Moor Hall, Romford Road, Aveley, RM15 4UU

-- '
Application for a premises licence to be granted
under the Licensing Act 2003
PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST
Before completing this form please read the Guidance Notes at the end of the form. If you are
completing this form by hand please write legibly in block capitals. In all cases ensure that your answers
are Inside the boxes and written In black ink. Use additional sheets if necessary. You may wish to keep
a copy of the completed form for your records.
rn0012.. HALL VeNiJE.. et
I/We
e.~NTS
L-10
[Insert name(s) of applicant]
apply for a premises licence under section 17 of the Licensing Act 2003 for the
premises described in Part 1 below (the premises) and I/we are making this
application to you as the relevant licensing authority in accordance with section 12
of the Licensing Act 2003
Part 1 - Premises details
Postal address of premises or, If none, ordnance survey map reference or description
Post town
A\C.L_f..Y
I
Post code
«..m I5
4Uu
Telephone number at premises (if any)
Non-domestic rateable value of premises
Of ~PL\L.PiT• OrJ
Part 2 - Applicant details
c_)
Please state whether you are applying for a premises licence as
(_ Bf\ f'J()
Please tick ./yes
a) an individual or individuals*
L]
please complete section (A)
b) a person other than an individual*
D
a
please complete section (B)
D
Please complete section (B)
iii. as an unincorporated association, or
Ll
please complete section (B)
Iv. other {for example a statutory corporation)
0
please complete section (B)
I.
Ii.
as a limited company
as a partnership
Public Protection Bringing together Environmental Health & Trading Standards
U\PR01 .doc
- Requests/059687/PPC02277
1
,(
'
e)
the proprietor of an educational establishment
Ll
Ll
Ll
f)
a health service body
Ll
Please complete section (B)
g)
a person who is registered under Part 2 of the Care
Standards Act 2000 (c14) In respect of an Independent
hospital
Ll
Please complete section (B)
h)
the chief officer of police of a police force In England and
Wales
Ll
Please complete section (B)
c)
a recognised club
d)
a charity
please complete section (B)
Please complete section (B)
Please complete section (B)
*If you are applying as a person described in (a) or (b) please confinn:
Please tick .,....yes
Cl
• I am carrying on or proposing to carry on a business
which involves the use of the premises for licensable activities; or
• I am making the application pursuant to a
•
•
statutory function, or
a function discharged by virtue of Her Majesty's prerogative
(A) INDIVIDUAL APPLICANTS (fill in as applicable)
Mr
C]
Mrs
Cl
Miss
C]
Ms
C]
Other title
(for example, Rev)
Surname First names
Please tick .lyes
Ll
I am 18 years old or over
Current postal
address if
different from
premises address
Post Town Daytime contact telephone number
E-mail address
(optional)
Postcode
-
'
SECOND INDIVIDUAL APPLICANT (IF APPLICABLE)
Mr
L]
L]
Mrs
Miss
L]
Ms
L] Other title
(for example, Rev)
First names
Surname Please tick .lyes
LJ
I am 18 years old or over
Current postal
address If
different from
premises address
Postcode
Post Town Daytime contact telephone number
E·mall address
(optional)
(B) OTHER APPLICANTS
Please provide name and registered address of applicant In full. Where appropriate please give any
registered number. In the case of a partnership or other joint venture (other than a body corporate),
please give the name and address of each party concerned
Name
0'\())2_ \1ALL vcNue ~
eve.NTS LIO
Address
(n(X)(Z_
HAL L
'2..()'T\(-'( £.0 QQ(-'()
f\
.L :- 'I
ess.ex
R fl\1 '5
4uLJ
Registered number (where applicable)
CY~ '~ 2.G 3~
Description of applicant (for example partnership, company, unincorporated association etc)
L\<Y\\iEO c~PAN'/
Telephone number (If any)
E-mail address (optional)
0~4-5
51<1 2..<"6,b
.JOO\€. .. oe.A Y@
u vE, .. c_o . LU(
3
Part 3 Operating Schedule
Day
Month
Year
When do you want the premises licence to start?
I I I I
Day
If you wish the licence to be valld only for a limited period, when
do you want it to end?
Month
I
Year
I
___..,__ _._
.____..______...__ _.....__.......____,_ If 5,000 or more people are expected to attend the premises at any one time,
please state the number expected to attend
Please give a general description of the premises (please read Guidance Note1)
• A 'T€fY"\PQ'2.flf!.Y mAroLee lf\J T\1e GA'2.0ef...J fCr.. lf"'.:£ o'r
vve-oD\NQ ~Pr\CNS f\r-.0 f\Jl\Jc::rlONS
a f"Ul'Cr \ CN , 5Urre: AOJ'f\C£f'-''T \u H~ ·­
I
-
'
What licensable activities do you intend to carry on from the premises? (Please see sections 1 and 14 of the Licensing Act 2003 and Schedule 1 and 2 to the Licensing Act Please Please tick Y"'yes
Provision of regulated entertainment
a)
plays (if ticking yes, fill in box A)
b)
films (If ticking yes, flll In box B)
c)
indoor sporting events (if ticking yes, fill in box C)
d)
boxing or wrestling entertainment (if ticking yes, fill In box D)
e)
live music (if ticking yes, fill In box E)
f)
recorded music (If ticking yes, fill in box F)
g)
performances of dance (if ticking yes, fill in box G)
h)
anything of a similar description to that falling within (e), (f) or (g)
(if ticking yes, fill in box H)
Provl1lon of entertainment facllltles for;
i)
making music (if ticking yes, fill in box I)
LI
j)
dancing (If ticking yes, fill in box J)
LI
k)
entertainment of a similar description to that falling within (I) or 0)
(if ticking yes, fill in box K)
LI
Provision of late night refreshment (If ticking yes, fill in box L)
Supply of alcohol (if ticking yes, flll In box M)
In all cases complete boxes N, 0 and P
5
A
... ' Plays
Standard days and timings
(please read Guidance Note 6)
Day
Start
Finish
Wiii the
performance of a play take place
Indoors or outdoors or both ­
Indoors
Outdoors
please tick [·I'] (please read Guidance Note 2).
Both
Please give furtber details here (please read Guidance Note 3)
Mon
Tue
Wed
State any uuonal varlalloOJ for perfonnlng plays (please read Guidance Note 4)
Thur
Fri
Non standard timings. Whsir! l(OU Intend to use the erem!s!l!S for the l!!l!rformans;! of
Ill!~ 1!1 ltiff!l!rent ll!DH mlbS!U llll!d I!! the Qo!umD S!!! t!J1 llfl, RIH•l llll (please read
Guidance Note 5)
Sat
Sun
B
Fiims
Standard days and timings
(please read Guidance Note 6)
Day
Start
Finish
Wiii the exhibition of fllms take place Indoors
Indoors
or outdoors or both ­
Outdoors
please tick[./] (please read Guidance Note 2).
Both
Please give furtfler details here (please read Guidance Note 3)
Mon
Tue
State any seasonal varjatlons for the exhibition of films (please read Guidance Note 4)
Wed
Thur
Fri
Sat
Sun
-­
Non 1li!Dli1Md 1!mll!A!· Whe~ ~u IDllD!il 1'! !.!!! lt!! IH!mlHI fS!c t!l! Hiblllll!sm S!! 1llml
Ill ~lffl11Dl llmH mlb2U 1111!5;1 ID !b! Si21Yml'.! S!D lb! llll. Rl!BI! ll!l (please read
Guidance Note 5)
c
Indoor sporting events
Standard days and timings
(please read Guidance Note 6)
Day
Start
Plea1t give further detalls here (please read Guidance Note 3)
Finish
Mon
Tue
State any te8son8! y8~l8tlons for Indoor •porting events (please read Guidance Note 4)
Wed
Thur
Non 1tandi!rd t1mlng1. Where li!2Y Intend to YI! lb! p[!mlsas for l!JSfQQ[ !U!Qdlng
ev1n1! at dlffernnt times to those llllld In the column 2n the left, please list (please
read Guidance Note 5)
Frl
Sat
Sun
D
Boxing or wrestling
entertainment
Standard days and timings
Will the boxing or wrestling entertainment
take place indoors or outdoors or both ­
(please read Guidance Note 6)
please tick[./] (please read Guidance Note2).
Day
Mon
Start
Finish
Indoors
Outdoors
Both
Please give further detail• here (please read Guidance Note 3)
Tue
Wed
S!all i!n}! seasonal Vi!rlatlons for boxing or wrestling entertainment (please read
Guidance Note 4)
Thur
Frl
~on •!l!!dard timings. Wb!!'.! li!QY Intend !2 Y!' th! 1m!mi&H [2~ ~QlCl!Jg 1nd wraatl!ng
1nl!rtalnmen1 ai different times ls! !!lose llsta~ l!J the column on the !!ft, 1!18!!88 list
(please read Guidance Note 5)
Sat
Sun
7
E
Live music
Standard days and timings
Will the performance of live music take place
indoors or outdoors or both ­
Mon
Tue
Wed
Start
Finish
J) ('{)
cma
12.00
f'l.TI"\
111("(1
()J)O
Thur
r1 1~1
Frl
11?m
Sat
1200
-1'1.'C\
Sun
\'1.JX)
,-·Cv)
please tick [ vl] (please read Guidance Note 2).
Both
Please give further detalla here (please read Guidance Note 3)
1t'(: rnf\Q().\..ffi 1c-=> f\'Vf\ llYt~L_e FOZ.. Hree
FQ.Qv'\
12-An - 12.J\m Ou..e..11\.G rvt11CH 1'1 ""'­ u \E. ~v..: ,c_ m°ft'-1
PL:' ~·~.xu•eeo 1N ~ roc_Jn__ cir H
/mus1c.1Ar-J
~~ DflYJt"'f:. €1'JiEl2..--n·W-.A'Y'f-_~-./1 0 f\ g 1·\ NO f'.ce...
t:: ::f .0 r-.. i I :-...Jr-. t \ 1-....11'(?'12.1·A, ... ~ !-..r
f"'O
~~
c:-.,t--0
State any teasonal variation• for ptrformlng of !!ve mualc (please read Guidance Note
4)
N/A
,-K-"'l. ")
- - ll "[ ~ l: )
v-
Outdoors
(please read Guidance Note 6)
Day
Indoors
Non standard timings. Where you jntend to use !he premises for the performance of
llve mualc id different tlm•! ls! lboae llsted in the ~olum!J ga lbl !!fi, please ll1t (please
read Guidance Note 5)
N/A
F
Recorded music
Standard days and timings
Will the playing of recorded music take place
Indoors or outdoors or both ­
Start
Mon
'CV\
Finish
'I'
-'1-Y
../
Outdoors
(please read Guidance Note 6)
Day
Indoors
please tick [vl] {please read Guidance Note 2).
Both
Please give furthgr details here (please read Guidance Note 3)
'2.ec0<.0€0 muse rrif'H fY?_ PLJ\'1E:O ·n-\Q..O..X3+1
~fla:£S f.02_ sPCx-G'2.a..>l"O muslC oc \ r-J roc
·m .
1 12rY ~
-... ·-r·c"
~oe.rn
Jl.OQ
fY"'Y. "'(""
State anv seasonal yariatlons for playing recorded mu1!c (please read Guidance Note 4)
Thur
l11N.J
(\('~." "'(")
Fri
11 'J rt.")
rY'f."l'"'i
Tue
Wed
Cir fi
tJ/~
Non standard timings. Where you intend to use the premises for the olavtng recorded
mull!C 1nt!r:talom1al I& dlfflCIDl llmll ls! lb211 ll1llsl ID U!! ~OIYmD 20 lb11 lgft, O!!l!H
HE (please read Guidance Note 5)
Sat
11..00
Sun
1700
-
I'
·­
Y"\.
Q()'QD
N/P...
-
G
'
Performance of dance
Standard days and timings
Wiii the performance of dance take place
Indoors or outdoors or both ­
Outdoors
(please read Guidance Note 6)
Day
Start
please tick [..I] (please read Guidance Note 2).
Finish
Indoors
Both
Please give further detalls here (please read Guidance Note 3)
Mon
Tue
State any uuona! variations for perfomiingof dance (please read Guidance Note 4)
Wed
Thur
NS?n Sl!!nd!!r!i! tll!!lngs. Whl!ra l£OU Intend to use the greml~s for the 11erformauce of
~!!ID~ 1nt!!!::l!lnm1ni at !i!lfferent times tQ thQU ll•l!!!i! ID the CQll,!mn S!!J th! Id, PIH!!
!i!! (please read Guidance Note 5)
Fri
"
Sat
Sun
H
Anything of a similar
description to that falling
within (e), (f) or (g)
Standard days and timings
Please give a description of the !Ji:pe of the entertainment l£OY will be
providing
(please read Guidance Note 6)
Day
Start
Wiii this entertainment take place Indoors or
outdoors or both
please tick [..I] (please read Guidance Note 2)
Finish
Mon
Indoors
Outdoors
Both
Please give further details here (please read Guidance Note 3)
Tue
Wed
Thur
.
§!ml!! aal£ !&a§onal v1rlatlons for entertainment of a aimllar !i!tsc[jgtlon to that falling
within (el. (fl or (g) (please read Guidance Note 4
Fri
m
Sat
Non standard tlmlag1. Whgre ~u inlt!Jd Mll lb! g[!ml!!! for the enit!::l!l!lWID12f
1lmil1r s!!l!i'iP1!2n 1g !tJat f11U[!g within {el.(!) or (g} at dlfftrent !lmH tg 1!'.!2!! ll!l!U~ In
the column on the left. pleue list (please read Guidance Note 5)
sun
9
-·
'
Provision of facilities for
making music
Standard days and timings
Please give a description of the type of the entertainment you will be
providing
(please read Guidance Note 6)
Day
Start
Finish
Mon
Will the facilities for making music be Indoors
or outdoors or both
Outdoors
please tick [v"] (please read Guidance Note 2)
Both
Indoors
Please glye further details here (please read Guidance Note 3)
Tue
Wed
Sl1t1 !!nl£ n1sgnal variation a for the l!rov111on 2! fa!!llltlH !gr !l!!!~lne music) (please
read Guidance Note 4)
Thur
Frf
Ngn sl!oda[s! llmlmUla Wbiri ll'.~U! IDliDs! 10 uu the l!remlees for grovl1l2n 2f f!!!lllllgs
for making m1i11I!! !Dl!!:blnmenl 1t different times 12 lhoae llstgd In tbe !!Olumn on the
left. please list (please read Guidance Note 5)
Sat
Sun
J
Provision of facllltles for
dancing
Standard days and timings
Wiii the facilities for dancing be Indoors or
outdoors or both ­
(please read Guidance Note 6)
please tick [v'] (please read Guidance Note 2).
Day
Mon
Start
Finish
Indoors
Outdoors
Both
Please give further details here (please read Guidance Note 3)
Tue
Wed
State anl£ seasonal variations for l;?[O_vldloa dancing facjllli•! (please read Guidance
Note 4)
Thur
Fri
Sat
Sun
~Qn •l!!n!;!ard ljm!nes. Whe!§ JtOU Intend to use th! l!rtml!H t2r llli provision of
f!!!illl!es for dancing !!nlertalnment a! s!lfferent times to th2se [email protected] In the column on
the left. please llst (please read Guidance Note 5)
K
Provision of facilltles for
entertainment of a slmllar
description to that falling
within 0) or (k)
Standard days and timings
Please give a description of the type of the entertainment you wlll be
providing
(please read Guidance Note 8)
Day
Start
Finish
Mon
Wiii the facllltles for making music be
Indoors or outdoors or both
Outdoors
please tick [.I') (please read Guidance Note 2).
Both
Indoors
Pleate give furtbtr detail• here (please read Guidance Note 3)
Tue
Wed
~tale anit teBSQ!l!!l lllCl1ll2n1 fQr Jhe 11r2~l!l2!1 2f fi!~lllll•• for 1nllrtalnm1nt of!
1lm!lar description to that fal!!np wltbln mO[ (K) (please read Guidance Note 4)
Thur
Fri
Non standard Umlngs. Where vou Intend to use the premises for provision offacllltlu
f2r making !!l!i!!I~ gnll!!!lnmtat 11 sHffer:11Jl !lm1• to !:!!O!! ll1ted In the column 2n d]g
left. plea11 !let (please read Guidance Note 5)
Sat
Sun
L
Late night refreshment
Standard days and timings
Wiii the provision of late night refreshment
take place indoors or outdoors or both ­
Finish
Start
Mon
12-~
- 11:
Tue
1&n
(l'(Y)
Wed
l'l ::lt'""'L'\
~"
Thur
') '2(-'1)
f\C'l:"'n
Frl
12....~
("(\N'\
Sat
I? 'l.i -y"\
( ' {-1 ' { )
Sun
., '7(-n ~
-
-
....,
- --­
.
Outdoors
(please read Guidance Note 6)
Day
Indoors
please tick[~] (please read Guidance Note 2).
Both
Please give further details here (please read Guidance Note 8)
Statg any uasonal variations for the provision Qf late night refreshments (please read
Guidance Note 4)
Non standard timings. Where Y()U !ntgnd t2 use the premises for the pr2vlslon of late
nlabl r1freehm!nt at s!lffe!!nt times to thoB& llated In the column on the left, pleaee llst
(please read Guidance Note 5)
11 M
-·
'
Supply of alcohol
Standard days and timings
Will the supply of alcohol be for
consumption
(please read Guidance Note 6)
please
Day
Start
v:tJ.
rY'l.Y:J
Tue
7 ()()
N\(")()
Wed
l200_ QOJ.)_
Fri
Sat
Sun
1\'J(Y)
{))i'f)
li?ffi
(iY'\)
0 (")'.)
ili_)Q_
12.D.)
("'i)(Y)
I
(please read Guidance Note 7).
Both
Finish
Mon
Thur
tick[~]
On the
oremises
Off the
oremises
State any 1tuonal varfatlon1 on the 1upply of alcohol (please read Guidance Note 4)
No!l sf!nda{d timings. Wh!i! ri xgu Intend to us2 !h• 11remlse!,! f or the SU(!(!lli'. of alcohol
at dlf:(e[!!nl limes to those 1!!1•5! la lb!i! cotumn 21! lhg It!!. Pli!B!! llet (please read
Guidance Note5)
State the name and details of the lndlvldual whom you wish to specify on the licence as
premises supervisor
Name
-:1:00~ ... o.&.A~l ...........
N/A v
Please give further details here (please read Guidance Note 4)
0
-• ,
Hours premises are open
to the public
Standard days and timings
(please read Guidance Note 6)
Day
Start
State any seasonal variation (please read Guidance Note 4))
Finish
Mon
Tue
Wed
1---­
l-'-L-u::"'-l--1~~~~
Non standard timings. Where you Intend to use the premlsea to open to the public at
deferent times from tf!ose llated In the column on the left. please list (please read
-'-- ---'-------' Guidance Note 5)
Thur
Fri
Sat
Sun
p
Describe the steps you intend to take to promote the four licensing objectives:
lease read Guidance Note 9
a General - all four llcensln ob ~tlves b,c,d,e
bl The prevention of crime and disorder
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• s1er-s AT exrrs f\S~NG ~ 1D 1..ffh€: Pl2€ ·rn1ses QvitTL'i'
d The reventlon of ubllc nuisance
e) The protection of children from harm
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CHECKLIST
Please tick -.lyes
• I have made or enclosed payment of the fee
8
• I have enclosed the plan of the premises
Jm
• I have you sent copies of this application and the plan to responsible authorities
and others where applicable
~
• I have enclosed the consent form completed by the individual I wish to be premises
supervisor, if applicable
~
• I understand that I must now advertise my application
m
• I understand that if I do not comply with the above requirements my application will
~
be rejected
IT IS AN OFFENCE, LIABLE ON CONVICTION TO A FINE UP TO LEVEL 5 ON THE
STANDARD SCALE, UNDER SECTION 158 OF THE LICENSING ACT 2003 TO MAKE
A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION
Part 5 - Signatures (please read Guidance Note 10) Signature of applicant or applicant's solicitor or other duly authorised agent. (See Guidance Note 11) If signing on behalf of the applicant please state in what capacity. Signature~--· ······ ··· · ···
Capacity .. D.\.<2.ec.1~
... ........... .......... .
....... ...... ......... ... .... .. ... Date
02-.. fe.g,12.,Ll.ffi(\(.. 20.\5.... For joint applications signature of 2nd applicant or 2nc1 applicant's solicitor or other authorised agent.
(please read Guidance Note12) If signing on behalf of the applicant please state In what capacity.
Date .. ... ....... .... ..... ..... .... .... ... ....... .... . .
Signature ..... ...... ... ............... .. .. .. ........ .. .. .. .. ... ... .
Capacity .... .. .. ... .. .... .... .... .. ......... ... ... .... ... .. ... .. ... .
Contact name (where not prevlously given) and postal address for correspondence associated with
this application (please read Guidance Note 13)
~00\c
G,~f\'/
m(X)'l... HALL ,
n ,-.,...,... ["_·~
If""\
~ 11.,..~
Post town
Telephone number (if any)
il-.Of'C>
Postcode
O-=l-'4-'12- C1 14 <(;&1­
If you would prefer us to corre~nd with you by e·mall your e-mail address (optional)
JOOK~: .. ~~e.A'V
Cf.U U\.e
.. CO~ u~
Guidance Notes
1. Describe the premises. For example the type of premises, its general situation and layout and any
other information which could be relevant to the licensing objectives. Where your application includes
off-supplies of alcohol and you Intend to provide a place for consumption of these off-supplies you
must include a description of where the place will be and its proximity to the premises.
2. Where taking place In a building or other structure please tick as appropriate. Indoors may include a
tent.
3. For example the type of activity to be authorised, If not already stated, and give relevant further details, for example (but not exclusively) whether or not music will be amplified or unamplifled. 4. For example (but not exclusively), where the activity will occur on additional days during the summer
months.
5. For example (but not exclusively), where you wish the activity to go on longer on a particular day i.e.
Christmas Eve.
6. Please give timings in 24 hour clock (e.g. 16:00) and only give details for the days of the week when
you intend the premises to be used for the activity.
7. If you wish people to be able to consume alcohol on the premises please tick on, If you wish people
to be able to purchase alcohol to consume away from the premises please tick off. If you wish people
to be able to do both please tick both.
8. Please give information about anything intended to occur at the premises or ancillary to the use of the
premises which may give rise to concem in respect of children, regardless of whether you Intend
children to have access to the premises, for example (but not exclusively) nudity or semi-nudity, films
for restricted age groups, the presence of gaming machines.
9. Please list here steps you will take to promote all four llcenslng objectives together.
10. The application form must be signed.
11. A applicant's agent (for example solicitor) may sign the form on their behalf provided that they have
actual authority to do so.
12. Where there is more than one applicant, both applicants or their respective agents must sign the
application form.
13. This is the address which we shall use to correspond with you about this application.
15
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