Fillable Application for licence for house in multiple occupation (London Borough of Harrow)

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Application for licence for house in multiple occupation (London Borough of Harrow)

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  • 19 check-boxes
  • 540 other fields

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1
Application for licence for
house in multiple occupation
Please use the accompanying notes when completing this form.
If you have more than one house in multiple occupation you will need
to complete a separate application form for each property.
Please fill in the form using BLOCK CAPITALS and black ink.
If you require more space to answer any question, please use
additional sheets, specifying which question your answer relates to,
and attach the sheets to the application form.
Type of application (please tick appropriate box):
New licence Renewal of licence
Address of property to be licensed
Is the applicant the proposed licence holder? Yes
No (see note 1) If yes, please go straight to
Part 2 of the form. If no, please complete Part 1 of the form.
For office use only
Date received
Date passed to officer
Reference number
Fees received
Surname First name(s)
Address
Telephone numbers: Home Work
Mobile Fax number
Email address Date of birth
What is your relationship to proposed licence holder: (please tick the appropriate box)
Friend Relative Agent Solicitor Other (please specify)
What is your interest in the property?
Please go to Part 2.
PART 1. APPLICANT DETAILS - see note 1
Postcode
Postcode
Is the proposed licence holder (please tick the appropriate box)
Trustee Charity
Partnership Other
Company Individual
Other (please specify)
Name of proposed licence holder (if a company, please
give full company name)
Address (if company please give registered address) Please note only UK addresses can be registered Licence holders
Telephone numbers: Home Work
Mobile Fax number
Email address Date of birth
Name of company secretary: (if applicable)
Name of directors/partners/trustees: (if applicable)
Please go to Part 3.
2
PART 2. PROPOSED LICENCE HOLDER DETAILS - see note 2
Postcode
PART 3. MANAGER DETAILS - see note 3
Has an agent or individual been employed to manage the property?
Yes - please go to 3.2 No - please go to 3.1
3.1 If no, please provide the name, address and telephone number of the person who is responsible for the
management of the property
Name Telephone number
Address
3.2 If yes, is the manager (please tick appropriate box)
Individual Company
Partnership Trustee Other (please specify)
P
ostcode
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:35 Page 2
PART 4. OWNERSHIP DETAILS OF THE PROPERTY TO BE LICENSED - see note 4
Name of manager (if a company, please give full company name)
Address (if a company, please give registered office address)
Telephone numbers: Home Work
Mobile Fax number
Email address Date of birth
Yes No
Is the manager a member of a Redress Scheme If
yes, please state which regulatory body
Please go to Part 4.
3
Postcode
Please provide the details of ownership and all others with a legal interest in the property to be licensed.
If you require more space, please continue on a separate sheet.
4.1 Name of freeholder(s)
Surname of freeholder 1 Forename(s)
Address of freeholder 1
Email Telephone
Surname of freeholder 2 Forename(s)
Address of freeholder 2
Email Telephone
Postcode
Postcode
4
4.2 Name of mortgagee
e.g. bank, building society or other who has a loan secured against the property.
Address of mortgagee
Email Telephone
4.3 Name of leaseholder(s) (if none, state none). Please continue on an additional sheet if necessary.
Surname of leaseholder 1 Forename(s)
Address of leaseholder 1
Email Telephone
Surname of leaseholder 2 Forename(s)
Address of leaseholder 2
Email Telephone
Surname of leaseholder 3 Forename(s)
Address of leaseholder 3
Email Telephone
Surname of leaseholder 4 Forename(s)
Address of leaseholder 4
Email Telephone
Postcode
Postcode
P
ostcode
Postcode
Postcode
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:35 Page 4
5
Yes No
PART 5. OCCUPIER INFORMATION - see note 5
4.4 Name of person who collects the rent
Surname
Forename(s)
Address of person who collects the rent
Email Telephone
4.5 Person who receives the rent
Surname
Forename(s)
Address
Email Telephone
4.6 Name of any other person who may be bound by a condition of the proposed licence and who is not referred
to in Parts 1, 2 and 3 of the form:
Surname Forename(s)
Address
Email Telephone
Please go to Part 5.
Postcode
Postcode
Postcode
Please include all occupiers, including children and babies occupying the lettings
5.1 Total number of persons currently living on the premises:
5.2 The maximum number of persons who may occupy the premises
and the number I wish the premises to be registered for:
5.3a Total number of households/family units:
5.3b The maximum number of households/family units who could
occupy the premises and number I wish the premises to be
registered for:
5.4 Are any of the people listed in Parts 1, 2, 3 and 4 of the form
living in the property? (please tick appropriate box)
If yes, please state their names:
7
• Please continue on a separate sheet if necessary
• You may find it helpful to draw your sketch plan before completing this section.
Please ensure that the details you provide in this section match those
in your sketch plan.
• Please note that failure to provide or providing false measurements will result in your license being invalid
Floor ar
ea
Number of
(m2) occupiers Name of occupiers
Type of tenancy (e.g.
Statutory, Assured Shorthold)
Please go to Part 6.
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:35
Page 7
8
PART 7. AMENITIES - see note 7
7.1
Please specify which lettings detailed in Part 5 have exclusive use of a bath
and/or shower
7.2
How many shared baths and/or showers are there in the property?
Baths Showers
7.3
Please specify which lettings detailed in Part 5 have exclusive use of a WC
7.4
How many shared WCs are there in the property?
7.5
How many shared WCs are in a separate compartment to the bathroom?
6.1 When was the property built? (please tick appropriate box)
Pre 1919 1919 to 1944
1965 to 1980 Post 1980
6.2 Description of the property (please tick appropriate boxes)
Detached Semi-detached
Purpose built block of flats
House converted into self-contained flats
1945 to 1964
Terraced End of terrace
Mixed residential and commercial
Other (please specify)
6.3 Description of occupation (please tick appropriate boxes)
S
hared house
Hostel S
tudios
A
mix
of
s
elf-contained units
and
s
hared a
ccommodation
Self-c
ontained s
ingle household unit
Shared flat
Bedsits with shared facilities
Other (please specify)
6.4 If the accommodation is within a converted property, was the conversion done in
accordance with the relevant building regulations in force at the time?
Yes No
If yes, what year was the conversion carried out? Date
Please provide the relevant Building Control completion certificate for the conversion.
6.5 Please tick all of the floors the property has:
Basement residential
Bas
ement storage
Ground floor
Fourth floor
First floor
Fifth floor
Basement commercial
Second floor
Sixth floor
Third floor
Over six floors
Please go to Part 7.
PART 6. PROPERTY INFORMATION - see note 6
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:35 Page 8
P
ART 8. FIRE SAFETY - see note 8
8.1 Does the property have a system of fire detection?
Yes No
If yes, does the system include:
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
a) a fire alarm control panel
b) heat detectors in the kitchens
c) mains wired smoke detectors in rooms
d) battery powered smoke detectors in rooms only
e) mains wired smoke detectors in common parts
f) battery powered smoke detectors in common parts only
g) sounders /alarms on all levels
h) call points in the communal areas
If there is a mains wired fire alarm and detection system, has it been tested in
accordance with the BS5839:2017 at least quarterly?(Please provide a copy of a
current certificate of testing showing compliance to BS5839:2017)
Yes No
Yes No
Is there a log book of inspection / testing?
If yes, what is the date of the last entry?
Name the person responsible for maintaining the alarm system
Please state the location of the log book (if applicable).
8.2 Does the property have an emergency lighting system?
Yes No
If yes, has the system been tested in accordance with BS5266:
Part 1: 2016 at least every three years? (If yes, please provide
a copy of the most recent periodic inspection and test certificate)
Yes No
7.6 Please specify which lettings detailed in Part 5 have exclusive use of a wash hand basin
7.7 How many shared wash hand basins are there in the property?
7.8 What kitchen facilities are provided in the house? (please tick appropriate box)
Shared kitchen(s)
Mixture of exclusive/shared kitchens
Exclusive use of kitchens only
7.9 How many sets of shared kitchen facilities are provided in the house?
7.10 How many lettings have exclusive use of a set of kitchen facilities? (please specify)
7.11 How many sinks are there in the property?
Please go to Part 8.
9
By ticking this box I understand that it is an offence not to have smoke detectors in common parts
10
8.3 A
r
e the doors
that open on
to
the
com
munal
ar
eas fire doors
capable of 30 minutes fire resistance?
Yes No
If yes, are they fitted with self-closers?
Yes No
8.4 Is the following fire safety equipment provided:
Yes No
Yes No
Yes No
a) fire blankets in all kitchens
b) fire blankets in shared kitchens only
c) fire extinguishers
If yes for fire extinguishers,
please indicate in the space below how many and where they are located
Yes No
Yes No
Has the fire safety equipment been serviced in the last 12 months
8.5 Does each tenant have clear written instructions on what
to
do in the event of a fire?
8.6 Are the tenants provided with upholstered furniture?
8.7 Does all the upholstered furniture you provided comply with with
the Furniture and Furnishings (Fire) (Safety) Regulations 1988 (as amended)?
Yes No
Yes No
Please go to Part 9.
PART 9. PROPERTY MANAGEMENT - see note 9
9.1
Is there, displayed in a suitable position within the property, a notice giving the
name, address and telephone number of the manager?
Yes No
9.2
How many gas appliances are there in the property?
9.3
Does a Gas Safe registered contractor carry out safety checks
Yes No N/A
for any gas appliances in the property?
Please provide copies of the latest gas safety certificates.
9.4
How many gas safety certificates are enclosed (copies)?
9.5
Is there a programme in place for general maintenance of the property? Yes No
Yes No
Yes No
Yes No
If yes, does this include:
Structural repair
Amenities
Equipment
Furniture
Yes No
Yes No
9.6 Are there adequate financial arrangements in place to allow for
repairs works to be carried out at the property?
9.7 Are the rooms and areas in common use in good repair?
Yes No
Yes No
Are the rooms and areas in common use in a good decorative state?Are the
rooms and areas in common use in a clean condition?
Yes No
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:36 Page 10
Yes No
Yes No
Yes No
Yes No
Yes No
9.8 Are arrangements in place for the regular cleaning of common parts?
If yes, how often are the common parts cleaned?
9.9 Are all of the staircases, passageways, corridors, halls, lobbies,
balconies and entrances in common use free from obstruction?
9.10 Are the amenities in common use regularly cleaned?
Are the amenities in common use in a good state of repair?
9.11 Is the residents’ living accommodation in a good state of repair?
9.12 Are all the windows in a good state of repair?
Yes No
Yes No
Are all the windows fully operable?Are all
the windows double glazed?
Yes No Some
9.13 What form of heating does the property have?
Yes No
Yes No
Yes No
Yes No
Yes No
Gas fired central heating
Off peak night storage heaters
Individual wall mounted gas heaters
Individual wall mounted electric heaters
Other (please specify)
Is the loft insulated
If there are cavity walls, do you have cavity wall insulation
Yes No
9.14 Is the property free from all pests and vermin?
Yes No
If no, please provide the details of the pest control contractor
responsible for treating the infestation.
Please go to Part 10.
PART 10. TENANCY MANAGEMENT - see note 10
Yes No
Yes No
10.1 Are the tenants provided with written details of the terms
of the their tenancy?
10.2 Is an inventory prepared at commencement of occupancy?
10.3 Are rent books provided?
Yes No
If rent books are not provided, are the tenants given
receipts/rent statements?
Yes No
Yes No
10.4 Are the tenants provided with a complaints procedure?
10.5 Is there an emergency 24 hour contact telephone number that can
Yes No
be used by the tenants in relation to the property?
If yes, please provide the number:
10.6 Are tenants required to provide deposits at the
commencement of their tenancy? Yes No
12
Yes No
If yes, is there a written procedure to deal with deposit disputes at the end of a
tenancy?
10.8 Does the Tenancy Agreement include any clauses relating to Anti-social
Behaviour (ASB)?
10.9 Do you have an ASB Action Plan in place at the property?
Please go to Part 11.
11.1 Subject to the provisions of the Rehabilitation of Offenders Act 1974, please state the
Name Date Court Offence Sentence
Relevant is
s
ues include:
i) Criminal offences involving: Fraud, Dishonesty, Violence, Drugs, Schedule 3 of the Sexual Offences Act
2003.
ii) Practiced unlawful discrimination on grounds of sex, colour, race ethnic
or national origins or disability in
connection with a business.
iii) Contravened any provision of housing and/or landlord and tenant law.
These include but are not limited to:
a. A Control Order under the Housing Act 1985
b. Proceedings by a local authority
c. The local authority carrying out Works in Default
d. A Management Order under the Housing Act 2004
PART 11. RELEVANT INFORMATION - see note 11
particulars of any relevant issues (see below) recorded against any person named in
Parts 1,2, 3 and /or 4 or any person associated or formerly associated
on a personal or work basis with
those named in Parts 1, 2, 3 and/or 4. (Continue on a separate sheet if necessary.)
If not applicable, please tick this box. Application will not be accepted without this section
completed.
Yes No
Yes No
13
e. Harassment or illegal eviction.
iv) Contravened any Approved Code of Practice (ACoP)
v) Any criminal offence or subject to any other proceedings brought by a local authority or other
Regulatory Body (for example breaches of the Environmental Protection Act 1990, planning control or
compulsory purchase proceedings or fire safety requirements)?
11.2 Has any person named in Parts 1, 2, 3 and /or 4 of this form previously held
or do they currently hold a licence for another house in multiple occupation? Yes No
If yes, please provide the addresses of these properties, along with details of the authorities that issued
the licence.
11.3 Has any person named in Parts 1, 2, 3 and/or 4 of this form ever applied
for and been refused a House in Multiple Occupation licence? Yes No
If yes, which authority refused the licence? When was it refused?
11.4 Has any person named in Parts 1, 2, 3 and/or 4 of this form ever
breached any condition of a licence issued under Parts 2 and 3 of the
Housing Act 2004?
Yes No
If yes, please provide details of the licence condition(s) breached and the local authority in which they
were breached
Please go to Part 12.
12.1 Is the proposed licence holder a member of any landlords’
association or other professional body?
Yes No
If yes, please indicate which:
12.2 Is the proposed licence holder an accredited landlord?
Yes No
If yes, please indicate which accrediting body:
12.3 Please list in the space below any training courses undertaken or conferences attended by the
proposed licence holder/manager, in the last three years, which support this application.
Postcode
Postcode
PART 12. ADDITIONAL INFORMATION -
see note 12
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:36 Page 13
Membership number:
14
Please go to Part 13.
Note to applicants: It is a criminal offence to knowingly supply information which is false or misleading for
the purposes of obtaining a licence. Evidence of any statements made in this application with regard to
the property may be required at a later date.
We may approach other authorities, such as the Police, Fire and Rescue Service, Office of Fair Trading
etc. and tenants for additional information and verification. Signing of this application will be taken as
your agreement to any such action.
If we subsequently discover something which is relevant and which you should have disclosed, or which
has been incorrectly stated or described, your licence may be cancelled or further action taken.
13. FURTHER INFORMATION
Please use this space if you need more room for any of your answers or for any additional information
you think may be relevant to the application.
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:36 Page 14
1
5
PART 14. DECLARATION - see note 14
As the applicant, 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:
• A
ny mortgagee of the property to be licensed;
• A
ny owner of the property to which the application relates (if that 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 email address or fax number (
if any);
• The
name,
address,
telephone
number
and
email
address
or
fax
number
(if
any)
of
the
proposed
lic
ence
holder
(if
it
will
not
be you);
• Whether this 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.
I/we declare that I/we have served a notice of this application on the f
ollowing persons who
are
the
only
persons
known
to
me/us
that
are
required
to
be
informed
that
I/we
have
made
t
his
application.
Name Address Date
Description of the persons interest in
the pr
operty or the application
Postcode
Postcode
Postcode
Postcode
16
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 reckless as to whether it is false or
misleading.
Name of applicant
Date
Name of proposed
licence holder
(if different to applicant)
Date
Name of manager
(if different to applicant)
Date
Name
(if different to applicant)
Date
Name
(if different to applicant)
Date
Please go to application checklist.
You must submit these documents with y
our
application in any event.
CHECKLIST FOR SUBMITTING AN APPLICATION
Signature
Signature
Signature
Signature
Signature
App.HSD West London lic-oct06:WL licencing app-oct06 7/10/08 13:36 Page 16
Please check the following:
• A sketch plan for the property detailing the
layout and position of each room (Minimum
A4 Size)
• A certificate from a Gas Safe Register
approved gas engineer
• A current Installation Inspection and Test
Certificate
• A Current Fire Safety Risk Assessment
• Tenancy agreements for every tenancy within
the property.ASB Action Plan for the property
• Cheque made payable to ‘London Borough of
Harrow’
The council may require you to submit, or you may wish
to submit, other documents, for example, copies of
planning permissions, building regulations approvals,
licence agreements, certified accounts
(or summaries), recent portable electrical equipment
tests in support of your application.
P
lease send completed application form, payment
(
where required) and copies of any necessary
documentation
to:
Harrow
Council,
Community
Safety
Services, Private
Sector
Housing
Enforcement,
Civic
Centre,
PO
Box
18,
Station
Road,
Harrow
,
Middlesex
HA1
2UT
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Application for licence for house in multiple occupation (London Borough of Harrow)

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Completed 20 December 2020

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