HomeMy WebLinkAboutMP26-015 �E BR(pv
V1,LL4 BROOK
BU G DPARTMENT
938 KING *�E
RaoK,NY 10�73 -� 2
(914)939- brookn . ov
APPLICATION FOR PERMIT TO INSTALL MODIFY AND/OR
REMOVE MECHANICAL EQUIPMENT
OFFICE USE ONLY, Z
Permit#: �A '(e 0 1 `� Building Inspector:
Application Fee: Date of Approval: JAIL 3 D 2026
Permit Fee: ZSHD �-_4j t:. Bldg/Use Class: Res. ( ); Comm. ( ;
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE
BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLF.1I.1)
WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM 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.Scaled 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#U26.3/or NY State Workers Compensation Waiver)
6.Payment of Permit Fee:
Residential=$18.00/1000.00 of Construction/Materials Cost with a minimum fee of$150.00.
Commercial =S25.00/1000.00 of Construction/Materials Cost with a minimum fee of$275.00.
7. Inspection by Building Department for removal and/or installation. ('48 hoar notice required)
8. Any electrical work requires a separate Electrical Permit and Electrical Inspection.
9.Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection.
Application dated, is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit
for the installation,m dific ion,and/or removal of the specific Mechanical Equipment as listed below.The applicant and
property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with the
approved plans,and with all applicable Local,County,State&Federal laws,codes,rules and regulations.
L Address: )l J MCI, 91fiC P01-A1 `51f-T "' SBL: J`'� - ��] — I A one: C f —
2.Property Owner: y►V� F-z b-z- r'i�[.1 � j �_,Q� Address: e
Phone#: 14f- �Dj —4 Cell#: email: vz -4crk .�{'j�l(�
3.Contractor:6-)A S-Cft f6rWkf,)r1*A �Mix� Address:,`fD M� AVA ;
Phone#: Cell#: email: , oJ1 f Y)
4.Scope of Work:New Installation( )-Replacement -Removal( )-Other( j
5.Type of Equipment: 1 (p LLI C•7'dya
6.Location of Equipment: st10PC�Ir-I
r C,v
7.Cost of Equipment including Installation Cost:$ -1 d �
1 6/l/2024
STATE OF NEW YO��RK,,,,C��OU��NTY 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 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.
Sworn to before me this Sworn to before me this
day of ,20 2,tp day of 20
i re of P Signature of Applicant
Pri t e of Property,Off+ �.(,a-(, Print me of A�tl
ry Public Not
AhENA UKANJM At.ENA HAPANIM
NOTARY F JK C,STATE OF WW YORK NOTARY Pi BM.STATE OF Will!Ym
Reqistretion No.01HA00130+3 RIO istretion No.0114A001S043
QutlNied in Westehester County Qualified In Westchester Coumv
my Cwmissw Expires$119=7 ly COVAti Lion Ett WIVJ 21
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.
2 611/2024