ORKNEY ISLANDS AREA LICENSING BOARD
APPLICATION FOR CONFIRMATION OF PROVISIONAL PREMISES LICENCE
Licensing (Scotland) Act 2005, section 46
Question 1
Name, address and postcode of premises in respect of which provisional premises licence is held
Question 2
Particulars of applicant
Name, address, including postcode, email address and telephone numbers of applicant. Where applicant is a company, please also provide registered office and company registration number.
Question 3
Date of issue of Provisional Premises Licence
DECLARATION BY APPLICANT OR AGENT ON BEHALF OF APPLICANT
If signing on behalf of the applicant please state in what capacity.
I hereby confirm that since the provisional premises licence was issued, or if, since that time, an application for a variation of the licence has been granted under section 30, since the last such application was granted:
- that there has been no variation (other than a minor variation) made to the operating plan or layout plan for the premises to which the licence relates.
I further confirm that the contents of this Application are true to the best of my knowledge and belief.
Signature …………………………………… * (see note below)
Date …………………………………………
Capacity ……………………………………. APPLICANT/AGENT (delete as appropriate)
Telephone number and email address of signatory ………………………………………….
………………………………………………………………………………………………………..
- Data Protection Act 1998
The information on this form may be held on an electronic public register which may be available to members of the public on request.
READ APPLICATION CHECKLIST ON NEXT PAGE
IMAGE: The application checklist page contains a checklist of required documents and a table showing premises licence categories, rateable-value bands, category fees, application fees after deducting the £200 provisional licence payment, and boxes to tick.
APPLICATION CHECKLIST:
I have enclosed the relevant documents with this application –
please tick the relevant boxes
(i) Application Fee
Grant of Premises Licence Category Fee as undernoted, less £200 initially paid for Provisional Premises Licence:-
| Premises Licence Category | Rateable Value of Premises | Category Fee | Application Fee | Please tick |
|---|---|---|---|---|
| 1 | Premises rated at nil or not shown in the valuation roll Visitor Attractions Clubs Private Accommodation | £200.00 | £0.00 | |
| 2 | £1 – £11,500 | £800.00 | £600.00 | |
| 3 | £11,501 – £35,000 | £1100.00 | £900.00 | |
| 4 | £35,501 – £70,000 | £1300.00 | £1100.00 | |
| 5 | £70,001 – £140,000 | £1700.00 | £1500.00 | |
| 6 | £140,000 – And above | £2000.00 | £1800.00 |
(ii)
Provisional Premises Licence (including the provisional operating plan and layout plan attached) and Summary
(iii)
Operating Plan with section 4(g) – Premises Manager – completed
(iv)
Layout Plan (7 copies)
(v)
Planning Certificate
(vi)
Building Standards Certificate
(vii)
Food Hygiene Certificate