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BUILDING DEPARTMENT
VILLAGE OF RYE'OROOK -a ' AUG 2 2 2024
938 KING STREET RYE 131200K,NY 10573
(444)939-0668 � V '
wwwrryebrookny.i!ov
INTERIOR BUILDING PERMIT APPLICATION
FOR OFFICE USE ONLY: yf� ,/ //��
Approval Date: AUG 2 3 2024 P rmit#: / ��pplication Fee:$ / 00—'66
Approval Signature: Permit Fees:$_ (P _ DISC _
Disapproved: lather:
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below.
1. Job Address: ID HIGH PPIMT CIR- RYE L FOQK SBL: IQ ,'73 39 zone:.
2. Proposed Improvement.(Describe indetail): K1I7HL1v ISA-CI<SPL SH1. UPDATE t_rCrHril�lG�
BRTHROoM ReN0VAno1VS 1/z GAT-H Hr+L-L)NAV &A rH IVIASTI~R6ATH . t--lV/N& koom
,4ND 3fd FLOOR UPDATT W&HT7NG_
* S4ME LOCAT70NS
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 1: TIER I1: TIER Ill:
4. 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...) :No: Yes:
(If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
5. Occupancy;(i fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction:
6. N.Y State Construction Classification: N.Y.State Use Classification:
7. Property Owner: KELLI BUMF Address: 10 HI61 POINT GIR
Phone# Cell# (110 830-7249 email: ke11v, budde77t,!atnaH.com
S. Applicant: Address:
Phone# Cell# email:
9. Architect: Address:
Phone# Cell# email:
10. Engineer: Address:
Phone# Cell# email:
11. General Contractor: Address:
Phone# Cell# email:
12. Estimated cost of construction $ ono
(NOTE The estimated cost shall include all labor,material,scat7'olding,flxe equipment,processional ices,and material and labor which may be donated
gratis,)
13. Job Timetable: Start: R U 6-US T 2(, 20 2 4 Finish:
(I)
6/l/2024
BUILD) 1k0AR MENT JaD
VtL,� E OF RY OOK I AUG 2 2 2024
938 KING _ ET RYE Br; ,NY 10573 �
�`�
4)939-OC�Ir VILLAGE OF kYiv BROOK
>�7
www.ryebrookn�iy.�ov BDI.I`?Il1MG DE PARTfI,IEPJT
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:
I, KELLY BL)W ,residing at, HIGH POINT CIRCLE
('Print name) (Address where you lip c)
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;
10 1-11 (,H POlN T' CIRCLE ,Rye Brook,NY.
I.lull 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.
iU4 &' te6l L
(Signature ofPropelM) [)'Cr("))
KELLY 60bbF
(Print Name of Property Owner(s))
Sworn to before me this
da of 20 a*'�
(Notary ihlic)
SHARI IJIELILL0
Notary Public,State of New York
No.01NI E6160063
Qualified in westchester County, (2)
Commission Expires January 29,2D�
brI r2o2a
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:
KE LILY SUDDE ,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.
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 Sworn to before me this
day of A u g U S{ , 20 Z H day of 20
ignature of P erty 04iferw v Signature of Applicant
kfLLY BUDDE
ame of Property Owner Print Name of Applicant
n�L' &'Lv.
Notary Public SHARI MELILLO Notary Public
Notary Public,State of New York
No.01NIE6160063
Qualified in Westchester County
--ommission Expires January 29,20V
(4)
6/l no24