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Use this form for a pavement café licence during the COVID19 pandemic for a single premises where food or
drink is supplied to members of the public.
Please read our ‘Pavement café licensing - guidance for applicants during the Covid 19 pandemic’ before filling
in this form. If you need any help, email us on pavementcafes@belfastcity.gov.uk with a phone number and
we will contact you to discuss.
Type of premises (for example Café or Public House): _______________________________________
Name of Business Premises: ___________________________________________________________
Address: _________________________________________________________________________
____________________________________________________________ Postcode: ___________
Contact phone number: ________________________ Email: ________________________________
First name(s): _______________________________ Surname: ______________________________
Designation (for example Owner, Director, Manager): _______________________________________
Business or company name: ___________________________________________________________
Business/Company address: __________________________________________________________
________________________________________________________________________________
__________________________________________________________ Postcode: _____________
Contact phone number: ________________________ Email: _______________________________
Tem
p
orar
y
PavementCaféLicenceA
pp
lication
2. Applicant details
1. Premises details
3. Details about the site and size of the proposed pavement ca
f
é
OfficeUseOnly

www.belfastcity.gov.uk
Is the pavement café: directly outside or remote from the premises?
If remote, tell us its location: __________________________________________________________
________________________________________________________________________________
Size of pavement café: Length (along frontage) _________m Depth (out from frontage) __________m
Total width of existing footpath: ___________________ m
Will it be within 10m of a road junction? Yes No If ‘Yes’, tell us the distance? __________m
Notes:
For remote pavement cafes, you must provide a management plan or risk assessment outlining how you intend to
maintain control over the pavement café.
You must include with your application:
a location plan, showing the location of the pavement café (outlined in red) and the surrounding area.
a site plan showing the occupied street space, size and type of barriers, number and type of tables and chairs,
and any other pavement café furniture.
We require both of these plans in order to process your application.
Type of barrier or enclosure: __________________________________________________________
________________________________________________________________________________
Height of barrier or enclosure: __________m
Total number of tables: _____________________ Total number of chairs: _______________________
Total number of umbrellas/parasols: ____________ Total number of space heaters: _________________
Tell us about any other items to be provided in the enclosure: __________________________________
________________________________________________________________________________
Do you intend to install a fixed awning above the Pavement Café? Yes No
Tell us where you will securely store the pavement café furniture (tables, chairs, barriers and other articles)
when the business premises is closed: ___________________________________________________
________________________________________________________________________________
Notes:
A tapping rail is to be provided to barriers (see guidance).
Photographs, manufacturer’s details or drawings of the proposed barriers and furniture must be included.
Is alcohol to be consumed in the pavement café? Yes No
Are the premises licensed under the Licensing (NI) Order 1996? Yes No
4. Details about the p
r
oposed enclosure and furniture
www.belfastcity.gov.uk
5. Alcohol consumption details
3. Details about the site and size of the proposed pavement ca
f
é
If ‘Yes’, is the premises a:
Public Hotel Restaurant Guest house Refreshment room in
housewith restaurant public transport premises
Hours of operation
Monday to
Tuesday to
Wednesday to
Thursday to
Friday to
Saturday to
Sunday to

Please make sure that you have included the following information (as appropriate) with your application:
*documentswhichMUSTbesubmittedwithyourapplicationform
Please tell us if you will be sending us any of this documentation at a later date.

I/we confirm that I have placed the appropriate Public Notice in a prominent place at or near the
premises. I confirm that it can easily be read by the public, and that it will be displayed for 28 days from the
date I make this application, and include a copy
ingCo
ntrolService,GroundFloor,4‐10LinenhallStreet,BelfastB2BP
*
Application form
filled in, signed and dated
*
Location plan
*
Site layout plan
Details of the furniture
including furniture manufacturers’ details/drawings/photographs
A copy of the public notice you have fixed to the premises
t
his can be a photograph
Public liability insurance declaration
required before grant of licence, annually & on renewal
Management plan
/
risk assessments
for remote pavement cafes, or as required
Copy of planning permission (if relevant)
6. Proposed operating hours for the pavement ca
f
é
7. Checklist for all documentation required when making your application
8. Confirmation of public notice fixed to premises
www.belfastcity.gov.uk
I/we confirm that there is/will be third party public liability insurance cover for the pavement café to
minimum value of £5 million:
The relevant declaration of public liability insurance:
is included will be provided later (before the licence is granted)
Belfast City Council is the Data Controller under the General Data Protection Regulation (GDPR) for the
personal data it gathers for the purposes of processing your licence application and enforcing pavement
café licensing. You are providing your personal data to the Council whose lawful basis for processing is for
compliance with a legal obligation under the Licensing of Pavement Cafés Act (Northern Ireland) 2014.
The personal data will be shared internally within the Council with staff who are involved in providing this
service and where necessary, between internal departments with the purpose of supporting an effective
delivery of service. It may also be shared with the Police Service of Northern Ireland (PSNI), DFI Roads
and other government departments as appropriate for the purposes of approving and reviewing pavement
café applications.
As part of application process the Council may list the addresses of the premises and date of current
pavement café applications and proposed layouts on the Council website, along with a list of currently
licensed pavement cafes and licence issue date. The applicable legislation requires the Council to make
current pavement café applications available for viewing by interested members of the public, in order to
enable them to make objections.
Your personal data will not be shared or disclosed to any other organisation without your consent, unless
the law permits or places an obligation on the Council to do so. The personal data is held and stored by
the Council in a safe and secure manner and in compliance with Data Protection legislation and in line with
the Council’s Records Retention and Disposal Schedule.
If you have any queries regarding the processing of your personal data, please contact building control’s
policy and legal officer at buildingcontrol@belfastcity.gov.uk or phone 028 9027 0650. If you wish to
contact the Council’s Data Protection Officer, please write to Belfast City Council, City Hall Belfast, BT1
5GS or send an email to dataprotection@belfastcity.gov.uk
I/we make this application to Belfast City Council for a pavement café licence, under the provisions of the
Licensing of Pavement Cafés Act (Northern Ireland) 2014 and I confirm that, to the best of my knowledge and
belief, the information provided on this application form and submitted documents is correct.
Signature of applicant: _________________________________________ Date: _______________
9. Confirmation of public liability insurance
10. Applicant’s declaration
Privacy notice - how we will use information about you
Building Control Service, Ground Floor, 4-10 Linenhall Street, Belfast BT2 8BP
Phone02890270650E‐mailpavementcafes@belfastcity.gov.uk
www.belfastcity.gov.uk
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