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BUILDING &PARTMENT
V1l rE OF RYL ROOrc R! FEB 2 4 2025
938 KING .ET RYE BROOK,NY 10573
-0 VILLAGE OF RYE BROOK
jrve ov BUILDING I)EPARTMENT
FOR OFFICE USE ONLY: I
Approval Date: FEB 1 , 2025 Pe 1 ���'�/ Application #
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: _ Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fec:4/co_ b Permit Fees: —/6tJC.
` 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.
1. Job Address: 40 de//A/I // _ _SBL: t one:
Property Owner:CU07 V 14 pya_4Y ! j 1—,ft 1
Phone#: Cell#: 7p/ email: .�,py1
2. Applicant: ddress: PA
Phone#: Cell#: �q . Q (�� email:
3. Roofing Contractor: Address:
Phone#: Cell#: 94r j email: 4 4W r ,
4. Job Description, list all Methods& Materials:
7
IF IV
5. Estimated Cost of Job: S INOTF:The estimated cosl shall include all si �
imhrmement�,. lahor. material. a11�. ding. lieed ctluipmcnt,rrol'cssional Ices, Lind material and lahor which may he donatckl gratis,y
b. if corner property,indicat street frontage:
7. Construction Type: NYS Construction Class:
S. Number of stories: Height: r;7<-
9. Is garage being re-roofed:No:*Yes: ( )Attached No: ( ) • Yes: ( )Number of Cars:
10. Is roof peaked,hip,mansard, flat,etc: A,, rAd J 1A I �r%�Lr�
11, Estimated date of completion: f�
-1-
611/2024
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:
Evan L. Goldenberg,Architect 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
Architect/Construction Manager 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 i Sworn to before me this
day of Jell th' , 20.25 day 1 , 20-24
Sign o Prope Owner ;T—gnIqr.7.f Applicant
Print Name ofPrcp rty Owner Pr�Name of Applicant
n
Notary Public o Public
i A,YRON j. ADLEY f
Notary Pub lie-state of New York
No.01 HE0014B56 Jet}s�Bu��
Qualified!n Kings County
My Commission Expires Oct-25,2 ,
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6/112024