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BUILDING TMENT
VIL EOFRYE OOK
p
938 KING E )939-0668 T RYE BRooK,NY 10573 OCT 2 5 224
wv►�yrrlrvrbroolcny. ov VILLAGE OF RYE BROOK
E MENT
FOR OFFICE USE ONLY:
Approval Date: ou _ erm" Application#
Approval Signature: TTM ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee:,A 100- 0b Permit Fees:
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: /0-c-) 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,additions,alterations or for a change in use,as per detailed statement described below.
1. JobAddress: (0 fiIA All �+r• 1 __
2. Parcel ID#: _ - 1 Zone:
3. Proposed Improvement(Describe in detail): f-eA pr— &Dj
4. Property Owner: SGM I!AA4 t►-�Ivg t_ _
Address:
Phone# Cell# ���, 2 �� e-mail qV..I&jo L
List All Other Properties Owned in Rye Brook:
Applicant:
Address:
Phone# Cell# e-mail
Architect: '1 t_V_ ��c�,d�l�-�✓
Address:
Phone# 9 S-i 9 01 , t-)b q Cell# e-mail
Engineer:
Address:
Phone# Cell# e-mail
General Contractoix-
00 //l [3 DQ �C — V)� /P z-
Address:)00. !q47 kh-�7/77 Q Ile V /0
Phone 4 1C �)&7c�-Cell# e-mail
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6/1/2024
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5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction:
6. Area of lot: Square feet: 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: 1s`fl: 2"dfl: 31 fl:
10. Total Square Footage of the proposed new construction:
11. For additions,total square footage added: Basement: I It fl: 2"d fl: 3'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. Number of stories: Overall Height: Median Height:
15. Basement to be full,or partial: finished or unfinished:
16. What material is the exterior finish:
17. Roof style;peaked,hip,mansard,shed,etc: Roofing material:
18. What system of heating:
19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this
application.
20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire
suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No:
(if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a
Stormwater Management Control Permit as per§217 of Village Code? Yes: No: Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings)
23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No:
(ifyes,you must submit a Site Plan Application,&provide a detailed topographical survey)
24. 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)
25. 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)
26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No:
(f yes,applicant must submit a Tree Removal Permit Application)
27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No:
Indicate: TIER 1: TIER IL TIER III: (if yes,a Home Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
29. What is the total estimated cost of construction: $ 6: o QD Note.The estimated cost
shall include all site improvements, labor,material,scaffo in ,fixed equipment,professional fees, including any material and labor which
may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O.
30. Estimated date of completion:
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6/1/2024
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.
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. By signing this application, the property owner further declares that he/she has inspected the subject
property, and that to the best of his/her 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.
Sworn to before me this 5Sworn to before me this
day of ! , 20()4 day of . 20
Signature of Pr pe A er Signature of Applicant
Scl r'4'1 tM a d rk lkqt C
Print Name of Pr erty Owner Print Name of Applicant
Notary Pu Notary Public
GREGORY M.RN€RA
Notary Public,State of New York
No.01 R16441398
Qualified In Westchester County
Commission Expires September 26,18`
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