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St Paddys Day Approval 2012 r �y_13t9�� Y Mrd 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 v ..� �C 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. c (&� ate_ �� �.- ' is 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? V—. - w--st cu 1(c vA •- 1 t� 8. How many people are expected to attendMov,e ent? O 9. How will crowd control be managed if there is an overflow crowd? k� PO(LCO .,b 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,-, 00 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. q ) 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? �� .s — T(?'j C5=. 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 C- 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 o coe-✓' 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.) Kz"k s' )p C� r.'� 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, 3 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 V[] 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. r l 6-tN I QjjY& k 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