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SEPARATIE APARTMENT OR
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TAPE IDENTIFICATION SIGN;
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PRIORTOTHEISSUANCEOFA C/O)
AS FEQUiP.ED By Iv°Y STATE LmMyl
BUILDIN. R RTMENT p is LS V L5
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VILLAGE OF RYE BROOK D]
938 KING S*ET RYE BR"NY 10573 OCT 2 2 2019
(914)939- 68 04'4 939-5801
ww N;r a .arm VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
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FOR OFFICE USE ONLY:
Approval Date: MAR 2 5 1020 it# .D ; Application 4
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:
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EXTERIOR BUILDING PERMIT APPLICATION
Application dated: 10/mFiis 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 PR-(Al LANte V /05-7 3 �1•�
2. Parcel ID#: /L 9• Z5—/ _ • 02- Zone:
3. Proposed Improvement(Describe in detail): I-Jkt ) r!rG'/J.S 'GCCT�DI�f �c�//V 6j1L /Y1lL�
A t rAC4 b IOW 4_t_i_1 L,.1tZ M-4-1--1
4. P"Re
rrty Owner: s 4 ,eye 8&44 PAF-TA jC,K' L L
Address:"Z-rA1Y1 �/2!1h� 5 aJr¢Q-/L(lfT�o/�1f1C_ �Q,l��L t eYk (4ytk AJ Y �oS�3
Phone# tl1lf 21*-505l- cell# yi* ZZq 505/o e-mail'J"Ot30is 6v/�B iY/l �4i/1'I
List All Other Properties Owned in Rye Brook: /.`tr L)Af 0"
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
ell
3/21/19
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: 9e-i,AN
Subiect Property: , � 2Y I vYwOS-c L>-�_ SBL: 129.25-1-1.82 Zone: PUD
Please take notice that the subject; ?I One or Two Family; ❑ Commercial,
YNew Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure
to be constructed or performed at the subject property will utilize;
ZI Truss Type Construction(TT)
dPre-Engineered Wood Construction(PW)
❑ Timber Construction (TC)
in the following location(s);
❑ Floor Framing, including Girders& Beams (F)
❑ Roof Framing(R)
C"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 con forma rice with NYCRR§1264 for Commercial Buildings,
and NYCRR§1265 for One&Two Family Dwellin
[)are Design ores
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