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TMENT DIECIEWE B
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VII.j kbE OF RYE- OK MAR 18 2025
938 KING� ET RYE BR i€ NY 10573
VILLAGE OF RYE BROOK
w of ov BUILDING DEPARTMENT
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FOR OFFICE USE ONLY: D 5 ,r�
Approval DateAR 20 erm` ` �— V/ Application#
Approval Signature: : ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: Permit Fees:
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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:yi0 9mUcCkOp4d
Property Owner:ftdIj jItar,&A. Address: j0 r mUwk Arad
Phone#: Cell#: 9/4- g946 email: acre,3 &alp 11"wUni .
2. Applicant:/JilCk iWA'0 Address: d Gad3l
Phone#: l, Cell#: 9/H• r�.77.0�3 email: / I'
3. Roofing Contractor:!'f.54NGriXG s~Sbn—Address: C y 1 A7d/
Phone#: •�, 7.04$3 Cell#: email: C A
4. Job Description,list all Methods&Materials:Qmav b—hfy Do-, ;Ile►
rte sE„A 'e— .3orL grit A" 091a GAe�Z hgi t
5. Es ated Cost of Job:$J5.6W (NOTE:The estimated cost shall include all site
improvements,labor,materia,s`T ca�ffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If comer property,indicate street frontage:
7. Construction Type: Oef M T NYS Construction Class:
S. Number of stories:Pa Height: 61.5 G 1
9. Is garage being re-roofed:No:O•Yes:O Attached No:( )•Yes: Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc:
11. Estimated date of completion: ZAIA Oi:7•k OdAftK Is 159&4
-1-
611/2024
Please note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
91a&C2n;/II0_ ,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
_conn!5� 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.
Sworn to before me this Sword to before me this
day of A�2LF/ 20 day of ,�WArz(-tf ,20 zZ�Z
Signature of Property Owner Signatuue'o pplicant
1�.tl dh;*46e t; A6ek �oo'IIU
Print Name Progertyf(fwner Print Name of Applicant
Na No b
George C Palmiero George C Palmiero
Notary Public-State of New York Notary Public-State of New York
No.01 PA6089211 No.01 PA6089211
Qualified in Westchester County Qualified in Westchester County
Commission Expires March 24,20 Z 7' Cornrni� lion Expires March 24,20 Z_
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