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BUILDING DEPARTMENT
�`
VIL GE OF RV ROOK D � ��
IE
938 KIN REET RYE BROOK,NY 10573
, )93 OCT 18 2021 gE
14 9-0668
VILLAGE 01= BROOK
FOR OFFICE USE ONLY:
Approval Date: 1 8 1 Permit# t30� Application#
Approval Signature: kk=_� ARCHITECTURAL REVIEW
BOARD: ;
Disapproved: ; Date: l L `1 Vl�
BOT Approval Date: Case# Chairman: MLI
PB Approval Date: Case# Secretary: -- t
ZBA Approval Date: Case#
Other: --7
Application Fee: ! ermit Fees: b `
FENCE J WALL J GATE PERMIT APPLICATION
Application dated:in I/5 f 2 ( is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit
for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of
Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code.
1. Job Address:22 Valley Terrace Rye Brook NY 10573
2. Occupancy/Use: 1 family S.B.L.#: .-, G-2 —Vk Zone: 7esidentialX
3. Proposed Fence/Wall/Gate(describe in detail):=
Furnish and install 64' linear privacy fence --
4. Property Owner: Ralph Camacho
Address: 22 Valley Terrace. Rye Brook, NY 10573 —
Phone# 914-939-4029 Cell# 914-227-6740 email: rcamacho5450_Qmail.com --
Applicant: Adelo Ramirez —
Address: 5 Anderson St Apt 402 New Rochelle N Y
10801 ==Phone# Cell=
# 914-393-2406 email: losgemelosl67@me.com —Architect/Engineer:=
==Address:=
==Phone=
# Cell# email: ---
Contractor: Gemelos Renovation&Maintenance
LLC
5. Address& Phone: 5 Anderson St.402 New Rochelle NY
10801 914-393-2406
6. If building is located on a corner lot,which street does it front on: N/A
7. What is the estimated cost of construction $2,828.26 NOTE:
The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and=mate for
I..i... -.1.:.•l........4-...4....... A:-1
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:
Ralph Camacho , 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
Adelo Ramirez 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 tAeflorV me,this Sworn to before me this
day of 46� , 20 0'\ I day o0G�` 20 2-1
Signature o Property Owner Signature of Applicant
R h Camacho Ralph Camacho
Pri ame of Property ner Print Name of Applicant
n�_WOItc U 101- Notary Public
MIRIAM P GOMEZ
Notary Public, State of New York
Registration #01 G06 789 2
Qualified In Westche o n
Ly-
Commission Expires
2
8112/2021