APPLICATION FOR TENT PERMIT
VILLAGE OF CEDARHURST
Permit No. __________________________
Date Received: _____________________
www.cedarhurst.gov | building@cedarhurst.gov
Issued Pursuant to the Provisions of the Building Zone Ordinance and Building Code of the
VILLAGE OF CEDARHURST, NASSAU COUNTY, NY
PLOT DIAGRAM
NOTE: - This application is to be made out in duplicate, together with
information sheet for Department of Assessments, and together with
separate plot plan or survey. Two (2) fully detailed architectural and structural
drawings to a scale of at least one-quarter inch to the foot shall accompany
application for permit, one set to be led with the records and one set thereof
(bearing the approval of the Building Department) shall be kept at the site
of the work.
Zone: ________________ Section: ________________ Block: ____________ Lots: _____________
Location: _________________________________________________________________________________________
General description of proposed work: __________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
NCFM Permit Number: ______________________________________________________________________________
HVAC WALLS HAZMAT COOKING FIRE EXTINGUISHERS MAX OCCUPANCY
QUANTITY
NOTE: Locate all buildings and indicate all set-back dimensions, exits/entrances, re system locations, hazmat locations,
and any other pertinent information clearly on the plot diagram.
EVENT DETAILS
Start time:__________________ End time:__________________ Number of people expected: ____________________
Setup date/time: _______________________________________ Removal date/time: ___________________________
Emergency contact info
Name:_______________________________________________________ Phone Number: ______________________
Company: _______________________________________________________________________________________
In consideration of the granting of the permit requested the applicant agrees to comply with all the rules and regulations of the Building Code and the
Building Zone Ordinance of the Village of Cedarhurst, and with every other provision of the Ordinances of the Village of Cedarhurst and with every other
provision of law relating to the erection or alteration of said structure.
APPLICATIONS FOR TENT PERMITS WILL BE EXAMINED AS SOON AFTER FILING AS VOLUME OF BUSINESS
ALLOWS. NO WORK IS TO BE STARTED UNTIL TENT PERMIT APPLICATION HAS BEEN APPROVED BY VILLAGE
BUILDING DEPARTMENT.
Fee Amount: _______________ Receipt #: ________________ Check #: ____________________ Cash
Name Address Telephone #
Property
Owner
Company
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of the Incorporated Village of Cedarhurst
Signature of applicant
Signature of owner
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signature
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