Fillable COMMUNITY NOISE INFORMATION SHEET Community Noise Application (Attached) (City of Columbus)

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COMMUNITY NOISE INFORMATION SHEET Community Noise Application (Attached) (City of Columbus)

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DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
COMMUNITY NOISE
INFORMATION SHEET
REQUIREMENTS
• Community Noise Application (Attached)
• Pr
oof of Identity
(i.e. State issued Driver’s License/I.D. Card, Military I.D., Passport)
• N
oise Petition
(Required only if you intend to operate within 1,000 feet of a residential area, with the exception of Lane Ave,
until 10:00 p.m., between Olentangy River Rd on the west and N High St on the east during Ohio State
University home football games.)
PRICING
• Application fee - $20.00
• Community Noise License fee - $150.00 per day
OFFICE LOCATION & HOURS
4252 Groves Road
Columbus, OH 43232
Monday - Friday
8:00 a.m. to 3:30 p.m.
THIS PAGE INTENTIONALLY LEFT BLANK
Page 1 of 6
Rev 8/8/2019
DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
COMMUNITY NOISE
APPLICATION
PERMIT VARIANCE
APPLICANT INFORMATION
Full Name:
Residential Address:
City: State: Zip:
Phone: Email:
Business Address (If applicable):
City: State: Zip:
Race: Sex: Height: Weight: Hair: Eyes:
Have you had a City of Columbus license and/or permit refused, revoked or suspended within the past three (3) years?
Yes No
If yes, please explain:
Have you been convicted of a felony? Yes No
If yes, list all felony convictions that occurred in the United States within the past five (5) years:
Are you on felony probation or parole? Yes No If yes, date began:
EVENT INFORMATION
Name of Event: (If applicable)
Proposed Location of Gathering:
Proposed Date(s): Purposed Time(s):
Please give a general description of the gathering:
Estimate the maximum distance the sound will be heard from during operation of the equipment:
OFFICE USE ONLY
License # __________________________
Issue Date _________________________
Expiration Date _____________________
THIS APPLICATION FOR PERMIT/VARIANCE SHALL BE COMPLETED BY THE PERSON RESPONSIBLE FOR ORGANIZING THAT,
WHICH IS TO BE PERMITTED, OR ISSUED A VARIANCE.
Page 2 of 6
Rev 8/8/2019
Will this equipment be used within a thousand (1,000) feet of a residential area? Yes No
(If yes, attach petition form, signed by at least 70% of the tenants or owners occupying such dwellings)
Will noise be emitting from a stationary or moving vehicle? Yes No
If yes, what area(s) of the city do you plan to operate in? (If applicable)
If you are operating from a stationary vehicle, give a general description as to the location and size of the area: (If applicable)
VEHICLE INFORMATION (If applicable)
Year: Make: Model:
VIN: Color:
Please be advised this section is voluntarily optional and exists for the convenience of the applicant:
The applicant expressly authorizes the Licensing Division of the City of Columbus, Department of Public Safety to contact the
Income Tax Division of the City of Columbus - City Auditor and in turn expressly authorizes the Income Tax Division of the City of
Columbus - City Auditor to provide access to the Licensing Division of the City of Columbus, Department of Public Safety current
municipal tax information related to the applicant listed above in relation to the Short-Term Rental Permit for which application is
being made. Any information provided to the Licensing Division will be held in strict confidence at all times and shall not be
disclosed to any other department or division of the City of Columbus, nor used for any other purpose other than as stated.
Yes No
All information contained in this application is subject to disclosure as a matter of public record. Any
false statement made or given in this application shall result in denial, revocation, or future revocation
of the license under Columbus City Code Chapters 501 and 540, and may be referred for criminal
prosecution under Ohio Revised Code Chapter 2921.13 (A-3).
State of Ohio, County of Franklin
I, _____________________________________, being duly sworn, affirm and swear that I am the
(Print Applicant’s Name)
individual making the foregoing application; that he or she is knowledgeable with respect to that
which is to be licensed and to the information contained in the application; that the answers,
statements, and allegations made in this application are true and accurate to the best of my
knowledge and belief; and that I am an owner/operator/applicant of that which is to be licensed by
this application.
____________________________________
(Applicant’s Signature)
Sworn to before me and subscribed in my presence this ____ day of ___________________, 20____.
________________________________
Notary or Agent of Director of Public Safety
The application must be signed, dated and notarized.
Page 3 of 6
Rev 8/8/2019
DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
COMMUNITY NOISE
PETITION
Full Name:
Residential Address:
City: State: Zip:
Business Address:
City: State: Zip:
Name of Event: (If applicable)
Proposed Location of Gathering:
Proposed Date: Proposed Time:
Estimate the maximum distance the sound will be heard from during operation of the equipment:
We, the undersigned, who reside within 1,000 feet of the lot or parcel of ground located
at ____________________________ hereby state that we have no objections to the
operation of the sound equipment to be used at the above location on (date/time)
_________________________. It is understood that this petition is for the above stated
dates and times only.
Full Name
Signature
Date/Time
WHILE PETITIONING, THE APPLICANT IS RESPONSIBLE FOR NOTING THE ADDRESS, TIME, AND DATE FOR ANY UNOCCUPIED
RESIDENCES.
Page 4 of 6
Rev 8/8/2019
Full Name
Signature
Date/Time
Page 5 of 6
Rev 8/8/2019
Full Name
Signature
Date/Time
Page 6 of 6
Rev 8/8/2019
Full Name
Signature
Date/Time
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COMMUNITY NOISE INFORMATION SHEET Community Noise Application (Attached) (City of Columbus)

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Completed 21 January 2021

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