Application for Project Information Memorandum and/or Building Consent (Form 2) Section 33 or section 45, Building Act 2004 For Official use Project Number: Date Received: Items marked * are mandatory for all applications. Complete this form in BLOCK CAPITALS using BLACK or BLUE ink. 1. Type of Application I request that you issue a*: (Tick one box only) for the building work described in this application Project Information Memorandum (PIM) only Building Consent only OR Amendment to Building Consent: Building Consent including PIM 2. The Building Valuation Roll Number: Street Address*: Description*: Lot: DP: Building Name (if applicable): Number of Levels: Number: Number of Occupants*: Floor Area* (all floors incl.): Existing: m2 Additional: m2 Current lawfully authorised use: (refer NZBC A1 “Classified Use) Approx year building first constructed: (if an addition or alteration) 3. The Owner [include preferred form of address, eg, Mr, Miss, Dr, if an individual] Owner’s Name*: Contact Person: (if owner is a company) Mailing/ Street Address/ Billing Address*: Registered Office: Phone Number: Cell Phone: Fax: e-mail: website: 4. The Agent (if applicable) The Agent will be the first point of contact for communications with the Council / Building Consent Authority regarding this application / building work and will receive all correspondence including all invoices. Agent’s Name: Contact Person: (if is a company) Mailing/ Street Address/ Billing Address: Registered Office: Telephone Number: Cell Phone: Fax: e-mail: website:
8. Project Information Memorandum (Applicable only if applying for a PIM or combined PIM & Building Consent) The following matters are involved in the project: Subdivision 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] (use additional sheets if required) 9. Building Consent (Not applicable if applying for Project Information Memorandum (PIM) only) The following plans, specifications and supporting documents are attached to this application*: [All plans and specifications must meet the minimum requirements set out in the regulations or required by the building consent authority.] 10. Means of Compliance with the New Zealand Building Code (Not applicable if applying for Project Information Memorandum (PIM) only) The building work will comply with the building code as follows* (use additional sheets if required):
NZBC Clause Means of compliance¥ Waiver/modification required¤ Acceptable Solution (eg. AS1, AS2 etc) Alternative Solution B1 (Structure) B1 B2 (Durability) B2 C (Protection from Fire) C1 D1 (Access Routes) D1 D2 (Mechanical Installations for Access) D2 E1 (Surface Water) E1 E2(External Moisture) E2 E3 (Internal Moisture) E3 F1 (Hazardous agents on site) F1 F2 (Hazardous building materials) F2 F3 (Hazardous substances and processes) F3 F4 (Safety from falling) F4 F5 (Construction and demolition hazards) F5 F6 (Visibility in Escape Routes) F6 F7 (Warning systems) F7 F8 (Signs) F8 G1 (Personal hygiene) G1 G2 (Laundering) G2 G3 (Food prep. and prevention of contamination) G3 G4 (Ventilation) G4 G5 (Interior environment) G5 G6 (Airborne and impact sound) G6 G7 (Natural light) G7 G8 (Artificial light) G8 G9 (Electricity) G9 G10 (Piped services) G10 G11 (Gas as an energy source) G11 G12 (Water supplies) G12 G13 (Foul water) G13 G14 (Industrial liquid waste) G14 G15 (Solid waste) G15 H1 (Energy efficiency provisions) H1 ¥ Provide reference 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. 11. Compliance Schedule (Not applicable if applying for Project Information Memorandum (PIM) only) Are there any specified systems associated with this project? * YES, the following specified systems are altered, added to, or removed in the course of the building work: (specified systems are defined in regulations) NO, there are no specified systems associated with this project. [Go to Section 12]