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BUILDIIZ- f R.TMENT D
V11
E OF RYE BROOK SEP 16 2022
938 YONG ET RYE BROOK,NY 10573
t. 14)939-0668 VILLAGE OF RY1= BROOD
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date: SEP 2 0 ermit#Wc=-)6>�/0 / Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other: :
Application Fee b Permit Fees:
ROOF PERMIT APPLICATION
Application dated: qj ` 2--,2 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: s SBL: 1�o,7,5—' 6, RZo'ne Q-F
_
Property Owner: ���1 iLLh Address: SC �f 1CX �.0�1 T�y
RUQ
Phone#: R(La Q cell#: email 1/D�f� ► 3 J(�,(71d�1 l+Cm
2. Applicant: Address:�(n ISO n(A�Q )c
Phone#:q ILl aq y'e 9 9 Cell#: 01?3 email: Q !G tj G 4 i/ �D✓1
3. Roofing Contractor: Q U- P U-�, c '—vt (V oXddress: el S e-'-'-Wc•-t
-Ebaue.#:OeQ k/ /00 MQV'> J97 Cell#: )q -S7rrS-- `f3;-D email:
4. Job Description,list all Methods&Materials ,-�ZC3.�
5. Estimated Cost of Job:$ too (NOTE,:The estimated cost shall include all site
improvement. labor.material.scaffolding,fixed equipment,profAXon-5TTees,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: c�2 Height:
9. Is garage being re-roofed:No: •Yes: ( )Attached No:( )•Yes:{ )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc:
11. Estimated date of completion:
4-
8l1212021
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.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,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 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 Sworn to before me this
day of , 20 day of (}� , 20 a�Z
i
tgnature of Pro Owner ASiggnat�= Applicant
nn
L[ t a r� �h Lt. I A f?( ck
Print Name of Property OwnerPrint Name of Applicant
d&,O� C�1�
Notary Public Notary Public
ILEANA CORDOVA
NOTARY PUBLIC,STATE OF NEW YORK ILEANA CORDOVA
Registration No.OIC06424575 NOTARY PUBLIC,STATE OF NEW YORK
Qualified in PCTTNAM County Registration No. O1 CO6424575
Commission Expires NOVEMBER 01,20k2 'Qualified in PUTNAM County
Commission Expires NOVEM13ER 01.20,24
-2-
8112/2021