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R J U N
BUIQRYE
ENT 1 2075
VIOK
938 KINGNY 10573 ViLLAGE OF RYE BROOK
BUIL-DING DEPAi iMENT
FOR OFFICE USE ON
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Approval Date:JuN 3 2 Pe �lv) Application
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other: ,,,��11 AA
Application Fee:q Qv' b Permit Fees:,N (�0
ll ROOF PERMIT APPLICATION
Application dated: —/ 7 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: 48 Greenway Ln. Rye Brook, NY 10573 SBA: 129.84-2-37 Zone:���
Property Owner: Joshua Balsam Address: 48 Greenway Ln. Rye Brook, NY 10573
Phone#: Cell#: (646) 643-4601 email: joshua.e.balsam@gmail.eom
2. Applicant: Empire Solar Solutions, LLC Address: 2-8 Johnes St. Newburgh, NY 12550
Phone#: Cell#: (845) 317-8019 email:Courtney@empiresolarny.com
3. Roofing Contractor: Empire Solar Solutions, LLC Address: 2-8 Johnes St. Newburgh, NY 12550
Phone#: Cell#: (845) 317-8019 email: Courtney@empiresolarny.com
4. Job Description,list all Methods&Materials: Re roof of 18 squares. No plywood to be touched. See specs
attached.
(NOTE:The estimated cost shall include all site
N. Estimated Cost of Job:$ 13,000
improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If corner property,indicate street frontage: NIA
7. Construction Type: Roof NYS Construction Class:
8. Number of stories: 2 Height:
9. Is garage being re-roofed:No Yes:( )Attached No:( )•Yes:( )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: Hip
11. Estimated date of completion:1 Week after permit is issued
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61112024
s
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:
Shannon Murphy ,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
Contractor for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attomeY,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 I Sworn to before me this L
day of ,20- 5 day of MN1e , 20_Z6
S' ure o roperty Owner tgnature of Applicant
Joshua Balsam Shannon Murphy
Print Name of Property Owner Print Name of Applicant
Notary Puh is Notary Public
COURTNEY ELIZABETH ROBERTS
CdURTNEY ELIZABETFI ROBERTS
NOTARY PUBLIC-STATE OF NEW YORK
No.D1R06439611
NOTARY PUBLIC-STATE OF NEW YORK Qualified in R064396Dutchess Count
No.01 R0643Dutche 6 f 1 My Commission Expires 08-29-2026
Qualified in Dutchess County
My Commission Expires 08-29-2026
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