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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.org
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
August 22,2023
Village Of Rye Brook
938 King Street
Rye Brook,New York 10573
Re: Harkness Park, Rye Brook,New York 10573
Tent Permit#23-001 issued on 6/5/2023
This certifies that the temporary tent installed under the above captioned permit has been satisfactorily
removed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
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BUILDING DEPARTMENT H
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VILLAGE OF RYE BROOK MAY 12 2023
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 VILLAGE OF RYE BROOK
m2m.ryebrook.or2 BUILDING DEPARTMENT
TENT / CANOPY / MEMBRANE STRUCTURE PERMIT APPLICATION
FOR OFFICE USE ONLY: n
Approval Date: JUN 0 5 202It
�o�3'GY.� Application Fee: $
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Approval Signature: Permit Fee: $
Disapproved: Other:
Application dated: 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. rk
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1. Job Address: R 40 10�T �l 1 — i"/ KWLSS SBL: Zone:
2. Business/Property Use: NYS Use Class:
3. Property Owner: VL 1 0,V 6tZ— / Address: 4 3C K/rl q �,
Phone#: �j l 9�! / Cell L7 email: LKI
4. Applicant: 14n ICP K U 1 i ICE( Address: :M e Q S
Phone#: Cell#: email:
5. Tent Company: Address:
Phone#: Cell#: email:
6. Number,Size(s)&Use(s)of Tent/Canopy: rrt— ' a l'AyEL
7. Exact Location(s)of Tent/Canopy: 'r ASS C'
8. Installation Date: V7 2__2�, Removal Date: 3 —31 ?3
9. HVAC Required:No:X•Yes:( )Describe:
10. Electrical Required:No:X•Yes:( )Describe:
11. Plumbing/Sanitary Required:No:/K•Yes:( )Describe:
12. Cooking Equipment:No( •Yes( )Describe:
1
8/12/2021
STATffNEW YORK,COUNTY OF WESTCHESTER ) as:
r11 CP t N)\C IC � ,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 0
day of ,20 day f , 20
Signature of Property Owner S' ture of Applicant
.Jatnl 'LL � � �u +� ICIC
Print Name of Property Owner Print Me of Applicant
V �
Notary Public Notary Pu A
Public,State of Nev, York
No.01RIWI398
QuaOtied In Westchester Canty
Comn*Won Expires September 26,2c
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.
2
8/12/2021