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A 0 � F � � b o BUILM-R MENT F C E ��,JJ VIL OK D v938 KING ,NY 10573 r - 4 2025 . ov VILLAGE OF RYE BROOK Pt !t.nINd� DEPARTMENT FOR OFFICE USE ONLY: _r �r Approval Date: JUN 2 Per it �0� -7; Application# ,�5-& / eo Approval signature: ARCHITECTURAL REVIEW BOARD: Disapproved: e. > Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# 0 Other: Application Fee•4 00r ,6 Permit Fees: EXTERIOR BUILDING PERMIT APPLICATION Application dated: 0 0 O 4 -c) is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,stru Lures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: Z1 G I NCo" AVE ' A_q F 6 kOn k I N Y /06 -7 3 2. Parcel ID#: Zone: 0 3. Proposed Improvement(Describe in detail): 12t aze- Ay_ `_ G17 Old ey-e--ex j S`fi'y -5-ba-6 (TA4 --br✓a ec-rl 46—h o Gave-t r.1apia f ane is 2-DX /0 T2..� D^e rs l 'X I �. Co ,V" o W- 4. Property Owner: 9 A-ig l73A, 13 0k ATrt K Address: L 1 N Co c A) "0-- ,� y E &Z045 K p4y 105r/ 73 Phone# q 2� -DC1 R 7 Cell# e-mail C)"rQ'thak! eq 'C[ 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 Contractor: Address: Phone# Cell# e-mail (1) 6/l/2024 5. Occupant ,2-Fam.,Commercial.,ete...)Pre-construction: Post-construction: 6. Area of lot: Square feet: �-.l_ 56: .sq Acres: D`3 5 a "e o IF 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 comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I`fl: 2nd fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I'fl: 2'fl: 3rd fl: 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: (ifyes,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:_�J,�Area: 22. Will the proposed projec equire a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,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: (if yes,you must submit a Site flan 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: V (if 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 9/28/07? Yes : No: (ifyes, the area and elevations of theflood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: ✓ Indicate: TIER 1: TIER 11: TIER IH: (if yes,a Home 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: $ I t 0 O C) W 4o `, + -0A_X 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 additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: 7 V L-1 5 (2) 6/112024 BUILDING DEFAR MENT VI1+AG E OF RYE OK j U N - 4 2025 938 KING 9i'R ET Rv BRcdc NY 10573 I4) -06 1` VILLAGE OF RYE BROOK ' BUILDING DEPARTMENT 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: 3J, IJ g I T� P yIXA-r"U/CI ,residing at, Z �'lNt0I- /V A VE K�fe= Q�06K (Print name:) (Address where vou live) / [I /4>5--73 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; API;- '�`�� L;� c�k 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 of Property Owncr(s)) 8" ) -/A A3 A -rN ox/ (Print Name of Property Owner(s)) Sworn to before me this day of 20 - (Notary Public) SHARI MEULLO Notary Public,State of New York No.01ME616OO63 Qualified in Westchester County (6) Commisslon Expires January 29,20�� 6/1/2024 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. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I -1—A k-)v kA7311 o , 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 CrSN M kC� 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 Sworn to before me this day of , 20 day of , 20 Signature caner Signature of Applicant A-6 )7-A- 6UKA7710KI Print Name of Property Owner Print Name of Applicant Notary Public Notary Public SHAftI MfULLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires Jantfary 29,20ZJ (8) 6/l/2024