219703 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 362497 Page 1 of 1
e ONE CIVIC SQUARE DEPT OF HOMELAND SECURITY
CARMEL, INDIANA 46032 DIV OF FIRE SAFETY-PERMIT DIVISION CHECK AMOUNT: $272.00
302 WEST WASHINGTON ST ROOM E241 CHECK NUMBER: 219703
INDIANAPOLIS IN 46204
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4359003 272 . 00 FESTIVAL/COMMUNITY EV
�•°•�, APPLICATION FOR AMUSEMENT
Return this completed form to: FOR OFFICE USE ONLY
y4...-.. - ENTERTAINMENT PERMIT Permit number n/�
' State Form 42235(R6 12-10) DEPARTMENT OF HOMELAND SECURITY ��`q
�' ,a• �' Approved by State Board of Accounts,2010 DIVISION OF FIRE SAFETY-PERMIT DIVISION ���JJJ 1
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.
Type of facility ❑Theater ❑Dance Hall ❑Night Club ❑Cabaret ❑Special Event 121 Other(specify)
❑Assembly Hall ❑Roller Rink ❑Lodge Hall ❑Carnival Fair ❑Gymnasium Outdoor venue
Name of facility City County
City of Carmel "Civic Square and Gazebo" Carmel Hamilton
Address of facility(number and street,city,state,and ZIP code)
1 Civic Square Carmel Indiana 46032
Specific room or floor number Description of facility
n/a Outdoor area around city hall, police and fire department headquarters, fountain.
Closest intersecting street or road Direction from intersection
Veterans Way ❑North ❑South ❑East ❑West
•- o
Type of applicant Name of applicant Telephone number
El Owner 0 Operator ❑Lessee City of Carmel ( 317 )571-2600
Address of applicant(number and street,city,state,and ZIP code)
1 Civic Square Carmel Indiana 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 Indiana 46032 ( )
Responding fire department
City of Carmel Fire department
Address of fire department(number and street,city,state,and ZIP code)
2 Civic Square Carmel Indiana 46032
• o a
Type of permit request Name of event
❑Special Event Endorsement 0 Annual Event All events at this location (see attached list)
Date of event(month,day,year) Hours of event Intended occupant load
If Special Event Endorsement,existing operating permit number
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 resp and at all times with the laws,rules,and regulations of the Fire Prevention and Building Safety Commission
and will not be used for other rp cept a rein stated.
Signatu Date(month,day,year)
April 25th 2013
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....................................... .--.----............................................................. $272.00
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 am_ount/year of permit
$ 20
Event Date Time Who Location
Hamilton County Police Memorial Service 1-May 7 p.m. Carmel Police Department Gazebo at Carmel City Hall
National Day of Prayer 2-May noon Jane Reiman Gazebo at Carmel City Hall
Endless Summer Band -Summer Concert Series 5-Jun 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
Rick K&The All-nighters-Summer Concert Series 12-Jun 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
Flying Toasters-Summer Concert Series 19-Jun 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
Indiana Wynn Symphony Band Festival 22-Jun Indiana Wynn Symphony Gazebo at Carmel City Hall
Indianapolis Jazz Orchestra -Summer Concert Series 26-Jun 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
CarmelFest 3-Jul &4-Jul Carmel Rotary Club Gazebo at Carmel City Hall
New Old Cavalrey-Summer Concert Series 10-Jul 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
The Back Beats-Summer Concert Series 17-Jul 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall -
Blair and Company-Summer Concert Series 24-Jul 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
Mike Milligan &Steam Shoval -Summer Concert Series 31-Jul 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
CPD National Night Out 6-Aug 6:30 p.m. Carmel Police Department Gazebo at Carmel City Hall
Endless Summer Band -Summer Concert Series 7-Aug 7:30 p.m. Fountain Square Committee Gazebo at Carmel City Hall
Holiday on the Square 23-Nov 4:30 p.m. I City Event Gazebo at Carmel City Hall
Kibbe, Sharon
From: Sheeks, Cindy L
Sent: Friday, April 26, 2013 11:33 AM
To: Kibbe, Sharon
Subject: Re: Claim - Fire Entertainment Permit Renewal
Yes
Cindy Sheeks
On Apr 26, 2013, at 8:31 AM, "Kibbe, Sharon" <skibbe(@carmel.in.gov>wrote:
> Hi Cindy-
I >
>Would the attached application be sufficient documentation to accompany a claim in the amount of$272 for the
renewal of the Fire Entertainment Permit? The check would then be attached to the application and submitted to the
State (IDHS). Steve and Nancy have determined that the claim will be paid out of the Community Relations Dept.
budget. I presume you would need a signed application -correct?
>Thanks,
>Sharon M. Kibbe
> Mayor's Office
>City of Carmel
>One Civic Square
>Carmel, IN 46032
> 317.571.2483 Direct
>317.844.3498 Fax
>skibbe@carmel.in.gov
><2013 Carmel AE permit.pdf>
I
1
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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/25/13 Application $272.00
t 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Dept. of Homeland Security - 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#/TITLE AMOUNT Board Members
1203 Application 43-590.03 $272.00
I hereby certify that the attached invoice(s), or
I I
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
Sunday, May 05, 2013
Director, Community Relations/Economic Development
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund