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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK D t� U�I,` ,
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 MAY ' 2 2023
'wVm%ryebrook.orQ
VILLAGE OF RYE BROOK
i BUILDIN(-,
FOR OFFICE USE ONLY: l2 7
A roval Date: erm # of !pp MAY 1 � � Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: ase# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee Permit Fees:
APPLICATION TO INSTALL PHOTOVOLTAIC SOLAR ARRAY
Application dated: v is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
installation of Photovoltaic Solar Arrayas per detailed statement described below.
� S
�LZ- L- 1jj t�,' ��,1� BL: s? 12— Zone:1. Job Address:
2 Type,kW&Location of Array, (use additional sheets if necessary): 3!so
bKW
GcA--:—If —mcwLaLeroh- err 1 1
77 0K P o Salt
3.Property Owner: t7 A dress: L tw
Phone# Ce # e-mail CUNj
4.Applicant: kU r ft;=vkAL acaoQ Address:c10pw t,Iyrf'ue a.,R�&kawl'a(o;s�3
Phone# 2-9 Cell# e-mail a$On tt
5. Design Eng r: 5�`? 1N 1� Address:2822.Ca:? b o 3oc ( .
' iU
Phone# -�� Cell# e-mail lacmikaris. mid "`67
6. Solar Contractor: +?C f 1�1 (2&AJ]24�a1M) Address:
'�J y L45�3
Phone# , 1 I�i\J. -a z-9 Cell# e-mail f1 i ,I(1,SQ1 l e�
7. Occupancy;(�1-Fam-2-Fam.,Commercial.,etc...)Pre-construction: ` ~l }1 Post-construction:
[gym
8. If building is located on a comer lot,whi�4L
street does it front on:
9. N.Y. State Construction Classification: ''K, N.Y.State Use Classification:
10. Construction Type&Location: O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT];
O Pre-e a ed w d[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR] tier:
��v
11. Number of stories: 2W Roof Style: (hip,shed,mansard,etc...)
12. Will a New Roof Be Installed: No?Yes ❑ (a separate roofing permit is required to re-roof an existing building)
13. Roofing Material&Number of Layers: Eg 1V3 r 2 L�[�,�� -
1
8/12/2021
14. Will the proposed project disturb 400 sq. ft.or more of land,or create 400 sq. ft.or more of impervious coverage requiring a
Stormwater Management Control Permit as per§217 of Village Code? No:P 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:V (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:11 Yes: ❑
(If yes,applicant must submit a Tree Removal Permit Application)
17. Does the proposed project involve a Horne-Occupation as per§250-38 of Village Code? No: es: ❑
Indicate:TIER I:_TIER II:_TIER III:_ (if yes,a H me occupati/on�Permit Application is required)
LY 18. What is the total estimated cost of construction: $ t 0 V
(Note:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and
labor which may be donated gr tis.If the final cost exceeds the estimated cost,an additional fee will be required prior o issuance of the CIO).
19. Start Date: V (�� �—� Completion Date: Z Z
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 non-refundable.
STATE OF NEW�Y-{�ORK,COUNTY OF
OF WESTCHESTER ) as:
I, 1C'1'1�S 1"FT' �GLSE�a-1 ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further staters that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the,
T 1 bCtJF for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,ant,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 me this
day of h 20 2 3 day of efore 20�
Notary Public Notary Public
Sigdature of Property Owner Signature fApp scant
Print Name of Property Owner Print Name of Applicant �
EWL
N6tsry P bI XSIRONew York
EMILY QUfROA
Wled in !ronx 27
Co E 4r6public-State of Now York
Q�nlifled in Bronx County 2 MIL No.01QU6350827
My Camtnlselon Expires 1112112fto Notary PubblMl,ipe illfled In 11ronx County
Qual t1"ii��4>l%1@tt 1lr�kre:t11216iole
t,t1 Commialr �6
8/12/2021