Fillable 1447 - Application for Special Event_Revised FEBRUARY 24 2010 _2_

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1447 - Application for Special Event_Revised FEBRUARY 24 2010 _2_

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Special Events Application – Page 3 – Revised FEBRUARY, 2010
Telephone #1: __________________________ E-mail Address: _______________________________________
Telephone #2: __________________________
*Property Owner: ___________________________________________________________________________
*Please Note – A letter of Consent is required from the property owner for the approval of this application.
Is the letter attached? [ ] Yes [ ] No
Will any portion of this event take place on Public or City Property? [ ] Yes [ ] No
Will there be a charge for admission? [ ] Yes [ ] No If yes, how much? _________________________
Has this event been held in the past? [ ] Yes [ ] No
If so, Indicate the city location of last event: ____________________________________________________
Is the event to take place: [ ] Indoors [ ] Outdoors [ ] Both
Number of Expected Daily Attendants: ___________
(BSO or Fire Details may be required - refer to page 6)
Please indicate the duration of the event:
DAY DATE START TIME END TIME TOTAL # OF HOURS
Anticipated Date and Time to Begin Set-Up: _____________________________________________
Anticipated Date and Time for Completion of Break-Down: ________________________________
*Do you have a site plan for the event to be submitted with this application? [ ] Yes [ ] No
*Please Note
– A site plan indicating the following conditions must accompany the application or the application will be
rejected, resulting in a significant time delay. The fire department must have easy access to the special event area.
The site plan must include the following: entrances and exits, emergency vehicle access routes, parking, general
vehicular drive paths, fire hydrant locations, fire department connections, street closure requests, fenced areas,
grandstand, bleacher or other seating locations, tent and stage locations, cooking areas, and locations of any
pyrotechnical material, fireworks, etc. In addition, the site plan must include the location of any rides (animal or
mechanical), petting zoos, exhibits, DJ’s, bands, performers, sanitary facilities, recreation vehicles for overnight
housing, etc.
Is there a request for any road closures? [ ] Yes [ ] No
Please identify the street name(s) and/or locations for closure requests: ___________________________
Special Events Application – Page 4 – Revised FEBRUARY, 2010
__________________________________________________________________________________________
Please Note
– These streets must also be identified on the site plan.
*Are you requesting to fence the event area? [ ] Yes [ ] No
Please Note
– You must identify any fencing area on the site plan.
*Will Canopies (tent structure with no sides) be used for this event? [ ] Yes [ ] No
*Please Note
- All tent structures with canopies in excess of 400 square feet [Per NFPA 1: Table 1.12.19(a)] require
building permits and inspections. All canopies must be flame retardant. A certificate of flame retardency and a sample
of the canopy fabric for field testing must be submitted for product approval with this application. This information can
be obtained from the canopy manufacturer or the canopy rental company. Please apply for the permit at the Building
Department located at 100 W. Dania Beach Blvd. Please allow 8-10 working days for permit approvals.
*Will Tents (With Sides) be used for this event? [ ] Yes [ ] No
*Please Note
– All tents in excess of 200 square feet [Per NFPA 1: Table 1.12.19(a)] require building permits and
inspections. All tents must be flame retardant. A certificate of flame retardancy and a sample of the tent fabric for field
testing must be submitted for product approval with this application. This information can be obtained from the tent
manufacturer or the tent rental company. If the tents have sides, they are treated as buildings. They must have two
separate exits remotely located from each other with electrically illuminated exit signs that have a battery back-up. In
addition, they must have emergency egress lighting and fire extinguishers. Provide a life safety plan for these tents
indicating the location of all Exits, Exit Signs, Emergency Lighting, Aisle Spacing, Fire Extinguisher locations, etc.
Permits must be obtained for all tents and electrical work. Please apply for all permits at the Building Department
located at 100 W. Dania Beach Blvd. Please allow 8-10 working days for permit approvals.
*Will electricity be required for this event?
(for lighting, sound, cooking, other power needs, etc.) [ ] Yes [ ] No
*How will this electricity be supplied? [ ] On-Site [ ] Generator [ ] Combination of Both
Please Note
– The use of generators, temporary wiring, temporary electrical connections, etc. require permits and
inspections. Please apply for the permit(s) prior to setting up at the Building Department located at 100 W. Dania
Beach Blvd. Events requiring electricity are the responsibility of the applicant and must have a master electrician on
site. Please allow 8-10 working days for permit approvals. Any generator less than 5KW does not require a permit.
Will there be live entertainment at this event? [ ] Yes [ ] No
Please indicate the type (Band, DJ, Live Performers, etc.): _____________________________
Please specify the hours of entertainment:
DAY DATE START TIME END TIME TOTAL # OF HOURS
*Will a stage(s) be used in this event? [ ] Yes [ ] No
*Please note Fire Extinguisher Requirement in the next question.
*Do you have adequate fire extinguishers for this event? [ ] Yes [ ] No
*Please Note
- Fire extinguishers must be supplied for each tent, canopy, cooking appliance and stage. They must be
accessible from anywhere in the tent or on the stage without having to travel any further than 75 feet for access.
Extinguishers must be easily accessible and not obscured from view. Fire extinguishers must be commercial “ABC
Multi-Purpose” (minimum 5lbs.) fire extinguishers that are currently certified and tagged by a licensed company. You
Special Events Application – Page 5 – Revised FEBRUARY, 2010
need to demonstrate that this requirement will be met by making a note on the site plan indicating compliance with all
of the above requirements or providing a letter to the City fire prevention bureau to that effect.
*Will there be concessions or sales of food at this event? [ ] Yes [ ] No
Please specify: _______________________________________________________________________
*Please Note
STATE HEALTH INSPECTIONS FOR FOOD: Pursuant to Florida law (Chapter 509, Florida
Statutes) event sponsors are required to contact the State Health Inspector no less than 3 days prior to the
event. Advance notification of 7 to 10 days is advisable. Please send a fax with your event plans and contact
information to Fax Number (954) 956-5699. The Inspector’s office will contact you to discuss food vendors and
amounts and types of food you plan to make available to the public, whether it is being given away or sold.
An original Certificate of Liability Insurance and Workers’ Compensation Certificate is required from all vendors. You
must ensure that the Liability Certificate is for this specific event, has the proper dates, and names the City of Dania
Beach as an Additional Insured. No event will be approved without this insurance.
*Will any type of cooking appliances be used by either the Sponsor of the Event or any of its vendors? [ ] Yes
[ ] No
*If so, indicate the type of appliance(s) to be used and the number of each appliance to be used:
[ ] N/A
[ ] Electric Grill(s); #____
[ ] Gas Grill(s); #____
[ ] Charcoal Grill(s); #____
[ ] Smoker Grills(s); #____
[ ] Grease Fryer(s); #____
[ ] Oven(s); #____
[ ] Electric Range Burner(s); #____
[ ] Gas Range Burner(s); #____
*Please Note
– Grease Fryers are not permitted indoors unless they are protected with an approved Hood and a
UL300 Compliant Wet Chemical Automatic Fire Suppression System in accordance with NFPA 96.
*Does each cooking appliance have its own dedicated Fire Extinguisher? [ ] Yes [ ] No
*Please Note
- Each cooking appliance must have its own dedicated fire extinguisher. Class K fire extinguishers are
required for fryers. You need to demonstrate that this requirement will be met by making a note on the site plan
indicating compliance with all of the above requirements or providing a letter to the fire prevention bureau.
*Does each cooking area have the proper clearances from all other event areas? [ ] Yes [ ] No
*Please Note
- Cooking areas can be located no closer than 30 feet from any tent or canopy structure, event rides,
stages, grandstands or bleachers, etc. Ensure that this measurement is demonstrated on the site plan.
*Will there be sales of alcohol at this event? [ ] Yes [ ] No
*Please Note
– An original certificate of liquor liability insurance naming the City of Dania Beach as additional insured
and a 1/2/3 Day Special Sales License is required to be submitted with this application. The license must be obtained
from the State of Florida Department of Business and Professional Regulation.
If Yes, Please Specify Types of Alcohol to be Sold: [ ] N/A [ ] Beer [ ] Wine [ ] Liquor
[ ] Mixed Drinks [ ] Other: _____________________________________
If alcohol is being served, please indicate how the beverages will be served: [ ] N/A
[ ] Draft Truck [ ] Cold Plate [ ] Mini-Bar [ ] Beer Tub [ ] Table Service
Special Events Application – Page 6 – Revised FEBRUARY, 2010
Other: ______________________________________________________________________________
Will there be alcohol given away at this event? [ ] Yes [ ] No
Please Specify Types of Alcohol to be given away: [ ] N/A [ ] Beer [ ] Wine [ ] Liquor
[ ] Mixed Drinks [ ] Other: _____________________________________
Will there be retail sales at this event? [ ] Yes [ ] No
Please Specify: ______________________________________________________________________
*Will there be any carnival rides, mechanical or vehicular rides, or animal rides at this event?
[ ] Yes [ ] No
*If yes, please describe: ________________________________________________________________
What is the name of the vendor or vendors providing the rides? [ ] N/A
____________________________________________________________________________________
*Please Note
- If carnival rides are to be present, the rides must be inspected by a state inspector, city electrical
inspector, and fire inspector 48 hours prior to the rides opening.
Are you providing to us a copy of the ride vendor’s Certificate of Liability and Workers’ Compensation
Insurance with this application? [ ] Yes [ ] No
*Please Note
– An original Certificate of Liability and Workers’ Compensation Insurance is required for any and all
rides. Ensure that the Certificate is for this specific event, has the proper dates, and names the City of Dania Beach as
an Additional Insured. No event will be approved without this insurance.
*Will recreational vehicles be used for temporary overnight housing? [ ] Yes [ ] No
*Please Note
– Indicate the locations of these on the site plan.
*Will there be any use of pyrotechnics or fireworks displays at this event? [ ] Yes [ ] No
*Please Note
- Pyrotechnics fireworks displays require special applications, permits and inspections as well as an
original Certificate of Liability and Workers’ Compensation Insurance. In addition, a Fire Inspector will be required to be
present during set-up and displays. This expense will be passed on to the event. (BSO or Fire Details may be required
- refer to page 6)
*Will there be use of any Grandstands or Bleachers for seating at this event? [ ] Yes [ ] No
*Please Note
- Bleachers and Grandstands may have to meet special safety code requirements. Locations must be
indicated on the site plan. Plumbing permit is required for portable toilets.
*Are portable, ADA compliant sanitary facilities being provided for this event? [ ] Yes [ ] No
If so, How many? ________ [ ] N/A
*Please Note
– Provide the locations of all sanitary facilities on the site plan.
*Is there a request for any temporary signage for this event? [ ] Yes [ ] No
*Please Note
– Any questions regarding temporary signage should be directed to City Code Compliance,
(954)924-6810.
Are there any services being requested from the City of Dania Beach? [ ] Yes [ ] No
If yes, please explain: _________________________________________________________________
Please list any other conditions, terms or relevant information related to this event that may be of interest to
the City:
Special Events Application – Page 7 – Revised FEBRUARY, 2010
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
BSO DETAIL REQUIREMENT
Based upon anticipated attendance, site or building size, site location, and ability to assure public safety requirements,
a Broward Sheriff’s Office Detail may be required.
FIRE WATCH REQUIREMENT
A Fire-Watch may be imposed depending on the type of event, number of persons present and hazards involved. The
number of personnel and apparatus required may vary depending on the type of event and hazards involved. Below
are the current rates charged for the presence of a fire watch detail, fire inspector or both:
Off-Duty detail assignment services performed by Dania Beach Fire Rescue Personnel will be paid at
their current overtime rate of pay with benefits (3 Hour Minimum). In addition, a City administrative fee
of 10% will also be charged based on the total cost of personnel and apparatus. Personnel costs are
currently estimated to be $84.42 per hour, per person (3 hour minimum).
The cost of apparatus is as follows:
Rescue Truck - $32.00 per hour
Engine (1500 gpm) - $71.00 per hour
Ladder (1500 gpm) - $80.00 per hour
The City of Dania Beach requires payment 14 days in advance for the detail services and fees are to be made payable
to The City of Dania Beach by means of cash advance or a cashier’s check
. Fees are based on individual employee’s
overtime rates which vary from person to person. The amount estimated is based on the highest overtime rate
currently payable in addition to fees for FICA, Medicare, Worker’s Compensation and Administrative fees. In the event
that the entire estimated amount is not required for services, the City will refund the money, less the expenses incurred
for the service. Should the amount of time required for the fire watch detail exceed that agreed upon before the event,
the Event sponsor will be required to pay for any overage based on the actual cost for the Fire Watch. The Event
sponsor will be responsible to pay the actual service price incurred.
The information I have provided on this application is true and complete to the best of my knowledge. I
understand that approval of this event is contingent upon review and approval of all City Disciplines, the City
Attorney’s Office and the City Commission.
___________________________________ ________________________________________
Signature of Applicant Title
___________________________________
Print name of Applicant
________________________________
Date
_________________________________________________________________________________________________________________
STATE OF FLORIDA
COUNTY OF BROWARD
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Special Events Application – Page 8 – Revised FEBRUARY, 2010
The foregoing instrument was acknowledged before me on _________________________________, 200____.
by _____________________________, who is personally known to me, or, if not, such person produced the
following form of identification:____________________________.
NOTARY PUBLIC
My Commission expires: _______________________
My Commission number: _______________________
Special Events Application – Page 9 – Revised FEBRUARY, 2010
SPECIAL EVENT APPLICATION / PERMIT FEES
$100.00 Beach Weddings
$150.00 All Other Events
$280.00 Special Events Involving Fire Inspections
$100.00 Private Parties (over 26 participants)
$50.00 Small Parties (under 25 participants)
Special events requiring the use of Broward Sheriff’s Office
shall require advance payment of the applicable special
detail rate.
Special Events requiring the use of personnel from the Fire
Department or the use of City Lifeguards shall require
advance payment of the applicable overtime rate.
A late fee of $75.00 will be assessed for any application that
is received by the City sixty (60) days or less before the date
(or starting date) of the event.
Rental rates are subject to the applicable 6% sales tax.
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1447 - Application for Special Event_Revised FEBRUARY 24 2010 _2_

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