Fillable Special Event Application Private Property ATTACHEMENTS CHECKLIST

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Special Event Application Private Property ATTACHEMENTS CHECKLIST

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Rev. 04/02/2020 1
CITY OF HICKORY SPECIAL EVENTS/ACTIVITIES APPLICATION
PRIVATE PROPERTY EVENTS
Submit to Planning & Development Permit Center
The purpose of this application is to provide information about your event or activity for various departments and
agencies to determine if they need to be involved in the approval and/or permitting process. City staff may contact you
with specific questions.
Any City staff may require a pre-planning meeting with appropriate staff and the applicant. The
applicant is responsible for notifying the Planning & Development Permit Center of any changes to this application.
Incomplete applications will not be accepted. A complete and accurate application must include and meet the
following:
• Attached de
tailed site plan from a GIS or Google map
• Submitted at least 90 days prior to the planned event to allow for sufficient review time from staff, as well as
approval from City Council.
• Depending on the specific event, a permit application and/or fee(s) from individual departments may be required.
Event date av
ailability:
• Applicant should contact permit center to verify date availability prior to submission of application
• Applications and events are prioritized based on a first come-first served basis.
• The City may approve or disapprove an event’s requested date based on availability of resources.
• Events that occur on an annual basis will receive priority the following year.
APPLICANT INFORMATION
Name of Event: _____________________________________________________________________________________
Applicant Name & Title: ______________________________________________________________________________
Organization: _______________________________________________________________________________________
Mailing (Billing) Address: _____________________________________________________________________________
City / State / Zip: ____________________________________________________________________________________
Daytime Phone: _________________ Cell: _________________ Email:_________________________________________
Description of the Event: _____________________________________________________________________________
__________________________________________________________________________________________________
APPLICANT
’S SIGNATURE ____________________________________________ DATE: _________________________
Event Address:
Date of Event: Rain Date (if applicable):
Event Start Time: Event End Time:
Set-Up Begins: Clean-Up Ends:
Preferred Date & Time of Inspection:
Estimated Attendance:
The Event is:
Private (by invitation only);
Open to General Public
City of Hickory
PO Box 398
Hickory, NC 28603
Phone 828-323-7410
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Rev. 04/02/2020 2
TENTS & MEMBRANE STRUCTURES
POWER SOURCES
HAZARDOUS MATERIALS
Will there be any portable heaters?? Yes No
Will there be any deep fat fryers?? Yes No
Will the event have any hazardous materials such as propane, butane, gasoline, diesel tanks, helium cylinders, or
other upright tanks?
Yes No
If yes, all tanks must be secured in a manner to prevent accidentally being knocked over. All helium tanks not
being used shall have their caps in place.
Will there be any fireworks, lasers, torches, candles or pyrotechnics? Yes No
If yes, contact the Hickory Fire Department Division of Fire and Life Safety at (828) 323-7522 for more information.
MECHANICAL RIDES
** Tent is a structure, enclosure, or shelter, with or without sidewalls or drops **
Will tent(s) be used for the event? Yes No If so, number of tent(s) planned: _______________
Size of Tent(s) planned:________________________________________________________________
Percentage of side walls, if any, to be used for each tent: ______________________________________
Detail tent location, size, percentage of side walls and spacing for each on required site plan.
** Membrane structure is an air-inflated or air supported structure **
Will membrane(s) structures be used for the event? Yes No If so, number of membrane structures planned: ____
Size(s) air inflated/air supported membrane structures planned: ________________________________
Detail membrane structure location(s), size, and spacing for each on required site plan.
Will you use electric generators? Yes No If yes, will Power Distribution boxes be used? Yes No
Provide c
ontact information for contractor supplying generator power:
Name: __________________________Phone:_______________ Email:________________________
Will you use electric power from an existing structure? Yes No
If yes, will direct wiring to breakers be required? Yes No
Provide
contact information for person responsible for setup of power:
Name:___________________________Phone:_______________Email:________________________
Does the event include mechanical rides, or other similar attractions? Yes No
If yes, please describe attractions: ____________________________________________________________
Applicants contracting with amusement ride companies are required to provide the City of Hickory with a
certificate of insurance, naming the applicant and the City of Hickory (if applicable) as additional insured on general
liability. Please contact the NC Department of Labor to determine what requires inspection.
Rev. 04/02/2020 3
VOICE/MUSIC AMPLIFICATION
ALCOHOL
VENDORS
Are there any musical entertainment features related to your event? Yes No If no, proceed to next section.
If yes, state the number of bands and type of music: Number of bands: ____________
Type(s) of music: __________________________________________________________
______________________
Will a portable or temporary stage be utilized? Yes No
If yes*, state the number of portable or temporary stages: _______________________________________________
Will stage have canopy with frame that supports equipment (lighting, etc.)? Yes No
If yes* state the size of canopy: _________________________________________________________
Provide contact information for contractor providing stage:
Name:__________________________________Phone:__________________Email:______________________
______
*A Temporary Stage Certification Form must be completed for Catawba County Building Services*
Will your event have amplified sound? Yes No
If yes, indicate times: Start time: ___________ Finish time: ____________
Will alcoholic beverages be served? Yes No (If yes, NC ABC permit required.)
Will alcoholic beverages be sold? Yes No (If yes, NC ABC permit required.)
What type of alcohol will be served?
Draft Beer Can/Bottle Beer Wine Liquor
Who will be serving the alcohol? ____________________________________________________________________
Times for alcohol to be served: ______________________________________________________________________
Locations within event site where alcohol will be served: _________________________________________________
__________________________________________________________
__________________________________
Upon approval of this application, applicant will provide their North Carolina ABC permit to the Permit Center.
If the event will have food vendors, please check the following that apply:
Served Sold Free Catered Prepared Outdoors
Does the event include food concession and/or cooking areas? Yes No
If yes, please list each vendor. Use additional sheet, if necessary.
VENDOR
COOKING METHOD
(gas, electric, charcoal, other)
FOOD ITEM
Fire Code requires a fire extinguisher at each cooking location. Food and beverages shall not be sold at an event
unless approved and licensed, if necessary, by the Catawba County Health Department.
Event organizers are responsible for arranging health inspections for their events.
An applicant having any food service must contact the Catawba County Health Department
Rev. 04/02/2020 4
EVENT SCHEDULE
Provide a detailed schedule of the event, including dates and times for entertainment, activities, hours of event, start
time, finish time, etc. If the event requires an extended time frame for set-up, include details with a timeline listing
the times and locations where streets or public property will be impacted and when dismantling will be completed.
(Use additional sheet of paper if necessary)
CITY SERVICES
The City of Hickory does not provide amenities such as portable washrooms,
sound systems, tables, chairs, tents, canopies, or other equipment.
SPECIAL EVENTS CONE/BARRICADE REQUEST:
Number of Cones Requested? ________________ Number of Barricades Requested? __________________
Drop-off/pick-up Location? _________________________________________________________________
Drop-off Date and Time: ________________________Pick-up Date and Time: ________________________
Drop-off/pick-up Contact: __________________________________________________________________
Phone Number: ________________________ Email: ____________________________________________
Drop-off/pick-up contact MUST be present for drop-off and pick-up.
If the contact person changes from above, please notify Chelsey Brooks at (828) 323-7500 or email at
cbrooks@hickorync.gov. If a contact person is not present or cannot be reached at the drop-off time, cones/
barricades will NOT be left.
For events on Saturdays, Sundays, or holidays, cones/barricades are typically dropped off on the last business day
before the event and picked up on the first business day after the event. Business hours are Monday through Friday
7 a.m. – 3:30 p.m. If the Traffic Division needs to adjust the number of cones/barricades to be provided or the drop-
off/pick-up dates or times, the applicant will be contacted at the phone number or email provided above.
DATE TIME ACTION ADDITIONAL NOTES
Rev. 04/02/2020 5
TRASH AND RECYCLING PLAN
How many trash bins are you requesting for trash? ______________________________________________
How many recycle bins are you requesting? ___________________________________________________
Delivery Location? _______________________________________________________________________
Date and Time for trash or recycling bins to be emptied\picked up: _________________________________
Applicants are responsible for cleaning and restoring the site after the event. The cost of any employee overtime
incurred because of an applicant’s failure to clean and/or restore the site following the event will be paid for by the
applicant. If you reasonably believe that no litter will be generated during your event, please state this in your plan.
SAFETY AND SECURITY (CHECK TYPES OF SECURITY REQUESTED):
Beer/Alcohol Security Stage Security Event Area Security Gate Security
Road Closure Security Money Handling Security Other __________________________________
Overnight Security From ______: ______ To ______: ______
Dates & Times security will be on site: ________________________________________________________
Security provided by: ____________________________ Number of Security Personnel: ________________
Applicant may be required to hire sworn off-duty City of Hickory police officers to provide security to ensure public
safety. The Hickory Police Department will determine the number of security personnel required on site.
FIRE AND EMS STANDBY (CHECK TYPE OF SERVICES REQUESTED):
FIRE WATCH/STANDBY MEDICAL STANDBY
Dates requested: _________________________________________________________________________
Times requested: From _______:_______ To _______:_______
The City of Hickory Fire Department will determine the number of personnel and apparatus required on site. The
applicant will be required to pay standby fees, as outlined in the City of Hickory Fee Schedule, for all personnel and
apparatus standby at events.
SITE PLAN/MAP
A detailed map and site plan of the event from either GIS or Google Maps is required. Included in the event map (if
applicable):
• Outline or diagram of the entire event venue, including the names of all streets or areas that are part of the
venue and the surrounding area.
• Location of the event/activity on the property with approximate distances from roads, fire hydrants, existing
buildings, etc.
• Location of temporary structures that will be used during the event. Must indicate size of temporary structures,
distances between temporary structures and existing buildings.
• Identify how each temporary structure will be used. Example: type of vendor, food preparation, alcohol sales, etc.
• Identify location of all cooking devices and open flames.
• Location of all fencing, barricades, or other restrictions that will impair access to and from the event or property.
• Identify all designated parking areas.
• Identify location of any generators and fuel storage.
Rev. 04/02/2020 6
ATTACHMENT CHECKLIST
In addition to the Special Event Application form, the following supporting documents are required to complete your
application package and begin the review process:
All Events:
Detailed Site Plan from GIS or Google Maps
Parking Plan for participants and volunteers (May be included in site plan)
Volunteer Plan for events with an anticipated attendance of 100 participants or more (how many, their duties)
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Special Event Application Private Property ATTACHEMENTS CHECKLIST

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Completed 13 July 2020

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