Park Use Permit - Maple Grove Baptist ChurchCITY OF OKEECHOBEE
55 SE THIRD A VENUE
OKEECHOBEE, FL 34974
Tele: 863-763-3372 ext. 217 Fax: 863-763-1686
e -mail Junha fn( )r!f'ofoke ,_ d robe t. am
Park Use Permit
Permit Number: 027
Permit Expiration: December 16, 2016 11:59PM
Purpose of Request: Jerry Ferrell & Family Benefit
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee
Applicant: Maple Grove Baptist Church
Phone Number: 863 - 946 -2850
Current Zoning: P
Subdivision: City of Okeechobee
Date(s) of Event: December 16, 2016 10A -4P
State: Florida Zip Code: 34974
Applicant's Address: 12777 E SR 78, Moore Haven, FL
Address of Project: Park 4
FLU Designation: Public
Restrictions /Remarks: All debris must be removed within 24 hours of expiration date.
Tents or canopy's larger than 10x10 require certificate on file & Fire inspection.
Electric and water sources not required.
, Tctd eJ December 13, 2016
General Services Assistant Date
Page 1 of 3
Revised 11/4/16
CITY OF OKEECHOBEE
►� y.°F °'`yetis 55 SE THIRD AVENUE
■ °�;� OKEECHOBEE, FL 34974
R. �� Tele: 863 - 763 -3372 ext. 217 Fax 863 - 763 -1686
■ Ma 4,�` PARK USE AND /OR TEMPORARY STREET/
•�,;,,,,��•' SIDEWALK CLOSING
PERMIT APPLICATION
Date Received:
I,2 - 1) , (
Date Issued: l ?- i 3 - / c'
Application No:
/ (a. - c' -
Date(s) & Times of Event: 1a jtLo - /0 - I/
Information:
}
Organization: �' 1.) L, r� ,.,1 j/47,,T r- �ti,,,9 l f �J> �' (- C-
Mailing Address: /2-7 7 7 c 2 72� ;/.,/ r7(r .2a ..•r 23 -i-(.5-1 /Vf ,.',A6-- 1-(4,,e7,of FL
Contact Name: S,.,, (-Y. ;Z,,,, „/
E -Mail Address: - ,,: ,,, ,. i , J , , l .. -. I, y.,4 c:. /-1- J (,; ei) y/4,4,0• G `k(
Telephone:
Work:
&,3 _. c-r��j -2235,,
Home:
'.S(-') ` /97 C).-(c,,5
Cell:
Cj C(y/ - - 2g1S-e)
Summary of activities: C Ct<in 4 A Sex vi nq �, j 'pi Ck t '* Q O
el el chi Lh , 11 611-! ( ?i L ,61t - //L 1')4i) i) L: S j 1 f'i rz. 6;1/(7- () d tI L y
10 )( 10 (1. A, -■it y
1--=-/ t_ C 7 -A 1 C' . /-) C v 7—(..:3,4 c t/ YL Y CC_ 73
Proceeds usage:
JerrL
Ferrell and -0,11-11kf ben -e- &—
Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 /#4 ❑ #5 ❑ #6
[Park 3 is location of Gazebo. Park 4 is location of Bandstand]
(If other private property used in conjunction with this Park Use Permit please provide the address and
parcel number below along with notarized letter of authorization from property owner)
Additional Addresses, if applicable
Parcel ID:
Page 2 of 3
Revised 11/4/16
TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION
(Street Closings require City Council approval. Meetings lst & 3rd Tuesdays but subject to change)
Address of Event:
Street(s) to be closed:
Date(s) to be closed:
Time(s) to be closed:
Purpose of Closing:
Attachments Required for Use of Parks Attachments Required for Street /Sidewalk Closings
• Site Plan
• Site Plan
• Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee as
additional insured.
• Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee and R.E.
Hamrick Testamentary Trust as Additional Insured.
• Proof of non -profit status (IRS Determination
Letter)
• Original signatures of all residents, property owners and
business owners affected by the closing.
■ State Food Service License if > 3 days.
• State Food Service License if > 3 days.
• Notarized letter of authorization from
property owner, if applicable.*
• State Alcoholic Beverage License, if applicable. **
* Required if private property used in conjunction with a Park Use application.
** Alcoholic beverages can be served only on private property. Alcoholic beverages NOT ALLOWED in City
Parks, City streets or City sidewalks. See additional note below.
❑ Please check if items will be sold on City streets /sidewalks. Each business will need to apply for a Temporary
Use Permit 667 along with the Street Closing application.
Note:
• Clean -up is required within 24 hours.
• No alcoholic beverages permitted on City property, streets or sidewalks.
• No donations can be requested if any type of alcoholic beverages are served on private
property/business unless you possess a State Alcoholic Beverage License. Please note there are inside
consumption and outside consumption licenses. You must have the appropriate license(s).
• The Department of Public Works will be responsible for delivering the appropriate barricades.
• Dumpsters and port -o -lets are required when closing a street for more than three (3) hours.
Applicant must meet any insurance coverage and code compliance requirements of the City and other regulations
of other governmental regulatory agencies. The applicant will be responsible for costs associated with the event,
including damage of property. By receipt of this permit, the applicant agrees and shall hold the City harmless for
any accident, injury, claim or demand whatever arises out of applicant's use of location for such event, and shall
indemnify and defend the City for such incident, including attorney fees. The applicant shall be subject to
demand for, and payment of, all of the actual costs incurred by the City pertaining to the event including, but not
limited to, Police, Fire, Public Works or other departmental expenses. The City reserves the right to require from
an applicant a cashier's check or advance deposit in the sum approximated by the City to be incurred in providing
City services. Any such sum not incurred shall be refunded to the applicant of this Park Use /Street Closing
Permit.
Page 3 of 3
Revised 11/4/16
I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03 -8 and
04 -03, concerning the use and the rules of using City property, that the information is correct, and that I am the
duly authorized agent of the organization. I agree to conform with, abide by and obey all the rules and
regulations, which may be lawfully prescribed by the City Council of the City of Okeechobee, or its officers, for
the issuance
Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick
Testamentary Trust if closing streets or sidewalks.
c.- /2 - /2 - //
Applicant Signature Date
••••OFFICE USE ONLY••••
Staff Review
Fire Department:
Date:
/3 bec.,02016
Building Official:
It
Date:
1 2.12. 11,0
Public Works:
Date:
12- )2- 1/,
I
Police Department:
/
Date:
2 / 3 --/G
BTR Department:
�� �
Date:
i p� - 3 -1(a
City Administrator:
Date:
l L/ �6
I
City Clerk:
i
I l / do ( 1
Date:
(2 L5 / a
l
NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND
RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO
EVENT FOR PERMITTING.
Temporary Street and Sidewalk Closing submitted for review by City Council on
Date
Temporary Street and Sidewalk Closing reviewed by City Council and approved
Date
Detail by Entity Name
Page 1 of 3
FLORIDA DEPARTMENT Of STATE
DIVISION OF CORPORATIONS
DIVISION of
CORPORATIONS
an o lcial State of Florida wehsite
Florida Not For Profit Corporation
MAPLE GROVE BAPTIST CHURCH, INC.
Filing Information
Document Number N37690
FEI /EIN Number 59- 2353574
Date Filed 04/17/1990
State FL
Status ACTIVE
Principal Address
12777 E SR -78
MOORE HAVEN, FL 33471
Changed: 04/21/2009
Mailing Address
12777 E SR -78
MOORE HAVEN, FL 33471
Changed: 04/21/2009
Registered Agent Name & Address
GARVIN, PATTY
12777 E SR 78
MOORE HAVEN, FL 33471
Name Changed: 04/26/2007
Address Changed: 04/21/2009
Officer /Director Detail
Name & Address
Title D
BROWN, KENNETH A
37385 OLD LAKEPORT RD
MOORE HAVEN, FL 33471
Title ST
BROWN, LOUISE
http: // search. sunbiz. org / Inquiry / CorporationSearch /SearchResultDetai1 ?inquirytype Entit... 12/12/2016
Detail by Entity Name Page 2 of 3
3735 OLD LAKEPORT RD
MOORE HAVEN, FL 33471
Title Pastor
Garvin, Scott A.
12777 E SR -78
MOORE HAVEN, FL 33471
Title Mrs.
Thomas, Janelle
1031 13th Street
Okeechobee, FL 34974
Annual Reports
Report Year Filed Date
2015 05/22/2015
2015 11/03/2015
2016 03/13/2016
Document Images
Florida Department of State, Division of Corporations
http: // search. sunbiz. org / Inquiry / CorporationSearch /SearchResultDetail ?inquirytype = Entit... 12/1 2/2016
V lol nV �c V • V fi V V n• nn aVn • n
r
I certify from the records of this office that MAPLE GROVE BAPTIST CHURCH,
INC., is a corporation not for profit organized under the laws of the State of
Florida, filed on April 17, 1990.
The document number of this corporation is N37690.
further certify that said corporation has paid all fees and penalties due this office
through December 31, 1996, that its most recent annual report was filed on
February 26, 1996, and its status is active.
further certify that said corporation has not filed Articles of Dissolution.
6ibxEn under tug Itani nab. fly
6reaf$SEttI of tlje$Sfttfe of Iizri%a>
at ZallatiassEe, file Ciapifoi, iiTis iife
Twenty -ninth bag of July, 1996
Sattbr t . 4aiix �xxrr
SrcrEtary of$fafe
Jackie Dunham
From: Jackie Dunham
Sent: Tuesday, December 13, 2016 1:05 PM
To: 'Iynch0516 @yahoo.com'
Cc: 'garvinguy @yahoo.com'
Subject: Park Use Permit
Attachments: 027 - Ferrell BBQ Benefit.pdf
Please see the attached Park Use Permit for the Ferrell BBQ Benefit on Friday, December 16th in Park 4. If you
have any other questions please let me know otherwise much success for the Ferrell family.
Jackie'Du rw
Ac1:itr'a-twei Secv'etavy
City of Okee.chob-e,e,
55 SE 7vcLAvevu e.
Okeechob, EL 34974
rote' 863 - 763 -3372 eect: 217
Fa -' 863 -763 -1686
jdunham(a),cityofokeechobee.com
Website: http: / /www.cityofokeechobee.com
NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.
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