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HomeMy WebLinkAboutPP26-017 CN (N M M W = PO N rya r/) _ M a w 00 a U o W r- a _ cn � VS 1�{ Z U E : H o A ur) z d w sx Z z W 09)o00 V Ln Z 87 Fj M r� Ln 3 W C7 v. O s 00 cn G a w a1-4 �+ N 6R { U CY GY U �r x W w w © H a ° H w xa o a �` a w z 04zI w BR BUILDING DEPARTMENT DD VILLAGE OF RYE BROOK FEB 0 2 2M6 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.rycbrookny.gov PIIILDING DEPARTMENT PLUMBING PERMIT APPLICATION 7FOR OFFICE USE ONLY BP#: PP#: i Approval Date: � � Permit Fee: $ ; '� A Approval Signature: 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 WORT{PROGRESSED OR COMPLETED WITHOUT A =emove THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF 750.00 Application dateis hereby made to the Building Inspector of the Village of Aye Brook NY,for the issuance of a Permit to instalng as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: (/s L//,�L / SBL: Zone: 2.Proposed I York:�IeZ, h 4. E i 3.Property Owner:✓/r-d9,6t 1 V Z LM Vx111) Address: yS U y -)P-re Phone#: Cell#: 4�4 ?5:,.; .7��K email:41/ 4.Master Plumber: , e' rMP !� ;. 41- Address: ram, Lic.#:IW-5 Phone#:ql� f; ,+� r 0 '/;W CeII#: /�%� �7 17emai1: /E,l. Tri1Lt Company Name; lL-e //t!.i� gil��U/Cg C+llddress: .� INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural? Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor 31 Floor 4t°Floor 511 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) I- 6/I/2024 S ATE/OF NEW YORKK,COUNTY OF WESTCHESTER ) as: 5,/Gd���� ,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 Master Plumber 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 a this A Sworn to before me this J day of ,20 X E; day of �-t- r� 20 Signature of Property jbwner Signature of Applicant Print Name of Property Owner Print Name of App cant NMA"PUBLICATE OF NEW YORK NOTARR1 PUBLIC,STATE OF NEW YORK PUTNW COUNTY 10.01 MB16W L1C.#41 12 QUALIFIED IN WESTCHESTER COU NTY, COMM.EXP ZZ COM SION EXPIRES iANtJARY 29, is app tca ion 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. Applications 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- 6/1/2024 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 www.r_Vebrookny.gov 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 YORK,COUNTY OF WESTCHESTER ) as: ,✓� V l keA l /��'�' ,residing at, �IJ� �/%rLG�'I" 7?`/4/` '� 401 e (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, 7 2jj �L T�f�" ��•�/#��r P7 /l y /0 j ,Rye Brook,NY. (Job Address) 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 stone 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. (Signature of Property Owners})' (Print Name of Property Owners}) Sworn to before me this L RICHARD SK,IERU day of ,20 NOTARY PUBLIC STATE OF NEW YORK PUTNAM COUNTY UC.#018KM21 (Notary Public) �;.--` COMM.D(P. z. i 7G -3- 6/1/20z4