Doc# 515637 Page 1 of 2 BA Form 103
Notification of exempt building work
Sec
tion 97, Building Act 2004
Version:
10
Date
: January 2020
Code:
BA Form 103
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)
Current, lawfully established use:
B. OWNER
Name of owner: (include title)
Contact person:
(if different from owner)
Mailing address:
Street address / registered office:
Contact details: Landline number:
Daytime number:
Facsimile number:
Email address:
Mobile number:
After hours number:
C. THE TRADES PEOPLE - The trades people employed are:
Builder: Name: Licenced Practitioner Number:
Plumber: Name: Licenced Practitioner Number:
Drainlayer: Name: Licenced Practitioner Number:
Owner: Name: Licenced Practitioner Number:
Other: Name: Licenced Practitioner Number:
Doc# 515637 Page 2 of 2 BA Form 103
D. NOTIFICATION
I request that the following work be recorded as Exempt Building Workpursuant to the Building Act 2004, Schedule 1, and recorded
on my Timaru District Council building records:
Identify which clause of Schedule 1 applies:
Description of work:
The following information is attached: Site plan identifying existing buildings and any proposed buildings
Existing floor plan
Proposed floor plan
Other (identify what):
I confirm that ALL building work will comply with the New Zealand Building Code, the Resource Management Act and the Timaru
District Council District Plan. I also understand that Council will have no liability as the building work is exempt and will not be
checked for compliance or inspected by Council.
Signature:
Name:
Date:
For use of Timaru District Council:
Recorded as Exempt Building Work: Declined as Exempt Work (required Building Consent):
Signature:
On behalf of the Timaru District Council
Position:
Fee (payable on application): Receipt no:
Date paid: Date applicant advised:
Signature:
click to sign
signature
click to edit
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