Licensing Department, City Of Chelsea, MA

Special Event Request 2022

May 12, 2022
submission #21
Application

CONTACT INFORMATION

Event/Activity Name ---
Facility (See link to park locations and descriptions above) ---
***Other Description Between Williams and Second Street, the roadway of Arlington St and the parking lots under the viaduct
Event Date Saturday, June 18, raindate June 25
Applicants Name ---
Contact Person ---
Email Address ---
Cell Phone ---
Day Phone ---
Billing Address ---

EVENT INFORMATION

Name of Supervisor / Vendor on Site ---
Supervisor / Vendor Phone Number +16174664186
Name of Second Supervisor on Site ---
Second Supervisor Phone Number +16173967929
Total Estimated Number of Participants 400
Estimated Number of ADULT Participants 380
Estimated Number of YOUTH Participants 20
Organization Type City or School Use
Activity Community Use (please specify below)
Brief Description of Event ---

First Preference For Event Date

Is this event happening on one date or multiple dates? ---

First preference: Single Date - Time

Date 2022-06-18
Total Time (ex. 2:00pm-6:00pm) ---
Set-up Time (ex. 2:00pm-3:00pm) ---
Total Event Time (ex. 3:00pm-5:30pm) ---
Breakdown Time (ex. 5:30pm-6:00pm) 8 to 9:30 pm

Second Choice - Single Date

If your first choice date is not available, do you have a second choice? ---

Specialized Event

Does your event fall under one of these categories? No

Licensing Department and Inspectional Services Department

Are any of the following part of your event? Food and beverages , Items will be for sale at event, Music, entertainment, or amplified sound on site, Stages or other temporary structures, Generator

Food and Beverage/ Fire Department and Licensing

Will food and beverages be: ---
Please specify all food and beverages that will be provided ---

Items for Sale - Detail

Please describe the items that will be available for sale at the event We will seek vendors but as of now no likely. We will be including commercial booths like auto body artists with outreach tables who may have some small giveaways.
How will the items be offered for sale? (check all that apply) Vendors will be selling items

Music and Entertainment: One Day Entertainment License Requirement

Please describe the type of music or entertainment to be provided: One band and a DJ.

Department of Public Works

Will you require lighting? (Please call 617-466-4200 during business hours, and 617-828-7327 after hours).) ---
Will you require use of restrooms, if available? ---

Attachments

Please upload any attachments (proposed site plan) ---

Additional Information

Please list any additional Special Requirements ---
Indemnification / hold harmless / cleanup

Indemnification/Hold harmless/cleanup

The signatory shall be responsible for and shall indemnify and hold harmless the City of Chelsea from and against all damages, claims or demands that may, during the term of this license, arise by negligent or intentional acts of signatory or signatory's employees. I am responsible for any and all indemnity and hold harmless the City of Chelsea
If a permit is issued, I agree that my organization will leave the permitted area clean and orderly, and that all trash will be placed in trash receptacles. I agree to pick up and clean any trash caused by this event
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature. Yes
Up Load Insurance policy/agreement
First Review by Special Events Coordinator

Decide which Departments should review this application:

Should Fire Department review? Yes, FD should review.
Should Police Department review? Yes, Police Department should review.
Should Licensing review? Yes, Licensing should review.
Should Inspectional Services review? Yes, Inspectional Services review.
Should Public Works review? Yes, Public Works review needed.
Should Traffic and Parking review ? Yes