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BUILD! q TM ENT
VIU, 01FRY'kki�,00K
?(VAI� R MAR 2 5 2025
938 KING ET Ri'E BR NY 10573
-1, EE
JI.4)93
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION
FOR E.xi*F-RIOR WORK Wtucn Dors No'j, REQUIRE VILLAGE ARCHITECTUPLAI. ItLviEw BOARD APPROvAL
FOR OFFICE USE ONLY:
APPROVAL DATE: Ktqq�/ PERMIT CATION FEE:'Voa
APPROVAL SIGNATURE: A PERMIT FEES:
H.O.A.APPROVAL: DATE:
DISAPPROVED: OTHER:
Application dated: 03113/2025 is hereby made to the Building Inspectorol'the Village ot'Rye Brook.NY,for the issuance of a Permit for the
construction of buildings.structures.additions.alterations or for a change in use,as per detailed statement dvsxribed below.
I. Job Address: 209 Irenhyl Ave, Rye Brook , NY 10573-2911
2. ParcellD#., 135.76-1-25
3. Proposed Improvement(Describe in detail):
Installation of( 16 ) replacement Andersen Acclaim Double Hung Windows into existing
openings with no structural alterations.
4. Property Owner: Rolayne Peterson
Address: 209 Irenhyl Ave, Rye Brook , NY 10573-2911
Phone# (914)937-0399 Cell 9 e-mail rcgpet@aol-com
List All Other Properties Owned in Rye Brook:
Applicant: Lindsay Loson
Address: 2261 Market Street STE 10301, San Francisco, CA 94114
Phone#_ 315-335-8730 -Cell k __,_rnaij lindsay@permitflow.com
Architect- N/A
Address:- N/A N/A N/A N/A
Phone 9 Cell e-nizid
Engineer, N/A
Address: NIA Phone N/A NIA
N/A Cell e-e-mail1�
General contractor: Fairchester Custom Windows LLC- Renewal by Andersen
Address: 421 West Ave, Building 1, Stamford, CT 06902
Phone (203) 249-1986 -Cell 9 e-mail PERM(TS@RBAWestchester.com
Doc[D: ldl69e8coae2ecac69le5Ba7364a3fOe83lel63a
N/A
5. Occupancy;(J-Fam.,2-Fam..Commercial.,etc...)Pre-construction: NIA Post-construction:
6. Area of lot: Square feet: N/A Acres: N/A
7. Dimensions from proposed building or structure to lot lines: front yard: N/A rear yard: NIA
right side yard: NIA left side yard: NIA other: N/A
8. If building is located on a corner lot,which street does it front on: N/A
9. Area of proposed building in square feet: Basement: N/A I'fl: N/A 2"d fl: N/A 3'd fl: NIA
10. Total Square Footage of the proposed new construction: N/A
11. For additions,total square footage added:Basement: N/A 1.fl: N/A 2"d fl: N/A 3 d fl: N/A
12. Total Square Footage of the proposed renovation to the existing structure: N/A
13. N.Y.State Construction Classification: N/A N.Y.State Use Classification: N/A
14, Construction Type&Location: ( )Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT];
O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor& Roof Framing[FR];Other:
N/A
15. Number of stories: NIA Overall Height: A Median Height: N/A
16. Basement to be full,or partial: N/A finished or unfinished: N/A
17. What material is the exterior finish: N/A
18. Roof style:peaked,hip,mansard,shed,etc: N/A Roofing material: N/A
19. What system of heating: N/A
20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this
application.
21. Will the proposed project require the installation of a new,or an extension/modification to an existing auto atic fire
suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No: N/A
(if yes,applicant must submit a separate:tutomatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a
Storm%vater Management Control Permit as per§217 of Village Code? Yes:—No:—Area: N/A
23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: NIA (if yes,applicant must submit a Site Plan Application,&provide detailed drawings)
24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: N/A
(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey)
NIA
25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No:
/if yes,the area of wetland and the Welland buffer:one must be properly depicted on the survey&site plan)
26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9128/07? Yes : No: N/A
(if yes, the area and elevations of the flood plane twist he properly depicted on the surrey&site plan)
27, Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: N/A
(if yes,applicant rnusi submit a Tree Removal Permit Application)
28. Does the proposed project involve a Home-Occupation as per§250-39 of Village Code? Yes: No: N/A
Indicate:TIER l: TIER II: TIER 111: (fyes.a Home Occupation Permit Application is required)
29. What is the total estimated cost of construction: $ 47,562 .vote:estimated cost shall include
all site improvements, labor,material,scaffolding,fired equipment,professional fees, including any material and labor which mrav be
donated gratis.lfthe final cost exceeds the estimated cost,an additioona ll fee will be required prior to issuance of the C/O.
NA
30. Estimated date of completion:
(2)
6/I l--024
Doc ID: ldl69e8cOae2ecac69le58a7364a3fOe83lel63a
-5 D lilt
B u1LDfN,(�-",RTM ENT
A VIL('-'�)�(E OF Ryk*'OOK MAR 2 5 2025
938 KING ET RvE;BRIOIMi,NY 10573
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
Nv�vw.'"el 0
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. AN-i 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:
ROLAYNE PETERSON residing at. 209 Irenhyl Ave, Rye Brook , NY 10573-2911
I['1611 P1,1111':I
being duly sworn,deposes and states that (.$)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;
209 Irenhyl Ave, Rye Brook , NY 10573-2911 Rve Brook,NY.
I tllh \L]111c10
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.
ROLAYNE PETERSON
1'w "'jrk".'d
13RJJAN TAAC.DoNALD
XOZWRMUC
Sworn to before me this
my co"Alboum
day of_&Irfeh 2 0
T\7
Doc ID: ld169e8cOae2ecac691e58a7364a3f0e83le163a
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.
STATE Of NEW YORK.COUNTY OF W+ESTCHESTER ) as:
LINDSAY LOSON ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual storing 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
Agent for the legal owner and is duly authorized to make and file this
application.
(uadtcatc atchiled.contractor,agent,auomcv.ew)
That all statements contained herein are true to the best of his/her knowledge and belief, and that any work perforated. 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 stornlwater or
groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property.
Sworn to before me this
Z.1 50, Sworn to before me this 13th
day of March �o 25
day of �� 0 y
t3R1ar,t MACDoNALn 4mi-an-
aNOTARYPUBLJC
Signature ol(Propertr Owner 5ta Signature of Applicant
My COMMISSION EXPIRES Od.312026
ROI_AYNE PETERSON LINDSAY LOSON
Prinl Name of Propert, Print Name ol-Applicant
Kelsey Proper
Notary Public _— Molar} Public HH415727
Florida Broward County
I„ KELSEY PROPER
o t Notary Pubdlc-State of Florida
N _ Commission if HH415727
'. Expires on aurae 28 2027
OF F��
Notarized remotely online using communication technology via Proof.
Driver License produced for ID.
t ti
Doc ID: 1 d 1 69e8c0ae2ecac691 e58a7364a3f0e831 el 63a