APPLICANT //
CORRESPONDENCE DETAILS //
If you are acting on behalf of the applicant e.g. agent, consultant or architect
please ll in your details in this section.
*Applicant’s Full Name / Company / Trust:
(Name Notice is to be issued in)
All trustee names (if applicable):
Contact Name if company or trust:
*Postal Address:
*Post code:
Contact details supplied must be for the applicant and not for an agent acting on their behalf and must include a valid postal address
*Email Address:
*Phone Numbers: Day Mobile:
*Name & Company:
*Phone Numbers: Day Mobile:
*Email Address:
*Postal Address: *Postcode:
Our preferred methods of corresponding with you are by email and phone. Fast track applications must have an
electronic address for service. The decision will be sent to the Correspondence Details by email.
The Applicant is:
Owner Prospective Purchaser (of the site to which the application relates)
Occupier Lessee Other - Please Specify
Must be a person or legal entity (limited liability company or trust).
Full names of all trustees required.
The applicant name(s) will be the consent holder(s) responsible for the consent and any associated costs.
INVOICING DETAILS //
Invoices will be made out to the applicant but can be sent to another party if paying on the applicants behalf.
For more information regarding payment please refer to the Fees Information section of this form.
*Attention:
*Postal Address: *Post code:
Please provide an email AND full postal address.
*Email:
Applicant: Agent: Other, please specify:
Email: Post:
Please select a preference for who should receive any invoices and how they would like to receive them.
Page 1/5 // January 2019
APPLICATION FOR
DEEMED PERMITTED
BOUNDARY ACTIVITY
Under Section 87BA of the Resource Management Act 1991 (Form 9A)
PLEASE COMPLETE ALL MANDATORY FIELDS* OF THIS FORM.
This form provides contact information and details of your application. If your form does not provide the required information it will be returned to you to
complete. Until we receive a completed form and payment of the xed fee, your application may not be accepted for processing.
OWNER DETAILS // Please supply owner details for the subject site/property if not already indicated above
*Attention:
*Email:
Details are the same as above
Applicant: Landowner: Other, please specify:
DETAILS OF SITE // Legal description eld must list legal descriptions for all sites pertaining to the application.
Any elds stating refer AEE’ will result in return of the form to be fully completed.
Address / Location to which this application relates:
Legal Description:
Can be found on the Computer Freehold Register or Rates Notice – e.g Lot x DPxxx (or valuation number)
District Plan Zone(s):
SITE VISIT REQUIREMENTS //
Is there a gate or security system restricting access by council?
Is there a dog on the property?
Are there any other hazards or entry restrictions that council sta need to be aware of?
If ‘yes please provide information below
YES NO
YES NO
YES NO
DEVELOPMENT CONTRIBUTIONS INVOICING DETAILS //
If it is assessed that your consent requires payment of development contributions, any related correspondence and invoices will be sent via email.
Invoices will be addressed to the person responsible for paying development contributions (e.g owner, business owner, leaseholder...) but can be
sent to another party paying on their behalf.
For more information please see appendix 1 at the end of this form.
DETAILS OF SITE // Legal description eld must list legal descriptions for all sites pertaining to the application.
Address / Location to which this application relates:
Legal Description:
Can be found on the Computer Freehold Register or Rates Notice – e.g Lot x DP xxx (or valuation number)
District Plan Zone(s):
SITE VISIT REQUIREMENTS // Should a Council officer need to undertake a site visit please answer the
questions below
Is there a gate or security system restricting access by council?
Is there a dog on the property?
Are there any other hazards or entry restrictions that council sta need to be aware of?
If ‘yes please provide information below
YES NO
YES NO
YES NO
Click here for further information and our estimate request form
Please select a preference for who should receive any invoices.
Owner Name:
Owner Address:
If the property has recently changed ownership please indicate on what date (approximately) AND the names of the previous owners:
Date:
Names:
Page 2/5 // January 2019
INFORMATION REQUIRED TO BE SUBMITTED //
Attach to this form any information required
To be accepted for processing, your application should include the following:
A description of the activity
Computer Freehold Register for the property (no more than 3 months old)
and copies of any consent notices and covenants
(Can be obtained from Land Information NZ at https://www.linz.govt.nz/).
A plan (drawn to scale) of the site at which the activity is to occur, showing the height, shape and
location of the proposed activity.
The full name and address of each owner of the site
The full name and address of each owner of an allotment with an infringed boundary
Written approval from each owner of an allotment with an infringed boundary (Form 8B) including
signatures on the plan - Click here
for the Form 8B
We prefer to receive applications electronically – please see Appendix 2 – Naming of Documents Guide
for how documents should be named. Please ensure documents are scanned at a minimum resolution of 300 dpi.
Each document should be no greater than 10mb
PRIVACY INFORMATION
The information you have provided on this form is required so that your application can be processed under the Resource
Management Act 1991 and may also be used in statistics collected and provided to the Ministry for the Environment and
Queenstown Lakes District Council. The information will be stored on a public register and may be made available to the
public on request or on the companys or the Council’s websites.
DESCRIPTION OF THE PROPOSAL
Consent is sought to:
PREAPPLICATION MEETING OR URBAN DESIGN PANEL
Have you had a pre-application meeting with QLDC or attended the urban design panel regarding this proposal?
Yes No Copy of minutes attached
If ‘yes’, provide the reference number and/or name of sta member involved:
Page 3/5 // January 2019
FEES INFORMATION
Section 36 of the Resource Management Act 1991 deals with administrative charges and allows a local authority to levy
charges that relate to, but are not limited to, carrying out its functions in relation to receiving, processing and granting of
resource consents (including certicates of compliance and existing use certicates).
All charges related to the processing of a deemed permitted boundary activity application are payable prior to issuing of
the decision.
LIABILITY FOR PAYMENT – Please note that by signing and lodging this application form you are acknowledging that the
Applicant is responsible for payment of invoices and in addition will be liable to pay all costs and expenses of debt recovery
and/or legal costs incurred by QLDC related to the enforcement of any debt.
DEVELOPMENT CONTRIBUTIONSYour development, if granted, may also incur development contributions under the
Local Government Act 2002. You will be liable for payment of any such contributions.
A list of Consent Charges is available on the on the Resource Consent Application Forms section of the QLDC website. If you
are unsure of the amount to pay,
please call 03 441 0499 and ask to speak to our duty planner.
Please ensure to reference any banking payments correctly. Incorrectly referenced payments may cause delays to the
processing of your application whilst payment is identied.
Please note that if the Applicant has outstanding fees owing to Council in respect of other applications, Council may choose
to apply the initial fee to any outstanding balances in which case the initial fee for processing this application may be deemed
not to have been paid.
PAYMENT // A xed fee must be paid prior to or at the time of the application and proof of payment submitted.
Please note processing will not begin until payment is received (or identied if incorrectly referenced).
I conrm payment by: Bank transfer to account 02 0948 0002000 000 (If paying from overseas swiftcode is – BKNZNZ22)
Cheque payable to Queenstown Lakes District Council attached
Manual Payment at reception (can only be accepted once application has been lodged and
acknowledgement email received with your unique RM reference number
*Reference
*Amount Paid
*Date of Payment
Please reference your payments as follows:
Applications yet to be submitted: RM followed by rst 5 letters of applicant name e.g RMJONES
Applications already submitted: Please use the RM# reference that has been assigned to your application, this will have been
emailed to yourself or your agent.
Fixed Fee for Deemed Permitted Boundary Activity : $448.00 incl GST
Page 4/5 // January 2019
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: resourceconsent@qldc.govt.nz
www.qldc.govt.nz
Please select
APPLICATION & DECLARATION
The Council relies on the information contained in this application being complete and accurate. The Applicant must take all reasonable
steps to ensure that it is complete and accurate and accepts responsibility for information in this application being so.
If lodging this application as the Applicant:
I/we hereby represent and warrant that I am/we are aware of all of my/our obligations
arising under this application including, in particular but without limitation, my/our
obligation to pay all fees and administrative charges (including debt recovery and legal
expenses) payable under this application as referred to within the Fees Information section.
If lodging this application as agent of the Applicant:
I/we hereby represent and warrant that I am/we are authorised to act as agent of the Applicant in
respect of the completion and lodging of this application and that the Applicant is aware of all of
his/her/its obligations arising under this application including, in particular but without limitation,
his/her/its obligation to pay all fees and administrative charges (including debt recovery and legal
expenses) payable under this application as referred to within the Fees Information section.
I hereby apply for the deemed permitted boundary activity for the Proposal described above and I certify that, to
the best of my knowledge and belief, the information given in this application is complete and accurate.
Signed (by or as authorised agent of the Applicant) **
Full name of person lodging this form
Firm/Company Dated
**If this form is being completed on-line you will not be able, or required, to sign this form and the on-line lodgement will be treated as
conrmation of your acknowledgement and acceptance of the above responsibilities and liabilities and that you have made the above
representations, warranties and certication.
OR:
PLEASE TICK
APPENDIX 2 // Naming of Documents
Development
Contribution
Estimate Request
Form
APPENDIX 1 // Development Contributions
Will your proposal result in a Development Contribution and what is it?
A Development Contribution can be triggered by the granting of a resource consent and is a nancial charge levied on new
developments. It is assessed and collected under the Local Government Act 2002. It is intended to ensure that any party,
who creates additional demand on Council infrastructure, contributes to the extra cost that they impose on the community.
These contributions are related to the provision of the following council services:
Water supply
Wastewater supply
Stormwater supply
Reserves, Reserve Improvements and Community Facilities
Transportation (also known as Roading)
Click here for more information on development contributions and their charges
OR Submit an Estimate request *please note administration charges will apply
While it is not essential that your documents are named the following, it would be helpful if you could title your documents
for us. You may have documents that do not t these names; therefore below is a guide of some of the documents we
receive for resource consents. Please use a generic name indicating the type of document.
Application Form 9 Plan to Scale
Computer Register (CFR) Aected Party Approval/s
Covenants & Consent Notice
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: resourceconsent@qldc.govt.nz
www.qldc.govt.nz
Page 5/5 // January 2019
click to sign
signature
click to edit
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