B73 V2 12/07/2017 Page 1 of 4
Invercargill City Council
101 Esk Street
Private Bag 90104
Invercargill 9840
New Zealand
Phone: 0800 422 435 or
Phone: (03) 211 1777
Application for a discretionary exemption
from building consent
Building Act 2004 - Schedule 1, exemption (2)
1. About this form
Please check that the forms that you are using are current at the time of application as they are subject to
change without notice.
General information can be found on our website at www.icc.govt.nz
A building consent exemption under Schedule 1(2) of the Building Act 2004 is the formal decision issued by a
territorial authority confirming a building consent is not required for the intended building works.
2. Location of proposed work
Street address:
Legal description of land where building is located (e.g. Lot Number, DP)
3. The applicant (must be the property owner or person authorised to act on their behalf - attach
written confirmation)
New Zealand Companies Registered Number: (if applicable)
Name of applicant:
Applicant’s postal address: (Must be a New Zealand address)
Contact person: (If different from the applicant)
Email:
Phone number:
Owner details: (If different from the applicant)
Name:
Email:
Phone Number:
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4. The agent acting on behalf of the owner
New Zealand Companies Registered Number: (if applicable)
Name of agent:
Agent’s postal address: (Must be a New Zealand address)
Contact person: (If different from the agent)
Email:
Website:
Phone number:
Relationship to owner: (state details of the authorisation from the owner to make the application on the owner’s behalf)
First point of contact for communications with the Council: (Mark boxes as appropriate)
Applicant
Owner
Agent
My preferred method of written
communication is:
Email
Post
All related invoices are to be charged to: (Mark boxes as appropriate)
Applicant
Owner
Agent
My preferred method of written
communication is:
Email
Post
5. Project details
Provide a description of the work to be considered for exemption. Before completing this application please refer
to MBIE guidance documents:
https://www.building.govt.nz/projects-and-consents/planning-a-successful-build/scope-and-design/check-if-you-
need-consents/building-consent-exemptions-for-low-risk-work/schedule-1-guidance/
in particular the sections that discuss work that is unlikely to be approved.
Brief projection description
If your application is for a temporary
structure, include critical dates.
Estimated value of work:
If yes, is it coordinated by CP Reg Engineer
Yes
No
If yes, name of Engineer:
Application comments: (For example, related application numbers, or notes of processing staff)
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6. Exemption details
All fields in this section must be completed (or separate quality assurance documents covering all aspects provided with the application)
otherwise your application will be not accepted.
This should consider the complexity of the work, the risks and consequences of it not complying, and any quality assurance that can be offered.
Refer to MBIE for further guidance, and in particular the guidance examples on how to complete this application.
Detailed description of work
Describe the proposed work in detail;
specify work not to be covered by
exemption; for earthquake repairs,
specify damage to the building.
Grounds for exemption
(a)
The completed work is likely to comply with the Building Code if it
is carried out in accordance with your proposal.
There are two grounds on which the
Council can decide to exempt building
work from requiring building consents.
Please nominate which of these that you
believe applies to this project (both
options may be selected if necessary).
OR
(b)
If the completed work were not to comply with the Building Code,
it would unlikely endanger any people or building provided it is
carried out in accordance with your proposal.
Means of compliance
Specify the standards, acceptable
solutions, or MBIE guidance documents
that may apply.
Design responsibilities
Who is carrying out the design
work?
What qualifications and proven
record of compliance do they have
in carrying out work of this
complexity?
Notes:
Comprehensive details of all
designers and consultants involved
in the project along with relevant
experience in similar works must
be provided.
Construction responsibilities
Who is carrying out the building
work?
What qualifications and proven
record of compliance do they have
in carrying out work of this
complexity?
Notes:
Comprehensive details of all
contractors involved in the project
along with relevant experience in
similar works must be provided.
Quality assurance
Outline everything you are offering
to satisfy council that the
requirements of Schedule 1, 2(a)
and/or (b) of the Building Act 2004
will be met.
Notes:
Summarise the QA system to be
used to ensure compliance e.g.
inspection schedules and
completion documents.
Document can be attached.
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7. Supporting documents
Include all relevant drawings (plan,
elevations, typical sections), supporting
documents, specifications, photos, and
critical member sizes and critical
construction details, if any.
If an engineer is involved, provide the
engineer’s calculations and sketches,
including a producer statement - design.
8. Declaration
[To be completed and signed by applicant or agent]
I/we understand that the fee charged at lodgement is a fixed fee for the Council to assess this application. This will
be paid before the decision is released. The fee is payable whether the application is approved or declined.
If the application is not accepted for processing an administration fee may still be charged.
Where an invoiced amount has not been paid by the stated due date, the Council may commence debt recovery
action. The Council reserves the right to charge interest, payable from the date the debt became due, and recover
costs incurred in pursuing recovery of the debt.
All of the above information is, to the best of my knowledge, true and correct. I understand that all plans,
documentation and reports submitted as part of an application are required to be kept available for public record,
therefore the public (including business organisations and other units of the Council) may view this application, once
submitted.
I/we understand that no work covered by this application is to commence until the building consent exemption
decision is approved.
Print name:
Date:
Applicant or agent signature:
PRIVACY INFORMATION:
If you would like to request access to, or correction of, your details, please contact the Council.
9. Information
GENERAL INFORMATION:
For general enquiries please phone 0800 422 435 or (03) 211 1777 or email use building@icc.govt.nz
SUBMIT AN APPLICATION USING ONE OF THE FOLLOWING METHODS:
You can submit your application using our online form at www.icc.govt.nz
An application can also be lodged via the following methods:
Post your application to: Invercargill City Council, Private Bag 90104, Invercargill 9840
Hand delivered to the Invercargill office, 101 Esk Street, Invercargill or Bluff Service Centre
All applications will be checked for completeness prior to acceptance. Please ensure that you have compiled your
documents carefully to avoid delays in accepting your application. If your application is incomplete it will not be
accepted.
F O R O F F I C E U S E O N L Y
Approved
Declined
Fee:
Time Spent:
Reasons:
Signature:
Date:
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