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BUIL - MENT
VH'I',A 6E OF RYE OK I�OV 2 2022
938 KING \� ET RYE BR NY 10573
-c VILLAGE OF RYE BROOK
_p BUILDING P.�-PARTMENT
�v.
FOR OFFICE USE ONLY:
NOV 2 3 Z 2
Approval Date: Per 't# �; Application#
Approval Signature: MX V ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
SOT Approval Date: Case# : Chairman:
i
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee Permit Fees: 7
\\ 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: Q''7�L L to-COl,.1 f je+sju r SBL: /3571 1 q
Zone:/�� �
Property Owner: HA-q.1C utf C)Cc- 1 Address: )fl - L11/C-0L'.0 gvbr, Q-`lt`.r�°PCA(_J yl
Phone#: "-5Y 7& Cell#: 31) X%_L0 email:
2. Applicant: YEC Address: Ql r K)'A—
Phone#: qf q S''�i ccQa 3 Cell#: email: �.�p�,
3. Roofing Contractor: Address:
Phone#: r~ .5 5 PaAi 3 Am#: 1 6_T email:
4. Job Description,list all Methods&Materials: o\r\ In
e-
5. Estimated Cost of Job: $ gl (NO'1'1,:'The estimated cost shall include all site
improvements,labor,material.scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If corner property,iodic a street frontage:
7. Construction Type: NYS Construction Glass:
8. Number of stories: Height:
9. Is garage being re-roofed:No:O•Yes:( )Attached No:O•Yes:'10 Number of Cars: 'L
10. Is roof peaked,hip,mansard,flat,etc: VVIO _
11. Estimated date of completion: 2 1
8/1212021
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:
1A }-(Z-I,l CAROCZ I ,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/ber 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_Z ad.' Sworn to before me this W
day of AfD r--(- Y? b* , 20-a day of , 20 V,,—f
7-7
�l
Signature of Property er Signature of App 'cant
G U
Print Name� -Property OvVner Print Name of Applicant
Notary Public Notary Aublic
LISA F.GRECO
NOTARY PUBLIC STATE OF NEW YORK
WESTCHESTER COUNTY HOPE 8,VESPIA
LIC.#01GR6089461 Notary Public,State of New York
COMM. EXP.03/24/2023 No.01VE5084028
Quallfied in Westchester Caun
Commission Expires August
_2_
8/12/2021