Overview
Indiana Entertainment Permit Sample
APPLICATION FOR AMUSEMENT |
Return this completed form to: |
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ENTERTAINMENT PERMIT |
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State Form 42235 (R6 / |
DEPARTMENT OF HOMELAND SECURITY |
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DIVISION OF FIRE SAFETY - PERMIT DIVISION |
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Approved by State Board of Accounts, 2010 |
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302 West Washington Street, Room E241 |
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Indianapolis, Indiana 46204 |
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INSTRUCTIONS: 1. Include an updated floor plan with this application.
2. If claiming exempt status, include a valid 501c letter with this application.
FOR OFFICE USE ONLY
Permit number
Receipt number
FACILITY INFORMATION
Type of facility |
Theater |
Dance Hall |
Night Club |
Cabaret |
Special Event |
Other (specify) |
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Assembly Hall |
Roller Rink |
Lodge Hall |
Carnival Fair |
Gymnasium |
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Name of facility |
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City |
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County |
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Address of facility (number and street, city, state, and ZIP code) |
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Specific room or floor number |
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Description of facility |
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Closest intersecting street or road |
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Direction from intersection |
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North |
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South |
East |
West |
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APPLICANT INFORMATION
Type of applicant |
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Owner |
Operator |
Lessee |
Name of applicant
Telephone number
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Address of applicant (number and street, city, state, and ZIP code)
If incorporated, name of principal officer of corporation
Name of person to contact for inspection |
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Address of contact person (number and street, city, state, and ZIP code) |
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Telephone number |
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Responding fire department
Address of fire department (number and street, city, state, and ZIP code)
PERMIT REQUEST INFORMATION
Type of permit request |
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Special Event Endorsement |
Annual Event |
Name of event
Date of event (month, day, year) |
Hours of event |
Intended occupant load |
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If Special Event Endorsement, existing operating permit number |
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APPLICATION CERTIFICATION
I, or we, ________________________________________________, 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 used for other purposes except as herein stated.
Signature
Date (month, day, year)
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PERMIT FEES |
Fees are based on occupancy load, effective September 30, 2006. |
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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 |
Special Event Endorsement |
$99.00 |
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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
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20 _____ |
File Characteristics
| Fact Name | Details |
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| Governing Law | The Indiana Entertainment Permit is governed by the Indiana Fire Prevention and Building Safety Commission regulations. |
| Application Purpose | This form is used to apply for permits related to various entertainment events, including theaters and special events. |
| Required Documents | An updated floor plan and, if applicable, a valid 501c letter must be submitted with the application. |
| Permit Types | Applicants can request a Special Event Endorsement or an Annual Event permit. |
| Fee Structure | Permit fees vary based on occupancy load, ranging from $99 for 1-99 persons to $272 for 10,000 or more persons. |
| Inspection Requirement | Contact information for inspection must be provided, including the name of the person to contact and their phone number. |
| Certification Statement | The applicant must certify the accuracy of the information provided under penalty of perjury. |
Essential Points on This Form
What is the Indiana Entertainment Permit form used for?
The Indiana Entertainment Permit form is required for venues that host events such as theaters, dance halls, nightclubs, and other entertainment facilities. This form ensures that the venue complies with safety regulations and is properly licensed to operate events that may attract large crowds.
What information do I need to provide on the application?
When filling out the application, you will need to provide:
- Facility information, including the type of facility, name, address, and specific room or floor number.
- Applicant information, such as your name, contact details, and, if applicable, the name of the principal officer of your corporation.
- Permit request information, including the type of permit you are applying for and details about the event, such as the date, hours, and intended occupant load.
Additionally, you must include an updated floor plan and, if claiming exempt status, a valid 501c letter.
What are the fees associated with the permit?
Permit fees vary based on the occupancy load of the venue. As of the latest update, the fees are as follows:
- 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
- Special Event Endorsement: $99.00
How do I submit the application?
To submit your application, return the completed form along with any required documents to the Department of Homeland Security, Division of Fire Safety, Permit Division at the following address:
302 West Washington Street, Room E241
Indianapolis, Indiana 46204
How long does it take to process the application?
The processing time for the Indiana Entertainment Permit can vary. It is advisable to submit your application well in advance of your event to ensure that you receive the permit in a timely manner. Check with the Permit Division for specific timelines based on current workloads.
What happens if I need to change the details of my event after submitting the application?
If you need to make changes to your event details after submitting the application, contact the Permit Division as soon as possible. Depending on the nature of the changes, you may need to submit a new application or an amendment to your existing application. Always keep communication open to ensure compliance with regulations.
Misconceptions
Here are five common misconceptions about the Indiana Entertainment Permit form:
- Only large events need a permit. Many believe that permits are only necessary for large gatherings. However, any event that meets the criteria for an amusement or entertainment venue requires a permit, regardless of size.
- Submitting the application is all that’s needed. Some think that just filling out the form guarantees approval. In reality, additional documentation, like a floor plan or 501c letter, may be required to complete the application process.
- Permits are only for specific types of venues. While certain venues, like theaters and nightclubs, are commonly associated with permits, other types, such as assembly halls and gyms, also need them. Any facility hosting entertainment activities must comply.
- Fees are fixed and do not vary. There is a misconception that permit fees are the same for all events. In fact, fees depend on the expected occupancy load, meaning they can vary significantly based on the number of attendees.
- Once a permit is issued, it never expires. Some assume that a permit is a one-time requirement. In truth, permits often need to be renewed annually or for each event, depending on the type of request.
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