Indiana Entertainment Permit Form PDF Details

In Indiana, the process of organizing events that draw crowds, whether it's a concert in a night club or a carnival at the local fairgrounds, entails securing an Amusement Entertainment Permit to ensure everything runs smoothly and safely. Administered by the Department of Homeland Security's Division of Fire Safety – Permit Division, the purpose of this permit is to uphold safety standards and compliance with the state's regulations. The State Form 42235 (R6 / 2-10), known as the application for this permit, requires applicants to provide comprehensive details about the event, including a current floor plan of the venue and, if applicable, proof of exemption status such as a valid 501c letter. The form caters to a variety of event types by allowing applicants to specify the nature of the facility hosting the event, ranging from theaters and dance halls to gyms and assembly halls. Critical to this process is the accurate reporting of intended occupant load, a factor that directly influences the permit fee. These fees are structured to scale, based on the size of the audience, ensuring that events both large and small are accommodated. In addition to furnishing contact information for both the applicant and the responding fire department, the form mandates an official certification verifying the accuracy of the information provided and compliance with relevant laws and regulations. Acknowledging the importance of safety and legal adherence, the Amusement Entertainment Permit serves not just as a bureaucratic hurdle but as a foundational step in planning secure and enjoyable events throughout Indiana.

QuestionAnswer
Form NameIndiana Entertainment Permit Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesapplication for amusement indiana, entertainment permit, indiana entertainment permit, application for amusement indiana online

Form Preview Example

APPLICATION FOR AMUSEMENT

Return this completed form to:

ENTERTAINMENT PERMIT

 

State Form 42235 (R6 / 2-10)

DEPARTMENT OF HOMELAND SECURITY

DIVISION OF FIRE SAFETY - PERMIT DIVISION

Approved by State Board of Accounts, 2010

302 West Washington Street, Room E241

 

 

Indianapolis, Indiana 46204

 

 

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)

 

 

 

 

Assembly Hall

Roller Rink

Lodge Hall

Carnival Fair

Gymnasium

__________________

 

 

 

 

 

 

 

 

 

 

Name of facility

 

 

 

 

City

 

County

 

 

 

 

 

 

 

 

 

 

Address of facility (number and street, city, state, and ZIP code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Specific room or floor number

 

Description of facility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Closest intersecting street or road

 

 

 

Direction from intersection

 

 

 

 

 

 

 

 

 

North

 

South

East

West

 

 

 

 

 

 

 

 

 

 

APPLICANT INFORMATION

Type of applicant

 

 

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

E-mail address

 

 

 

 

Address of contact person (number and street, city, state, and ZIP code)

 

Telephone number

 

 

(

)

 

 

 

 

Responding fire department

Address of fire department (number and street, city, state, and ZIP code)

PERMIT REQUEST INFORMATION

Type of permit request

 

Special Event Endorsement

Annual Event

Name of event

Date of event (month, day, year)

Hours of event

Intended occupant load

 

 

 

If Special Event Endorsement, existing operating permit number

 

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)

 

PERMIT FEES

Fees are based on occupancy load, effective September 30, 2006.

 

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

 

 

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

$

20 _____

How to Edit Indiana Entertainment Permit Form Online for Free

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This PDF doc will need some specific information; to guarantee correctness, please make sure to take note of the recommendations below:

1. To get started, once filling in the indiana state form 42235, begin with the section that includes the next blank fields:

Part # 1 in submitting entertainment license indiana

2. Once your current task is complete, take the next step – fill out all of these fields - Responding fire department, Address of fire department number, Telephone number, Type of permit request, Name of event, Special Event Endorsement, Annual Event, PERMIT REQUEST INFORMATION, Date of event month day year, Hours of event, Intended occupant load, If Special Event Endorsement, I or we hereby certify under, Signature, and Date month day year with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

How you can fill in entertainment license indiana part 2

A lot of people often make some errors while filling out Special Event Endorsement in this area. Be sure to review what you enter here.

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