Housing Act 2004 - Houses in Multiple Occupation (HMO) Mandatory Licensing Application

Fill in this form in black ink only, write clearly within the boxes provided and complete in conjunction with the guidance notes. If you make a mistake, or do not complete all the relevant sections, it may delay the processing of the application and incur further charges. Please return completed form to: Central Licensing Administration Unit, Cedar Drive, Thrapston, Northamptonshire, NN14 4LZ Address of HMO to be licensed:

Postcode: Please indicate the type of licence you are applying for:

Application for a Licence Variation of an existing Licence Renewal of a Licence Please indicate the type of house for which the application is being made:

House in multiple occupation Flat in multiple occupation A house converted and comprising only of self contained flats

Please indicate how the HMO is operating:

Traditional HMOs - bed-sits

HMO with shared facilities

Household with lodgers

A hostel, B & B, care home

Supported lodgings

Do you hold a HMO licence in another local authority?:

Yes No If Yes, who is the local authority: Date granted: / /

Have you been refused a HMO licence in another Authority? Yes No Details of the Applicant:

Title: Mr Mrs Miss Ms Other

Full name: D.O.B. / /

Address:

Postcode: Telephone: Home: Work: Mobile:

Email: Proof of Identification Photo ID: Passport Driving Licence Other Proof of address: (see note 2): Utility bill Driving Licence Bank statement Other Interest in property: If the property has more than 7 people planning permission is required. Have you checked with our building

control and planning department? Yes No

Details of the Manager/Managing agent, if applicable (Person having control):

Title: Mr Mrs Miss Ms Other

Full name:

Address: Postcode: Telephone:

Details of the Proposed Licence Holder:

Title: Mr Mrs Miss Ms Other

Full name:

Address:

Postcode: Telephone: If the proposed licence holder is NOT the person having control of the property, the person having control of the property and the proposed licence holder MUST sign the following declarations: I, consent to being named as the proposed licence holder of the above named property.

Name (please print):

Signature: Date: / /

I, as the person having control of the property, hereby give my consent to the above named being licence holder.

Name (please print):

Signature: Date: / /

PART ONE – LICENCE HOLDER DETAILS

1.1. If the proposed licence holder is part of a company, partnership, charity or trust, please indicate which and provide contact details of all directors / partners / trustees – please use separate sheet if more than two. If not part of a company, partnership etc. please go to question 1.2

Company Partnership Charity Trust

Name of company/partnership/charity/trust:

Registered company no.:

Director Partner Trustee Secretary Full name: D.O.B. / / Company/partnership charity/trust registered address:

Postcode: Telephone: Email:

Director Partner Trustee Secretary Full name: D.O.B. / / Company/partnership charity/trust registered address:

Postcode: Telephone: Email:

1.2. Fit and Proper Person – see guidance note 4

The local authority must consider evidence whether the proposed licence holder, and any person associated or formerly associated with them, whether on a personal, work or other basis, is a fit and proper person.

1.3. Has the proposed licence holder, or anyone associated with the proposed licence holder, ever accepted a simple caution, previously known as a formal caution by the Police or convicted of an offence involving any of the following?

PLH Associate Yes No Yes No Fraud Dishonesty Violence Drugs Sexual offences Act schedule 3

1.4. Has the proposed licence holder, or anyone associated with the proposed licence holder, ever

accepted a simple caution, convicted of an offence or served with Statutory Notices under any of the following?: PLH Associate Yes No Yes No Housing or Landlord and Tenant Law Environmental Protection Act 1990 Statutory Nuisance Legislation Public Health Legislation Building Regulations or Planning Laws

1.5. Has the proposed licence holder, or anyone associated with the proposed licence holder, been in

control of a property: PLH Associate Yes No Yes No Subject to a Control Order or Management Order Where works have been carried out in default Been refused or breached conditions of a licence

If you have answered ‘yes’ to any of the above questions, it is necessary for the Council to undertake a further ‘fit and proper person’ check on the Proposed Licence Holder and anyone associated with them. Please contact the Council on 01832 742102 to request the additional ‘fit and proper person’ form and return to the address on the front page together with this application form.

PART TWO – PROPERTY DETAILS

SECTION 2: DETAILS OF PROPERTY TO BE LICENSED To be completed for all properties requiring a licence 2. Please attach a sketch plan, with measurements, showing the location and size of each room in the property.

Below is an example showing the type of sketch and detail required. Please use the abbreviations listed below to mark details on the plan. Please provide a separate sketch of each floor level of the property. Please add additional sheets if you require further space. If you already have plans of the property you may submit these separately, or we can provide sketch plans for you at a charge.

Shared Kitchen

Conservatory

Hall

4 mtrs

HD

CP

AS

SD1 mtr

E/L

SD

1.5 mtrs

Final Exit To Street

SD AS

FD

FD

5 mtrs

FB

C

W.C.

F

W9

S

5 mtrs

5 mtrs

4.5 mtrs

4 mtrs

EXAMPLE GROUND FLOOR PLAN

SH

FD

Utility RoomWHB

FD

gas &electric

meter cupd

Letting No. 1

Letting No. 2

SD

HD

FD

EMERGENCY LIGHTINGEL

HEAT DETECTOR

FIRE BLANKET

W9 WATER EXTINGUISHER

EXTINGUISHERFOAMEither

SHOWER

WATER CLOSET

COOKER

FRIDGE

BATH

WASH HAND BASIN

FAP FIRE ALARM PANEL

S

B

F

AAF

SH

WC

C

KEY TO SYMBOLS TO BE USED ON PLAN

WHB

FB

AS

CP

SMOKE DETECTOR

FIRE DOOR

ALARM SOUNDER

CALL POINT

SINK

NOTE: All fastenings to doors required for escape purposes must be thumb-turn type locks, easily openable from the inside without the use of a key.

Key of symbols to be used on plan FD Fire door EW Escape window EL Emergency lighting CP Manual call point FAP Fire alarm control panel SD Smoke detector linked to whole house system HD Heat detector linked to whole house system AS Alarm sounder linked to whole house system SA Combined smoke detector/alarm, maybe linked or stand-alone HA Combined heat detector/alarm, maybe linked or stand-alone FB Fire blanket WE Water extinguisher FE Foam extinguisher DP Dry powder extinguisher SH Shower B Bath WC Toilet WHB Wash-hand basin C Cooker S Sink F Fridge

Sketch pad Notes:

Sketch pad Notes:

Sketch pad Notes:

Sketch pad Notes:

2.2 Please indicate the type of property to be licensed:

Detached Semi-detached Terrace End terrace Other (please indicate below)

2.3 Please give approximate date of construction of the property:

Pre 1900 1919-1945 1945-1964 1965-1979 Post 1980

2.5 If the property has been converted into self-contained flats, what was the approximate date: / / 2.6 Please provide details of any building works carried out to the property. Please include copies of planning consents, building regulations approval or certificates issued on completion of works.

Description of works Date of completion

2.6 How many storeys are there in the property? Include basement and attic flats. See note 5 and 6.

1 2 3 4 5 If more specify

2.7 Over which levels are the storeys situated? such as: ground floor, first floor, second floor (see note 6): 2.8 Is any part of the property used for separate commercial activity? Yes (please indicate below) No 2.9 How many households occupy the property at present? 2.10 How many individual people occupy the property at present? 2.11 Is there a resident landlord? Yes No - please go to question 2.14 2.12 Is the proposed licence holder the resident landlord? Yes No 2.13 Which rooms in the property are occupied by the resident landlord? 2.14 Please indicate the number of households you would like the licence for: 2.15 Please indicate the number of occupants you would like the licence for: 2.16 What form of heating is there in the property?

Radiator/s as part of the gas/oil fired central heating system: Yes* No *If yes, please provide a copy of a valid gas safety certificate Individual wall-mounted electric heater/s Yes* No Other, please state:

2.17 How old is the kitchen? 2.18 How old is the bathroom? 2.19 Is there adequate noise insulation between converted flats? Yes No 2.20 Does the property have cavity wall insulation? Yes No 2.21 Does the property have loft insulation ? Yes* No *If yes, what thickness is the insulation?

Please complete the following table indicating the facilities that are provided within the whole dwelling by ticking the boxes relevant to indicate the facilities that each individual letting unit has use of within the property. See note 7 for further guidance.

Num

ber o

f peo

ple

shar

ing

Shar

ed (S

) or e

xclu

sive

(E)

Show

er o

r bat

h

Was

h ha

nd b

asin

Mec

hani

cal e

xtra

ct fa

n

Fixe

d he

atin

g

No.

of h

obs

No.

of m

icro

wav

es

No.

of c

onve

ntio

nal o

vens

No.

of c

upbo

ards

**

No

of fr

idge

s with

no

free

zer c

ompa

rtm

ents

No.

of f

reez

ers

No.

of f

ridge

s with

free

zer

com

part

men

ts

No.

of s

inks

and

dra

iner

s

No.

of d

ishw

ashe

rs

Met

res o

f kitc

hen

wor

k to

p

Refu

se d

ispos

al

No.

of e

lect

rical

sock

ets

Fire

doo

r with

smok

e se

als

and

self

clos

ers

Fire

Bla

nket

Floor Use

(e.g. kitchen, bedroom etc)

Size (m2)

G Kitchen 8 5 S - - Y Y 4 1 1 5 2 1 0 1 0 4 Y 6 Y Y

PART THREE – DETAILS OF FACILITIES AND MANAGEMENT

To be completed for all properties requiring a licence

3.1 Is there a system of fire detection incorporating: a fire alarm panel Yes* No sounders / alarms on all levels Yes* No emergency lighting in the common hallways Yes* No mains powered smoke / heat alarms in kitchen/common rooms and hallways Yes* No battery operated smoke alarms Yes* No 3.2 Is there a current fire alarm test certificate? Yes – please provide a copy No 3.3 Is a contractor employed to inspect and maintain the fire alarm system? Yes - please state who No

Please provide a copy of the service contract for the alarm and fire system. Is there a log book of inspection/testing ? Yes No Where is it kept? 3.4 Is there a current emergency lighting test certificate? Yes - please provide a copy No Please provide a copy of the most recent periodic test certificate for the electrical installation and if applicable the most recent PAT certificate. 3.5 Is the main exit door and doors from individual lettings openable from the inside without the use of a key? Yes No

3.6 Has a fire safety risk assessment been undertaken at the dwelling? Yes - please provide a copy No 3.7 Have you had your property inspected for the presence of asbestos? Yes - provide a copy of any report No

3.8 Tenancy Management - Please confirm whether you provide the following: Tenancy agreements/written details of terms of tenancy, including sanctions for anti social behaviour Yes* No

If you use a standard form of tenancy agreement, please provide a copy Yes* No Inventory and schedule of condition at commencement of occupancy Yes* No Rent book/receipts Yes* No Repairs contact/procedure Yes* No Complaints procedure Yes* No Any further information you feel will help you to assess your management skills:

PART FOUR – DECLARATIONS

DECLARATION OF APPLICANT AND PROPOSED LICENCE HOLDER

Please note that it is a criminal offence to knowingly supply information that is false or misleading for the purposes of obtaining a licence. Evidence of any statements made in this application may be required at a later date. If we subsequently discover something, that is relevant and which you should have disclosed, or which has been incorrectly stated or described, your licence may be cancelled or other action taken.

Operating an HMO that should be licensed without a licence is an offence liable to an unlimited fine following prosecution. Alternative sanctions may include the issuing a Civil Penalty Notice of up to £30,000.

In addition, a Residential Property Tribunal may make a rent repayment order requiring you to repay any rents due during the period for which the property was unlicensed.

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 functions under Parts 1 to 4 of the Housing Act 2004 that is false or misleading and which I/we know is false or misleading or I/we are reckless as to whether it is false or misleading.

Name (please print):

Signature: Date: / / Name (please print):

Signature: Date: / /

Enclosures to be submitted with the application Hard copy

included with application

Sent as file in email (clearly

labelled)

A Evidence of permanent residential address of proposed licence holder

B A copy of Building Regulations completion certificate and planning consents – if applicable

C Clear copies of tenancy agreement (s) or written terms of tenancy, including sanctions for anti-social behaviour for all current tenants

D A copy of current fire alarm test certificate E A copy of recent fire risk assessment in respect of the property

F A copy of current emergency lighting system test certificate

G A copy of service contract for alarm and fire systems

H

A copy of original certificate showing that the gas installation and appliances have been inspected by a competent person (must be a GAS SAFE registered inspector) in the last 12 months. Provision of this certificate is obligatory if there is a gas supply.

I A copy of most recent periodic test certificate for the electrical installation

J A copy of most recent PAT certificate – if applicable

K A copy of Energy Performance Certificate L A copy of relevant insurances associated with letting an HMO

M A clear copy of photographic ID i.e. passport (front cover, back cover and inside photo page) or clear photo card driving licence

M A passport type/size photograph of licence holder

O A copy of landlord’s original DBS certificate

P

Current photos of the property to be licenced • All bedrooms • All living areas • All bathrooms • All kitchens • Communal hallway • Fire alarm panel if applicable • Front external • Rear external • Communal garden

Q Application Fee:

Fee paid (if paying by debit or credit card):

To make an internet payment please log on to our host website for payments www.east-northamptonshire.gov.uk and click on the following link:

Select ‘All other Council Bills’ followed by ‘Licensing Unit’ and then use the drop down list to select the appropriate ‘HMO Licence’ fee. Follow the on-line instructions to

complete the payment.

Payments by debit/credit card may also be made by calling our payment line on: 01832 742211.

Application fee enclosed (if paying by cheque):

Cheques to be made payable to: EAST NORTHAMPTONSHIRE COUNCIL And crossed a/c payee. We DO NOT accept cash payments.

Current application fees are available from our website at www.northantslicensing.gov.uk

PART FIVE – ADVISING OTHERS OF YOUR APPLICATION

Under Schedule 2 contained in the Licensing and Management of Houses in Multiple Occupation and Other Houses (Miscellaneous Provisions) (England) Regulations 2006 there is an obligation to advise other people that an application for an HMO licence is to be submitted You must let certain people know in writing that you have made this application or give them a copy of it. You can do this by completing the attached form. The persons who need to know about it are: • Any mortgagee of the property to be licensed • Any 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 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 will not be you) • This is an application for an HMO licence under Part 2 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 To help you comply with the requirements of these regulations the Council has produced a form which is printed on the next page. Use Section 5A to supply the required information to the persons who are required to be notified by law as listed in the paragraph above. Fill in the lower part of the form with your details, then photocopy it as many times as you need and fill in the name & address of the person you must notify. Complete the box at the top with the names and addresses of persons you need to notify about your application and deliver them individually. When you have completed and given/sent copies to everyone that you need to, you must fill in Section 5B to confirm to the Council that you have notified everyone about your licence application.

I / We confirm that I / we have served notice of this application on the following people, who are the only people known to me / us that are required to be informed that I / we have made this application. Name (please print):

Signature: Date: / / Name (please print):

Signature: Date: / / Full name:

Address: Postcode:

Email: Interest in the property or the application:

Date of service of Notice: Full name:

Address:

Postcode: Email: Interest in the property or the application:

Date of service of Notice:

Section 5A: Notification of Intention to apply for an HMO Licence

To:

Name/address of the person you must notify

This document is to inform you that:

I (your full name):

Of (address):

My telephone number is: My email address is:

Intend on (date of application): To apply under Part 2 of the Housing Act 2004 (name of authority)

For an HMO licence in respect of (address for HMO to be licensed)

The Licence holder will be (Licence holder name):

Of (Licence holder address):

Licence holder telephone number is:

Licence holder email address is:

Licence holder fax number is:

Section 5B: Confirmation that notification of intention to apply for HMO licence has been served on all relevant persons Please continue on a separate sheet if necessary 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.

Name Address Description of the

person’s interest in the property or application

Date of Service

PART SIX – OTHER HOUSES LICENSED TO PROPOSED LICENCE HOLDER

Under Schedule 2 contained in the Licensing and Management of Houses in Multiple Occupation and Other Houses (Miscellaneous Provisions) (England) Regulations 2006, there is a requirement that the proposed licence holder for an HMO licence must provide details of other HMOs or houses which he/she holds a licence under Part 2 of the Housing Act 2004. You must provide details of such HMOs both in the area of the Local Authority in which you are applying for a licence and those for which you have a licence in other local authorities. 6.1.1 If you have not been awarded a licence in respect of any houses other than the one for which you are now applying please tick the box here. If you tick this box you may ignore the rest of this form

List all other HMOs or houses for which the applicant also holds a licence under Part 2 or 3 of the Housing Act 2004. Please photocopy sheet as necessary if you hold more than 5.

Address of the property Local Authority

1

Postcode:

2

Postcode:

3

Postcode:

4

Postcode:

5

Postcode:

Privacy Notice Your personal information – what we need and why East Northamptonshire Council, Kettering Borough Council and Corby Borough Council (the councils) collect your personal information from this form to process your application. We may also use this information for enforcement purposes under the Housing Act 2004. We will not collect any personal information from you that we do not need. How we keep your information safe? The Councils takes data security seriously. The information you provide will be held in our dedicated secure databases and is only accessed by authorised staff. Who do we share your information with? We need to share your personal information internally and where appropriate with our partner councils to process your application. We are also obliged by law to share your information with Northamptonshire Fire and Rescue Service and Northamptonshire Police, and any other local authority you have referenced in your application. We may also contact any third parties who you have told us have an interest in the property for verification purposes, and where appropriate, for investigation under any housing legislation. No other third parties have access to your information unless the law expressly allows them to. Your name, address and the licensed address will be placed on the public register which can be found at www.(web address here) for the duration of your licence, as is required by law. How long do we keep your data? We will keep your personal information for the licensed period (5 years) and for a period of 7 years from the end of your licence under the Housing Act 2004. When we no longer need to hold your personal information it will be securely destroyed. Your Data Rights and Our Privacy Policy For information about your rights as a data subject, please see our Privacy Policy on the website. If you are wish to make a complaint about the use of your personal data or you would like further information about data protection at East Northamptonshire Council, please contact our Data Protection Officer

I, as the proposed licence holder, confirm that I have read and understood the privacy statement and acknowledge that information provided in this application may be shared as required with other statutory bodies. Name (please print):

Signature: Date: / /