Application Number (Office Use Only) - __________/___________________
1 - Applicant Details: (Must be the owner of the building)
Application for
Regularisation Certificate
Full Name: ________________________________________________________________________________________
Address: _________________________________________________________________________________________
___________________________________________________________________________Post Code: ____________
Phone: __________________________ Fax: ________________________ Email: _____________________________
Full Name: ________________________________________________________________________________________
Address: _________________________________________________________________________________________
___________________________________________________________________________Post Code: ____________
Phone: __________________________ Fax: ________________________ Email: _____________________________
3 - Address / Location that the Unauthorised Work took place:
Address: _________________________________________________________________________________________
__________________________________________________________________________ Post Code: _____________
4 - Description and Date of Unauthorised Work:
Description of Works: ________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________ Approx date work carried out: _______________________
5 - Use of Building & Additional Information
6 - Charges (Please refer to the guidance and separate Building Control Charges Tables A, B and C)
If Table A, please state number of new dwellings: ________ If Table B, please state floor area (m
2
): ______
If Table C, please state estimated cost of work excluding VAT: £ _______________________
Applicable charge for Regularisation Application enclosed: £ _________ ( Refer to paragraph 5.3 of Charges Table ABC
Guidance Notes)
Data Protection Act 1998: Gwynedd Council is the data controller for the purposes of the Act. The information on this form will be used for the purpose of planning or building control applications and for the preparation of the
statutory public register. It may de disclosed to other council's registration under the Act.
2 - Agent Details: (if applicable)
This notice is given in relation to the building work as described, is submitted in accordance with Regulation 12(2) and is accompanied by
the appropriate payment. I understand that further charges will be payable following the first statutory inspection by the local authority.
Name - ___________________________ Signature - _______________________________ Date - _________________
7 - Declaration
BCF-04
If new building or extension, state present use: __________________________________________________________
If existing building, state present use: ___________________________________________________________________
Does the building fall within the scope of the Regulatory Reform (Fire Safety) Order 2005? Yes
No
Was the electrical work undertaken by a Part P Competent Person
(Domestic Only)? Yes No
version 0.1
05/04/2011
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