Special Event Permit Application

Special Event Permit Application

Please take time to review the Special Event Permit Application and Instructions BEFORE you begin completing the application form.
The Town of Burgaw is proud to have its residents and visitors host a multitude of community events in order to improve the quality of life and contribute to the economic vitality of the Town. The following pages include the Town of Burgaw’s Special Events Permit Application and accompanying instructions developed to guide you through the permit process.

For more information please contact (910) 300-6401 or csuggs@burgawnc.gov.

On behalf of the Town of Burgaw we thank you for contributing to the vitality of our community and offer you best wishes for a successful event.

THERE ARE NO SHORTCUTS TO THE PROCESSING OF A SPECIAL EVENT PERMIT
APPLICATION. PLEASE ALLOW A MINIMUM OF THIRTY (30) DAYS FOR THE
PROCESSING OF THE SPECIAL EVENT PERMIT APPLICATION.

A completed application must have all applicable sections of the application
complete and must include a detailed map of the event layout. Any
application that is submitted without a map of the event layout will be deemed
incomplete and returned to the applicant.

Instructions
Completed Special Events Permit Applications must be received no later than thirty (30) days prior to the event start date and may be submitted as early as six (6) months prior to the event start date.

In general, any organized activity involving the use of, or having impact upon public property, street areas or the temporary use of private property in a manner that varies from its current land use, requires a permit.

It is our goal to assist event organizers in planning safe and successful events that create a minimal impact on the communities and residents surrounding the events.
Permit Application Process
The Permit Application Process begins when the Event Organizer submits a completed Special Event Permit Application. During the initial application screening process, you will be allowed time to provide all pending documents (e.g. Liability Insurance, secondary permits, etc.). Upon receipt of your completed Permit Application, a representative from the Town will contact you.

A completed application must have all applicable sections of the application complete and must include a detailed map of the event layout. Any application that is submitted without a map of the event layout will be deemed incomplete and returned to the applicant.

Your Town Liaison will distribute, for review, copies of your Permit Application to all Town Departments affected by your event. You may be contacted individually by these departments only if they have specific questions or concerns about your event.

Please be aware that in some cases you may need
to contact federal, state or county agencies in addition to the Town of Burgaw.

Throughout the Permit Application Process, you will be notified if your event requires any additional information, permits, licenses or insurance. Delays in providing the requested items often delay the ability to finish the Permit Application Process and approve a Permit Application in a timely manner and could result in denial of the application.

Note: Keep in mind that acceptance of your Permit Application should in no way be construed as final approval or confirmation of your Permit Application.
Host Organization Contact Information

The Host Organization is the organization accepting all financial responsibility for the event and provides the required insurance.
Organization Name*
Type of Organization*
*Not-profits must provide copy of determination letter
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physical Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid fax number.
Website Address
Event Organizer Contact Information

The Event Organizer is the applicant given authorization by the host organization to apply for the Special Event Permit.
Name*

First NameLast Name
Title
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email Address*
example@example.com
On-Site Contact Information

Contact information for the person who will be on-site and will be the primary contact on the day(s) of the event.
Contact Information
Name

First NameLast Name
Title
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Event Details

Please complete the entire section.
Event Name*
Type of Event*
If "Other," please specify below.
If "Other," please specify
Detailed Event Description (50-Word Minimum)*
Is this an annual event?*

YesNo
Is this a multi-day event?*

YesNo
If so, how many days?
Is there an admission fee?*

YesNo
If so, please include admission fee(s).
What is the anticipated overall attendance?*
What is the anticipated daily attendance?*
What was the previous year's attendance (if applicable)?
Event Set-Up and Tear-Down

If you will be utilizing street closures, please refer to the next section to provide all street closure information.
How many days will your organization require to set up the event?*
How many days will your organization require to tear down the event?*
Event Set-Up Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Event Start Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Event End Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Event Tear-Down Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Please list any additional days needed for this event.
Street Closures
Closure Start Date and Time
Closure End Date and Time
Please list the streets, from intersection to intersection, which will be closed for your event. Space is provided for up to five (5) entries. If you need more space, please provide an additional document at the end of this page with the requested information. Your Site Plan/Map must show all streets and street closures and must include a designated 12-foot wide emergency lane.
Street Closure 1
Street Name
From (Cross Street)
To (Cross Street)
Street Closure 2
Street Name
Type of Closure

Street ClosureSidewalk ClosureLane Closure
From (Cross Street)
To (Cross Street)
Type of Closure

Street ClosureSidewalk ClosureLane Closure
Street Closure 3
Street Name
From (Cross Street)
To (Cross Street)
Type of Closure

Street ClosureSidewalk ClosureLane Closure
Street Closure 4
Street Name
From (Cross Street)
To (Cross Street)
Type of Closure

Street ClosureSidewalk ClosureLane Closure
Street Closure 5
Street Name
From (Cross Street)
To (Cross Street)
Type of Closure

Street ClosureSidewalk ClosureLane Closure
Additional Street Closures Upload

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Venue Details
Venue Name
Venue Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Venue Description
Please provide written permission from property owner.

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Staging Details
The following items will be used at the event (please mark all that apply):

Amplified MusicBleacher(s)Dance Floor(s)Live Entertainment*JumperLoud Speaker(s)Microphone(s)Disc Jockey (DJ)Moving Vehicles (including golf carts)Stage(s)CanopiesEZ-Up(s)Other
*If Live Entertainment is selected, please describe
Stage Size and Number
EZ-Up Size and Number
Canopy Size and Number
Do you need power on the square or at the depot? Provided by:
Note: If any of the above items will be used, please indicate their location on your attached Site Plan/Map with a Legend. Use of the above items may require the Event Organizer to meet Fire Department, ADA regulations, and insurance requirements.

Note: All formal requests to use the courthouse square for an event should be made through Pender County Government.

Note: All formal requests to use the Burgaw Community House or Train Depot for events at a rate beyond the already agreed upon rate must go before the Burgaw Board of Commissioners for approval.
Catering and Alcoholic Beverages

The Event Organizer must obtain a health permit for the event including all food providers. If alcoholic beverages will be provided or sold at the event, an ABC Permit is required. The ABC Permit application must be submitted to the Town for approval a minimum of ten (10) days prior to the event. Police services may be required.
Event will include the following (Please mark all that apply):

Alcoholic BeveragesProfessional CateringNon-Profit Food VendorsPre-Packaged Food/Beverage ItemsPotluck ItemsRetail Food Vendors
Sanitation
Restroom Facility Details

Some events will require the presence of portable restrooms and/or hand-washing stations. Use of these items will require the Event Organizer to meet ADA regulations. Please contact your rental company for attendance to restroom ratios. Please indicate location(s) on your Site Plan/Map.
Will the Event Organizer provide portable restroom facilities?*

YesNo
Site Plan/Map Instructions
All applicants are required to submit a detailed Site Plan/Map.

Site Plans/Maps must include a legend showing the use of symbols for people, vehicles, first aid station(s), cooking station(s), food tables, stage(s), platform(s), barricades, 12-foot wide fire lane, etc.

If using Computer Assisted Generation (CAG) for the site plan/map please ensure the use of Arial fonts no smaller than size 10.
Site Plan/Map Upload*

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Animals
If animals will be present, food service canopies/tents must be at least fifty (50) feet away. Please indicate the location of the animals on the Site Plan/Map. Additional permitting may be required. It will also be required that the Event Organizer provides portable hand-washing stations.
Will there be any kind of animals at this event (e.g. petting zoo, pony rides, etc.)?*

YesNo
If yes, please list type of animal(s)
Insurance
The Host Organization and/or Event Organizer must provide a General Liability Insurance Certificate providing evidence of general liability insurance coverage in the minimum amount of $1,000,000 combine single limit, $2,000,000 aggregate AND $1,000,000 Auto Liability if the event includes any moving vehicles including golf carts AND an additional insure endorsement naming the Town of Burgaw, its officers, employees, and agents as additional insured. $1,000,000 Liquor Liability is required if the event is selling alcohol. $1,000,000 Liquor Host is required if the event is distributing alcohol at no charge. All vendors participating in the event and service providers must provide insurance, as well as all contracted services for the event (i.e. security services, rentals, traffic management, etc.). This document must be submitted no later than fifteen (15) days prior to the event start date.
General Liability Insurance Certificate Upload

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Indemnification Agreement
The Host Organization and/or Event Organizer(s) agree, in consideration of the granting of this Application and Special Event Permit for:

Event Name* to be held on Event Date(s)* by   Event Organizer/Primary Applicant *  of   Host Organization*    .

The Host Organization and/or Event Organizer(s) agree to defend, indemnify and hold harmless the Town of Burgaw's employees, managers, council members, and volunteers from any and all losses, damages, claims for damage, liability, lawsuits, judgement expense and cost(s) arising from any injury or death to any person or damage to any property including all reasonable costs for investigation and defense thereof (including, but not limited to, attorney fees, costs and expert fees) arising out of or attributed to the issuance of Applicant's Special Event Permit, regardless of where the injury, death or damage may occur, unless such injury, death or damage is cause by the sole negligence or willful misconduct of the Town.

Print Name*      Title*

Signature*     Date*
Should be Empty:

Special Event Permit Application

Instructions

Permit Application Process

Host Organization Contact Information

Event Organizer Contact Information

On-Site Contact Information

Event Details

Event Set-Up and Tear-Down

Street Closures

Street Closure 1

Street Closure 2

Street Closure 3

Street Closure 4

Street Closure 5

Venue Details

Staging Details

Catering and Alcoholic Beverages

Sanitation

Site Plan/Map Instructions

Animals

Insurance

Indemnification Agreement