St Paddys Day Approval 2012 r
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City of Atlantic Beach • 800 Seminole Road • Atlantic Beach,Florida 32233-5445
Phone (904)247-5826 • Fax (904)247-5845 • http://www.coab.us
REGISTRATION FORM
FOR TEMPORARY TENTS AND AWNING STRUCTURES
Within residential and commercial Zoning Districts, temporary tents and awning structures may be used
on private property within the City of Atlantic Beach following submittal of this completed form to the
Building and Zoning Department. These may be used only for private temporary events, such as
weddings and private parties and may be placed upon the property for a period not to exceed four (4) days
or ninety-six (96)hours.
DATE V
APPLICANT NAME: / I S,l
MAILING ADDRESS: CIO 1- ft'+- 1 G �--J� �
ADDRESS WHERE TORARY TENT OR AWNING WILL BE PLACED (If different from mailing
address.) ' c4Lkk.
DATES THAT THE T ORARY TENTS AND AWNING STRUCTURES WILL BE LQCATED ON
THE PROPERTY: "a -C�' IU, , 2,o] 2- through LA c.�. I '�- 2--
TEMPORARY TENTS AND AWNING STRUCTURES "SHALL BE FULLY SECURED, AND THE
BELOW SIGNATURE ACKNOWLEDGES THAT THE PROPERTY OWNER AND/OR THE COMPANY
INSTALLING ANY TENT OR AWNING ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR
SUCH.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT.
Signature of propeUt
ner or authorized
SIGNATURE PRINT NAME �-
CONTACT INFORMAT ON OF PERSON SUB TING THIS REGISTRATION FORM (PLEASE PRINT)
NAME CA,�I t6
MAILING ADDRESS v l'C% L G :` 1(L ' �� Y l ��h" �' %cc L. Z
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PHONE FAX E-MAIL 1_c-
1. What type of alcohol will be served and how? eer? ine? 'Other? Served inside? Outside?
2. Provide approved copy of any required Alcoholic Beverage Permits from the Division of Alcohol
Beverages and Tobacco? (Additional permit required by DABT for anyexpv n of Lice sed Premis )
3. Identify the event sponsor and provide app priate contact person in case of anemergency.
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4. Provide a site pian depicting the layout and location of all activities, including parking and traffic flow
distribution points, any tents,fences, security check points, and location of planned events and activities.
5. Has the business consulted with neighboring businesses to obtain their approvals? (�@.S - NCL111
6. Will there be outdoor music?+( Will there be amplified outdoor music?IkJC3 What hours?
7. Will there be a live band? What hours?
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8. How many people are expected to attendMov,e
ent?
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9. How will crowd control be managed if there is an overflow crowd?
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10. What specific special events are planned? (...such as bobbing for apples; ring toss; dunking booths; wet
t-shirts; bikini contests; all male/female "review") �j I A- ,
11. How will parking be located and managed? Include site plan showing parking areas to be used for this
event. d�t ak4a-p
12. How will security needs be provided;particularly with respect to prohibiting minors from being served.
(See following question.) Will off duty police or private security be used? Who is the contact person on-
site if problems arise? (Must be approved by City of Atlantic Beach Police Department,-,
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13. How are they going to assure that(110plecopple consuming alcohol are old enough? Wrist bands? Door
men? g
14. Are any tents to be erected on the property? Tent registration form e aired.
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15. Will there be any outdoor heating or cooking? If so, address how any by-products and refuse will be
handled, including grease/oil/refuse. How will any extra trash collection and disposal needs,during and
after the event,be addressed? W k-0 - -e�vra_
16. Will there be any extension of electricity into the parking areas, outdoor areas or any yards?
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n -%17. Special temporary events cannot negatively im act traffic flows, partparticularly in any adjacent
residential
areas, or close or block any public street or right-of-way Please address. 0 yt
18. Address how fire code requirements and access for emergency vehicle be monitored and maintained at all
times during the Special event. `,, ��G Q- � r L
19. Are there going to be any fires or fireworks? 0
20. Other than service animals, are there going to be any animals allowed as part of this special event?
2 N'o
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2 1. Is'this a first time event or a continuation of an annual event?
22. Were they complaints or problems at prior events of this nature? 5Z
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23. What additional signage will be used? (Such as for advertising, restrooms, alcohol consumption? (City
Sign regulations apply.) 00
24. How will the event be promoted and advertised(such as through the use of fliers, TV, Radio, etc.)
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25. Acknowledge by signature below that this special event will comply with all City of Atlantic Beach laws
and ordinances and that the event will be conducted and managed as represented within this application.
Such acknowledgement extends to all those organizing, planning and staffing this event.
SIGNATURE_" DATE L 1 Z
PRINT NAME
City of Atlantic Beach
Planning and Zoning Department
This approval verifies compliance with applicable
zoning, subdivision and other local land
development regulations, but does not constitute
approval for the issuance of permits. Compliance
EVENT APPROVED: with Florida Building Code and all other applicable
local, state and Federal permitting requirements
must be verified by signature of the City of Atlantic
Beach Building Official prior to the Issuance of a
Building permit.
REQUEST DENIED: Approved Br
Date:
U rector
SIGNED: DATE:
Department of Public Safety
SIGNED: DATE:
"'Jim Hans n, City Manager
Ald i ; �f 11 4 e ec( k �� ►�'. ��f- /����Y f��''C� U �� ���� �/�c G o f=Jc e r3,
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DBPR ABT-6029—Division of Alcoholic Beverages and Tobacco Application for Extension of
Licensed Premises or Amended Sketch of Licensed Premises
STATE OF FLORIDA DBPR Form
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6029
Revised 0912010
NOTE—This form must be submitted as part of an application packet
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation or your local district office. Please submit your
completed application to your local district office. This application may be submitted by mail, through
appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be
found on AB&T's page of the DBPR web site at the link provided below.
http://www.myflorida.com/dbpr/abt/district offices/licensing html
SECTION.1
INSTRUCTIONS FOR COMPLETING
DBPR ABT—6029
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
APPLICATION FOR EXTENSION OF LICENSED PREMISES OR AMENDED SKETCH OF LICENSED
PREMISES
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation or your local district office. Please submit your
completed application to your local district office. This application may be submitted by mail, through
appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be
found on AB&T's page of the DBPR web site at the link provided below.
httpi//www.mvflorida.com/dbpr/abt/district offices/licensing.html
GENERAL REQUIREMENTS
This application must be submitted for approval when changes are made to the licensed premises
whether the extension is permanent or temporary.
Please complete all information. Incomplete applications will be returned. All questions are applicable
and must be answered fully and truthfully.
You must provide an original application and a copy of all supporting documentation. All signatures must
be original.
APPLICATION REQUIREMENTS
Applicants for Temporary Extension of Premises Permits must submit the application at least
seven (7)days prior to the first date of the event to insure the permit is issued by the event date.
Zoning Approval—Applies to Permanent or Temporary Extension of Premises Only
Zoning approval is executed by the city or county zoning authority in which the business to be licensed is
located. This application is to be taken to the Zoning Department(City or County)that governs the
location of your business. Applications must be submitted within 180 days of receiving this approval.
Affidavit of Applicant
Read and sign in the presence of a notary. The affidavit must be signed by the individual applicant, a
partner of each general partnership, a general partner of each general partnership of a limited
partnership, a managing member or manager of a limited liability company, or one of the officers of a
corporate applicant.
Sketch of Premises
A sketch of the entire premises (existing premises on file with the division and the additional area to be
included), drawn in ink or computer generated (letter size), which includes all walls, doors, counters, sales
areas, storage areas, etc. No architectural drawings are accepted.
Amended Sketch of Premises
Draw, in ink, a complete amended sketch of the premises, which includes all walls, doors, counters, sales
areas, storage areas, etc. Changes may be made to the existing premises only; no additional
rooms may be added.
Note: The completion of Section 3-Zoning Approval does not apply to amended sketch premises.
SECTIQN 4 ° gF�lpp►VITrOF ARpLICANT
NOTARIZATION'001JIIRED
Business Name(D/B/A)
"I, the undersigned individually, or if a registered legal entity for itself, its officers and directors, hereby swear
or affirm that I am duly authorized to make the above and foregoing application and, as such, I hereby swear
or affirm that the attached sketch is a true and correct representation of the extended licensed premises and
agree that the place of business may be inspected and searched during business hours or at any time
business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic
Beverages and Tobacco, the sheriff, his deputies, and police officers for the purposes of determining
compliance with the beverage and cigarette laws."
I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and
837.06, Florida Statutes that the foregoing information is true and correct."
If applying for a temporary extension, check the box to confirm the following statement:
❑ "I understand that the premises must be restored to its original form at the conclusion of the
authorized temporary event."
STATE OF
COUNTY OF
APPLICANT SIGNATURE
APPLICANT SIGNATURE
The foregoing was( ) Sworn to and Subscribed OR ( )Acknowledged Before me this Day
of 20 , By who is ( ) personally
(print name(s)of person(s) making statement)
known to me OR( )who produced as identification.
Commission Expires:
Notary Public
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SECTION 5 .DESCRIPTION'OPRE7Name(D/B/A)
ress , ��_ �G-Coun State Zip C2FL No Is the proposed premises movable or able to be moved?
2. Yes ❑ No Is there any access through the premises to any area over which you do not
have dominion and control?
3. Neatly draw a floor plan of the premises in ink, including sidewalks and other outside areas which
are contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar
locations and any other specific areas which are part of the premises sought to be licensed. A
multi-story building where the entire building is to be licensed must show each floor plan.
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APPLICATION CHECKLIST
Select the appropriate transaction below and comply with the corresponding application requirements.
rTRANSACTION APPLICATION REQUIREMENTS
❑ Pay$100 fee for temporary extension of licensed premises only
Extension of Licensed (make check payable to the Division of Alcoholic Beverages and
Premises Tobacco)
❑ Complete DBPR ABT-6029 Division of Alcoholic Beverages and
Tobacco Application for Extension of Licensed Premises or
Amended Sketch of Licensed Premises
❑ Complete DBPR ABT-6029 Division of Alcoholic Beverages and
Amended Sketch Tobacco Application for Extension of Licensed Premises or
Amended Sketch of Licensed Premises
❑ Section 3 of this application does not apply