HomeMy WebLinkAboutTP22-001 �yE 6R
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VILLAGE OF RYE BROOK
MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914)939-0668 Christopher J. Bradbury
www.ryebrook.or,g
TRUSTEES BliILDING & FIRE INSPECTOR
Susan R. Epstein \1ichael J. Izzo
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
September 6,2022
Village Of Rye Brook
938 King Street
Rye Brook,New York 10573
Re: Harkness Park, Rye Brook,New York 10573
Tent Permit#22-001 issued on 6/21/2022
This certifies that the temporary tent installed under the above captioned permit has been satisfactorily
removed.
Sincerely,
Michael J. Izzo
Building&Fire Inspector
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BUILDING DEPARTMENT I O v
VILLAGE OF RYE BROOK H SUN 15 2022
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
www.rygbr000k-m BUILDING DEPARTMENT
TENT/ CANOPY / MEMBRANE STRUCTURE PERMIT APPLICATION
FOR OFFICE USE ONLY:
J UN 2 2 2022 c��
Approval Date: ermit# � .:�_ Application Fee: $
Approval Signature: VVW Permit Fee: $
Disapproved: Other:
Application dated: 1 �� is hereby made to the Building Inspector for the issuance of a Permit to place a Tent,Canopy,or other Fabric or
Membrane Structure on public or private property within the Village of Rye Brook in conformance with Chapter 31 of the NY State Fire Code as per
detailed statement described below.
1. Job Address: 10 411DOI SBL: Zone:
2. Business/Property Use: pp NYSS Use Class:
3. Property Owner: Q e O C CO 0 Address: 9 3g S
Phone#: / _5d Cell#:�Ty3p8-,�0 ? email: T KU N I bel Y 4u&trd,1V g
4. Applicant: .TQ r1 1 C? VV✓11 C le 1 be4-49ddress: 57i1� 010
Phone#: Cell#: email:
5. Tent Company: Address:
Phone#: Cell#: email:
6. Number,Size(s)&Use(s)of Tent/Canopy: _ TQ h+ aQ x yd 1-1QA V�L CA�'t p
7. Exact Location(s)of Tent/Canopy: U A 2 k g E S-.5'
8. Installation Date: Lp � Removal Date: O -3)
9. HVAC Required:No:( •Yes:( )Describe:
10. Electrical Required:No:( •Yes:( )Describe:
11. Plumbing/Sanitary Required:No:(x)•Yes:( )Describe:
12. Cooking Equipment:No q•Yes( )Describe:
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8/12/2021
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.
Sworn to before me this Sworn to before me this
day of , 20 day of Ste^ ,20�
Signature of Property Owner S' ature of Applicant
�Tq n) Ce et)0 L��
Print Name of Property Owner t Name of Applicant
A�2�_�\� A 0, �L
Notary Public Notarf)NA t MELILLO
Notary Public,state of New York
No.O1ME6160063
Qualified In Westchester County
Commission Expires January 29.201L.
This application must be properly completed in its entirety and must 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.
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8/12/2021