MUHLENBERG TOWNSHIP 210 George Street

Reading, PA 19605

Phone: 610-929-4727

Fax: 610-921-3764

Email: info@muhlenbergtwp.com

WWW.MUHLENBERGTWP.COM

Dear Applicant,

Please complete the required new business applications for each new business based on the intended use.

This New Business Packet contains the following: Zoning Application, Use & Occupancy Application, Fire

License Application, Berks Earned Income Business Questionnaire, Business Emergency Contact Form,

Health License Application and Grease Trap License Application. The forms required are dependent on the

type of business you are opening. Please see instructions below.

Required applications are:

Zoning

Use & Occupancy

Fire License

Berks EIT Business Form

Emergency Contact Information

Other applications:

The completion of the following applications are contingent upon:

Commercial Building Permit Application - Please note: In the event of a structural and/or building

changes/alterations, a Building Permit Application must be filled out and submitted along with

building plans.

Health License Application - preparation and sales of food, beverages

Grease Trap License Application - discharge of oil, grease, sand and any substances deemed

harmful or hazardous to the public sewer systems.

Please contact Customer Service if you have any additional questions regarding this packet.

Muhlenberg Township welcomes you!

Page 1 of 2 Rev. 6/20/19

Township of Muhlenberg

210 George Street

Reading, PA 19605 610.929.4727

Application For Zoning Permit

Code Enforcement Department

Application No.______________

Permit No.

PART A: To Be Completed By Owner/Applicant Name Of Owner: Address:

Phone No:

Name Of Applicant, If Other Than Owner: Address:

Phone No:

Name Of Contractor: Address:

Phone No:

Property Location:

Subdivision Name: Lot No: Lot Area:

Tax PIN: Zoning District:

APPLICATION Is Hereby Made For The Following:

[ ] Accessory Structure - [ ] Deck, [ ] Patio, [ ] Porch, [ ] Balcony [ ] Other [ ] Sign Permit

[ ] Shed, Use: [ ] Agricultural Structure

[ ] Fence, Shall Not Be Located Within Township or State Road Right-of-Ways or Clear Sight Triangles.

[ ] New Business, Description of Business:

DESCRIPTION OF WORK TO BE PERFORMED:

Building/Structure & Lot Coverage Information: (Proposed Building/Structure unless otherwise noted)

Building/Structure Footprint Area (sf): New Construction: Existing:

Impervious Area (1)

(sf): New Construction: Existing:

Building/Structure: Height: Stories: Feet: Width: Length:

Floor Area (sf): Living: Basement and Attics With 7'-6" (+) Ceiling Height): Total:

Is Structure located within a floodplain area? [ ] Yes [ ] No Flood Zone:________________

(1): Includes driveways to the street right-of-way line, parking lots, sidewalks, and unroofed patios and decks

Estimated Cost of project/improvement: $

Number of Off street parking spaces on site:_________ Number of Employees:_________ Per shift (At highest staffed shift)________

STATEMENT BY APPLICANT, OWNER and/or OWNER'S AGENT: I hereby certify that I am the OWNER or the AGENT of the OWNER, that I am authorized to make this application and that the information contained in this application is accurate to the best of my knowledge. Further, I/we agree to adhere to all applicable Township of Muhlenberg Ordinances and Regulations. I/we are also aware that a USE & OCCUPANCY PERMIT, issued by Township of Muhlenberg shall be required prior to use or occupancy of the building or structure.

Signature of Applicant: _________________________________________________________________________ Date: _________

Signature of Property Owner/Agent: _______________________________________________________________ Date:_________

Page 2 of 2 Rev. 6/20/19

Application For Zoning Permit

Sketch of Property Showing Location of Existing/Proposed Buildings/Structures and Set Backs Below:

PART B: TO BE COMPLETED BY THE ZONING OFFICER

Additional Approvals:

[ ] Plumbing [ ] On-Lot Sewage Disposal

[ ] Driveway [ ] Public/Community Sewage Disposal

[ ] Fire Code [ ] Industrial Waste Discharge

[ ] Public Water [ ] Labor & Industry

Fees:

Zoning Permit: $________

Certificate of Use & Occupancy: $________ Paid by:

Driveway Permit: $________ Check No.

Fire Permit: $________ Date Paid:

TOTAL DUE: $________

Approval/Denial:

[ ] Application Approved *

[ ] Application Denied

Reason(s) for Denial:

Permit Expiration Date:________________

Zoning Officer's Signature: Date:

* The Owner/Applicant is advised that deed restrictions or covenants may prohibit this activity. It is the Owner/Applicant's

responsibility to review and comply with these restrictions. Approval of this permit application by the Zoning Officer does

not relieve the Owner/Applicant from complying with these restrictions.

Permit No.______________

Date of Issue ____________

TOWNSHIP OF MUHLENBERG

210 George Street, Reading, PA 19605

Application for a Certificate of Occupancy Business and Industrial

OWNER OF BUILDING

Name: _________________________________________________________________________________

Address: ________________________________________________________________________________

___________________________________________ Telephone Number _____________________

TENANT OF BUILDING

Business Name: __________________________________________________________________________

Business Location: ________________________________________________________________________

____________________________________ Telephone Number____________________

OWNER OF BUSINES

Name: __________________________________________________________________________________

Home Address: ___________________________________________________________________________

_______________________________________ Telephone Number ____________________

BUILDING INFORMATION

Proposed Use For Building __________________________________________________________________

Anticipated Date of Occupancy: ______________________________________________________________

Square Footage of Tenant Space ______________sq. ft. Is Tenant Space Sprinklered? Yes ___ No ____

Is Tenant Space Currently Connected to Automatic Fire Alarm? Yes______ No_______

Date Requested for Final Inspection _______________________________ Time: _____________________

Signature: _____________________________________________________________________

Name Printed: __________________________________________________________________

Title (Owner, Manager, etc.)_______________________________________________________

INSTRUCTIONS: 1. Permit Fee $150.00 per hour. The Occupancy Permit Fees will be invoiced by the Township. Fees must be paid prior to the

issuance of any Occupancy permit. PLEASE write separate check for this form. 2. Print or type all information.3. Make check or money order payable to the TOWNSHIP OF MUHLENBERG. (Do not send cash)4. Send form and check or money order to: Township of Muhlenberg, 210 George Street, Reading, PA 19605

Attn: Building Inspector

Application should be filed ten (10) days prior to date requested for final inspections Rev. 6/20/19

APPLICATION FOR FIRE LICENSE TOWNSHIP OF MUHLENBERG

210 George Street Reading, PA 19605

(610) 929-4727

INSTRUCTIONS: (Please PRINT or TYPE all information) 1. Determine License Fee as defined on reverse side2. Make check or money order payable to TOWNSHIP OF MUHLENBERG (Do not send cash)3. Mail completed application and payment to: Muhlenberg Township, 210 George Street, Reading, PA 19605

BUSINESS INFORMATION

Business Name: ______________________________________________________________________________

Business Address: ____________________________________________________________________________

Business Phone: ( ) ________________________ Business General Email: __________________________

Business Owner Name: _________________________ Business Owner Address: __________________________

Business Owner Phone: ( ) _____________________ Business Owner Email: _______________________

Person to contact at business location for inspection scheduling_________________________________________

Category (see back for definitions) ______________________________________________________________

Quantity of above Category (see back for definitions [people, SF, units, etc.]) __________________________

INFORMATION FOR PROPERTY LOCATED IN MUHLENBERG TOWNSHIP Same as Business Owner? YES ☐ No ☐ (if no, fill in property owner information below)

Property Owner: Last Name__________________________ First Name ________________________________

Property Owner Address: _______________________ ______________________________________________

Property Owner Email__________________________ Property Owner Phone: ( )______________________

ADDRESS TO BE USED FOR MAILING PURPOSES (PLEASE COMPLETE ALL LINES – DO NOT WRITE “SAME AS ABOVE”)

Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________

E-Mail Address: _______________________________

Signature: ____________________________________ Name Printed: __________________________________

Title: _________________________________________________

Rev. 6/20/19

_____________________ Application Date

PLACE OF ASSEMBLY (Based on # of People) - Assembly occupancy includes, among others, the use of a building or structure, or a portion thereof, for the gathering of persons for purposes such as civic, social or religious functions; recreation, food or drink consumption; or awaiting transportation. E.G. - Motion picture theaters, Symphony and concert halls, Television and radio studios admitting an audience, Theaters, Banquet halls, Night clubs, Restaurants Taverns and bars, Amusement arcades, Art galleries, Bowling alleys, Places of religious worship, Community halls, Courtrooms, Dance halls (not including food or drink consumption), Exhibition halls, Funeral parlors, Gymnasiums (without spectator seating), Indoor swimming pools (without spectator seating) Indoor tennis courts (without spectator seating) Lecture halls, Libraries, Museums, Waiting areas in transportation terminals, Pool and billiard parlors, Arenas, Skating rinks, Swimming pools, Tennis courts

APARTMENT BUILDINGS (Based on # of Units) - Residential occupancies containing sleeping units or more than two dwelling units where the occupants are primarily permanent in nature.

BUSINESS GROUPS (Based on Square Footage) - Business occupancy includes, among others, the use of a building or structure, or a portion thereof, for office, professional or service-type transactions, including storage of records and accounts. Business occupancies shall include, but not be limited to, the following:

Airport traffic control towers, Animal hospitals, kennels and pounds, Banks, Barber and beauty shops, Car wash, Civic administration, Clinic—outpatient, Dry cleaning and laundries: pick-up and delivery stations and self-service, Educational occupancies for students above the 12th grade, Electronic data processing Laboratories: testing and research Motor vehicle showrooms, Post offices, Print shops, Professional services (architects, attorneys, dentists, physicians, engineers, etc.), Radio and television stations, Telephone exchange, Training and skill development not within a school or academic program.

EDUCATIONAL GROUP (Based on # of students) - Educational occupancy includes, among others, the use of a building or structure, or a portion thereof, by six or more persons at any one time for educational purposes through the 12th grade. Religious educational rooms and religious auditoriums, which are accessory to places of religious worship in accordance with Section 508.3.1 and have occupant loads of less than 100, shall be classified as A-3 occupancies.

DAY CARE (Based on # of persons) – This group shall include buildings and structures occupied by persons of any age who receive custodial care for less than 24 hours by individuals other than parents or guardians, relatives by blood marriage, or adoption and in a place other than the home of the person cared for.

Health Care Facility, Hospital, Nursing Homes, Etc. (Based on # of Patients) - This occupancy shall include buildings, structures or parts thereof housing more than 16 persons, on a 24-hour basis, who because of age, mental disability or other reasons, live in a supervised residential environment that provides personal care services. The Occupants are capable of responding to an emergency situation without physical assistance from staff.

INDUSTRIAL/FACTORY (Based on Square Footage) - occupancy includes, among others, the use of a building or structure, or a portion thereof, for assembling, disassembling, fabricating, finishing, manufacturing, packaging, repair or processing operations that are not classified as a Group H hazardous or Group S storage occupancy. Aircraft, Appliances, Athletic equipment, Automobiles and other motor vehicles, Bakeries, Beverages; over 12-percent alcohol content Bicycles, Boats, Brooms or brushes, Business machines, Cameras and photo equipment, Canvas or similar fabric, Carpets and rugs (includes cleaning) Clothing, Construction and agricultural machinery, Disinfectants, Dry cleaning and dyeing Electric generation plants Electronics Engines (including rebuilding) Food processing, Furniture, Hemp products Jute products Laundries Leather products Machinery Metals, Millwork (sash & door), Motion pictures and television filming (without spectators) Musical instruments, Optical goods, Paper mills or products Photographic film Plastic products Printing or publishing Recreational vehicles Refuse incineration Shoes, Soaps and detergents, Textiles Tobacco Trailers Upholstering, Wood; distillation, Woodworking (cabinet)

HOTELS/MOTELS ETC. (Based on # of rooms) – Residential occupancies containing sleeping units where the occupants are primarily transient in nature.

LODGING/ROOMING, FOSTER HOMES, ETC. (Based on # of units) - Residential occupancies containing sleeping units or more than two dwelling units where the occupants are primarily permanent in nature.

MERCANTILE (Based on Square Footage) - Mercantile Group M occupancy includes, among others, the use of a building or structure or a portion thereof, for the display and sale of merchandise and involves stocks of goods, wares or merchandise incidental to such purposes and accessible to the public. Mercantile occupancies shall include, but not be limited to, the following - Department stores, Drug stores, Markets, Motor fuel-dispensing facilities, Retail or wholesale stores, Sales rooms

STORAGE, WAREHOUSE, PARKING GARAGE, FREIGHT TERMINAL, ETC (Based on Square Footage) - Buildings occupied for storage uses that are not classified as Group S-2, including, but not limited to, storage of the following: Aerosols, Levels 2 and 3, Aircraft hangar (storage and repair) Bags: cloth, burlap and paper, Bamboos and rattan, Baskets, Belting: canvas and leather, Books and paper in rolls or packs, Boots and shoes, Buttons, including cloth covered, pearl or bone, Cardboard and cardboard boxes, Clothing, woolen wearing apparel, Cordage, Dry boat storage (indoor), Furniture, Furs, Glues, mucilage, pastes and size, Grains, Horns and combs, other than celluloid, Leather, Linoleum, Lumber, Motor vehicle repair garages, Photo engravings, Resilient flooring, Silks, Soaps, Sugar, Tires, bulk storage of Tobacco, cigars, cigarettes and snuff, Upholstery and mattresses, Wax candles, Asbestos, Beverages up to and including 16-percent alcohol in metal, glass or ceramic containers, Cement in bags, Chalk and crayons, Dairy products in non-waxed coated paper containers, Dry cell batteries, Electrical coils, Electrical motors, Empty cans, Food products, Foods in noncombustible containers, Fresh fruits and vegetables in non-plastic trays or containers, Frozen foods, Glass, Glass bottles, empty or filled with noncombustible liquids, Gypsum board, Inert pigments, Ivory, Meats, Metal cabinets, Metal desks with plastic tops and trim, Metal parts, Metals, Mirrors, Oil-filled and other types of distribution transformers, Parking garages, open or enclosed, Porcelain and pottery, Stoves, Talc and soap stones , Washers and dryers

MUHLENBERG TOWNSHIP 210 George Street

Reading, PA 19605 Phone: 610-929-4727

Fax: 610-921-3764 Email: info@muhlenbergtwp.com

WWW.MUHLENBERGTWP.COM

REGISTRATION QUESTIONNAIRE – BUSINESS

ACCOUNT # ______________________ (FOR BUREAU USE ONLY)

BUSINESS NAME: ___________________________________________________________________

BUSINESS LOCATION: _________________________________________________________________________

MAILING ADDRESS FOR FORMS: ____________________________________________________

____________________________________________________

DO YOU OWN _____ RENT _____ THIS LOCATION? IF RENT, FROM WHOM ________________ (NAME & ADDRESS) ____________________

____________________

MUNICIPALITY: MUHLENBERG TWP FED EIN # _________________________

DATE BUSINESS STARTED _________________ NUMBER OF W-2 EMPLOYEES ______________ (this location) (this location)

BUSINESS PHONE NUMBER (_____) _____-___________

BUSINESS ENTITY (select one) SOLE PROPRIETORSHIP _________ PARTNERSHIP _________ CORPORATION __________ OTHER _______________________

DESCPRIPTION OF BUSINESS _________________________________________________________

OWNER – PARTNERS – OFFICERS, NAMES & HOME ADDRESS

_____________________________________________________________________________________

_____________________________________________________________________________________

I declare under the penalties provided by law that this questionnaire has been examined by me and this, to the best of my knowledge, is complete and accurate.

SIGNED _________________________________________________ TITLE ______________________

DATE _____________________________________

1) Name: Phone:________________

2) Name: Phone:________________

3) Name: Phone:________________

MUHLENBERG TOWNSHIP

POLICE DEPARTMENT 210 George Street

Reading, PA 19605

PHONE: (610) 929-5454 FAX: (610) 921-1144

BUSINESS EMERGENCY UPDATE FORM

Please make a photocopy of this form prior to completing and submitting in order

to facilitate any name changes in the future. Additional faxes must be sent to keep

your emergency callout list accurate. PLEASE TYPE OR PRINT ONLY.

Business Name: ______________________________________________

Address: ___________________________________________________

Phone: _____________________________________________________

Business Alarmed: Yes □ No □

Alarm Company Name/Number: _________________________________

Please list names and phone numbers for up to three people who can respond

immediately after business hours with a key and/or access code.

Comments:

Muhlenberg Township Commercial Building Permit 210 George Street, Reading PA 19605 610.929.4727

Date of Application ____________________ Permit # (dept. use only)_________

Building ____ Electric ____ Fire Alarm ____ Plumbing ____ Mechanical ____ Fire Suppression ____ New Construction ____ Addition ____ Repair/Alteration ____

Description of scope of work:

Cost of Construction/Improvement (include labor & material): Building $ Plumbing $ Mechanical $ Electric $ Sprinkler/Fire Alarm $

Please Note: PLANS – 3 full sets of construction drawings, signed and sealed PLAN REVIEW FEES – paid at time of permit issuance ALL FEES – must be paid at time of permit issuance COMPLETENESS - incomplete plans will be returned in their entirety

This permit is issued contingent upon all work being in compliance with the 2015 IBC, PA UCC and all other applicableMuhlenberg Township amendments and regulations.

Plumbing, mechanical contractors must be licensed with Muhlenberg Township.

48 hour notice to the Building Code Official (610.929.4727) is required to schedule individual required inspections for each tradediscipline.

Discipline Name, address, city & phone License #

Architect/Engineer

General Contractor

Excavation

Concrete

Carpentry

Electrical

Plumbing

Sewer

Mechanical

Roofing

Masonry

Drywall/Lath

Sprinkler

Paving

Fire Alarm

Under penalty of intentional misrepresentation and/or perjury, I declare that I have examined and/or made this application and is true and correct to the best of my knowledge and belief. I agree to construct said improvement in compliance with all provisions of the ordinances of Muhlenberg Township and applicable Building Codes. I realize that the information that I have stated here in, forms a basis for the issuance of the building permit herein applied for and approval of any plans in connection therewith shall not be construed to permit any construction upon said premises or use thereof in violation of any provision of the UCC therewith. Where no work has been started within 180 days after the issuance of a permit or when more than 180 days lapse between approval of required inspections, such permit shall be void. I hereby certify that I am the owner at this address or that, for the purpose of obtaining this approval, I am acting on behalf of the owner.

___________________________________________ _______________________________________ Signature of owner/representative Signature of contractor

DEPARTMENT USE ONLY Building Code Official Approval _______________________________ _________________________________________ Permit fees $_____________________ Check # ________________________ Permit issued date __________________ Zoning Approval ________________ Attached: plumbing permit #_____________ mechanical permit #____________

Owner: _________________________________________ Mailing Address: _____________________________________ Home Phone: ____________________ Work Phone: ___________________________ Cell: __________________________ Job Site Address: _______________________________________________________________________________________ Is this a LERTA (Local Economic Revitalization Tax Assistance) construction project? YES NO

APPLICATION FOR HEALTH LICENSE

TOWNSHIP OF MUHLENBERG 210 George Street Reading, PA 19605

(610) 929-4727

INSTRUCTIONS: (Please PRINT or TYPE all information) 1. Complete both sides of the Health License application form. Incomplete forms will delay processing.1. Determine License Fee as defined on reverse side2. Make check or money order payable to TOWNSHIP OF MUHLENBERG (Do not send cash)3. Mail completed application and payment to: Muhlenberg Township, 210 George Street, Reading, PA 19605

BUSINESS INFORMATION

Business Name: _____________________________________________________________________________

Business Address: ____________________________________________________________________________

Business Phone: ( ) ________________________ Business General Email: ___________________________

Business Owner Name: _________________________ Business Owner Address: _________________________

Business Owner Phone: ( ) _____________________ Business Owner Email: ________________________

Food & Beverage License Type (see back for descriptions) ___________________________________________

Liquor License # (if applicable) ___________________

INFORMATION FOR PROPERTY LOCATED IN MUHLENBERG TOWNSHIP

Same as Business Owner? YES ☐ No ☐ (if no, fill in property owner/landlord information below)

Property Owner: Last Name__________________________ First Name _________________________________

Property Owner Address: _______________________ ______________________________________________

Property Owner Email: _________________________ Property Owner Phone: ( ) _____________________

ADDRESS TO BE USED FOR MAILING PURPOSES (PLEASE COMPLETE ALL LINES – DO NOT WRITE “SAME AS ABOVE”)

Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________

E-Mail Address: _______________________________

Signature: ___________________________________ Name Printed: __________________________________

Title: _________________________________________________

Rev. 6/20/19

_____________________

Application Date

Additional information required for retail food establishments:

TYPE OF BUSINESS (check one):

___ Co-op ___Corporation ___ Limited Liability Company ___ Limited Liability Partnership ___ Non-Profit __ Partnership ___ Sole Proprietorship

TYPE OF SERVICE (Check all that apply):

□ Retail Grocery Store □Farmer Market Stand (immediate consumption foods) □Dine-In Food Service

□Take-Out Food Service □Catering □Convenience Store □Mobile Facility □Church/Fire Hall/Non-profit

□Bar / Club □On-the-Farm Retail Store □School □Organized Camp □Salvage Food □Frozen Dessert

NUMBER OF SEATS (mark “0” if no seats): ____ inside ___ outside TYPE OF WATER SUPPLY (check one): ____ Public ____ Non-Public (MUST PROVIDE DEP WATER TEST)

NAME OF WATER SUPPLIER: _______________ NAME OF REFUSE COLLECTOR: _____________________

HOURS OF OPERATION (check one): □ Open all year □ Open ________ (month) to ________ (month)

DAYS OF OPERATION & TIME (Check days which apply & complete time facility is open):

□Monday Time __________________ □Friday Time_____________________

□Tuesday Time __________________ □Saturday Time_____________________

□Wednesday Time __________________ □Sunday Time_____________________

□Thursday Time __________________

TYPE OF MENU (Check all that apply): □Full Service Menu (numerous items) ** attach menu

□Limited Menu (a few items) ** attach menu □Specific Food Items(list items) _________________________

□ Full Service Grocery with Departments: □Bakery □Deli □Café □Produce □Meat □Seafood □Dairy

Other, list __________________________________________________

Do you plan on serving any raw animal food undercooked, raw, or cooked to order? YES NO List: _________________________________________ If yes, is a consumer advisory on your menu? YES NO

Do you have a Certified Food Manager on Staff? YES NO Exempt (non-profit) or other exempt facility If YES: Please attach a copy of the National Certificate If NO: Do you have a Person-In-Charge enrolled in Food Safety Training? YES NO If YES, Name, Date, and Location of Course___________________________________________

Do you have an employee Health policy? YES NO Do you have an employee policy for Cleanup of Vomiting or Diarrheal Events in the facility? YES NO

Food & Beverage License and Inspection (includes 1 inspection and 1 re-inspection if needed)

Non-Profits (must provide a copy of their 501-c-3) $10.00

Vendor - Temporary (2 weeks or less) $100.00

Vendor – Temporary (charitable event) $35.00

Mobile Units $150.00 per unit

License of a retail food facility that has a seating capacity of less than fifty (50) $150.00

License of a retail food facility that is not described above $300.00

Duplicate license for each retail food facility location $25.00

Third and subsequent follow-up inspections – cost per inspection $300.00

Food Merchant operating in buildings exceeding 30,000 sq. feet $500.00

Food & Beverage License Late Payment Fee (set by ordinance) License Fee is doubled if not paid by due date

Rev. 6/20/19

MUHLENBERG TOWNSHIP 210 George Street Reading, PA 19605

Phone: 610-929-4727 Fax: 610-921-3764

Email: info@muhlenbergtwp.com WWW.MUHLENBERGTWP.COM

MUHLENBERG TOWNSHIP GREASE TRAP/OIL INTERCEPTOR APPLICATION

NAME OF BUSINESS ESTABLISHMENT __________________________________________________________

ADDRESS _________________________________________________________________________________

CONTACT NAME _______________________________________ PHONE # ____________________________

1. NAME OF GREASE/OIL COLLECTOR __________________________________________________________

2. TELEPHONE # FOR GREASE/OIL COLLECTOR ___________________________________________________

Check one:

_____Continuous Discharge ($200 per trap/interceptor)

_____Intermittent Discharge ($100 per trap/interceptor)

_________________________________________________ ____/____/_______ Authorized Signature Date

Forward payment and application to: Muhlenberg Township 210 George Street Reading, PA 19605