Application for Special Use Permit
Fraternities and Sororities
Local Law #8 of 2010
Section: 300-60.10
Delhi, NY 13753
Name of Landlord _________________________________________
Approved 2/28/11
Chapter Officers for NAME OF ORGANIZATION
Phone #
Date of Birth
Mailing Address
1. Please outline and describe what each officer is responsible for. Identify the person
responsible for risk management, the house manager, fire safety officer, and RA (if
2. Directory of all members residing at this location.
Approved 2/28/11
Individual Cell #
Date of Birth
Home Mailing Address
3. Alumni Corporation Members and Faculty/Staff / Community Advisors
What is their role?
Phone #
Mailing Address
4. Contact information for the owner of the property (Name, Phone #, and Address)
5. Contact information for location representative (if the owner is not local)
6. Is this residence within the permitted zoning district?
7. Statement certifying that the Delhi Fire Department, tele #746-2221, has attended a
chapter meeting for fire safety by the end of September. Please provide a summary
statement of what occurred at this meeting. (attach a copy of the appropriate
8. Statement certifying that the chapter has attended a Police Department training
session outlining laws applicable to use of building, activities of group and behavior of
members. Please provide a summary of what occurred at this meeting and attach a
copy of the appropriate documentation.
9. Outline of chapter and house policy (given to members at the beginning of the year).
Approved 2/28/11
10. Clear and detailed copy of fire safety policies (include emergency procedures,
responsibilities of on-site fire safety officer, and exit plans)
11. Policies for dealing with alcohol consumption in chapter facility (risk management)
12. Policies regarding property maintenance (trash removal, grounds keeping, and snow
removal, etc.)
13. Insurance policy number and name of company your insurance is provided through
(please attach a copy).
14. Date of fire / smoke detector system inspections (please attach copies)
15. Occupancy limits by number of people for recreational and assembly use of your
chapter house (Village CEO).
16. Document any construction or changing in building layout or structure since the last
special use permit was issued (if this does not apply please note that)
17. Document any changes or construction planned for the next year.
18. Document any changes in fire safety elements for the next year.
Approved 2/28/11
19. Copy of the letter your chapter sent to neighbors within 500 feet of the property.
20. Provide a summary of the chapter involvement on the campus and in the community
(community service activities, leadership on campus, special accomplishments, etc.)
21. Planning Board conditions, if any:
Approved 2/28/11