TO: The Municipal Building Surveyor Telephone City of Ballarat PO Box 655 BALLARAT VIC 3353

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1 APPLICATION FOR A DIVISION 2 OCCUPANC PERMIT (For a Place of Public Entertainment) Building Act 1993 BUILDING REGULATIONS 2006 Part 11, Regulation 1002 Form 5 TO: The Municipal Building Surveyor Telephone City of Ballarat PO Box 655 BALLARAT VIC 3353 Fax FROM: Owner of Land o Agent of Owner of Land o Event Applicant s Name: Event Applicant s Postal Address: Contact Person s Name: Contact Person s Telephone Numbers: Landline: Mobile: Contact Person s Address: OWNERSHIP DETAILS: (Only if Agent of Owner listed above) Owner s Name: Owner s Postal Address: Owner s Telephone Numbers: Landline: Mobile: Owner s Address: Description Public Place of Entertainment Prescribed fee $ Receipt No. Date Price Postcode: Postcode: In accordance with Section 54 of the Building Act 1993, I hereby apply for an Occupancy Permit for a Place of Public Entertainment at: No Street/Road.....Suburb Melways Ref:.. (Address of property where the event is proposed to be held) NAME OF THE PROPERT [Where Applicable] EXISTING PROPERT DETAILS Information of existing buildings proposed to be used for the event: o ou are required to attach a copy/s of the most current Annual Essential Safety Measures Report for the building/s: Copies attached o es o No PRESCRIBED TEMPORAR STRUCTURES Is it proposed to have any temporary: Seating stands for more than 20 persons? Stages exceeding 150 m2 in floor area? es o No o Tents or Marquees with a floor area more than 100 m 2? es o No o es o No o Prefabricated buildings exceeding 100m 2? es o No o Note: If the answer to any of the above is es, please provide details below Type of Structure: Size/Capacity of Structure: Bld. Commission Permit No: Hire Company Details: Hire Company Contact Person Temporary Structure Erectors Registration No. Hire Company Contact Telephone Hire Company Address Note: Structural details/certification may also be required for temporary structures that do not require a Victorian Building Authority Occupancy Permit. Location of all temporary structures to be indicated on the site plan for the event

2 NAME OF EVENT PERIOD OF OCCUPATION Day Mon Tues Wed Thurs Fri Sat Sun Date Commencement Time Conclusion Time LOCATION FOR THE DISPLA OF OCCUPANC PERMIT Note: Must be in a prominent position accessible to the Public. NUMBER OF PERSONS Note: Indicate the maximum number of persons to be in attendance at the event at any one time ie. includes participants and spectators: SAFET OFFICER DETAILS Name: Address Home Postal Address Mobile: Qualifications (Provide Documents) Name: Address Home Postal Address Mobile: Qualifications (Provide Documents) TOILET FACILITIES Nominate the number and location of all existing and portable/temporary toilet facilities. Note: Facilities should be distributed as evenly as possible across the event site. Location No of Female No of Male No of Disabled [Unisex] Closet Wash Closet Urinals Wash Closet Wash Fixtures Basins Fixtures Basins Fixtures Basins Female Closet Fixtures No of Disabled Female Wash Basins Male Closet Fixtures Male Wash Basins TOTAL DRINKING WATER How many drinking water fountains do you propose to provide? Where will the drinking water fountains be located? Notes The location of all proposed drinking water fountains/taps must be nominated on the site plan for the event. Drinking water fountains should be distributed as evenly as possible UNSAFE AREAS Are there any unsafe areas where public access should be restricted ie. portable generators, stages etc. es No If yes provide details and indicate locations on site plan. Location of unsafe areas EMERGENC MANAGEMENT & EVACUATION PLAN Have you prepared an emergency management and evacuation plan for the proposed event? es No Note: An emergency management and evacuation plan must be provided with this application.

3 LIGHTING Will the event be conducted after daylight hours? es No If yes, provide details of lighting and detail on site plan. FIRST AID Will a First Aid Room be provided? es No Dimensions of First Aid Room Note: Location of first aid roo to be indicated on site plan FIRE SERVICES Is there any existing fire fighting equipment such as fire extinguishers, hose reel and hydrants that are located within the venue? es No If yes indicate type and location on event site plan. Will additional fire fighting equipment be provided within the venue? es No If es indicate type and location on the event site plan. OTHER FEATURES Is it proposed to have any: Fireworks/Explosives/Flammable Materials ES o NO o Amusement Rides ES o NO o Naked Flames ie. [Theatrical Productions] ES o NO o Alcohol sold or provided for benefit ES o NO o Activities within Council s Parks, Gardens or Reserves * ES o NO o Activities on roadways or footpaths * ES o NO o Changed traffic conditions/traffic Management Plan ES o NO o * Must be approved by Council. NOTES: Further information will be required should the event include any of the above listed features. Locations of fireworks, amusement rides, naked flames and the like must be marked on the site plan for the event. SITE PLAN Provide a Full Scaled Site Plan showing the extent of the site boundary fencing, permanent features and all details as outlined. ** Refer to the attached checklist** Location of All structures Any existing underground services (call dial before you dig) Amenity locations Width of exits and the locations and passageways Drinking water locations Fire extinguisher, hydrant, hose reel locations First Aid Stations Vehicle entry points Public exclusion areas or Unsafe areas Site boundary fencing Lighting Locations (if conducted after daylight hours) Applicants Declaration: I,..... am authorised to apply for this Permit on behalf of Signature of Owner/Agent of Owner NOTES: Date 1. At least 20 working days are required for processing of a Division 2 Occupancy Permit. 2. Any event held within the City of Ballarat Gardens or Reserves must be approved by Council s Events Unit. 3. Any event on Council controlled roadways or footpaths must be approved by Council s engineering Department. 4. Council is collecting this information in accordance with Regulation 1002 of the Building Regulations The personal information will be used solely by Council for the purpose of processing the Occupancy Permit Application. ou may access this information by contacting Council on If you fail to provide this information your application may not be processed.

4 PLACES OF PUBLIC ENTERTINEMENT & PRESCRIBED TEMPORAR STRUCTURES SITE PLAN CHECK LIST Use this checklist when applying for a POPE permit or a Siting Approval. The following information must be included on your site plan: Existing Elements Temporary Elements POPE Siting Direction of North Existing sensitive areas (such as fauna or flora sites) Existing drinking water fountains Temporary drinking water sources and Fountains Existing toilet facilities Temporary Toilet Facilities Emergency access/egress routes Temporary Emergency Services Access Emergency Assembly Areas Emergency Assembly Areas Existing power sources Existing lighting towers Temporary generators, power boxes, and light towers Existing sewerage, gas and electricity Connection points for temporary connections Temporary power sources, generators and distribution boxes. Existing fire extinguishers, hoses or water points (taps) Temporary Firefighting equipment Existing First Aid Facilities Temporary First Aid Facilities Existing steps and ramps Pedestrian routes including access within, to and from the venue (including disabled routes) Existing entry and exit points Temporary entry and exit points Fencing (mesh and picket) Existing fences and gates Pedestrian Barriers Entry & Exit Points Temporary viewing and seating areas Existing picnic areas Existing seating areas Seating areas for wheelchairs Temporary Picnic or quiet areas Existing car parks including access car parks Existing bus stops/train stations Existing traffic lights and pedestrian crossings Temporary Car parks including Access car parks Delivery/Collection areas Taxi and Access and bus drop off pick up points Temporary Structures: Existing buildings and structures Tents & marquees (Show size of each) Prefabricated buildings (Show size of each)

5 Stages (Show size of each) Seating Stands (Show size of each) Food Vendors Aerial rigs Air castles and mechanical rides Ticket Offices//Registration areas Site Offices Existing Administration Facilities Operation or communication centres Media areas Security Station Lost children/property area Existing Unsafe Areas Restricted areas (fireworks discharge areas, fuel storage, generator areas, back of house for performers etc) Existing Liquor Licence Areas Liquor Service Areas (Show locations and Barriers) Location of POPE / Siting Approval Permits and Certificates

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