Fillable Special-Event-Application-V10-Blank - Application and Affidavit 2014 version - draft

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Special-Event-Application-V10-Blank - Application and Affidavit 2014 version - draft

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TOWN OF ANDOVER
Special Event Application Form
Applicant and Sponsoring Organization Information
Name of Organization / Sponsor: _______________________________ Non-Profit No.
Address: City: State: Zip:
Tax ID #: Applicant name:
Phone: Email:
Web Site:
Event Manager: ___________________________________ Contact Info: _______________________
Other Contact person/s: __________________________________ Contact Info: _______________________
Event Information
Event Type: Run/Walk/Bike Home/Garden Show Parade Sidewalk Sale
Concert Fair/Festival/Carnival Food Truck
Other (specify) _____________________________________________________________________________
Event Title:
Start Date2 & Time : ____________________ End Date & Time:
Open to the Public: Yes No
Estimated Attendance: #_______________
Set Up Date/Time & Description:
Breakdown Date /Time & Description:
Block Party
New Event to Andover Returning Event
Non-Profit Profit
Rain Start Date & Time: Rain End Date & Time:
Start Date1 & Time :___________________ End Date & Time
Start Date3 & Time : __________________ End Date & Time
Other
001
Is there a fee collected from Public to attend? Yes No
002
Requested Location(s):
The Park
Old Town Hall/ Townhouse -- Outside/ Sidewalk
Downtown
Please see Andrea Zaimes with Municipal Services, Facilities and Field Information at 978-623-8727
information: https://andoverma.gov/270/Facility-Field-Rentals about the three locations below.
1.Town or School building, name:
2. Fields town or school name:
3. Old Town Hall/ Townhouse -- Inside
Andover High School fields, gym or field house - Please see Athletic Director’s
Office at 978-247-5500
Collins Center - Please see more information at: http://www.collins-center.com/
Senior Center - Please see Renee Baker from Elder Services at 978-623-8320 or
email: Renee.Baker@andoverma.us
Recreation Park at 165-183 Abbot St. - Please see Jessica Downing
from Recreational Services at 978-623-8342 or email: JDowning@andoverma.us
Street(s) or Route Information
Street(s) or Street Route ( Run/Walk/ Bike ) :
Specify:
Please provide Map and Layout of proposed location and Usage
Other, Street Closure, Sidewalk Closure :
Specify
Event Details
Please indicate whether the following items pertain to your event. Complete by applicant.
YES NO
L
ocation: Use of Town Property
Townhouse or Old Town Hall Sidewalk use
The Park
Downtown Area, describe:
Closures and Police/ Fire Rescue
Street or Sidewalk Closure, Detour Signs? provide names:
Parking Lot(s) Closure, names:
Fencing, Barrier(s) and / or Barricade(s) or Traffic Cones? which:
Request Banner(s), Sign(s), need Cert. of Insurance, which:
Request/ require Police Detail, (not typically required for Block Party)
Request First Aid Facilities and Ambulance (s), which:
Food Services or Alcoholic Beverages
Food Concession and/or Food Preparation
Please specify method: Propane Gas Electric Charcoal Catered Other Propane Use
Propane for portable heaters or artisans may need propane
Alcohol Beverages Served (Beer & Wine, All Liquor or Donated) - req. Town Clerk's and Health Div.
Licenses
Licenses or permission for
Will you be holding a raffle or game of chance? (Town Clerk's Office) Describe:
Music and/or Amplified Sound - If yes please indicate Start Time End Time
> The Town of Andover requires noise at reasonable levels and only until 9 PM.
Will your event have Entertainment? - describe:
Amusement Rides (Building Dept.)- list and describe:
Inflatable Device(s) (Building Dept.) – list and describe:
Will your event have Fireworks? (Board of Selectman and Fire Rescue)
Will your event have animals? If yes, specify:
Facilities, Utilities and Structures
Will your event require lights? If so, specify hours:
Will your event require electricity or electrical connections? where:
Will you event require temporary water connection? where:
Will you set up table(s) and/or chair(s)? Approximate number?
Does your event require electricity? (Building Dept. -Electrical Inspector ) Source:
Booth(s), Exhibit(s), Display(s) and/or Enclosure(s)
Canopy (ies) and or Tent(s) (Building Dept.)- describe & dimensions:
Scaffolding, Bleacher(s), Platform(s), Grandstand(s) or related structure(s)
Stage(s), which and indicate dimension:
>Scaffolding, Bleachers, Platforms, Grandstands or Stages (may require Building Dept. Permit)
Trash, Restrooms or Trailers
Trash or Rubbish Container(s) (Municipal Services)
Applicant to provide Dumpster(s) and Dumpster Vendor ( Health Div. & Fire Rescue Permits)
Use of Town Restrooms - explain which Town or School Buildings
Applicant to provide Portable Toilet(s) –
explain where and provide approximate no./ vendor:
Applicant to provide and use Vehicle(s) and/or Trailer(s) - approximate number:
Applicant to provide and use Sleeping Trailer(s) and/or other accommodations, describe:
003
Town Manager-978-623-8210 * Municipal Services–978-623-8700 * Fire Rescue -978-475-1281
Police Dept.-978-475-0411 Ext.1034 * Health Div.-978-623-8640 * Town Clerk's Office–978-623-8230
Municipal Services Facilities Div.-978-623-8727 * Building Div. (Building, Gas, Plumbing, Electrical) 978-623-8620
Recreational Services 978-623-8342 * Elder Services 978-623-8320 * Athletic Director's Office 978-247-5500
Special Events Contacts:
004
Signature of Applicant: _____________________________________ Date:_____________________________________
Other Permits
Please note that all components of the event are subject to approval by the Town Manager's Office and may also
require approval by and/or permit(s) from other Town agencies and departments. It is the responsibility of the
applicant to secure all necessary Town of Andover permits, and submit payments required for permits.
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Completed 10 July 2020

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