Administration Centre Avoca Rd Wakeley 2176 Tel: (02) 9725-0222 Fax: (02) 9725 1220 Correspondence to PO Box 21,

Fairfield NSW 1860

OFFICE USE ONLY

BC No.

BUILDING CERTIFICATE APPLICATION

Environmental Planning & Assessment Act 1979. Sections 149A-149G

APPLICANTS DETAILS
We will post all correspondence and the determination to this address. Should these details change, please inform Council. Failure to do so may lead to the refusal of your application.

Mr Given Names

Mrs

Miss

Ms

Other:

Family Name or Company Name Postal Address (No DX) Postcode Phone Fax Alternate Phone Email Owner - of the land which the building is erected on. (Identification must be provided); or Purchaser - under contract of sale of property. (Copy of front page of contract is to be provided); or Solicitor or Agent; or Any other person - with the consent of the owner of that land (Complete the owners consent section on the back of this form);
or

Who may apply:

To qualify for the issue of a Building Certificate the applicant must be one of the following people:

A public authority - with the consent of the owner of that land (Complete the owners consent section on the back of this form).

SITE DETAILS (Complete all applicable parts)

Location and title description of the property. We need this to correctly identify the land. (These details are available from rates notices, property deeds, or from Council property maps. If unsure ask for assistance.)

Unit/Shop or Suite Street Suburb Lot(s) Deposited Plan(s) Building Name (if applicable): Residential

Street No. Postcode Section (if applicable) OR Strata Plan No. Commercial/Industrial

DESCRIPTION OF BUILDING
If it is difficult to describe what you wish Council to assess, it is suggested that you attach a highlighted site/ floor plan

Whole of property Other Structure/s Description: Part of Building Floor Area Description: m2(For Commercial or Industrial Buildings Only)

Unauthorised work* Unauthorised work* Unauthorised work* Unauthorised work*

CONTACT DETAILS FOR ACCESS TO PROPERTY

For access to the building we will need a contact person who can be contacted between 8.30am and 4.30pm, Monday to Friday. (Please note: Persons meeting Council officers on site or permitting access must be at least the age of eighteen)

Name Address

Phone

Mobile

YOUR DECLARATION
I am applying for a Building Certificate as described in this application. I declare that all the information given is true and correct. I also understand that if incomplete, the application may be delayed or rejected, and that additional information or fees may be requested if required. I have attached hereto an original/ certified copy of an original up to date survey report of the building/s or part as described above together with the prescribed fee (see reverse). I do understand that information provided on this form and associated documents received, becomes open access information under the Government Information (Public Access) Act 2009.

Applicants Signature:

Date:

OWNER(S) CONSENT/S
Must be signed by the owners of the land. If more than one owner, every owner must sign. For a company, each director of the company must sign For Applications for a property including the common property in a strata plan, the owners corporation (or other appropriate person) must consent to application or a stamp is to be provided. As owner(s) of the land to which this application relates, I/we consent to this application. I/we also give consent for authorised Council officer (s) or agents to enter the land to carry out inspections for any building or part of buildings

Owners Name: Address: Phone Number: Signature: Owners Name: Address: Phone Number: Signature: Owners Name: Address: Phone Number: Signature: Owners Name: Address: Phone Number: Signature:

If you are signing on the owners behalf as the owners legal representative, please state the nature of your legal authority and attach documentary evidence: (eg Power of Attorney, Executor, Trustee, Company Director)

FEES & PAYMENT

The following fees are prescribed under Clause 260 of the Environmental Planning & Assessment Reg 2000

Residential* Class 1 Building (together with any Class 10 Buildings on the site) or a Class 10 Building. $250.00 Commercial/ Industrial* - In the case of any other classes of building. $250.00 Floor area < 200m2 $250.00 plus an additional 50 cents per square metre over 200. Floor area 200m2 2,000m2 $1,165.00 plus an additional 7.5 cents per square metre over 2,000 Floor area > 2000m2 *Note: If the work is Unauthorised an Additional Unauthorised Building Works fee applies. This fee is determined by the Building surveyor and is equal to the fee
payable for a combined DA/CC for the subject unauthorised structure(s) taking into consideration the industry standard construction cost.

Re-Inspection Fee - In the case where Council is required to carry out more than one inspection before issuing at building certificate. $90.00 per re-inspection (GST inclusive) Urgency Fee - Zone 2 (a) & Residential A only An initial response will be issued within 3 days of receipt of application. $360.00 (GST inclusive)

OFFICE USE ONLY

BC Amount (Code 462 VC 154.043) Urgency Fee (Zone 2(a) & Res A only)
(Code 41 VC 155.043) Re-Inspection Fee (If Applicable) (Code 44 VC 152.043) Unauthorised Works Fee (If Applicable) (Code 44 VC 152.043)

$ $360.00 $90.00 $

Receipt No.: Receipt No.: Receipt No.: Receipt No.: Signature:

Date: Date: Date: Date: Date:

Updated & Printed 22/06/2012

Customer Service Officer