Town of Andover Online Form Center

2. TOWN OF ANDOVER - Block Party Application Form
4. Name of Organization / Sponsor*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Applicant Name:*
14. Event Title:*
16. Start Date & Time:*
17. End Date & Time:*
19. Rain Start Date & Time:
20. Rain End Date & Time:
22. Type of Organization*

    1. Non-Profit
    2. For Profit
23. Non-Profit No.
24. Tax ID #:
26. Email:*
27. Phone:*
29. Web Site:
30. Has your event been here before?*

    1. New Event to Andover
    2. Returning Event
32. Event Manager:*
33. Contact Info:*
35. Other Contact Person(s):
36. Contact Info:
38. Estimated # of Attendees:*
40. Set Up Date/Time & Description:*
42. Breakdown Date/Time & Description:*
44. Street(s) Information:*

    1. Street(s)
    2. Other, Street Closure, Sidewalk Closure
45. Specify Street:*
47. Upload Map and/or layout of proposed location and usage.
49. Closures and Police/Fire Rescue
51. Street or Sidewalk Closure, Detour Signs?*

    1. Yes
    2. No
52. Provide names:*
54. Parking Lot(s) Closure?*

    1. Yes
    2. No
55. Provide names:*
57. Fencing, Barrier(s) and / or Barricade(s) or Traffic Cones?*

    1. Yes
    2. No
58. Which ones?*
60. Request/require Police Detail? (not typically required for Block Party)*

    1. Yes
    2. No
62. Food Services or Alcoholic Beverages Permits
64. *Town Clerk, Select Board approval and/or Health Div. Licenses are required

    Block parties must abide by Town of Andover Bylaws (A.12 S.20.5b) regulating the consumption of alcoholic beverages on public ways.

66. Food Concession and/or Food Preparation?*

    1. Yes
    2. No
67. Please specify method:*

    1. Propane Gas
    2. Electric
    3. Charcoal
    4. Catered
    5. Other Propane Use
69. Licenses or Permits for the following:
71. Will you be holding a raffle or game of chance?*

    1. Yes
    2. No
72. Describe:*
74. Music and/or Amplified Sound?*

    1. Yes
    2. No
75. Start Time:*
76. End Time:*
78. Will your event have Entertainment?*

    1. Yes
    2. No
79. Describe:*
81. *The Town of Andover requires noise at reasonable levels between 7:00am and 10:00pm at the discretion of Andover Police Dept.
83. Amusement Rides? (Building Dept.)*

    1. Yes
    2. No
84. List and describe:*
86. Inflatable Device(s)? (Building Dept.)*

    1. Yes
    2. No
87. List and describe:*
89. Will your event have Fireworks?*

    1. Yes
    2. No
91. Facilities, Utilities and Structures
93. Canopy(ies) and or Tent(s)? (Building Dept.)*

    1. Yes
    2. No
94. Describe & dimensions:*
96. Other Permits

    Please note that all components of the event are subject to approval by the Town Manager's Office and may also require approval by and/or permit(s) from other Town agencies and departments.  It is the responsibility of the applicant to secure all necessary Town of Andover permits, and submit payments required for permits.

98. Affidavit of Applicant

    By entering your signature/name below indicates that everything I have stated in this application is correct to the best of my knowledge.  I have read, understand and agree to abide by the policies, rules and regulations of the Town of Andover as they pertain to the requested usage.  The permit, if granted is non-transferable and is revocable at anytime at the absolute discretion of the Town of Andover Town Manager's Office (or designee).  All programs and facilities of the Town of Andover are open to all citizens regardless of race, sex, age, color, religion, national origin or disability.

100. Signature of Applicant:*

     Please Enter your name above.

101. Date*
     Date
Leave This Blank:


103. 1. Receive an email copy of this form.
104. Email address

     This field is not part of the form submission.

105. Submit

* indicates a required field