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Bum MENTR I
V E OF RYE' K SAP 19 2022
938 KING ET RYE BR NY 10573
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE QNLh':
SEP 2 0 2 2' � ����Q Application#
Approval Date: Permit 4 pp
Approval Signature: ARCHITECTURAL REVIEW-BOARD:
Di%apprmed: = Date:
BOT Approval Date: Case# Chairm
PB Approval Date: Case# Secre
ZBA Approval Date: Case#
Other:
Application Fee: -lob Permit Fees: �OP
ROOF PERMIT APPLICATION
Application dated: `1 2 Z 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: 19 H o l 1� Lane-, due W td< N q SBL: Zone:
Property Owner: A rN( I e kc Y1 a rA Address: Iq No I ky Lact . !,j e Rr �Go
,,ryry �Y
Phone#: "I �-I---' Lj qq` q+I Cell#: � �y 4ZI+1 email• a V,L VN8
2. Applicant: al.�toOl�t.�f�OC Address: I S ��W 4lf S-F(ee.{-
Phone#: a I q ` S - 5?l(+ Cell#: 19-551- $3(01 email c.tto.5 C0<1` ICgQh Vtti+l co
3. Roofing Contractor: %L d O bar-C 4 Aa Address: 1 EE c�AWLIt �, � '�", W e S� R r ral er t, NJ
Phone#: Cell#: ail: �G�-I�OSCOY�rAI'�t�'1�� '1u�1-1
4. Job Description,list all Methods&Materials: fy-4 S l qA- e- roukinn
L ( r- e 1 11 rLk i +�ra
i ma l I . 2elpliaie aA+ a.
5. Estimated Cost ofJob: $ 2.0t lCt..i • E""0I I.: the cstimatcd co';[shall inciudc all ;itc
I,1b.11. m:.:[Lri.1l. 'cit[01jin '. IIWd Ckiuipment. professional fees.and material and labor N+hich may he donated gratis.)
6. If corner property,indicate street frontage:
7. Construction Type: `` NYS Construction Class:
8. Number of stories: L Height: 12—'Cj,
9. Is garage being re-roofed:No:( )•Yes:0 Attached No:( )•Yes:0 Number of Cars:
10. Is roof peaked,hip,mansard,flat etc: IkG K 6
11. Estimated date of completion: oL W ak k0-," 0, a P_f
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 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:
e( w,p u,cc)f yyk ,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
Co �4—cL t^ for the legal owner and is duty 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 wil I 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 V illage of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this � Sworn to before me this !ft
f c`r. r , 20_2D day of, , 20
Signature of Property Owner gnatur f Ap licant
t Name of Property Owner ftt Name of Applicant
Notary Public Notary Public
SHARI MELILLO SHARI MELILLO
Notary Public,State of New York Notary Public,State of New York
No.OIME6160063
Qualified In Westchester County No.OWestch 0063
Qualified In Westchester County
commission Expires January 29,20� Commission Expires January 29,20—D
-2-
8112/2021