Town of Andover Online Form Center

2. TOWN OF ANDOVER - Special Event 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. Event Type:*

    1. Run/Walk/Bike
    2. Concert
    3. Block Party
    4. Home/Garden Show
    5. Fair/Festival/Carnival
    6. Parade
    7. Food Truck
    8. Sidewalk Sale
    9. Other
39. Other (specify):
41. Is this event open to the public?*

    1. Yes
    2. No
42. Is there a fee collected from Public to attend?*

    1. Yes
    2. No
43. Estimated # of Attendees:*
45. Set Up Date/Time & Description:*
47. Breakdown Date/Time & Description:*
49. Requested Location(s):

    Please indicate below the location(s) you are requesting within the Town of Andover.

51. Town or School building name(s):*
53. Field Name and/or location(s):*
55. Street(s) or Route Information:*

    1. Street(s) or Street Route (Run/Walk/Bike)
    2. Other, Street Closure, Sidewalk Closure
56. Specify Street or Route:*
58. Upload Map and/or layout of proposed location and usage.
60. Location: Use of Town Property
62. Describe:*
64. Closures and Police/Fire Rescue
66. Street or Sidewalk Closure, Detour Signs?*

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

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

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

    1. Yes
    2. No
77. Request/Require a Fire Fighter Detail/First Aid Facilities and/or Ambulance(s)?*

    1. Yes
    2. No
78. Which ones?*
80. Food Services or Alcoholic Beverages Permits
82. *Town Clerk, Select Board approval and/or Health Div. Licenses are required
84. Food Concession and/or Food Preparation?*

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

    1. Propane Gas
    2. Electric
    3. Charcoal
    4. Catered
    5. Other Propane Use
87. Propane for portable heaters or artisans? (Fire Prevention)*

    1. Yes
    2. No
89. Please Explain:
91. Alcohol Beverages Served? (Beer & Wine, All Liquor or Donated)*

    1. Yes
    2. No
93. Licenses or Permits for the following:
95. Will you be holding a raffle or game of chance?*

    1. Yes
    2. No
96. Describe:*
98. Music and/or Amplified Sound?*

    1. Yes
    2. No
99. Start Time:*
100. End Time:*
102. Will your event have Entertainment?*

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

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

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

     1. Yes
     2. No
115. Will your event have animals?*

     1. Yes
     2. No
116. Please specify:*
118. Facilities, Utilities and Structures
120. Will your event require lights?*

     1. Yes
     2. No
121. Specify hours:*
123. Will your event require electricity or electrical connections?*

     1. Yes
     2. No
124. Where/what source:*
126. Will your event require temporary water connection?*

     1. Yes
     2. No
127. Where:*
129. Will you set up table(s) and/or chair(s)?*

     1. Yes
     2. No
130. Approximate number?*
132. Booth(s), Exhibit(s), Display(s) and/or Enclosure(s)?*

     1. Yes
     2. No
133. Scaffolding, Bleacher(s), Platform(s), Grandstand(s) or related structure(s)?*

     1. Yes
     2. No
135. *Scaffolding, Bleachers, Platforms, Grandstands or Stages may require Building Permit
137. Canopy(ies) and or Tent(s)? (Building Dept.)*

     1. Yes
     2. No
138. Describe & dimensions:*
140. Will your event require stage(s)?*

     1. Yes
     2. No
141. Indicate dimensions:*
143. Trash, Restrooms or Trailers
145. Trash or Rubbish Container(s)? (Municipal Services)*

     1. Yes
     2. No
146. Applicant to provide Dumpster(s) and Dumpster Vendor (Health Div. & Fire Rescue Permits)*

     1. Yes
     2. No
148. Use of Town Restrooms?*

     1. Yes
     2. No
149. Explain which Town or School Building(s):*
151. Applicant to provide Portable Toilet(s) - 1 ADA Portable Toilet required*

     1. Yes
     2. No
152. Explain where and provide approximate number and vendor:*
154. Applicant to provide and use Vehicle(s) and/or Trailer(s)?*

     1. Yes
     2. No
155. Approximate number:*
157. *Please note: You may be required to provide a Certificate of Insurance
159. 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.

161. 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.

163. Signature of Applicant:*

     Please Enter your name above.

164. Date*
     Date
Leave This Blank:


166. 1. Receive an email copy of this form.
167. Email address

     This field is not part of the form submission.

168. Submit

* indicates a required field