Application
CONTACT INFORMATION
| Event/Activity Name |
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| Facility (See link to park locations and descriptions above) |
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| ***Other Description |
Chelsea Walk/Luther Place Lot
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| Event Date |
October 7,2023
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| Applicants Name |
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| Contact Person |
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| Email Address |
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| Cell Phone |
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| Day Phone |
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| Address |
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EVENT INFORMATION
| Name of Supervisor/Vendor on Site |
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| Supervisor/Vendor Phone Number |
+17815520717
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| Name of Second Supervisor on Site |
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| Second Supervisor Phone Number |
+16178896863
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| Total Estimated Number of Participants |
25
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| Estimated Number of ADULT Participants |
15
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| Estimated Number of YOUTH Participants |
10
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| Organization Type |
City or School Use
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| Activity |
Community Use (please specify below)
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| Brief Description of Event |
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| Special Requirements |
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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 |
2023-10-07
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| Total Time (ex. 2:00pm-6:00pm) |
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| Set-up Time (ex. 2:00pm-3:00pm) |
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| Total Event Time (ex. 3:00pm-5:30pm) |
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| Breakdown Time (ex. 5:30pm-6:00pm) |
2pm-2:30pm
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Second Choice - Single Date
| If your first choice date is not available, do you have a second choice? |
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Second Preference: One Date
| Date |
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| Total Time (ex. 2:00pm-6:00pm |
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| Set-up Time (ex. 2:00pm-3:00pm) |
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| Total Event Time (ex. 3:00pm-5:30pm) |
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| Breakdown Time (5:30pm-6:00pm) |
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| Facility (please see link above for park locations and descriptions) |
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Specialized Event
| Does your event fall under one of these categories? |
Yes
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Type of Event
| Select which event type your request is for |
Community Event
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Licensing Department and Inspectional Services Department
| Are any of the following part of your event? |
More than 50 people in attendance, Food and beverages , Music, entertainment, or amplified sound on site, Tents larger than 10x10, Stages or other temporary structures, Generator
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Food and Beverage/ Fire Department and Licensing
| Will food and beverages be: |
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| Please specify all food and beverages that will be provided |
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| Food Trucks |
No/No
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Music and Entertainment: One Day Entertainment License Requirement
| Please describe the type of music or entertainment to be provided: |
Local youth talent will perform a cover of a popular song.
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Tents: Detail
| Please describe the number and size of tents to be used: |
We will utilize 7-8 10X10 tents.
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Department of Public Works
| Will you require electricity? (Please call 617-466-4211 (during business hours) and 617-697-3913 (after hours).) |
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Additional Information
| Please list any additional Special Requirements |
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Requested Usage from City of Chelsea
| Tables |
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| Chairs |
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| Electricity |
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| Stage |
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Equipment
| How many tables are needed? |
9
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| How many chairs are needed? |
50
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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 do not agree/no estoy de acuerdo
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| 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 do not agree
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| I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature. |
Yes
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| Up Load Insurance policy/agreement |
Blank (1).docx
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First Review by Special Events Coordinator
Decide which Departments should review this application:
| Should Fire Department review? |
Yes, FD should review.
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| Should Police Department review? |
Yes, Police Department should review.
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| Should Licensing review? |
No, no Licensing review needed.
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| Should Inspectional Services review? |
Yes, Inspectional Services review.
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| Should Public Works review? |
Yes, Public Works review needed.
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| Should Traffic and Parking review ? |
Yes
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