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BUILDING DEPARTMENT FEB - 7 2022
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
..(914)939-0668 BUILDING DEPARTMENT
Eyebroolorg.
FOR OFFICE USE ONLY: 1 11 CAS
Approval Date: _ e mit# ci d" i J.J Application#
Approval Signature: ARCHITECTURAL REVW.W BOARD:
Disapproved: Date:
BOT Approval Date: ase# Chairman:
PB Approval Date: C Secretary:
ZBA Approval Date: Case#
Other:
Application Fee:475—Ab Permit Fw" Cc
ROOF PERMIT APPLICATION
Application dated: Jis hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance f a Permit to
Re-Roof an Existing Bui ding,as per detailed statement described below. r
1. Job Address: o (3o 1RIA) p L ej G6 _SBL: 1411. Zone �/--
Property Owner: �M' '4 VA S a U U Z Address: I t9 5a 04140 PLACJf A!Uo K
Phone#:_9/i/-30S-y _Y _Cell#: email:
2. Applicant:! L tpy�r UJ/VT&C T;�e�-/Address: W2
Phone#: j IS 3O Cell#: q q 03'7q 1 email: rFAle.i �}CC OZt ol
3. Roofing Contractor: QQK* 1r_-fd_5 Address:
Phone#: Cell#: i.
4. Job Description,list all Methods&Materials:
't (rule g �;' D t y
S. Estimated Cost of Job:S l
� a2 � (NOTE:The estimated cost shall include all si
improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated atis.)
6. If corner property,indicate street frontage:
7. Construction Type: NYS Construction Class:
8. Number of stories Height: 7
9. Is garage being re-roofed:No: •Yes:( )Attache No:( )•Yes:("_)Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: " �,G(ri'�
11. Estimated date of completion: '7
811212021
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 b low,
Any application not bearing the legal property owner's notarized signatu e(s)
shall be deemed null and void, and will be returned to the applicant.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
(print name of individual signing as the applicant) being duly sworn,deposes and states that he/she is the applicant able named,
and fitrther states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
(indicate architect,contractor,agent,attozney,etc.) for the legal owner and is duly authorized to make and file this application.
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work perfo ed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in thi application
and in any accompanying approved plans and specifications,as well as in accordance with the New York State L niform 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 l_ZZ19wom to before me this
day o ,20 day of 20 Z�-
ignature of Property O er :/ Si o A cant
Tint Name of Property Owner t Name of Applicant
otary Pub
ublic
CAROLYN MARIE CANNISTRARC JOHN DIONISI
Notary Public-Stale of New York Notary Public State of Ne York
No.01CA6177080 Qualified - Westchester County
Qualified in Westchester County # OI DI4804045 Exp. 9/ 0/22
My Commission Expires Nov.5,2023
-2-
8/1712021