HomeMy WebLinkAboutMP26-019 BUILD MENT
VIL 71. of RY' OOK J A N 1 Z�26 1
938 KING :I r Ryl B' ,NY 10573
`i I ) -0 VILLAGE GF RYE BRCC;C
oV Pl_sri r?��,u - �,�.�T^�LI�T
APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE
HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT
FOR OFFICE USE ONLY: PERMIT#: JA P _Z (D I�
Approval Date: Al --,I 24 Permit Fee: $ LJ
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$750.00
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 NYS Board form(Form#C105.2 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.
8. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection.
Application dated, 12IW2026 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. -R_Z -i?—�,_S 4:J s" -J" l .
1. Address: 1200 King Street, Rye Brook, NY 10573 SBL: 124.73-1-1 Zone: NIA
2. property Owner: Tom Paine 1 � , a i OaKAddress: 1200 King Street, Rye Brook, NY 10573
Phone#: (516) 524-4541 Cell#: email: Tom.Paine@atriaseniodiving.com
3, Contractor: HVAC Tech Inc. Address: 115 Weyman Avenue, New Rochelle, NY 10805
Phone#: (g 14) 424 0685 Cell#: email: hvactech@ymaii.com
4. Scope of Work:New Installation()o•Replacement( )•Removal( )•Other( ):
5. List Equipment: (3)30-Ton, 100% Outdoor Air Rooftop units. (1)20-Ton 100% Outdoor Air Rooftop unit
(1) 17-1/2 ton, gas-fired, packaged rooftop unit, (1) 12-1/2 ton, gas-fired, packaged rooftop unit,
(2) 25 ton, gas fired, packaged rootop unit.
6. Location of Equipment: Roof
7. Method of Installation/Removal(list all equipment needed to perform job): Rigging using Cranes
L
7/l/2025
I
STATE OF NEW YOM COUNTY 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 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,th Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn t efore me this 1 Sworn to before me this U
day of 20�-� day of 2(
0 61JI-..I "— _DAA.' _.
Signature of Property Owner S e of Applicant
Tom Paine 4 Ornela Shehi
Print N e f Pro a Owner Print Name of Applicant
Notary Public
t % RON FRIEDEN Ousmane Diop
Notary Public-State of New York Notary Public State of New York
No.01FR6206366 Registration No.01D16392371
Qualified in Kngs County Qualified in Westchester County
My Commission Expires May 18,20g
My Commission Expires May 28,2027
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.
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