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Version 2018.1
Application for listed building consent for alterations, extension or demolition of a listed building.
Planning (Listed Buildings and Conservation Areas) Act 1990
1. Applicant Name and Address
Title: First name:
Last name:
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
Company
(optional):
House
number:
House
name:
House
suffix:
Unit:
2. Agent Name and Address
Title:
House
name:
House
suffix:
House
number:
Unit:
Company
(optional):
First name:
Last name:
Address 1:
Address 2:
Town:
Address 3:
County:
Country:
Postcode:
If you would rather make this application online, you can do so on our website:
https://www.planningportal.co.uk/apply
Local Planning Authority details:
Upon receipt of this form and any supporting information, it is the responsibility of the Local Planning Authority to inform you of its
obligations in regards to the processing of your application. Please refer to its website for further information on any legal, regulatory and
commercial requirements relating to information security and data protection of the information you have provided.
Please be aware that once you have downloaded this form, Planning Portal will have no access to the form or the data you enter into it. Any
subsequent use of this form is solely at your discretion, including the choice to complete and submit it to the Local Planning Authority in
agreement with the declaration section.
Privacy Notice
This form is provided by Planning Portal and based on the requirements provided by Government for the sole purpose of submitting
information to the Local Planning Authority in accordance with the legislation detailed on this form.
It is important that you read the accompanying guidance notes and help text as incorrect completion will delay the processing of your
application.
If printed, please complete using block capitals and black ink.
Please ensure that the information you submit is accurate and correct and does not include personal or sensitive information. If you require
any further clarification, please contact the Local Planning Authority directly.
Publication of applications on planning authority websites
Information provided on this form and in supporting documents may be published on the authority's planning register and
website.
Version 2018.1
3. Description of Proposed Work
Please describe the proposals to alter, extend or demolish the listed building(s):
Has the work already started without consent?
NoYes
If Yes, please state when the work was started (DD/MM/YYYY):
(date must be pre-application submission)
Has the work been completed without consent? NoYes
If Yes, please state the date when the work was completed (DD/MM/YYYY):
(date must be pre-application submission)
4. Site Address Details
Please provide the full postal address of the application site.
House
name:
House
suffix:
House
number:
Unit:
Address 1:
Address 2:
Town:
Address 3:
County:
Postcode
(optional):
Easting: Northing:
Description of location or a grid reference.
(must be completed if postcode is not known):
Description:
Version 2018.1
Have you consulted your neighbours or the local community about the proposal?
Yes No
If Yes, please provide details:
7. Neighbour and Community Consultation
6. Pre-application Advice
Has assistance or prior advice been sought from the local
authority about this application?
NoYes
If Yes, please complete the following information about the advice
you were given. (This will help the authority to deal with this
application more efficiently).
Please tick if the full contact details are not
known, and then complete as much as possible:
Officer name:
Reference:
Date (DD/MM/YYYY):
(must be pre-application submission)
Details of pre-application advice received?
5. Related Proposals
Are there any current applications, previous
proposals or demolitions for the site?
NoYes
If Yes please describe and include the planning application
reference number(s), if known:
Description
Reference
number
8. Authority Employee / Member
It is an important principle of decision-making that the process is open and transparent. For the purposes of this question, "related to"
means related, by birth or otherwise, closely enough that a fair-minded and informed observer, having considered the facts, would
conclude that there was bias on the part of the decision-maker in the local planning authority.
Yes No
If Yes, please provide details of their name, role and how you are related to them.
Do any of the following statements apply to you and/or agent? With respect to the authority, I am:
(a) a member of staff
(b) an elected member
(c) related to a member of staff
(d) related to an elected member
Version 2018.1
9. Materials
Please provide a description of existing and proposed materials and finishes to be used in the building (demolition excluded):
Existing
(where applicable)
Proposed
Not
applicable
Don't
Know
External walls
Roof covering
Chimney
Windows
External doors
Ceilings
Internal walls
Floors
Internal doors
Rainwater goods
Boundary treatments
(e.g. fences, walls)
Vehicle access and
hard standing
Lighting
Others
(add description)
Are you supplying additional information on submitted drawings or plans?
Yes No
If Yes, please state plan(s)/drawing(s) references:
Version 2018.1
12. Listed Building Grading
Please state the grading (if known) of the building in the list of
Buildings of Special Architectural or Historic interest? (Note: only
one box must be ticked)
Grade I
Grade II
Grade II*
Ecclesiastical Grade I
Ecclesiastical Grade II
Ecclesiastical Grade II*
Don't know
13. Immunity From Listing
Has a Certificate of Immunity from Listing been sought in respect of
this building?
Yes No Don't know
If Yes, please provide the result of the application:
10. Demolition
If Yes, which of the following does the proposal involve?
Does the proposal include the partial or
total demolition of a listed building?
Yes
No
a) Total demolition of the listed building:
Yes No
NoYes
b) Demolition of a building within
the curtilage of the listed building:
c) Demolition of a part of the listed building:
Yes No
Please provide a brief description of the building or part of the
building you are proposing to demolish:
If the answer to c) is Yes:
i) What is the total volume of the
listed building?(cubic metres)
ii) What is the volume of the part
to be demolished?(cubic metres)
iii) What was the (approximate) date of the
erection of the part to be removed? (MM/YYYY)
(date must be pre-application submission)
Why is it necessary to demolish or extend (as applicable) all or part
of the building(s) and or structure(s)?
11. Listed Building Alterations
If Yes, do the proposed works include:
(you must answer each of the questions)
Do the proposed works include alterations
to a listed building?
Yes
No
a) Works to the interior of the building?
Yes No
b) Works to the exterior of the building?
NoYes
c) Works to any structure or object fixed
to the property (or buildings within
its curtilage) internally or externally?
Yes No
d) Stripping out of any internal wall, ceiling
or floor finishes (e.g. plaster, floorboards)?
Yes No
If the answer to any of these questions is Yes, please provide
plans, drawings, photographs sufficient to identify the location,
extent and character of the items to be removed, and the
proposal for their replacement, including any new means of
structural support and state references for the plan(s)/drawing(s):
Version 2018.1
14. Ownership Certificates
One Certificate A, B, C, or D, must be completed with this application form
CERTIFICATE OF OWNERSHIP - CERTIFICATE A
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
I certify/ The applicant certifies that on the day 21 days before the date of this application nobody except myself/ the applicant was the
owner* of any part of the land or building to which the application relates.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
Date DD/MM/YYYY):Or signed - Agent:Signed - Applicant:
Signed - Applicant: Or signed - Agent: Date DD/MM/YYYY):
CERTIFICATE OF OWNERSHIP - CERTIFICATE B
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
I certify/ The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) who, on the day
21 days before the date of this application, was the owner* of any part of the land or building to which this application relates.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
Name of Owner
Address
Date Notice Served
CERTIFICATE OF OWNERSHIP - CERTIFICATE C
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
I certify/ The applicant certifies that:
• Neither Certificate A or B can be issued for this application
• All reasonable steps have been taken to find out the names and addresses of the other owners* of the land or building, or of a
part of it, but I have/ the applicant has been unable to do so.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
The steps taken were:
Name of Owner
Address
Date Notice Served
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
On the following date (which must not be earlier
than 21 days before the date of the application):
Date DD/MM/YYYY):Or signed - Agent:Signed - Applicant:
Version 2018.1
14. Ownership Certificates (continued)
CERTIFICATE OF OWNERSHIP - CERTIFICATE D
Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990
I certify/ The applicant certifies that:
• Certificate A cannot be issued for this application
• All reasonable steps have been taken to find out the names and addresses of everyone else who, on the day 21 days before the
date of this application, was the owner* of any part of the land to which this application relates, but I have/ the applicant has been
unable to do so.
* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.
The steps taken were:
On the following date (which must not be earlier
than 21 days before the date of the application):
Notice of the application has been published in the following newspaper
(circulating in the area where the land is situated):
Date DD/MM/YYYY):
Or signed - Agent:
Signed - Applicant:
15. Planning Application Requirements - Checklist
Please read the following checklist to make sure you have sent all the information in support of your proposal. Failure to submit all
information required will result in your application being deemed invalid. It will not be considered valid until all information required by
the Local Planning Authority (LPA) has been submitted.
The original and 3 copies* of a completed and dated
application form:
The original and 3 copies* of a plan which identifies the
land to which the application relates and drawn to an
identified scale and showing the direction of North:
The original and 3 copies* of other plans and drawings or
information necessary to describe the subject of the application:
The original and 3 copies* of the completed dated
Ownership Certificate (A, B, C, or D - as applicable):
The original and 3 copies* of a design and access statement,
if required (see help text and guidance notes for details):
*National legislation specifies that the applicant must provide the original plus three copies of the form and supporting documents (a
total of four copies), unless the application is submitted electronically or, the LPA indicate that a smaller number of copies is required.
LPAs may also accept supporting documents in electronic format by post (for example, on a CD, DVD or USB memory stick).
You can check your LPA's website for information or contact their planning department to discuss these options.
16. Declaration
I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional
information. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the
genuine opinions of the person(s) giving them.
Or signed - Agent:Signed - Applicant: Date (DD/MM/YYYY):
(date cannot be
pre-application)
17. Applicant Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
18. Agent Contact Details
Telephone numbers
Country code:
National number:
Extension
number:
Country code:
Mobile number (optional):
Country code:
Fax number (optional):
Email address (optional):
Version 2018.1
19. Site Visit
Can the site be seen from a public road, public footpath, bridleway or other public land?
NoYes
If the planning authority needs to make an appointment to carry
out a site visit, whom should they contact? (Please select only one)
Other (if different from the
agent/applicant's details)
ApplicantAgent
If Other has been selected, please provide:
Contact name: Telephone number:
Email address:
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Completed 4 July 2020

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