TOWN OF GREENE, MAINE

Mass Gathering License Application

(Minor, 500-999 persons; Major, 1,000 or more persons)

 

For office use only

Date filed:                                                                                ____________________________                Application Fees:

Fee paid:            ____________________________                            Non-profit, minor               $1.00_______

Date ApplicationReceived:            ________________                                  Non-profit, major               $1.00_______

Publication Dates:            ______________________                                  For-profit, minor                    $ 100.00_______

Publication Names:            ______________________                                  For-profit, major                    $ 250.00_______

Public Hearing Date:                                                   ______________________   

Issued/Denied:            ______________________

 

 

 

 

This application must be filed with the Town Clerk not less than sixty (60) days before the date of the event. Application must be accompanied by a non-refundable application fee as indicated above.

 

Name of Applicant (or name of organization and authorized agent):___________________________________

 

________________________________________________________________________________________

 

Is applicant a not-for-profit organization?____________(If yes, attach a copy of State of Maine and IRS tax exempt certificates.)

 

Address of Applicant:____________________________________Home Telephone #____________________

             Work Telephone #____________________

Name of Event:_______________________________________________________________________________

 

Location where event will be held:________________________________________________________________

 

Is this property owned by the applicant?____________ (If no, attach a copy of the contract with or letter of authorization from the owner allowing use of the property for the event.)

 

Name of Promoter (if different from above):_________________________________________________________

 

Telephone #:________________________Address:__________________________________________________

 

Date(s) of Event:___________________________Time (start and finish times):____________________________

 

Expected Attendance:__________________________________________________________________________

 

Description of Event (Attach additional sheets if necessary.):___________________________________________

 

__________________________________________________________________________________________

 

Will food be sold and/or served at this event?_____________

 

Will alcoholic beverages be sold and/or served at this event?______________

 


Description of Property:

 

A.                 Seating capacity:                                                                                   ________permanent             ________temporary             ________other

B.                 Standing room:             _________________square feet

C.                 Number of toilets available:                                           ________permanent    ________portable

D.                 Number of parking spaces available:                                                     ________on site            ________off site

E.                  Are all parking lots lighted? (Applicable only if event runs into evening hours.)

________yes                           ________no    If no, which lots are not lighted?_____________________________

 

_____________________________________________________________________________

 

F.                  Source of potable water:_________________________________________________________

 

G.                 Refuse containers available – number and size:_______________________________________

 

H.                 Name of refuse disposal company (Attach copy of agreement to pick up refuse or describe plan for proper disposal of waste.)

 

_______________________________________________________________________________

 

I.                    When will refuse be picked up?_____________________________________________________

 

Public Safety:

J.                   Describe first aid/medical personnel and provisions:______________________________________

 

_______________________________________________________________________________

 

K.                Describe fire/emergency equipment and availability:______________________________________

 

_______________________________________________________________________________

 

L.                  Describe communication system:_____________________________________________________

 

_______________________________________________________________________________

 

M.               Number of certified police officers:____________________________________________________

 

N.                Other security personnel (provide company name and qualifications):________________________

 

_______________________________________________________________________________

 

Traffic Plan:

 

O.                Description of routes persons attending the event are likely to take, include number of traffic controllers and deployment descriptions._____________________________________________

 

_____________________________________________________________________________

 

_______________________________________________________________________________

 

P.                  Describe methods used to publicize alternate routes of reaching the scene of the event.

 

_____________________________________________________________________________

 


Q.                Provide statement of availability of private towing firms to remove disabled vehicles._____________

 

_______________________________________________________________________________

 

_______________________________________________________________________________

 

Other:

 

R.                 Name of liability insurance carrier (Attach proof of insurance.)____________________________

 

_______________________________________________________________________________

 

S.                  Type of performance guarantee (i.e., escrow account, letter of credit):________________________

 

_____________________________________________________________________________

 

I have received a copy of the Mass Gathering Ordinance of the Town of Greene, and hereby submit this application, which is true and complete to the best of my knowledge and ability.

 

______________________________________________

Signature of Applicant

 

Reviewed by: (Name and Date)

 

_________________________________________              ___________________(Town Clerk)

 

_________________________________________              ___________________(Code Enforcement Officer)

 

_________________________________________              ___________________(Fire Chief)

 

_________________________________________              ___________________(Public Works Director)

 

Approved by:  (Town Manager or Selectmen’s name(s), as appropriate, and date)                                             

 

_________________________________________              ___________________

 

_________________________________________              ___________________

 

_________________________________________              ___________________

 

_________________________________________              ___________________

 

_________________________________________              ___________________