Fillable 1. What are you applying for? (Tararua District Council New Zealand)

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1. What are you applying for? (Tararua District Council New Zealand)

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COUNCIL USE ONLY
BC Number
Section 33 or 45. Building Act 2004.
Receipt Number
Amount Paid
1. What are you applying for?
Tick all applicable
¹ For PIM only applications complete Sections 1 to 7, and 13 only.
Follow instructions as per section.
Building Consent
Project Information Memo (PIM)¹
Amendment to Building Consent
2
Building Consent using a National Multiple-Use
Approval (‘MultiProof’)
3
Staged Consent
2
2
Please enter existing building consent number below:
3
Please enter National Multiple-Use Approval number below:
2. What building work are you doing?
Tick all applicable
If your building work is not listed, tick
and provide details (this includes amendments to building consents)
RESIDENTIAL
New detached dwelling
New multi-residential dwelling
(more than 2 household units)
Plumbing works
Major alterations/additions – any
work that includes altering or
attaching to the exterior of a
building
Minor alterations – any internal
work that does not include
altering the exterior of the
building
New solid fuel burner
Garage / detached carport
Other,
(please provide details below)
COMMERCIAL/INDUSTRIAL
New commercial / industrial
building
Major alterations/additions – any
work that includes altering or
attaching to the exterior of a
building
Seismic strengthening
Minor alterations – any internal
work that does not include
altering the exterior of the
building
Internal fit-out only (including
Other,
(please provide details
below)
APPLICATION FOR BUILDING CONSENT (Form 2)
05-12-2017 v1.10 GoShift Building Consent Application Page 1 of 10
3. Where is the building work?
Complete all fields, enter N/A where not applicable
What is the street
address?
*No street address?, State nearest street intersection & distance / direction from that
intersection
Legal description: LOT: DP:
Building name:
Location of building within site/block
including near street access:
Level /
Unit #:
Does the building or site have any cultural or heritage significance, or is it a Marae?
Yes
No
If Yes, provide details
If a sub division is proposed and you have not yet received a s224 certificate, the application will also need to provide
any relevant information stating legal description as at the date of application and, if subdivision is proposed, include
details of the relevant resource consent number and any proposed lot numbers.
If Yes, complete the following:
Resource Consent No.
Proposed LOT No.
4. Who owns the building or land?
Complete all fields
Owner name: Title: e.g. Mr, Mrs, Ms, Dr
Owner email address:
Owner contact numbers: PH: Cell:
Owner mailing address:
Indicate which of the following Proof of Ownership documents is attached to your application. Your document must be
less than 3 months old.
Copy of Certificate of
Title
Copy of Lease
Agreement
Agreement for
Sale & Purchase
Other document showing
full name of legal owner
Are you using an Agent?
Yes
No
If Yes, please also complete the following
Who is the first point of contact for further correspondence?
Agent
Owner
Who is the first point of contact for invoicing?
Agent
Owner
Agent name: Title: e.g. Mr, Mrs, Ms, Dr
Agent email:
Agent contact numbers: PH: Cell:
Agent mailing address:
Relationship to owner:
05-12-2017 v1.10
GoShift Building Consent Application
Page 2 of 10
5. Who’s involved in the build?
Complete all fields per line, or select N/A where not applicable. If you have additional roles
to add, please use the table in Appendix A
.
Role
N/A
Trade
Designer
Name:
Address:
Contact number:
Email:
Licensing class:
Registration number:
LBP:
Trade
Architect
Name:
Address:
Contact number:
Email:
Licensing class:
Registration number:
NZRAB:
6. What are the specifics of the site?
Complete all fields
What is the wind zone?
Low
Medium
High
Very High
Extra High
Specific Design
State value below
What is the exposure zone?
Low (B)
Medium (C)
High / Sea spray (D)
Does the proposed building work cover two or more allotments?
Yes
No
Are there public drains on the site?
Yes
No
Is the site subject to natural or created hazards such as erosion, subsidence, flooding, slips,
cut and fill or contamination?
Yes
No
Is it a sub-division?
Yes
No
Are there any alterations to land contours (e.g. earthworks)?
Yes
No
Are there new or altered connections to public utilities?
Yes
No
Are there new or altered locations and/or external dimensions of buildings?
Yes
No
Is there new or altered access for vehicles?
Yes
No
Is the building work over or adjacent to any road or public place?
Yes
No
Does the building work involve the disposal of storm-water or wastewater?
Yes
No
Is the building work over any existing drains or sewers or in close proximity to wells or
water mains?
Yes
No
Are there any other matters known to the applicant that may require authorisation from the
territorial authority?
Yes
No
If Yes, please provide a summary here
Page 3 of 10
05-12-2017 v1.10
GoShift Building Consent Application
7. What are the details of the building work?
Complete all fields, or enter N/A if not applicable
Provide a full description of
the building work:
E.g. 4 Bedroom dwelling with,
multiple cladding types and
attached garage
Estimated value of the building work (including GST): $
If the application is for an amendment to a building consent, please add the
additional value if applicable (including GST):
$ N/A
What is the intended life of the building?
50+ years
Limited Life
If Limited Life, please indicate the intended life of the building years
Have you discussed this project with Council prior to applying?
Yes
No
Does the project include Restricted Building Work?
Yes
No
Are you applying for Owner/Builder exemption to complete the Restricted
Building Work?
Yes
No
If Yes, please complete and attach the
Statutory Declaration as to Owner Builder
form
(click here)
If No, please complete and attach the
Memorandum from Licensed Building Practitioner: Certificate of Design Work
form (click here) for each
type of building work being undertaken
Total number of floor levels: Levels below ground:
Current floor area: Proposed new total floor area:
If you are making alterations to an existing dwelling, please complete the following:
Is there any Recladding?
Yes
No
Is Recladding covered by a claim under
the Financial Assistance Package
scheme?
Yes
No
If Yes, please provide Financial Assistance Package reference number
Does the building work involve a swimming pool?
Yes
No
Year first constructed:
Current lawful established use:
Proposed use:
Will the building work result in a change of use of the building?
Yes
No
If you are unsure how to determine if a change of use will occur, please refer to the guidance provided by the Ministry of Business, Innovation and
Employment: http://www.building.govt.nz/managing-buildings/change-of-use-and-alterations/
If Yes, please provide details
Page 4 of 10
05-12-2017 v1.10 GoShift Building Consent Application
b
8. What clauses of the building code does your building work comply with?
Please read the following carefully:
•
You are required to indicate what code clause(s) your building work complies with
•
Unless otherwise noted below, your application will be assessed under Acceptable Solutions
•
If you are using another means of compliance, please provide details of the standard(s) that your building work
complies with and the means of compliance in the space provided. Use a separate sheet of paper if necessary
•
If you do not provide all the necessary information to show how your application complies with the Building Code, it
will be returned unprocessed.
I understand that this application is to be assessed against Acceptable Solutions, unless otherwise stated in the
following section.
Please tick to indicate your agreement.
B1 Struct
ure
F1 Hazardous agents on site
G5 Interior environment
B2 Durability
F2 Hazardous building
materials
G6 Airborne & impact sound
C1 Protection from fire
F3 Hazardous substances and
processes
G7 Natural light
C2 Prevention of fire occurring
F4 Safety from falling
G8 Artificial light
C3 Fire affecting areas beyond
fire source
F5 Site safety
G9 Electricity
C4 Movement to place of safety
F6 Visibility in escape routes
G10 Piped services
C5 Access & safety for fire-
fighting operations
F7 Warning systems
G11 Gas as an energy source
C6 Structural stability
F8 Signs
G12 Water supplies
D1 Access routes
F9 Means of restricting access
to residential pools
G13 Foul water
D2 Mechanical installations
G1 Personal hygiene
G14 Industrial liquid waste
E1 Surface water
G2 Laundering
G15 Solid waste
E2 External moisture
G3 Food preparation &
prevention of contamination
H1 Energy efficiency
E3 Internal moisture
G4 Ventilation
Provide details of all Verification Methods being used
(include relevant code clause and means of compliance)
Provide details of all Alternative Solutions being used
(include relevant code clause and means of compliance) or details of any waivers
and modifications (including applicable code clauses)
Page 5 of 10
05-12-2017 v1.10 GoShift Building Consent Application
9. What specified systems are in your building?
Complete all fields
Does your building work involve any Specified Systems (SS)?
Yes
No
Residential
please complete the following
N/A
If Yes, please complete Specified System 16 (Cable Car) below
SS16 Does your building work involve a cable car?
Yes
No
If Yes, please provide detail
below
SS Cable cars
Existing
Removed
Altered
Added /
New
Complete this section if the cable car is being altered or added
Performance Standards Inspection & Maintenance
Procedures
Reporting
Frequency
Provide any other details
Commercial
please complete the following and Appendix B (Specified Systems)
N/A
If applicable, what is the existing compliance schedule number?
Risk Group:
Total occupancy numbers:
10. Does your build require a fire design review?
Certain applications for building consent must be submitted to the Fire and Emergency New Zealand Fire Engineering
Unit (FEU) for review.
For commercial / industrial applications please complete the following:
Is your building of a type defined in the Gazette notice and section 46 of the Building Act,
2004?
Yes
No
05-12-2017 v1.10
GoShift Building Consent Application
Page 6 of 10
11. Have you attached all required documents?
You are required to provide all the necessary documents to support your application. This includes (but is not limited to)
the following sections:
•
Section 4: Proof of Ownership
•
Section 6: Plans showing land and boundary features as required
PIM, development of contribution notice or certificate attached to PIM
•
Section 7: Statutory Declaration as to Owner Builder form OR Memorandum of Licensed Building
Practitioners – Certificate of Design Work (for each type of building work being undertaken)
•
Section 8: Plans, specifications and other supporting information in relation to the compliance method of
the build, e.g. where the work deviates from an Acceptable Solution method.
Please check your application and ensure all the supporting information is attached otherwise your application will be
returned
.
When you are satisfied your application is complete, please complete section 13 and send to your local Building Consent
Authority.
If you are unsure about what information to include in your application, a guidance document is available (click here)
Privacy Information
The information you have provided on this form is required so that your building consent application can be processed
under the Building Act 2004. The Council collates statistics relating to issued building consents and has a statutory
obligation to forward these regularly to Statistics New Zealand. The Council stores the information on a public register,
which must be supplied (as previously determined by the Ombudsman) to whoever requests the information. Under the
Privacy Act 1993 you have the right to see and correct personal information the Council holds about you.
12. Your application fees
Your council will charge fees for your consent application. These will include statutory levies payable to BRANZ and the
Ministry of Business, Innovation & Employment.
A full fee schedule can be found on the Council’s website. Please consult this before submitting your application.
13. Have you signed the application?
I request that you issue a project information memorandum, project information memorandum and building consent, or
building consent for the building work described in this application.
All of
the information contained in this application is, to the best of my knowledge, true and correct. I understand that
work must not commence until the building consent is issued and uplifted.
Name and signature of the owner / agent on behalf of and with the authority of the owner
Owner / Agent Name:
Owner / Agent Signature:
(Enter your name and tick the
acknowledgement box if you do
not have a digital signature)
Date:
Your loc
al council (or their website) will be able to help you with information specific to the site your application covers.
05-12-2017 v1.10 GoShift Building Consent Application Page 7 of 10
I understand that this application may only be made with the owner's approval. Please tick to indicte your agreement.
click to sign
signature
click to edit
Appendix A List of those involved in the build
Role
Trade
Name:
Address:
Contact number:
Email:
Class:
Registration number:
Trade
Name:
Address:
Contact number:
Email:
Class:
Registration number:
Trade
Name:
Address:
Contact number:
Email:
Class:
Registration number:
Trade
Name:
Address:
Contact number:
Email:
Class:
Registration number:
Trade
Name:
Address:
Contact number:
Email:
Class:
Registration number:
05-12-2017 v1.10 Page 8 of 10
GoShift Building Consent Application
Appendix B List of specified systems
(Commercial / Industrial Building Consent Applications)
The specified systems for the building are as follows:
Tick all applicable and outline the performance standards and reporting frequency
The following specified systems
are existing, being altered, added
to, or removed in the course of the
building work
Existing
Altered
Added/New
Removed
Complete this section if systems are new,
altered or added only
Performance
standards
Inspection &
maintenance
procedures
Reporting
frequency
SS1 Automatic systems for fire
suppression (e.g. sprinkler
systems)(includes Gas/Flood
Systems)
SS2 Automatic or manual
emergency warning systems
for fire or other dangers
SS3 Electromagnetic or automatic doors or windows
S3.1 Automatic doors
SS3.2 Access control doors
SS3.3 Interfaced fire or smoke
doors or windows
SS4 Emergency lighting systems
SS5 Escape route pressurisation
systems
SS6 Riser mains for use by fire
services
SS7 Automatic backflow preventers
connected to a potable water
supply
SS8 Lifts, escalators, travellators or other systems for moving people or goods within buildings
SS8.1 Passenger-carrying lifts
SS8.2 Service lifts
SS8.3 Escalators and moving
walkways
SS9 Mechanical ventilation or air
conditioning systems
SS10 Building maintenance units (for
providing access to the exterior
and interior walls of a building)
SS11 Laboratory fume cupboards
SS12
Audio Loops or other assistive listening system
SS12.1 Audio loops
SS12.2 FM radio frequency
systems and infrared beam
transmission systems
05-12-2017 v1.10 GoShift Building Consent Application Page 9 of 10
The following specified systems
are existing, being altered, added
to, or removed in the course of the
building work
Existing
Altered
Added/New
Removed
Complete this section if systems are new,
altered or added only
Performance
standards
Inspection &
maintenance
procedures
Reporting
frequency
SS13
Smoke control systems
SS13.1 Mechanical smoke
control
SS13.2 Natural smoke control
SS13.3 Smoke curtains
SS14
Emergency power systems for, or signs relating to, a specified system in 1-13 above
SS14.1 Emergency power
systems
SS14.2 Signs for systems
SS15
Other fire safety systems or features
SS15.1 Systems for
communicating spoken
information intended to
facilitate evacuation
SS15.2 Final exits
SS15.3 Fire separations
SS15.4 Signs for
communicating information
intended to facilitate
evacuation
SS15.5 Smoke separations
SS16 Cable cars
05-12-2017 v1.10 GoShift Building Consent Application Page 10 of 10
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1. What are you applying for (Tararua District Council New Zealand)

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Completed 11 November 2020

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