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BUILDING 69PARTMENT � E C E tl \1 E
VILLAGE OF RYE BROOK OCT 14 2025
938 KING ST"OET RYE BROOK,NY 10573
-01.4) -0668 VILLAGE OF RYE BROOK
wvv t 6kn . 7ov BUILDING DEPARTMENT
FOR OFFICE USE ONLI': /� 2
Approval Date:OCT 15 ZOZS ermit# '�/ L.J Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: Permit Fees:
ROOF PERMIT APPLICATION
Application dated: /0//4// is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to
Re-Roofan Existing Building,r:per detailed statement described below.
1. Job AddressyQLwyrlZZ yflD6EDR jerffFfXxL A /05-/3SBL: / % •5/ JL Zone:
Property Owner: —77 - Addressf/yCa.,N%,eX, DGE'Pie 4ny ,- oock A(XdV J3
Phone#:Cj/'/�.9 4 3 2. 1 3 Cell#:9�y-`r62`b3 28 email:$�a,1,F0X e A --ol-601W
2. Applicant:AlV r&Q✓1f " /!SD Addres ��yf,Q�/,�lL c-1X&F my/�3
Phone 939./53o Cell#:F1/ 1`jl//6 2.63 2 3 nemail•5_fC�rfoxe-0Qe>l.Cool
3. Rooting Contractor: �' U t �_t^ ( d-f�Cf/'J(�Address: e/n k✓ �11 r! �'� �6��V
Phone#: `1 �� —�.2�--D��7 Cell#: X0 3 O email: uj-+ye/D1;-,►:eri c-6o4¢45 � G�
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4. Job Description,list all Methods&Materials: facAque rk�s >-'`7
,ace- pteard w'e t- C lup �: @r GS*r+ 0 1-1 C"lt rt1 trM
} r1�
5. Estimated Cost of Job:$ �,I , 6 00 (NOTE.: The estimated cost shall include all site
improvements,labor,material,sca li lding,fined 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: ( 1 Attached No:( )•Yes: ( )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc:
11. Estimated date of completion:
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6/112024
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:
A,,,�.ry-6t ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of indiv�igning 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
for the legal owner and is duly authorized to make and file this application.
(indicate archi(e"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 confonnance 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 ! Sworn to before me this
day of Q c4w ,20 d y , 20
az
Signature of Propertykwner &gnature of App scant
4,41 i f-/ON 1 �S 611
Print Namc of Property Owner aryMblic
Applicant
Notary Public
CHNIS ER J.BRADBURY
Notary Public,State of New York
No.01 BR6159985
oualified in 1Nestchaster County
Commission Expires January 29,20.�
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6/1/2024