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HomeMy WebLinkAboutBP26-019 Gr �o `G o o a o a a N N cn oz J n r/� I� r�r- �i p 72 Lo z & � W � w 4 � ° � � .� ro Q ■ pq �, c a a� a cr Q W n h o a 94 rt W Ls 1 ram A � 00 y a�i p v w V bbc a 4 ■ tz U Is 00 O M o -ZI G [� lu � W A H o08 ct-0 li wog , zo 14 u o 01' 4 =1 P W i+ x a BUILD TMENT VM E O>~R� ROOK JAN 2 3 2626 938 KING ET RYE BR NY 10573 wVol ��- INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: r 3 Z026 er t it: Z(c ' ul Application Fee:$ Approval Signature: Permit Fees:$ r7 3-� Disapproved: _-- Other: Application dated: 2 d 1 is hereby made to the Building Inspector of the Village o I Rye Brook,NY.itir 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: I J l- ` L1 SBL: i Z • 7 Zone: Pu D 2. Proposed Improvement.(Describe in detail): C/ 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER 11: 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: Yes: (I[`yes,please submit a separate Automatic:Fire Suppression System Permit application& 2 sets ol'detailed engineered plans} 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. MY State Construction Classification: N.Y.State Use Classification):�� 7. Property Owner: Address: I�JLa �r RLASI� Ct U I 1 CJCa� L rt:'ti 11 Phone# f`` Rc�traon `�Cell# L U�� - `� email: LI 3 j_ 8. Applicant: `rclY]itl Ct r) 1pH c(A alp Address: j fii / Phone# S I(o- 961-26T!S; Cell# 9 f q-70 9-7i' S.G 1 email: 0 WI Gt✓ 9. Architect;' L(✓ � � ~ ( fl 1 ° Phone# ~ 3 - dy LL Cell# email: y 10. Engineer; Address: Phone# Cell# email: 11. General Contractor:7k t A t—1 Y"11Q C f C� ddress: }� �) 6; ILcSC cd ICA . G eI1uxcd L ahhG�� `f Phone# J I L- 'Zb/'2+-�S Cell# J y -160_7SS� email: l C �I+c6%a i>Iodgkt i fa.S � 12. Estimated cost of construction $ 3040Q0 00 _ Ca,� (!TOTE:I a;hall iatclude all labor material,scaffolding.Breit equtpanew.professional fees,and material and labor which may be donated gratis.)13. Job Timetable; Start: tl Z 0e Finish: I"i C4 r-cl, (I) 61]E2o24 BUILDJNG DEPAR MENT VILI; E OF RYF_ OOK 938 KING ST>E FE'r RYE BRO(-) , NY 10573 ' (914)939-0668 �e . 0V ##:P###*###*#********i.•*:t**•k*#***•k********'ki'*tk'Rtk'r#'k7k'�'f!'P'k#*****#***#********##tF*******************F**#***# 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 SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YOLLR��K,COUNTY OF WESTCHESTER ) as: [ 1 ( 1()e , residing at, (Print name) (Address where 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; {`fC71 , Rye Brook,NY. (Job Addre,.) 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. /,7 ) 0(14 R/' (Signature of P pert",Ownerlsy) (Pnnt\ e l Praperty Owner(s)) Sworn to before me this Z �" C!-1R3STOPHER J.6F#ADBUE�Y day of `]�"'Y''\] _ , 20 Hutary Pubs ic,State Of New York No.01 BR6159985 Qualified in Westchester County \ n r� Puhli�I commission Expires January 29,20 .!- (2) 6!1/2024 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. ST TE OF NEW PORK, OUNTY OF WESTCHESTER ) as: `M( OF_I C1 0 1)aV a(fie_ ,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 legal owner of the property to which this application pertains, or that (s)he is the ? C?rd K R 0 C" for the legal owner and is duly authorized to make and file this application. ('indica(e 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 z3 Swom to before me this a-0 day of , 20!�C_ a o 20_!�_L Signatu o. petlyOwner ureo pplicant MCI a.v' �►�t5 �� C �C7 1 �w��;�C Print Name of Property droner Print Narne of Applicant Notary Public Nota lic C STOPNERJ.BRApBURY Notary Public,State of New York No.41 aR6159985 ©ery Emnnusi poallfietk in Westchester County Notary Pubisc,State of New Ynrk No. 047019 Commission Expires January 29,20 QvtiliNgd In Nassau County Comrnisslon Expires March 30, 20 2'7 (4) 61112©24