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Q Z V z x w w A RW Z rs; ° pd o b BUILD NG DEPARTMENT D LE G JE U U r� VIL ' E OF RYE BROOK JUN 2 5 2024 938 KiNc ET RYE BRO(%,NY 10573 VILLAGE of RYE BROOK �, �$i` BUILDING DEPARTMENT w 'r ov �_-Y� INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: J U L � B P rut , : A litativn Fee: S PP PP Approval Signature: Permit Fees: $ Disapproved: Other: Application dated: is hereby made to the Building Itispectorof the Village of Rye Brook,NY,for the issuance of Pen-nit for tyre interior alteration ofafi existing bui[ding,or for a change in use,as per detailed statement described below. 1. Job.Address:_ 5 Loy r,�1�& Ave dI# L:� � �2 2 Zone: /S� 2. PrCk- h ed Improvement. (Describe in detail): u y 71 kteh(1 J 4+I4'1 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes. indicate: TIER L TIER it: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an exi tin,g automatic lire suppression system(Fire Sprinkler, ANSI_ System, FM-200 System,Type I Flood,etc...) :No: 2r., Yes: (If yes, please submit a separate Automatic Fire Suppression System Permit application&2 set(of detailed engineered plans) 5. Occupancy; l ant.. fam.,Comm.,etc...)Prior to Construction: I ,F'r ly After Construction: I 4 6. N.Y State Construction Classification: f2 D �` N.Y.State Use Classificaa ion: 'S�1 �a;L., 7. Property Owner: r V I d (3OIk Pt r _Address: C0 k �f��I 4 0 � e to a /1/'y Phone# fl y`�71 "77y5- Cell# �/` _ S_71- 779f- email: &(,u G0/d40i LZ Lo ��i/f 8. Applicant: Address: Phone# Cell 4 email: t 11 � 9. Architect: L w,t'. rY►ck5: Address: )0 r-•i �� � tt,l.�_ Kt sGr Y Phone# r 5 6 Cell 4 �-' email: U P,�a7l i+Arcl; e'er.Is.eon, 10. Engineer: Address: Phone f# Cell-1 email: 11. General 11 Address: /3::� l( Phone# Cell Tf 9/),� - ice'3 c7?'7 email: 1�o t?Ay' Lx 't�') M i t� ".-. 12. Estimated cost of construction $ r �L (NOTE:The er►intaled cost shall include all labor.nt,teriol.+call'uldinc,11'.0d e(Iuipment.professional tcev,and materiat aid labor which mad lie donated crab,.) 13. Job Timetable:Start: :Otk Bfr M.t Finish: '� eY►p„� (ll 6 1 2024 BUILDA1kF _ .TMENT VILI_XCE OF R AiUOOK E C E N E 938 KING STREET RYE BRt'(J�,NY 10573 (9a ocb JUN 2 5 2024 DD -- -= VILLAGE OF RYE BROOK 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: residing at, �- (c)t,,t746y KK6,- ((L) > e �/�57� I Print n�n�r i i Ad�h� > .�hcr;� ,ai lip r h being duly swom, 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; 2(2ur6 2 AIDE' t Qe �e X(b ok, IT.IL 10,Cz Rye Brook, NY. (Joh Addres,) 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 roofdrains, 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. G 1Si nature of Property Ownen>i1 I Print N:nn�ef Prup�•m lJ��ni!<i� � Sworn to before me this day of _1-a„ e y 20 otan' PuNICP DEBORAH' ANNE SARRO-AKAI_SKI Notary: �;�lio, State of New York r4o.41-4700224 12) Qualified in Olestchester County Commission Expires September 30, 6 t 20,14 This form must he properly completed&,notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR) To: The Building Inspector of the Village of Rye Brook. From: ��y,n�r� l�i�C4i� Clone— Subject Property: C_ �� r Q;cS% { 0c-e_ SBL: �2 f �2one: Please take notice that the subject; ne or Two Family; ❑ Commercial, ❑ New Structure E kfC�" [E F E ❑ Addition to an Existing Structure c�ttehabilitation to an Existing Structure JUN 2 5 2024 DD / to be constructed or performed at the subject property will utilize; VILLAGE OF RYE BROOK ❑ Truss Type Construction(TT) BUILDING DEPARTMENT Pre-Engineered Wood Construction(PW) /❑ Timber Construction(TC) in the following location(s); dloor Framing, including Girders& Beams(F) oof Framing(R) ❑ Floor Framing and Root'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 §1264 for Commercial Buildings, and NYCRR§1265 for One& Two Family Dwellings. Sworn to before me this Sworn to before me this day of vrt e— ,20-2 day of .7A o e , 20 �2 Signature of Pr Owner SigniatuP6 of Design Professional P/ri Na ie of Pr erty Ow JJ Print Name of Design Pr fessional ,G a.t1�4� 6�._ Notary Public Notary Ifublic DEBOP` ' ''' -4ARRO-AKALSKI DEBORAH , NNE SARRO-AKALSKI Notez:.. ',_, r az .te of New York Notary Public; State of New York No.41-4700224 No.41-4700224 Qualified in Westchester County t'l Qualified in Westchester County Commission Expires September 30, x'��� Commission Expires September30, -2G25'" This application must be properly completed in its entirety and must 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: '—ig S-11 P.^-►C . _ ,being duly sworn, deposes and states that he/she is the applicant above named, (print name df individ—ual signing as the applic utt 1 and furthers te$ thtt (s?he is the legal owner of the property to which this application pertains, or that (s)he is the t C 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 lISF� YW Sworn to before me this day of fv►+ 20 day of 'J�r C , 20 �2 9' 9j%Niy!!f Signature of Property Owner,Ile Signatur f Applicant ✓J Uop O le 1 i L—uil l l ✓r►` Print Name of Property Owner Print Name of Applicant f Notary Public Notary Public DEBORA '3ARRO-AKALSKI DEBORAH ANNE SARRO-AKAESKI Notary '�(;,; c, ::.Mute of New York Notary Public, SM6 of New York 1 4?-4700224 NO.4? 4700224 Qttallfied in Westchester County OU811Ned In Westchester County C©mrnlssion Expires September 30, aa�� C'Qmmissicn Cxv,*PG September 30,_L?a�S" (4) 0 1 2024