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f { BUILDING.DEPARTMENT L f
VILLA&OF RYE' WOK S�P - 8 ZQ22 `-�
938 KING §TT4ET RYE]36ok,NY 10573
�\ -p668 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLt :
Approval Date: $gyp _ �� e it#/`�/`� � Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman: /
t
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee b Permit Fees:
p ROOF PERMIT APPLICATION
Application dated: 1c —'D4 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: SBL: t W-1 /^7
Zone:/Q
Property Owner: Address:8
Phone#: 6J 2- 51 S Cell#: p emai
2. Applicant: A i FW `C- Address: 1
Phone#: �j El? �S Cell#: 'J`J 1-1 /►1rq
3. Roofing Contractor: Sc t dress I v' "
Phone#: 5 ' - � Cell#; S' 2 email i
4. Job Description,list all Methods&Materials: -Y e_.GL ~
r1ef-
it -
l I cesin i c1d 4 LkMe — 9_e
5. Estimated Cost of Job: $ 3 Z. 4pu' 66 (,NO I E: I he estimated cost II include all site
nupm��m�nt�. L�In�r. nt;aerial oklin�. �i�r�i c�luih:una. nvoiL,„io'",al t"c,,and material and latx)r"hich ma,, he donated gr ii,.1
6. If comer property,indicate street frontage:
7. Construction Type: NYS Construction Class:
8. Number of stories: Height:
9. Is garage being re-roofed:No:( )•Yes:( )Attached No: ( )•Yes:O( Number of Cars: �L-
10. Is roof peaked,hip,mansard,flat,etc:
11. Estimated date of completion: ft
0(6(U_ Uri ilayra-
MW{ t'6 rant �-
&122021
09/25/2022 THU 11! 19 FAX I
1
of the
plea
se note that this application must Include the n therspaceip provided below.
legal owners) of the above-menttoned prop® ownees notarized signature(s)
Any application not bearing the lndg wprill breturned to the applicant.
shalt be deemed null and void, a
....arura,ru.ar�Y •
,NaAa,,a arrYr„aarwNaAla,r Ya uYrY�*a YraY,aYHr,rap,Haaa►rY.r Y.Ya.Ya.a,,,r rY,♦,rr►
UN 4LEST6R ? 11wt.above named,
ST�NEW ���duly sworn,deposes end elates that he/she Is the apD
' (pll�l�amaorindtvidurl�ignl.�+e °f�PI�.Gn�i1the propertyto whleh this application �rtMns, 0[ that (cNtG IA 111e
and (hither a s that )he is the legal ovrnar offortha cif
al owner and is duly attth062ed to make and Pilo this npplic a^•
and bolief,and that arty work performed,or use
(IndtcatV WthlWa QuIl"Wo�,gapl I.at�Tb7•ale) st()fhjs1heT IlWIOn
That all ntntetnerits contained herein am true tl>dsill be tbo onft7rman ckw4h the desalts ea eat forth and contained in this epp
e uniform Fire
conducted at the above captiancd ProPCI'tY With
ved plans and speciftcatlocis,as well as in aecordanli +WS,ordinances and regulecluns
and In any acaornpanying appro P
prevention$o BuildlnQ Code,the�Od°oe�0 Village of Rye Brook and ell other applicable
5.yh Sworn to before+toe tt+lA
Swrnn to before me thts day of ,20-1�
�of d 20 Z2
? naturo of Applicant
gig o o party O ner
priq Name of Appli
Print Name of Property Own
° Public
N Ic
KEISHA 4AO0 N1ptRTlN � 'inootatrr
NOTARY PUBLIC,8TATE OF MfiW YORK
RepleMon No,OIMAS376089
(ass Ned In Bronx County Vccaar awasr. a?
Conwim"on Expkee,luly 16,2028
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