(To be filled in by the Building Department)
S.C.T.M. No. 0800 _______-_______-_______
Application/Permit No. ________________
Zoning District____________
Accepted by ________________ Date ____________
Approved by _____________ Date ____________
Permit Issued _____________ Expires ___________
Recei
t No.
Fee
TOWN OF SMITHTOWN
Suffolk County, NY
TENT APPLICATION
THIRTY (30) DAYS REQUIRED TO PROCESS
For the Temporary installation of a
Tent/Canopy/Awning*
TO BE FILLED OUT BY APPLICANT
“TENT APPLICATION”: Is hereby made by the undersigned for a permit, required by Chapter 273 of the
code of the Town of Smithtown for the temporary installation of a tent/canopy/awning.
SIZE: _____________of tent/canopy/awning (circle one)How Many ________ Color of Fabric _____________
Will the following be provided?
Side panels: Yes
No Generator: Yes No Electric Lighting or Outlets: Yes No .
Heating Equipment: Yes No Cooking Equipment: Yes No
ALL INSURANCES MUST BE SUBMITTED WITH APPLICATION
Workers’ Compensation, Disability and Liability - (see Insurance requirements)
PROPERTY OWNER:________________________________Phone no. Fax no._________________
ADDRESS:_________________________________________________________________________________
LOCATION OF TENT:_______________________________________________________________________________
TENANT/BUSINESS (if not Property Owner): Phone no. Fax no._____________
CONTRACTOR: Phone no. Fax no.__________
ADDRESS:___________________________________________________________________________________
DATE OF INSTALLATION:__________________________
DATES & APPROXIMATE TIME TENT TO BE USED:_______________________________________________
NOTE: This permit is for the temporary installation of a tent/canopy/awning only
WEBforms\app_Tents_perm_instr rev 05112015
3
AFFIDAVIT
I_____________________________________asthe_______________________________beingdulysworndeposeandstatethatto
(Print name) (Owner, Owner’s Agent, Architect, Contractor)
thebestofmyknowledgeandbeliefthestatementscontainedinthisapplicationtogetherwiththeplansandspecificationssubmittedareatrueand
completestatementofallproposedworktobedoneonthedescribedpremisesasithasbeenapprovedbytheTownofSmithtownandthatall
provisionsoftheZoningandBuildingOrdinanceandtheStateBuildingCodeandallotherlawspertainingtotheproposedworkshallbecomplied
with,andthatsuchworkisauthorizedbytheowner
Sworntobeforemethis:Signature
________________________________________________________________
_______
(Owner, Owner’s Agent, Architect, Contractor)
_______Dayof________________________20________
_________________________________________________
(NotaryPublic,NewYork)
Notary Stamp