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Home » Our Forms » Bed & Breakfast Application

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Section I - Applicant Information

Name of Applicant*

First Name* Last Name*

Inspection Contact

Email Address*

Phone Number*

Business Name*

Address*

Street Address* Address Line 2 City* State* ZIP Code*

Website Address*

Years in Business (Years)*

Section II - Business Information

Is Applicant open year round?*

Yes

If NO, average number of months per year in operation?

Is there a manager on the premises/duty 24 hours daily?*

Yes

Is the applicant’s property listed on the National Register of Historic Places?*

Yes

Section III - Revenue Information

Please provide annual revenue estimates. This information is used only for business income recommendation. General Liability base premiums are rated on a “per room” basis.

Room Rental

Room Rental - Current Year*

Room Rental - 1st Prior Year

Additional Food/Beer/Wine

Additional Food/Beer/Wine - Current Year*

Additional Food/Beer/Wine - 1st Prior Year

Liquor

Liquor - Current Year*

Liquor - 1st Prior Year

Weddings

Weddings - Current Year*

Weddings - 1st Year Prior

Equipment Rental (bikes, scooters, water sports, etc)

Equipment Rental - Current Year*

Equipment Rental - 1st Year Prior

Other

Describe:

Other - Current Year*

Other - 1st Year Prior

Section IV - Building Information

Parking Area Footage

Number of Buildings*

Building 1

Building Square Footage*

Number of Rooms*

Number of Elevators*

Number of Stories*

Year Built*

Average Room Rate*

Occupancy Rate*

If the building is over 15 years old, when were the following updates performed?

HVAC

MM slash DD slash YYYY HVAC

Electrical

MM slash DD slash YYYY Electrical

Plumbing

MM slash DD slash YYYY Plumbing

Roof

MM slash DD slash YYYY Roof

Building 2

Building Square Footage*

Number of Rooms*

Number of Elevators*

Number of Stories*

Year Built*

Average Room Rate*

Occupancy Rate*

If the building is over 15 years old, when were the following updates performed?

HVAC

MM slash DD slash YYYY HVAC

Electrical

MM slash DD slash YYYY Electrical

Plumbing

MM slash DD slash YYYY Plumbing

Roof

MM slash DD slash YYYY Roof

Building 3

Building Square Footage*

Number of Rooms*

Number of Elevators*

Number of Stories*

Year Built*

Average Room Rate*

Occupancy Rate*

If the building is over 15 years old, when were the following updates performed?

HVAC

MM slash DD slash YYYY HVAC

Electrical

MM slash DD slash YYYY Electrical

Plumbing

MM slash DD slash YYYY Plumbing

Roof

MM slash DD slash YYYY Roof

Section V - Restaurant/Lounge/Bar

Are there any designated areas where food is served outside of breakfast?*

Yes

If YES, operated by:

Applicant

Leased to Others

Are there any designated areas where alcohol is served?*

Yes

If YES, operated by:

Applicant

Leased to Others

Is liquor served on the premises?*

Yes

Section VI - Pools

Are there any pools on the premises?*

Yes

If YES, please answer the following questions:

Number of pools

Are all pools fenced with self-latching gates?

Yes

Height of fence

Are the depth markings clearly shown?

Yes

Are warning signs and rules posted and clearly visible?

Yes

Is rescue equipment, including ring buoy and Sheppard's Hook, available poolside?

Yes

Are there any water slides, diving boards, diving platforms, rafts or similar equipment?

Yes

Are walking surfaces slip-resistant?

Yes

Are all swimming pools and hot tubs in compliance with the Virginia Graeme Baker Safety Act?

Yes

Section VII - Weddings

Does the applicant host wedding ceremonies of any kind?*

Yes

If YES, Does the applicant host “cocktail hours” or serve alcohol to guests?

Yes

Section VIII - Additional Services

Does the applicant provide any equipment available for rental? (bikes, scooters, water sports, etc.)*

Yes

If YES, please describe

Section IX - Maintenance

Do you have written procedures for inspecting and maintaining of your premises?*

Yes

Who performs building and/or site maintenance, service and repair?

Landscaping/Lawn Care Operations*

Employee

Independent Contractor

N/A

General Maintenance & Repairs*

Employee

Independent Contractor

N/A

Elevator Maintenance & Repair*

Employee

Independent Contractor

N/A

If done by an independent contractor, is Applicant named as additional insured with a hold harmless on the subcontractor's policy?*

Yes

N/A

If done by an independent contractor, does the independent contractor provide certificates of insurance with at least $1,000,000 liability limits?*

Yes

N/A

Section X - Fire Protection

Is the complex in compliance with all applicable state and local statutes governing safety devices?*

Yes

Are there smoke alarms in each unit?*

Yes, Hard-Wired

Yes, Battery

Yes, Both

Are carbon dioxide detectors in each unit?*

Yes, Hard-Wired

Yes, Battery

Yes, Both

Are buildings sprinklered?*

Yes

If yes, what percentage?

Does the building have a Central Station Fire Alarm?*

Yes

Is there aluminum wiring on the premises?*

Yes, Repaired

Yes, Not Repaired

If there is repaired aluminum wiring, please describe

Is a secondary means of egress provided if over two stories?*

Yes

Are floor plans showing evacuation instructions and nearby fire exits posted in every guest room?*

Yes

Do all buildings/floors have clearly marked fire exits?*

Yes

Emergency lighting provided in all common areas?*

Yes

Do individual guest rooms have balconies?*

Yes

If YES, are balcony platforms and railings regularly inspected for structural integrity?*

Yes

N/A

Are cooking facilities provided in guest rooms?*

Yes

If YES, is there an operational automatic extinguishing system in place?*

Yes

N/A

Are extinguishing systems inspected on a regular basis?*

Yes

N/A

How often are extinguishing systems inspected?

Are showers/tubs protected with non-skid surfaces or mats?*

Yes

Section XI - Security

Does the Applicant complete background checks on all newly hired employees?*

Yes

Does the employment process include verification of whether the individual has ever been convicted of any crimes, including sex-related or child abuse-related offenses?*

Yes

Do room doors have deadbolt locks and door chains?*

Yes

Do adjoining room doors have deadbolt lock?*

Yes

Does the Applicant use card keys in lieu of metal keys?*

Yes

Are any rooms accessible by exterior hallways?*

Yes

Does the building have a central burglar alarm?*

Yes

Does the facility have CCTV for monitoring parking and entrances?*

Yes

Do premises have lighting in parking areas, walkways & common areas?*

Yes

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