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VILLAGE OF RYE BROOK
WESTCHESTER Cour0rY, NEW YORK
No: 24-064
Certificate of ®ccupaucp
'This is to certify that L 0 /U Z-1 in
of, P&I having duly filed an application on
ffiart-44 a7, 20 1:2, q requesting a Certificate of Occupancy for the premises known as,
cif' , Rye Brook,NY, located in a p- 7 Zoning
District and shown on the most current Tax Map as Section: -7 Block: c Lot:
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. %J , issued 19 1 such authority and permission is hereby granted
to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following
New York State Classifications, Use: P-616ne '141 Construction: 1-47.8
for the following purposes: V-ea f K I/ �e� a
Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the
following:
This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises,
building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes
for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from
complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition.
No changes or rearrangement in the structural parts of thp ilding or' e exit facilities shall be made,and no enlargement,
whether by extending on any side or by increasing in ight hall made, r s the building be moved from one location
to another until a permit to accomplish such change h�b4 obtained fro a ilding Inspector.
Building Inspector,Village of Rye Brook: Date: MAY 2 9 2024
--1 (�� i— E-� 0
�� v BUILD yjENT For offi a use onl
PERMIT#
t 2 2U24 VII. !? •.I �IGs OK ISSUED:'�/-3 — 9a
I.l MAR 938 KING STILE $; : YORI{10573 DATE: 3— zD7—aL-J
VILLAG9 O`C FEE:d / I O— PAID).
BUILDIN DEPARTMENT U
UI
APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE,
AND CERTIFICATION OF FINAL COSTS
TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK AND PRIOR TO THE FINAL INSPECTION
ssrrrrsasstrrsrrasrsaasaa•rs«♦rrrsrs«sregrrrr•rr«rrar«rr«♦rant«rtrsssssssr«srtstrsaa.rrssrr•psssrssswtaprrrrs«ssrrrsrtt«t
Address: 2l Ga r� rc,e p 73
Occtpancy/Use: r>7,♦/ Parcel ID#: / 3-5 ro 7-Z—3 Z Zone:
Owner:Lo, o�S�.+�{o �,.���rny —CBZvsT Address:
P.E./R.A.or Contractor: /� Address:
Person in responsible charge: Address:
Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a
Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned hi accordance
with law:
STATE OF NEW YORK,COUNTY OF WESTCHESTER as:
(Print Name of Applicant) being duly sworn,deposes and says that he/she resides at
(No.and Street)
in (City/Town/Village) ,in the County of in the State of ,that
he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements,
labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may
have been donated gratis was:$
for the construction or alteration of: F-Q,ec- \<N: s=A7,f,� Apb-ho,A
Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of
Occupancy!Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in
accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and
as erectedlcompleted complies with the laws governing building consttutction.Deponent fut•ther understands that it shall be unlawful for an
owner to use or permit the use of any building or premises or pail thereof hereafter created,erected,changed,converted or enlarged,wholly
or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building
Inspector as per§250-1 O.A.of the Code of the Village of Rye Brook.
Sworn to before me this 64fk Sworn to before me this
day of rG 20 day of 20
Signature 6rProparty,Owntt
Stgnature of Applicant
fia C- 11�atl
Print Na of Properly Owner Prim Name of Applicant
Notary Nublic
Notary Public
ISTEN RAY
' Notary Public-State of Ftortda
Commission#HH 120753 S/Is021
of F; My Comm.Expires Apr 22,2025
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BUILDING DEPARTMENT MAR 2 8 2024
VILLO fE OF RYE 1016 K VILLAGE OF RYE BROOK
938 KINOST ET RYE B �t NY 10573 BUILDING DEPARTMENT
ww "
PLUMBING PERMIT APPLICATION
I t►R OFF-I( F I ,F ()Nil liP#: 935 �C) 7 PP#: O� /
Approval Date: L�\`\
Permit Fee:S
:approval Signature: Disapproved:
I►O NO I S I %R 111 ORh or(-0NS-rRl'('77ON UNTIL A PF'RN11T HAS BEEN ISSUED BY THE Bull DI\(
IN%Pl.( IOR. 1 HF.AD%IINISTRATI%E FE F.FOR N' )Rh PRO GRFSSFn OR('OMPI FTFD N'frllOtT
11I R�11 l IS 12'.OF TIIF "TOTAL(OST OF (ONSTRUC'TI N WITII A NIINIM1II'M FEE OF$750 00
Wfication dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of
a Permit to install and�or remove Plumbing 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.S
Stt
ate.County and Local Codes.
.gddrcvs. Q Ile v ✓�'�,,e� 9ye POQ4'TJY /(r73 SBL: f_ 1/�i J-�-3a lone:
_.Proposed Work:
3 Property Owner:�T S7' Address: 'I .•,
Phone-7: -- — Cell a:�r�5�—(iG 7'/ �l C
email.
;.MasterPlumber: Q ��( � f• r 1 �l/�/lC'
/�� 4 Ad
� dress•�1 ^�- :�tUo 1`. •t �1 i p,_ w �_
_ Phone a:
Cclla�rlemail: wSj•�
Company Name:P �� Inm
u.'`�'s� � S.r. ( Address: � J n
IND --\ C
ICATF FIXTURE,'& LIN BE,1N E P
Location Water Unnals Drinking Sinks Shower Bath Lau nd Do 2LLQW - I F:
C'loscts Fountains Tubs Tabs ry mastic Fire Sanitary Natural, Other* Total
st floor
Service Service Sce-cr LP Gas
I st Floor `
3"Floor
4"Floor
S"Floor
F.xtcnur
S ' 1_u►Wier I:yutpmcnVPru\ide Details:
( Xk <
(Notarized Signaturea pA4uird
.I-
t/1r2a2 t
tier 11 e►I NI Yt►RK.(YNIN-I l'(►I'WI'ST('Ill'tirl:i( ► as:
bang July sworn,deposes and states that he/she In the applicant above named.
r► w.n.r..r..A..ar.r.y..w��.she a+...M►
:urd ftutlscr .fates fhaf(%)be is else Masler Plumber lot the legal owner and is duly authorized to nuke and file this application.
7lsaf all sfalcnunl.s contained herein are true to The best of his/her knowledge and belief,and that any work performed,or use
conducled of life atfine captioned propcety will he in conformance with the details as set forth end contained in this application
and rn am accomp:Fly fig approved plans and specilicalions,as well as in accordance with the New York State Uniform Fire
Pre%enoon& nuJdmg('rile,die('rife of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Swnrn m hcfnrcm1�e this_p? 7.66 6� �n in���� j
Jay of 20 0IJ-- day of C ,20
Signs tic of f'rrrerty Owner Signature of Applicant
dP-nntNac ofPropcOwner Print Name of Applicant
he o�tar�yv
NNtstarr i .State of New York
No.OIME6160063
y I
Notary Public State of Florlds
Qualified In Westchester County.
Fred* Use Thorpe Commission Expires January 29.200
l My Commission HH 309487
S �rErAplydlilI-a+dnozs opc • completed in its entirety and must include the notarized signature(s) of
lily Ic"'J ()I llic subject property, and the applicant of record in the spaces provided. Applications
nM prf►llcrl.y c-mlpleled in its entirety and/or not properly signed shall be deemed null and void and will be
rrfllrnct! In OIL. appll('allf.
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BUILDING DFPARTMEN"T MAR 2 8 2024
V I LLA(.E OF RYE BROOK I f
938 KIN;STau:FT RYF RRO(1K,NY 10573 ` VILLAGE OF RYE BROOK
„49t4) r-0668 I BUILDING DEPARTMENT
...................................................................................................,....
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 COMPLETLU AND NOTARILED FORM WILL. BC RETURNED TO THE APPLICANT .
STATE
OF NEW YORK.COUNTY OF WESTCHESTER
LPL"�/2S6trYf"o(�tl�n4 Trws?' residing at, (Ro Roxcr�tit���I�cQ� �J-l•hL4n�iv�/ 1o�fa8
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;
-91 ✓a llw T Yrar,--, fZvc ,7�roo ( /u2s Rvc Brook.NY.
Further that all statements contained herein are true,and that to the best of his/her knowledge and belict,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.
C'1. 1 J • ,
Swom to before me this 00h
day o 20 02
Notary Publlo Stato or Florida
F►ods Mae Thorpe
�lll My Commlaalon MH 309407
Expiraa 91612026
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