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BUILDV,WMENT ECE � " E
VOKOCT - 7 2025
938 KING NY 10573
AinVILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY: Ron
/,,
Approval Date: Permit# -5 Application#
Approval Signature: OCT 202 ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: 100RCL Permit Fees:
ROOF PERMIT APPLICATION
Application dated:JoI7105 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 Buillling,as per detailed statement described below.
1. Job Address: 13 Highview Ave. Rye Brook, NY 10573 SBL: 141.35-1-14 Zone: R�;)'r
Property owner: Alicia Lucero Address: 13 Highview Ave. Rye Brook, NY 10573
Phone#: Cell#: (914) 565-1750 email: aliciamocha5C@gmail.com
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: CourtneyQempiresolarny.com
4. Job Description,list all Methods&Materials: Re roof of 12 squares. No plywood to be touched. See specs
attached.
5. Estimated Cost of Job:$ 8,000 (NOTE:The estimated cost shall include all site
improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If corner property,indicate street frontage: N/A
7. Construction Type: Roof NYS Construction Class:
8. Number of stories: 1 Height:
9. Is garage being re-roofed:Nolo.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
-I-
6/1/2024
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,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.
Sworn to before me this 1X Sworn to before me this g
day of 2)2,(t)bGrnj2ctf- , 20 7n day of 71)
eo 20_Pf:�
Signature df Property Owner Sig ature of Applicant
Alicia Lucero Shannon Murphy
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
COURTNEY ELIZABETH ROBERTS
COURTNEY ELIZABETH ROBERTS
NOTARY PUBLIC-STATE OF NEW YORK
NOTARY PUBLIC STATE OF NEW YORK
No.01 R06439611
Qualified in Dutchess County No.01 R06439611
My Commission Expires 08-29.2026
Qualified in Dutchess County
My Commission Expires 08-29-2026
6/1/2024