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VILt,'OEET
E/of R ROOK
938 KIN RYE B NY 10573 MAR - 7 2025
4 39-0 6t
ov VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date:_ AQT_4 )nqcP mit Application#
Approval Signature: ARMTECTURAL REVIEW
BOARD: _
Disapproved: Date: / o�
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary
ZBA Approval Date: Case#
Other: `
Application Fee:4� L , �� Permit Fees:
FENCE / WALL / GATE PERMIT APPLICATION
Application dated: 2�— is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Pennit
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.
I. Job Address: (j �vi fV- ,d (7 r,ve Q
2. Oc �cupancy/Use: / 4 S.B.L.#: / c)9i i 6' 7—/— 1 Zone: —fS
3. Proposed Fence/Wall/Gate(describe in detail):
VNe11 jW r� �/ �11�w+ I�► t��► -f��►le S ft'a v n �� ram„ -ArJ b�,),tS
101 o �l ra✓ SEG
4. Property Owner:
Address: 10 rD v14 r e(d 5 U
Phone# Cell#q I`(—3 —email: �e. L, F f y 1�fP 0)I'r''Gl t .L 0 ►'�
J
Applicant:
Address:
Phone# Cell# email:
Architeet(Engineer:
Address:
Phone# Cell# r email:
Contractor: t4i r (f -, I
Address&Phone: '+ �ca� a W �/M (e f C�"r` 7�' wr
5. If building is located on a comer lot,which str t does it front on:
6. What is the estimated cost of construction Oc), O G
(NOTE:The estimated cost shall include all site irfiprotrements,labor,material.scaffolding,fixed equipment,professional fees.and
material and labor which may be donated gratis.)
7_ Estimated date of completion: CO--
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:
,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 24 2� day of , 20
of Property Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
Notary P Notary Public
GRSGM M.RNERA
Ntrtary public,State of New York
No.01 RI6441398
Qualified In Wastcbester County
Commission Expires September 26,20
2