HomeMy WebLinkAboutRP21-063 O
O
C,q a =
o
t5 o p
w W oE (b
rr
a 4)
C c y ocu 9
/■� �n 7� lfi � a `n v� � U .�
>zq
O
Q p
a O �'S. co
OC
O e
W a> �
w Qr
a� N
QO � -00
Q w min - 0
w a a a w� "? a
A W O p ✓, - ° > -
7 � m 0
w W OG d4 E, a o L o ca
= Q U � F U � Oer � a• 3 � '�'
_
O zeMA °
?• .., �, 0j)
W Z C7 op 3
�I a W W � � �° „v
BUIL ry n MENT FnD 1E C LL, Q V i
rL
V E OF RY OK O C T 2 7 2 221 DD
938 KING ET RYE BR NY 10573
®r � VILL-AGE OF .RYE BROOK
BUILDIrvC [)!P:RARTMENT
yty�
FOR OFFICE USE ONLY:
. OCT 2 8 202 /— J�
Approval Date: mEt# �� Q fQ3 Application#
Approval Signature: ARCHITECTURAL REVIEVIN BOARD:
Disapproved: Date: /
BOT Approval Date: IGAC# Chairman:
PB Approval Date: ase# ; Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: Permit Fees:
ROOF PERMIT APPLICATION
Application dated: 101a71,202—( is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Pei mit to
Re-Roof an Existing Building,as per detailed statement described below.
I. Job Address: q J_a-Ja V)I g. :Ad, R-r?. 9F-"a -j NI SBL:/35, ab/-33 Zone:JC—/S
Property Owner: M e-1 v 71 h 44 1 p QX— Address: J-U "+ 10 R�tt 8 r o+J-, is 7
Phone#: 9 1`f-q 3?'e?6 Z t}' Cell#: (b 01 q/ email•►h hKa4 p" ib A?.,. tb wl
2. Applicant: f Poritl4l Address:
Phone#: Cell#: email:
3. Roofing Contractor: %Q'0�t F. tir, C,*M bR Address: /aa 0)004Q1e iK;l
Phone#: 114- 739- &40 Cell#: Q Jy-$Oy--s cg C email:
4. Job Description,list all Methods&Materials:Fc MOVP.*-ME(OLM,oil -Chin i�1(,A F Tint berIk*-- 9,D
5hskSlqA.(Qpj1r XP— COLW ct1rP ed4c..k new 1cQa cleeVe- r—plocQ—
5. Estimated Cost of Job:$J3i (NOTE:The estimated cost shall include all site
improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If corner property,indicate street frontage:
7. Construction Type: 004 4,r%Y►-- NYS Construction Class:
8. Number of stories: t W a Height:
9. Is garage being re-roofed:No:( )•Yes:( )Attached No:{ )•Yes: ( )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: Q-
1 1. Estimated date of completion:
8112l2021
Please note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant.
***R#**#*##*RRR#RRRRRRRR*RRR**RRRRR RRRR*RR**RRRRRR R*R RRRR RR RRR*RRRRR**RRRRRRR RRRRRR*R*#RRRRRRRRR RR*R***R*R
STATE OF NEW YOM COUNTY OF WESTCHESTER ) as:
M ,Z I v 14, f g I P e r ,being duly sworn, deposes and states that he/she is the applicant above named,
(print�dividual signing at the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc.)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this application
and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this an Sworn to before me this
day o 0G -E 20 _ day of , 20
Si attire of Property Owner Signature of Applicant
)� P e iv y h 14 #o
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
SHARI MELILLO
Notary Public, State of New York
No. 01 ML616'10,63
Qualified in Westchester County
Commission Expires January 29,20.1�__l
-2-
8/12/2021