5.d) Meisters Special Event Permit ApplicationFA.ID
juL 2 4 2014
SCANDIA
14727 209`x' Street North
Scandia, Minnesota 55073
(651) 433-2274 www.ci.scandia.maus
Special Event Permit Application
INSTRUCTIONS: Fill out this form completely, sign it and include all required attachments. If additional space is
needed, attach additional sheets. Submit to the City of Scandia at least 30 days prior to the date of the event with the $25.00
permit fee. You will be notified at the time of application of the date for City Council consideration of the request.
1. Name, purpose and description of event:
C' -cc C'2�.
Location address:
Date(s):
Event starting Time: q /Y-.
Set-up start date and time:
OO Event ending time: 11on R./'11
Dismantle by- date and time: 9 / } I xbo m.
Anticipated number of participants and/or spectators:
If there is a fee or donation required as a condition of
attendance, please describe:
2. Attach sketch or site plan showing the location of the following as applicable:
route (beginning/ end, direction of travel,
traffic control points)
ticketing/ registration/ entry locations
entertainment or stage locations
portable toilet facilities
fencing locations
parking areas for participants/ spectators
sign locations
_ speaker (sound amplification) locations
_ food concession areas (cooking, serving,
consumption)
alcoholic beverage concession area
other concession areas
size and location of any tents or structures
trash/recycling receptacle area
fireworks or pyrotechnics site
_ first aid facilities
other as may be applicable
City ofScandia, Special Event Permit Application, Page I of 7
3. Applicant information:
Name:
Address:
Phone:
E -Mail:
Affiliation/ organization:
Are you an authorized applicant for this organization?
Title: ACAS
Cell: h l IL--—t`1.'�%—
Will this person have authority to cancel or modify event plans?
Will this person be present at the event and in charge of the event
at all times?
If no, provide contact information for person who will be the
responsible parry on the day of this event
Name:
Address:
Phone:
E -Mail:
Title:
Cell:
Yep No
Yes,\, --No
Yes x No
4. Entertainment:
Describe entertainment plans. If there will be music, sound amplification or any other noise impact,
nlease describe including the intended hours.
Describe the toilet and hand washing facilities present on the site (type, number & location) as well as
temporary/ portable facilities to be provided. Describe the source of potable (drinking) water.
City ofScandia, Special Event Permit Application, Page 2 of 7
6. Parking and traffic control:
Describe the location and number of parking spaces available. Describe arrangements that have been
made for traffic control.
7. Emergency/ medical services:
Describe measures that will be taken to ensure emergency vehicle access (police, fire, ambulance) to
the event area.
8. Security/ crowd management:
Describe your proposed procedures and staffing for the event operations and crowd control.
9. Trash/recycling, event clean-up:
Describe the number, type and location of trash/ recycling containers to be provided. What provisions
have heen made for clean -un of the site and surrounding area after the event?
Name of trash/ recycling hauler:
10. Lighting:
Describe any temporary or permanent lighting that will be added for the event.
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11. Temporary structures or construction.
Describe any tents, canopies, enclosures, stages, platforms, scaffolding, risers, bleachers, fences, and
any other type of temporary structure or construction for the event. Event sponsor is responsible to
obtain any building or electrical permits that may be required for such construction.
12. Advertising and promotion.
Describe how this event will be advertised and promoted. Describe any signs (size, type, location.)
All signs must comply with Scandia Development Code Chapter 2 Section 9.13 including a permit if
required.
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13. Noise:
Describe expected type, duration and timing of any noise sources. Describe measures to be taken to
ensure compliance with city noise ordinance (Ordinance No. 65.)
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14. Fireworks or pyrotechnics:
Will any fireworks or pyrotechnics be used at the event? Yes No -
If yes, describe in detail. Fire Department approval will be required.
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15. Food and beverages:
Will alcoholic beverages be served? Yes�No.
If yes, describe the type of beverages and the status of the liquor license:
Will food and/or non-alcoholic beverages be served? Yes .ham No
If yes, describe what will be served and any plans for cooking food in the event area, including fuel
source to be used:
Has a license been obtained from the Washington County
Department of Health and Environment? (please attach) Yes No
16. Other concessions:
Describe what vendors or concessionaires you will allow at the event, and how you intend to regulate
and monitor their activities.
17. Gambling:
Will there be any gambling (raffles, pull -tabs, bingo, etc.) at the
event? Yes No
If yes, a lawful gambling permit will be required as provided by state law and Scandia Ordi ce No.
100. Describe the gambling activity and the status of the gambling permit.
18. Workers compensation compliance:
In accordance with Minnesota Statutes all applicants for license and permits to operate a business in
Minnesota must submit acceptable evidence of compliance with workers' compensation insurance
requirements. Please complete the certificate of compliance and attach to this application.
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