Fill - Free fillable CITY OF LEBANON N.H.Applications & Permits Physical address: (City of Lebanon) PDF form

CITY OF LEBANON N.H.—Applications & Permits

Lebanon City Manager’s Office:

Physical address: 20 West Park Street

Lebanon, NH 03766

Mailing address: 51 North Park Street

Lebanon, NH 03766

Email: manager@lebanonnh.gov

Phone: 603-448-4220

Lebanon City Hall offices are closed to the public until further notice. All City Department staff will be available to

answer questions via phone or email.

The City of Lebanon continues to accept applications and permits via email, through the mail or dropped into the

green mailbox outside of the entrance to 20 West Park Street. Application and permit information can be found

on our website here:

https://lebanonnh.gov/203/Applications-Permits

All permits issued for the 2020 calendar year will remain in effect at this time, but with the rapidly evolving

circumstances regarding COVID-19, these may be rescinded. You will be notified at the earliest possible time for

you to plan accordingly.

The City of Lebanon is actively engaged with the New Hampshire Department of Health and Human Services

(DHHS) and our local and regional partners with regards to State and local response to the COVID-19 virus.

We encourage all to visit our website for the latest updates and information:

https://lebanonnh.gov/1350/COVID-19

USE OF CITY PROPERTY CHECKLIST

Use of City Property applications will be reviewed, along with the below checklist, to ensure all City

requirements are met. Please be aware that Colburn Park must remain open and accessible to the

general public.

1. Masks must be worn by all people entering the event, and by those monitoring the entry point.

If participants or people associated with the event are less than six feet apart, masks must be

worn.

2. Hand sanitizer needs to be accessible for all entering the event.

3. Bathroom facilities need to be provided and sanitized after each use.

4. How many vendors will be part of the event? (Please note that vendors are required to be at

least ten feet apart from each other, face a directional walking path, and be able to segregate

from other park activities)

5. Only one entrance and one exit for the event is permitted.

6. Layout Plan required. Please use the attached layout of Colburn Park to show proposed

entrance, exit, vendor locations (indicating distances between), and the directional flow of

participants when they enter.

7. How many event organizers will be in attendance to ensure proper hygiene, bathroom

sanitization, and social distancing?

Pursuant to State of New Hampshire Emergency Orders, I hereby attest to the fact that my business is

deemed an essential service and is in compliance with all New Hampshire issued emergency orders

currently in effect.

________________________________________

Signature

________________________________________

Printed Name

________________________________________

Title

________________________________________

Date

USE OF CITY PROPERTY CHECKLIST

Last Revised 07-18-18 City of Lebanon—Application for Permit

Use of Colburn Park & Parade/Race/Walk

Page 1 of 3

Colburn Park ‐ Described as the enƟre area bordered by North Park Street on the north, West

Park Street on the west, South Park Street on the south and East Park Street on the east,

excluding the sidewalks along those streets.



1. If a tent lar ger than 15’ x 15’ is to be used, this permit is condional upon review,

inspecon and approval by the Lebanon Fire Department.Please contact a Fire

Inspectorat448‐8810tosetupameforinspecononcethetentisinplace.

2. If 50 or more people are expected at an event, a  Place of Assembly Permit may be

required from the Lebanon Fire Department.This permit is condional upon review

andapprovalbytheLebanonFireDepartment.PleasecontactaFireInspectorat448‐

8810.

3. Trashistobedisposedofattheconclusionoftheevent.

4. Any fund‐raising acvies must be held well within the conﬁ nes of Colburn Park; no

solicitaonsofanytypearetooccurnearthevariousentrancestothePark.

5. If a public address system or ampliﬁcaon is to be used a Sound Permit must be

obtained from the Lebanon Police  Department.No ampliﬁcaon equipment may be

usedonSundaysexceptbetweenthehoursof1:00pmand5:00pmunlesspermissionis

grantedbytheCityCouncil.

6. Unless a waiver is granted, a CerƟﬁcate of Insurance must be provided to the City

Manager’sOﬃcepriortotheevent.

7. Vehicles are allowed in Colburn Park only for unloading/loading purposes.Please

restricttravelintheParktothepavedwalkwaysonly.Anydamagedonetothegrass

orotherareasoftheparkistheresponsibilityoftheapplicant.

8. Ifelectricityisrequiredforyourevent:

a. Please contact the Lebanon Recreaon Department at448‐5121 at least 48 hours

priortotheeventtoretrievethekeytotheelectricalbox.Ifyoureventfallsona

SaturdayorSunday,besureto contactRecreaonby theWednesdaypriorto the

event.

b. This permit is condional upon an electrical safety check to be conducted by the

City’selectricalinspector.PleasecontacttheCodes Departmentat least48 hours

priortotheeventat448‐1524toscheduleasafetywalk‐throughpriortotheevent.

If you event falls on a Saturday or Sunday, be sure to contact the Codes

Department by the Wednesday prior to the event and speak with the City’s

ElectricalInspectortogoovertheelectricalsafetyissues.

9. Ifwaterisrequiredforyourevent,pleasecontactUliesMaintenanceat298‐5190at

least48hourspriortotheevent.Ifyoureventfallsona SaturdayorSunday,besure

tocontactUliesMaintenancebytheWednesdaypriortotheevent.

CITYOFLEBANONN.H.—ApplicationforPermit



COLBURN PARK USE & PARADE/RACE/WALK

Last Revised 07-18-18 City of Lebanon—Application for Permit

Use of Colburn Park & Parade/Race/Walk

Page 2 of 3



10.Alcoholuse,saleorconsumponisprohibitedunlessanAlcohol ExempƟonisgranted.

ANewHampshireliquorlicensemustbeprovidedifthereistobeanysaleofalcohol.

Licenseemusthave acopyoftheNH  Liquor License intheirpossessionontheday  of 

theevent.

11.The Licensee will serve alcohol pursuant to state and federal laws regulang the

distribuonandconsumponofalcohol.



Parade / Race / Walk‐a‐Thon

1. Coordinate planned route with the Lebanon Police Department to assure  the Parade

Routeisadequatelysupervisedbypolicepersonnel.

2. Insurance Requirements Form accompanied by a Cerﬁcate of Insurance, if needed,

mustbeprovidedtotheCityManager’sOﬃcepriortotheevent.

3. Detailedsketchormapofparaderoute.



Insurance Requirements



ACerﬁcateofInsurancemustbeprovidedforeventswhich are ancipatedtoaract25 or

moreparcipants.Iflessthan25parcipantsareexpected,theCityManagermaywaivethe

requirementattherequestoftheapplicant(seeaachedInsuranceRequirementsForm).



TheCerﬁcateofInsurancemustlisttheCityofLebanonasaddionalinsured,andmustbein

anamountnotlessthan$500,000perpersonand$1,000,000peroccurrence.



Checklist:

 CompletedApplicaon

 InsuranceRequirementsForm

 CerﬁcateofInsurance

 SoundPermit(ifneeded)

 PlaceofAssemblyPermit(ifneeded)

 AlcoholExemponApplicaon(ifneeded)

 DetailedSketch/MapRoute

 RoutecoordinatedwithLebanonPoliceDepartment

Last Revised 07-18-18 City of Lebanon—Application for Permit

Use of Colburn Park & Parade/Race/Walk

Page 3 of 3

CITYOFLEBANONN.H.—ApplicationforPermit



COLBURN PARK USE & PARADE/RACE/WALK

BUSINESSNAME:

CONTACTPERSON:

StreetAddressCityStateZip



PHONE: EMAIL:



Purpose:

Date(s)EventtobeHeld:

StartTime:EndTime: ParadeRaceWalk‐a‐Thon

RouteofParade/Race/Walk:

 PleaseCompleteAttachedInsuranceRequirements Form.UnlessaWaiverisGranted,PleasePro-

videaCertiicateofLiabilityInsurance

 Ifalcoholicbeveragesaretobeserved,anAlcoholExemptionmustbeissued(CityCode§14)

ReviewRequirementsforConsumptionand/orSaleofAlcoholandcom pletetheAlcoholExemp-

tionForm



ApplicantagreesbytheirsignaturebelowthattheyhavereadandagreetothetermsandconditionsoftheUse

ofCityPropertyandParade/Walk/Race.



Signature:__________________________________________________________________Date:_______________________________

FOROFFICEUSEONLY

DATERECEIVED: LICENSE#

CertiicateofLiabilityInsuranceProvided

InsuranceRequirementsFormProvided

NHLiquorLicenseProvided

PoliceDepartmentApprovalReceived

ALCOHOLTOBESERVED?YesNo

AlcoholExemptionFormProvided

NHLiquorLicenseProvided(SaleofAlcohol)

CITYMANAGER: Date:

APPROVAL:

Waiver(s)Requested:CertiicateofLiabilityInsuranceWorker’sCompBondforDamage

MAYOR: Date:

AgreementandSignature

click to sign

signature

click to edit

City of Lebanon

Insurance Requirements

Page 1 of 3

CITY OF LEBANON N.H.

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                 



                



INSURANCE REQUIREMENTS

I, (please print legibly) , hereinaer referred to as the

LICENSEE, have requested the use of public facilies, hereinaer referred to as LICENSED PREMISES,

owned and operated by the City of Lebanon, hereinaer referred to as the CITY. The LICENSEE

understands that this aachment constutes a part of that permied use.

1. RELEASE FROM PERSONAL LIABILITY

The LICENSEE hereby releases and forever discharges the City, its heirs, agents, and assigns from any

an all liability for any and all damage to property the LICENSEE brings to the LICENSED PREMISES or any

and all bodily injury the LICENSEE, its employees, invitees, agents, or assigns may suer while at the

LICENSED PREMISES. The LICENSEE has aached hereto a cercate evidencing worker’s

compensaon insurance overage for any and all of its employees.

LICENSEE Signature Date

1.1 Opon to Waive Requirement for Worker’s Compensaon Insurance: The

requirement for worker’s compensaon insurance coverage may be waived by the CITY

if the LICENSEE ceres that they will not have any employees working at the LICENSED

PREMISES. It is understood and agreed by the LICENSEE that waiver of the requirement

for worker’s compensaon insurance coverage does NOT, however, relieve the

LICENSEE from providing the CITY with a Cercate of Insurance, or liability for claims of

property damage, or personal injury to volunteers or non-employees that my assist at

the LICENSED PREMISES.

 I, , hereby cerfy that no employees will

be present at the event, and therefore am requesng a Waiver of Worker’s

Compensaon Insurance by the CITY.

Request for Waiver of Worker’s Compensaon Insurance: [ ] Approved [ ] Denied

City Manager Signature Date

2. RELEASE FROM INDEMNIFICATION FROM THIRD PARTY LIABILITY

The LICENSEE hereby releases the CITY from liability for any property damage or personal injury that

any parcipants may suer while at or on the LICENSED PREMISES. The LICENSEE further indemnies

and holds the CITY harmless from and against all claims for such property damage or personal injury

from third persons on the LICENSED PREMISES at the permission of the LICENSEE, including reasonable

aorney’s fees, whether or not such claims result in ligaon.

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signature

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City of Lebanon

Insurance Requirements

Page 2 of 3

2.1 Cercate of Insurance: The LICENSEE understands that it is required to have valid

liability insurance in force to guarantee its promise to pay damages to parcipants

outlined in Secon 2 above.

 Aached to this release is a valid Cercate of Insurance (required to be in the

amount not less than $500,000 per person and $1,000,000 per occurrence and must list

the City of Lebanon as addional insured) evidencing the LICENSEE’S ability to indemnify

any individual who claims or might claim that acons of the LICENSEE caused him or her

damage to property or bodily injury.

 Tenants Users Liability Insurance Policy (TULIP) is available to individuals or clubs

who need coverage for private events. Low cost coverage is obtainable for single-day

events like weddings, pares, reunions, concerts or charity benets. TULIP insurance

will need to be provided prior to any event held on City property by a private group.

(TULIP informaon sheet aached)

LICENSEE Signature Date

2.2 Waiver of requirement for Cercate of Insurance: The requirement for

Cercate of Insurance may be waived by the CITY if the LICENSEE expects to aract

only 25 parcipants or less. It is understood and agreed to by the LICENSEE that waiver

of the requirement for a Cercate of Insurance does NOT waive the requirement for

acceptance of liability outlined in Secons 1 and 2.

 I, , am hereby requesng a waiver

from the requirement to provide a Cercate of Insurance as I do not expect to

aract more than 25 parcipants at any given me during the event.

The LICENSEE further promises that it will return the LICENSED PREMISES to the CITY in a

condion equal to or beer than its condion prior to its use. This includes removal of

any and all equipment which the LICENSEE brings to the LICENSED PREMISES as well as

lier, and also to repair all facilies damaged during the term of the permit.

Request for Waiver of Liability Insurance: [ ] Approved [ ] Denied

City Manager Signature Date

3. LIABILITY FOR DAMAGE TO CITY FACILITIES

Bond for Damage: The LICENSEE posts a bond (or leer of credit or cash deposit received by the CITY

this date) in the amount of $ payable to the CITY to be used by the CITY to

guarantee the promise in Secon 3 above. The bond (leer of credit or cash deposit) shall be in an

amount determined by the City Manager taking into account the intensity of use that the LICENSEE

ancipates for the LICENSED PREMISES. The LICENSEE understands that the CITY may take this bond

click to sign

signature

click to edit

City of Lebanon

Insurance Requirements

Page 3 of 3

(leer of credit or cash deposit) and repair any and all damage, replace any and all equipment

removed, remove any and all lier, or in any other manner expend it in order to return the LICENSED

PREMISES to a condion equal to what it was before the premises permied use.

3.2 Waiver of requirement of bond for damage: The CITY may waive the requirement

for a bond (leer of credit or cash deposit). Waiver of the requirement for a bond

(leer of credit or cash deposit) does not waive the liability of the LICENSEE for damage

to CITY property outlined in Secon 3.

 I, , am hereby requesng a waiver

from the requirement to provide a Bond for Damage based on the informaon

provided in this applicaon and the low intensity of use expected at this event.

Request for Waiver of Bond for Damage: [ ] Approved [ ] Denied

City Manager Signature Date

TULIP Coverage – A Guide for Users

Tenants Users Liability Insurance Policy (TULIP)

The TULIP PROGRAM provides low cost General Liability insurance to “third party” users of

various venues and facilities. It is used by institutions that permit “third parties” to use their

facilities for specific events. It protects both the facility user and the facility itself against claims

by “third parties” who may be injured or lose property as a result of participating in the event.

Events may range from very low risk activities, such as seminars, receptions or weddings, to

higher risk events including camps, sports events and concerts. The premium is based upon the

risk associated with the event or activity, the number of days needed, the number of participants

and if there are any special requirements, including alcohol liability, food service, etc.

Here’s what you need to do:

• Go to link: https://tulip.onebeaconentertainment.com/e/tulip/apply.aspx

• Enter the City of Lebanon’s venue ID Code – OB54-402 (this will pre-fill the City of

Lebanon’s address).

• Enter your event information.

If you have any difficulty with this process, please call NH Primex at 1-800-698-2364 x136.

City of Lebanon

Application for Sound Permit

Page 1 of 2

CityCodeChapter110.NoiseFromSoundAmpliicationSystems

§110‐4Permitrequired.

It shall be unlawful for any person to use or operate or cause to use or operate any sound-

amplifying equipment for commercial or noncommercial purposes on the street, in front

of or outside of any building, place or premises, or in any vehicle operated, standing or

being in or on any public street, highway, park or place or from any stand platform or

other structure or anywhere on or in the public streets highways, parks or places within

the corporate limits of the City of Lebanon unless he/she shall ϐirst obtain a permit from

the City of Lebanon.

§110‐6Termsforissuanceofpermits.

A. The issuing authority shall be the Chief of Police, and a permit shall not be denied for

any speciϐic time, location or use to any applicant who complies with the provisions of

this article, except as hereinafter excepted:

(1) Improper and incorrect application.

(2) Overlapping in the granting of permits for the same purpose or for more than one

purpose within a maximum of 100 yards of each.

(3) In any location within 100 yards of a school, courthouse, church, hospital or similar

institution.

(4) In any location between the hours of 8:00pm and 8:00am.

(5) In or on any vehicle standing or in motion between the hours of 8:00pm and

8:00am.

(6) In any location where the volume of sound emitted from the sound-amplifying

equipment will be audible for a distance in excess of 100 yards from the place or

places where such sound-amplifying equipment or apparatus will be located.

(7) In any location where, upon investigations by the issuing authority, it shall be

determined that the conditions of vehicular and/or pedestrian trafϐic are such that

the use of sound-amplifying equipment or apparatus will constitute a threat to the

safety of pedestrians or vehicle operators.

§110‐7Sundaysandlegalholidays.

Except between the hours of 1:00pm and 5:00pm, on Sundays and legal holidays, and only

by special permission of the City Council for good cause shown, permission to use and

operate sound-amplifying equipment shall not be granted. This is so ordered to ensure

against interference with religious services or civic observances and the general

tranquility of the community.

§110‐10Permitfees.

No permit fees shall be imposed upon any applicant for permit under the terms of this

article.

CITY OF LEBANON NH—POLICE DEPARTMENT

APPLICATION FOR SOUND PERMIT

City of Lebanon

Application for Sound Permit

Page 2 of 2

CITY OF LEBANON NH—POLICE DEPARTMENT

(INACCORDANCEWITHCITYCODE§110)



PleasesubmittotheLebanonPoliceDepartmentatleasttwoweekspriortotheevent.

APPLICATION FOR SOUND PERMIT

Applicant Name:

Business/Organization:

Street Address City State Zip

Phone: Email:

EVENTINFORMATION

Location of Event:

Event Purpose:

Event Date:_______________________________________ *Start Time:_______________End Time:_______________

*HoursarelimitedtoMonday‐Saturday,8am—8pmandSunday1pm—5pm,unlessapprovalbyCityCouncil.

Type of Sound Equipment: Number of Units:

ApplicantagreesbytheirsignaturebelowthattheyhavereadandagreetothetermsandconditionsoftheCity

CodeChapter110—ApplicationforSoundPermit.

Signature: __________________________________________________________________ Date: _______________________________

FOROFFICEUSEONLY

Date Received: PERMIT #

AgreementandSignature

SOUNDTRUCKINFORMATION(ifapplicable) 

Vehicle Registration #:

Name & Address of Vehicle Operator & Sound Amplifying Equipment Operator:

Proposed Route of Truck:

Approximate Distance the sound will be audible from the vehicle:

Year/Make/Type of Vehicle:

APPROVAL

Police Chief Approval: Date:

City Council Approval (ifneeded): Date:

City of Lebanon

Exemption to Allow Alcohol on City Property

Page 1 of 2



-







-



- 

-



- 





- 

-

---



               

           



           





 

             



 



 

 



EXEMPTION TO ALLOW ALCOHOL ON CITY PROPERTY

City of Lebanon

Exemption to Allow Alcohol on City Property

Page 2 of 2

CITY OF LEBANON N.H.

(IN ACCORDANCE WITH CITY CODE §14-5)

The purpose of this article is to regulate and control the consumption and possession of alcoholic

beverages in certain places. The authority for this article is RSA 47:1 and RSA 47:17.

EXEMPTION TO ALLOW ALCOHOL ON CITY PROPERTY

NAME:

ORGANIZATION:

ADDRESS:

PHONE: EMAIL:

EVENT INFORMATION

DATE: START TIME: END TIME:

LOCATION:

PURPOSE:

TYPE OF EXEMPTION REQUESTED

Consumption of Alcohol Sale of Alcohol* Both Consumption/Sale

*For the sale of alcohol, please attach a copy of your New Hampshire Liquor License.

Please provide the name and phone number of the person (over the age of 21) designated to remain

substance-free and to monitor the event for appropriate alcohol consumption by attendees.

Name: Phone/Cell #:

Please provide the names and phone numbers of two (2) designated drivers who will not consume alcohol,

and will be available until the end of the event.

Name: Phone/Cell #:

CONDITIONS OF USE:

 The exemption time period shall not exceed 12 hours.

 Alcohol will be served only pursuant to State and Federal Laws regulating the distribution and

consumption of alcohol.

 Please have a copy of the NH Liquor License in your possession the day of your event.

FOR OFFICE USE ONLY

DATE RECEIVED: PERMIT #

Monitors Name Provided

Designated Drivers Names Provided

NH Liquor License Provided

Police Chief Approval:

Date Received:

FINAL APPROVAL:

CITY MANAGER: Date:

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CITY OF LEBANON N.H.Applications & Permits Physical address: (City of Lebanon)

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