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BULL RTMENT D
VIL dLA E OF RYOROOK
938 KMG *ET RYE BROOK,NY 10573 MAY 3 0 2018
(914)939,,014)939-5801
w' zr ek.o reVILLAGE OF RN'E BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date: ermit# - 3 Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:Application Fee: -1y
Permit Feesl 13 4 (0 4J •z :
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: 21 LAJwr-Ji24r42 t&NJK_ r 24k" 62o0tC. NN IPS33
2. Parcel ID#: I Zvi- Z5 —1 - t 115 Zone: g -V
3. Proposed Improvement(Describe in detail): NK,bU C'a N S'V_u-C 7(U N - S t r J hLd_ jlr�p N11 L-4 A T�pek4-t)
7ww1 �1tiJh w�+N �t�.J�S�t�u� 3p5krnk�lr At-30 41w104,�ti--
4. Property Owner: 5 G fZ 4 k- 32o D k TIP-fZl-t-Jk/L S L P L
Or,
Address: VJA2Jpryl (dp0 kL 1 5 11.!i k/Lr.f� t OnsrtL D2 t t''} f 2y� 13►2CDIL IS`� I05�_3
Phone# q "t Z2-4 -5D5L0 Cell# 1`I 27-4 "505(P e-mail?DK8P(S(w►t2JrRmejQoµe,CDM
List All Other Properties Owned in Rye Brook: N 0 rJ 1 Z--
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: t j �+eCvt �Tk�ilc�'L�
Subject Property: 21 Lavender Lane SBL:129.25-1-1.115Zone: PUD
Please take notice that the subject; 0 One or Two Family; ❑ Commercial,
aNew Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure
to be constructed or performed at the subject property will utilize;
C 1 Truss Type Construction(TT)
❑ Pre-Engineered Wood Construction (PW)
❑ Timber Construction (TC)
in the following location(s);
❑ Floor Framing, including Girders & Beams (F)
❑ Roof Framing(R)
(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§t264 for Commercial Buildings,
and NYCRR§1265 for One & Two Family Dwellings.
Date tksign sessional
s13ojI�
Date PqlSn r
! /- d// Chnstin
D"1C Notary Pubhc,State of New Yorlt
No.01 BM 166307
Qualified in VY mbater County
Commission Expires May 21.10"-
Z () 19