Fillable Form 4056 Parade And Race Permit (Town of Concord)

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Form 4056 Parade And Race Permit (Town of Concord)

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The Form 4056 Parade And Race Permit (Town of Concord) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Town of Concord

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TOWN OF CONCORD
Office of the Town Manager
22 Monument Square
Concord, MA 01462
(978) 318-3000
APPLICATION FOR PERMIT FOR USE OF TOWN PROPERTY/FACILITIES
Applications for any use of town property must be submitted to the Town Manager’s office. The attached worksheets
must be completed by the applicant(s), in full, at the time of request. Any use of Town property, roadways or facilities
for public events require a certificate of insurance from the applicant naming the Town as an additional insured. A
permit must be obtained at least thirty (30) days prior to the event, or use, is to take place. To ensure this timetable is
met, applications should be submitted at least forty-five (45) days in advance.
NAME & DESCRIPTION OF EVENT: ____________________________________________________________________
PLEASE DESCRIBE THE EVENT IN AS MUCH DETAIL AS POSSIBLE: ____________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
EVENT, USE OR PRODUCTION DATE: ______________________________ TIMES: _____________________________
LOCATION(S) REQUESTED (incl. addresses): ___________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
(Permission for use of school grounds must be coordinated through the Concord School Department directly.)
**IF THIS EVENT IS A RACE, RIDE, WALK OR OTHER ‘LIKE’ EVENT, PLEASE ATTACH ROUTE MAP(S)**
ROUTE MAP(S) ATTACHED? YES NO
WILL FOOD BE SERVED? YES NO
(If yes, contact BOH for addl. Permits)
IF YOUR GROUP PLANS ON ERECTING A TENT, OR ANY OTHER SEMI-PERMANENT STRUCTURE, FOR OR DURING
YOUR EVENT, YOU MUST CONTACT THE BUILDING DEPARTMENT TO SECURE THE PROPER PERMIT(S).
APPLICANT & SPONSORING ORGANIZATION
NAME OF APPLICANT(S): ____________________________________________________________________________
APPLICANT EMAIL: _______________________________________ DAYTIME PHONE #: _________________________
APPLICANT ADDRESS: ______________________________________________________________________________
ORGANIZATION INFO: FOR PROFIT NON-PROFIT
_________ Tax ID# _________ 501c3 # or FID #
ORGANIZATION NAME: _____________________________________________________________________________
BUSINESS ADDRESS: ________________________________________________________________________________
MAILING ADDRESS (if different): _______________________________________________________________________
BUSINESS PHONE: (___)__________ ALTERNATE PHONE: (____)__________ Email: ____________________________
PURPOSE OF EVENT: FUNDRAISER FOR PROFIT OTHER: _________________
LIST BENEFICARIES: ____________________________________________________________
(to be verified by TMO or CPD staff)
(FOR OFFICE USE ONLY)
EVENT: ________________________________________________ DATE(S): ______________________________
PUBLIC SAFETY RESPONSE – WORKSHEET
POLICE:
Extra Police Personnel Required YES NO
If Required, Expense Estimated at _______ HRS. x $_________/HR. = $_____________
FIRE/EMS:
Extra Fire/EMS Personnel Required YES NO
Stand-By Fire/EMS Required YES NO
Ambulance Required YES NO
If Required, Expense Estimated at _______ HRS. x $_________/HR. = $_____________
PUBLIC WORKS:
Highway/CPW Personnel Required YES NO
If Required, Expense Estimated at _______ HRS. x $_________/HR. = $_____________
FACILITIES & GROUNDS:
Facility Personnel Required YES NO
If Required, Expense Estimated at _______ HRS. x $_________/HR. = $_____________
BOARD OF HEALTH: Permit Required ________ Date Applied
BUILDING DEPARTMENT: Permit Required ________ Date Applied
Application Received By: ________________
(staff initials) Date: _____________________
Approved by Assistant Town Manager: __________________________________________ ___________
Kate Hodges, Signature Date
Referred to Police Department: YES No ___________
Date:
Approved by Police: YES NO
Comments or Conditions of Approval: _________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
CERTIFICATE OF INSURANCE RECEIVED: YES NO
If NO, date required: ______/________/________
Insured By/Holder____________ ______________________________Limits of Liability: _______________________
Company Address: ________________________________________________________________________________
Town Listed as Additional Insured: YES NO
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Form 4056 Parade And Race Permit (Town of Concord)

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Completed 16 July 2020

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