Application for Occupation Certificate - Gosford City Council

OFFICE USE ONLY
Application No
__________________
Date Received
__________________
Gosford City Council
49 Mann Street Gosford
Postal: PO Box 21, GOSFORD NSW 2250
Tel (02) 4325 8222
Fax (02) 4323 2477
Email goscity@gosford.nsw.gov.au
Web http://www.gosford.nsw.gov.au
Application for Occupation Certificate
Made under the Environmental Planning and Assessment Act 1979, Section 109C(1)(c)
CERTIFICATE TYPE
If all work is complete tick Final, if you are applying for a certificate for part of the work then tick Interim.
Interim Certificate Final Certificate
This form can also be used for a change of building use for an existing building.
APPLICANT DETAILS
Application can only be made by a person who is eligible to appoint a principal certifying authority – this person is the
applicant for the development consent. However, if the applicant is the licensed building (excluding owner builder) then the
occupation certificate MUST BE applied for by the owner.
Full Name/s or Company Name
Phone (Bus)
Address Details
Phone (Priv)
Mobile
Email Address
SUBJECT PROPERTY
Unit/Street Number Street Name Suburb
Lot No Section DP / SP No.
DEVELOPMENT CONSENT/COMPLYING DEVELOPMENT CERTIFICATE DETAILS
Before an occupation certificate may be issued, the certifying authority must be satisfied that:
- A development consent or a complying development certificate is in force with respect to the building, and
- A construction certificate has been issued with respect to the plans and specifications for the building.
(Not required if development involves no works that is subject to change of use)
Development Application or
Complying Development Certificate No
Date Determined
CONSTRUCTION CERTIFICATE DETAILS – not required for change of building use(not associated with building works)
Construction Certificate No
Occupation Certificate IR 8740859 – 8 October 2013
Date Issued

BUILDING DETAILS
The building classification must be the same as that specified in the development consent or complying development
certificate.
Whole/Part of building
Use
New
BCA Class
Existing
ATTACHMENTS – Indicate the following documents accompanied with the application
Development Consent or CDC Construction Certificate Fire Safety Certificate
Compliance Certificate BASIX Certificate Smoke detector certificate
Wet area installation certificate Land survey Engineering report
Termite control certificate Work as executed stormwater Final acoustic certificate
Mechanical ventilation Certificate Rainwater/Stormwater Cert. Window glazing certificate
Trade waste permit Acid sulphate report Other
APPLICANT DECLARATION
I the undersigned declare that the details provided to Gosford City Council is to the best of my knowledge, true and
correct. And that works have development consent and have been completed in accordance with the consent and
applicable conditions.
Applicant Name
Applicant Signature
Date Signed
RIGHT OF APPEAL
Under Section 109K of the Environmental Planning & Assessment Act where the certifying authority is a Council an
applicant may appeal to the Land and Environment Court against the refusal to issue an occupation certificate
within 12 months from the date of the decision.
LODGEMENT DETAILS – You can lodge the completed application by
VISITING Gosford City Council Monday to Friday 8.30am – 5.00pm
49 Mann Street
GOSFORD NSW 2250
EMAIL goscity@gosford.nsw.gov.au (The completed application form must be sent as an attachment)
POST PO Box 21, GOSFORD NSW 2250
PRIVACY AND PERSONAL INFORMATION
Information on this form is being collected by Council for administrative and assessment purposes. It may be used
by Council staff and other government agencies for the purpose of assessing your application. This application
form and any supporting documents lodged with Council may be made available for public access. It is the
applicant’s responsibility to ensure any documents do not contain any personal or financial information.
Occupation Certificate IR 8740859 – 8 October 2013 Page 2