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Home My WebLink About329167 08/27/18 CITY OF CARMEL, INDIANA VENDOR: 370676 ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITI?HECK AMOUNT: $*******272.00* CARMEL, INDIANA 46032 PERMIT DIVISION CHECK NUMBER: 329167 9M�TON�` 302 WEST WASHINGTON ST,ROOM 241 CHECK DATE: 08/27/18 INDIANAPOLIS IN 46204 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1203 4359003 APPLICATION 272.00 FESTIVAL COMMUNITY EV VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) Vendor# 370676 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER DEPARTMENT OF HOMELAND SECURITY IN SUM OF$ CITY OF CARMEL PERMIT DIVISION An invoice or bill to be properly itemized must show:kind of service,where performed,dates service 302 WEST WASHINGTON ST, ROOM 241 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. INDIANAPOLIS, IN 46204 Payee $272.00 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Community Relations Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT APPLICATION 43-590.03 $272.00 1 hereby certify that the attached invoice(s),or 8/8/18 APPLICATION $272.00 1203 101 1203 101 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,August 22,2018 Heck, Nancy Director I 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer DEPARTMENT OF HOMELAND SECURITY APPLICATION FOR AMUSEMENT DIVISION OF FIRE AND BUILDING SAFETY ENTERTAINMENT PERMIT FIRE AND BUILDING CODE ENFORCEMENT State Form 42235(R1013-18) 302 WestWa p Indiana ngtoStreet, Room E241 Telephone:(317)232-2222 Fax:(317)233-0307 INSTRUCTIONS: 1. If non-exempt,include appropriate fee with this application.See page 2 for Permit Fees. 2. If claiming exempt status,please submit State Form 56400.Amusement and Entertainment Fee Exemption. 3. Include an updated plan. 4. Make all payments payable to th Indiana.Department_oWomeland-Secur . 5. Return completed form and paym nt7o thea"gen yc at the above address. FACILITY INFORMATION Type of facility: El Theater ❑Dance Hall ❑Night Club ❑Cabaret ❑Special Event ❑Haunted House ❑Assembly Hall ❑Roller Rink ❑Lodge Hall EZ Carnival I Fair ❑Gymnasium EZ Other(specify) small music e, Name of facility County CARMEL CITY CENTER AND GAZEBO HAMILTON Address of facility(number and street,city,state,and ZIP code) ONE CIVIC SQUARE CARMEL INDIANA 46032 Specific room floor or number Description of facility OUTSIDE AREA I CITY HALL GROUNDS Closest intersecting street or road Direction from interse�finn VETERANS WAY AND GRADEL DRIVE [I North ❑South ❑East West APPLICANT INFORMATION Type of applicant Name of applicant Telephone number QJ Owner ❑Operator ❑Lessee BRUCE KNOTT ( 317 ) 571-2600 Address of applicant(number and street,city,state,and ZIP code) 2 CIVIC SQAURE CARMEL INDIANA 46032 Name of person to contact for inspection E-mail address Telephone number BRUCE KNOTT BKNOTT@CARMEL.IN.GOV ( 317 ) 417-5043 Address of contact person(number and street,city,state,and ZIP code) 2 CIVIC SQARE CARMEL INDIANA 46032 ANNUAL PERMIT INFORMATION Type of permit request(This event will be going on all Dates(month,day,year)and hours of event Occupant load For renewal,please provide: year,daily,nightly,or weekends.) 9 Annual Event Endorsement SEE ATTACHED LIST 10,000 AE#2926892 Description of activities I event(Please use additional sheet to list events,if needed.) ENDORSEMENTSPECIAL •- • Type of permit request(One time event,additional to annual.) Dates(month,day,year)and hours of event Occupant load AE# ❑Special Event Endorsement you are applying under(Must first have an annual permit.) Name of event and description of activities.(Use separate sheet,if needed.Please attach all Floor and site plans as required by 675 1A 12-9-3(a)(2).) EVENT DETAILS Is they.mooing to be(check appropriate h—: Stage: El Temporary 'aOutdoor ❑Canopy ❑Tent ❑Outdoor Stage Equipment 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(our)knowledge and belief and that the operation of the place of amusement or entertainment or events described above conform in every respect and at all times with the laws,rules,and regulations of the Fire Prevention and Building Safety Commission and ill not ed for other purposes except as herein stated. Signatur Date(month,day,year) AUGUST 08,2018 -FOR OFFICE USE ONLY Permit number Fee identification number Type of permit Fee amount Type of payment Year of permit Page 1 of 2 PERMIT FEES Fees are based on the occupancy load and the number of seating configurations or arrangements covered by the application.See 675/AC 12-3-8. If you are a location where your occupant load is based entirely on fixed seating,and all planned amusement or entertainment activities covered by this application will utilize a single floor plan,your fee will be based on the Category A fee schedule only. If your planned amusements or entertainments will utilize more than one seating configuration or arrangement,or your occupant load is not based entirely on fixed seating,your fee will be determined by adding your totals from the Category A and Category B fee schedules. If you are applying for a Special Event Endorsement,disregard Category A and Category B. Amusement and Entertainment permit and inspection fee authority.IC 22-12-6-7 Affected.IC 22-12-6;IC 22-14-3-4. CATEGORY Please check the appropriate box. ❑ 1 -99 Persons=$99.00 ❑ 1,000-4,999 Persons=$203.00 ❑ 100-499 Persons=$134.00 ❑ 5,000-9,999 Persons=$237.00 ❑ 500-999 Persons=$168.00 10,000 Persons or More=$272.00 CATEGORY Please insert number of seating configurations or arrangements and multiply by$99.00. X $99.00 = $ ENDORSEMENTSPECIAL EVENT❑ Check here if you are applying for a Special Event Endorsement. Special Endorsement=$99.00 Total payment $ 272.00 Page 2 of 2 W1 r IOU A. i G � lJ. ;: L- ' fansba a ,I tt i W .�I 1 3 � (D !, 1 - - ` - i 1 Ir' ho s