1
For Office Use
Ref no.................................
Fee .....................................
Date paid ...........................
Receipt no .........................
Certificates of Design
...........................................
................................
.......
Midlothian Council
Building Standards
Fairfield House
8 Lothian Road
Dalkeith EH22 3ZN
Tel 0131 270 7500
Fax 0131 271 3537
www.midlothian.gov.uk/buildingstandards
Completion Certificate - Submission
Building (Scotland) Act 2003
Submission under section 17(1) and (7) of a completion certificate
Please refer to the accompanying guidance Notes when completing this form.
You can submit a Completion Certificate - Submission on-line through the eBuilding Standards portal.
1
Relevant Person (see below)
Name...............................................................................................
Address............................................................................................
........................................................................................................
.........................................................................................................
Post code.........................................................................................
Tel no......................................... Fax no........................................
Email...............................................................................................
Relevant Person
The completion certificate must be submitted by the relevant person as
defined by the Building (Scotland) Act 2003, that is:
a) where the work was carried out, or the conversion made, otherwise
than on behalf of another person, the person who carried out the
work or made the conversion.
b) where the work was carried out, or the conversion made, by a
person on behalf of another person, that other person.
c) if the owner of the building does not fall within paragraph (a) or (b)
and the person required by these paragraphs to submit the
completion certificate has failed to do so, the owner.
2
Duly authorised agent (if any)
Name...............................................................................................
Address............................................................................................
.........................................................................................................
.........................................................................................................
Post code.........................................................................................
Tel no......................................... Fax no........................................
Email...............................................................................................
3
Owner (if different from applicant) [See note 1]
Name...............................................................................................
Address............................................................................................
.........................................................................................................
.........................................................................................................
Post code.........................................................................................
Tel no......................................... Fax no........................................
Email...............................................................................................
4
Details of building warrant
Date of building warrant (and any amendments)................................
Reference number of building warrant...............................................
Address of building to which the building warrant applies (Include
post code if known)
............................................................................................................
............................................................................................................
Post code.............................................................................................
(If different) Address of building to which this submission applies
(Include post code if known) [see note 2]
............................................................................................................
............................................................................................................
Post code.............................................................................................
5
Description of building
Does this submission cover all the work under the above building
warrant?
YES NO
If NO, please describe the work to which this submission applies:
............................................................................................................
............................................................................................................
Is this the last submission related to the above building warrant?
YES NO
6
Relaxation Directions
Was any relaxation of the provisions of the building regulations
given?
YES NO
If YES, give date(s) and reference number(s)
Date.....................................................................................................
Reference number...............................................................................
7
Certificates
Do any certificates from approved certifiers of construction
accompany this submission?
YES NO [If YES, see annex 1]
Did any certificates from approved certifiers of design
accompany the building warrant application? [see note 3]
YES NO
2
8
Notices
Please indicate if this submission is as a result of any of the
following notices, and if so give the reference number.
Building regulations compliance notice (Section 25)
Reference number..............................................................................
Building warrant enforcement notice (Section 27)
Reference number..............................................................................
Defective building notice (Section 28)
Reference number..............................................................................
Is the building subject to any Dangerous building notice? (Section
29)
YES NO
If YES, give the reference number....................................................
9
Date work was completed
Date....................................................................................................
10
Declaration
I/We* submit a completion certificate in accordance with the
details supplied above and with any necessary accompanying
information.
[and where the certificate is submitted for work done under a
building warrant]
This completion certificate is confirmation that the work was
carried out and/or conversion* made in accordance with the
building warrant.
This completion certificate also confirms that in the case of work
for the construction of a building, the building as constructed
complies with the building regulations; that in the case of the
provision of services, fittings or equipment in or in connection
with a building that the services, fittings or equipment provided
comply with building regulations; and in the case of conversion of
a building that the building as converted complies with building
regulations.
[and when the provisions of building regulations apply]
I enclose a copy of the energy performance certificate(s) for the
buildings.
I enclose a copy of the statement of sustainability issued for the
purpose of regulation 9 of section 7 of schedule 5 to the Building
(Scotland) Regulations 2004.
I enclose a fire safety design summary submitted in accordance
with regulation 41 (bd) of the Building (Procedure) (Scotland)
Regulations 2004.
[and where the certificate is submitted for work done in
response to a notice where no warrant was required]
This completion certificate is confirmation that the work done in
response to a continuing requirement enforcement notice/a
building regulations compliance notice(where no warrant was
required)/a defective building notice (where no warrant was
required)/a dangerous building notice* has been completed in
accordance with the requirements of the notice.
[and if there are any continuing requirements in the building
warrant]
This completion certificate confirms acceptance of the continuing
requirements as stated below, made under section 22 of the Act,
imposed by the building warrant.
Continuing requirements (please list in full).
..........................................................................................................
Signed.................................................................................................
Relevant person/duly authorised agent on behalf of relevant
person*
Dated..................................................................................................
*Delete as appropriate
Notes
1 The name and address of the owner is required as the procedure
regulations require the owner to be informed if a
completion certificate is accepted or rejected.
2 Where the address has been amended since the building warrant
was granted, or where the submission covers only part of a building
warrant (for example is for one house in a development of several
dwellings that were subject to a single warrant) an address
identifying the work covered by the submission must be supplied.
3 Where a certificate from an approved certifier of design includes
details yet to be designed, the Notification of Finalisation of
Details model form must be completed by the approved certifier
and approved body and forwarded to the verifier.
4 Any applicant aggrieved by the decision of a verifier to reject a
completion certificate may, by summary application made within
21 days of the date of the decision, appeal to the sheriff. If a
verifier has not determined this submission within 14 days from
the date of receipt by the verifier of the certificate, the submission
is deemed rejected and an appeal may be made to the sheriff in
the same way and subject to the same timescale.
ANNEX 1 -
CERTIFICATES FROM APPROVED CERTIFIERS
Please list reference numbers of any certificates from approved
certifiers of design and/or construction which relate to this
submission, and attach the signed certificates to this completion
certificate:
1) Scheme....................................................................................
Reference number...................................................................
2) Scheme....................................................................................
Reference number...................................................................
3) Scheme....................................................................................
Reference number...................................................................
Annex 1 Important Note: The certificates must be signed by
certifiers fully approved to issue certificates for the matters certified
on the date the certificate was signed.
Form 5 Completion Certificate - Submission
25 May 2018
WARNING - This certificate does not permit the occupation or use
of a building following construction or conversion. It is an offence to
occupy or use such a building until a ‘notice of acceptance of a
completion certificate’ is obtained except where this is done solely
for the purposes of the construction or conversion of the building.
Note that temporary permission may be obtainable from a verifier,
and note that the restriction on occupation or use does not apply to
alterations.
If any person submits a completion certificate containing a statement
which that person knows to be false or misleading in a material
particular or recklessly submits a completion certificate containing a
statement which is false or misleading in a material particular the
person is guilty of an offence and liable on summary conviction to a
fine not exceeding level 5 on the standard scale.
Address to which you should send this submission
Building Standards Manager,
Midlothian Council,
Fairfield House,
8 Lothian Road,
Dalkeith,
Midlothian EH22 3ZN
Data Protection Act 2018
For information on how your personal data is used by Building
Standards visit our data protection page here.
urposes of determining this application.
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