HomeMy Public PortalAboutSURFERS FOR AUTISM.pdfDATE ISSUED: 09 -4 -2013
WORK DESCRIPTION
WORK LOCATION
OWNER NAME
ADDRESS
CITY, ST, ZIP
PHONE NUMBER
CONTRACTOR NAME
ADDRESS
CITY STATE ZIP
FLOOD ZONE
BUILDING VALUATION
SQUARE FOOTAGE
OCCUPANCY TYPE
TOTAL FEES CHARGED
PROPERTY IDENTIFICATION #
PROJECT VALUATION
CITY OF TYBEE ISLAND
BUILDING PERMIT
TENTS - SURFERS FOR AUTISM
BEACH_S OF PAVILION
SURFERS FOR AUTISM
7899 SANTA FE TRAIL
BOCA RATON FL 33487
SURFERS FOR AUTISM
7899 SANTA FE TRAIL
BOCA RATON FL 33487
P
$ 200.00
$ 1.00
PERMIT #: 130554
TOTAL BALANCE DUE: $ 200.00
It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil
and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all
environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be
approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction
covered by this permit.
This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work
will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless
work has begun within six months of the date of issuance.
Signature of Building Inspector or Authorized Agent:
%L�i ✓l. tt fl
P. 0. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328
(912) 786 -4573 - FAX (912) 786 -9539
www.cityoftybee.org
Event:
CITY OF TYBEE ISLAND
TENT /CANOPY APPROVAL /REQUIREMENTS
Telephone: (912) 472 -5030 • Fax: (912) 786 -9539
Surfers for Autism
Date(s) of Event: 09/07/2013
Contact Person:
Location of Tent: Beach - Pavilion
Don Ryan, 7899 Santa Fe Trail, Boca Raton, FL 33487 561 -445 -7154
Number and size of Tents: 4 - 10' x 20'
2 — 10' x 10' pop up tents
1 — 16' oval tent
Date Erected: 09/07/2013
Date Down:
09/07/2013
DNR Permit required: Yes Received On 04/17/2013
Tent Provider: Tents are "E -Z UP" provided by Surfers for Autism
Tent Erected by: Surfers for Autism, Inc.
Address: 7899 Santa Fe Trail, Boca Raton, FL 33487
Emergency phone number: 561 - 445 -7154 Don Ryan (Kim Ryan — 561 - 400 -6111)
Wind resistance: Defer to experience and monitoring by Don Ryan and staff
On -site tent expert: Don Ryan
Emergency phone number: 561 - 445 -7154
Flame retardant certificate - Date of last treatment, name of chemical used in treatment, name of firm or
individual treating fabric and testing agency and standard use. Labeling and /or other certification may be
acceptable to the fire code official. Received 03/21/2013
Site plan — Received 03/21/2013
Emergency access
• For tents that have more than one exit, there shall be an unobstructed fire break passageway of not Tess
than twelve (12) feet in width and free from guy ropes or other obstructions shall be maintained on all
sides of tent.
• For every 50 feet of side -by -side tents, provide a minimum 5 foot wide emergency access walkway.
Comprehensive general liability - Hosting organization, permit holder, or host establishment
Liability insurance - Tent provider
Hold Harmless Agreement - Hosting organization, permit holder, or host establishment
Per Provider and provider's engineer, tent will be secured by ground by 80 pound sand ballasts secured with
1,000 pound nylon straps — 4 per tent.
Maximum Occupant load: 10' x 20' — 40 people
Required number of approved fire extinguishers: Organizer is providing five (5) 3A4OBC with current
inspection tag. Fire extinguishers must be visible and readily available for use within 75 feet of travel distance.
Tables allowed: Yes How many tables: 16
Seats allowed: No
Protective mats - Protective mats or other approved means shall be placed over electrical cables on walkways.
Wiring and Lighting - All wiring and lighting shall be free from damage. All electrical connections, switches, and
fuses shall be in approved enclosures and secured in place to prevent a tripping or safety hazard. Ramp and
secure all electrical cables and /or electrical wiring.
Cooking allowed: No
No smoking permitted within the tent. Approved "No Smoking" signs posted.
Power Source — The Pier
Emergency Plan - Tybee Island Police and Fire Departments will be briefed by Event Organizer on Emergency
Plan.
Crowd Control Managers: Don Ryan and staff
High Winds: Tents will be evacuated immediately when winds are forecasted to be 35 mph or above.
Comments:
Same event held at various locations and times in many coastal areas. Discussed with Mr. Ryan — will defer to
his experience and expertise for crowd management and life safety.
City Official Signature
,.,..) K 02.6
City Official Printed Name: Dianne K. Otto
Approval Date q -17143
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f o l l o w i n g i n f o r m a t i o n b a s e d o n t h e c o n s t r u c t i o n d r a w i n g s a n d s i t e p l a n :
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# O f f - s t r e e t p a r k i n g s p a c e s
T r e e s l o c a t e d & l i s t e d o n s i t e p l a n
A c c e s s :
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S e t b a c k s : F r o n t R e a r S i d e s ( L ) ( R )
# S t o r i e s H e i g h t V e r t i c a l d i s t a n c e m e a s u r e d f r o m t h e a v e r a g e a d j a c e n t
g r a d e o f t h e b u i l d i n g t o t h e e x t r e m e h i g h p o i n t o f t h e b u i l d i n g , e x c l u s i v e o f c h i m n e y s , h e a t i n g
u n i t s , v e n t i l a t i o n d u c t s , a i r c o n d i t i o n i n g u n i t s , e l e v a t o r s , a n d s i m i l a r a p p u r t a n c e s .
During construction:
On -site restroom facilities will be provided through 1.Lis �i oz./ c.-
On -site waste and debris containers will be provided by S )RFdzJ s— yr r i
Construction debris will be disposed byA/i' r7a ZL ' S by means of
I understand that I must comply with zoning, flood damage control, building, fire, shore
protections and wetlands ordinances, FEMA regulations and all applicable codes and regulations.
I understand that the lot must be staked out and that the stakes will be inspected to ensure that the
setback requirements are met. I understand also that a certified plot plan showing elevation must
be attached to this application and that an as-built elevation certification is due as soon as the
habitable floor level is established. Drainage: I realize that I must ensure the adequacy of
drainage of this property so that surrounding property is in no way adversely affected. I accept
responsibility for any corrective action that may be necessary to restore age impaired by this
permitted construction.
Date.
/
Signature of Applican
Note: A hermit normally takes 7 to 10 days to process.
The following is to be compy
Zoning certification
Approved rezoning/variance?
Street address and number: N
Is it in compliance with City z
If not, has street name and/or
FEMA Certification attached _ -764(-4-/
State Energy Code Affidavit a
Utilities and Public Works:
Describe any unusual finding(:
Access to building site
Distance to water main tap site
Distance to sewer stub site _
Water meter size
Storm drainage
s/3o/L3
6,ayJ)
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Approvals:'
Zoning Administialor
Code Rnforcement Officer
Water /Sewer
Storm/Drainage
Inspections
City Manager
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elI o 0
200 4 ro s
FEES
Permit
Inspections
Water Tap
Sewer Stub
Aid to Consi.
TOTAL
ATLANTIC OCEAN
•
N
PIER
PAVILION
Aprox
100 ft
LIFE GUARD
TOWER
SURFING ZONE
N
RE-615 MEQICAI✓FIRST -AID
• •
RAFFLE TENT FOOD/WATER
1
SURF RE
LATE
SUP
TERS
ALL TENTS IN BLUE ARE OWNED
BY SURFERS FOR AUTISM, INC
t
ANNOUNCEMENTS/MUSIC
GAMES
VOLUNTEER TENT
NM4?
ij
10 K �O
AUTISM RESOURCES
PARKING LOT 1
.9 - 20
JYRfE&J 1011 AWL 1M
Event:
CITY OF TYBEE ISLAND
TENT /CANOPY APPROVAL /REQUIREMENTS
Telephone: (912) 472 -5030 • Fax: (912) 786 -9539
Surfers for Autism
Date(s) of Event: 09/07/2013
Location of Tent: Beach - Pavilion
Contact Person: Don Ryan Phone:
7899 Santa Fe Trail, Boca Raton, FL 33487
Number and size of Tents:
4- 10'x20'
2 - 10' x 10' pop up tents
1- 16' oval tent
Date Erected: 09/07/2013
Date Down:
561 - 445 -7154
09/07/2013
DNR Permit required: Yes Received On
Tent Provider: Tents are "E -Z UP" provided by Surfers for Autism
Tent Erected by: Surfers for Autism, Inc.
Address: 7899 Santa Fe Trail, Boca Raton, FL 33487
License number: N/A
Emergency phone number: 561 - 445 -7154 (Kim Ryan - 561 - 400 -6111)
Wind resistance: Defer to experience and monitoring by Don Ryan and staff
On -site tent expert: Don Ryan
Emergency phone number: 561 - 445 -7154
X
Flame retardant certificate - Date of last treatment, name of chemical used in treatment, name of firm or
individual treating fabric and testing agency and standard use. Labeling and /or other certification may be
acceptable to the fire code official. Received
X
Site plan - Received 03/21/2013
Emergency access
• For tents that have more than one exit, there shall be an unobstructed fire break passageway of not less
than twelve (12) feet in width and free from guy ropes or other obstructions shall be maintained on all
sides of tent.
• For every 50 feet of side -by -side tents, provide a minimum 5 foot wide emergency access walkway.
Comprehensive general liability - Hosting organization, permit holder, or host establishment
Liability insurance - Tent provider
e-0
Hol Harmless Agreement - Hosting organization, permit holder, or host establishment
ky,
Provider and provider's engineer, tent will be secured by ground by 80 pound sand ballasts secured with
1,000 pound nylon straps - 4 per tent.
7•�
Maximum Occupant Toad: 10' x 20' - 40 people
Required number of approved fire extinguishers: Organizer is providing five (5) 3A4OBC with current
inspection tag. Fire extinguishers must be visible and readily available for use within 75 feet of travel distance.
Tables allowed: Yes How many tables: 16
Seats allowed: No
Protective mats - Protective mats or other approved means shall be placed over electrical cables on walkways.
Wiring and Lighting - All wiring and lighting shall be free from damage. All electrical connections, switches, and
fuses shall be in approved enclosures and secured in place to prevent a tripping or safety hazard. Ramp and
secure all electrical cables and /or electrical wiring.
City Official Signature Approval Date select
City Official Printed Name: select
Cooking allowed: No
No smoking permitted within the tent. Approved "No Smoking" signs posted.
Trash and Debris: Keep ground area and thirty (30) foot perimeter clear of trash and debris. No hay, straw,
shavings, or similar materials shall be permitted to be used within any structure used as assembly occupancy.
Power Sources — The Pier
Emergency Plan - Tybee Island Police and Fire Departments will be briefed by Event Organizer on Emergency
Plan.
Crowd Control Managers: Don Ryan and staff
High Winds: Select
Comments:
Same event held at various locations and times in many coastal areas. Discussed with Mr. Ryan — will defer to
his experience and expertise for crowd management and life safety.
City Official Signature Approval Date select
City Official Printed Name: select
����G E O R G I A
C O A S T A L R E S O U R C E S D I V I S I O N
M A R K W I L L I A M S A . G . ' S P U D ' W O O D W A R D
C O M M I S S I O N E R D I R E C T O R
A P R 1 7 2 0 1 3
M r . D o n C . R y a n
P r e s i d e n t / C O O
S u r f e r s f o r A u t i s m
7 8 9 9 S a n t a F e T r a i l
B o c a R a t o n , F L 3 3 4 8 7
R E : L e t t e r o f P e r m i s s i o n ( L O P ) , S u r f e r s f o r A u t i s m , A c t i v i t i e s w i t h i n t h e S t a t e ' s
J u r i s d i c t i o n , C i t y o f T y b e e I s l a n d , C h a t h a m C o u n t y , G e o r g i a .
D e a r M r . R y a n :
T h i s L e t t e r o f P e r m i s s i o n ( L O P ) i s i n r e s p o n s e t o y o u r r e q u e s t d a t e d A p r i l 1 0 , 2 0 1 3 t o s p o n s o r
t h e 2 0 1 3 S u r f e r s f o r A u t i s m e v e n t o n t h e b e a c h s e a w a r d o f 1 6 t h S t r e e t a n d T h e S t r a n d o n T y b e e
I s l a n d , G e o r g i a . S u r f e r s f o r A u t i s m w i l l p r o v i d e s p e c i a l n e e d s c h i l d r e n a n o p p o r t u n i t y t o s u r f a n d
s o c i a l i z e w i t h o t h e r s u r f e r s a n d t h e i r f a m i l y m e m b e r s .
Y o u r r e q u e s t i n c l u d e s t h e p l a c e m e n t o f a s i x t e e n ( 1 6 ) 1 0 ' X 1 0 ' t e n t s , f o u r ( 5 ) 1 0 ' X 2 0 ' t e n t s a n d
o n e ( 1 ) 1 6 ' X 2 0 ' t e n t . A l l t e n t s w i l l b e p l a c e d o n t h e d r y s a n d b e a c h l o c a t e d s e a w a r d o f 1 6 t h a n d
S t r a n d a n d a p p r o x i m a t e l y 1 0 0 f e e t s o u t h o f t h e p i e r & p a v i l i o n . T h e e v e n t w i l l b e s e t u p
S a t u r d a y , S e p t e m b e r 9 a n d r e m o v e d S a t u r d a y , S e p t e m b e r 9 , 2 0 1 3 . T h i s p r o p o s a l d o e s n o t
i n c l u d e t h e u s e o f a n y m o t o r v e h i c l e s o n t h e b e a c h .
A l l a c t i v i t i e s p r o p o s e d i n a s s o c i a t i o n w i t h S u r f e r s f o r A u t i s m w i l l o c c u r s e a w a r d o f t h e s a n d
d u n e s . N o i m p a c t s t o t h e s a n d s h a r i n g s y s t e m a r e p r o p o s e d a n d a c c e s s t o t h e b e a c h i s a v a i l a b l e t o
t h e p u b l i c a t e x i s t i n g c r o s s o v e r s a l o n g T h e S t r a n d .
T h e D e p a r t m e n t a u t h o r i z e s t h e p r o p o s e d e v e n t a s o u t l i n e d i n t h e a t t a c h e d p r o j e c t o v e r v i e w . N o
h e a v y e q u i p m e n t i s a u t h o r i z e d i n c o n n e c t i o n w i t h t h i s p r o j e c t . A n y i n c i d e n t a l i m p a c t s t o t h e
d u n e s o r v e g e t a t i o n m u s t b e r e s t o r e d t o p r e - p r o j e c t v e g e t a t e d a n d t o p o g r a p h i c c o n d i t i o n s . N o
s t o c k p i l i n g o f m a t e r i a l s i s a l l o w e d i n t h e d u n e s . T h i s L O P i s n o t m e a n t t o e x e m p t t h e a b o v e
r e f e r e n c e d a c t i v i t y f r o m f u t u r e e n v i r o n m e n t a l l a w s .
T h i s L O P i s v a l i d f o r t h e a b o v e r e f e r e n c e d p r o j e c t . A n y c h a n g e i n t h e u s e , l o c a t i o n , o r
c o n f i g u r a t i o n o f t h e a p p r o v e d p r o j e c t , w i t h o u t p r i o r n o t i f i c a t i o n a n d a p p r o v a l f r o m t h i s o f f i c e
c o u l d r e s u l t o n t h e r e v o c a t i o n o f t h i s p e r m i s s i o n a n d i n t h e r e q u i r e d r e m o v a l o f t h e m a t e r i a l s a n d
r e l a t e d s t r u c t u r e s . T h i s p r o j e c t m u s t c o m p l y w i t h a l l o t h e r F e d e r a l , S t a t e , a n d l o c a l s t a t u t e s ,
o r d i n a n c e s a n d r e g u l a t i o n s .
O N E C O N S E R V A T I O N W A Y I B R U N S W I C K , G E O R G I A 3 1 5 2 0 - 8 6 8 6
9 1 2 . 2 6 4 . 7 2 1 8 1 F A X 9 1 2 . 2 6 2 . 3 1 4 3 1 W W W . C o A S T A L G A D N R . o f c
LOP Surfers for Autism
Page 2 of 2
APR 1 7 2013
Since the event will occur during the period of May 1 to October 31, the area must be surveyed
by a person in possession of a DNR Sea Turtle Cooperators Permit prior to commencement of
any event activities. All sea turtle nests must be relocated to a suitable site outside the proposed
event area.
This Letter of Permission is not meant to exempt the above referenced activity from future
environmental laws. This project must comply with all other Federal, State, and local statutes,
ordinances and regulations. If you have any questions or concerns about this project feel free to
contact Deb Barreiro at 912.266.3695 or by e-mail at deb.barreiro @dnr.state.ga.us
Sincerely,
Brad Gam
Chief
Ecological Services Section
Enclosure: 2012 Surfers for Autism Site Plan
cc: Karen Reese
City of Tybee Special Events Coordinator
P.O. Box 2749
Tybee Island, GA 31328
File # 82108.1011AM SurfersforAutism2103
ATLANTIC OCEAN
Surf / Recreation Zone--•
APROX 'f 00 FT_
•
PIER
PAVILION
■ = SURFERS FOR AUTISM TENTS
0 = SPONSOR / RESOURCE TENTS
• = MEDICAL PROVIDED BY SURFERS FOR AUTISM
REGISTRATION / MEDICAL
RAFFLE
lO X 10 POP UPS
FOOD / WATE$/ FUN & GAMES VQLUNTEERS
ODEiMO.
$cAlin0m0
10X10 POP UPS
M(2.[ / 1PIOK I }G°30
10X10 POP UPS
N
JUNERJ FOR AUtIJM►�
Danes / Beach Access
SURFE -2
OP ID: 9C
AWRL CERTIFICATE OF LIABILITY INSURANCE
DAT 08 /14D/YYlY)
08!14!12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 800- 526 -1379
Bollinger, Inc. 973- 921 -2876
101 JFK Parkway
Short Hills, NJ 07078 -5000
AJ Morgan
e CT
PHONE FAX
(A/C, Ho. Ext): (NC, No):
LILY EXP
(MWDDIYYYYI
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Markel Insurance Company
INSURER B :
38970
INSURED Surfers for Autism, Inc.
Kim Ryan
7899 Santa Fe Trail
Boca Raton, FL 33487
INSURER C :
09/09/13
INSURER D :
5 1,000,000
INSURER E :
COMMERCIAL GENERAL LIABILITY
INSURER F :
$ 100,000
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AWL
INSR
SUBR
wvD
POLICY NUMBER
POUCY EFF
(MMIDD/YYYY]
LILY EXP
(MWDDIYYYYI
UNITS
A
GENERAL LIABILITY
X
3602AH021772
09/09/12
09/09/13
EACH OCCURRENCE
5 1,000,000
X
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea ocaxrence)
$ 100,000
CLAIMS -MADE I X1 OCCUR
MED EXP (Any one person)
$ 5,000
X
Inc! Participants
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO- LOC
X� POLICY I- JFCT
PRODUCTS - COMP/OP AGG
$ 1,000,000
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
-
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED
HIRED AUTOS
SCHEDULED
O
ON-OWNED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA UAB
EXCESS UAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
5
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
WC STATU-
TORY LIMITS
_
OTH-
ER
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
Y! N
N1 A
EL EACH ACCIDENT
EL DISEASE - EA EMPLOYEE
$
tf yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
A
Accident Insurance
Full Excess
4102AH021771
09/09/12
09/09/13
Med Max: 25,000
Ded: 250
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
The certificate holder is listed as an additional insured on the
liability policy. Coverage is provided under this policy for
sponsored /supervised activities of the named insured.
CERTIFICATE HOLDER CANCELLATION
CITYGAO
City of Tybee Island
P.O. Box 2749
403 Butler Avenue
Tybee Island, GA 31328
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE EREOF,
ACCORDANCE WITH THE OLICY PROVISIONS.E WILL BE DELIVERED IN
P
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)
01988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
STATE OF GEORGIA
COUNTY OF CHATHAM
HOLD HARMLESS / INDEMNIFICATION AGREEMENT
THIS AGREEMENT is made the / a day of
A u_r-e
ors rti, Lt5 ice 1 ri c
,20 /3 ,by
(hereinafter referred to as "Owner")
WITNESSETH
Owner hereby agrees to protect, defend, indemnify and hold harmless the City of Tybee Island, Georgia (a
political subdivision of the State of Georgia), its Mayor and Council, officers, agents, and employees
(hereinafter referred to as "City ") from and against any and all liability, damages, claims, suits, liens, and
judgments of whatever nature, including any claims for contribution and /or indemnification for injuries to any
person or persons, or damage to the property or other rights of any person or persons, caused in any manner
pertaining to the location of privately constructed or any other privately owned structures and plants, which
protrudes into the right -a -way of any City street.
The undersigned further recognizes and agrees that this license does not confer upon the undersigned any
rights, title, estate, or interest in said licensed premises; nor does this license agreement confer upon the
undersigned a license coupled with an interest or easement. This license merely gives the undersigned a
revocable privilege, it being expressly understood and agreed that, regardless of any improvements or
investments made, expense and harm incurred or encountered by the undersigned, this agreement shall be
subject to revocation, cancellation or termination, this license shall be null and void.
IN WITNESS THEREOF, Owner has hereunto set its hand and affixed its seal on the day and year first above
written.
Event:
CITY OF TYBEE ISLAND
TENT /CANOPY APPROVAL /REQUIREMENTS
Telephone: (912) 472 -5030 • Fax: (912) 786 -9539
Surfers for Autism
Date(s) of Event: 09/07/2013
Location of Tent: Beach - Pavilion
Contact Person: Don Ryan Phone:
7899 Santa Fe Trail, Boca Raton, FL 33487
Number and size of Tents:
4- 10'x20'
2 — 10' x 10' pop up tents
1 — 16' oval tent
Date Erected: 09/07/2013
Date Down:
561- 445 -7154
09/07/2013
DNR Permit required: Yes Received On
Tent Provider: Tents are "E -Z UP" provided by Surfers for Autism
Tent Erected by: Surfers for Autism, Inc.
Address: 7899 Santa Fe Trail, Boca Raton, FL 33487
License number: N/A
Emergency phone number: 561 - 445 -7154 (Kim Ryan — 561 - 400 -6111)
Wind resistance: Defer to experience and monitoring by Don Ryan and staff
On -site tent expert: Don Ryan
Emergency phone number: 561 - 445 -7154
X
Flame retardant certificate - Date of last treatment, name of chemical used in treatment, name of firm or
individual treating fabric and testing agency and standard use. Labeling and /or other certification may be
acceptable to the fire code official. Received
X
Site plan — Received 03/21/2013
Emergency access
• For tents that have more than one exit, there shall be an unobstructed fire break passageway of not less
than twelve (12) feet in width and free from guy ropes or other obstructions shall be maintained on all
sides of tent.
• For every 50 feet of side -by -side tents, provide a minimum 5 foot wide emergency access walkway.
Comprehensive general liability - Hosting organization, permit holder, or host establishment
Liability insurance - Tent provider
Hold Harmless Agreement - Hosting organization, permit holder, or host establishment
Per Provider and provider's engineer, tent will be secured by ground by 80 pound sand ballasts secured with
1,000 pound nylon straps — 4 per tent.
Maximum Occupant load: 10' x 20' — 40 people
Required number of approved fire extinguishers: Organizer is providing five (5) 3A4OBC with current
inspection tag. Fire extinguishers must be visible and readily available for use within 75 feet of travel distance.
Tables allowed: Yes How many tables: 16
Seats allowed: No
Protective mats - Protective mats or other approved means shall be placed over electrical cables on walkways.
Wiring and Lighting - All wiring and lighting shall be free from damage. All electrical connections, switches, and
fuses shall be in approved enclosures and secured in place to prevent a tripping or safety hazard. Ramp and
secure all electrical cables and /or electrical wiring.
City Official Signature Approval Date Select
City Official Printed Name: select
Cooking allowed: No
No smoking permitted within the tent. Approved "No Smoking" signs posted.
Trash and Debris: Keep ground area and thirty (30) foot perimeter clear of trash and debris. No hay, straw,
shavings, or similar materials shall be permitted to be used within any structure used as assembly occupancy.
Power Sources — The Pier
Emergency Plan - Tybee Island Police and Fire Departments will be briefed by Event Organizer on Emergency
Plan.
Crowd Control Managers: Don Ryan and staff
High Winds: Select
Comments:
Same event held at various locations and times in many coastal areas. Discussed with Mr. Ryan — will defer to
his experience and expertise for crowd management and life safety.
City Official Signature Approval Date Select
City Official Printed Name: select
3/30/13 Print
Subject: FW: Application items
From: KIM RYAN (kimsfa @Ive.com)
To: cmorton723 @yahoo.com; �—
Date: Thursday, March 28, 2013 12:40 PM
Fingers crossed - and there is info and answers below too
Kim Ryan
Surfers For Autism
Facebook: https: // www. facebook .com / #! /surfersforautism
http: / /www.surfersforautism.org
Online Store: http:/ /surfersforautism.storenvy.com/
From: surferforautism @ live.com
To: kimsfa @live.com
Subject: FW: Application items
Date: Tue, 26 Mar 2013 07:35:20 -0400
Don C Ryan
President /COO
Surfers For Autism
561.445.7154
www.Surfe►sForAutism.org
1/6
3/30/13 Print
http: / /www. surfline.com/surf- news /florida- based - nonprofit - shares -the- stoke -at- nobbys- beach_67211 /
http://www.msnbe.msn.com/id/21134540/vp/38157425#38157425
http://www.youtube.com/watch?v—ZpVoXYHjId8
https: / /www.facebook.com/media/ set / ?set =a. 425934759811 .209289.350102134811 #! /surfersforautism
http://www.eastemsurf com/feature_ 102611/
http: / /www.surfline.com/surf- news /florida- based - nonprofit - wraps -up- years -10th- event -at- fort- myers- beach_61522/
This message and any attachments are intended only for the use of the addressee and may contain information that is privileged and confidential. If the
reader of this message is not the intended recipient or an authorized representative of the intended recipient, you are hereby notified that any
dissemination of this communication is strictly prohibited. If you have received this communication in error, please notify me immediately by replying to
this e -mail message, then delete this message and any attachments from your system. Thank you.
From surferforautism@live.com
To: jbryant @cityoftybee.org
CC: cmorton @cityoftybee.org
Subject: FW: Application items
Date: Tue, 26 Mar 2013 06:52:52 -0400
From: surferforautism @live.com
To: jbryant @cityoftybee.org
CC: cmorton @cityoftybee.org
2/6
3/30/13
Subject: RE: Application items
Date: Mon, 25 Mar 2013 11:02:55 -0400
Good Morning,
Print
Please review all attached documents regarding the request to be permitted for The 3rd Annual Coastal Empire Surfers For Autism Beach Festival on
9 -7 -2013 at Tybee Beach Pier S. side. Following are answers to questions not contained in the attached documents.
• When will the tents be erected?
• When will the tents be taken down?
• Who will be erecting the tents? Surfers For Autism Volunteers
• Have you applied for the DNR permit? Not At This Time.
• What is the wind resistance on the tents?
• Need a flame retardant certificate?
• Need a copy of liability insurance.
• How will the tents be secured? 801b Sand Ballasts Secured w /1000 lb Nylon Straps, 4 Per Tent.
• Will there be tables and chairs? Attached Site Plan.
• Will there be electricity? If so, from where? The Pier
• Will there be generators? City Ordinance Prohibits The Use Of Generators On The Beach.
• Will there be cooking in the tents? City Ordinance Prohibits Open Flames or Cooking On The Beach.
3/6
3/30/13 Print
Thanks, have a blessed day.
Don C Ryan
President /COO
Surfers For Autism
561.445.7154
www.SuifersForAutism.org
http: / /www.surfline.com/surf- news /florida- based - nonprofit- shares - the - stoke -at- nobbys -beach 67211/
http://www.msnbc.msn.com/id/21134540/vp/38157425#38157425
lattp://www.youtube.com/watch?v—ZpVoXYHjId8
httpsi /www.facebook.com/media/ set / ?set= a.425934759811.209289.3 50102134811 #! /surfersforautism
http://www.eastemsurf com/feature_102611/
http: / /www.surfline.com/surf- news /florida- based- nonprofit - wraps -up- years -10th- event -at- fort-myers -beach 61522/
This message and any attachments are intended only for the use of the addressee and may contain information that is privileged and confidential. If the
reader of this message is not the intended recipient or an authorized representative of the intended recipient, you are hereby notified that any
dissemination of this communication is strictly prohibited. If you have received this communication in error, please notify me immediately by replying to
this e -mail message, then delete this message and any attachments from your system. Thank you.
From: jbryant @cityoflybee.org
To: surferforautism @live.com
Date: Thu, 21 Mar 2013 13:17:36 -0400
Subject: Application items
Hi Don,
4/6
3/30/13 Print
Going by last year's permit, I'm guessing some of the following will not apply but could you answer the following questions.
• When will the tents be erected?
• When will the tents be taken down?
• Who will be erecting the tents?
• Have you applied for the DNR permit?
• What is the wind resistance on the tents?
• Need a flame retardant certificate?
• Need a copy of liability insurance.
• How will the tents be secured?
• Will there be tables and chairs?
• Will there be electricity? If so, from where?
• Will there be generators?
• Will there be cooking in the tents?
Thanks,
Jerris
ahni t-hlank
5/6
3/30/13 Print
Jerris Bryant
Administrative Assistant
City of Tybee Island
Planning and Zoning
912.472.5033
912.786.9539 - Fax
This email and any filestransmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the named addressee you
should not disseminate, distribute or copy this e -mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e -mail from your system. Please
note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of The City of Tybee Island. The recipient should check this email
and any attachmentsfor the presence of viruses. The City of Tybee Island accepts no liability for any damage caused by any virustransmitted by this email. City of Tybee Island P.O. Box 2749
Tybee Island, GA 31328
6/6
CITY OF TYBEE ISLAND
TENT /CANOPY PERMIT APPLICATION
Telephone: (912) 472 -5030 • Fax: (912) 786 -9539
i
5 0 , e f E R s ifs, 0-1504 , / C .
Applicant's Name: Do G
_
Applicant's Telephone/- `/ 5i.D - 7/ Jam/
Applicant's Address: 7 ,879 _SA, -( ? /-E f L Z.--P R/9 76"^ F2 55 Y-377
Date(s) of Event: - / - ) 3 Type of Event: Jf Ate// f ,.._s-/-7 V-' (.___
Number of Tents /Canopies: ' Size / 41 ' x U ' Number of Exits '
- per tent
Number of Tents /Canopies: Size ' x Number of Exits
per tent
Number of Tents /Canopies: Size ' x Number of Exits
per tent
Number of Tents /Canopies: Size ' x Number of Exits
per tent
Name and address of Tent Provider 3. L) F-€:-e5/24.9--- AS:1 Si''\ I iLl�
Tent Site Location(s) S/ 72 PL ,Q1/%1 .�d`/r / }{z iT
Date Erected 7-7- /3 Date Down: 2 - 7 ` /3
Will electrical power be provided? Yes No 1/
Y
Will cooking be done inside the tent(s)? i No
I have received and read a co • `
copy of -e t and Tent and
Canopy Policy. 2
Date 34//'3
Applicant Signature
Applicant Printed Name ,.L f ,
Approvals: Signature Date
Planning & Zoning Manager
Building Official
City Manager
Attachments to Permit Application
✓ Site Plan
✓ Provide a seating/table arrangement floor plan
✓ Certificate of Liability insurance
✓ Tent provider's Liability insurance
✓ Emergency Plan
✓ Hold Harmless Agreement
✓ Flame Retardant Certificate
✓ Information on staking method to be used
✓ A letter by the Tent Contractor (stating size(s) of the
tent/canopy, date(s) of event, date to be installed and
removed, and that the tent /canopy will be dismantled if the
wind speed exceeds the tent capacity.)
✓ Wind resistance data to be provided by tent manufacturer or
engineer
✓ Name, address, phone number, license number, emergency
phone number of tent contractor
oa�s�Np
International E -Z UP Inc. Certificate of Fabric Flame Resistant
ALt._ --/-"Air
c5,
International E -Z UP , Inc. warrants that the fabrics used in this E -Z UP Brand Shelter / Tent
(* small tent) that is displaying a sewn on "Warning label" has been certified by the
manufacturer or its supplier as have being made of a flame resistant material so that:
The Fabric (500d Polyester) and has been independently tested and shown to meet or exceed
the minimum requirements of CPAI - 84 tent and wall material.
The CPAI -84 meets the requirements in the following codes:
• California State Fire Marshal, Title 19, Subchapter 1, Article 4 section 332 (a) (2)
Definition :
• Small Tent . A tent designed for use by Tess than 10 people. (California State Fire
Marshal, Title 19, Article 2 section 310. )
• CPAI -84 : Fabrics complying with the flame resistance requirements set fourth in " A
Specification for Flame Resistant Materials Used in Camping tentage " 1995 revision.
Copies of an independent test laboratory's certification to the above standards are on file at
International E -Z UP Inc.
1601 Iowa Ave.
Riverside , California 92507
and copies are available by calling 1- 951 - 781 -0843 and speaking with a customer service
representative.
Certificate Update: February , 2004
Note:
There has been a code interpretation regarding the definition of "tents" in California Health and
Safety code section 13115 (b) and Also the provisions in Article 32, Section 3216.1 of 2001
California Fire Code concerning cooking and heating apply, as of 6/2004.
PROFESSIONAL
FEATURE PACKAGE:
Exclusively Available on
Professional Grade Shelters:
CUSTOM GRAPHIC
OPTIONS:
0 Professional Grade Fabric
Available in 22 Custom
Colors
0 Imprint Graphics
0 Full -Bleed Digital Printing
10'x15' [alp mx4.5m] HIGH
STRENGTH STEEL WHITE FRAME
WITH IMPRINT GRAPHICS
Eclipse' II Instant Shelter®
The Eclipse"' II is the # 1 Best Selling Professional Shelter worldwide. Rigorous quality control,
exceptional materials, fine craftsmanship and attention to details are just a few reasons why the
Eclipse"' II is the ultimate in portable Instant Shelter® models.
ECLIPSEIi
Professional
1 0' x 20' (3.0 m x 8.0 m) AIRCRAFT ALUMINUM FRAME WITH FULL -BLEED
DIGITAL GRAPHICS
Event Marketing
10' x 10' (3.0 m x 3.0 ri4 HIGH STRENGTH STEEL BLACK FRAME WITH
IMPRINT GRAPHICS
Business & Civic Events Portable Signage
Corporate Events Trade Shows
Advertisement Commercial Use
0 Patented, One -Piece
Instant Frame
0 Pull Pin AutoSlidere for
Quick Lock and Release
0 Toggle Leg Adjustments
for Variable Heights
and Surface
0 Steel Reinforced
Strengthened Outer Leg
0 Bolt -On Top Adds Security
in Windy Conditions and
Protects Against Wear
and Tear
0 Fixed Attachment Points for
Expanded Accessory Options
0 Metal Footpad with
Recessed Weld for Minimal
Wear and Increased Stability
FEATURES:
0 High Strength Steel Available
in White or Black* or
Aircraft Aluminum Frame
0 High Strength Steel Sizes:
8'x8'[2.5mx2.5m)
10' x 10' [3.0 m x 3.0 m)
10'x1513.0mx4.5m]
10'x20'[3.0mx6.0m]
0 Aircraft Aluminum Sizes:
10'x10'[3.0mx3.0m]
10'x15'[3.Omx4.5m]
10' x 20' [3.0 m x 6.0 m)
0 Elevated Center Design with
Double Braced Trusses
for Strength and
Increased Headroom
0 Optional Wind Vent Top
Available [10' x 10' Size Only)
0 Auto Peak° Tensioner
0 Bracket Mount Points
(7 Per Leg)
0 Increased Pull-Pin Pressure
0 Push Button Release
0 Meets CPA( -84 Fire
Resistant Requirements
0 5 Year Warranty
*Black Frame Available only on 10', 15' and 20'
Rental Industry Catering Events
Exhibit Booths
Product Demonstrations
ACCESSORIES:
0 Roller Bags
0 Sidewalis
0 Railskirts
0 Pro Flags
0 Banners
0 Heavy -Duty Stake Kit
0 Weight Bags
0 Sky Banner."
0 Brackets
0 Modular Shelter Bracket
0 Vendor Table
0 Instant Table'
0 Directors Chair
International E -Z UP, Inc.
e Iowa Avenue
Riverside„ Colifkrm ie 92507 (800) 45 -SHADE
(9511781-0843 • FAX (800 810 -8775 {800) 457 -4233
• _J
TO ORDER:
#1 Best Selling Instant Shelter; in the Worl E Z U P . CO M
\*O �S�
OR16tM
HUBTM Instant Shelter®
Be the center of all the excitement with the HUB"" Shelter. The HUB"" hexagon design with clear span
roof presents a unique look for the Instant Shelter® market. Six sides add 50% more graphic impressions
versus traditional 4 -sided shelters.
loaancnEt
Professional
16' x 16' HUB'"' WITH RNPRINT GRAPHICS AND RAILSKIRT OPTION
IDEAL FOR:
0 Sports Events
0 Outdoor Festivals
PROFESSIONAL
FEATURE PACKAGE:
Exclusively Available on
Professional Grade Shelters:
0 Patented, One - Piece
Instant Frame
0 Pull Pin Auto - Slider(' for
Quick Lock and Release
0 Toggle Leg Adjustments
for Variable Heights
and Surface
0 Steel Reinforced
Strengthened Outer Leg
0 Bolt -On Top Adds Security
in Windy Conditions and
Protects Against Wear
and Tear
0 Fixed Attachment Points for
Expanded Accessory Options
0 Metal Footpad with
Recessed Weld for Minimal
Wear and Increased Stability
0 Rental / Catering
0 Trade Shows
FEATURES:
0 Combination High Strength
Steel and Aircraft
Aluminum Frame
0 Available in Two Sizes:
13'x13'[4.0mx4.0m)
16'x16'[4.9mx4.9m)
0 Professional Grade
Fabric Top
0 Bracket Mount Points
(7 Per Leg)
0 Increased Pull - Pin Pressure
0 Higher Peak for
Greater Visibility
0 Cathedral Ceifing/Clear
Span Roof for Maximum
Internal Space
O Quick Connect Ceiling Fan/
Light Fixture Ready
0 5 Year Warranty
13' x 13 HUB WITH IMPRINT GRAPHICS
0 Product Demos
0 Event Marketing
ACCESSORIES:
0 Sidewalls
0 Railskirts
0 Light /Fan Kit
0 ProFIagTH
0 Heavy - Duty Stake Kit
0 Weight Bags
CLEAR SPAN PEAK
0 Ticket Booths
0 Hospitality Center
CUSTOM GRAPHIC
OPTIONS:
0 Professional Grade Fabric
Available in 22 Custom
Colors
0 Imprint Graphics
0 Full - Bleed Digital Printing
International E -Z UP, Inc. TO ORDER:
1601 Riverside, town Avenue 800 -45 -SHADE
Riverside, California 92507
951 /781- 0843 - FAX 800/810-8775 800-457-4233
#1 Best Selling Instant Shelter' in the World
ti
OR1Gt
HUB'" Professional Colors:
KELLY GREEN
PRODUCT NAME r
13'x13' HUBTM
High Strength Steel Upper Support with
16'x16' HUB'''
Mcioft Aluminum leg and Foot Pod
FRAME
TOP FABRIC
Professional Grade Fabric
PRODUCT INCLUDES
Frame, Top and (over 1.l
WARRANTY
5 Yeas
FRAME/TOP WEIGHT
100 lbs. / 19 bs.
104 bs. / 24 Is.
PACKAGE WEIGHT
123 bs.
132 bs.
BOX DIMENSIONS - FRAME
66'1. x 16.5" W x 10" H (2 Boxes)
BOX DIMENSIONS - TOP
24" L x 12" W x 113"H
Overal
Maximum
Height
10' 7"
Put -Pion
Bolt On Tap
Maximum I Bracket
Clearance mots
—Height
6' 10"
Ay.�
VA I r
16'x16'
Overall
_ Maximum
Height
11' 9"
EZUP.COM
eilenole""w
ECLIPSE' II Professional Colors:
Pull - Pin
Maximum
Valance
Clearance-
Height
I�
Bracket
Pants
Maximum
- Headroom
0
Maximum
-Peak
Height
ECLIPSE"" II Frame Colors:
11:
cox
m
J
W
0
(EclipseTM' II Shelter Black Frame
Available Only on the 10', 15' and
20' Frames)
PRODUCT NAME
ECLIPSE-` II
8'x 8' (2.5 m x 2.5 m) 10'x10'(3.0mx3.Om) 10' x 15' (3.0 m x 4.5 m) 10'x20'(3.Omx6.Om)
SIZE
FRAME
High Strength Steel Frame is Heavy Duty, White or Block (10', 15' & 20') Powder -Coated Steel
Aircraft Aluminum Frame is Rust Free and 25% Lighter than the High Strength Steel Option
TOP FABRIC
Professional Grade Fabric
PRODUCT INCLUDES
Frame, Top and (over Bag
WARRANTY
5 Years
HIGH STRENGTH STEEL SHIPPING WEIGHT
57 lbs. (26 kg)
67 lbs. (30 kg)
72 lbs. (33 kg)
116 lbs. (53 kg)
ALUMINUM SHIPPING WEIGHT
N/A
52 lbs. (24 kg)
63 lbs. (29 kg)
92 lbs. (42 kg)
TOP FABRIC SHIPPING WEIGHT
8 lbs. (4 kg)
12 bs. (5 kg)
18 lbs. (8 kg)
22 lbs. (10 kg)
BOX DIMENSIONS - HIGH STRENGTH
STEEL FRAME
55" L x 10" W x 10" H
(1.4 m x 0.2 m x 0.2 m)
66" L x 13" W x 10"H
(1.7 m x 0.3 m x 0.2 m)
66" L x 13" W x 10" H
(1.7mx0.3mx0.2m)
66" l x 12° W x 10" H (2 Boxes)
(1.7mx0.3mx0.2m)
BOX DIMENSIONS - ALUMINUM FRAME
N/A
66" L x 1 1 " W x l0" H
(1.7 m x 0.3 m x 0.2 m)
66" L x 13" W x 10" H
(1.1 m x 0.3 m x 0.2 m)
66" L x 12" W x 10" H (2 Boxes)
(1.7mx0.3mx0.2m)
BOX DIMENSIONS - TOP
27 "Lx 15 "Wx4 "H
(0.7 m x 0.4 m x 0.1 m)
27 "Lx 15 "Wx4 "H
(0.7 m x 0.4 m x 0.1 m)
27 °1x15 "Wx5 "H
(0.7 m x 0.4 m x 0.1 m)
27" L x 15" W x 5" H
(0.7 m x 0.4 m x 0.1 m)
MAXIMUM PEAK HEIGHT
10' (3.0 m)
11' 2" (3.4 m)
11' (3.4 m)
11' 5" (3.5 m)
MAXIMUM HEADROOM
6' 7" (2.0 m)
7' 1" (2.2 m)
6' 10" (2.1 m)
7' 3" (2.2 m)
MAXIMUM VALANCE CLEARANCE HEIGHT
6' (1.8 m)
6' 9" (2.1 m)
6' 7" (2.0 m)
6' 9" (2.0 m)
u ORDER:
tool lowoAvenue )j
Riverside, : olifcrn:c , 2507 (800) 45 SHADE
(800) 457-'233
(951 j 7E' -D8 3 • FAX 1800; 8'0-8775
ATLANTIC OCEAN
TIDE LINE
4— Surf / Recreation Zone
LI
APROX 9 00 FT_
■
PIER
PAVILION
■ = SURFERS FOR AUTISM TENTS
= SPONSOR / RESOURCE TENTS
• = MEDICAL PROVIDED BY SURFERS FOR AUTISM
REGISTRATION / MEDICAL
RAFFLE
10 X 10 POP UPS
FOOD / WATE : FUN & G, MES V ► LUNTEERS
PA/A OUNC ENTS
EN RTAIN: NT
010 MOMOVI
7
10X10 POP UPS
0020
10 X 10 POP UPS
4- N
Dunes / Beach Access
__i
JURf ER1 FOR AUUJM.
CITY OF TYBEE ISLAND
TENT /CANOPY PERMIT APPLICATION
Telephone: (912) 472 -5030 • Fax: (912) 786 -9539
i
..50te Er2S/1--z) /c tf�r pi-1 , /,JC .
Applicant's Narne:-1 )oAi G . -ry 1 6
Applicant's Telephone- `/VD
_ - 7/[
Applicant's Address: 7(9 25) -5,AA - /J/n /`E , f c W) R�7 F2
5 /--377
Date(s) of Event: "' 1 - / 3 Type of Event: /. F7CW t
S T7 v-,9
Number of Tents /Canopies: -
Size / a '
U '
x Number of Exits
per tent
Number of Tents /Canopies:
Size ' x Number of Exits
per tent
Number of Tents /Canopies:
Size ' x Number of Exits
per tent
Number of Tents /Canopies:
Size ' x Number of Exits
per tent
Name and address of Tent Provider
U 4. fi" Te5 �( 60,-. I(_
Tent Site Location(s) S / 72
pL�1,-,./ J ! G ()L./ I A} l-
Date Erected 7- 7-/3
2 - �
Date�Down: 7 - 3
Will electrical power be provided? Yes
Will cooking be done inside the tent(s)?
No !�
{�
)s / No
I have received and read a copy ofttie
°., -e 1- and Tent and
Canopy Policy.
. Date 4;47
Applicant Signature �i�'
Applicant Printed Name / Al
Approvals:
Planning & Zoning Manager
Signature Date
Building Official
City Manager
Attachments to Permit Application
✓ Site Plan
✓ Provide a seating/table arrangement floor plan
✓ Certificate of Liability insurance
✓ Tent provider's Liability insurance
✓ Emergency Plan
✓ Hold Harmless Agreement
✓ Flame Retardant Certificate
✓ Information on staking method to be used
✓ A letter by the Tent Contractor (stating size(s) of the
tent /canopy, date(s) of event, date to be installed and
removed, and that the tent /canopy will be dismantled if the
wind speed exceeds the tent capacity.)
✓ Wind resistance data to be provided by tent manufacturer or
engineer
✓ Name, address, phone number, license number, emergency
phone number of tent contractor