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PREMISES/PART OF PREMISES (Waimakariri District Council New Zealand)

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Waimakariri District Council
1 of 6 Application for Certicate for Public Use
APPLICATION FOR CERTIFICATE FOR
PUBLIC USE
Under The Building Act 2004, Section 363A
BC No.
Private Bag 1005, Rangiora 7440
Phone 0800 965 468 (0800 WMK GOV)
Fax 03 313 4432 - waimakariri.govt.nz
PREMISES/PART OF PREMISES
1. Description of premises/part of premises for which certicate is sought:
2. Site address:
(Street / Road / Township
3.
Building Name:
BUILDING WORK AFFECTING PREMISES/PART OF PREMISES
4. Building consent number to which the application relates:
5. Issued by:
COUNCIL
THE AGENT
PLEASE NOTE - Authorisation is required from the owner to act as agent.
12.
Agent’s name:
(Company or Organisation name if applicable)
13.
Contact person:
14. Mailing address:
15. Street address / Registered office:
16. Mobile: Landline:
Email:
THE APPLICANT
6. Owner’s name:
(Company or organisation name if applicable)
7.
Contact person:
8. Mailing address:
9. Street address / Registered office:
10. Mobile: Landline:
Email:
11. The following evidence of ownership is attached to this application:
Council to provide (additional charge of $15)
Copy of Certificate of Title OR
(Current within 1 month of being issued and must include a deposited plan [diagram])
Signed copy of Sale and Purchase Agreement
(If Certificate of Title is not issued)
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Waimakariri District Council
2 of 6 Application for Certicate for Public Use
APPLICATION
1 7. I wish to receive my approved documentation in the following format:
PLEASE NOTE - If CD or Hard Copy please confirm if you wish to pick it up from the council or have it posted.
(post) OR (pick-up)
Hard copy:
18.
All Certicate for Public Use related invoices/refunds to be billed and sent to:
Owner Agent
Or other
(If other please complete below)
19.
Company name:
(If applicable)
20.
Contact person:
2 1. Mailing address:
22. Mobile: Landline:
Email:
PLEASE NOTE - Any refunds are to the receipted name unless written authorisation has been received from the receipted person or company.
PROJECT
23. I conrm that a Code Compliance Certicate has not been issued for any part of the building work
24. It is intended to permit members of the public to use the premises / part of the premises described
in the Premises section on page 1 for the following purposes and in the following circumstances:
(Describe purposes and circumstances)
25. Members of the public can use the premises / part of the premises described above safely because:
(State reasons for statement, and include any precautions taken to protect the public, information on any specied systems in the premises
or part of the premises, and the management of any special risks (e.g. means of escape from re on site.)
26. When do you request the issued CPU to expire?
Electronically (email)
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Waimakariri District Council
3 of 6 Application for Certicate for Public Use
KEY PERSONNEL
BUILDER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
DESIGNER(S)
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
CERTIFYING DRAINLAYER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
CERTIFYING PLUMBER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
CERTIFYING GASFITTER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
REGISTERED ELECTRICIAN
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
STRUCTURAL ENGINEER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
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Waimakariri District Council
4 of 6 Application for Certicate for Public Use
NOTES
Detail any management plans that may be required to achieve safety and amenity in the building:
ATTACHMENTS
The following documents are attached to this application:
Plans and Diagrams showing the premises or part of the premises described above (One copy clean and unstamped)
Must include:
• North orientation arrow
• Distance from all boundaries
• Show all other buildings on property (size if possible)
• Distance from any hazards (ie water race/open drains)
Documentation relevant to the safety of the premises / part of the premises
(e.g. Engineers report, certicates concerning specied systems)
One copy of all information required
(all plans to be dimensioned, scaled and accurate. Plans preferred size A3)
Application fee
(as per Council Fees and Charges Schedule)
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150506072717[v04] Waimakariri District Council
V4 - 22/03/2019 5 of 6 Application for Certicate for Public Use
OWNER / AGENT AUTHORISATION
I request that you issue, under Section 363A(2) of the Building Act 2004, a Certicate for Public Use for the premises
or the part of the premises described on Page 1.
PLEASE NOTE - By entering your name in the box below you are giving your authority for the application to proceed.
Name: Date:
I am the
Owner
Agent
Note: If acting on behalf, by entering your name above you hereby declare that you are authorised to act as Agent for
the Owner.
NB: Ensure Agent Authorisation section is completed - see below.
AGENT AUTHORISATION
(TO BE AUTHORISED BY OWNER)
PLEASE NOTE - By entering your name in the box below you are giving your authority for this application to proceed.
I authorise
to act as Agent on my behalf for this Certicate
for Public Use application under Section 363A(2) of the Building Act 2004.
Name (Owner): Date:
TERMS OF TRADE
I/We understand that:
Building Consents shall be paid for when the consent is collected or if the consent is not collected within three months after the date
of consent being granted, the work done to date portion i.e. admin and processing costs of the account will be due and payable. The
balance of the invoice will be payable when the consent is collected.
All other accounts shall be paid by the 20th day of the month following the month in which the invoice is issued.
I/We agree to pay according to these terms for any goods or services you supply to us. Failure to meet these Terms of Trade may
result in any credit arrangement being withdrawn with any balance becoming payable within seven days. Should failure to meet the
terms of trade result in debt recovery and/or legal proceedings, any costs whatsoever incurred in the collection of the debt including
debt collector’s fees and commissions and legal costs, charges and expenses on a solicitor and own client basis will be added to
the account and will be payable by me/us.
OFFICE USE ONLY
Further information required? Yes No
Date of acceptance: Officer:
OFFICE USE ONLY
Amount paid: $
Date:
Officer:
Date payment processed:
Receipt
Officer:
Fee paid on application Deposit invoice sent
Waimakariri District Council
6 of 6 Application for Certicate for Public Use
IMPORTANT INFORMATION
All the relevant information on this form is required to be provided under the Building Act 2004 and/or Resource Management Act 1991
for the Waimakariri District Council to assess your application. Under these Acts this information has to be made available to members
of the public if requested. The information contained in this application may be made available to other units of the Council. You have
the right to access the personal information held about you by the Council which can be readily retrieved. You can also request that the
Council correct any personal information it holds about you.
APPLICATION INFORMATION
When is a Certicate of Public Use Required?
In premises intended for public use affected by building work, Section 363 of the Building Act 2004 applies in the following situation:
A Building Consent has been issued to undertake the building work, but a Code Compliance Certicate has not yet been issued; or
Under Section 363 of the Building Act 2004 it is an offence to permit people to use parts of premises intended for public use that
are affected by building work, unless the Territorial Authority conrms it is satised it is safe for members of the public to do so, this
will take into account any safety precautions that have been put in place. Once all building work is complete, a Code Compliance
Certicate must be obtained.
Failure to Obtain Certicate for Public Use
Under Section 363(4) of the Building Act 2004 a person who commits an offence is liable to a ne not exceeding $200,000
and in the case of a continuing offence, to a further ne not exceeding $20,000 for every day or part of a day during which the
offence continues.
AGENCY
The owner may authorise an agent to submit an application on their behalf.
The Agent will be the rst point of contact for all communications with the Council/Building Consent Authority regarding this
application under Section 363A of the Building Act 2004. They will receive all correspondence and must be authorised by the
Owner - see page 5.
CERTIFICATE OF PUBLIC USE FEES
The application fee for a Certicate for Public Use (CPU) includes one inspection. Additional processing and inspections required for the
issue of a CPU will be charged at an hourly rate - refer to the Schedule of Fees & Charges on Council’s website, waimakariri.govt.nz
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PREMISESPART OF PREMISES (Waimakariri District Council New Zealand)

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Completed 29 July 2020

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