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BUILDING 1)EFAr4'MENT D
VILE AGE OF RYE OK ECENE
938 KING 9TRF.F.'r RYE BRoox;NY 1057 J UL 2 3 2025 DD
4. n .%ov
VILLAGE OnFC RYE
bBROOK
FOR OFFICE USE ONLY:
Approval Date: i � � ; Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other: /y�
Application Fee:It / u 16' Permit Fees:
ROOF PERMIT APPLICATION
Application dated:Qom] ai l a�) 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: Ic SBL: I f i (--/—! aone.r41'f
Property Owaer:,l \)Sp /�5 c Address: . t
Phone#:9 1 4 III b�IC Cell#: email: �• nRik� ' CCU{\
2. Applicant: �� t 1C1.M W�Zk 'c Address:
Phone#:RL4.5 bIQ -�-(oo l Cell#. email: j - ccxr\
3. Roofing Contractor:Q—L:i MCA 4,AA l CYR, Address:ay L1 a(KAy&e N*poM
Phone#:9}4 C1 q '49(q Cell#: J email: {-i 1w, rcnLh corn
4. Job Description,list all Methods&Materials: C"YNf _
r l V
5. Estimated Cost of Job:$ • 0CU (NOTE:The estimated cost shall include all site
improvements,labor,material,sc ffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If comer property,indicate street frontage:
7. Construction Type: NYS Construction Class:
8. Number of stories: Height:
9. Is garage being re-roofed:No: Yes:( ),Attached No:{ )•Yes:( )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: � i I�2 1(�1�� T'- -Of
11. Estimated date of completion: Au
_ -
B1t12024
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.
a••..aaNaaa..a....aa.•.aaaa•«a.a•a•a........................•.........
..•.aaaaa.a«i1a.«.a•aafa«aaalaa•a..
USTTE OF NEW Y w QOUNIY OF WFSTCH STF.R
� ,being duly swan,deposes and states that he/she is the applicant above named.
and fwtber states Mbe is the legal owner of the property to which this application pertains, or that Whe is the
a82for the legal owner and is duty tutbonimd to make and Me this application.
owkw o qar, C ArimuY•etc-)
That all statements eontaimein arc true to the best of his/her knowledge and belief and that any work performed,or use
eoachwad at the above captioned property will be in conforrrtapce with the details as set forth and cootaioed in dtis application
and in any accompanying approved plans and specifications.as well as in accordance with the New York State Uniform Fire
Prevention dt Building Code.the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Swm to bbeff is � w om me this S om to bcfim me this
day of 3 \ ,24,27.�:i' coy of 20
--� GL
Sigrue of Pro es
AAperty Owner Sigx9m of Appl
Urfi UU
Prim Name of p er Print Hum of
Notary Notary lie
` \
�
NM F.AGMI
WILSOM ALCAMTARA NoWy Pam-ft*o1 Now Ytr&
Mpt/ry P.014C-State Of New York NO.OIAGGU4731
NO,01AL641'R415
Qualified 1n Westchester County meow in LWy
A1y Cv.n+scion E.P+'es Jul 6,40" �� ^ipk May11.G>,ae(yv�7
X� 7;7
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