER -
NOTARY PUBLIC-STATE OF NEW YORK &yi,{teDI 01111TNER
02LE621 7684 NOTARY PUffk5$%1NtW *YORK
, 'Nestchesler counly N0
=b1116147684
my commission Expires February 16, 20.�" Aualkifetllei4"LA Ayf�jF�ftpunt/`yy/�
I1!!;Ih I I'. lo11111k.I[ill III its 0111101 .11ltt I11lii! !M�!GoIIltt11t51 nTs N�IR?r lT .'7«t
i
111L Ik'. ;ii (l'.:Ir IY;) trl Ilk: titll,jt•k'i Itttrlh11'k. .110 111, :11+1)11k'lmt I�l I'�ifllri II1 1f14 �It:rt�j (ry{ati lil�tl. �IylalPl:li
1I+ t Imrltt l l'. + rultl�l:�l in ilti rlllirclt :ultlr 'r lu+l 1+ru1+:11+ ';T'�lu'ki :li tll l+k di't 01! ':I 111.111 ,111d k unl 'wo ,k II1 1.,
Ik 1ur11tikl I!! flit .1P111it.1111
i
III II DING UVIA R I MENT
Nit 11(:I ()F RI r Iittw►r k JAN 2 � 2025
93H h l". spirt t l Rvc It tit►ok,NV 10573
1
')1 a) -0668
,.n, t' 'e ►I'n . r�,►
f*1,♦fffiRiRR Rff RRiRRRi kfiiR iff iR*fRA*++++w►wwRtw+4aw w+rrrwr wwtt++trwrwrwrrrirw*wrrr#rrrrwrrttttttat t.tt
AFFIDAVIT OF COMPLIANCE
VILLAGE DI '216 i S VORM SEWEjRS AND SANI7AR.Y SEWERS
THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED
ALONG WITH ANY BUILDING OR PLUMING PERMIT APPLICATION. ANT BUILDING OR PLUMBING PERMIT
APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT
STATE OF NEW YORK, COUNTY OF WEST'C1IES"1 I:R ) as:
� siding at. ,
^gin!
being duly sworn.deposes and states that Mhe is the applicant above named•and further states that(s)hc is the
legal owner of the property to which this Affidavit of(•ompliance pertains at:
Rye Brook. v1'.
best of
er
e and
bel
ef. that
1-urdier that all statements contained herein are true.and that er'thc Sturm sehwertor sanitarrdsewerr.and
further rc�s
there are: no known illegal crass-connections concerning � ndrtN in accordance with all State.
uric s or other prohifiited stormwater or groundwater connections or sou
State-
that there are no roof drains. sump p p°
of inflow or in filtration of any kind into rite sanitary sc"cr from the subject p pe
County and Village Codes.
aS ��
j•„ .rr . � f',r�,. :., r,.n,;�... S. t.IITI�(ER
AMANDA Of NEEMt PORK
t() �fOre me this y � NOTARY �►dUC-STATE
Sworn . 20 No. 02LE621 76e4OSIl county
1
ou011lied in Weffc FAD uarY T b' 2&-
(�8} Or MY Commission Expires
-i-
{