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R, lu 9 BUUILDING DEPARTMENT � � VILLAGE OF RYE BROOK w 938 KING STREET RYE BROOK,NY 10573 Ll (914)939-0668 AUG 11 2025 w w w.rvebrookny.j!o8, VILLAGE OF .AYE B.9001S $UILfal.\'t, DF-W;�? nen.I, ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: _\ /� Q APPROVAL DATE: AUG i 5 E I ll APPLICATION F'EQE:4/011 / APPROVAL SIGNATURE: PERMIT FEES: -0 3 /C0`/0-6 H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated:-_-7^2 Q 1244 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,structures,addi�s,al1ter`atio r for a change use s per de d state des�ed be f V • ��� 1. Job Address: � '�/}/� // � 2. ParcelID#: Zone: 3. Proposed l irovement(Describe in detail):, pTir.�'C/&� 4. Property Owner: Address: z1q1Z,0o0Wd Vg -;_75 ^7 Phone# � _p / � Cell# e-mail fjyydx U e List All Other Properties Owned in Rye Brook: Applicant: Address: �4A � �� U� „1��� Phone# Cell# �J-� 3 Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: 1�4'��� /ZC V7K4vT Address: �l Y ``lIIZAOA /�' Phone# Cell# ?1W---V3 3572 e-mail C /I27 ��• 33 (1) 6n i2o24 5. Occupancy 2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 6. Area of lot: quare feet: N 4 Acres: 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 corner lot,which street does it front on: _ 9. Area of proposed building in square feet: Basement: lot fl: 2iid fl: 3 d fl: 10. Total Square Footage of the proposed new construction: N 11. For additions,total square footage added:Basement: r)7 1 S'fl: 2nd fl: 3'd 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. Construction Type& Location:O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW]; Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: , finished or unfinished: 17. What material is the exterior finish: 18. Roof style:peaked,hip,mansard,shed,etc: '� Roofing material: l 19. What system of heating: LV 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 autom c fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No: V (if yes,applicant must submit a separate Automatic 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 ofjmpervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: 7 Area: 23. Will the proposed projec require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes, applicant meat 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: 1/ (f yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 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 wetland buffer zone 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 9/28/07? Yes:—No: ✓ (if yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan) / 27. 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) 28, Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER I: TIER 11: TIER III: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: S__ /r Note:estimated cost shalt include all site improvements,labor,material,scaffolding fixed equipmen,professional fees,including any material and labor which may be donated gratis.If the,/mal cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: I� /t— (2) 6/1/2024 BUILDING DEPARTMENT D^F C VtL.LAGE OF RYE.BROOK F. 938 KING STREET RYE BROOK,NY 10573 I AUG 11 20? (914)939-0668 ; 1.w._ . 51 %i w1 N,r 1 rhrookn�'.Qov VILLAGE Or k'Y L i t;OOK *ir'3:ir.Y**a'e*+Fre*k*n**fi*****#***#*************fit*************4ik**ir#pit 4:4h7ir*.Fir**Y*ir****1e************•k**t*•k dr*1F** 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 YYOrRK, COUNTY OF WESTCHESTER f) as: r� I, ��Nr�i ty y�K� , residing at, �f K-�'��� - 4V( Yt II'inu iul'r hir r,It� l 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; D �A+'io Vc- Rye Brook, NY. r luh lildrr�.i 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. dQ;;0 (Signalureul-Prol (N'ller(s)) �_ tJsl NMI (Prim . ,- Sworn to before me this day of 20 MICHAEL CARVALHO Notary Public,Stale of Rhode Island , My Commission Expires 01/19/2028 &112024 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. ST TE OF NEW YORK,COUNTY OF WESTCHESTER ) as' K6+rt5`fN1A _ __1 being duly sworn,deposes and states that he/she is the applicant above named, (print name ofindiniduol signing as the applicant) and ftylhcr states th t (s)he is the legal owner of the property to which this application pertains, or that (s)he is the .>,�l r- 1 C4,;I` _ _ 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 properly owner further declarer; that he/she has inspected the subject property, and that to the best of his/hcr 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, Swum to before me this__A-------� _ ___ Sworn to before me this __ day Of� "_ , 20 J day of . I 20 Sig urc orPntpetty Owner Signature of.applicant nn--� . D (L,r_ ' _;"A+'D (p t#h Print Name of Property Owner � Print Nance of Applicant Notar) Public Notary PubVc Richard C.Lama KwryPublic stattl d Q �WestcLA6rJ0 i2 Carat f °� �0 - Cornrnrssfor Exfll. feb.a 2U MICHAEL CARVALHO Notary Public,State of Rnoric Island '.My Commission Expires 01/19,'2028 ia} tit 1,202a