HomeMy WebLinkAboutAbandoned Application Building Permit Check List&Zoning Analysis
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Address: SBL:
Zone• "-12 - LSD a Use: Z( a Const.Type: Other. G o 2,�•�s- N TL�� F 12
Submittal Date: S�l of 11( Revisions Submittal D (0 7-Z Z l Z l lL Z
Applicant: l.jrx�
Nature of Work: `�PA-) k
\4 N Q v fZ
Reviews:ZBA: PB: BOT: er.
OK SEP 1
( ( ) FEES:Filing. ZS BP: C/O: Legalization:
( ) (�APP: Dated Notarized. ✓ SBL: ✓Truss I.D. Cross Connection: H.O.A.:
Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening.
( ) (✓f ENVIRO:Long. Short: Fees: 2 S • ' a -f- N/A:
( ) (� SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan er.
( ) (✓f SURVEY:Dated Current Archival:- Sealed: Unacceptable:
( ) (v/PLANS:Date Stamped Sealed. `/ Copies: 2 Electronic: f Other.
(� 0 ) License: Workers Comp: Liability Comp.Waiver. Other.
CODE 753#: Dated N/A:
( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other.
( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery._Other.
( ) ( ) PLUMBING:Plans: Permit: Nat. Gas: LP Gas: N/A/: Other.
( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other.
( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other.
( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other.
O O 2020 NY State ECCC: N/A: Other.
Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. _
(� ( ) Other. O F r--► k "i
(�ARB mtg. date: 2 approval:- J AN 1 ?nPr:
O A mtg.date: approval• Vnotes:
(�mtg.date: 10 21 approval I,h9129. notes:
REQUIRED EXLSTING PROPOSED NOTES
Arm 3 l (P'q O. t S p ,b .f
Circle: l O o I--,• l O J —
Fr n ? S At la l c4Es.
Front: t y d> — _
Front: 72 — �v
Sides: -.> 5- - a>l
&&r. &-,!;-
Main Co v 17 o , o S.S IL D
Accs.Cov
Ft.H Sb: 3
S .H S
Z S4S
Z? �
Ft.Imp: S o t!o•1 ��!',S ��
Par ' . �^
Height/Stories: z
notes:
ti>
Residential Building Permit Fee Work Sheet
Permit#: Date Issued SBL: Zone:
Address:
Property Owner&Contact Info:
Job Description:
For all new dwellings and for additions measuring 800 sq. ft. or more made to existing
dwellings, the following fee schedule shall apply: (plus any alteration fees)
Total Sq. Ft. (excluding basements)x $225.00 x $I5.00/$I,000.00
Basement Sq. Ft. x $65.00 x $I5.00/$I,000.00
--------------------------------------------------------------------------------------------------------------------
New Construction Sq.Ft. • New Construction Cost • $wilding Remit Fee
Basement= sq.ft.x$65.00 = $ x$I5.00/$I,000.00 = $
Attached Garage= sq. E x$225.00= $ x$I5.00/$I,000.00 = $
I,,Fl. = sq. ft.x$225.00= $ x$I5.00/$I,000.00 = $
2°d Fl. = sq. ft.x$225.00=$ x$I5.00/$I,000.00 = $
Y Fl. = sq. ft.x $225.00= $ x$I5.00/$I,000.00 = $
4,1 Fl. = sq. ft.x$225.00= $ x$I5.00/$I,000.00= $
Total Sq.Ft. = sq. ft. Total Cost= $ Total B.P.Fee= $
Total Amount Paid = $
Total Amount Due= $
Date: Signed:
et
BUI4V"'VDP-
7Yb',4HE
VILOOK REVISE
938 KING ,NYNSrF(�,E�P7 2021
DATED_ ooK
BUILDING DEPARTMENT
ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS
This form must be completed and signed by the applicant of record and a copy shall be
submitted to the Building Department prior to attending the ARB meeting. Applicants
failing to submit a copy of this check list will be removed from the ARB agenda.
Job Address:��j }}�,�,�-�'} �e r- rQ Date of Submission:
Parcel ID #: Zone: } Q
Proposed Improvement(Describe in detail):
i4ew or-q- APPLICANT CHECK LIST:
MUST BE COMPLETED BY THE APPLICANT
k�'-Q--Q- U The following items must be submitted to the Building
I kiUtLA-o-o,,.}�,,;,� Department by the applicant-no exceptions.
Property Owner: On&AN, �e� 1. ( mpleted Application
9 2. ( Two(2) sets of sealed plans. (one full size Imaximum
Address: Zj ark �r-1 ve allowable plan size=36"x 42"; and one I I"x 17")
T Phone# 3. ( wo(2) copies of the property survey.
�9 I4� (o?2 �- 21 z? 1
—� 4. ( T o (2) copies of the proposed site plan.
Applicant appearing before the Board: 5. ( One electronic/disc copy of the complete
6. (a plication materials.
ling Fee.
Address: 3 3rnr-Q { ` rt p (L(ra SIC 7. ( )Any supporting documentation.
�Gt i�1 27�73� N4 8. ( ) HOA approval letter. (if applicable)
Phone# 1 9. ( ) Photographs.
Architect/Engineer: Sgrne Mau f-, 10.( ) Samples of finishes/color chart. (a sample board or
model may be presented the night of the meeting)
Phone#
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Sworn to before me this �� Sworn to before me this a�
day of , 20 \ day of trr, , 2014
Signature of Property Owner l /— ignature of Applicant
t Name of Property Owner Pr' t Name of Applicant
Notary Public Notary Public
SHARI MELILLO
Notary Public,State of New York III SHARI MELILLO
No. 01 ME6160063 Notary Public, State of New York
Ouali:ied in Westchester County No. 01 M`6160063
Commission Exoires J tiary 29 20 nuali,`ied in Westchester County
Commission EXnirP.s,,i Saar•/29 20
8/12/2021
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
938 KING STREET, RYE BROOK,NY 10573
(T) 939-0668 (F) 939-5801
ARCHITECTURAL REVIEW BOARD
Wednesday, January 19, 2022
ANNOUNCEMENT: PER THE GOVERNOR'S EXECUTIVE ORDER THIS MEETING WILL BE
HELD VIRTUALLY THROUGH THE ZOOM PLATFORM. THE PUBLIC CAN ACCESS THE
MEETING THROUGH THE FOLLOWING LINK: https://us02web.zoom.us/j/81417970741
OR
BY OPENING ZOOM AND ENTERING THE MEETING ID: 81417970741
NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.#
1 Whippoorwill Rd 5 Ft High Black Aluminum Consent 5663
(Davis) Fence w/Arched Gate - Agenda
Rear Yard.
19 Talcott Road Add Skylight to Roof Line Consent 5664 -
-(Gamboa) in Conjunction With Agenda
Bathroom Renovation
70 Rock Ridge Dr Roof Top Solar Array Consent 5665
(Malik) Agenda
55 South Ridge St Roof Top Solar Array Consent 5666
(Rodriguez) Agenda !
51 Hawthorne Ave Add Driveway Consent 5667
(Miller) (Exterior/Interior Agenda
Alterations)
545 Westchester Refurbish Exterior Steps, 5659
Ave(Castiglia) Railing,New Aluminum
Awning, & Retaining Wall
12 Birch Lane Revision To Prior Approval 5668
(Outdoor Kitchen)
85 Valley Terrace New Egress Window, and 5669
(Krebs) Window Close Up to
Facilitate Basement
Renovations
57 Hillandale Road Amendment To Prior 5670
(Grossberg) Approval
ML NM
MR SE -
JM ✓ SF
AC MI
KC 1�
275 S. Ridge Street Legalize Store Front 5671
(Washington Park Changes
Plaza)
10 Arlington Rd New Single Family 5672
(Gizzo) Dwelling w/Attached 2 Car
Garage
47 Hawthorne Ave New 1 Family Dwelling 5673
(Miller)
ML NM
MR SE
JM SF
AC M
KC
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BUIL MENT Ff DD
VIL E OF RYE rOK938 KING ET RYE BR NY IJDATE
REUI
PLANrSEP 2 0 2021
w o r
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********************************************************************************
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date: Permi Application #
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: e: y 77
BOT Approval Date: Case a
PB Approval Date: / '?r7 oZ Case# e e a
ZBA Approval Date: Case#
Other:
Application Fee: Permit Fees:
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: 9-_a0—a7, is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below.
1. JobAddress: S I � 't' C3 � I"t`Le. Lo Aoj::g) pp
2. Parcel ID#: S — — 3 Zone:
3. Proposed Improvement(Describe in detail): S
e are C LO QA V-P_vJ A-" OZ-t V6-e S7�9-eX-
�IQ�j�jucx.a-e.
4. Property Owner: ly-NCLI?AC Gnb marr� P l ► ��2.
Address: Z q (?Q,(uc_ DR I LA- Sr, ) (Qti O n o
Phone# Cell# q 14k G 7 Z - Z ZI e-mail a i
List All Other Properties Owned in Rye Brook:
Applicant: Q;
Address:
Phone# Cell# e-mail
Architect: v-,
Address: "j'- r-arr.
Phone# Z7 3-- -2 3So Cell#_9 01 S (�Z e-mail � SC cif Ic,ko eGr,,,u.,�
Engineer:
Address:
Phone# Cell# e-mail
General Contractor:
Address:
Phone# Cell# e-mail
(I)
sn 2/2021
5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: I 4:"0,mJ4 Post-construction:
6. Area of lot: Square feet: J. . �p 5L*2e /S�7 o7.L S" Acres: 3 P
7. Dimensions from proposed building or structure to lot lines: front yard: Z b rear olivy&p"'r I A
right side yard: left side yard: other:
8. If building is located on a corner lot,which street does it front on: *_ F] ,
9. Area of proposed building in square feet: Basement: O 1 St fl: 2°d fl: 31 fl:
10. Total Square Footage of the proposed new construction: O
11. For additions,total square footage added: Basement: O 15,fl: 2°d fl: 31 fl:
12. Total Square Footage of the proposed renovation to the existing structure: Z S4 9 5 O 13 r
13. N.Y.State Construction Classification: _V_ N.Y. State Use Classification: 9 -Z
14. Number of stories: 2— Overall Height: n o c�x&y,;at. Median Height: h o C.h ctn ti
15. Basement to be full,or partial: finished or unfinished:
16. What material is the exterior finish:
17. Roof style;peaked,hip,mansard,shed,etc: Roofing material:
18. What system of heating:
19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this
application.
20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire
suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: ✓
(if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
21. 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? Yes: No: 1/ Area: 3 91 •S
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: ✓ No: (f yes,applicant must submit a Site Plan Application,&provide detailed drawings)
23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: ✓
(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey)
24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: ✓
(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan)
25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No:
(f yes, the area and elevations of theflood plane must be properly depicted on the survey&site plan)
26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No:
(ef yes,applicant must submit a Tree Removal Permit Application)
27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No:
Indicate: TIER I: TIER II: TIER III: (f yes, a Home Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
29. What is the total estimated cost of construction: $ /Si OOQ • 0o 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 gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO.
30. Estimated date of completion:
(2)
8/12/2021
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573
(914)939-0668
RESIDENTIAL LOT AREA COVERAGE
Address: 51 �6zx�. Pf" " Section: I �`S".7S Block: I Lot: 23
PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-88)
YOUR ZONE AREA IN MAIN ACCESS. DECK
ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX.
CHECK MAX.
R-35 35,000 14% 4% 5%
R-25 25,000 14% 3.5% 4%
R-20 20,000 14% 3.5% 4%
R-15 15,000 16% 3.5% 4%
R-15A 15,000 12% 3.5% 4%
R-12 12,500 17% 4% 4%
R-10 10,000 20% 4.5% 3.5%
R-7 7,500 23% 4.5% 3.5%
R-5 5,000 30% 5% 3.5%
R-2F 5,000 30% 5% 3.5%
Existing: Proposed:
1. AREA OF LOT 31 0 0 Sq. Ft. Is 767•6S Sq. Ft.
2. AREA OF HOUSE
a. Coverage of Main Building
(Including Attached Garage or Accessory Building) 17 4 G Sq. Ft. 174(e Sq. Ft.
b. Area of 1 sc Floor Divided By Area of Lot x 100 %
3. AREA OF ACCESSORY BUILDING
(Includes Detached Garages, Tool Shed, Playhouses) b Sq. Ft. o Sq. Ft.
a. Coverage of Accessory Building
Area of Accessory Building Divided By Area of Lot x 100 % %
4. AREA OF DECK Sq. Ft. 1 6 4 Sq. Ft.
a. Coverage of Deck
Area of Deck Divided By Area of Lot x 100 % a (o (D %
I attest to the best of my knowledge and belief, the above information is correct.
rchitect's Signa re
(3)
8/12/2021
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573
(914) 939-0668
IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS
Address: S 4LW'e..Section: 1-6Y, -A- Block: I Lot: 8 3 Zone: P—1Sf}
IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above
the ground which are comprised of materials through which water cannot readily flow, including, but not limited to
asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court
yards,sports courts,swimming pools,patios,sidewalks,ramps,terraces and driveways.
TOTAL MAXIMUM PERMITTED MAX. PERMITTED
COVERAGE Zoning IMPERVIOUS
LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT
(sq.ft.) For Base Lot For Lot Area YARD(%)
Area(sq.ft.)* Over Base R-35 15
Lot Area %) R-25 20
0 to 4,000 0 55 R-20 30
4,001 to 6,000 2,200 35
6,001 to 12,000 2,900 27 R-15 35
12,001 to 16,000 4,520 26 R-15A 35
16,001 to 20,000 5,560 25 R-12 40
20,001 to 30,000 6,560 24
30,001 to 40,000 8,960 23 R-10 45
40,001 &larger 11,260 22 R-7 40
R-5 30
R2-F 30
*"Base Lot Area"is the minimum end of the lot size
range in the"Lot Area"column
Area of lot: )S) 7 o1 5 Ax"s .ft. Existin AllowedProposed
Total impervious coverage = Z �� S .ft. 3 S . ft. Z.7 Vp S .ft.
Front impervious coverage = 16 % 3Y % 15.S %
I attest to the best of my knowledge and belief, the above information is correct.
tect's SignatutV
(4)
8/12/2021
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573
(914)939-0668
BULK REGULATIONS IN RESIDENTIAL DISTRICTS
Address: S 4Ct, oaAnA- PfiP, Section: 135. -).S— Block: Lot: 83
MAXIMUM GROSS FLOOR AREA
USE FORMULA: Maximum Gross Floor Area = 4,000 + [ (Lot Area —21,780) x 0.11478421 ]:
a. Allowed = 3 3 OZ- Sq. Feet
b. Existing = ZS' 4 9 Sq. Feet
c. Proposed = Z S-4 `i Sq. Feet
HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS
DEFINITION: A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of
the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane
beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the
specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer
windows not covering more than 10%of the entire roof area, shall be permitted to extend. Height and Setback shall be calculated using
the formula; Height/Setback= X, where X is the required side or front yard ratio for the zoning district in which a property is located
as specified in Article VIII of Chapter 250. A complete elevation view for the proposed improvement must be included on the drawings.
FILL IN YOUR RATIOS:
ZONE EXISTING PROPOSED REOU/RED
FRONT: FRONT: FRONT: .44
R-3S SIDE: SIDE: SIDE: 1.20
FRONT: FRONT: FRONT: .48
R-2S SIDE: SIDE: SIDE: 1.30
FRONT: FRONT: FRONT: .60
/P20 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .60
R-15 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: no FRONT: .80
R fSA SIDE: SIDE: ,, SIDE: 2.40
FRONT: FRONT: FRONT: .69
jr-f2 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .80
R-f0 SIDE: SIDE: SIDE: 2.40
FRONT: FRONT: FRONT: .96
R7 SIDE: SIDE: SIDE: 3.00
FRONT: FRONT: FRONT: 1.20
R--S SIDE: SIDE: SIDE: 4.00
FRONT: FRONT: FRONT: 1.20
R-2F SIDE: SIDE: SIDE: 4.00
1 attest to the best of my knowledge and belief, the above information is correct.
chitect's Sign re (5)
8/12/2021
BUILD MEN REVI
VIL E OF RY OOK PLAN
938 KING ET RYE BR ,NY 1 ��TE SEP 2 0 2021 zD
4 -0 LVILLIAUr- Ur K
BUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS
THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED
ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT
APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT .
STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as:
3J, rr'iaay— a(-y--,s&24 rn tpa , residing at, Z!j tparlL� dDMi ja ,Sow
(Print name (Address where you live)
being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
AyOL , Rye Brook, NY.
(Job Address)
Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that
there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further
that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources
of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State,
County and Village Codes.
(Sid,nature of Property Omvner(s))
V'k
(Print Name of Property Owner(s))
Sworn to before me this
day of , 20
(Notary Public)
SHARI MELILLO
Notary Public, State of New York
No. 01 ME6160063
O ialified in Westchester County (6)
Commission ExnirAs,! iani 29 20�
8/12/2021
This form must be properly completed & notarized by the Design Professional of
record and the Property Owner. Failure to provide this
permit application will delay the permitt rk
PLANS
SEP 20 2021
VILLAGE OF RYE OOK
Notice of Utilization of Truss Type, Pre-Enginee I bbj]EPARTMENT
or Timber Frame Construction.
Title 19 Part 1264 & 1265 NYCRR
To: The Building Inspector of the Village of Rye Brook.
From: S Cyr• (cvAo Z:�SR- �- rt
Subject Property: S-j �6t.n a. a vQ, SBL: 13S.7S— I f43_Zone:f_ — IY44
Please take notice that the subject;5t One or Two Family; ❑ Commercial,
❑ New Structure
❑ Addition to an Existing Structure
❑ Rehabilitation to an Existing Structure �CLI vewlN-�
to be constructed or performed at the subject property will utilize;
❑ Truss Type Construction (TT)
❑ Pre-Engineered Wood Construction (PW)
❑ Timber Construction (TC)
in the following location(s);
❑ Floor Framing, including Girders & Beams (F)
❑ Roof Framing (R)
❑ Floor Framing and Roof Framing (FR)
Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or
building utilizing truss type, pre-engineered wood, or timber construction must be posted with a
Truss Identification Sign, installed in conformance with NYCRR§iz64 for Commercial Buildings,
and NYCRR§ia65 for One & Two Family Dwellings.
Date e P ofe'onal
Date y P r[y Owner
Date Notary Public
(7) SHARI MELILLO
Notary Public,State of New York
No. 01 ME6160063
Duali`ied in Westchester County
Commission Exnires J, -laru 29 20
This application must be properly completed in its entirety by a N.Y. State Registered
Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where
indicated. It must also include 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 YORK,COUNTY OF WESTCHESTER ) as:
7ZZOnr, 6 SCjn,,r 1 coo_-JT1,, Ring 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
�A"enz- 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. By signing this application, the property owner further declares that he/she has inspected the subject
property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or
groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property.
Sworn to before me this C�1' Sworn to before me this �D
day of%,(}�2,N.�r , 20� day of �'- , 20 09
r s-�
Signature of Property Owner ignature of Applicant
6
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
SHARI MEULLO
Notary Public,State of New`OeK SHARI MELILLO
No.01 ME6160063 Notary Public, State of New York
O 1alifled in Westchester County
Commission Exnires i uary 29 2002 No. 01 ME61 G0053
0,lali`ied in Westchester County
Commission Expires,' tangy?a �r �
(8)
8/12/2021