HomeMy WebLinkAboutBP26-025 BUILDI114 R'fMENT
VIL[.AGE OF Ri' OOK DD
938 KING:STREET RYE BR ' ,NY 10573 JAN 3 =jOK
(914 -()
W4+ cv VILLAGE OF
-- -' BUILDING DEPARTMENT
INTERIOR BUILDING PERMIT APPLICATION -'�
FOR OFFICE USE ONLY:
Approval Date: gB 12 & t - 02�Application Fee:S a
Approval Signature: Permit Fees:S
Disapproved: Other: `
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,N for cissUNof1f74itf04e
interior alteration of an existing building,or for a change in use,as per detailed statement described below.. i
1. Job Address: M ' SB `� Zone:
2. Proposed Improvement. (Describe in detail): 91 b s e. ri e �
3. Does the proposed iFprovement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook?
No: Yes: If yes,indicate: TIER I: 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,ANSL System, FM-200 System,Type I Hood,etc...) :No:_,)(.._Yes:
(If yes,please submit a separate Automatic Fire Suppression System Permit application& 2 sets of detailed engineered plans)
5. Occupanc 1 lam)2 fam.,comm.,etc...)Prior to Construction: After Construction:
6. N.Y State Construction Classification: N.Y.State Use Classification:
7. Property Owner: spa. C Q(,i s I " Address: 1 6 ehyLdO
Phone# Cell# " VIT4 /7 Z email: e r- R.Qbler 111M ic ml
8. Applicant:_o u L F TL O?/t C S Address: 4 y LA-1 t0 t0 0 15 V.
Phone# Cell# email:
9. Architect: Address:
Phone# Cell# email:
10. Engineer: Address:
Phone# Cell# email:
it. General Contractor: Address:
Phone# Cell# email:
12. Estimated cost of construction $
MOTE:The estimated cost shall include all labor,maten .scaffolding.fixed equipment,professional fees,and material and labor which may be donated
gratis.)
13. Job Timetable: Start: V Finish:
(t)
6/V2024
BUILDING MPARTMENT
ViL��E oIF RYE aOK
938 KING t:T RYE BR NY 10573
(914) -0'
ov
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:
I, ;r'o 1z 4„ ,! t M b 6/L'S ,residing at, � r�+ /�''��1'� tAJ O 0 Of Q U
(Print name) I. ddre, %'here%ouli�el
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;
�xh IN W o D p� a U , 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 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.
0 C fta GCS
o
1,i.,11 :June of Propem rh%ner(o)
Sworn to before me this 91-.),
day of bol Ir'le, 20
ihotury P _lic �
GREGORY M.R1VE A YORK
NO'r Sy K;aL{C,STATE of
No.OiR%W396
GQoUmAmIJFaSlQN` 3 CH
SEP�� � _
s/v2a2a
This form must be properly completed¬arized by the Design Professional of
record and the Property Owner. Failure to provide this completed form with your
permit application will delay the permitting process.
Notice of Utilization of Truss Type, Pre-Engineered Wood,
or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR)
To:The Building Inspector of the Village of Rye Brook.
From:
Subject Property: SBL: Zone:
Please take notice that the subject;❑ One or Two Family; ❑Commercial,
❑ New Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure
to be constructed or performed at the subject property will utilize;
Truss Type Construction(TT)
❑ Pre-Engineered Wood Construction(PW)
❑Timber Construction(TC)
in the following location(s);
❑ Floor Framing,including Girders& Beams(F)
❑ Roof Framing(R)
❑ Floor Framing and Roof Framing(FR)
Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or
building utilizing truss type, pre-engineered wood, or timber construction must be posted with a
Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings,
and NYCRR§1265 for One&Two Family Dwellings.
Sworn to fore me this Sworn to before me this
day of (ln�JL 20 day of 120
"IL& C F 1Zn5,/tS
Signature of Property Owner Signature of Design Professional
rig i ame of Property O r. Print Name of Design Professional
No ary is Notary Public
GREGORY M. RNERA
NOTARY PUBLIC,STATE OF NEW YORK
NO,OIR164413M
QUALIFIED IN WESTCHESTER COUNY/ (3)
COA# Mi ON EXPIRES Sl PTEMBER 26,20
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 NEW YORK,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 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.
B signing this application, the property owner further declares that he/she has inspected the subject property,and that to
Y g g PP P P h'
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 6 Sworn to before me this
20 day of , 2.0
day•f , Y
ev'.( e R p- a.51 c 5
Signature of Property Owner Signature of Applicant
p d �= Zb S/Crz
Print me of Property Owner Print Name of Applicant
c
tiotary Publ Notary Public
GREGORY M. RKM
NOTARY PUBLIC,STATE OF NEW YORK
NO.01R16441395
QUALIFIED IN WESTCHESTER COUN
COl�rttS;ICXN WIRES�R 26,201
(4)
6/1/2024