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BUILDIlS#�ARTMENT JUL _ 202
VILLAd,E OF RYF. BROOK
938 KING ST ' FT RYE BRcaolc NY 10573 VILLAGE OF RYE BROOK
4)9 {
{9139-5801 BUILDING DEPARTMENT
k�f 7
FOR OFFICE USE ONLY:
.Approval Date: JUL ~1 7 2�1 N mi itx'd 30 Application #
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other: rr__
Application Fee: " b Permit Fees:
-`1-7141
ROOF PERMIT APPLICATION
Application dated: 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: 1-34 Louis Court SBL: 141.43-1-27 Zone: R2F-2FAM
2. Property Owner: Grant Street Senior Housing,LP Address:25 South Regent St,PCNY Phone#:914-396-9606
3. Cell#: email: LouLazz@aol.com
4. Applicant: Louis Larizza Address:25 South Regent Street,PCNY Phone#:914-396-9606
5. Cell#: email: LouLazz@aol.com
6. Roofing Contractor: Pawling Holdings,LLC_Address:25 South Regent Street,Port Chester,NY
7. Phone#:914-396-9606 Cell#: email:LouLazz@aol.com
8. Job Description, list all Methods&Materials:Repair and installation of 30 year architectural shingles on roof
9. Estimated Cost of Job:$ --'/0, 00 Q — (NOTE:The estimated cost shall include all site
impro%ements,labor,material,scaffolding,fixed equipment.professional fees,and material and labor which may be donated gratis.)
10. If corner property,indicate street frontage:
11. Construction Type: Residential NYS Construction Class:
12. Number of stories: 2-1l2 Height:28'to peak
13. Is garage being re-roofed:No: ( )•Yes: ( )Attached No: ( ) •Yes: ( }Number of Cars: No Garage
14. Is roof peaked,hip,mansard,fat,etc: Peaked
15. Estimated date of completion:
-t-
61112020
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:
Louis Larizza,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 Contractor 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 t this ) Sworn to before me this ll�
day of , 20 a/ day of 20
i
Signaaf Prope O ner Signatur f App ica tLouiizza Louis izza
Grant Street Senior Housing LP Managi Member
Print Name of Property Owner Print Name of Applicant
Notary Public
Notary P iic
HOPE B. VESPIA
Notary Public, State of New York HOPE B.VESPIA
No. OIVE5084028 Notary Public, State of New York
Qualified in Westchester Count No. Of VE5084028
Commission Expires August 25,20 ' Qualified in Westchester County
Commission Expires August 25,2VZ
61112020