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HomeMy WebLinkAboutMP26-012 BUILD N MENT VEL E Off' RY OOK 438 KING 1c T RYE BR ,NY 10573 JAN 21 2026 `t + 14).9 -0 ©v APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: _P ^ Okm I� Approval Date: 2 Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN 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$750A0 REQUIREMENTS FOR RELEASE OF PERMIT&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. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NY Board form (Form#C1051 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit' RESIDENTIAL = $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. K. 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. 1. Address: } r, Rt SBL: 1 y q— ti y Zone: 2-ct" c/ 2. Property Owner. C lrj c1r1 SC-�1�f'. L� Address: \51 Phone#: Cell#: email: 3. Contractor: Cck., ` 9 C l LLL Address: l Phone#: [�_R'At, Cell#: email: r t k-UC ir1C-(C", 4. Scope of Work:New Installation{ }•Replacement -Removal( )•Other( }: 5. List Equipment: ( t, V-,C�c C_ _ (!_y Ck P CU'V t D-)L �Un�CiLS r 6. Location of Equipment: f — y .5�JY1,Ln 7. Method of Installation/Removal(list all equipment needed to perform job): t 7/V2025 SITE OF NEW YORK,COUNTY OF WESTCHESTER ) as: � IC_h4Q k- lPe rt being duty 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 tc efore me this 1 Sworn to Wore me this 1 day of 20 day of 20 ,46 Signature of Property Owner Si ature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public FMY DEOLNA BARON-DANIEL ARY PUBLIC,STATE OF NEW YORK Registration No.01BA0032946 Qualified in Westchommiuion ExPitss 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 7/1/2025 F BUILD _ TMENT "VIL E OF RYE BROOK 938 KING ET RYE BROi[ ,NY 10573 4 '9-0668 W okny.(rOv AFFIDAVIT OF COMPLIANCE `TILLAGE 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 SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: Q I, su. 'r_, 5L�Ye-` � r , residing at, 4 � - � �t 1 (Prialt name) (Address inhere ou 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; �J2, (,,Y 9, L , Rye Brook,NY. (Job Addr' 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. I- . irc„I PropertN Tnrriert�sh Su�c�� 5h�2 t cr- (Print Name of Property O%,wr, i Sworn to before me this r _ day of ,Q DEOUNA BARON-DANIEL ' ` NOTARY PUBLIC.STATE OF NEW YORK Qualified in Westchester Co ty fhotary Public) My Commission Expires ' -3- 61U2Q24