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BUIL 11S r ` � . MENT
VILX OOK
938 KING • . 1�'t~I; ,NY 10573
gov
VILLAGE
DEAR7
AGE OF
FOR OFFICE USE ONLY:
Approval Date: Per # P� -cr au
- � Application# 1``,�3c �-��lU
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved:. Date:
BOT Approval Date: Case# : Chaitman:
:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: / Permit Fees: [I ('0
EXTERIOR BUILDING PERMIT APPLICATION
11Application dated: I, )-�J is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
construction of building ,structures,additions,alterations or for a change in use,as per detailed statement described below,
1. JobAddress:
2. Parcel ID#: �6-r 3 L - /—c-) Zone: /S
3. Proposed improvement(Describe in detail): � 'fT%I Gt 'O ) 4
4. Property Owner: l_ U<<G1 r1 L tom`-
3 p
Address: c; i[' o I rkne JY{ , I.-�u L �j tit
Phone# }4 6'f i, Doll# e-mail 1/I f
List All Other Properties Owned in Rye Brook:
Applicant:
Address:
Phone# Cell# e-mail
Architect:
Address:
Phone# Cell# e-mail
Engineer:
Address:
Phone# Cell# e-mail
General Can actor:
Address: S/,-)%7 /j /O J'1p eN-
Phone# !2)4-330 -QO 39 Celi# tiwnran .w�� ;Y-.....,,�•r,i..,,..�
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6/1/2024
5. Occupancy;(I-Pam.,2-Fam.,Commercial.,etc..,)Pre-construction: Post-construction:
6. Area of lot: Square feet: _ Acres:
7. Dimensions from proposed building or structure to lot lines: front yard: rear yard:
right side yard: left side yard: other:
8. If building is located on a corner lot,which street does it front on:
9. Area of proposed building in square feet: Basement: 11,fl: 2'd fl: 31d fl:
10, Total Square Footage of the proposed new construction:
11. For additions,total square footage added:Basement; 1°'fl: 21 fl: 31d ft:
12. Total Square Footage of the proposed renovation to the existing structure:
13, N.Y.State Construction Classification: N.Y.State Use Classification:
14. Number of stories: Overall Height: Median Height:
15. Basement to be full,or partial: finished or unfinished:
16. What material is the exterior finish:
17. Roof style;peaked,hip,mansard,shed,etc: Roofing material:
18. What system of heating:
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 I Hood,etc...) Yes: No:
({f yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
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: Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: ({fyes,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:
(tf 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:
(f 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 9/28/077 Yes: No:
(lfyes,the area and elevations of the flood plane must be properly depicted on the survey&site plat)
26. Will the proposed project require a Tree Removal Permit as per§235 of Village Coda? Yes; No:
(#yes,applicant must submit a Tree Removal Pet?nit Application)
27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No:
Indicate: TIER I: TIER H: TIER III; (If yes,a Horne Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
29. What is the total estimated cost of construction: $ l ; ' ' 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 additionalfee will he requiredprior to issuance of the C/O.
30, Estimated date of completion:
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611t2024
BUILDt�t�r : MENT
ViI. p j OOK
938 Kilvc NY 10573
wry �i' c 1 ov
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, � f d
(Print name) (Address where you live)
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;
r'
i
Rye Brook, NY,
(Job 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.
(Signature 011roperty Owner(s))
(Print Name of Properly ONvner(s))Sworn to before me this—A U+ -�"
day of �;; , 20 SUSAN 00I11RiTT•ATKINSON
Rotary Public aI Connecticut
I.D.S Milli
(Notary Pu�lic) My Cc�nfniyfi0n�M�131►I026
(6)
6/I/2024
This application must be properly completed in its entirety by a N.Y. State Registered
Architect or N.Y. State Licensed Professional 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.
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STATE OF EW YORK,COUNTY OF WESTCHESTER ) a%
j� being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as t(ne applidant)
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 ail 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 10 U 7 Sworn to before me this
day of ,20 ,-)l day of �,, ,20' _
Signature of Property Owner Signature o Applicant
Print Name of Property Owner _ Print Name of Applicant
^tip �/cal `t
No ary Public Notary Public
K$,11S'1AN PORRITT•ATKINSON
y Public of Connecticut
I.D. # 125101
mmission Expires S1a112025
(8)
6/112024