Special Event Request 2023

CONTACT INFORMATION

Event/Activity Name	---
Facility (See link to park locations and descriptions above)	---
***Other Description	Arlington street, between 2nd and williams street
Event Date	Saturday, August 26, 2023
Applicants Name	---
Contact Person	---
Email Address	---
Cell Phone	---
Day Phone	---
Address	---

EVENT INFORMATION

Name of Supervisor/Vendor on Site	---
Supervisor/Vendor Phone Number	+16173967929
Name of Second Supervisor on Site	---
Second Supervisor Phone Number	+16176425557
Total Estimated Number of Participants	150
Estimated Number of ADULT Participants	120
Estimated Number of YOUTH Participants	30
Organization Type	Commercial Group
Activity	Community Use (please specify below), Other (please specify below)
Brief Description of Event	---
Special Requirements	---

First Preference For Event Date

Is this event happening on one date or multiple dates?

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First preference: Single Date - Time

Date	2023-08-26
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)	6:00pm- 8:00pm

Second Choice - Single Date

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

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Specialized Event

Does your event fall under one of these categories?

Yes

Type of Event

Select which event type your request is for

Community Event

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, 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	---
Food Trucks	No/No

Items for Sale - Detail

Please describe the items that will be available for sale at the event	Street food and non-alcoholic beverages.
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:

Popcorn machine DJ Audio PA system

Machinery Detail

Please describe the machinery that will be used on site, including power source (gas, diesel, electricity)

Small generators to provide electricity for vendors and audio equipment.

Department of Public Works

Will you require electricity? (Please call 617-466-4200 during business hours, and 617-470-2747 after hours).)

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Attachments

Please upload any attachments (proposed site plan)

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Additional Information

Please list any additional Special Requirements

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Requested Usage from City of Chelsea

Tables	---
Chairs	---
Electricity	---
Stage	---

Equipment

How many tables are needed?	8
How many chairs are needed?	4

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	blank COI.docx

Decide which Departments should review this application:

Should Fire Department review?	Yes, FD should review.
Should Police Department review?	No, no PD review needed.
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