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Home My WebLink About233146 5 /29/2014 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1 } ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITY is rr CARMEL, INDIANA 46032 DIV OF FIRE SAFETY-PERMIT DIVISION CHECK AMOUNT: $272.00 ?' 302 W WASHINGTON ST CHECK NUMBER: 233146 INDIANAPOLIS,IN 46204 CHECK DATE: 512912014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1203 4359003 272 . 00 APPLICATION FOR AMUSEMENT Return this completed form to: FOR OFFICE USE ONLY ENTERTAINMENT PERMIT Permit number DEPARTMENT OF HOMELAND SECURITY State Form 42235(R6/2-10) DIVISION OF FIRE SAFETY-PERMIT DIVISION Approved by State Board of Accounts,2010 302 West Washington Street,Room E241 Receipt number Indianapolis,Indiana 46204 INSTRUCTIONS., 1. Include an updated floor plan with this application. 2. If claiming exempt status,include a valid 501c letter with this application. FACILITY INFORMATION Type Rfacility ❑Theater []Dance Hall ❑Night Club ❑Cabaret 0 Special Event ❑Other(specify) ❑Assembly Hall ❑Roller Rink ❑Lodge Hall ❑Carnival Fair ❑Gymnasium Name of facility City County Carmel City Center and Gazebo Carmel Hamilton Address of facility(number and street,city,state,and ZIP code) One Civic Square Specific room or floor number Description of facility Outside area surrounding city hall and the fire dept. headquarters Closest intersecting street or road Direction from intersection Rangeline Rd ❑North ❑South ❑East 2 West APPLICANT INFORMATION Type of applicant Name of applicant Telephone number +❑Owner ❑Operator ❑Lessee Bruce Knott ( 317 ) 571-2600 Address of applicant(number and street,city,state,and ZIP code) 2 Civic Square Carmel IN.46032 If incorporated,name of principal officer of corporation Name of person to contact for inspection E-mail address Bruce Knott bknott@carmel.in.gov Address of contact person(number and street city,state,and ZIP code) Telephone number 2 Civic Square Carmel IN 46032 ( 317 )571-2600 Responding fire department Carmel Fire Dept. Address of fire department(number and street,city,state,and ZIP code) 2 Civic Square Carmel IN.46032 PERMIT REQUEST INFORMATION T - Type of permit request Name of event ❑Special Event Endorsement 0 Annual Event I Carmel Fest and other annual listings as attached Date of event(month,day,year) I Hours of event Intended occupant load July 03,04 2014(see attached) Noon to 10pm + 10,000 If Special Event Endorsement,existing operating permit number AE2926892 (this is an annual renewal, not a special event) APPLICATION • I,or we, Bruce A Knott ,hereby certify,under penalty of perjury,that the information contained in this application is true and accurate to the best of my knowledge and belief and that the operation of the place of amusement or entertainment or events described above.will conform in every respect and at all times with the laws,rules,and regulations of the Fire Prevention and Building Safety Commission and will not be use th r pu es_ cept as herein stated. Sign at Date(month,day,year) May 20 2014 PERMIT FEES Fees are based on occupancy load,effective September 30,2006. 1-99 persons..............................................................................................................................................................$99.00 100-499 persons .....................................................................................................................................................$134.00 500-999 persons .........•...........................................................................................................................................$168.00 1,000-4,999 persons...............................................................................................................................................$203.00 5,000-9,999 persons...............................................................................................................................................$237.00 10,000 persons or more.........................................................................................................................................R$272 6- SpecialEvent Endorsement.......................................................................................................................................$99.00 FOR OFFICE USE ONLY Date permit issued(month,day,year) Date of reinspection(month,day,year) Date of inspection(month,day,year) Type of permit Fee amount/year of permit - — - $ -- 20 City of Carmel 2014 Events at City Hall and Gazebo Permit AE2926892 Summer Concert Series- Flying 6/4/2014 7:30 Carmel Fountain Gazebo at Toasters p.m. Square Committee Carmel City Hall Summer Concert Series- Big Rosco 6/11/2014 7:30 Carmel Fountain Gazebo at &the Hammers p.m. Square Committee Carmel City Hall Summer Concert Series-The 6/18/2014 7:30 Carmel Fountain Gazebo at Bishops P.M. Square Committee Carmel City Hall Concert by the Indiana Wind 6/20/2014 5:00 Indiana Wind Gazebo at Symphony p.m. Symphony Carmel City Hall Summer Concert Series- 6/25/2014 7:30 Carmel Fountain Gazebo at Indianapolis Jazz Orchestra p.m. Square Committee Carmel City Hall CarmelFest 2014 7/3/2014 4:00 Carmel Rotary Gazebo at p.m. Carmel City Hall CarmelFest 2014 7/4/2014 All Day Carmel Rotary Gazebo at Carmel City Hall Summer Concert Series-My 7/9/2014 7:30 Carmel Fountain Gazebo at Yellow Rickshaw p.m. Square Committee Carmel City Hall Summer Concert Series-The 7/16/2014 7:30 Carmel Fountain Gazebo at Woomblies Orchestra p.m. Square Committee Carmel City Hall Summer Concert Series-Zanna- 7/23/2014 7:30 Carmel Fountain Gazebo at Dool p.m. Square Committee Carmel City Hall Summer Concert Series- Blair& 7/30/2014 7:30 Carmel Fountain Gazebo at Company p.m. Square Committee Carmel City Hall National Night Out 8/5/2014 6:30 Carmel Police Gazebo at p.m. Department Carmel City Hall Summer Concert Series-Endless 8/6/2014 7:30 Carmel Fountain Gazebo at - -Summer-- - ~ = p.m. Square Committee Carmel City Hall Holiday on the Square 11/22/201 3:30 City Event Gazebo at 4 p.m. I Carmel City Hall x VOUCHER NO. WARRANT NO. ALLOWED 20 Dept. of HomelanSe urity - Permit Division IN SUM OF$ 302 West Washington Street, Room E241 Indianapolis, IN 46204 $272.00 ON ACCOUNT OF APPROPRIATION FOR Community Relations PO#/Dept. INVOICE NO. ACCT#rr1TLE AMOUNT Board Members 1203 Application 43-590.03 $272.00 I hereby certify that the attached invoice(s), or bill(s) is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Wednesday, May 21,2014 Director, Corringnity Relations/Economic Development Title i Cost distribution ledger classification if 1 claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc. Payee Purchase Order No. i Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 05/20/14 Application $272.00 1 hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer