Application Form
Certificate of Compliance
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Application Form Certificate of Compliance
Notes to Applicants:
1. A Certificate of Compliance can only be issued where all details of the proposal submitted comply fully with the rules of the Gore
District Plan and any relevant National Environment Standard. The applicant must provide sufficient information to enable
assessment of all relevant rules in the District Plan.
2. Includes plans showing any changes proposed to the layout of activities and structure on the site. Also include additional pages if
insufficient space is available to respond to any information requested.
3. The Council may be able to issue a Certificate of Compliance for parts of a proposal where other parts require resource consent for
approval. Discussions should be held with the Gore District Council Planning Services to ensure correct procedures are being followed.
4. A Certificate of Compliance cannot be issued where a proposed plan or plan change has been notified and the activity could not be
lawfully carried out without resource consent under that plan or change plan.
5. Requests for Certificates of Compliance are proposed on a cost recovery basis for the actual time taken by the Council to assess the
request. Providing detailed responses to all matters listed on this form will assist in minimising costs to the applicant.
6. If you need advice and/or wish to discuss the Certificate of Compliance process please contact Planning Services by email to or phone (03) 209 0330 to talk to, or make an appointment to see, a planner.
The full legal name of Applicant(s) are required. For Trusts, Estates and Partnerships, the name of the Trust,
Estate or Partnership must be given and the full legal names of all trustees, executors or partners are
Trust Partnership Company Private Person(s)
Trust or Company Name (if applicable):
Full Names:
Site Description
I am/We are the: (owner, occupier, lessee, prospective purchaser etc) of the site
Street Address of Site:
Legal Description:
Certificate of Title Identifier:
Address for Correspondence
Name: (Put your name here if you are preparing the application for someone else.)
Address: Postcode:
Email: Phone (daytime):
Address for Invoices or Refunds (if different from above)
Address: Postcode:
Bank Details for Refunds
Bank Account Name:
Bank Account Number:
Ownership of the Site
Who is the current owner of the site?
If the applicant is not the site owner, please provide the site owner’s contact details:
Address: Postcode:
Email: Phone (daytime):
Current Use of the Site
Describe in detail the current use of the site. Details are also required of the bulk and location of buildings,
parking provision, traffic movements, manoeuvring, noise generation, signage, hours of operation, number of
people on-site, number of visitors etc. Include plans showing what is existing.
Application Form Certificate of Compliance 2
Application Form Certificate of Compliance 3
Activity for which Certificate of Compliance Sought
Describe in detail the activity for which a Certificate of Compliance is sought. Details are required of any
changes to activities and buildings of the site. Include plans showing what is proposed.
District Plan Zoning
What is the District Plan zoning of the site?
Compliance with District Plan Rules
Please detail the District Plan Rules that apply to the activity and in turn demonstrate how the proposal will
comply with each of these requirements.
Application Form Certificate of Compliance 4
Further Assistance
Please discuss your proposal with us if you require any further help with preparing your application.
The Council does provide pre-application meetings without charge to assist in understanding the issues
associated with your proposal and completing your application. This service is there to help you.
Please note that we are able to provide you with planning information but we cannot prepare the
application for you. You may need to discuss your application with an expert such as a planning
consultant, surveyor or lawyer, if you need further advice.
Gore District Council Planning Services staff can be contacted as follows:
In Writing: Gore District Council, PO Box 8, Gore 9740
In Person: Gore District Council, 29 Bowler Avenue, Gore,
but please phone first to make an appointment.
By Phone: (03) 209 0330
By Email:
There is also information on our website at
Information Requirements
Completed and Signed Application Form
Description of Activity
Site Plan, Floor Plan and Elevations (where relevant)
Historic Copy of Certificate of Title (less than 3 months old) including any relevant restrictions
(such as consent notices, covenants, encumbrances, building line restrictions)
Application Fee (cash, cheque, Internet banking or EFTPOS only; no Credit Cards accepted)
Bank account details for refunds
Payment Method
Cash (do not post)
EFTPOS (at Gore District Council)
Internet banking
Cheques payable to: Gore District Council
Post cheques to: Gore District Council
PO Box 8, Gore 9740
Internet Banking Payments: Gore District Council
Account Number: 03-0915-0289519-00
Particulars: Please use your Name
Reference: Please use your Address
In order to ensure your application is not rejected or delayed through requests for further information,
please make sure you have included all of the necessary information.
I certify that, to the best of my knowledge and belief, the information given in this application is true and correct.
I accept that I have a legal obligation to comply with any conditions imposed on the Resource Consent should
this application be approved.
Subject to my/our rights under section 357B and 358 of the Resource Management Act 1991 to object to
any costs, I agree to pay all the fees and charges levied by the Gore District Council for processing this
application, including a further account if the cost of processing the application exceeds the deposit paid.
Signature of Applicant/Agent (delete one): Date:
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