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BUILD MENT
VI ' �E OF RY OK 3 1 MAR 13 2024
438 KING ET RYE BR I 14573
-� VILLAGE OF RYE BROOK
_p RUIMNG DEPARTMENT
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FOR OFFICE USE NLY\r-►
ll�*,,r�
Approval Date: `� P rmit# l- cf q Application#
Approval Signature: V1 ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# : Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: )'V 66-9 Permit Fees:
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. q
1. Job Address: k�Y1 Zra-L L SBL: /ol/ �'7 P/t � Zone: —�
Property Owner: OdU--tr) C@.N �� Address: u1 go(kIVltLdytV T-mcl � 'CW&-U1)OLV 16�-)�
Phone#: MI 9 0-1 8 j)d Cell#: email: Ca M 060 /e oma?l I.At t
2. Applicant: -PQ 1 h I VP 1ILIyU F L L.L. Address:_�� C'L 11t/.Y �4 d(.M art*i(t , W iuvo
Phone#: n I LI 3/ Cell#: 611 L4 )Li 'J(,b ( email: L i h (.C'm It
3. Roofing Contractor:) 4t 1't wzl o 111� Address: r 1�4LW 610 KI41U
Phone#:qlu )c17 Cell#: _� ? ]LA[►t/ email: &'j, �1 �`NL1oNZlYIQ{�xj .
4. Job Description,list all Methods&Materials:
ro mjlA i' ne V#j
nL) tW-9VJ - "M,41�7 a s id
5. Estimated Cost of Job: $ 01 C, /TU. VO (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: AJr/4
7. Construction Type: '` T4,U11 l NYS Construction Class: ALAI]lKQYtW
8. Number of stories: �)!-`��L�2I Height:
9. Is garage being re-roofed:No:( )•Yes:0e)Attached No:( )•Yes:V)Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: petq et
11. Estimated date of completion: LodelpusT
4-
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.
STA�E OF NEW YORK,COUNTY OF WESTCHESTER ) as:
e rr ✓�.f rum. ,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
�.ry.\ Z4 b t- 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 2- Sworn to before me this
day ofl?i'�lrl f 20� day�o r�lt�r� , 201
Z - -1.
Signature of Property 6wnor�r ��% tg�P ! yZV�L� 4 11/ft, Si ature of Applicant
�6FNEWYORK y _ � �i�STATE��� '
j/PfAAY PUBLIC �OF NEW YORK� � Ja- t ,Lf- ,�
P •n N of rope* ero1P 7502 i� y = NOT�RYFUBLIC i plicant
-ri�\, = 7+;10Wrwimwn,:r.am comrn
S
otary is '�i,�S�Gx'FXL'; �``�N tary P blic
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