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$UILDING DEPARTMENT
DEC ' 2025 VILLAGE OF RYE BROOK
938 K NG STREET RYE BROOK,NY 10573
VILLAGE OF RYE BROOK (914)939-0668
BUILDING DEPARTMENT
Apprm al 1):oc DEC 16 2025 P '�;5 Application#
Approval Sir)natary V ARCHITECTURAL REVIEW BOARD:
Date:
BOT Approval Date: Case-# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
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Application Fee: Permit Fees: `, •�
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ROOF PERMIT APPLICATION
Application dated: � is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to
Re-Roof an Existing Building,as per detailed statement described below.
1. Job Address: +-1 q I�_ Tt�.�t) IfO1ff W �i�ae SBL: 1 Z`y
Property Owner: tc'.+1LtL' I Szc ke_ Address:W gush KO OLy Close,
Phone#: Cell#: 151 �} —`tU email:
2. Applicant: �A is nc►-P,i ��<e— Address: Fl(,/ 6ru.,s� I,Lot 6! Sef'_
Phone#• Cell#• S-I& L68' c/08S7 email: ,,,,`at.L
3. Roofing Contractor: ; —ITT— {�c3U Address: G� �lrr/riDr!y rd 1r tt o- ec_ A �+'ld.J'�',/
Phone#:<;�L4 6_-53 I "9 y T Cell#: email: (n,dAe rm o--roe).Co/?)
4. Job Description,list all Methods&Materials: Re-move a ,fe.1 ,S ul r ^I'
r d e S der- Sd-r A=r r l�r�L
5. Estima ed Cost of Job:$ cyJ 00
6. If corner property,indicate street frontage:
7. Construction Type: t7" NYS Construction Class:
& Number of stories: � 16 S Height:
9. Is garage being re-roofed:No:( )-Yes:()o Attached No: ( )•Yes: (l�Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: �e oj<4
11. Estimated date of completion:
_ -
611/2024
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 iegal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant..
STATE OF NEW ORK,COUNTY OF WESTCHESTER ) as:
/1't.(_t uc-[ I ke ,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
h/ 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 belie,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 an accompanyinga roved lans and specifications,as well as in accordance with the New York State Uniform Fire
Y PP P Pe
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 t Qw� 20 z'� day of , 20
Signature of Pro er Signature of Applicant
Print Name of Owner Print Name of Applicant
Notary Public Notary Public
ALEXANDER S.YELLEN
NO-TARY PL BLIC,STATE OF NEW YORK
No 02Y-6 dZ L s(.,
Qualified in Nark Lounty
Commission Expires April B,20=
6/1/2024