In addition to the usual terms and condition set forth in the Facility Usage Permit form, the following will also
apply when alcohol is served:
1. An additional $50 non-refundable Alcohol Application fee shall be paid in advance.
2. Applicant must be at least 21 years of age.
3. Only beer and wine may be served in bottles or cans.
4.
Some uses may require a Special Events License from the Oregon Liquor Control Commission (OLCC) in addition
to the City Of Stayton Alcohol Use Permit. An event charging a fee for anything whatsoever, e.g.,
membership/club fees, service fees, initiation fees, admission, donations for food / beverages, etc., or open to the
public, will require an OLCC Special Events License. Please call OLCC (503-872-5070) to determine and/ or
confirm if you need an OLCC License. The OLCC License must be turned into the City Administrator no later
than 1 week prior to the event. Applicant will be denied use of the facility if the OLCC License is not
provided within the time frame specified.
5. In general, no OLCC Special Events License is required when: (a) there is no charge or fundraising for anything
whatsoever, (b) function is totally hosted by a private individual, (c) function is personal and non-commercial, (d)
no monetary gain is to be realized by the host, and (e) the host personally invites all guests.
6. Minimum of a $1,000,000 insurance policy listing the City of Stayton as an additional named insured
1. I agree, by signing this application, to accept any and all liability resulting from the service of alcoholic beverages
during my event. I further agree to hold harmless the City of Stayton from any and all claims resulting from the
service of alcoholic beverages during my event.
2. I agree, by signing this application, to familiarize myself and comply with all applicable Oregon Laws and the
regulations of the OLCC relating to the sale and/or service of alcoholic beverages.
DO NOT WRITE BELOW THIS LINE: CITY USE ONLY
Alcohol App. Fee:
Date Paid:__________ Receipt No:______________ Initial:__________
Security Charge:
__________ Date Paid:__________ Receipt No:______________ Initial:__________
Alcohol Deposit:
__________ Date Paid:__________ Receipt No: Initial:__________
Liability Insurance Policy received: ___________ ___________
Date Initial
Public Works Department:
Tel: (503) 769.2919
Fax: (503) 767.2134
CITY OF STAYTON
Application for use of alcohol at City Rental Facilities
Alcohol Conditions:
Please complete the following:
Estimated Attendance:
to
Serving time of alcohol: From
Requested Date:
Email Address:
Contact Number:
Applicant Name:
Event Ends:Event Begins:
Type of Event:
----------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------
Authorized Signature of Applicant
Beverages to be served:
Date
Approved by City of Stayton
Date
Admission charge or solicitation made of participant?:
Yes No
Open to the Public?:
Yes No
Alcohol Conditions:
**If emailed, form must be signed electronically or
applicant must hand sign prior to rental finalization.
__________
______________
click to sign
signature
click to edit
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