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s BUILDING DEPARTMENT R
ID
938 KING ST l�
g `� 2 2018 VILLAGE OF RYE BROOK
�Ev15Ep EE ET RYE BROOK,NY 10573 JAN 1 9 201$
PLANS (914)939�6 {-914)939-5801
P�` VILLAGE OF RYE BROOK
ww "e[c.or DATED BUILDING DEPARTMENT
' _— -
FOR OFFICE USE ONLY:
Approval Date: AN 1 rmit N ' CJ / Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# : Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other: g
Application Fee: Permit Fees: Z G
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: Z� L A✓4�!D e/L L A^-*.- 4 y/c BACWA�_ N Y /US-73
2. Parcel ID#: 7 2 g1 25- /- /• 12/ Zone:
3. Proposed Improvement(Describe in detail): N/cu) S11,4 L4e IGP�IMLY ^_/T4e"kD
l)w&Lc/&J6 w1-174 RAj,tin-/-kl�r AtiID 6pe,464L_ .
4. Property Owner: S C t/�L /3�OdL 7�q eThlkes LL C
Address: WA-eT/im 41e4-A PF 5 /NTkZA-fA i/aAJAc- 7.),e �C /l y, y�C /3le60-,t Jy /J5 a3
Phone# q 14 2 24-5054r Cell# '?"q 7-7- Y -5054, e-mail_JV U.80/S kUA9JR1r e.eW
List All Other Properties Owned in Rye Brook: /JD/Jk.
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 NYCRR
To: The Building Inspector of the Village of Rye Brook.
From: F32r,atJ Shliti-Li — 110P—PT�k„f TjBSI nJ *01`&Calr74e
Subject Property: 27 Lavender Lane SBL: 129.25-1-1.121Zone: PUD
Please take notice that the subject; One or Two Family; ❑ Commercial,
C' New Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure
to be constructed or performed at the subject property will utilize;
ElTruss Type Construction (TT)
C�Pre-Engineered Wood Construction (PW)
11 Timber Construction (TC)
in the following location(s);
❑ Floor Framing, including Girders & Beams (F)
❑ Roof Framing (R)
d 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.
Due IXcnign Prof n
Datc lInvert
!8 -18
Owe ary Public
TRISHA MARTINEZ
NOTARY PUBLIC-STATE OF NEW YORK
No O1 MA6331 843
Qualified in Dulchess County
My Commission Expaes October 19, 2019