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2. Entity Name*
3. DBA*
5. First Name*
6. Last Name*
8. Business Address*
10. Owner*
11. Manager*
13. Primary Contact Email Address*
14. 24-hour Contact Number*
16. Ideal Start Date*
17. Proposed Days & Hours of Operation*
19. Parking Lot/Land Owner*
20. Evidence of Control of Extended Premises
    If you do not own the parking lot or land you are seeking to extend your premises onto, you must include evidence of control of extended premises.
22. Do any other businesses share the parking lot besides your restaurant?*

    1. Yes
    2. No
23. If yes, include a letter from all other users.

    If you share the parking lot, the other users of the lot must indicate their knowledge and support of the use of the lot for outdoor dining by submitting signed acknowledgment of the restaurant's plans.

25. Awnings, Tents or Umbrellas?*

    1. Awning(s)
    2. Tent(s)
    3. Umbrella(s)
    4. None

    If you plan to erect a tent, you are required to get written permission from your abutting neighbors. You must also contact the Building Department.

26. Permission from abutting neighbors supporting the tent
28. Detailed description of expansion*

    Please summarize, in detail with square footage and capacity, the alterations you wish to make.

29. Detailed Floor Plan*

    Please upload a detailed plan that includes dimensions and layout of tables and chairs

31. Extension of premises must be EITHER:*

    1. Contiguous to the licensee’s premise with either a clear view of the area from inside the premises.
    2. The licensee may commit to providing management personnel dedicated to the area.
32. Barriers/Delineation of Area*

    1. Jersey barriers provided by the city
    2. Stanchions with rope, chain, etc.
    3. Fencing
    4. Other
33. If other, please explain
35. Will the expansion cause potential noise concerns/complaints from neighbors?*

    1. Yes
    2. No
36. If yes, please explain:
38. ADA Accessibility

    The outdoor dining areas and barriers must be accessible and meet ADA and Massachusetts Architectural Access Board's regulations.

42. Certification of Safety Standards and Guidelines

    By signing below, I, being the owner or manager of the above referenced establishment located at the address indicated above, acknowledge, accept, and will comply with the responsibilities of maintaining a safe outdoor dining experience for guests and for staff in the outdoor dining area through the diligent adherence to my submitted plans.

44. Signature*
45. Date*
    Date
47. Certification of Compliance with ABCC Guidelines For Extension of Premises to Patio & Outdoor Areas

    By signing below, I being the owner or manager of the above referenced establishment located at the address indicated above, acknowledge, accept, and will comply with the guidelines for extension of premises to patio and outdoor areas.

49. Signature*
50. Date*
    Date
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field