Fillable Special Events Combined W-out Tent 2017 - Special Events - Part I OF 4- Temporary App

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Special Events Combined W-out Tent 2017 - Special Events - Part I OF 4- Temporary App

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BENSALEM TOWNSHIP
Building and Planning Department
Office 215-633-3644 ▪ Fax 215-633-3753
2400 Byberry Road ▪ Bensalem PA 19020
Rev 5/2009
Permit No.:
Date:
Name
Address
Phone
Owner Information
Owner’s Signature Date
Event Description
Name
Address
Phone
Applicant Information
Applicant’s Signature Date
Address
Tax Parcel No.
Property Location
of Event
Name
Address
Phone
Local Contact
Information
Starting Date
EQGLQJLQGDWH
Dates of Event
Additional
Information
▪ Police/Public Safety Department Special Events application MUST also be filed along
with this application. It is a separate application and is a requirement for all events.
Questions regarding their application should be directed to Susan Reigg 215-633-3711.
▪ Applications should be submitted 10 days in advance of event.
▪ All fees, insurance and performance bond requirements are due at the time of
submission of this application. Bonds and insurance requirements must be in
accordance with the Code of the Township of Bensalem Chapter 56.
APPROVALS
NAME TITLE DATE
YES NO
Zoning Officer
YES NO
Building Inspector
YES NO
Electrical Inspector
YES NO
Fire Inspector
FOR B & P USE ONLY
Check #:
Amount: $
Township of Bensalem Dept. of Building & Planning
TEMPORARY PERMIT APPLICATION
FOR SPECIAL EVENTS
Ending Date
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF PERMIT
SPECIAL EVENTS APPLICATION
FORM MUST BE FILLED OUT AND RETURNED TO THE POLICE DEPARTMENT, OFFICE OF PUBLIC
SAFETY AT LEAST 1 WEEK PRIOR TO EVENT
Any questions regarding application, contact Susan Riegg at 215-633-3711.
Contact Information
Name of Applicant
Address of Applicant
Phone No. Home Work Cell
Emergency Contact Name
Emergency Contact Address
Emergency Contact Telephone Home Work Cell
Event Information
Location of Event
Type of Event
Concert (type)/Carnival etc.
(include as much info as possible)
Number of Event Employees
Dates of event/number of Days
Times Event Will Be Held
Highest Number of Attendees expected
Ticket Information
Ticket Sales (method/duration)
In advance (Ticketmaster, etc)
At door
Public Safety Information
Police Services Requested
(Traffic/crowd control/protection)
Number of Officers
EMS Services Requested
(Ambulance, First Aide Station, etc)
Number of Personnel
Fire Department Services Requested
Number of personnel
Page 2
Additional Township Departments/Services Required
Public Works (specify) Road Barriers (specify)
Parks & Recreation (specify) Township Property being used (specify)
Applicant’s Name: Date:
Signature: Phone No.
Rev. 4/2009
Office Use Only
DPS Number of Officers Required
Date Type of Services Required
Approved Rejected
EMS Number of Personnel Required
Date Type of Services Required
Approved Rejected
Fire Number of Personnel Required
Date Type of Services Required
Approved Rejected
Approved by:
Signature Date
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Special Events Combined W-out Tent 2017 - Special Events - Part I OF 4- Temporary App

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Completed 11 July 2020

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