VILLAGE OF WAPPINGERS FALLS
BUILDING DEPARTMENT
OFFICE OF CODE ENFORCEMENT
OFFICE OF THE FIRE INSPECTOR
2582 SOUTH AVENUE
WAPPINGERS FALLS, NY 12590
PHONE: (845) 297-5277 FAX: (845)296-0379
E-mail: bmurphy@wappingersfallsny.gov
www.wappingersfallsny.gov
TENT SALE PERMIT
Date: _____________________
Name: _____________________________________________________________________________________
Address:___________________________________________________________________________________
Phone / Contact:____________________________________________________________________________
Date of Sale: _______________________________________________________________________________
Time of Sale: _______________________________________________________________________________
Address of Sale: ____________________________________________________________________________
Location of Tent: ____________________________________________________________________________
Purpose: ___________________________________________________________________________________
___________________________________________________________________________________
GENERAL LIABILITY INSURANCE.- Proof of insurance MUST be submitted from the applicant
and/or property owner at the time of the application.
� Each occurrence must be a minimum of 1 million dollars
� Your insurance producer/broker must provide their business name, location and an office phone number.
Accepted Forms:
- Acord 25 (2009/01) - Certificate of Liability Insurance
- Acord 25 (2009/09) - Certificate of Liability Insurance
- Acord 25 (2010/05) - Certificate of Liability Insurance
Date Received : ___/___ / _____ Received By: _____________________________ � Fee _______________ � Feed Paid
Zoning Department Use:
[ ]
Zoning Administrator
Date
Owner’s Signature Date
click to sign
signature
click to edit
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