Licensing Department, City Of Chelsea, MA

Special Event Request 2022

Jul 30, 2022
submission #66
Application

CONTACT INFORMATION

Event/Activity Name ---
Facility (See link to park locations and descriptions above) ---
***Other Description This is an important celebration for the Central American community in the city of Chelsea.
Event Date 9/10/2022
Applicants Name ---
Contact Person ---
Email Address ---
Cell Phone ---
Day Phone ---
Billing Address ---

EVENT INFORMATION

Name of Supervisor/Vendor on Site ---
Supervisor / Vendor Phone Number +16173357351
Name of Second Supervisor on Site ---
Second Supervisor Phone Number +18574522805
Total Estimated Number of Participants 200
Estimated Number of ADULT Participants 150
Estimated Number of YOUTH Participants 50
Organization Type Non Profit - may be asked to provide State Tax # or Federal EIN#
Activity Community Use (please specify below)
Brief Description of Event ---
Special Requirements ---

First Preference For Event Date

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

First preference: Single Date - Time

Date 2022-09-10
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) 5:00pm -6:00pm

Second Choice - Single Date

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

Second Preference: One Date

Date ---
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 (5:30pm-6:00pm) ---
Facility (please see link above for park locations and descriptions) ---

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? More than 50 people in attendance, Food and beverages , Event will generate revenue/ make money (e.g. sponsorships, vendor fees), Items will be for sale at event, Music, entertainment, or amplified sound on site, Stages or other temporary structures, Generator, Machinery powered by gasoline, diesel, or electricity

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 soda, water, juice cultural food candy
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: the music is going to be provided by a licensed dj, and he will provide the sounds and equipment necessary for the event.

Machinery Detail

Please describe the machinery that will be used on site, including power source (gas, diesel, electricity) A generator will be used to provide electricity for the event.

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? ---

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 Insurance.pages
First Review by Special Events Coordinator

Decide which Departments should review this application:

Should Fire Department review? No RD review necessary.
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 ? No