EXEMPT Form V1. August 2017
APPLICATION FORM BUILDING CONSENT EXEMPTION
under Building Act 2004 Schedule 1(2)
OWNER / APPLICANT (attach evidence of ownership to this application, and if not the owner, attached details
of authorisation to lodge application on owner’s behalf).
Name:
Phone No:
Postal address:
Cell phone:
Fax:
Email:
Signature:
Date:
BUILDING LOCATION
Street address:
(or RAPID number)
Legal description:
Year of construction:
Valuation number:
Current, lawfully established use:
PROJECT (Provide sufficient description of building works to enable scope of work to be fully understood)
Description of building works
Estimated value of work (incl. GST)
$
Provide details of any proposed new use
ATTACHMENTS
Producer Statements References to determinations / opinion
Copies of plans and specifications Photographs
Other:
DECISION (to be completed by the Territorial Authority)
Approved Building consent is not necessary because either:
The completed building work is likely to comply with the building code; or
If the completed building work does not comply with the building code it is unlikely
to endanger people or any building, whether on the same land or on other property.
Not Approved A building consent is required for the above project.
Building Control Officer:
Date:
PLEASE NOTE: assessment of the information provided with this application has only been made in
consideration of the Building Act 2004. Additional authorisations may be required under other
legislation including the Resource Management Act, Health Act, Sale and Supply of Alcohol Act etc.
and remain the responsibility of the owner to check.
FEES: An assessment fee plus time spent will be invoiced as per the Councils fee schedule.
Assessment fee $________ plus _______ hours = $___________ Invoiced: Y N
Exemption from Building Consent
(exemption 2 only)
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome