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ID
BUIL 16�4A Q E C E I V IE
VIL E OF RYESOOK
DD
938 KING ET RYE BROOk,NY 10573 MAY - 2024t
939-0668
www. 39-06c.or VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY: ,r�Q /� h
Approval Date.M l 024 P it# C.i Application# rl R �'(,r�9
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date,
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fe Permit Fees:
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: ��/ —�`T 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.
I. JobAddress imn
/ + &bk ,
2. Parcel ID#: /1/r z` / Zone:
3, Proposed Improvement(Describe in detail):� did t-t OLUt -etxi; jLu de k 0,1W-1
ra 4 oo
4. Property Owner: C + ` ,v
Address: k f /,J, l4 � , MY 1 3 LY—_ �/
Phone# 4IJ 6o2 08 Cell# e-mail j oc*�Q,�Qt,r�7�/Lo�11� u
f
List All Other Properties Owned in Rye Brook: A
Applicant:
Address:
Phone# Cell# e-mail
Architect:
Address:
Phone# Cell# e-mail
Engineer:
Address:
Phone# Cell# e-mail
General Contractor: L• S D&4 CL)ld
QZ
Address: �^'
Phone#—4,07 _ 5'971
Cell# e-mail
�YMA, a-61
a)
G/]/2023
5. Occupancy;(1-Fam., -Fam., ommercial.,etc...)Pre-construction: Post-construction: ,
6. Area of lot: Square feet: -Bi-, I — Acres: L
7. Dimensions from proposed building or structure to lot lines: front yard: rear yard:
right side yard: left side yard: other:
S. If building is located on a corner lot,which street does it front on: AA
9. Area of proposed building in square feet: Basement: 11,fl: 21 fl: 311 fl:
10. "Total Square Footage of the proposed new construction: "57.0
11. For additions,total square footage added:Basement: I"fl: 2"d fl: 31 fl:
12. Total Square Footage of the proposed renovation to the existing structure: 320
13. N.Y.State Construction Classification: N.Y,State Use Classification:
14. Number of stories: 2 Overall Height: ?I Median Height: l8
15. Basement to be full,or partial: ,,,,``�� finished or unfinished:
16. What material is the exterior finish: LAXX J
17. Roof style;peaked,hip,mansard,shed,,etc: Twka material:
materia l ilk"
18. What system of heating:B �-
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 1 Hood,etc...) Yes: No: X
(if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineeredplans)
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: X Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: (if 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: x
(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: k
(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:
(if 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 1: TIER 11: TIER III: (if yes,a Home Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property: tti/,Q
29. What is the total estimated cost of construction: S 1% 5M 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 GO.
30. Estimated date of completion: III r2 Af
(2)
611/2023
BUILDING' DEPARTMENT
Vll.LA�q�lF:OF R14F 11 BOOK
938 Ki-s(:$ irET Rl't:13Rt yK,N1' 10573
(014) 39-0as, R D
MAY - 1 2024
►�w r �rw knr N
ALLAGE
• 71Cb AR
1"__ A BROOK
_ rnnB�1T
AFFIDAVIT OF COMPLIANCE �
VILLAGE CODF, §21 G• S-1014M SL•WITS AND SANITARY SF;WF.RS
Tsi■ M71DAVIT MUST BEAR THE NOTARIZED SIGNATURE or THE LEGAL PROPERTY OWNER AND BE SUBMITTED
ALONG WITH ANY RUtLDINO OR PLUMBING PER141T APPLICATION. ANT BUILDING: OR PLUMBING PERMIT
APPLICATION SVINITTED WITROUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETVPONZD TO THE APPLICANT.
STATE OF NEW YORK,COUNTY OF WESTC11ESTER ) as.
J. To 64 1 O ,residing at,-!)a &.� RLr(gt JT
I I'r hit n.unel IAddre„�;hcr tuu li�e)
being duly s%%orn,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;
5Wltif ����� � " . , Rye Brook, NY
f Job AJJns�J
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.
NL:n�ourrr.l I'n�prm Uh�ncrtsll
vrc
rihim".amc��Ll'r��m Uhrrx•rN}11
Sworn to before me this
X:� 11 .20�
i Norm Public!
SHARP MELILLO
Notary Puotit,state of New York
No.01ME6160063
puallfled in Westchester County
mmisslon Expires January 29.2pZ� (6)
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This application must uu P--P-rly vVrllrrWSUU tlr Li.7 OrlllroLr Mr P N. 'OLatu r�cyta lvrvu
Architect or N.Y. State LicensedProfessional 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.
•AfYlRf•••ffl11Af111AA111AlA111f•Ai1RRif•AR11iR•Y11YliiAYf YAAYARAIAAYliRRR►YRRRAYA A1ARf AAAARA1ii1rRAYili�i
STATE OF NEW yOg K,COUNTY OF WESTCHESTER ) as.
I.ul$ 54,gci, CI,� .Or4?I.LL,being duly sworn,deposes and states that he/she is the applicant above named,
I print name of nndtsidual srgning as the aPpbcant)
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.
Iindicate ambnccL contractor,agent,attomc},etc 1
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.
S",om to before me this hv 1 l Sworn to before me this
day of i ,20 c�4 day of 20
Signature of Prope-q O cr Signature of Applicant
J 0 In t �-6,Gww
Print Name of Property OvmLr Print Name of Applicant
'A� V\-I
Notary Public Notary Public
SHARE MELILLO
Notary Public,State of New York
No.OJLME6160063
Qualified In Westchester County
Commission Expires January 29,20�1
181
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