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� E RTMENT D ��
V1lt OF RYE BROOK
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938 KING S ET RYE BROOK,NY 10573
(914)93 14)939-5801 FEB 2 S 2013
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VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY: `]
Approval Date: JUN 7 Z P mit # ( : Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: ase# : Chairman:
PB Approval Date: Case# Secretary.
ZBA Approval Date: Case#
Other:
Application Fee: Permit Fees:
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: 3 6 A 0-n 1� I A L Pl r JkL 12- l k l31ZCLIZ— 1 ti y I D5I 3
2. Parcel ID#: I Z"1. Z5 " I I • 3 Zone:
3. Proposed Improvement(Describe in detail): ►J k t7 0 fJ��i p I r �'� `s t�1 j�iL 1�1�l�1 I i 4 r T 1�1 C✓lkJb
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4. Property Owner: S ( 2yi-L 82CDy. Ppiz J ke-S L► CC_-
Address: V itIZJWV Alll {LP B INIkepi0,i ILt iAL. DW S� 4 tLgkt i3eLDL� lvq IOSB
Phone# ,(lot 12'A -5bf � Cell# "ll i 2Z4 -.SD51� e-mailJDltO�GlSl�ll%AQTf�t� U�,CILYII
List All Other Properties Owned in Rye Brook: IN U t K—
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
(I)
12.8.16
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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 NYCRR
To: The Building Inspector of the Village of Rye Brook.
From: BV_I o r.S C�lc rzk—
Subject PropgM: 3 Gardenia Lane SBL:129.25-1-1.3 Zone: PUD
Please take notice that the subject; CfOne or Two Family; ❑ Commercial.
CENew Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure
to be constructed or performed at the subject property will utilize;
d Truss Type Construction(TT)
D'Pre-Engineered Wood Construction (PW)
❑ Timber Construction(TC)
in the following location(s);
❑ Floor Framing, including Girders & Beams(F)
❑ Roof Framing (R)
eFloor 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§ti64 for Commercial Buildings,
and NYCRR§riz65 for One & Two Family Dwellings.
[rate Iks Pr unal
Datc Pr et
[)ate _ ti.,tan Public
TRISHA MARiiNEZ
NOTARY PUBLIC-STATE OF NEW YORK
No. GIMA6331843
Qualified In Dutchess County
My Commission Expires October 19, 2019