Fillable Application For Building Consent PIM

Fill Online, Printable, Fillable, Blank Application For Building Consent PIM Form

Use Fill to complete blank online CLUTHA DISTRICT COUNCIL NEW ZEALAND pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Application For Building Consent PIM

On average this form takes 62 minutes to complete

The Application For Building Consent PIM form is 4 pages long and contains:

  • 1 signature
  • 210 check-boxes
  • 146 other fields

Country of origin: NEW-ZEALAND
File type: PDF

Use our library of forms to quickly fill and sign your Clutha District Council New Zealand forms online.

BROWSE CLUTHA DISTRICT COUNCIL NEW ZEALAND FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Form 2: Application for project information memorandum
and/or building consent
Section 33 or 45, Building Act 2004
1. THE BUILDING [Complete all applicable sections]
2. APPLICATION [Nominate as applicable]
3. THE PROJECT
Central Otago District Council
Clutha District Council
Dunedin City Council
Gore District Council
Invercargill City Council
Mackenzie District Council
Queenstown Lakes District Council
Southland District Council
Timaru District Council
Waimate District Council
Waitaki District Council
OFFICE USE ONLY:
Street address of building: ………………………………………………………….…..……………….……..….…..…
…..…………………………………………………………………………………………….
[If no street address – details of nearest intersection] ………………………….……………….……………………….…………
Legal description of land where building is located: Lot ………………………. DP………………...………….
Site area ……………… (m
2
) Sec ………………………. Block……………...…………
Building name: ……….…………………….……… Valuation Number ………………………….……………….
Location of building within site/block number: [Include nearest street access] …………………………….………………
………………………………………………………………………………………………………………………………
Number of levels: [Above & below ground] ………………..………..….. Level /Unit Number: …………..……………
Floor area: …………………..…..… (m
2
) [Indicate area affected by the building work]
Current, lawfully established, use: ……………………………………… Year First Constructed: ………………
[Add no. of occupants per level and per use if more than 1] ……………………………………………..…………………………………………
………………………………………………………………………………………………………………………………
Year first constructed: [Approximate date is acceptable e. g.: c1920s or 1960-1970] ……………………………………
I request that you issue a: (for the building work described in this application)
Project Information Memorandum (PIM)
Project Information Memorandum (PIM) and Building Consent (BC)
Building Consent The existing PIM No [If applicable] is: …..………..……………….
Amendment to an existing Building Consent. The existing BC No is: ………………….……..…
Staged Consent – Being stage ……….. of ……….. stages
State the reference number if this application involves a National Multiple Use Approval: ……………………………………….…………
Name: …………………….………………….……Signature: …………….….…………………………Date: ………….…..……
The signature is that of the Owner OR the Agent on behalf of and with the approval of the Owner
This is my address for service and I acknowledge that some communications may be by email.
Please nominate if email address is not available
DESCRIPTION OF BUILDING WORK: (Provide sufficient information below to enable scope of work to be fully understood)
…………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………
……….…………………….……………………….……………………….………..…………….…………………….……………………………………………
Current use of building: ............................................................................................................ [E.g. Home, implement shed, office]
Will the building work result in a change of use of the building? Yes No. If Yes, provide details of the new use of the building:
…………………………………………………………………………………..........………………………………………………………………………………
Intended life of the building if less than 50 years: ……………… [Years]
List Building Consents previously issued for this project (if any): …………………………………………………………………………………………………...……
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]
Is prescribed energy work to be part of this Building Consent (tick if applicable) Gas Electricity
SBCG FORM 2
Version - 1 November 2019 Page 1 of 4
Consent
Number: ……………………….
FEES
Consent…………………………
BRANZ………………………….
MBIE…………………………….
Accreditation……………………
Other…………………………….
Total ____________________.
Paid ……………………………..
RCT No…………………………
Issued:…………………………..
click to sign
signature
click to edit
4. OWNER 5. AGENT [Only required If application is being made on behalf of the owner]
5. THE BUILDING [If item is not applicable put NA in the space]
6. RESTRICTED BUILDING WORK
7. PROJECT INFORMATION MEMORANDUM [Do not fill in this section if the application is for a building consent only]
Name of Owner: …………..............…………...…………...................
Contact person ……………….………………….…….…..…………….
Mailing address: ……….…………………………………..……………
……………………………………..……………………..……..…..……..
Street address/registered office: ……………………………………….
……….………..…………………………………………..…….…………
Phone No.: Landline: ………………………….……………….…….
Mobile: …………………………….………..….………
Daytime: ………………………….……………...………
After hours: …………………….………………..….………
Facsimile: ………………………………..………….……
Email: ……………………………………………………………………...
Website: ………………………………………………………..….………
THE FOLLOWING EVIDENCE OF OWNERSHIP IS ATTACHED:
Certificate of Title Lease Agreement
Agreement for Sale and Purchase Other document
Name of Agent: …………………………………….........................………
Contact person: …………………………………..….……….….…………
Mail address: ………………………………………………….….…………
……………………………………..……………………..……..….….……..
Street address/registered office: ………………………………………….
……….………..……………………………………………..……..…………
Phone No.: Landline: ………………………….…………….…….…….
Mobile: …………………………….…………...…………
Daytime: ………………………….………..…..…..………
After hours: …………………….……………..………………
Facsimile: ………………………………...…..…….………
Email: …………………………………………………….……..…………...
Website: ………………………………………………….……….…………
Relationship to owner: [State details of the authorisation from the owner to make
the application on the owner’s behalf] ……………………………………………
……...….………………………………………..……………………….…
SBCG FORM 2
Version - 1 November 2019 Page 2 of 4
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 supervising the restricted building
work (If these details are un-known at the time of the application, they must be supplied before the building work begins.):
Name
Licensing Class
Licensed Building Practitioner Number
(or registration number if treated as being licensed under
section 291 of the Building Act 2004)
Note: Continue on another page if necessary
8. BUILDING CONSENT
THE BUILDING WORK WILL COMPLY WITH THE BUILDING CODE AS FOLLOWS:
NZS 4121 Alternative Solution Waiver/Modification
Accessible
Design
Method
Please complete
Form SBCG 34.1
Please complete
Form SBCG 23.1
□
B1
Structure
□ B1/AS1 □ B1/AS3 □ B1/VM1 □ □
□ B1/VM4
□
B2
Durability
□ B2/AS1 □ B2/VM1 □ □
□
C1-6
Protection from fire
□ C/AS1 □ C/AS2 □ C/VM1 □ □
□ C/VM2
□
D1
Access routes
□ D1/AS1 □ □ D1/VM1 □ □
□
D2
Mechanical installation for
□ D2/AS1
□ □
D2/AS2
□ □ □
access
□ D2/AS3
□
E1
Surface water
□ E1/AS1 □ E1/VM1 □ □
□
E2
External moisture
□ E2/AS1 □ E2/AS2 □ E2/VM1 □ □
□ E2/AS3
□
E3
Internal moisture
□ E3/AS1 □ □
□
F1
Hazardous agents on site
□ F1/VM1 □ □
□
F2
Hazardous building materials
□ F2/AS1 □ □
□
F3
Hazardous substances and
processes
□ F3/VM1 □ □
□
F4
Safety from falling
□ F4/AS1 □ □
□
F5
Construction and demolition
hazards
□ F5/AS1 □ □
□
F6
Visibility in escape routes
□ F6/AS1 □ □
□
F7
Warning systems
□ F7/AS1 □ □
□
F8
Signs
□ F8/AS1 □ □ □
□
F9
Restricting access to
residential pools
□ F9/AS1 □ F9/AS2 □ □
□
G1
Personal hygiene
□ G1/AS1 □ □ □
□
G2
Laundering
□ G2/AS1 □ □ □
□
G3
Food preparation and
prevention of contamination
□ G3/AS1 □ □ □
□
G4
Ventilation
□ G4/AS1 □ G4/VM1 □ □
□
G5
Interior environment
□ G5/AS1 □ □ □
□
G6
Airborne impact sound
□ G6/AS1 □ G6/VM1 □ □
□
G7
Natural light
□ G7/AS1 □ G7/VM1 □ □
□
G8
Artificial light
□ G8/AS1 □ G8/VM1 □ □
□
G9
Electricity
□ G9/AS1 □ G9/VM1 □ □
□
G10
Piped services
□ G10/AS1 □ G10/VM1 □ □
□
G11
Gas as an energy source
□ G11/AS1 □ □
□
G12
Water supplies
□
G12/AS1
□ G12/AS2
□
G12/VM1
□ □
□
G13
Foul water
□
G13/AS1
□ G13/AS2 □ G13/VM1 □ □
□ G13/AS3 □
G13/VM4
□
G14
Industrial liquid waste
□ G14/AS1 □ G14/VM1 □ □
□
G15
Solid waste
□ G15/AS1 □ □
□
H1
Energy efficiency
□ H1/AS1 □ H1/VM1 □ □
□
B1-H1
Simple House Solution
□ SH/AS1
□
B1-H1
Back Country Hut
□ BCH/AS1
Acceptable Solution
Nominate relevant clauses
Means of Compliance
Nominate relevant compliance path(s) for each clause selected.
Verification
Building Code Clause
The following plans and specifications are attached to this application: (please enter these in section 10 over page)
SBCG FORM 2
Version - 1 November 2019
Page 3 of 4
9. COMPLIANCE SCHEDULE (specified systems are defined in regulations)
The specified systems for the building are as follows:
The following specified systems are being altered, added to,
or removed in the course of the building work:
or
There are no specified systems in the building.
10. ATTACHMENTS
11. CONTACTS (involved in this project)
The following documents are attached to this application (All plans and specifications must meet the minimum requirements set out in the
regulations or required by the building consent authority):
[Nominate as applicable]
Plans and specifications (list) (or attach a list)………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………..
Memoranda from licensed building practitioner(s) who carried out or supervised any design work that is restricted building work
Project Information Memorandum Development contribution notice Certificate attached to Project Information Memorandum
Other information relevant to this application: [Please specify]: …………………………………………..…………………………..…………..
……………………………………………………………………………………………………………………………………………………….
Current Certificate of title provided
Please provide the details required by completing either form:
• SBCG27 Compliance Schedule Specified Systems (or)
• SBCG11 Application for amendment to Compliance Schedule
SBCG FORM 2
Version - 1 November 2019 Page 4 of 4
Designer
Name(s): ............................................................................................
Postal Address: .................................................................................
...........................................................................................................
Mobile: ........................................... Daytime: ...................................
Reg No: ............................ Email: ....................................................
Engineer
Name(s): ...........................................................................................
Postal Address: ................................................................................
..........................................................................................................
Mobile: ........................................... Daytime: ..................................
Reg No: ............................ Email: ...................................................
Builder
Name(s): ............................................................................................
Postal Address: .................................................................................
...........................................................................................................
Mobile: ........................................... Daytime: ...................................
Reg No: ............................ Email: ....................................................
Gasfitter
Name(s): ...........................................................................................
Postal Address: ................................................................................
..........................................................................................................
Mobile: ........................................... Daytime: ..................................
Reg No: ............................ Email: ...................................................
Drainlayer
Name(s): ............................................................................................
Postal Address: .................................................................................
...........................................................................................................
Mobile: ........................................... Daytime: ...................................
Reg No: ............................ Email: ....................................................
Plumber
Name(s): ...........................................................................................
Postal Address: ................................................................................
..........................................................................................................
Mobile: ........................................... Daytime: ..................................
Reg No: ............................ Email: ...................................................
Electrician
Name(s): ............................................................................................
Postal Address: .................................................................................
...........................................................................................................
Mobile: ........................................... Daytime: ...................................
Reg No: ............................ Email: ....................................................
Other
Name(s): ...........................................................................................
Postal Address: ................................................................................
..........................................................................................................
Mobile: ........................................... Daytime: ..................................
Reg No: ............................ Email: ...................................................
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Application For Building Consent PIM

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document