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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK -D
938 KING STREET RYE BROOK,NY 10573
(9 4)&9-0668 LJUL 1 2022
W roo c.or
`- —f VILLAGE OF RYE= BRC
FOR OFFICE USE ONLY: (y�
Approval Date: SEP 2 2 201 rmit# �� 3 Application# 5 7& a
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# : Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case# �
Other:
Application Fee: Permit Fees: Z
APPLICATION TO INSTALL PHOTOVOLTAIC SOLAR ARRAY
Application dated: / 'r�1 ' _is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
installation of a Photovoltaic Solar Array as per detailed statement described below.
l. Job Address: E till�c�ne�.E�o (ZA. SBL: 115• aw— LL 3�'z �Q5
(Zone:
2 Type,kW&Location of Array, (use additional sheets if necessary): � U a, Q . (J
1 S a la,r -
I , �'l
3.Property Owner:�rfz�GY 1 Address:c�� C q{05
Phone#M 14' II -_M'5' Cell# e-mail ,
4.Applicant:1,pal4U Y()G- Address: 3 fod 1/1os;�
Phone# Cell
11#����� 'p3(Q U e-mai]Mi L,qV I nA Dv�?,i Orr
5. Design Engi
neer: �](Wn Address• .ID .J f �n� i 5UQ (A
W.Phone# �� I�� T Cell
# a-mail j(�T(1(��A VI Qi 1Q 1(I Q QfS.CO►Y7
6. Solar Contractor: f a_- I Address:WEW„)hVZ!?�`[ 1�S(ab'
Phone#M)Lpj` -n(P D Cell# e-mail P11'1�llu.61II'Q
7. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction:
8. If building is located on a corner lot,which street does it front on: ► �. �� r
9. N.Y.State Construction Classification: od N.Y. State Use Classification: -
10. Construction Type&Location: O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT];
O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR]; ther:
eoo-� sbti� /``
11. Number of stories:.- Roof Style: (hip,shed,mansard,etc...)
12. Will a New Roof Be Installed: NoX Yes ❑ (a separate roofing permit is required to re-roof an existing building)
13. Roofing Material&Number of Layers: �S D ►�
8/12/2021
14. Will the proposed project disturb 400 sq.ft. or more of land,or create 400 sq. or more of impervious coverage requiting a
Stormwater Management Control Permit as per§217 of Village Code? No: Yes: ❑ Area:
15. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
No: Yes: ❑ (If yes,applicant must submit a Site Plan Application,&provide detailed drawings)
16. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?No: Yes: ❑
(If yes,applicant must submit a Tree Removal Permit Application) �$
17. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? No: Yes: ❑
Indicate:TIER 1: TIER lI:_TIER III: if yes a IIomc Occupation Pe nit Application is required)
18. What is the total estimated cost of construction: $ 14,6's R •
(Note:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and
labor which may be d/onra�ted ratis.If the final cost exceeds the estimated cost,an additional fee will beJrequired prior to issuance of the CIO).
19. Start Date: -�/ dui pZ p2 Completion Date: I d La.>
This application must bear 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 nonrefundable.
STATE PF NEW YORK,JQPUNTY OF WESTCHESTER ) as:
1, ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of indAridual signing as the applicant)
and further star s that(s)he 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 110 Sworn to before me this I
day of A Od 20 day of
Notary Public Notary Public
6�i�
Igna%e—of Property Owner Signature of Applicant
Print Najak of Property Owner Print Name of Ap licant
N*Ury Public-state of Nsw York Melissa Ann Mitchell
2
NO.01OU6350827 NOTARY PUBLIC,STATE OF NEW YORK
Qualified In Bronx County Registration No.01MI6420346
MY commission Expires 1112ff4" Qualified in Westchester County
Commission Expires August 2,2025
8/12/2021