Building Consent, PIM, COA Application - Whangarei District Council

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Declaration (see guidance note 3) I/we give authority for the person named as agent to act in that capacity on my/our behalf in connection with all matters pertaining to this application Signature of owner Date Print name Or Letter received 4 First point of contact for communication with Council/building consent authority Owner Agent Other Note: Contact details must be in New Zealand To assist in prompt communication with our customers, Council prefers to contact you by email where possible. Please indicate below that you authorise WDC to contact you in this manner Yes No – please use my postal address 5 I/we request that you issue a: Project information memorandum Project information memorandum & building consent Building consent Certificate of acceptance (provide date building work undertaken) Date (for the building work described in this application) Owner Agent on behalf of and with the authority of the owner Signature Name (Please print) Date Position or title (Please print) 6 The project 6.1 Description of the building work (see guidance note 4.1) 6.2 Intended use 6.3 Will the building work result in a change of use of the building? No Yes If yes, provide details of the new use 06/702151 February 2012 2
7 Intended life of the building if less than 50 years (see guidance note 4.2) years 8 List building consents previously issued for this project (if any) 1 2 9 Project size and value (see guidance note 4.3) Estimated value of the building work on which the building levy will be calculated (including goods and services tax) (state estimated value as defined in section 7 of the Building Act 2004) $ Ground floor area of project Upper floor area of project Total floor area of project 10 This application is in relation to (please box) (see guidance note 4.4) Domestic Commercial Industrial Multi storey Number of levels 11 What is the nature of the consent (please box) (see guidance note 4.5) New Building exclude domestic garages and domestic outbuildings Foundations only Alterations, repairs, extensions, conversions, re-siting, installation of heating appliances & plumbing & drainage only Other new construction and demolition Plumbing and drainage (only includes on-site effluent disposal) 12 Staged Consents Is this a staged project (see guidance note 4.6) Yes No If yes, is stage of an intended stages 13 Restricted building work (see guidance note 12) Will the building work include any restricted building work? Yes No If Yes, provide the following details of all licensed building practitioners who will be involved in carrying out or supervision the restricted building work: (if these details are unknown at the time of the application, they must be supplied before the work begins) Name Licensing class Licensed building practitioner number (or registration number if treated as being licensed under the section 291 of the Building Act 2004) 06/702151 February 2012 3
Page 1: Private Bag 9023 | Whangarei 0148 |
Page 5 and 6: Other Name Reg no Email Address Pos
Page 7 and 8: 19 Code clauses (see guidance note
Page 9 and 10: 20 Compliance schedule (see guidanc
Page 11: Office use Application not accepte

Building Consent, PIM, COA Application - Whangarei District Council

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