Fill - Free fillable Ashland, VA, 23005 The Town of Ashland welcomes (Town of Ashland, VA) PDF form

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The Town of Ashland welcomes those seeking to film on location in “the Center of the Universe”. To

ensure that town services are available and that staff are properly prepared to provide any necessary

assistance, we require that this film application be completed a minimum of 21 days prior to any

permitted activity. While applications will be accepted within 21 days of activity, we cannot guarantee

any staff availabilities or requested street closures. The Town’s permit process is designed to manage

all location filming on public property, as well as filming activity on private land, which may have an

impact on public property, or the use of public amenities. This includes (but is not limited to) activities

that:

• Interrupt or impede traffic on town streets

• Interrupt or impede pedestrians on sidewalks

• Require wires or cables running across or over sidewalks or town streets

• Require the use of generators, tripods, dollies, booms or other equipment on sidewalks or

streets

• Impact on public use of, or access to public parking areas, community facilities and parks

We recommend that those interested in filming in Ashland schedule a pre-meeting prior to making an

application. To set up a pre-meeting, or for more information about this process, please contact Joe

Topham at (804) 798-1073 or jtopham@town.ashland.va.us.

PRIMARY CONTACT INFORMATION – This person will be the main point of contact for the Town

Name: ______________________________________________________________________________

Company: ________________________________________________________________________

Email: ______________________________________________________________________________

Phone: ____________________________________Alternate Phone_____________________________

Address: _____________________________________________________________________________

City: ________________________________________State __________________ZIP________________

Filming Permit

Town of Ashland

Department of Planning and Community Development

101 Thompson Street

Ashland, VA, 23005

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phone: (804) 798-1073

fax: (804) 798-4892

jtopham@town.ashland.va.us

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OTHERS AUTHORIZED AS A CONTACT FOR THE TOWN

Alternate #1

Name: ______________________________________________________________________________

Company: ____________________________________________________________________________

Email: ______________________________________________________________________________

Phone: ______________________________________________________________________________

Alternate #2

Name: ______________________________________________________________________________

Company: ____________________________________________________________________________

Email: ______________________________________________________________________________

Phone: ______________________________________________________________________________

ECONOMIC IMPACT FOR THE TOWN OF ASHLAND

Will you have any hotel overnight stays for this project in Ashland?: Yes No

Estimated value of meals/catering purchased in Ashland: $_______________________________

Estimated value of services purchased in Ashland (can include talent, production support, etc.): $

_____________________________________________________________________________

Estimated value of venue rental in Ashland: $ ____________________________________________

Other expenses (please explain):

Total value of all local Ashland expenses listed above: $ ________________________

Have you contacted the Virginia Film Office? Yes No

Have you received support from the Virginia Film Office? Yes No

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PRODUCTION DETAILS

Date(s): ______________________________________________________________________________

Rain date(s): __________________________________________________________________________

Start Time(s): ________________________________________________________________________

End Time(s): ________________________________________________________________________

Location(s) of Shoot – Please provide exact street locations:

_____________________________________________________________________________________

Story Content (story line, description of shoot): (Fillable Box)

Equipment (camera booms, lighting, any mobile equipment): (Fillable Box)

Will any outdoor lighting, loud noises, or extended hours be required? Please list below.

_____________________________________________________________________________________

Will any parking areas (streetside or lots) be needed for your production team? If so, please list below.

_____________________________________________________________________________________

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PRODUCTION DETAILS (CONTINUED)

Total Number of Cast and Crew: ________________________________________________________

Social Media handles/Facebook: __________________________________________________________

Website: _____________________________________________________________________________

STREET CLOSINGS

Any street closings will require Town of Ashland police officers for traffic control, which will incur fees.

Please list the purpose for why you need the street closed (such as for a shot, for parking, staging, etc),

and for how long they will be needed. Any officers hired must be paid the day of activities.

Location(s):

_____________________________________________________________________________________

SIDEWALK CLOSINGS

Any sidewalk closures will require the use of Public Works staff, which may incur a fee for the service.

Please list the purpose for the sidewalk closures, and how long they will be necessary.

Location:

_____________________________________________________________________________________

Have all adjacent property owners been notified? Yes No

ADDITIONAL REQUESTS

(Fillable Box)

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FIELDS BELOW FOR USE ONLY BY TOWN OF ASHLAND STAFF

ASHLAND POLICE DEPARTMENT

DATE OF RECEIPT ______________________________________

POLICE DEPARTMENT, ESTIMATE OF POLICE STAFF-HOUR NEEDS _______________________________

POLICE DEPARTMENT, ESTIMATE OF COST FOR CONTROL PURPOSES ___________________________

APPROVED BY _________________________________________________DATE __________________

COMMENTS __________________________________________________________________________

_____________________________________________________________________________________

DEPARTMENT OF PUBLIC WORKS

DATE OF RECEIPT ______________________________________

PUBLIC WORKS, ESTIMATE OF STAFF STAFF-HOUR NEEDS _____________________________________

PUBLIC WORKS, ESTIMATE OF COST FOR NECESSARY SERVICES ________________________________

APPROVED BY _________________________________________________DATE___________________

COMMENTS __________________________________________________________________________

_____________________________________________________________________________________

TOWN ADMINISTRATION

DATE OF RECEIPT _______________________________________

APPROVED BY _________________________________________________DATE ___________________

COMMENTS __________________________________________________________________________

_____________________________________________________________________________________

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