The building
Street address of building: [for structures that do not have a street address, state the nearest street intersection and the distance and direction from that intersection]
Legal description of land where building is located: [state legal description as at the date of application and, if the land is proposed to be subdivided, include details of relevant lot numbers and subdivision consent]
Location of building within site/block number: [include nearest street access]
Number of levels: [include ground level and any levels below ground]
Area: [total floor area; indicate area affected by the building work if less than the total area]
Current, lawfully established, use: [include number of occupants per level and per use if more than 1]
The owner
Name of owner: [include preferred form of address, eg, Mr, Miss, Dr, if an individual]
Street address/registered office:
The following evidence of ownership is attached to this application: [copy of record of title, lease, agreement for sale and purchase, or other document showing full name of legal owner(s) of the building]
†Agent
†Name of agent: [only required if application is being made on behalf of the owner]
Street address/registered office:
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/building consent authority: [state full name, mailing address, phone number(s), facsimile number(s) and email address(es)‡]
Application
I request that you issue a †project information memorandum/†project information memorandum and building consent/†building consent for the building work described in this application.
Signature of †owner/†agent on behalf of and with the authority of the owner:
The project
Description of the building work:
Will the building work result in a change of use of the building?
†If Yes, provide details of the new use:
Intended life of the building if less than 50 years: . years
List building consents previously issued for this project (if any):
Estimated value of the building work on which the building levy will be calculated (including goods and services tax): $ [state estimated value as defined in section 7 of the Building Act 2004]
Restricted building work
Will the building work include any restricted building work?
*If Yes, provide the following details of all licensed building practitioners who will be involved in carrying out or supervising the restricted building work [If these details are unknown at the time of the application, they must be supplied before the building work begins.]:
Name | Licensing class | Licensed building practitioner number (or registration number if treated as being licensed under section 291 of Act) |
| | |
| | |
| | |
Note: Continue on another page if necessary.
§Project information memorandum
The following matters are involved in the project:
†Alterations to land contours
†New or altered connections to public utilities
†New or altered locations and/or external dimensions of buildings
†New or altered access for vehicles
†Building work over or adjacent to any road or public place
†Disposal of stormwater and wastewater
†Building work over any existing drains or sewers or in close proximity to wells or water mains
†Other matters known to the applicant that may require authorisations from the territorial authority: [specify]
║Building consent
¶The following plans and specifications are attached to this application:
Clause | | Means of compliance | | Waiver/modification required |
---|
[list relevant clause numbers of building code] | | [refer to the relevant compliance document(s) or detail of alternative solution in the plans and specifications] | | [state nature of waiver or modification of building code required] |
║Compliance schedule
†The specified systems for the building are as follows: [specified systems are defined in regulations]
†The following specified systems are being altered, added to, or removed in the course of the building work:
†There are no specified systems in the building.
†Attachments
The following documents are attached to this application:
†Plans and specifications [list]
†Memoranda from licensed building practitioner(s) who carried out or supervised any design work that is restricted building work
†Project information memorandum
†Development contribution notice
†Certificate attached to project information memorandum
*Delete if the applicant is an individual.
‡Contact details must be in New Zealand.
§Delete this section if this is an application for a building consent only.
║Delete this section if this is an application for a project information memorandum only.
¶All plans and specifications must meet the minimum requirements set out in the regulations or required by the building consent authority.
Schedule Part 2 form 2: amended, on 12 November 2018, by section 250 of the Land Transfer Act 2017 (2017 No 30).
Schedule Part 2 form 2: amended, on 1 March 2012, by regulation 4(1) of the Building (Forms) Amendment Regulations 2011 (SR 2011/418).
Schedule Part 2 form 2: amended, on 1 March 2012, by regulation 4(2) of the Building (Forms) Amendment Regulations 2011 (SR 2011/418).
Schedule Part 2 form 2: amended, on 31 March 2005, by regulation 4(1)(a) of the Building (Forms) Amendment Regulations 2005 (SR 2005/31).
Schedule Part 2 form 2: amended, on 31 March 2005, by regulation 4(1)(b) of the Building (Forms) Amendment Regulations 2005 (SR 2005/31).