Stallholder Application Form - Cotton Tree Market by lSU30ve4

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									Memorial and Plaque Request Form
This request form is for the management, placement, maintenance or development of a diverse range of memorials and
plaques on public land within the Sunshine Coast region, that commemorate and honour people and organisations who
have contributed significantly to our community, or commemorate significant events and places.

Please tick box to indicate that you have read:                The Memorials and Plaques Policy and
                                                               The Memorials and Plaques Guidelines
Please indicate the TYPE OF MEMORIAL you request (the Guidelines provide indicative costs of standard items):


        Category 1: standard memorial items (complete pages 1, 2 and 3)

                Plaque: on a bench, wall or similar feature/item of furniture, established in memory of any person,
        organisation or event. And/or

               Park Furniture: established in memory of any person, organisation or event; and taking form in the
        shape of a bench, wall, paving or similar feature/item of furniture.

                 Commemorative tree: planted in honour or memory of a person/s, organisation or event.

Note:   The term ‘standard’ is used for items that are designed, costed and installed according to conditions determined by council.

        Category 2: non standard memorial items (complete pages 1, 2, 3, 4 and 5)

               Object, sculpture or structure: can be identified as a memorial in form, have a designer/artist in the
        development of the work and which are to be located on land either owned or managed by council.

             Landscape feature: specific areas of the region that can be enhanced, redeveloped or reclaimed in
        commemoration of a person or organisation, event or place;

                Restoration of an existing feature: undertaken to commemorate a person/s, organisation, event or place
        in a way that contributes to the enhancement of the cultural, social, environmental and economic significance of
        the area in which they were located.

 1. Applicant Contact Details

 First Names                                                                    Last Name


 Organisation Name (if applicable)                                              ABN


 Postal Address


 Suburb                                                                         State                      Post code


 B/H Phone                             A/H Phone                                Mobile Phone


 Email address                                                                  Website


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Please Complete Page 2 for Category 1 and Category 2 items:
 3. Describe memorial item or feature being requested:




 4. Preferred Site(s) for memorial feature – please attach a copy of a map identifying the proposed site(s)
     st
 1 preference:          Town
                        Park
     nd
 2        preference:   Town
                        Park
                   2                                                                                                                       1
 5. Reasons for memorial request – please describe and attach evidence, that demonstrates the significance
 of the subject, person or theme of the proposed memorial feature. If your request is for a. the Restoration of an existing
 Memorial, or b. Memorial feature elsewhere that also honours the same person, group or event describe current location and its significance.




 6. Community Support – please describe and attach confirmation, of community support for the reasons given
 above. This will assist council in understanding the wider community perspective.




 7. Environmental Impacts of memorial feature – please describe how the proposal is designed or placed in a
 manner that is sensitive to the local environment (if the public space can be observed to hold a significant number of
 memorial items, please indicate how your proposal will complement existing items)




 8. Wording to be used on plaque or memorial (max 40 words):




 9. Agreement of deceased’s family member(s) if memorial request is from an organisation to recognise an individual


 Name:                                                                        Signature:


 The Burra Charter (the Australian International Charter for the Conservation of Monuments and Sites [ICOMOS]) states that the
significance of a place is embodied in:
            its fabric and its setting
            other evidence of its history
            its association with the community
2
  For example: An individual or organisation that has made a highly significant contribution to the cultural, political or social
development of the community or area and/or the history or development of the Sunshine Coast; An important anniversary or an
event unique and highly significant to the history and development of the Sunshine Coast; An historical or other culturally significant
event related to a particular site or area.
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CATEGORY 1 – Complete page 3 and then submit:
 10. Check List for CATEGORY 1 requests:
      I have reviewed the Guidelines for indicative costs of the items I request which totals $
      Payee’s name for council to invoice finalised costs upon approval of this request:
      I have attached a map identifying preferred proposed site
      I have attached evidence of significance and endorsement by community members/stakeholders
      I have responded to all sections of this request form

 11. Applicant’s Agreement
 I have read and understand the terms and conditions in the Guidelines and if my request is approved, I agree to comply with all
 regulations, maintenance and deaccessioning governing Memorials and Plaques.
 Applicant’s Name                                      Signature                                               Date




CATEGORY 1: Please print and post this completed request and attachments to:
 Att. Memorials and Plaques                            Deliver to any
 Sunshine Coast Regional Council                       Sunshine Coast Regional Council Customer Service Centre
 Locked Bag 72 Sunshine Coast Mail Centre        or    Att. Memorials and Plaques
 Nambour QLD 4560




                                                       OFFICE USE ONLY

   Agreement to Request                                 Further material required to determine suitability
   Request does not meet criteria
 Manager                                                                     Signature                                Date

 Council Branch responsible for project:
 Council Officer to manage project:

       Approved for installation
    1. Applicant notified with Letter of Agreement
    2. Item registered on Asset Register
    3. Inscription ordered
    4. Inscription proof read by Applicant and approved
    5. Applicant has paid for Item
    6. Item installed
 Comments:




(CATEGORY 2 REQUESTS please continue to Page 4)

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CATEGORY 2 REQUESTS: please continue:
Please refer to the Memorials and Plaques guidelines for the procedure relating to non standard memorial requests.
 The preliminary stage for consideration of your request will occur at the Memorials and Plaques panel meeting that
   meets quarterly.
 For this first stage, you will need to have provided council with:
        1. Evidence that your request meets the criteria for approval provided in your responses to Qs 3 to 9 (above);
        2. Additional detail of the proposal provided in your responses to Qs 12 to 21 (below): i.e. a concept design
              showing where the memorial feature would be placed and its size and design; plus the costs involved and
              the financial capacity of the applicant to meet these costs.
 The panel will consider if your request meets the Policy criteria. Built features will be additionally considered by the
   Public Art Panel. Following ‘in principle’ approval to proceed, a schedule for consultative design, construction and
   installation will be negotiated with the applicant on a case by case basis.

 12. Memorial Specifics:

 Height                        Length                        Width                           Total Ground Area


 Inscription                                                 Materials




 13. Concept design including detailed drawings, models and/or photos of the proposed memorial attached


 14. Memorial Designer/Artist Details

 First Names                                                              Last Name


 Organisation Name (if applicable)                                        ABN


 Postal Address


 Suburb                                                                   State                    Post code


 B/H Phone                           A/H Phone                            Mobile Phone


 Email address                                                            Website



 15. Public Safety Issues – are you aware of any potential safety issues in your proposal?


    The proposal has no public safety implications
    The proposal may affect public safety – please describe:




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 17. Memorial Maintenance and Repair – please attach a detailed maintenance plan including cleaning requirements and
 likely long-term costs for repairs or restoration developed and approved by a conservator




 18. Costs of construction – please itemise costs and attach any quotes received:
 Item:                                                           Cost $
 Item:                                                           Cost $
 Item:                                                           Cost $
 Item:                                                           Cost $
 Item:                                                           Cost $
                                                                 Total $
 19. Details of Existing Funds – please attach copies of statements from financial institutions of funds raised and letters of
 commitment for grants




 20. Payment of Memorial and/or Plaque costs – please give Name and address




 21. Annual Timetable of Ceremonies/Commemorations to Occur at Proposed Memorial (if applicable)




 22. Check List
      I have responded to all sections of this request form
      I have attached a map identifying preferred proposed site
      I have attached evidence of consultation and endorsement by community members/stakeholders
      I have attached a concept design including detailed drawings, models and/or photos of the proposed memorial
      I have attached copies of statements from financial institutions of funds raised and letters of commitment for grants
      I have attached a detailed maintenance plan approved by a conservator
 21. Agreement
 I have read and understand the terms and conditions and retained a copy for my records and if my request is approved, I agree to
 comply with procedures of the Memorials and Plaques guidelines and all regulations governing Memorials and Plaques.
 Applicant’s Name                                      Signature                                                 Date



Please post this completed request and attachments to:
 Att. Memorials and Plaques                            Deliver to any
 Sunshine Coast Regional Council                       Sunshine Coast Regional Council Customer Service Centre
                                                 or
 Locked Bag 72 Sunshine Coast Mail Centre              Att. Memorials and Plaques
 Nambour QLD 4560

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                                                  OFFICE USE ONLY

 Suitability Criteria
    There is demonstrated ownership, origin and/or context (if an object/artefact)
    Able to interpret and demonstrate particular themes, people or ideas important to the community
    Community and environmental appropriateness
    Proven association with some event or period in history that is considered by the relevant community as significant
    Does not compromise the aesthetic integrity of the site nor disturb the fabric or character of the proposed site
    Does not interfere with existing and proposed circulation and use patterns
   Is consistent with council’s planning scheme and approved plans for the proposed site
 More Information Required
   Further support materials are required to determine suitability
 Comment:



   Further stakeholder consultation required to determine suitability
 Comment:




   Refer to the Public Art Panel
 Comment:




 REQUEST APPROVED to proceed                      REQUEST NOT APPROVED
 Comment:




 Agreement

 Manager                                                                Signature                           Date




 Council Branch responsible for project:
 Council Officer to manage project:




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