For office use only: Licence type: mandatory additional Maximum number of Persons Maximum number of Households Peterborough City Council Housing Enforcement Officer Neighbourhoods & Community Empowerment Operations Directorate Bayard Place Broadway Peterborough PE1 1HZ Application to licence a House in Multiple Occupation in accordance with the Housing Act 2004 Part 2 Please indicate for which type of House in Multiple Occupation the application is being made: (please tick one only ) : House in Multiple Occupation Flat in Multiple Occupation House converted into self-contained flats (to which section 257 applies) Other (hostel, etc) Please State: You are advised to contact Planning Services regarding the planning requirements for using the property as a HMO Part 1. The Property 1.1 Address of property to be licensed Postcode 1.2 Age of property (please tick one) Pre 1919 1965-1980 1919-1945 Post 1980 1945-1964
1.3 Details of storeys and levels Number of storeys comprising the HMO Number of storeys in the building (insert 0 or 1 as appropriate) Basement Ground floor First floor Third floor Attic Mezzanine Second floor 1.4 Please provide the total number of each of the following: Separate letting units Habitable rooms (excluding kitchens) Bathrooms/shower rooms Toilets (not including outside toilets) Sinks Kitchens Households occupying the property People occupying the property Wash basins 1.5 Details of fire precautions Fire alarms How many smoke alarms are there in the property? Please state below where they are located
Emergency Lighting Give details below of any emergency lighting provided Fire Escape Route Detail below the fire escape routes Fire fighting equipment Please list below the type, size and location of all fire fighting equipment Signs and Notices Give details below of any fire signs and notices provided
Other fire safety provisions Give details below of any other fire precautions provided 1.6 Other Services and Equipment Gas If there is any form of gas supply to the property, complete the following section. The current Gas Safe Report must be posted or hand delivered to the address at the top of the form within 7 days of the application being made. Name of Gas Safe Registered Engineer Gas Safe Engineer s registration number Gas Safety Certificate number Date of expiry of Gas Safety Certificate Furniture Does all soft furniture (beds, sofas, armchairs, etc) supplied by you to any part of the property conform to current Fire Safety Regulations? Part 2. The Applicant, Proposed Licence Holder and Manager The Applicant 2.1 Name of Applicant 2.2 Address of Applicant Postcode Telephone Mobile Email
The Proposed Licence Holder 2.3 Name Home address* Telephone Mobile Email Date of birth * Note: the authority is required to publish the name and address of the licence holder in a public register. This register is available for unrestricted access on the Council s website. If you do not wish this home address to be published, please provide an alternative, acceptable, address in the space below. PO boxes are acceptable for this purpose. If you do not provide an alternative address, the home address will be published. Address for the purposes of the HMO licence register: 2.4 Has this person any unspent convictions that may be relevant to their fitness to be the licence holder, particularly in relation to the following Fraud or other dishonesty? Violence or drugs? Any offence listed in Schedule 3 of the Sexual Offences Act 2003? 2.5 If you have answered yes to any of the above questions, please provide full details in the space below
2.6 Please provide details below of any contravention by this person in relation to housing public health, environmental health or landlord and tenant law, which led to civil or criminal proceedings resulting in a judgement being made against him: 2.7 Please provide details of any finding by a court or tribunal against the proposed licence holder that he/she has practiced unlawful discrimination in, or in connection with the carrying on of any business, in relation to sex, colour, race, ethnic or national origins or disability: 2.8 Has the Proposed Licence Holder owned or managed or does he/she currently own or manage: a HMO which has been subject of a control order under Section 379 of the Housing Act 1985 in the five years preceding this application? a HMO for which a local housing authority has refused to grant a licence under Part 2 of the Act? a HMO for which a local housing authority has revoked a licence in consequence of the licence holder breaching the conditions of his licence? or does he/she currently own or manage, a HMO that is or has been the subject of an interim or final management order? which has been subject of any enforcement action taken under section 5(2) of the Act?
If you have answered yes to any of the above questions, please provide details in the space below. This information must include the address to which the occurrence relates, the relevant date of the occurrence and the local authority area in which the occurrence took place. 2.9 Please provide details of other HMOs that are licensed within the area of Peterborough City Council under Part 2 of the Act where the Proposed Licence Holder in this application is the licence holder: Licence No Address 2.10 Please provide details of other HMOs or houses within other Local Housing Authority (LHA) areas that are licensed under Part 2 or Part 3 of the Act where the Proposed Licence Holder in this application is the licence holder: Licence No Address Name of LHA
The Manager 2.11 Name Address Telephone Mobile Email * Note: the authority is required to publish the name and address of the manager in a public register. This register is available for unrestricted access on the Council s website. If you do not wish this home address to be published, please provide an alternative, acceptable, address in the space below. PO boxes are acceptable for this purpose. If you do not provide an alternative address, the home address will be published. Address for the purposes of the HMO licence register: 2.12 Has this person any unspent convictions that may be relevant to their fitness to be the licence holder, particularly in relation to the following Fraud or other dishonesty? Violence or drugs? Any offence listed in Schedule 3 of the Sexual Offences Act 2003? 2.13 If you have answered yes to any of the above questions, please provide full details in the space below
2.14 Please provide details of any contravention by this person in relation to housing public health, environmental health or landlord and tenant law, which led to civil or criminal proceedings resulting in a judgement being made against him: 2.15 Please provide details of any finding by a court or tribunal against the manager that he/she has practiced unlawful discrimination in, or in connection with the carrying on of any business, in relation to sex, colour, race, ethnic or national origins or disability: 2.16 Has the manger owned or managed or does he/she currently own or manage: a HMO which has been subject of a control order under Section 379 of the Housing Act 1985 in the five years preceding this application? a HMO for which a local housing authority has refused to grant a licence under Part 2 of the Act? a HMO for which a local housing authority has revoked a licence in consequence of the licence holder breaching the conditions of his licence? or does he/she currently own or manage, a HMO that is or has been the subject of an interim or final management order? which has been subject of any enforcement action taken under section 5(2) of the Act? If you have answered yes to any of the above questions, please provide details in the space below. This information must include the address to which the occurrence relates, the relevant date of the occurrence and the local authority area in which the occurrence took place.
The Person Having Control of the Building 2.17 Name Address Telephone Mobile Email Person(s) Agreeing to be Bound by a Licence Condition 2.18 Name Address Telephone Mobile Email Part 3. Statements, Declarations, Signatures, Dates and Fees 3.1 You must let certain persons know in writing that you have made this application or give them a copy of it. The persons who need to know about it are- any mortgagee of the property to be licensed any owner of the property the which the application relates (if it is not you) i.e. the freeholder and any head lessors who are known to you any other person who is a tenant or long leaseholder of the property or any part of it (including any flat) who is known to you other than a statutory tenant or other tenant whose lease or tenancy is for less than three years (including a periodic tenancy) the proposed licence holder (if that is not you) the proposed managing agent (if any) (if that is not you) any person who has agreed that he will be bound by any conditions in a licence if it is granted. You must tell each of these persons- your name, address, telephone number and e-mail address or fax number (if any) the name, address, telephone number and e-mail address or fax number (if any) of the proposed licence holder (if it is not you) whether this is an application for an HMO licence under Part 2 or for a house licence under part 3 of the Housing Act 2004 the address of the property to which the application relates the name and address of the local housing authority to which the application will be made the date the application will be submitted
Declarations, Signatures and Dates 3.2 I/we declare that the information contained in this application is correct to the best of my/our knowledge. I/we understand that I/we commit an offence if I/we supply any information to a local housing authority in connection with any of their functions under any of Parts 1 to 4 of the Housing Act 2004 that is false or misleading and which I/we know is false or misleading or am/are aware are reckless as to whether it is false or misleading. Signed (all applicants) Date 3.3 I/we declare that I/we have served a notice of this application on the following persons who are the only persons known to me/us that are required to be informed that I/we have made this application: Signed (all applicants) Date 3.3.1 Name Address Description of the persons interest in the property or the application Date of service Mortgage or other loan provider where the property is used as security
3.3.2 Name Address Description of the persons interest in the property or the application Date of service Freeholder, co-owner, etc 3.3.3 Name Address Description of the persons interest in the property or the application Date of service Proposed licence holder (if not the applicant)
3.3.4 Name Address Description of the persons interest in the property or the application Date of service Manager or person having control of the HMO (if not the applicant)
Fees 4.1 Calculator The licence fee for a HMO is 750 per property 4.2 Submitting applications Postal applicants Where an applicant wishes to make an application by post, the Housing Enforcement Officer should be contacted in advance to organise delivery and verification of proofs of service as well as payments (see 4.3 below) 4.3 Payment 1 By Telephone Payment may be made over the telephone by using a credit or debit card, please contact Business Support on 01733 747474. (option 6) 2 By Post Cheques, postal and money orders should be made payable to Peterborough City Council, crossed and sent to Bayard Place, Broadway, Peterborough, PE1 1HZ. Post dated cheques will not be accepted (receipts will not be issued unless specifically requested). 3 Online Payment can be made via the following Link quoting your reference number. www.peterborough.gov.uk/pay/hmo We do not accept payment by American Express On receipt of the application, the Housing Enforcement Officer will contact you to make an appointment to inspect the property. It is the aim of the authority to issue or refuse a licence within 8 weeks of receipt of the application where there are no undue delays in the process which are beyond the control of the authority. Peterborough City Council is registered under the Data Protection Act 1998 for the purpose of processing personal data. The details provided on this form will only be used for the stated purpose and not shared with other organisations without your knowledge.