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2. Note

   Note: the applicant will be required to answer each box before proceeding to the next bolded section of the application.

4. Applicant Name
5. Group Represented
7. Address
9. Phone
10. Email
12. Person In Charge of Event
14. On-Site Phone
15. On-Site Contact
17. Billing Address
19. Event Title
21. Event Set Up Date/Time
22. Start Date/Time of Event
23. End Date/Time of Event
25. Insurance

    Each applicant shall furnish a certificate of insurance showing insurance written by a company licensed in the State of Wisconsin, approved by the Village and covering any and all liability or obligations which may result from the operations by the applicant's employees, agents, contractors or subcontractors. The certificate shall provide that the company will furnish the Village with a ten-day written notice of cancelation, nonrenewal or material change. The policy shall provide minimum combined single limits for bodily injury and property damage of $1,000,000.

27. Upload Certificate of Insurance here:
29. Indemnification Required

    The applicant, in checking this box, agrees to defend, indemnify and hold harmless the Village from and against all liabilities, claims, demands, judgements and losses and all suits at law or in equity, costs and expenses, including reasonable attorney fees, for injury or death of any person or loss or damage to the property of any person, firm, organization or corporation, including both parties hereto and their agendas and employees, arising from the holding of such special event.

    • No permit is issued unless the applicant has agreed to the terms of this statement on the application.
30. **

    Click Checkbox Here
32. Alcohol

    Will there be alcohol served at the event?

    1. Y

    1. N
34. An establishment requesting Temporary Extension of Premise?

    1. Y

    1. N
35. Temporary Extension of Premise

    If so, please upload a completed Temporary Extension of Premise Application here:

37. Is your organization requesting approval of an application for a Temporary Class "B" / "Class B" Retailer's License?

    1. Y

    1. N
38. Temporary Class "B" / "Class B" Retailer's License

    If so, please upload a completed Temporary Class "B" / "Class B" Retailer's License here:

40. Alcohol Beverage Individual Questionnaire
    Form AB-100

    *required*

42. Are you requesting approval of Temporary Operator's License to Sell Fermented Malt Beverages and Wine?

    1. Y

    1. N
43. Temporary Operator's License to Sell

    If so, please upload a completed Temporary Operator's License to Sell Fermented Malt Beverages and Wine here:

45. Amplified Music / Entertainment

    Are you requesting a Short Term Cabaret License for amplified music or entertainment?

    1. Y

    1. N
46. Short Term Cabaret License

    If so, please upload a completed Short Term Cabaret License here:

48. Additional Vendors

    Any person selling goods, including food products and beverages, or takes sales order for the later delivery of goods on any public way or other public premises.

    Well there be vendors at the special event?

    1. Y

    1. N
50. Please List All Vendors Here

52. If unknown at this time, please email the Village Clerk state sales license when known in advance of the event at cto@shorewoodwi.gov and bsimerly@nshealthdept.org. 

53. Food Vendor License

    Upload food vendor license(s) here:

55. Road Closure

    Will there be a road closure required at this event?

    1. Y

    1. N

57. Site plan - applicants are required to submit a detailed site plan/map including street closures, barricade placements, race route, stages, alcohol sale location, tents, etc.

58. Site Plan

    Upload site plan here:

60. Barricades

    Barricades needed by number and location

61. Port-o-Potties

    Port-o-Potties needed by number and location

63. Dumpsters, Tents & Temporary Structures

    Do you have a temporary structure or tent on-site requiring a North Shore Fire Department Tent Permit?

    1. Y

    1. N
64. NSFD Permit

    If yes, upload approved NSFD permit here:

66. Will a dumpster be located on public property or in the public right-of-way?

    1. Y

    1. N
67. Obstruct Public Way Permit

    If so, upload an Application for Obstruct the Public Way Permit here: 

69. Will a dumpster or temporary structure be located on private property?

    1. Y

    1. N
70. Temporary Storage & Dumpster on Private Property

    If so, upload an Application for Temporary Storage & Dumpster on Private Property here: 

72. Cleanup

    Applicant agrees to take responsibility for the setup of any barrels/barricades and cleanup of the event:

    1. Y

    1. N
74. Person(s) Responsible for Setup
75. Person(s) Responsible for Cleanup

79. The applicant agrees by checking this box to restore the designated area upon which the special event took place to as near the present condition as possible as determined by the Village, including but not limited to the removal of all rubbish and debris; in the event that clean up and restoration are not done to the satisfaction of the Village and after notice seeking compliance, the Village may proceed to do so; any cost incurred by the Village to clean and restore the designated area will be paid by the applicant.

80. **

    Click Checkbox Here
82. Notification of Neighbors

    Applicants are required to notify all property owners and tenants on a roadway closure and the roadways abutting and adjacent to the roadway closures on both sides of a street in all directions 2 weeks in advance of the event and closure

84. Date/Method of Notice Delivery
85. Copy of Distribution Notice*

    Upload a copy of the notice and distribution area here:

87. If a new special event permit is applied for, or an application that generated significant public comment following a prior event, notice of the closure area must be provided at least seven (7) days prior to the application consideration before the Village Board.

88. New Distribution Notice

    Upload a copy of the new notice, distribution area and date of distribution here:

90. Special Event Emergency Plan

    All applicants are required to complete the ORGANIZER TEMPLATE Special Emergency Plan for the event applied for. To assist you in completing the template, we have provided you with an Event Organizer Response Guide.

91. Special Event Emergency Plan*

    Upload the completed ORGANIZER TEMPLATE Special Emergency Plan here:

93. Permit Fees

    All available permits must be submitted simultaneously/concurrently with the special event permit.

    Click on all that apply and add them to the cart:

    $1,500   Special Event Permit with Road Closure

    $100      Special Event Permit without Road Closure

    $0          Temporary Extension of Premise Application

    $10        Temporary Class "B" / "Class B" Retailer's Application

    $10        Temporary Operator's License to Sell Fermented Malt Beverages and Wine

    $40        Short Term Cabaret License

    Application for Obstruct the Public Way Permit

    $75        General Obstruction

    $75         Bagster (Parkway ONLY)

    $75         Dumpster/Storage Unit - Residential Streets

    $100       Dumpster/Storage Unit - Capitol/Oakland

    $150       Drive Lane Closure - Residential Streets

    $200       Drive Lane Closure - Capitol/Oakland

    $200       Full Street Closure - Residential Streets

    $250       Full Street Closure - Capitol/Oakland

    Application for Temporary Storage & Dumpster on Private Property

    $25         Storage Units (20 day limit)

    $50         Dumpster, Bagsters, Storage Units (40 day limit) 

Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit

* indicates a required field