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REVISED 8 KiNG ET RYE BR¢ox,NY 10573
PLANS AUG - 4 2011 (914)9 f4)939-5801 EOFR ROOK JUL 13 2017
DATED: e or V;LL/.GE of RYE bhoc;<
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FOR OFFICE USE ONLY: �]
Approval Date: S E P 1 2 2017 Permit#13Q (_1 0� Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# ; Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case# :
Other: h
Application Fee: J' Permit Fees:
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EXTERIOR BUILDING PERMIT APPLICATION
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below.
1. JobAddress: 23 �SUL -LC t AN6_ JOE t12001L-- t NN 105-13
2. Parcel ID#: 12q. 2S-I -I •42- Zone:
3. Proposed Improvement(Describe in detail): A pf-W 6-ONS-ra4j ' Q Ni- S?NUI,E ff9361t_�I A7Tn(- tEl�
Y CLL�)NG 1,4171-t k5ANay►eIvr im\)n 6 �r
4. Prope Owner: 3C, 21 E )3�t D t)X- PJ31CFN151 1 Ll-.
Address: 5 JNTt3ahaar.3+AL- 04,t,Vl; SUTE )14 kyC- PW_0L3x ,wM I OS 73
Phone# 1114 2-2-L1 Si-L56 Cell#Q(14 ZZL4 SDS_� e-mail CvvK
List All Other Properties Owned in Rye Brook: (VO�
Applicant:
Address:
Phone# Cell# e-mail
Architect:
Address:
Phone# Cell# e-mail
Engineer:
Address:
Phone# Cell# e-mail
General Contractor: SC Rye Brook Partners LLC - Jeff DuBois
Address: 5 International Drive Suite 114, Rye Brook, NY 10573
Phone# Cell# 914-224-5056 e-mail
(1)
12.8.16
This form must be properly completed & notarized 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 KYCRR
To: The Building Inspector of the Village of Rye Brook.
From: I3121q-PJ S14uo-- ,516N j`A NI'iEC-T1.�
Subject ProWgy: 23 SLc ke L ivy SBL:lm.Zs i-1. ► 2- Zone: PUD
Please take notice that the subject; R"O' ne or Two Family; ❑ Commercial,
KrNew 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)
C�Pre-Engineered Wood Construction (PW)
❑ Timber Construction (TC)
in the following location(s);
❑ Floor Framing, including Girders & Beams (F)
❑ Roof Framing (R)
P(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§1z64 for Commercial Buildings,
and NYCRR§1265 for One & Two Family Dwellings.
Date Iksign Professional
Da<`1- J3 �� PrON -- e
C 1, 13 ZO)-1
Date -- u He
Michelle Diane 7GimdaNOTARY PUBLIC,STATEReg No.OIG163Qusltf'ied m WestchesMy commissionE.Pir.