Fillable Form 4324 (City of Lebanon)

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Form 4324 (City of Lebanon)

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CITY OF LEBANON N.H.—Applications & Permits
Lebanon City Manager’s Office:
Physical address: 20 West Park Street
Lebanon, NH 03766
Mailing address: 51 North Park Street
Lebanon, NH 03766
Email: manager@lebanonnh.gov
Phone: 603-448-4220
Lebanon City Hall offices are closed to the public until further notice. All City Department staff will be available to
answer questions via phone or email.
The City of Lebanon continues to accept applications and permits via email, through the mail or dropped into the
green mailbox outside of the entrance to 20 West Park Street. Application and permit information can be found
on our website here:
https://lebanonnh.gov/203/Applications-Permits
All permits issued for the 2020 calendar year will remain in effect at this time, but with the rapidly evolving
circumstances regarding COVID-19, these may be rescinded. You will be notified at the earliest possible time for
you to plan accordingly.
The City of Lebanon is actively engaged with the New Hampshire Department of Health and Human Services
(DHHS) and our local and regional partners with regards to State and local response to the COVID-19 virus.
We encourage all to visit our website for the latest updates and information:
https://lebanonnh.gov/1350/COVID-19
City of Lebanon—Application for Vendor Permit
Last Revised 1/29/2019
Page 1 of 4
CityCodeChapter179
§179‐2.DEFINITIONS
AbuttingBusiness—Anylegitimatebusinesslocatedwithin,whetherbylease,rentalorownership,a
propertyinthecentralbusinessdistrictabuttingNorthorWestParkStreetsortheMallarea.
PublicStreetorSidewalk—Include all areas legally open to public use as public streets, sidewalks,
roadways,highways,parkways,alleysandanyotherpublicway.
Stand—Any newsstand, table, bench, booth, rack, handcart, pushcart or any other ixture or device
whichisnotrequiredtobelicensedandregisteredbytheDepartmentofMotorVehicles,usedforthe
display,storageortransportationofarticlesofferedforsalebyavendor.
Vendor—Anyperson,includinganemployeeoragentofanother,whosells or offers to sell food,
beverages,goodsormerchandiseonanypublicstreetorsidewalkfromastand,motorvehicleorfrom
hisorherperson.
§179‐5.APPLICATION
The application for a vendor’s permit shall contain all information relevant and necessary to
determinewhetheraparticularpermitmaybeissued,includingbutnotlimitedto:
A. Proofofidentityandbusinessaddressoftheapplicant.
B. Abriefdescriptionofthenature,characterandqualityofthe food, beverages, goods or
merchandisetobesold.
C. Ifemployedbyanother,thename andbusinessaddressof theperson,irm,association,
organization,companyorcorporation.
D. Ifamotorvehicleistobeusedinthevendingbusiness,adescription of the vehicle,
togetherwiththemotorvehicleregistrationnumber.
E. Adescriptionoftheproposedlocationofthevendingbusiness and the length of time
duringwhichitisproposedthatthebusinessshallbeconducted.
F. Nopermitshallbeissuedtoanapplicantunlesstheapplicantassumesliabilityfor
damages, property loss, injury or death or other related liability resulting from the
activitiesofthevendingoperation.
§179‐7.RESTRICTIONSAPPLICABLETOALLVENDORS
A. Stands/carts/vehiclestandsshallnot:
 Exceed9feetinwidthand18feetinlength.Heightshouldnotexceed10feet.
 Impedeaccesstotheentranceofanyadjacentbuildingordriveway.
 Occupymorethanhalfoftheavailablesidewalkwidth.
 Locatewithin25feetofairehydrant,ireescape,busstop,loadingzoneordriveway
ofairestation,policestationorhospital.
B. Hoursofoperation. Vendorsshallbe allowedtoengageinthebusinessofvendingonly
between7:00a.m.and9:00p.m.,exceptforabuttingbusinessesoperatingunder§179‐4D,
thatshallbeallowedtooperateintheirpermittedareaduringtheirnormalbusinesshours
orasotherwiseprovidedpursuantto§179‐4D.Allvendingstandsmustberemovedfrom
CITYOFLEBANON—ApplicationforPermit
VENDORS
City of Lebanon—Application for Vendor Permit
Last Revised 1/29/2019
Page 2 of 4
publicpropertyduringnon‐vendinghours,exceptforgoodreasonandbyspecialwaiverof
theCityManager.
C. Handicapped areas. No vendor shall block access to any handicapped parking space or
accessramp.
D. Removaloftrash.Alltrashordebrisoriginatingfromtheoperationofthevendingstand
shallbecollectedbythevendorandremovedfrompublicpropertydaily.
E. TheareaoccupiedbyavendorshallbelimitedtothatareasodesignatedbytheCity
Manager.
F. Novendorshallutilizeanopenireinconnectionwiththesaleordisplayofthevendor’s
wareswithoutapermitfromtheLebanonFireDepartment.
G. No vendorshallshout,makeanoutcry, blow ahorn, ringabell, oruseany othersound
deviceforthepurposeofattractingattentiontoanygoodswhichthevendorproposesto
sell.Vendingoperationsmustbereasonablyquiet,i.e.novendingstand orvehicle shall
emit excessive mechanical or compressor noise to the detriment of the environment
aroundColburnParkorMall.
H. Novendingactivityshallunreasonablyimpedethelowofvehicularorpedestriantrafic.
TheCityManagermayimposerestrictionsinadditiontothoselistedinthissection,when
warrantedinordertoassureatalltimesthepublic’suseofstreets and sidewalks for
purposesoftravel.
I. Itistheintentofthischapterthatgoodsormerchandisetobeofferedforsaleshallconsist
solely ofitemswhich can easily be carried away from the sales location by pedestrians,
andwhichentailnospecialneedsorproblemspertainingtoloading,handling,installation
ordelivery,suchasmightinterferewithvehiculartraficorwithotherusersofthepark
and mall. Heavy or bulky items such as tires, large appliances, large furniture items,
motorizedequipmentorthelikearegenerallynotpermitted.Allgoodsor merchandise
displayedshallbeforimmediatesaleanddelivery.Displaysoradvertisingwhoseprimary
purposeistopromotefutureoroff‐sitetransactionsarenotpermitted.TheCityManager
may denya permit to any vendor whosestand/vehicle/cart does not meet theintentof
thisSubsection.
HAWKER’S&PEDDLER’SLICENSE‐AvailablefromStateofNH
AHawker’s&Peddler’sLicensemustbeprovidedifthefollowingconditionsareapplicable:
InaccordancewithRSA320:1,“Theterms“hawker”and“peddler”shall meanand include any
person,asdeinedbyRSA358‐A:1,eitherprincipaloragent,who:
I. Travelsfromtowntotownorfromplacetoplaceinthesametownsellingorbartering,or
carryingforsaleorbarterorexposingtherefore,anygoods,wares,ormerchandise,either
onfootorfromanyanimal,cart,orvehicle;OR
II. Travelsfromtowntotown,orplacetoplaceinthesametown, offering to perform
personalservicesforhouseholdrepairsorimprovements,orsolicitsorinducesanyperson
tosignanycontractsrelatingtohouseholdrepairsandimprovements,includingcontracts
forthereplacementorinstallationofsidingonanyresidenceorbuilding;OR
III. Keepsaregularplaceofbusiness,openduringregularbusinesshoursatthesamelocation,
butwhooffersforsaleorsellsanddelivers,personallyorthroughhis agents, at a place
otherthanhisregularplaceofbusiness,goods,wares,ormerchandise.
City of Lebanon—Application for Vendor Permit
Last Revised 1/29/2019
Page 3 of 4
INSURANCEREQUIREMENTS
ACertiicateofLiabilityInsurancemustbeprovidedforeventswhichareanticipatedtoattract25
ormoreparticipants.Iflessthan25participantsareexpected,theCitymaywaivethe
requirementattherequestoftheapplicant.(InsuranceFormAttached)
Whenrequired,theCertiicateofLiabilityInsurancemustlisttheCityofLebanonasanadditional
insured,andmustbeinanamountnotlessthan$500,000perperson and $1,000,000 per
occurrence.
MOBILEFOODTRUCKS(effectiveJanuary1,2019)
 Allmobilefoodtrucksshallberequiredtohaveaninspectionandoperationalpermitissued
by the Lebanon Fire Department prior to operating within the City of Lebanon. Please
scheduleinspectionbycallingLebanonFireStation1at(603)448‐8810.
 AnymobilefoodtruckoperatingwithintheCityofLebanonthatproducesgreaseladenvapors
shallbeequippedwithanautomatic ire extinguishing system per the 2018 IFC Section
319.4.1.
 AnymobilefoodtruckoperatingwithintheCityofLebanonthatproducesgreaseladenvapors
shallbeequippedwithLP‐gasalarmperthe2018IFCSection319.8.5.
 Toreviewalloftheapplicablerequirementsformobilefoodpreparationvehicles,pleasevisit
the International Code Councils website, section 319 at the following link: https://
codes.iccsafe.org/public/document/IFC2018/CHAPTER‐3‐GENERAL‐REQUIREMENTS.
Checklist:
 CompletedApplication
 InsuranceRequirementsForm
 CertiicateofInsurance
 CopyofNHHawker&PeddlerLicense
 CopyofNHFoodLicense
 FireDepartmentInspection
City of Lebanon—Application for Vendor Permit
Last Revised 1/29/2019
Page 4 of 4
CITYOFLEBANON—ApplicationforPermit
(INACCORDANCEWITHCITYCODECHAPTER179)
VENDORS
BUSINESSNAME:
CONTACTPERSON:
STREET: CITY: STATE: ZIP:
PHONE: EMAIL:
VENDINGINFORMATION
DesiredDates:
ColburnPark—Area:
ABCD
VendingParkingSpace(SouthParkStreet):1 2 3 4 5
HanoverStreetMall
Daily$10Weekly$50Seasonal$100AbuttingBusinessPermit$125(one‐timefee)
DOOR‐TO‐DOORSALES
Name(s)ofIndividuals:__________________________________________________________________________________
Area(s)ofDoor‐to‐DoorSales:
__________________________________________________________________________________
VehicleInformation:Year______Make_________________Model__________________Color_________________
LicensePlate#__________________________IssuingState:__________________________________________________
 PleaseCompleteAttachedInsuranceRequirementsForm
 UnlessaWaiverisGranted,PleaseProvideaCertiicateofLiabilityInsurance
PermitType
LocationRequested

FOROFFICEUSEONLY
DATERECEIVED: PERMIT#
Waiver(s)Requested:
CertiicateofLiabilityInsurance Worker’sComp BondforDamage
FINALAPPROVAL:
CITYMANAGER: Date:
InsuranceRequirementsFormProvided FireDepartmentInspection
NHFoodLicense NHHawker&PeddlerLicense
City of Lebanon
Insurance Requirements
Page 1 of 3
CITY OF LEBANON N.H.
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                

INSURANCE REQUIREMENTS
I, (please print legibly) , hereinaer referred to as the
LICENSEE, have requested the use of public facilies, hereinaer referred to as LICENSED PREMISES,
owned and operated by the City of Lebanon, hereinaer referred to as the CITY. The LICENSEE
understands that this aachment constutes a part of that permied use.
1. RELEASE FROM PERSONAL LIABILITY
The LICENSEE hereby releases and forever discharges the City, its heirs, agents, and assigns from any
an all liability for any and all damage to property the LICENSEE brings to the LICENSED PREMISES or any
and all bodily injury the LICENSEE, its employees, invitees, agents, or assigns may suer while at the
LICENSED PREMISES. The LICENSEE has aached hereto a cercate evidencing worker’s
compensaon insurance overage for any and all of its employees.
LICENSEE Signature Date
1.1 Opon to Waive Requirement for Worker’s Compensaon Insurance: The
requirement for worker’s compensaon insurance coverage may be waived by the CITY
if the LICENSEE ceres that they will not have any employees working at the LICENSED
PREMISES. It is understood and agreed by the LICENSEE that waiver of the requirement
for worker’s compensaon insurance coverage does NOT, however, relieve the
LICENSEE from providing the CITY with a Cercate of Insurance, or liability for claims of
property damage, or personal injury to volunteers or non-employees that my assist at
the LICENSED PREMISES.
I, , hereby cerfy that no employees will
be present at the event, and therefore am requesng a Waiver of Worker’s
Compensaon Insurance by the CITY.
Request for Waiver of Worker’s Compensaon Insurance: [ ] Approved [ ] Denied
City Manager Signature Date
2. RELEASE FROM INDEMNIFICATION FROM THIRD PARTY LIABILITY
The LICENSEE hereby releases the CITY from liability for any property damage or personal injury that
any parcipants may suer while at or on the LICENSED PREMISES. The LICENSEE further indemnies
and holds the CITY harmless from and against all claims for such property damage or personal injury
from third persons on the LICENSED PREMISES at the permission of the LICENSEE, including reasonable
aorney’s fees, whether or not such claims result in ligaon.
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City of Lebanon
Insurance Requirements
Page 2 of 3
2.1 Cercate of Insurance: The LICENSEE understands that it is required to have valid
liability insurance in force to guarantee its promise to pay damages to parcipants
outlined in Secon 2 above.
Aached to this release is a valid Cercate of Insurance (required to be in the
amount not less than $500,000 per person and $1,000,000 per occurrence and must list
the City of Lebanon as addional insured) evidencing the LICENSEE’S ability to indemnify
any individual who claims or might claim that acons of the LICENSEE caused him or her
damage to property or bodily injury.
Tenants Users Liability Insurance Policy (TULIP) is available to individuals or clubs
who need coverage for private events. Low cost coverage is obtainable for single-day
events like weddings, pares, reunions, concerts or charity benets. TULIP insurance
will need to be provided prior to any event held on City property by a private group.
(TULIP informaon sheet aached)
LICENSEE Signature Date
2.2 Waiver of requirement for Cercate of Insurance: The requirement for
Cercate of Insurance may be waived by the CITY if the LICENSEE expects to aract
only 25 parcipants or less. It is understood and agreed to by the LICENSEE that waiver
of the requirement for a Cercate of Insurance does NOT waive the requirement for
acceptance of liability outlined in Secons 1 and 2.
I, , am hereby requesng a waiver
from the requirement to provide a Cercate of Insurance as I do not expect to
aract more than 25 parcipants at any given me during the event.
The LICENSEE further promises that it will return the LICENSED PREMISES to the CITY in a
condion equal to or beer than its condion prior to its use. This includes removal of
any and all equipment which the LICENSEE brings to the LICENSED PREMISES as well as
lier, and also to repair all facilies damaged during the term of the permit.
Request for Waiver of Liability Insurance: [ ] Approved [ ] Denied
City Manager Signature Date
3. LIABILITY FOR DAMAGE TO CITY FACILITIES
Bond for Damage: The LICENSEE posts a bond (or leer of credit or cash deposit received by the CITY
this date) in the amount of $ payable to the CITY to be used by the CITY to
guarantee the promise in Secon 3 above. The bond (leer of credit or cash deposit) shall be in an
amount determined by the City Manager taking into account the intensity of use that the LICENSEE
ancipates for the LICENSED PREMISES. The LICENSEE understands that the CITY may take this bond
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City of Lebanon
Insurance Requirements
Page 3 of 3
(leer of credit or cash deposit) and repair any and all damage, replace any and all equipment
removed, remove any and all lier, or in any other manner expend it in order to return the LICENSED
PREMISES to a condion equal to what it was before the premises permied use.
3.2 Waiver of requirement of bond for damage: The CITY may waive the requirement
for a bond (leer of credit or cash deposit). Waiver of the requirement for a bond
(leer of credit or cash deposit) does not waive the liability of the LICENSEE for damage
to CITY property outlined in Secon 3.
I, , am hereby requesng a waiver
from the requirement to provide a Bond for Damage based on the informaon
provided in this applicaon and the low intensity of use expected at this event.
Request for Waiver of Bond for Damage: [ ] Approved [ ] Denied
City Manager Signature Date
LEBANON FIRE DEPARTMENT
12 South Park Street
Lebanon, NH 03766
Issued: January 29, 2019
Phone: 603-448-8810
FAX: 603-448-8811
Email: fire@lebanonnh.gov
Requirements for Commercial Outdoor Cooking:
Farmer’s Market, Open Sided Pop-Up Style Tents, and Similar Situations:
o All cooking equipment that does not create grease laden vapors shall have a minimum of (1) 5
pound or 2A10BC minimum rated multi-purpose dry chemical extinguisher readily accessible to
the operator.
o All cooking equipment that creates grease laden vapors (broilers, fryolaters, cooking of bacon,
burgers, etc) shall have a minimum of (1) 6 liter Class K fire extinguisher.
Mobile Food Trucks:
o All mobile food trucks shall be required to have an inspection and operational permit issued
by the Lebanon Fire Department prior to operating within the City of Lebanon. Permits are
issued by the Lebanon City Manager’s Office. To schedule the inspection please contact
Maddy Goodell at 603-448-8810 at the Lebanon Fire Department, Station 1.
o Any mobile food truck operating within the City of Lebanon that produces grease laden vapors
shall be equipped with an automatic fire extinguishing system per the 2018 IFC Section
319.4.1.
o Any mobile food truck operating within the City of Lebanon that uses LP-gas shall be equipped
with a listed LP-gas alarm per the 2018 IFC Section 319.8.5
o All mobile food trucks shall be required to have an inspection and operational permit issued
by the Lebanon Fire Department prior to operating within the City of Lebanon.
o All mobile food trucks that do not create grease laden vapors shall have at a minimum (1) 5
pound or 2A10BC minimum rated, multi-purpose fire extinguisher in the path of egress from the
cooking area.
o All mobile food trucks that create grease laden vapors shall have the following equipment:
o Exhaust system which includes grease removal devices (IFC 319.3)
o (1) 6 liter Class K fire extinguisher in the path of egress (IFC 319.4.2)
o Mobile food trucks that utilize propane fueled cooking equipment shall comply with the
following:
o LP-gas containers transported on the vehicle and used to fuel cooking appliances shall
not exceed 200 pounds propane capacity (IFC 319.8.1)
o LP-gas containers shall be securely mounted and restrained to prevent movement (IFC
319.8.2)
Questions related to this bulletin should be directed to the Lebanon Fire Department, Fire Prevention Division at
603-448-8810. To review all of the applicable requirements for mobile food preparation vehicles, please visit the
International Code Council website, 2018 International Fire Code, Section 319. The link is provided below.
https://codes.iccsafe.org/public/document/IFC2018/CHAPTER-3-GENERAL-REQUIREMENTS
LEBANON FIRE DEPARTMENT
12 South Park Street
Lebanon, NH 03766
Issued: January 29, 2019
Application for Mobile Food Truck Permit
Date of Application:
Business Name:
Contact Person:
Business Address:
Business Tele #:
Contact Email:
Location of Food Truck:
**The following checklist will be used by the Lebanon Fire Department for the permit
inspection. An inspection is required prior to operating a mobile food truck within the City.**
Mobile Food Preparation Vehicle Inspection Form
Yes No
Does the mobile food preparation vehicle have appliances that produce smoke or
grease-laden vapors? (IFC 319.1)
Is an exhaust hood provided for cooking equipment that produces grease-laden
vapors? (IFC 219.3)
Is the cooking equipment protected by an automatic fire extinguishing system?
(IFC 319.4.1)
At least (1) 6L Class K fire extinguisher provided for cooking equipment that
produces grease-laden vapors or (1) 2A10BC multi-purpose dry chemical
extinguisher for all other vehicle present? (IFC 319.4.2)
Is the fire extinguisher easily accessible in the path of egress from the cooking
area?
Are cooking appliances connected to fuel supply piping using an appliance
connector complying with ANSI Z21.69/CSA 6.16? (IFC 319.5)
Are cooking appliances movement limited by restraining devices installed in
accordance with manufactures’ instructions? (IFC 319.5)
Does the vehicle have any cooking oil storage tanks? (IFC 319.6)
Cooking oil storage shall be limited to a maximum aggregate volume of 120
gallons and stored in such a way as to not be toppled or damaged during
transport. (IFC 319.6)
Do cooking oil storage tanks comply with Section 319.7 of the 2018 IFC?
(Listed tanks for product stored, no more than 200 gallons, normal/emergency
vents, proper components for transfer of oil)
Maximum aggregate volume of LP-gas containers transported on the vehicle and
used to fuel cooking appliances less than 200 pounds propane capacity? (IFC
319.8.1)
All LP-gas containers installed on vehicle securely mounted and restrained to
Mobile Food Preparation Vehicle Inspection Form
prevent movement? (IFC 319.8.2)
All LP-gas containers manufactured in compliance with NFPA 58 (319.8.3)
Is all LP-gas system piping, including valves & fittings adequately protected to
prevent tampering, impact damage, and damage from vibration? (IFC 319.8.4)
Is there a listed LP-gas alarm installed within the vehicle in the vicinity of LP-
gas system components? (IFC 319.8.5)
Are all fat fryers provided with a lid over the oil vat that can be secured to
prevent the spillage of oil turning transit?
Is the kitchen exhaust system cleaned at least every 6 months and free of
excessive grease build up? (IFC 319.10.1)
Does the fire protection equipment have a current inspection tag? (IFC 319.10.2)
Has the fuel gas piping system been inspected within the last 12 months by a
company licensed in NH for LP-gas piping work? (IFC 319.10.3)
Is an inspection tag affixed to the LP-gas system or within the vehicle with the
name of the inspection agency and date of inspection? (IFC 319.10.3)
Is there a way for employees to contact emergency services, such as a cell
phone?
Have all employees been trained in the proper method of shutting off fuel
sources, performing leak detection checks, and the use of portable fire
extinguishers?
Is the mobile food preparation vehicle positioned so that it does not block fire
lanes, fire hydrants, etc?
If a portable generator is used for electricity, is it positioned so that the exhaust
is at least 5 feet from any openings, air intakes, and means of egress?
Is the vehicle located at least 10 feet from any other building, vehicle, or
cooking operations?
Are wheel chocks utilized to prevent the vehicle from moving while food
preparation is occurring?
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Form 4324 (City of Lebanon)

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Completed 14 July 2020

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