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BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET
RYE BROOK, NEW YORK 10573
PHONE (914)939-0668 FAX (914) 939-5801
WEB SITE: www.rvebrook.orQ
FOR OFFICE USE ONL Application No:
Approval Date: ermit# ARCHITECTURAL RENEWBOARD.-
Approval Signature. 'Z APPROVED DATE:
Disapproved a/c: CHAIRMAN.
Villaze Board Referral. SECRETARY.
Approval.
ZBA Approval Date. Case#
Permit Fee:
APPLICATION FOR A tSIGN CPERMI
******************************************************************************************
Date:
Application is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the
construction of a sign, as per detailed statement as described below.
j 1. Address: c c�,: S f1�,00." � ?mil`f c✓
2. Section: Block. Lot: Zone:
�a2co 3. ✓Name of Applicant: M4400 Address: Phone No.: j(^ 3 /
Name of Owner: d st Address: ybb h
Name of Registered Architect: Address: Phone No.:
Name of Registered Engineer: Address: Phone No.:
Name of Builder: Address: Phone No.:
Who will supervise the work: Address: Phone No.:
4. If building is located on a corner lot,which street does it front on
;: 5. Quantity of signs or devices that are to be erected:
6. Size of sign or device: J
7. Number of feet from grade level to lowest point of sign or device: '
8. Number of feet from grade-level to highest point of sign or device T i
9. How supported? \V c-', 11 � E 6" How fastened?
10.Does the sign require electrical work? T( 0 (If yes, all electrical work including
lighting, requires a separate permit to be filed by a licensed electrician).
11.What is the estimated cost of construction:
Rt vQt_ ;
12. d date of cann"e"on.
The State Workman's Compensation Law provides that before a Building Permit is issued,the Contractor,Owner,Architect,
etc.,shall produce the following information:
Name of Compensation Insurance Carrier:
No.of Policy: Date of Expiration:
STATE OF NEW YORK )
/ ) as:
COUNTY OF WESTCHESTER )
Il P-2(O Al Q ECa PA( O BEING DULY SWORN DEPOSES AND SAYS THAT(S)HE IS THE
(name of individual signing application)
APPLICANT ABOVE NAMED. (S)HE IS THE �' C /�" ?� OF SAID OWNER
(contractor,agent,corporate officer,etc.)
OR OWNERS,AND 1S DULY AUTHORIZED TO PERFORM OR HAVE PERFORMED THE SAID WORK AND TO MAKE AND FILE
THIS APPLICATION: THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE TO THE BEST OF HIS
KNOWLEDGE AND BELIEF,AND THAT THE WORK WILL BE PERFORMED IN THE MANNER SET FORTH IN THE
APPLICATION AND IN THE PLANS AND SPECIFICATIONS FILED THEREWITH AND IN ACCORDANCE WITH ALL
APPLLICABLE LAWS,ORDINANCES AND REGULATIONS.
Sworn to before me: I,—
This��day of prr I ,20-Q-� (Signature of applicant)
Notary Public.
County:
JANE KANNING
Notary Public, State of New York
No 5062305
Qualified in Westchester County
Commission Expires June 24, °
a
New York United Hospital Medical Center
Care Without Limits.M, January 9, 2004
Michael Izzo
Building Inspector
Village of Rye Brook
938 King Street
Rye Brook, NY 10573
Dear Mr. Izzo:
On behalf of the 2004 Mayfair Board of Directors, I am requesting permission for The
New York United Hospital Medical Center to place a sign at the corner of Bowman
Avenue and Ridge Street from Wednesday, April 21, to Saturday, May 1, 2004. In
compliance with the sign law of the Village of Rye Brook, we assure you that our
Mayfair sign will meet your standards of 3' x 4'. The Mayfair event will be held on
Saturday, May 1, at Playland in Rye.
If confirmed, the staff of United Hospital Medical Center will deliver and pick up the
sign at a mutually convenient time. Jose Moniz, Facilities Director (934-3182), or
Angela Martin(934-3091)will arrange for the delivery and pick-up of the sign.
For all those in our communities who benefit from the services offered by United, thank
you for your consideration of this request.
Please call the Mayfair Office at 934-3415, or fax a letter of confirmation to 934-3416.
Sincerely,
�+ / n
Janet F. Meyers
Mayfair Office D 2
V
cc: Glenn W. Wilson, Win Ridge Realty, LLC J
Jose Moniz, Facilities Director y AN 1 5 2004
Angela Martin V11LAcE OF
BUQ01NG O r'rtDpK
DEPT
Member New York Presbyterian Healthcare
406 BOSTON POST ROAD • PORT CHESTER • NEW YORK 10573 • (914) 934-3415 • FAX (914) 934-3416
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