2. Owner (see guidance)
Full name(s) of owner(s)
Contact person (if the applicant is not an individual)
Postal address of owner Post code
Street address/registered office
Phone no landline Mobile
Website Email
Fax
The following evidence of ownership is attached:
Select type of ownership:
Fee Simple Incompleted or recently completed purchase Crosslease
Leasehold Trust or company
Private Bag 9023 | Whangarei 0184 | New Zealand
T: 09 430 4200 | 0800 WDC INFO | 0800 932 463 | F: 09 438 7632
W: www.wdc.govt.nz | E: mailroom@wdc.govt.nz
Form 2 - Application for Project Information Memorandum
(PIM), Building Consent (BC)
Building Act 2004
This form should be used to make application for
Project Information Memorandum (PIM) Section 33 of the Building Act 2004
Building Consent (BC) Section 45 of the Building Act 2004
PIM & BC Section 31(1)(a) of the Building Act 2004
MultiProof Consent Building Amendment Act 2009
1. The Building (see guidance)
Number Street
Suburb / Locality Postcode
Legal Description of Land Area (ha)
Building name (if applicable) No. Levels
Location of building within site/block no.
Level/Unit no. Year First Constructed
Total Floor Area (m
2
)
Currently lawfully established use (include number
of occupants per level and per use if more than 1)
Please enter the
street address of
the building
MultiProof Certificate Number
If you are filling in this form
electronically, please save a copy
to your computer first. You can
then open the form with Adobe
Reader and fill it in on your
computer.
DO NOT fill this form in within a
browser as you will lose your data.
Please ensure you fill in all
mandatory fields (mark N/A where
not applicable) before submitting
the form or there is a chance you
will be asked to resubmit before
your application can be processed.
BLDCONS-649536296-166 March 2020
3. Agent (see guidance)
Full name of agent
Contact person
Postal address Post code
Street address/registered office
FaxMobilePhone no landline
EmailWebsite
After hours
Relationship to owner
Declaration (see guidance)
I/we give authority for the person named as agent to act in that capacity on my/our behalf in connection with all matters
pertaining to this application.
Signature of owner Date
Print name
If you are completing and submitting this form electronically please print and complete the
following Authorisation form, include this form as a pdf attachment with your e-consent.
Note: This form covers declarations from sections 3, 5 and 18.
Do you want to nominate an agent?
Yes No
Ensure the following evidence of ownership is supplied with the application (dependant on the type of ownership):
Fee Simple
- Current Certificate of Title
Incompleted or recently completed purchase
- Current Sale and Purchase Agreement
- Current Certificate of Title
Crosslease
- Signed permission from Crosslease parties
- Current Certifcate of Title
Leasehold
- Details of lease duration
- Authorisation from owner
- Current Certificate of Title
Trust or Company
- Letter from Trust or body solicitor confirming ownership
- Current Certificate of Title
Declaration
4. First point of contact for communication with Council / building consent authority
Owner Agent Other
Note: Contact details must be in New Zealand
To assist in prompt communication with our customers, Council prefers to contact you by email where possible.
Please indicate below that you authorise WDC to contact you in this manner.
Yes (please ensure you specified a valid e-mail address above)
No - please use my postal address
If you are completing and submitting this form electronically please print and complete the
following Authorisation form, include this form as a pdf attachment with your e-consent.
Note: This form covers declarations from sections 3, 5 and 18.
Date
Name (please print)Signature
Position or title (please print)
Owner
Agent on behalf of and with the authority of the owner
5. I / we request that you issue a:
MultiProof Consent
PIM & BC
Building Consent (BC)
Project Information Memorandum (PIM)
(for the building work described in this application)
Declaration
6. The project
6.1 Description of the building work (see guidance)
6.2 Intended use
6.3 Will the building work result in a change of use of the building?
No Yes
If yes, provide details of the new use
If 'Other', please state description in same format as this list - i.e. 'New _____' or 'Alterations to Existing _____'
7. Intended life of the building if less than 50 years (see guidance)
Indefinite - more than 50 years Less than 50 years
Please state (years)
8. List building consents previously issued for this project (if any) (see guidance)
1 2
10. This application is in relation to (see guidance)
Domestic Commercial Industrial Multi storey
Number of levels
11. What is the nature of the consent (see guidance)
Plumbing and drainage (only includes on-site effluent disposal)
Other new construction and demolition
Alterations, repairs, extensions, conversions, re-siting, installation of heating appliances & plumbing & drainage only
Foundations only
New Building exclude domestic garages and domestic outbuildings
Total floor area of project (m
2
)Upper floor area of project (m
2
)
Ground floor area of project (m
2
)
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)
9. Project size and value (see guidance)
Include only the areas of the building where the footprint is increasing - please do
not include areas of internal alterations.
12. Staged Consents
Is this a staged project? (see guidance)
Yes
No
If yes, is stage of an intended
stages.
13. Restricted building work (see guidance)
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 unknown at the time of application, they must be supplied before
the work begins)
Name Licensing class
Licensed building practitioner number
(or registration number if treated as being licensed under the
section 291 of the Building Act 2004)
14. Other Key personnel (see guidance)
Please indicate the key personnel involved in this project.
Builder
Name Reg no Email
Address Post code
Phone no Mobile no Website
Designer
Name Reg no Email
Address Post code
WebsiteMobile noPhone no
Phone no Mobile no Website
Post codeAddress
EmailReg noName
Engineer
Phone no Mobile no Website
Post codeAddress
EmailReg noName
Certifying Drain Layer
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Certifying Plumber
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Registered Electrician
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Certifying Gas Fitter
Known To be advised
Known To be advised
Known To be advised
Known To be advised
Known To be advised
Known To be advised
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Other
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Other
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Other
WebsiteMobile noPhone no
Address Post code
EmailReg noName
Other
Known To be advised
Known To be advised
Known To be advised
Known To be advised
15. Vehicle Crossing (see guidance)
Is a vehicle crossing required for the project
Yes No
If yes, application no. (if already applied for)
16. Public utility connections required (see guidance)
Is this application subject to a utility connection application (Drainage, water connection or water meter installation)
Is there already a water meter in place?
Yes - Enter Account Number
No - Application made
No - Existing connections in place
N/A
17. Project Information Memorandum (To be completed with all applications, UNLESS a PIM has already been obtained)
The following matters are involved in the project:
Subdivision
Alterations to land contours
New or altered connections to public utilities
New or altered locations and/or external dimensions of buildings
New or altered access for vehicles
Building work over or adjacent to any road or public place
Disposal of stormwater and wastewater
Building work over any existing drains or sewers or in close proximity to wells or water mains
Other matters known to the applicant that may require authorisations from the territorial authority (specify)
18. Specific fire design (see guidance) (skip this section for PIM/COA applications)
Does the project involve a specific fire design
Yes No
If Yes, I understand that this application will be forwarded to the New Zealand Fire Service and agree to meet any and all
costs incurred by council in connection with this.
If you are completing and submitting this form electronically please print and complete the
following Authorisation form, include this form as a pdf attachment with your e-consent.
Note: This form covers declarations from sections 3, 5 and 18.
Name (please print)
Date
Signature
Owner Agent on behalf of and with the authority of the owner
Signature of
Declaration
19. Code clauses (see guidance) (skip this section for PIM applications)
The building work will comply with the building code as follows:
Clause
(which of the following clauses will be
involved in the proposed work)
Means of compliance
(refer to the relevant compliance document(s) or
detail of alternative solution in the plans and
specifications; if note applicable, state n/a)
Waiver/modification required
(state nature of waiver or modification of building
code required; if not applicable, state n/a)
B1 Structure
Involved Not Involved
B1/AS2
NZS4229 Other (specify)
NZS3604 NZS4203
B2 Durability
Involved Not Involved
NZS3602NZS3101B2/AS1
NZS4229 Other (specify)
C1 - 4 Fire
Not InvolvedInvolved
C/AS1 Other (specify)
D1 Access routes
Not InvolvedInvolved
Other (specify)
NZS4229NZS4121D1/AS1
D2 mechanical installations for
access
Not InvolvedInvolved
Other (specify)
EN81NZS4332
EN115
D2/AS1
E1 Surface water
Not InvolvedInvolved
AS/NZS3500.3E1/AS1
Other (specify)EN115
E2 External moisture
Not InvolvedInvolved
Other (specify)
E2/AS1 Specific design & testing
E3 Internal moisture
Not InvolvedInvolved
Other (specify)E3/AS1
F1 Hazardous agents on site
Not InvolvedInvolved
Other (specify)F1/AS1
F2 Hazardous building materials
Not InvolvedInvolved
NZS4223F2/AS1
Other (specify)
F3 Hazardous substances and
processes
Not InvolvedInvolved
F3/AS1 Other (specify)
F4 Safety from falling
Not InvolvedInvolved
Other (specify)
F4/AS1
F5 Construction and demolition
hazards
Involved Not Involved
Other (specify)F5/AS1
F6 Emergency lighting
Involved Not Involved
Other (specify)F6/AS1
F7 Warning systems
Involved Not Involved
Other (specify)EN115
NZS4515NZS4512F7/AS1
Involved Not Involved
F8 Signs
F8/AS1 Other (specify)
Involved Not Involved
G1 Personal hygiene
Other (specify)G1/AS1
Involved Not Involved
G2 Laundering
G2/AS1 Other (specify)
G3 Food preparation &
prevention from contamination
Involved Not Involved
G3/AS1 Other (specify)
Involved Not Involved
G4 Ventilation
Other (specify)
AS1668.2G4/AS1
Involved Not Involved
G5 Interior environment
G5/AS1 Other (specify)
Involved Not Involved
G6 Airborne and impact sound
G6/AS1 Other (specify)
Involved Not Involved
G7 Natural light
Other (specify)G7/AS1
G8 Artificial light
Involved Not Involved
Other (specify)
NZS6703G8/AS1
F9 Restricting access to
residential pools
Involved Not Involved
F9/AS1
Other (specify)
F9/AS2
G9 Electricity
Involved Not Involved
Other (specify)G9/AS1
G10 Piped services
Involved Not Involved
NZS5261G10/AS1
Other (specify)
Involved Not Involved
G11 Gas as an energy source
Other (specify)G11/AS1
G12 Water supplies
Involved Not Involved
AS/NZS3500.5
Other (specify)
AS/NZS3500.2G12/AS1
G13 Foul water
Involved Not Involved
BS5572 Other (specify)
AS/NZS3500.2G13/AS1
G14 Industrial liquid waste
Involved Not Involved
Other (specify)G14/AS1
Involved Not Involved
G15 Solid waste
Other (specify)G15/AS1
H1 Energy efficiency
Involved Not Involved
ALF design manual
Other (specify)
NZS4243NZS4218H1/AS1
NZS4214
20. Compliance Schedule (see guidance)
(only complete this section if the application is for a commercial building consent)
Does the building have an existing compliance schedule?
If yes, compliance schedule number
Yes No
If yes, will this project amend, add or remove any specified systems
Yes No N/A
Will this project result in a new compliance schedule being required for this building
Yes No
If yes, please complete and attach the Compliance Schedule application form
http://www.wdc.govt.nz/BuildingandProperty/BuildingConsents/Documents/Building-Compliance-Schedule-application.pdf
Please complete the checklist at the end of this form to indicate the plans and specifications
attached to this application
If you require assistance in completing this form,
please make contact with your nearest WDC Service Centre
0800 WDC INFO (0800 932 463)
If you require assistance of a technical nature,
please make an appointment with a building officer by telephoning 09 430 4224
The first half hour of this service is provided without charge
Application for Project Information Memorandum (PIM) and/or Building Consent (BC) Checklist
Please use this checklist to ensure you have provided all relevant information with your application
Incomplete applications will not be accepted
Applicant Use
Office
Use
Yes N/A Checked
For all applications
Have all questions on the form
been fully completed
Is a certificate of title attached
Is a sale & purchase agreement
attached
Has a MultiProof Certificate
been supplied
Application for PIM, PIM/BC, COA
1 Does site plan show
An appropriate scale
Legal description of property
Site area of property in m
2
Private drainage
Existing and proposed buildings
Topography showing contours
at 1m increments
Dimensions and m
2
of all
existing & proposed buildings
Distance from boundaries of all
existing & proposed buildings
North point
Retaining walls
Parking & vehicle access
Water meter N/A PIM
Sewer connections
Water source N/A PIM
2 Does floor plan show for PIM, PIM/BC, COA
Proposed use of each room
Room dimensions - N/A
Residential PIMS
Fixtures & fittings
3 Do elevations show for PIM, PIM/BC, COA
North South
East West
Wall cladding
Roof pitch - N/A PIM
Finished floor levels
Height in relation to boundary
Maximum building height
Building consent & COA documentation
- For timber floors
Dimensions
Pile size, centres
Footing size
Bracing
Joists and bearers
- For concrete floors
Dimensions
Mesh, size
5 Plans and specifications
The following plans and specifications are enclosed
Roof Framing Plan
Specific truss design calculation
and producer statement
Geotechnical Reports
E2 Risk Matrix
Cross Sections
Plumbing Layout
Stuctural engineering
Is there a signed Producer
Statement?
Structural Engineering Report/
Calculations
Are copies of calculations included
Has engineer/designer endorsed
all submitted plans
Specifications
Correct number of sets supplied
Bracing Calculations
Other supporting information (specify)
If commercial see Guidance note
4.7
Supplementary information for
commercial projects
Office use
Application not accepted
Reasons
Customer Services Representative Date
Application accepted
Receipt no Fees receipted $
DateCustomer Services Representative
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