HomeMy WebLinkAboutRP21-071 - ��������� `�`��s�7.11�L'7l��MJtl �! �•�����I � 171mtl�7L��� lu. �1='����1tl��
e
tA O O W
r- c a Q
�� F CD A
V
wo
oz CwE05i 0 ,2 :3 co
O
�l z � Z o
~ pQ ° w a a a
a
A z U Gw c� oco � o w
z oo o v w
d a
A w a U F" a you cw F"r
'� � Z U w Co Q •a � �
C7 O a � y
pq 0� a W � x � � �° •� �
D WE
BUILDflEPA�tTMENT DEC 16 2021 1 DD
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-Q668 BUILDING DEPARTMENT
war w.r�ook:org.
*****************+*****w#++*w*******+*+**w*+*w**********************++**w+ww+++*+**********+w+wwwwwwwwwwww
FOR OFFICE USE ONLY:
Approval Date: i e u # Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: ase# : Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee:A — Permit Fees:A/a5-- hic
`` ROOF PERMIT APPLICATION
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,.NY,for the issuance of a Permit to
Re-Roof an Existing Building,as per detailed statement described below.
1. Job Address: W WQQ()L,4-Vn SBL: S 7s 9 ZoneA)—F
Property Owner,:r lr Av✓ 2 Address: -J�j L/0 y!�)L g3t p f
Phone#: ��Y 3� 8 -a�►�- Cell#: email: L
2. Applicant: Address: L/36 /�
Phone#:I y l"?/ 2-2 � / Cell#: fir 6 13y email: 6 /4j-;-J
3. Roofmg Contractor: l iSa(` ,d� Ca Address:
Phone#: Cell#: I I �1l/� email:
4. Job Description,list all Methods&Materials: P� ( ,�C Ly"�(�
5. Estimated Cost of Job:$ 7,00 0 C) J (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: NYS Construction Class:
8. Number of stories: Height:
9. Is garage being re-roofed:No: Yes: O Attached No:O•Yes:( )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: tr 1J
11. Estimated date of completion: 2
-1-
811212021
E
f
This application must be properly completed in its entirety and must include the notarized
signature(s) of the legal owner(s) of the subject property, and the applicant of record in the
spaces provided. Any application not properly completed in its entirety and/or not properly
signed shall be deemed null and void and will be returned to the applicant.
Please note that application tees are nonrefundable.
I
I
STATE OF E OK,R CO T OF WESTCHESTER ) as:
being duty sworn, deposes and states that he/she is the applicant above named,
(print nm� i ividuEll signing at 111e appllcam)
and f rjher 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 duty authorized to make and fi to this application.
(indicate architect,conirgetor,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 confor•ntance 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.
By signing this application,the property owner further declares that he/she has inspected the subject property, and that to
the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater
connections or sources of infiltration into the sanitary sewer system on or from the subject property.
fr
Sworn to before❑te this Sworn to before the this I
day of clC , e_f— , 20 c day of,� C 'll
Signature ofProperty owner Signaturo of AP t
Print Name of Property Owner Print Neme of Applicant
otary lie Notary Public x ,
SHARI MELILLO
Notary Public, State of New York
N o. O VMI 6160063
NOTARY F IJGLIc,STATE OF- _t,J YURK j
rtegistralion No.01RRP, `E; Q tan?fied in Westch.:ster County, ,
Qualified in Westchrr !Cvunly Commission Exoires January 29.20�
commission Expires August 27,202 i
i
I
t
I
1
(d)
i
8112=1
I
i
I