Special Event Request 2024

EVENT INFORMATION

Event/Activity Name	2024 Box District Block Party
Is this a 400th Event?	Yes/Si
Is this event approved by the 400th committee?	No

CONTACT INFORMATION

Facility (See link to park locations and descriptions above)	---
***Other Description	Box District Park (180 Highland Street)
Event Date	July 20th, Rain Date July 27th
Applicants Name	---
Contact Person	---
Cell Phone	---
Email Address	---
Day Phone	---
Address	---
Name of Supervisor/Vendor on Site	---
Supervisor/Vendor Phone Number	+16175458347
Name of Second Supervisor on Site	---
Second Supervisor Phone Number	+16178191702
Total Estimated Number of Participants	500
Estimated Number of ADULT Participants	250
Estimated Number of YOUTH Participants	250
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?

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First preference: Single Date - Time

Date	2024-07-20
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)	4:00pm-5:00pm

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	---
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?

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 , 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	---
Food Trucks	No/No

Music and Entertainment: One Day Entertainment License Requirement

Please describe the type of music or entertainment to be provided:

DJ playing mainstream music that is culturally appropriate

Machinery Detail

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

DJ equipment and speakers, inflatable play structure, grills, generator (if we don't have access to city's electricity) Power source: electricity/generator (gas)

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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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?	30
How many chairs are needed?	36

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	TND - CITY OF CHELSEA - BLOCK PARTY 2024 - COI.pdf

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 ?	No