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BUILDI '- MENT
VILLAGE OF RYE OK MAR 13 2€124
938 KING 9TP& T RYE BR �€ NY 10573
-0 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE O. LY:
Approval Date: ` Permit# vV ; Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee4loc>A Permit Fees:
ROOF PERMIT APPLICATION
Application dated: 3/9/2024 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: 9 Charles Lane, Rye Brook, NY, 10573 SBL: 135.41 -1- 36 Zone: R15
Property Owner: Edwin & Stacy Gonzalez Address:
Phone#: Cell k (917)670 8714 email: skgl231@gmail.com
2. Applicant. Edwin Gonzalez Address:
Phone#: Cell#: (917)670 8714 email:
3. Roofing Contractor: John Clark/J.C. Home Improvemenkddress, 151 Cardinal Circle,Torrington, CT, 06790
Phone#: Cell#: 914-906-4121 —email: Jehome26@aol.com
4. Job Description,list all Methods&Materials: Roof Replacement
5. Estimated Cost of Job:$ 18,000
(NOTE: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,indicate street frontage: N/A
7. Construction Type: NYS Construction Class:
8. Number of stories: Two Height:
9. is garage being re-roofed:No:(X)•Yes:( )Attached No:( )•Yes:( )Number of Cars:
Ill. Is roof peaked,hip,mansard,flat,etc: peaked
11. Estimated date of completion:
10/30/2023
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:
,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/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 before /me this
day of 3 � � , 20_Z4L day of I r ( ,20—[4.�,6�� ��_ e/A
Z
Signature of Property Owner Signature of Applicant
!! R
Print Name of Prope Owner Print Name of Applicant
�.
AA
Notary Public Notary Public
SCOTT W.CRAIG SCOTT W.CRAIG
Notary Public of New York Notary Public of New York
REG NO. 01CR6390567 REG NO. 01CR6390567
COMMISSION EXPIRES O4/15/2027 COMMISSION EXPIRES O411512027
-2-
10130/2023