Highway Engineering
1 Independence Hill, Farmingville, NY 11738
Phone (631) 451-9090 Fax (631) 716-0572 www.brookhavenny.gov HW-06
Daniel P. Losquadro
Superintendent of Highways
BLOCK PARTY RULES
$50.00 PERMIT FEE (non-refundable) MUST BE SUBMITTED WITH APPLICATION.
F
ee is payable by check, money order or credit card. There is a $75.00 fee for returned checks and a service charge on credit card
transactions. We cannot accept cash.
ALL paperwork must be completed and returned a minimum of four (4) weeks prior to the party date. Applications cannot be faxed
or emailed. Incomplete applications will be returned. Applications may be submitted up to 6 months prior to the party date. Applicant
must be a resident within the area of the street to be closed and must be at least 21 years of age.
A b
lock party is limited to one block only, and may extend from one corner to the very next corner, BUT CANNOT CROSS OVER A
CROSS STREET. A portion of a block can be closed if all residents in the area to be closed sign the Hold Harmless Clause. Neighboring
blocks cannot be closed on the same day. Call for rules for dead end streets or cul-de-sacs.
The Hold Harmless Clause must be signed by a resident of EVERY HOUSE within the area to be closed, including all CORNER HOUSES.
Everyone signing the Hold Harmless Clause must be at least 21 years of age. Every residence within the party area must have a
signature; it does not matter where the driveway is located or which way the house faces. If a signature cannot be obtained from a
residence, the party must be moved beyond that property line, and the occupants must have an alternate means of ingress and egress.
All signatures must be on the Hold Harmless Clause form, not on plain paper. Signatures on plain paper, or on the back of the Hold
Harmless Clause form, will not be accepted. If a house is vacant, please note the house number on the Hold Harmless Clause and
mark it as vacant. List all vacant houses on the attached Vacant House Affidavit. Sign and date the affidavit.
Liability insurance in the amounts of $100,000 and $300,000 personal injury and $50,000 property damage is required for
groups/organizations. The insurance certificate must name the Town of Brookhaven and Superintendent of Highways as ADDITIONAL
INSURED.
Barricades are no longer available. You may use sawhorses, picnic tables, garbage pails or yellow tape to block the street.
BLOCKING THE STREET WITH VEHICLES IS PROHIBITED.
Emergency vehicles must be allowed access at all times. NO EXCEPTIONS.
Any person residing on said street must not be denied vehicular access to and from his/her property. NO EXCEPTIONS.
PERMITS ARE ISSUED UNTIL 10:00 PM ONLY. Everything must be off the street, and the road opened by 10:00 pm.
Cleanup of the street after the party is the responsibility of the residents.
FIREWORKS ARE ILLEGAL in the State of New York.
All inflatables, DJs/bands must be on private property, not in the roadway.
Please notify your mail carrier to make arrangements for mail delivery.
The Town of Brookhaven will notify the Suffolk County Police Dept. and the local Fire and Ambulance Depts. of this event.
Failure to comply with these rules will result in no further permits being issued for the street.
Call 631-451-9090, Monday-Friday, 8:00 AM-3:30 PM if you need additional information.
Town of Brookhaven
Highway Department
Highway Engineering
1 Independence Hill, Farmingville, NY 11738
Phone (631) 451-9090 Fax (631) 716-0572 www.brookhavenny.gov HW-06
Daniel P. Losquadro
Superintendent of Highways
APPLICATION FOR BLOCK PARTY PERMIT
Applicant must be a resident of the block being closed. In the event only a portion of a block is to be closed,
applicant must live in the area being closed. All applicants must be at least 21 years of age.
$50.00 PERMIT FEE (NON-REFUNDABLE) MUST BE SUBMITTED WITH APPLICATION
We accept checks, money orders and credit cards. There is a $75.00 fee for returned checks
and a service fee on credit card transactions. We cannot accept cash.
COM
PLETED APPLICATION MUST BE SUBMITTED AT LEAST FOUR (4) WEEKS PRIOR TO PARTY DATE
IN
COMPLETE APPLICATIONS WILL BE RETURNED
NAME: ______________________________________________________ TELEPHONE: __________________
ST
REET ADDRESS: _______________________________________________________________________________
HA
MLET: ___________________ ZIP CODE: __________ EMAIL ______________________________________
DATE OF PARTY: ____________________________ RAIN DATE: ___________________________
STARTING TIME: ________ ENDING TIME: Everything must be off the street and the road opened by 10:00 PM
ST
REET TO BE CLOSED: ___________________________________________________________________________
BEGINNING AT (include cross street or house #): __________________________________
END
ING AT (include cross street or house #): _____________________________________
HAVE ALL OF THE RESIDENTS WITHIN THE BLOCK PARTY AREA AGREED TO CLOSE THE STREET AND SIGNED
THE HOLD HARMLESS CLAUSE? YES _____ NO _____
HAS THI
S LOCATION HAD A PREVIOUS BLOCK PARTY? YES _____ NO _____
I certify that the information as stated is true and accurate. I also certify that I have received a copy of the
Block Party Rules and Regulations with this application and agree to comply with them. Failure to comply
with these rules and regulations may result in denial of future applications.
Signature of Applicant _______________________________________ Date______________
COMPLETED FORM CANNOT BE FAXED OR EMAILED
Town of Brookhaven
Highway Department
click to sign
signature
click to edit
Highway Engineering
1 Independence Hill, Farmingville, NY 11738
Phone (631) 451-9090 Fax (631) 716-0572 www.brookhavenny.gov HW-06
Daniel P. Losquadro
Superintendent of Highways
HOLD HARMLESS CLAUSE
MUST BE 21 YEARS OF AGE OR OLDER TO SIGN THIS FORM
THE UNDERSIGNED AGREE TO INDEMNIFY, DEFEND AND HOLD THE TOWN OF BROOKHAVEN HARMLESS FROM ANY LIABILITY
WHICH MAY ARISE BY REASON OF ANY INJURY OR DAMAGE TO PERSON(S) OR PROPERTY RESULTING FROM THE USE OF SAID TOWN
ROAD FOR PURPOSES OF A BLOCK PARTY OR FROM EXECUTION OF THIS AGREEMENT.
PARTY LOCATION: _____________________________________ PARTY DATE: _________ RAIN DATE: __________
Street Name and Hamlet
DO NOT WRITE ON THE BACK OF THIS FORM. USE ADDITIONAL FORM IF NEEDED.
PRINT NAME
SIGNATURE
ADDRESS
PHONE #:
(REQUIRED)
Town of Brookhaven
Highway Department
Highway Engineering
1 Independence Hill, Farmingville, NY 11738
Phone (631) 451-9090 Fax (631) 716-0572 www.brookhavenny.gov HW-06
Daniel P. Losquadro
Superintendent of Highways
VACANT HOUSE AFFIDAVIT
I, as applicant for the attached Block Party application, certify that the following houses are vacant
and not occupied by anyone. Should this/these home(s) become occupied prior to the Block Party,
I will provide Highway with a Hold Harmless Form signed by the new occupant.
____
_________________________________________________________________________
House # Street Hamlet
____
__________________________________________________________________________
House # Street Hamlet
____
__________________________________________________________________________
House # Street Hamlet
______________________________________________________________________________
House # Street Hamlet
____
__________________________________________________________________________
House # Street Hamlet
____
__________________________________________________________________________
House # Street Hamlet
Signature of Applicant _________________________________________ Date _________
Town of Brookhaven
Highway Department
click to sign
signature
click to edit