Page 1 of 4 BA Form 8
Application for certificate of acceptance
Sec
tion 97, Building Act 2004
Ver
sion: 13
Date: January 2020
Code: BA Form 8
Send o
r deliver your application to: Web: www.timaru.govt.nz
Building Services, Timaru District Council, Telephone: (03) 687 7236
2 King George Place, PO Box 522, Timaru 7940 Email: building@timdc.govt.nz
A. THE BUILDING (project location)
Street or road address:
Legal description:
(state
legal description as at the date of
application and, if the land it proposed to
be subdivided, include details of relevant lot
numbers and consent no)
Valuation number: Zone:
Lot: DP:
Section:
Building name:
(if applicable)
Location of building within site:
(include
nearest street access)
Number of levels:
(include ground level
and any below ground)
Level / unit number: (if applicable)
Area:
(total floor area (indicate area
affected by the building work if less than
the total area)
Current, lawfully established use:
(include number of occupants per level
and per use if more than one level)
Year first constructed:
(insert year,
approximate date is acceptable e.g. 1920s
or 1960-1970 if known)
B. OWNER
Landline number:
Daytime number:
Facsimile number:
Email address:
Mobile number:
After hours number:
Name of owner: (include title)
Contact person: (if different from
owner)
Mailing address:
Street address / registered office:
Contact details:
Please attach one of the following as
evidence of ownership (tick if
included):
Doc # 311027
Copy of certificate and title
Lease
Agreement for sale and purchase
Other document showing full name of legal owner(s) of building
Doc # 311027 Page 2 of 4 BA Form 8
C. AGENT (only required if application is being made on behalf of the owner)
Name of agent:
Contact person:
Mailing address:
Street address / registered office:
Landline number:
Daytime number:
Facsimile number:
Email address:
Mobile number:
After hours number:
Contact details:
Relationship to owner: (state the details
of the authorisation from the owner to
make the application on the owners behalf)
First point of contact: (state full name,
mailing address, phone numbers and email
address)
Name of contact: Mailing address:
Mobile number: Daytime number:
Email address:
I request that you issue a certificate of acceptance for building work described in this application.
Signed by the owner: OR Signature:
Name:
Date:
Signed by the agent:
(on behalf of, or
with authority from the owner)
Signature:
Name:
Date:
Invoice to: Owner Agent
Email address (if you would prefer via email):
click to sign
signature
click to edit
click to sign
signature
click to edit
Doc # 311027 Page 3 of 5 BA Form 8
Concreter: Address:
Mobile number:
Facsimile number:
Manufacturer:
Joiner: Address:
Mobile number:
Facsimile number:
Manufacturer:
Tanking applicator: Address:
Mobile number:
Facsimile number:
Manufacturer:
Plasterer/textured
coater:
Address:
Mobile number:
Facsimile number:
Manufacturer:
Gasfitter: Address:
Mobile number:
Facsimile number:
Manufacturer:
Electrician: Address:
Mobile number:
Facsimile number:
Manufacturer:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
D. BUILDING WORK
Description of the building work:
(provide sufficient description of building
work to enable scope of work to be fully
understood)
Date building work carried out:
Restricted Building Work (RBW): Yes No
The licenced building practitioner(s) who carried out or supervised the restricted building work is / are as follows (if applicable):
Name Licensing class
Licensed building practitioner no.
(or
registration no. if treated as being licenced
under section 291 of the Building Act 2004)
Particular work carried out or
supervised
Doc # 311027 Page 4 of 5 BA Form 8
Roofer: Address:
Mobile number:
Facsimile number:
Manufacturer:
Concealed fascia
installer:
Address:
Mobile number:
Facsimile number:
Manufacturer:
Others: Address:
Mobile number:
Facsimile number:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Business name:
Daytime number:
After hours number:
Registration/qualification:
Product name:
Manufacturer:
Yes No
Did the building work result in a change of use of the building?
(i.e. commercial, industrial, residential)
If yes, provide details of the new use:
Intended life of the building if less than 50 years:
List building consents previously issued for this project: (if any,
who issued the consent, date of issue, consent number)
Estimated value of the building work on which the building
levy will be calculated (including GST):
(state estimated value as
defined in section 7 of the Building Act 2004)
The following plans and specifications 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)
Specifications: Plans:
Calculations: Producer statements:
Other (specify):
Plumber: Address:
Mobile number:
Facsimile number:
Manufacturer:
Drain layer: Address:
Mobile number:
Facsimile number:
Manufacturer:
Carpenter: Address:
Mobile number:
Facsimile number:
Manufacturer:
Brick/block layer: Address:
Mobile number:
Facsimile number:
Manufacturer:
Deck/roof membrane
applicator:
Address:
Mobile number:
Facsimile number:
Manufacturer:
Doc # 311027 Page 5 of 5 BA Form 8
Reasons why a certificate of acceptance is required (tick boxes applicable):
The owner, or the owner’s predecessor in title, carried out building work for which a building consent was required, but a
building consent was not obtained because (explain in detail):
A building consent could not practicably be obtained in advance because the building work had to be carried out urgently (tick
one of the following):
(a) For the purpose of saving or protecting life or health or preventing serious damage to property as follows
(explain in detail)
(b) In order to ensure that a specified system was maintained in a safe condition or made safe as follows (explain
in detail):
The building consent authority that granted the building consent is unable or refuses to issue a code compliance certificate in
relation to the building work, and no other building consent authority will agree to issue a code compliance certificate for the
building work (state the details of name of building consent authority and building consent granted):
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