Outline
The Indiana Entertainment Permit form is a crucial document for anyone looking to host events or operate entertainment venues within the state. This form, officially known as the Application for Amusement, must be completed and submitted to the Department of Homeland Security’s Division of Fire Safety. It serves multiple purposes, primarily ensuring that facilities meet safety standards and regulations. When filling out the form, applicants need to provide detailed information about the venue, including its type—be it a theater, dance hall, or special event space—as well as the specific address and facility description. Additionally, the form requires applicants to indicate their status, whether they are the owner, operator, or lessee of the venue. An updated floor plan must accompany the application, and if the applicant claims exempt status, a valid 501c letter should also be included. The permit request section allows applicants to specify the type of event, its date, and expected occupancy load, which influences the fee structure based on the number of attendees. Completing this form accurately is essential, as it includes a certification statement that affirms the truthfulness of the information provided and compliance with applicable laws. Understanding the requirements and processes associated with the Indiana Entertainment Permit form can help ensure a smooth application experience and successful event planning.
Form 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
()
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 _____ |
Form Specifics
| Fact Name | Details |
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| Governing Law | The Indiana Entertainment Permit is governed by the Fire Prevention and Building Safety Commission laws. |
| Application Purpose | This form is used to apply for an entertainment permit for various types of facilities, such as theaters, dance halls, and special events. |
| Submission Location | Completed applications must be sent to the Department of Homeland Security, Division of Fire Safety - Permit Division in Indianapolis. |
| Required Attachments | An updated floor plan must accompany the application. If claiming exempt status, a valid 501c letter is also required. |
| Permit Types | Applicants can request a Special Event Endorsement or an Annual Event permit, depending on their needs. |
| Occupancy Fees | Permit fees vary based on the intended occupant load, ranging from $99 for 1-99 persons to $272 for 10,000 persons or more. |
| Certification Requirement | Applicants must certify that the information provided is accurate and that the facility will comply with all relevant laws and regulations. |
| Contact Information | Applicants must provide contact details for the person responsible for inspections and the responding fire department. |
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