APPLICANT // Must be a person or legal entity (limited liability company or trust). Full names of all trustees required.
DETAILS OF SITE
CORRESPONDENCE DETAILS //
If dierent than above – E.g. consultant, agent or architect
INVOICING DETAILS // The invoices will be sent to this email or postal address
*Applicant’s full name:
Company / Trust:
*Contact Person / All trustee names:
*
Address: Post code:
*Email Address:
Phone Numbers: Day Mobile:
*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)
*Name & Company:
Phone Numbers: Day Mobile:
*Email Address:
Please complete all *Mandatory fields of this form
*Attention:
*Email:
*
Postal Address: Post code:
Page 1/4 // July 2018
DEVELOPMENT
CONTRIBUTIONS
ASSESSMENT &
ESTIMATES FORM
Details of proposed subdivision, building or development, tick those that apply.
*LAND USE
Residential building or development including minor residential units
Non- residential building or development (Commercial/Industrial)
Visitor Accommodation
Restaurant/café/bar
Change in use
Primary Industry
SUBDIVISION
Residential including unit titles
Rural subdivision
Industrial subdivision
Commercial Subdivision
DEVELOPMENT DETAILS
*A brief description of the proposal (See below for additional information required):
Plans clearly indicating the proposed subdivision or development should be attached wherever possible.
PLEASE PROVIDE THE FOLLOWING INFORMATION:
FILL THIS SECTION IN IF SEEKING FOR AN ESTIMATE
*Number of underlying title(s)
If subdivision estimate: Number of additional
allotments created and their size in m
2
If landuse estimate: Number of additional household
units, to be developed and their size in m
2
For residential ats, the Gross Floor Area of the
at in m
2
For retail/commercial industrial activities the Gross
Floor Area (before and after development) in m
2
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: development.contributions@qldc.govt.nz
www.qldc.govt.nz
Page 2/4 // July 2018
PLEASE PROVIDE THE FOLLOWING INFORMATION CONTINUED:
PLEASE NOTE BELOW:
For restaurant/bar – Gross Floor Area (before and after
development) in m
2
For visitor accommodation – Gross Floor Area (before
and after development) in m
2
For mixed use provide the residential and
non-residential information above as necessary in m
2
For primary industry – site area m
2
“Maximum Contributions”
Section 203 of the Local Government 2002 allows the following maximum contributions.
203 Maximum development contributions not to be exceeded-
(1) Development contributions for reserves must not exceed the greater of-
(a) 7.5% of the value of the additional allotments created by a subdivision; and
(b) the value equivalent of 20 square metres of land for each additional household unit created by the development.
Please note that the development contributions are an estimate only subject to the policy current at this time. Any
development contributions levied in conjunction with your proposed application will be based on an assessment of the
information and policies at that time and may be subject to change.
Please note that your application will not be processed until all of the required information has
been supplied.
PRIVACY INFORMATION
The information you have provided on this form is required so that your application can be processed under the Local
Government Act 2002 and may also be used in statistics collected by 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 company’s
or the Council’s websites.
DEVELOPMENT DETAILS CONTINUED
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: development.contributions@qldc.govt.nz
www.qldc.govt.nz
Page 3/4 // July 2018
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.
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.
I hereby apply for the resource consent(s) 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
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: development.contributions@qldc.govt.nz
www.qldc.govt.nz
Page 4/4 // July 2018
click to sign
signature
click to edit
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