HomeMy WebLinkAboutBP26-026 BUILD ENT
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OK FEB 02 2026938 KmcQ IJrtirF Bir Y 10573
.0 8_.1 , VILLAGE OF RYE BROOK
oti, 91 JILDING DEPARTMENT
INTERIOR BUILDING PERMIT APPLICATION
FOR OFFICE USE ONLY: p-, `�
Approval Dale: Ay§ 2 i'crni it : V 2�0 — d�-`� Application Fee:$ -\Ai I C-0 `C� }
Approval Signature: Permit Fees:S Ir r30 W Q
Disapproved: Other:
Application dated: is hereby made to the Building Inspector of the Village of Rve Brook.,NY,for the issuance of a Permit for the
interior alteration of an existing building,or for a change in usc.as per detailed statement described below.
1. Job Address: 1$ f4 i"" A VE_ SBL: 3S-_V0L• e D 70S Zone: _-
2. Proposed Improvement.(Describe in detail);�hIS?q.f.L, 02 LOA1.L•5 l CF WfflC-# -M C4A"
A 2 BE.DaPpm APAAMc aArr RE-Mb✓F- A SIhAL sEGTIPAJ GI uJ, t—
SEWELOL) THE VLCMIS/) A00 1--1VW6R,0VM ELECDOUC/AI, To ems'JIry
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 II: 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.ANSI.System_FM-200 System,Type I Hood,etc...) :No: ; Yes:
(Ifyes. please submit a wlmralc Automatic Dire Suppression tip,<r m Perillit applicati4)n� ? sets ol`deia led engineered platis))
5. Occupancy;(i fain..2 fam.,comet.,etc...)Prior to Construction: Olelrt f3vta ,o A er construction:Z BED1 n7►I
6. N.Y State Construction Classification:_" N.Y.Stat se Classificati t :
E bR009- b t)P k-CAddress: O a ?� SrAll t t VVIVY
�. Property Owner: Y
Phone#9 lit �5'$$Z -q I G6 Cell# 5"?, emai 11Td f
8. Applicant: �.go 1M.oy Pon, aye- rumr..609 f `1-c- !6A"1E Ufa df_
Phone# 914 %V'L' { 14 C, Cell # S A-en 2— p email: 3M ti q 9'T5 @ 6 614)L• ct+rl
9. Architect: MJ06aw P ssa!'}!l _Address: l 1 g &Y Vt scu Ag. hl a r't71w �J Y
Phone# Ia31 141- If I Cell# S"E email:MA0MP 5MP �10
10. Engineer: Address:
Phone# Cell# email:
11. General Contractor:CAh2I E f. AE s' PPO Address:
Phone# Cell# ;z01 �4u- Doq.,r email:
12. Estimated cost of construction $ gOlt -2 M41fA't1014
( RAT. The esliniated cost shall include all laim.malcual.scalt'01din5,_fixed regml,ment.lm,le ,iunal tech,and motet i:i ..I labor„hick ntat be dottated
gratis.)
13. Job Timetable: Start: Finish:
tJIW tk x ^ {1)
6/1/2024
` �c J v
BUIL MENT D
VIL E OF RY DOK
938 KING ET RiT, BR ,NY 10573 � FEB 0 2 2026
-0
W ov VILLAGE OF RYE BROOK
PUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE §216_• STORM SEWERS AND SANITARY SEWERS
THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAI. 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 .
STATF OF NEW YORK, COUNTY OF WESTCHESTER ) as:
f-D4-- R-V& $R0oK.
I. T D Nn1 M94 (&n,otA per, residing at, 100 61- 0 51- C > Y
( rint nanw) (Addr1•+ %+hVrr V0Ll Iire)
being duly sworn,deposes and states that(s)he is the applicant above named, and further states that (s)he is the !IS
legal owner of the property to which this Affidavit of Compliance pertains at;
1 q- J rLa V lr 1ti >�i 1 /2�-bL 1 C)S_1 , Rye Brook, NY.
taoI,Addve )
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.
4�
i`i='M re of ilrore � O n >
zo4t'j N
(Prim Name of I'rolwrt� Owner(,)) � --
Sworn to before me this
day of e C'-�t �� , 20 Cl)
(Notary Public)
SHARI MELILLO
NOTARY PUBLIC,STATE OF NEW YORK
NO,01INE6160063
QUALIFIED#N WESTCHESTER COIJNTY
^U 41S&ON EXPIRES JANUARY 29,20—L7 ( )
6/1/2a2a
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.
STATE OF NF,W YORK,COUN7�() �R
*30 01� Foot C3, g y wa deposes and states that he/she is the applicant above named,
(print name of indi dual 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
for the legal owner and is duly authorized to make and file this application.
(indicate 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.
Swom to before me this Q Sworn to before me this
day of �"�GJ/ 20 � day of 20
Q Ja/1 W1 oe 44 "Of
Firn Ao,6nmr--
signatur Property Chimer Signature of Applicant
1 to of Prop C>•+n r Print Name of Applicant
Notary Public Notary Public
SHARI MRJI10
NOTARY PUKIC,STATE OF NEW YORK
NO,01MEsIsM
QUAUFIEU IN WESTCHESTER COWM
MIiillullSSl%i;*MS 14+RIARY 29,20
t4 1
611J2024