HomeMy WebLinkAboutAbandoned Application MAR 2 8 2022 J05�pH GUGUI�UMO ARCHITECT
6�} 1?OGEC?5 bt?I�
VILLAGE OF RYE BROOK NEW 1?0CHEUUE, NY I0804
BUILDING DEPARTMENT 914-804-1157
J6NYarch@gma!1,com
March 24, 2022
Department of Building
Village Hall
938 King St
Rye Brook, NY 10803
To Mr. Izzo.
On behalf of the owners of 32 Bonwit Rd, Mr. & Mrs. Conrad, we are requesting cancellation of the
current permit application for construction of new Single family dwelling at the aforementioned address.
At this time the owners of the property have decided to hold off on all plans to build at this location.
Please accept this letter as an official cancellation request.
If you have any questions or comments please let me know.
�1
Tha u,
J p glielmo,RA
Building Permit Check List&Zoning Analysis
Address: 3?� 1�c>Nw C—s SBL: 3s, .go l
Zone:�Z t Z Use: 'Z. 1 Const.T e Other.
Submittal Date: -2-
Applicant
Nature of Work
i i nu
ILWO -
Reviews:ZBA: F E 6 1 5 2 0 2 2 PB: BOT: Other.
1�1
OK
( ( ) FEES:Filing. 7S'•4,, BP: C/O: Legalization:
( ) (LyAPP: Dated: ✓ Notarized: ✓ SBL: ✓ Truss I.D. -- Cross Connection: ✓ H.O.A.:
Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening.
( ) ( ) ENVIRO:Long. Short: Fees: N/A:
(✓f ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other.
SURVEY:Dated: t t Z-d C Z C Current: ✓ Archival;- Sealed: ✓ Unacceptable:
PLANS:Date Stamped: ✓ Sealed: ✓ Copies: 7Z Electronic: ✓ Other.
(✓f ( ) License: Workers Comp: Liability Comp.Waiver. Other.
CODE 753#: Dated: N/A:
HIGH-VOLTAGE ELECTRICAL.•Plans: Permit N/A: Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other.
(� ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other.
PLUMBING Plans: Permit: Nat. Gas: LP Gas: N/A/: Other.
(� ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other.
(� ( ) H.V.A.C.: Plans: Permit N/A: Other.
( ) ( ) FUEL TANK:Plans: Permit Fuel Type: Other.
O O 2020 NY State ECCC: N/A: Other.
(vY ( ) Final Survey Final Topo: RA/PE Si offLetter. As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other.
( ) ( ) Other.
(- ARM mtg.date: approval;- notes:
( )ZBA mtg.date: approval;- notes:
( )PB mtg.date: approval• notes:
REQUIRED EXLSTING PROPOSED NOTES
Am. t Z , S -Z -5'-2- — a6
Erg"
Front:
Front 1 -5
adcs- I s' 4 0 7--1
Main Cov: 'i o - fo 1S A,
�Accs.Cov:— l 6,.
Ft.H S • (o`l J L
S .H S • 1 , 6 Ql'
a&. 3637z .5 Z(0& LL.
Tot. 6 6 3'7 s o (0 9 Aj OIL
Fr. 4 o °(o - 'z ,p Iz
P rku' • Z Z dZ
Height/Stories: 30 7- - Z o Z
notes: 10G022-S c- S 3.L—.S EAK
�coti - lo-4S�
Residential Building Permit Fee Work Sheet
Permit#$: Date Issued: SBL: Zone:
Address:
Property Owner&Contact Info:
Job Description:
For all new dwellings and for additions measuring 800 sq. ft. or more made to existing
dwellings, the following fee schedule shall apply: (plus any alteration fees)
Total Sq. Ft. (excluding basements)x $225.00 x $I5.00/$I,000.00
Basement Sq Ft. x $65.00 x $I5.00/$I,000.00
--------------------------------------------------------------------------------------------------------------------
New Construction Sq.Ft. • New Construction Cost • Building Permit Fee
Basement= sq.ft.x$65.00 = $ x$I5.00/$I,000.00= $
Attached Garage= sq. ft.x $225.00 = $ x$I5.00/$I,000.00= $
I"Fl. = sq. ft.x$225.00= $ x $I5.00/$I,000.00= $
2"d Fl. = sq.ft.x$225.00 = $ x$I5.00/$I,000.00= $
V Fl. = sq. ft.x$225.00= $ x$I5.00/$1,000.00= $
4d'Fl. = sq. ft.x $225.00= $ x$I5.00/$I,000.00= $
Total Sq.Ft. = sq. ft. Total Cost= $ Total B.P.Fee= $
Total Amount Paid = $
Total Amount Due= $
Date: Signed:
D IECIM w[E D
BUILDING DEPARTMENT FEB 1 1 2022
VILLAGE OF Rl'F BROOK
0
938 M.NG STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 1 BUILDING DEPARTMENT
w%%«.rvebrook.org
ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS
This form must be completed and signed by the applicant of record and a copy shall be
submitted to the Building Department prior to attending the ARB meeting. Applicants
failing to submit a copy of this check list will be removed from the ARB agenda.
Job Address: C�yN RAJ 11' &A-G> Date of Submission:
Parcel ID#:�35.5() - I - �� ;ZZone:g-
Proposed Improvement(Describe in detail):
i✓Yv I � ( �i1�C��.1✓ �A�1 it.`� APPLICANT CHECK LIST:
.NI UST BE COMPLETED BY THE APPLICANT
-DWeL-I►l g \N 1,0 Z CA-C- 6A--f�AGi The following items must be submitted to the Building
Department by the applicant-no exceptions.
Property Owner:-j-Zt)6A 1'&ixlw 1. (Completed Application
2. (✓)Two(2)sets of sealed plans. tone full size :maximum
t `( ai.owaele plan size=36's 4?"; and one I 1"xl?")
Address: \(� y�wCGAN t--( l;�fl; 3P-gL,-K, N
3. (✓STwo(2)copies of the property survey.
Phone# 4. (✓)Two (2)copies of the proposed site plan.
Applicant appearing before the Board: 5. One electronic/disc copy of the complete
To-sew application materials.
6. (✓)Filing Fee.
Address:(r, '�t✓�(, r� tit l lr�YV I LK ite ,l�`( IU�vf)' 2• ( )Any supporting documentation.
8. ( }HOA approval letter. (;(applicable)
Phone# Lf- 'tk- `ll 9. (✓)Photographs.
Architect/Engineer:k�LTtI 6 u,-6(-i e.M(r Nnitt t�'T 10.( )Samples of finishes/color chart. la sample board or
model may be presented the night of the meeting)
Phone# giK- 630q- 71 5 7
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions& Procedures,and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Sworn to before me this & l L Sworn to before ine this
day of 20 of y a d 20Kmv
- 4- --- �1 d
AA
Sr re o owner Sip a c o
Al Co VCA, Co rl ►�Q�
Prin[ IFroperty oOw � Print N n licant
7,
I---- ,
blic Notary P is
PA?RICIAA W11 III PATRICIA A-RITI
Notary Pub;.;:.Strttr-.of Nr!w`rf>:k Notary Put,6c.State o!NOW lbr K
No.01 R i9Ea;i024 No.01 R l4 t;f AU24
oualified in WesiUte'1[r my oualifiod in West:J c for way
Cortxaussron Expuw Cornaussm Expue s
8/12.2021
:\
EVISED _ BUIL R MENT {� M
R MAR 8 1022 VIL E OF RYE' OK D C IE� "
APPLICATION 938 KING ET RYE BRO ,NY 1OS73
DATED: - FEB 11 2022 DD
0 reQ
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date: Permit# Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapprove : Date:
BOT Appro 1 a e Chairman:
PB Approva Secretary:
ZBA Appro 1 Cas
Other:Application Fees 6 Permit Fees:
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: 24 C 1Z2 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: 32, 'LUON W!T 90& >
2. Parcel ID#: 13,5 1 5-D - t - e�)� I -:::— Zone: ►R-t Z
3. Proposed Improvement(Describe in detail): l.0 -T7A-(Al t-Y pwj/ -U414
W I-ril Z UkTt GAVE 0-
4. Property Owner: L_; )V6 t sJV-D(1 A ro}ieAa>
Address: \(D N\��h�,A L �Ylr r3 RCx��. N y
Phone# Cell# .J�0 e-maifD�CAJN9A'7 0 Fro KILA<,,NCI'
List All Other Properties Owned in Rye Brook: 32- -?:;,0j SYQ tT T_04,�S
Applicant: �O Wi 6l.,I,CA3 6LAXo
Address:-614 KQ&ei(ZS P�<, N>✓W KUG4EUr,'0 N`/ I0�_Y)`�
Phone# Cell# y/q-UU4-71S-7 e-mail �G� N`�c�CC�1n(���V1A1L,Ctl�l
Architect: ��U V} GLk67LA W-&A-Q iPii LAC A-rMCT
Address: Ka-76a6 -12?", New KOGNeU-G, l� ( 10 'I oL4
Phone# 7157 Cell# e-mail'�fWck'TCAn CIMPAL'uA
Engineer:
Address:
Phone# Cell# e-mail
General Contractor:
Address:
Phone# Cell# e-mail
(1)
8/12/2021
5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction:qPui Post-construction: ( f';AM lL`(
6. Area of lot: Square feet: 2 0,y32A Acres: (;),41
7. Dimensions from proposed building or structure to lot lines: front yard: >rj.(7' I/-_rear yard: 700
right side yard: ���d t y- left side yard: ��,Q t��- other: —
8. If building is located on a comer lot,which street does it front on:
9. Area of proposed building in square feet: Basement: I fl: 21 GG 2 d fl: O 3'd fl:
10. Total Square Footage of the proposed new construction: ZGG I 5a V—,-
1 l. For additions,total square footage added:Basement: 1 n fl: — 2"d fl: — 3'd fl:
12. Total Square Footage of the proposed renovation to the existing structure: —
13. N.Y.State Construction Classification: y N.Y.State Use Classification: -SktVA' o-FAN UJ/
14. Number of stories: Overall Height: Z 5 I.'0'f 41- Median Height: 20�-U
15. Basement to be full,or partial: -FULL- , finished or unfinished: �l>•I ISFF�l7
16. What material is the exterior finish: G0I�P051re /.�(P 104
17. Roof style;peaked,hip,mansard,shed,etc: PA44 --D Roofing material:k6?M_ .T 5J4//6j..ES
18. What system of heating: t "7 4 L
19. If private sewage disposal is necessary,approv b c un alth Department must be submitted with this
application.
20. Will the proposed project re 're n at f n n/ tcation to an existing automatic fire
suppression system?(Fire S S 2 od,etc...) Yes: V No:
(f yes,applicant must submit a t c s y e it application&2 sets of detailed engineered plans)
21. Will the proposed project dis r o o land,or create 400 sq.ft.or more of impervious coverage requiring a
Stormwater Management Co of it as per§217 of Village Code? Yes:vL No: Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: %/ (if yes,applicant must submit a Site Plan Application,&provide detailed drawings)
23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No:
(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey)
24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: ✓
(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan)
25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: V/
(ifyes,the area and elevations of thefood plane must be properly depicted on the survey&site plan)
26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No:
(if yes,applicant must submit a Tree Removal Permit Application)
27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No:
Indicate: TIER L TIER If: TIER III: (if yes,a Home Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
v3
29. What is the total estimated cost of construction: S Note:The estimated cost
shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which
may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO.
30. Estimated date of completion: ZoZZ
(2)
8/1 21202 1
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STRI-:eT RYu BROOK.NY 10573
(914)939-0668
RESIDENTIAL LOT AREA COVERAGE
Address: .,32 --FoN tf v c> Section: 135. 6-0 Block: I Lot:
PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-88)
YOUR ZONE AREA IN MAIN ACCESS. DECK
ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX.
CHECK MAX.
R-35 35,000 14% 4% 5%
R-25 25,000 14% 3.5% 4%
R-20 20,000 14% 3.5% 4%
R-15 15,000 16% 3.5% 4%
R-15A 15,000 12% 3.5% 4%
R-12 12,500 17% 4% 4%
R-10 10,000 20% 4.5% 3.5%
R-7 7,500 23% 4.5% 3.5%
R-5 1 5,000 30% 5% 3.5%
R-2F 5,000 30% 5% 3.5%
i Proposed:
1. AREA OF LOT Sq. Ft. 20, 3Z1 Sq. Ft.
2. AREA OF HOUSE
a. Coverage of Maid B i f
(Including Attached Garage or Accessory Building) O Sq. Ft. �0J Sq. Ft.
i
b. Area of 1st Floor Divided By Area of Lot x 100 75 %
3. AREA OF ACCESSORY BUILDING
(Includes Detached Garages, Tool Shed, Playhouses) Sq. Ft. 50 Sq. Ft.
a. Coverage of Accessory Building
Area of Accessory Building Divided By Area of Lot x 100 0,Z % 0.2 %
4. AREA OF DECK 0 Sq. Ft. Sq. Ft.
a. Coverage of Deck F� ° 2�
Area of Deck Divided By Area of Lot x 100 0 /o
I attest to the best of my knowledge and belief,the above information is correct.
Arc hit 's Sign ure
(3)
xnzrzo21
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573
(914)939-0668
IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS
Address: 32 T�bNVJ If RDSection: 135,iy Block: I Lot: orJ- -t- 7--Zone: 9-IZ
IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above
the ground which are comprised of materials through which water cannot readily flow, including, but not limited to
asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court
yards,sports courts,swimming pools,patios,sidewalks,ramps,terraces and driveways.
TOTAL MAXIMUM PERMITTED MAX. PERMITTED
COVERAGE Zoning IMPERVIOUS
LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT
(sq.ft.) For Base Lot For Lot Area YARD(%)
Area(sq.ft.)* Over Base R-35 15
Lot Area(%) R-25 20
0 to 4,000 0 55 R-20 30
4,001 to 6,000 2,200 35
6,001 to 12,000 2 900 R-15 35
12,001 to 16,000 4 0 R-15A 35
16,001 to 20,000 5 0 5 R-12 40
20,001 to 30,000
30,001 to 40,000 R-10 45
40,001 &larger 1 ,2 R-7 40
R-5 30
R2-F 30
*"Base Lot Area"is the minimum end of the lot size
range in the"Lot Area" column
Area of lot: 2- \ sq.ft. Existing Allowed Proposed
Total impervious coverage J0 S .ft. 6,636Sq. ft. 6W Sq.ft.
Front impervious coverage = v % 410 % 2 % -
I attest to the b t of my knowledge and belief,the above information is correct.
tect' Signature
(4)
8 12/2021
dEVBUILDING DEPARTMENT MAR - 8 2022
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 DAT K
(914)939-0668 BUILDING DEPARTMENT
BULK REGULATIONS IN RESIDENTIAL DISTRICTS
Address: �L T22tA1K11- f2D Section: Block: Lot:
MAXIMUM GROSS FLOOR AREA
USE FORMULA: Maximum Gross Floor Area = 4,000 + [ (Lot Area-21,780) x 0.11478421 ]:
a. Allowed = 32.S Sq. Feet Cam''3Z 1 - v Teo)
Lr_• 1451) x 0.t1q9y(42(j
b. Existing = O Sq. Feet r _,G7.y-f�
c. Proposed = 2, (1G( Sq. Feet
HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS
DEFINITION: A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of
the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane
beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the
specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer
windows not covering more than 10%of the entire roof area,shall be p r d t e e etback shall be calculated using
the formula; Height/Setback =X,where X is the a si o o t r r o ing i ict in which a property is located
as specified in Article VIII of Chapter 250. A comp) e v 'o e h s i v st be included on the drawings.
FILL IN YOUR RATIOS:
ZONE EX/ST/NG PROPIDSED )FEQU/RED
FRONT: FRONT: FRONT: .44
R-35 SIDE: SIDE: SIDE: 1.20
FRONT: FRONT: FRONT: .48
R-25 SIDE: SIDE: SIDE: 1.30
FRONT: FRONT: FRONT: .60
R-20 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .60
R f5 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .80
JF-f5A SIDE: SIDE: SIDE: 2.40
FRONT: FRONT: O.C-3 _FRONT: .69
12 SIDE: O SIDE: �_Gpq SIDE: 1.60
FRONT: FRONT: FRONT: .80
/P f0 SIDE: SIDE: SIDE: 2.40
FRONT: FRONT: FRONT: .96
R7 SIDE: SIDE: SIDE: 3.00
FRONT: FRONT: FRONT: 1.20
/P-S SIDE: SIDE: SIDE: 4.00
FRONT: FRONT: FRONT: 1.20
RdF SIDE: SIDE: SIDE: 4.00
1 atte the bigst�If
my knowledge and belief, the above information is correct.
A ct7 's g ature (5)
rc
8/12/2021
CC� � OM�
BUILDING DEPARTMENT R
VILLAGE OF RYE BROOK FEB 11 2022
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 wwwxyebrook.org BUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE &216 • STORM SEWERS AND SANITARY SEWERS
THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED
ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT
APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT .
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
31, �ud I-TK co^m/ J , residing at, (� �oH�Gq..r 1—•�J IQY� Q��,,{��/U y /�0 73
i Nddre�,% here "ou Inc)
being duly sworn, deposes and states that(s)he is the applicant above named,and further states that(s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
Q�NW,-r P , Rye Brook,NY.
Further that all statements contained herein are true,and that to the best of his/her knowledge and belief, that
there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further
that there are no roof drains, sump pumps,or other prohibited stormwater or groundwater connections or sources
of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State,
County and Village Codes.
Cla�itnnnirn
r l>
Sworn to before me this 10
day of , 20
l '
7 ' �7
PATRICIAA.RM
Notary PLUNIC,Slate of Now York
No.0'W 46 32024
ounlifict!it We:';11A c e,K Cowlty
Cornrne;sron txPuu;:_J �I �� . . . I f,1
u /7""�/• 8/1_'/2021
ILLUSTRATION OF HEIGHT / SETBACK RATIO
Setback Line for I /
Maximum Height I /
// I REAR I
a Min
imun
c
Setback Line
tFPOTENTIAL
1
a` Md �220 0 0
u 0 HOUSE L0 ` n 3= 5 a c c
0U ENVELOPE E cc c7Q a a
M I R
L FRONT
Area in which Average
Grade is Measured STREET
Average Grade Along Property Line
at Property Line
LLLVAI ION PLAN
Table R301.2.0) 2020 IRC
CLIMATIC & GEOGRAPHIC DESIGN CRITERIA
FOR RESIDENTIAL DISTRICTS IN RYE BROOK
GROUND- WIND SPEED TOPOGRAPHIC SPECIAL WIND- SEISMIC DESIGN
SNOW LOAD (mph) WINO EFFECTS WIND BOURNE CATAGORY WEATHERING
REGION DEBRIS ZONE
20 psf 115/120 NO NO NO D SEVERE
FROST LINE TERMITE WINTER DESIGN ICE BARRIER FLOOD AIR FREEZING MEAN ANNUAL
DEPTH PROTECTION TEMP. UNOERLAYMENT HAZARDS INDEX TEMP.
REQUIRED REUDIRED
42" YES 15 YES FIRM MAP 1000 52.2
36119CO279F
9/28/07
0a)
8/12/2021
This form must be properly completed & notarized by the Design Professional of
record and the Property Owner. Failure to provide this completed fo
permit application will delay t4 permitting process. D 771E �W I
FEB 11 2022 1 -3D]
Notice of Utilization of Truss Type, Pre-Engineered Wo d,VILLAGE OF RYE BROOK
or Timber Frame Construction. (Title 19 P.ti-t ] 64&, 126-;NYC[ lz) BUILDING DEPARTMENT
To:The Building Inspector of the Village of Rye Brook.
From:_=� C—ta CZ,dXo l+Ctt;[�7'
Subject Pronerry: 2- rr RD _SBL: 1 h,5-0 1-04,?-Zone: ?N-(2..,
Please take notice that the subject; ❑ One or Two Family; ❑Commercial,
PI New Structure
❑Addition to an Existing Structure
❑Rehabilitation to an Existing Structure
to be constructed or performed at the subject property will utilize;
o Truss Type Construction(TT)
rare-Engineered Wood Construction(PW)
❑Timber Construction(TC)
in the following location(s);
door 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 §1264 for Commercial Buildings,
and NYCRR§1265 for One&Two Family Dwellings.
Sworn to fore me this Sworn to before a this
day, of ,20 day f ,?0�
Si tur o er y Owner^ o tur esign Professional
Print Name o roperty O r o
i a Desig rofessional
�1
Notary ublic Cy . ti of P lic
M.TRICIAA,P I T I
Notary^uh!c,S!:ur 0 Ncw lbt K
No.01 RI46U624
oualificd Ill Westrh y•s�•v my
Cornrniss,on EWuos_ , t 11 Regina O'Hare
•/' t'I Notary Public,State of New York
No.01 OH5067784
Qualified in Westchester County_
Commission Expires Oct 28.20 �
This application must be properly completed in its entirety by a N.Y. State Registered
Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where
indicated. It must also 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 fees are non-refundable.
STAT OK NEW YORK,COUNTY OF WESTCHESTER ) as:
1U Ca being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states ``�a_t ( )he is the legal owner of the property to which this application pertains, or that (s)he is the
3� �1u�1� WU 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 confonnance 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.
Sworn to before me this I j V rc 0— Sworn to before me this /01:�L
day of 120 day of , 20 )U
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8/12/2021