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Home My WebLink AboutDocumentation_Regular_10_03/09/2017 ,s °" \A LLAGE OFTEQUESI A �Oy OOM M UNI TY DEVB_OPM ENT DBPARTM ENT 't IT t t e t Akar 345 Tequesta Dr. Deport Amount: fit n V. `� Tequesta, Honda 33469 �". N coot- 4 T (56 768 -0450 Fax (561) 768 -0698 ,',GE OF T EQUESTA F S A FECJAL EVENT PERMIT AFPU CATI ON ° 2 017 EB 2017 FIR Any Village resdent, or any Village business holding a current Village business tax receipt pursuant to Chapter 70, Article II, is ehgl5he I to apply for and obtain a special event permit pursuant to &-c. 78 -561. Any such resident or business that desires to conduct any type of special event within the Village must obtain a permit from the Village in order that the Village may adequately provide for the potential impacts created by the proposed event. A maximum of four (4) such permits shall be allowed per address or per business in any single calendar year. "qoeaal Event" is any outdoor activity, gathering or group of persons, vehides or both, organized and having a common purpose, upon public or private property, which is likely to inhibit the usual flow of vehicular or pedestrian traffic, which is likely to create noise in excess of that typically associated with the areas upon which the vent is to occur, or which is likely to preempt or restrict use of property typically accessible by the general public. Examples of special events indude, but are not limited to block parties, parades, races or walks, grand opening events, charity fundraisers, and other similar events not specifically permitted by the Village's zoning ordinance. Spedal Events that are sponsored by the village and held on village property shall be exempt from the provisions of this section. Written application must be submitted to the Village Community Development Department at least forty five (45) days prior to the date for which the special event is proposed; which application shall contain the following information: i DAZE OF SALE/ EVENT: ( j � 1 HOURS FROM : > • TO � I , TYPE OF EVENT: I In YN- y ) nctr` T e - �1 xYi f S P O LOCATION OF . CAO .� COVn` U yip , ! . PROPERTY OVVNER &I I I S CU L_- (Attach written consent of property owner of record.) Pint Name CONTACT I NFOF7v1 AT1ON: gONSOR or PERSON(5 REEPONS RI F FOR EVENT: - ;A 1 CP . �J (LA..41) C EMAIL b G flI' L 7 , �Gt MAILINGADDRESS TO. ?/ 1 -1( 7 - -- i 2 PI 1-2.77" 1 TF (i\ t. ��`IP 1 FAX NO.: J(Q� 277- t G )2(e PRaECTED NUM BEROFAIII7NDEl;5 2 T COUNOLAPPROVALREQUIRED: (.-1 ( )NO • Any proposed special event who attendance is contemplated to exceed 200 people in total shall require final approval by the Village Council which, after considering the recommendations of the Community Development Drector, the Police Chief and the Village Manager, may approve the application, deny the application in whole or in part; or approve the application with conditions. I SALCOHOL BEING Ste/ED? ( )YES ( ✓)NO • The service of alcoholic beverages at any special event shall require the issuance of the appropriate state alcoholic beverage permit, a copy of which must be provided to the village in conjunction with the special event permit application. • The Village may require the use of physical barriers to define and contain the outdoor area within which alcoholic beverages may be consumed and /or the use of security or off -duty law enforcement personnel at the special event. • It is the applicant's responsibility to monitor for and prevent excessive as well as underage consumption of alcoholic beverages at all times. Page 1 of 2 • By submitting a complete application, the applicant expressly agrees that it shall indemnify, defend and hold the Village harmless from any and all damage to any real or personal property, and from any and all injury or death suffered by any person directly or indirectly related to the consumption of alcoholic beverages in conjunction with the special event. NON- PFORTENT RPA • The Village may issue non - profit permits to any person or organization for the conduct or operation of occasional sales and /or fundraising projects held by non - profit enterpri either regularly or temporarily, when the applicant signs an affidavit that the applicant operates without private profit, for a civic, public, charitable, youth, service, educational, literary, fraternal, or religious purpo • A person making application under this sect ion must comply with all rules and procedures for the granting of special event permits as set forth in this section. All persons operating under a non - profit permit shall operatetheir non - profit enterprise in compliance with this section and all other rules and regulations of the\Allage. JAN THE FOLLOWING ITEM SAFE FL-QUI FED TO BE SUBM ITTED AT TIM E OF APPLICATION: • Proof of insurance in amounts acceptable to the Village for the type of event. The Village shall be named as an additional insured on all liability insurance. • Expected traffic, fire - rescue, and utilities impact, if any, and proposed mitigation plans. • Copy of all required state and county permits if event will be held on or utilize state and /or county- controlled property. • A refundable deposit is required if the event is held on any Village property. • Ste Plan required with each application accompanied with drawing indicating layout for event. • Al sale rtes shall be left in a dean and orderly manner upon completion of sale. • S'iould the sale/event indude the use of one or more tents, a $35.00 Fire Inspect ion Fee, due at time of application, and a certificate of flame resistance is required for each tent. Inspection to be done on the first day of event SPECIAL EVENT FEE • Under 200 attendees: $40.00 • Over 200 attendees: $100.00 3GNAT1JFE OFAPPUCANT: L l � [ q c (" — DATE / t L✓' I 7 R Name 9gnature F M END FORAFFRJVAL / `J COMM UNITY DEN. DI FECTOR <� / DATE z / e/f / BUILDING DI OR DATE POLJCE • O 7 -- DATE —/3 _ NPaA412Ur FgFE;HIEF: 44j / A1/ DATE • 9 • / T : DATE APPROVED BY: / VILLAGE MANAGER DATE v- ' s/ / 7 Approval /Fbview Notes: Page 2 Df 2 Goole Maps https://www.google.com/maps/@26.96943,-80.0961613,324a,20y,2... p h s: / /www. oo le.com/ma s/ 26.96943 80.0961 11p g g p Q 613,324a,20y,2... GooJ le Maps ()As \` ` z ef • LLa. IR r! ® ® • Fa' 4 Imagery (0201 / Google, Map data 02017 Google 50 ft C \)-e—,AX ya c vvc \)1/4) A\ 6 Ito ��QvC� -\‘&05e._ 5 �ja ,�; s'� C_\kit VILLAGE OF TEQUESTA FEB 6 Z017 BUILDING DEPARTMENT l of 1 2/62017 11:42 AM �'1 HANNHOM -01 RHOUGHTON A `C) RL" CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the csrtilcate holder Is an ADDITIONAL INSURED, the policy(Iss) must have ADDITIONAL INSURED provisions or be endorsed. M SUBROGATION IS WANED, subject to the terms and conditions of the certain policies require an endorsement. A policy, P� �Y m9 statement on i this certificate does not confer rights to the certificate holler In lieu of such endorsement(s). PRODUCER kale CT P.O. Merriam 1 Agency P1 wc N0, Ext): (518) 393 -2109 1 , Noi :(518) 346 -0996 Schenectady, NY 12301 mass: Insuranceemenlaminsurance.com INSURER(S) AFFORDING COVERAGE NAIC • mum A: American International Group women nNSURERB: VILLAGE OF TOM :STA Hannah's Home of South Florida, Inc INSURER C : PO Box 4512 INSURER D : JAN 3 L U ! r Jupiter, FL. 33469 INSURER E: INSURER F: ,p �^ DE!--“."-, dc MT COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE END POLICY NNW POLICY EFF POLICY DD/ BrsYrm lrYT pasoDrrn, LENTS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAa/34AADE 1 X 1 occult X X 01LX0921T56350/00 11/15/2016 11115/2011 I $ 100,000 N EXP any ors meson) $ 5,000 PERSONAL & ADV INJURY $ 3,000,000 GEHL AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I r& LOC PRODUCTS - COMP/OP AGG $ 3,000,0001 OTHER: $ A ALROIMO.LE u *aam COMBINED SINGLE LENT 1,000,000 X ANY AUTO 01 CAO461116913 0/00 11/1512016 11/1512017 BOOlLY INLxxtr (P. parson) $ - (TINNED SCIEDULED AUTOS ONLY AUTOS p BOODILY INJURY (Par accident! $ gra ONLY _ �Q (Pero. 1 p GE $ $ .-- iNBREL A LW ,— OCCUR EACH OCCURRENCE $ EXCISES LIAM CLNIAS -MADE AGGREGATE __$____ DED 1 1 RETENTION: $ MAIN LNBt 1 JTE 1 1 ER Y/N ANY El. EACH ACCIDENT t Fl 1CIIBR OCCLUDED? CUTTVE I I N/ A $ yr r � E.L. DISEASE - EA EMPLOYEE $ DE CSCRI'TION OF OPERATION below E.L. DISEASE - POUCY LIMT $ 1 DESCRIPTION OF OPERATIONS / LOCATION{ / VEHICLES (ACORD 101. Adage/NI Raar.ks Sekedrde, may M attached I more spate N ngNud) Codified. holder Is listed as additional Insured with respect to the Nobility arising out of the actNMes of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH 1 Village of TegRINts E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 357 Tequ.sta Drive Tequssta, FL 33469 AUTHORIZED REPRESENTATIVE J C dye ACORD 25 (2016/03) ID 1988 -2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD el. � s''il.r = VILLAGE OF TEQUESTA BUILDING DEPARTMENT 345 Tequesta Dr. A Tequesta, Florida 33469 -0273 . f (561) 768 -0450 FAX (561) 768 -0698 INVOICE January 31, 2017 Permit #: SEP17- 000001 Address: 4390 COUNTY LINE ROAD Contractor: HANNAHS HOME OF SOUTH FLORIDA INC 4390 S COUNTY LINE RD TEQUESTA FL 33469 2174 FEES: Description Total Cost Over 200 Attendees 100.00 Total Permit Amount: 100.00 Total Amount Paid: 0.00 Remaining Balance: 100.00 Maureen McGuinniss PAID vivativ CU - u;gy1;