Special Event Permit Application

TITLE, PURPOSE, LOCATION, AND DESCRIPTION OF EVENT

Type of Event

Refer Media or Citizen inquires to:

Media of Citizens Inquiry Phone Number

Format: (000) 000-0000.

Media of Citizens Inquiry Email

APPLICANT AUTHORIZATION

Attach a written communication from the organization or organizations in whose name the event will be advertised which authorizes you, the applicant, to apply for the special events permit on its or their behalf.

Applicant's Name

First NameLast Name

Email

example@example.com

North Topsail Beach Property Address

Example: 2008 Loggerhead Ct.

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Affiliation

Daytime Phone

Please enter a valid phone number.Format: (000) 000-0000.

Evening Phone

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Phone

Please enter a valid phone number.Format: (000) 000-0000.

REQUESTED EVENT COMPONENTS

Desired Event Date

MonthDayYear

Alternate Event Date

MonthDayYear

Hours of Operation

Hour Minutes

AM/PM Option

Until

until

Hour Minutes

AM/PM Option

Setup Day & Time

MonthDayYear

Hour MinutesAM/PM Option

Dismantle Day & Time

MonthDayYear

Hour MinutesAM/PM Option

Describe the number and type of animals to be used in the event, if any:

Attach a draft of the entry form for participants/spectators.

Anticipated number of participants:

Anticipated number of spectators

Attach either an insurance policy or a certificate of insurance including the policy number, amount and the provision that the Town is included as an additional insured. (Please note that insurance requirements depend upon the risk level of the event. Also, if your event can be classified as First Amendment expressive activity, insurance requirements can be waived by the Board of Aldermen under certain circumstances.)

Attach your “Plan for Cleanup Material Preservation.” Include number, type and location of trash containers to be provided for the event. Indicate who and how many will be responsible for emptying and cleaning up around containers during the event. Indicate who and how many will be responsible for cleaning up the event area after the event. Describe the number, type and location of portable toilets to be provided for the event area. Describe the number, type and location of portable toilets to be provided for the event (or permanent toilets to be used for the event). Include any other plan you have for ensuring post-event cleanliness and material preservation of city facilities, equipment, premises and streets.

Check off below items that apply to your event. Indicate these items on attached maps. Use, where necessary, a to-scale drawing.

Number of Portable Toilets

Number of Trash Containers

Number of Recycling Containers

Map of Event Location

AVAILABILITY OF FOOD, BEVERAGES AND/OR ENTERTAINMENT

If there will be music, sound amplification or any other noise impact, please describe, including the intended hours, the music, sound, or noise.

Alcoholic beverages to be served

Describe what system will be used to ensure that alcoholic beverages will be consumed only those 21 years and older

Describe how, where, when and by whom the alcoholic beverages will be served.

Attach to the application a copy of your permit from the State Alcoholic Beverage Control Board. Alcohol may not be served without a permit.

If a casino party, a dance, or live entertainment is part of your event, please describe.

Please describe all of the activities of your event for which a privilege license is required (contact Permit Specialist 910-328-1349).

Food and/or non-alcoholic beverages to be served?

Describe sanitation measures, food handling procedures, and the nature of the food (such as pre-packaged foods, hot dogs, pre-mixed sodas, unpeeled fruit, raw meats, vegetables, fish, or peeled and cut fruit).

You may need to have a health permit from the Onslow County Health Department –Environmental Health Division. Attach a copy of your health permit to this application.

If you intend to cook food in the event area, describe your area layout, including fuel or electrical source to be used.

SECURITY AND SAFETY PROCEDURES

Describe your proposed procedures for set up, operation, internal security and crowd control.

If the event is to occur at night, describe how you are going to light the event in order to increase the safety of participants and spectators coming to and leaving the event.

If you event includes vehicles or animals, describe the minimum and maximum speeds of the event and the minimum and maximum intervals of space to be maintained between units.

Attach a copy of your building permit (or permits) if you are installing any electrical wiring on a temporary or permanent basis and/or if you are building any temporary or permanent structures such as bleachers, scaffolding, a grandstand, reviewing stands, stages or platforms.

Will this event include the use of signs

If yes, please refer to the Town Unified Development Ordinance Section 8.09. Temporary signs (up for no more than 30 days) require a permit from the Town’s Planning & Zoning Department.

Give name, address and phone numbers of the agency or agencies which will provide first-aid staff and equipment.

Name of Agency

Name of Representative

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Indicate medical services that will be provided for the event

Rows	CHECK IF YES	HOW PROVIDED
AMBULANCES
DOCTORS
NURSES
PARAMEDICS

VENDORS OR CONCESSIONAIRES

Describe what vendors or concessionaires you will allow in conjunction with the event and the purpose or purposes of these concessions.

Describe how you intend to regulate, monitor and control the type, number and quality of vendors/concessionaires whom you may permit to operate in conjunction with the event.

MITIGATION OF THE IMPACT ON OTHERS

Describe how you intend to mitigate the impact of the special events on businesses, neighbors, motorists, and others. Attach additional sheets, if necessary, entitled “Mitigation of the Impact on Others.”

TOWN SERVICES/EQUIPMENT

Describe town services and/or equipment requested for this event. Town barricades, cones, and no-parking signs may be borrowed on an as-available basis. You should plan to pick up and return this equipment. If you or your volunteers cannot pick up and return this equipment, please explain why below. This will be reviewed and approved or denied by the Customer Service Coordinator.

AGREEMENT

I, the applicant, understand the filing of this application does not ensure the issuance of this permit. I also understand that all Special Event organizers and participants must comply will all applicable Town ordinances, traffic rules, park rules, State health laws, fire codes and alcohol licensing regulations. I have read the Town of North Topsail Beach Special Events Policy and I further understand that an incomplete application may be cause for denial of the event.

Hold harmless indemnification defense.
For good and valuable consideration I, the applicant agree to indemnify, defend, and hold harmless the Town of North Topsail Beach, and it officers, officials, employees, and agents from and against any and all liability, loss, damage, expenses, costs, including attorney fees arising out of the activities performed as described herein, cause in whole or in part by any negligent act or omission of the applicant/organization, anyone directly or indirectly employed by any of them or anyone whose acts any of them may be liable, except where caused by the sole negligence or willful misconduct of the Town.

Signature

Payment

Special Event Permit Fee

$25.00

Total

Payment Methods

Credit Card

Apple Pay

Google Pay