Doc# 515637 Page 1 of 2 BA Form 103
Notification of exempt building work
tion 97, Building Act 2004
: January 2020
BA Form 103
Send o
r deliver your application to: Web:
Building Services, Timaru District Council, Telephone: (03) 687 7236
2 King George Place, PO Box 522, Timaru 7940 Email:
A. THE BUILDING (project location)
Street or road address:
Legal description:
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:
Building name:
(if applicable)
Current, lawfully established use:
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
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.
For use of Timaru District Council:
Recorded as Exempt Building Work: Declined as Exempt Work (required Building Consent):
On behalf of the Timaru District Council
Fee (payable on application): Receipt no:
Date paid: Date applicant advised:
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