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V E OF RYE BROOK
938 KMG ET RYE BROOK,NY 10573 JAN 19 20%
(914)9 x(914)939-5801 VILLAGE OF RYE BROOK
wvi ,r okorz BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date: �U6 _ 1 -Permit 4 Application#
Approval Signature: ARCHITECTURAL REVIEW RD:
Disapproved: : Date:
BOT Approval Date: Case#_ Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
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Application Fee: Permit FeesA I 1 , Z k (0
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: 7-3 LAV1e&. i_-*2- LAhf/L l ,eye J32yok- i.JV /425-73
2. Parcel ID#: / 2-y• Z5`/ - / • 11 Zone:
3. Proposed Improvement(Describe indetail): /JkIAJ 00/JSfEUeT147AJ- S/ti(�Lk KAM/LN Ri�Li�I�C��
T7!-tJIGLLltiJ�6 W1�'1 ►C/NiSNIGJ [�pS�/Y1�ctiI�Ati/� Gr/a2/+�j�
4. Property Owner:
Address: lWR2 T/;/YJ 6 .5 I tiJT4z/Jlt?l1) JjAL V e STk //'f Q y� �3,eCOK /`I y lv5�3
Phone# q I if Z Z it-5a5to Cell# C1/H Z 2 4- 505'�e e-mail
L'A�'!
List All Other Properties Owned in Rye Brook:
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)
12.9.16
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 NYCRR
To: The Building Inspector of the Village of Rye Brook.
From: 13e(I►n1 9HU-`c_ — "/_,)49t t J A2C'f-tr
Subject Property: 23 Lavender Lane SBL: 129.25-1-1.117Zone: PUD
Please take notice that the subject; 0/one or Two Family; ❑ Commercial,
dNew Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure
to he constructed or performed at the subject property will utilize;
El"Truss Type Construction (TT)
Cf"Pre-Engineered Wood Construction(PW)
❑ Timber Construction(TC)
in the following location(s);
❑ Floor Framing, including Girders & Beams(F)
❑ Roof Framing(R)
C3'l;loor 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 w(x)d, or timber construction must be posted with a
Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings,
and NYCRR§1z65 for One & Tw•o Family Dwellings.Date Des►gn Prof
1- 1$ -I8
Die
1 - 18 -18
Date Nwary Public
TRISHA MARTINEZ
NOTARY PUBLIC-STATE OF NEW YORK
No. 01 MAb331 843
Qualified In Duichess County
My Commission Expires October 19, 2019