Chapter 36 Film Permit Application – Rev. 3/9/11 LD Page 2 of 5
INSURANCE REQUIREMENT
Applicant must provide proof of insurance coverage for damage to property in the amount of Two Hundred and Fifty Thousand
($250,000.00) Dollars for any single claim and for any aggregate occurrence in the amount of One Million ($1,000,000.00) Dollars; for
bodily injury for any person in the amount of Five Hundred Thousand ($500,000.00) Dollars and for any aggregate occurrence in the
amount of Two Million ($2,000,000.00) Dollars. Each such insurance policy shall name the Town of North Hempstead as an
additional insured party.
Return Insurance Certificate in the amounts indicated above (or greater) with completed application.
VEHICLE LIST
INCLUDE AS PAGE # 4 ON ENCLOSED OR PROVIDE AS REQUIRED IN § 36-5 I.
“List and description of all vehicles and their license plate numbers, including the applicant's vehicles and vehicles of the applicant's personnel.”
PROPS & EQUIPMENT LIST
INCLUDE AS PAGE # 5 ON ENCLOSED OR PROVIDE AS REQUIRED IN § 36-5 J.
“List and description of all props, sets and equipment to be used in connection with the Filming.” If filming activities include the use of explosives,
Fireworks or other explosive compounds refer to Chapter 19 of the Code of the Town of North Hempstead, entitled EXPLOSIVES, § 19-2 for permit
requirements.
PERMIT FEES
FILMING ($500 / DAY)
(Prep/Filming/Breakdown)
$500.00 X
=
USE OF BASECAMP LOCATION ($500 / DAY)
$500.00 X
=
USE OF TOWN OWNED FACILITY ($100.00 / HR)
$100.00 X
=
STANDARD FILMING BEFORE 7:30AM ($200.00 / HR)
$200.00 X
=
STANDARD FILMING AFTER 9:00PM ($100.00 / HR)
$100.00 X
=
CLOSURE: STREETS / SIDEWALKS
($100.00 / HR OR $500.00 / DAY)
$100.00 X
=
CLOSURE: STREETS / SIDEWALKS
($100.00 / HR OR $500.00 / DAY)
$500.00 X
=
PERMIT EXPEDITE FEE (LESS THAN 7 DAYS PRIOR
)
$250.00 X
=
TOTAL
DUE
PROVIDE NOTIFICATION TO RESIDENTS AND BUSINESSES WITHIN 300 FEET OF THE LOCATION OF ANY ANTICIPATED
PARKING (IF OCCUPYING MORE THAN THREE PARKING SPACES) OR TRAFFIC OBSTRUCTION. SUCH NOTIFICATION
MUST DISTRIBUTED TO EACH RESIDENT AND MERCHANT NOT LESS THAN 72 HOURS IN ADVANCE OF FILMING, WHEN
FEASIBLE.
FOR YOUR APPLICATION TO BE PROCESSED, ALL OF THE REQUESTED ITEMS MUST BE RETURNED TO THIS OFFICE.
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
IF YOU HAVE ANY QUESTIONS, PLEASE CALL (516) 869-7739, 7648 or 7642
AS PER § 36-6 E. THE HOLDER OF A PERMIT SHALL NOTIFY THE APPROPRIATE POLICE AND FIRE DEPARTMENTS THAT
IT INTENDS TO FILM AT THE AUTHORIZED LOCATION NOT LESS THAN FORTY-EIGHT HOURS BEFORE SUCH FILMING
SHALL COMMENCE.
I SOLEMNLY SWEAR AND AFFIRM UNDER PENALTY OF PERJURY, TO THE TRUTH OF ALL STATEMENTS HEREIN AND AGREE
TO ADHERE TO THE RULES AND REGULATIONS OF THE CODE OF THE TOWN OF NORTH HEMPSTEAD INCLUSIVE OF CHAPTER
36, THE NASSAU COUNTY CHARTER, THE LAWS OF THE STATE OF NEW YORK, AND EXPRESSLY AGREES TO INDEMNIFY AND
HOLD HARMLESS THE TOWN OF NORTH HEMPSTEAD FROM ANY AND ALL LIABILITY OR DAMAGES RESULTING FROM THE
ISSUANCE OF A PERMIT UNDER THIS CHAPTER OR FROM THE USE OF SUCH PUBLIC LANDS. ANY FALSE STATEMENTS MADE
HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210-45 OF THE PENAL LAW OF THE STATE OF
NEW YORK.
SIGNATURE
DATE
