Home 9 Forms & Applications 9 Propane & Outdoor Cooking Permit Application Propane & Outdoor Cooking Permit "*" indicates required fields Unique IDHomeowner's Name* First Last House #* Walk* Phone*Email* Check All That ApplyNo fee required. Must be installed by a licensed plumber. 80 Lbs. and Above No fee required. Must be installed by a licensed plumber.# of Tanks*FEE REQUIRED: $75 per Residence. Maximum of 3. Mosquito Control Device FEE REQUIRED: $75 per Residence. Maximum of 3.# of Devices*Please enter a number from 1 to 3.Maximum of 3.# of Tanks*Please enter a number from 1 to 4.Cannot exceed # of devices plus 1.Mosquito Control Device Fee: per residence.FEE REQUIRED per Residence (see below) Outdoor Cooking Permit FEE REQUIRED per Residence (see below)Please Select: Year-Round Resident ($200.00) Seasonal Resident ($100.00) Year-Round Resident Fee: Seasonal Resident Fee: # of Tanks*Please enter a number from 1 to 2.ONLY ONE OUTDOOR GRILL PER RESIDENCEWhere will device be used?* Ground Level First Floor Deck Second Floor Deck* *Only permissible on second floor deck that has direct exterior egress to or propane shut-off at ground level.NOTE: All tanks must be securely stored in accordance with the Village Code.The applicant /owner of the above referenced property hereby requests that a permit be issued pursuant to Saltaire Village Code §25-12 & §25-13 for the use and/or storage of a propane tank(s) at the above referenced premises as noted in this application. Applicant affirms that the tank(s) and any permissible device to which it is attached will at all times be used, maintained, and stored in strict accordance with Chapter 25 and all other provisions of the Code of the Village of Saltaire, and of all applicable regulations of the State of New York. Applicant hereby authorizes the Village Fire Marshal or other Village designated representative to enter the premises to inspect all tanks, their use and installation. Failure to provide access to conduct this inspection is grounds for the immediate revocation of this permit. Seasonal Resident and Mosquito Control Device applicant affirms that all tank(s) less than 80 lbs, used, stored or maintained pursuant to this Application will be securely anchored when on the licensed premises and removed from the licensed premises on or before November 30 each year. Failure to timely remove tanks may result in permit revocation, fines and denial of future applications. Consent By checking this box, applicant certifies and affirms that the information provided is accurate and complete, that he/she understands and accepts all permit conditions, and authorizes the below credit card payment.Initials* Date* MM slash DD slash YYYY Total Fee Due SignatureCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
