Temporary Outdoor Dining and Displays Application

Temporary Outdoor Dining and Displays Application
- THERE IS NO FEE FOR THIS APPLICATION -
Property Owner Point of ContactBusiness Owner Point of Contact
Property Owner Point of Contact
Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Business Owner Point of Contact
Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Applicant E-mail Address:
example@example.com
Location Information
Name of Establishment:
Address:
(If applicable, please include building and suite #)
(Note: Please leave Block, Lot & Zone if unknown)
Block:
Lot:
Zone:
This application must include a sketch of the proposed outdoor area, to scale as best as possible, depicting the dining area (including tables and chairs), sales areas (including display tables and registers), temporary structures, pedestrian traffic flow, physical barriers, signage and lighting.

Applicant must submit a Hold Harmless Agreement (see attached) and agree to furnish a Certificate of Insurance specifically naming the Borough of Prospect Park as additional insured providing general liability coverage including, bodily injury and property damage with minimum limits not less than $1,000,000.

The proposed outdoor dining and display area must meet the following standards:
- Tables and chairs cannot impede accessibility, pedestrian walk, travel ways, vehicular traffic or firelanes.
- In conjunction with Prospect Park’s Resolution No. 2020-95 pursuant to the Governor’s latest Executive Order and State Executive Directive 20-014 all social distancing guidelines shall be maintained.
- Prohibit smoking in any outdoor areas designated for the consumption of food and/orbeverages.
Have you read Covid-19 Protocols for Food or Beverage Establishments Offering Service in Outdoor Areas Pursuant to Executive Directive 20-014 Executive Order 150 and Borough Resolution No. 2020-95 Authorizing Temporary Outdoor Dining and Displays, and do you propose as part of this application to adhere to all of the mandated protocols, impose requirements on employees in and institute policies with respect to customers in?

YesNo
By signing this application, you are certifying that the above stated information is accurate and the documentation submitted with this application is a true representation of the property. Furthermore, you are acknowledging that this application is temporary relief to support business operations while applicable COVID-19 restrictions are in effect due to State Executive Orders, or other Federal or State requirements are imposed due to the COVID-19 pandemic. Any approval ultimately granted is subject to change whenever a new Executive Order, or Federal or State requirements are added or changed. The Zoning Officer and other Officials deemed appropriate reserve the right to inspect the property if approved to verify compliance with the authorized zoning permit.
Property Owner Signature *
Name:
Date:

MonthDayYear
Date
Applicant Signature & Name (if different):
Name:
Date:

MonthDayYear
Date
*OFFICE USE ONLY*
Permit #:
Date Issued:

MonthDayYear
Date
Zoning Review:
Health Review (if required):
Police Review:
Administration:
Should be Empty:

Temporary Outdoor Dining and Displays Application

Location Information

*OFFICE USE ONLY*

OFFICE USE ONLY