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BUILDING DEPARTMENT
VILLAGE OF RYE'BROOK OCT 2 9 2025
938 KING STREET RYE BROOK,NY 10573
10M Uo;.iov
FOR OFFICE USE ONLY: /���� .
Approval Date: Permit# - ; 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: b
ROOF PERMIT APPLICATION
Application dated: I,7 1 2Ci(25 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: 84 AarF_ �yEgq,�1*�N�-f SBL: ��.���"I Zone: R3-F
Property Owner: A&j(,FI A pEpT)om ) Address: %4- ikLC1 S AvC ONEgen Or, NCA
Phone#: Cell#: 0117 - (004 -C)1-1(o email: 1g83 Q_!�MCL1 CDM
2. Applicant:qs)r\ AAACl��i Address: 1 0-7 15t kie I*4 NM Ar r(_) KM
Phone#: Cell#: 203-424 (,;'Too email: C4_c n1 Gej,,5 S i 6, !�rrtL11 .Corti
3. Roofing Contractor: jbLo-fH�(-j9-S C&,6RM_TIQ IJ i 11 Address: IOr7 IS+ ka< :A 4 PWIC I Ill-
Phone#: Cell#: -D.�,-424-h`loo email: C.�Grn�G�.SS �gmcc i 1.Cam
4. Job Description,list all Methods&Materials: Q O F 1?EP i ACG*nG N r
5. Estimated Cost of Job: $ I f, 21 O (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:
7. Construction Type: NYS Construction Class:
8. Number of stories: 2 Height:
9. Is garage being re-roofed:No: ( ) •Yes:(X Attached No:( )•Yes:(x)Number of Cars: 2
10. Is roof peaked,hip,mansard,flat,etc: Hip
11. Estimated date of completion:
6/l/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:
, 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
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.
C�
Sworn to before me this 1) _ Sworn to before me this a
da C �e� , 20 day of �-2� , 20,;�-
Signature of Pro rty Owner Si Ap licant
eA 6— RC r dL AtJ A Mf�C�551
11,Ml.neof Property Owner P ' t ame of Applicant
Notary Public Notary Public
SHARI MELILLO
Notary Public,State of New York
No.01ME6160063 SHARI MEULLO
Qualified In Westchester County 21 Notary Public,State of New York
^nmrnission Expires January 29,20_ No.OIME6160063
Qualified in Westchester County
commission Expires January 29,20Z__7
-2-
6/1/2024