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PROJECT INFORMATION MEMORANDUM
AND/OR BUILDING CONSENT APPLICATION
(BAM 002)
Section 33 or section 45, Building Act 2004
(Only complete items within the shaded panels that are applicable to your project)
FOR OFFICE USE
Project No.: __________________________
Date Received: ________________________
This form is to be accompanied by the relevant office cover sheet.
APPLICATION
I request that you issue a
Project Information Memorandum only (PIM)
Building Consent only (for existing PIM No.____________ (attach a copy)
Building Consent (including Project Information Memorandum)
THE BUILDING
Street Address: (Include Postal Code and/or Rapid Number if
Number of Levels:
Level/Unit No:
Valuation Roll No.:
Approx Year Building was
First Constructed:
Applicable):
Legal Description:
Lot No.: ______________ D.P. No._______________
Total Floor Area (all floors included):
2
2
Add _____________m
Existing ______________m
Current Lawfully Established Use:
Building Name if Applicable:
THE PROJECT
Description of Building Work:
______________________________________
(eg. dwelling, commercial, farm shed, garage etc.)
Will the building work result in a
change of use of the building?
Yes
No
(Refer to Building (Specified Systems, Change of Use, and
Earthquake-prone Buildings) Regulations 2005 if in doubt)
If “Yes”, provide details of the new intended use.
______________________________________
THE OWNER
Intended life of the building:
Indefinite but not less than 50 years or
Specified as ________ years
List Building Consents previously issued for this
building (if any): (ie. is this project being constructed in stages?
Is this consent for a relocated or transportable building?)
________________________________________
Estimated Value (incl. GST) $ __________________
(ie. the estimated aggregate of the values of all goods and services.)
AGENT – APPLICANT
Owner’s Name:
Agent’s Name:
Contact Person:
Contact Person:
Mailing Address:
Mailing/Billing Address:
E-mail Address:
E-mail Address:
Contact Numbers:
Daytime:
After Hours:
Contact Numbers:
Daytime:
After Hours:
Mobile:
Fax:
Evidence of ownership attached to this application:
Certificate of Title
Sale and Purchase Agreement (If title not in
applicant’s name)
Kaikoura Building Consent Authority Manual
Mobile:
Fax:
Note – 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.
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Application Forms – Section 3 BAM002 V1.1.14
KEY PERSONNEL
Name of Builder:
Phone Number:
Mailing Address:
Registration Number:
E-mail Address:
Name of Craftsman Plumber:
Phone Number:
Mailing Address:
Registration Number:
E-mail Address:
Name of Registered Drainlayer:
Phone Number:
Mailing Address:
Registration Number:
E-mail Address:
Name of Designer:
Phone Number:
Mailing Address:
Registration Number:
E-mail Address:
Name of Engineer:
Phone Number:
Mailing Address:
Registration Number:
E-mail Address:
CULTURAL OR HERITAGE SIGNIFICANCE/NATURAL HAZARD OR CONTAMINATION
Does the building or site have any cultural or heritage significance?
Yes
No
Don’t know (Consult a
Council Officer)
Is the site subject to natural or created hazards such as erosion, subsidence, flooding, slips, cut and fill or
contamination?
Yes (provide details)
No
Don’t know (Consult a Council Officer)
RESTRICTED BUILDING WORK APPLIES FROM 1st MARCH 2012
Does application involve restricted building work
Yes
No
N/A
Certificate of Design Work included with application
Yes
No
N/A
Owner-builder exemption forms (Form 2B and Form 2C)
Yes
No
N/A
If yes, provide the following detail of all Licensed Building Practitioners who will be involved in carrying
out or supervising the restricted building work. If their details are unknown at the time of the application,
they must be supplied before the work begins – this is a requirement of the Building Act 2004, Section 87
failure to do so is an offence that may carry a fine.
In accordance with the Building Acct 2004 Section 88 the following documentation will be required on
completion of the project:- Record of Building Work (Form available from MBIE website Form 6A) or the
following link Memorandum from licensed building practitioner: Record of building work
Kaikoura Building Consent Authority Manual
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Application Forms – Section 3 BAM002 V1.1.14
KEY PERSONNEL
(Restricted Building Work)
BUSINESS/NAME:
DESIGNER OR ARCHITECT
ADDRESS:
REGISTRATION/QUALIFICATION:
REGISTRATION/LBP NO:
LANDLINE:
LICENCE CLASS:
MOBILE:
FAX:
EMAIL:BUSINESS/NAME:
ENGINEER
ADDRESS:
REGISTRATION/QUALIFICATION:
REGISTRATION/LBP NO:
LANDLINE:
LICENCE CLASS:
MOBILE:
FAX:
EMAIL:BUSINESS/NAME:
BUILDER
ADDRESS:
REGISTRATION/QUALIFICATION:
REGISTRATION/LBP NO:
LANDLINE:
LICENCE CLASS:
MOBILE:
FAX:
EMAIL:BUSINESS/NAME:
PLUMBER
ADDRESS:
REGISTRATION/QUALIFICATION:
REGISTRATION/LBP NO:
LANDLINE:
LICENCE CLASS:
MOBILE:
FAX:
EMAIL:BUSINESS/NAME:
DRAINLAYER
ADDRESS:
REGISTRATION/QUALIFICATION:
REGISTRATION/LBP NO:
LANDLINE:
LICENCE CLASS:
MOBILE:
FAX:
EMAIL:-
Kaikoura Building Consent Authority Manual
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Application Forms – Section 3 BAM002 V1.1.14
NOTES BY APPLICANT (Other notes or comments which you as the applicant may wish to add)
SIGNATURE
Signed by or for and on behalf of the owner:
□
Owner
□
Agent
_________________________
Date: __________________________
Note: If acting “for and on behalf”, please read the following declaration before signing: “I hereby declare that I
am authorised to act as agent of the owner and am aware of all responsibility including the implications associated
with producer statements.”
Note: All plans and specifications to be bound and indexed – application will be returned if not
For Office Use
Receipt Number:
Pim Fee:
Fees Paid:
Sewerage Contribution or Fee:
Date Received:
PO Box 6, Kaikoura
Water Contribution or Fee:
Phone 319 5026 Fax 319 5308
Kaikoura Building Consent Authority Manual
Website www.kaikoura.govt.nz
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Application Forms – Section 3 BAM002 V1.1.14
APPLICATION INFORMATION
Building Consent processing time is stopped whenever further information is required and starts again when the information is
received.
Once the Building consent has been processed it will be sent to you by post unless you inform Council that you wish to collect
it.
Work must not start until all fees relating to the Building Consent are paid, the Building Consent is issued, and any Resource
Consent requirements have been dealt with (e.g. amended plans have been provided to comply with the Resource
Management Plan), or a Resource Consent has been granted.
INSPECTIONS
During the process of construction, inspection will be necessary to confirm all work complies with your approved Building
Consent documentation. Please ring the Council on 319 5026 well in advance of requiring an inspection to ensure that a time
can be arranged.
The inspections required will be set out in the Building Consent documentation issued by the Building Consent Authority. The
first inspection must be carried out within 12 months of the Building Consent being issued. Failure to have a prescribed
inspection carried out and to be provided with confirmation that work has been approved may put the issue of the Code
Compliance Certificate for the work at risk.
CODE COMPLIANCE CERTIFICATE
A building consent is not completed until it has been issued with a Code Compliance Certificate. The Owner is required to
complete a separate application form to apply for a Code Compliance Certificate as soon as practicable after the building work
is completed. In any event no later than two (2) years after the granting of the building consent. Council is required to decide
whether or not a Code compliance Certificate can be issued.
PRIVACY ACT
Pursuant to the Privacy Act 1991 the following information is brought to your attention.
This document collects personal information about you and is collected pursuant to Section 33 and/or Section 45 of the
Building Act 2004. Pursuant to Section 217 of the Building Act 2004, the information contained in the document is being
collected and held by Kaikoura District Council. You do have the right of access to and correction of this information subject to
the provisions of the Privacy Act 1993.
Pursuant to Section 217 of the Building Act 2004 the building owner may request the plans and specifications to be marked
confidential for the purposes of security. Such a request must be in writing and addressed to: Senior Building Control Officer,
P O Box 6, Kaikoura.
ATTACHMENTS – Office Use Only
The following documents are required before Council can accept your application:
Current Certificate of Title
Evidence of ownership of property (if Title not in applicants name e.g. Sales & Purchase Agreement)
Written authorization from owner for Agency acting on their behalf (use attached template)
Plans and Specification for the Project (e.g. Site Plan, Floor Plan, Elevations (include daylight angles, construction details
drainage cross section as follows:Two copies of all plans and installation detail plus an extra copy of site plan, floor plans and elevations.
Schedule of New Zealand Building Code Assessment (Attached to this this application form)
Site Plan including North Point and site levels
Floor Plans
Smoke alarms – If appropriate are these indicated on floor plan
Installation Details of the fire and chimney (If appropriate as part of this application)
Elevations
Drainage Plans
H1/AS1 Energy Value Schedule or R Values on Cross Sections
Roof Truss – If appropriate are these included with applications
Specification
Supplied fully completed compliance schedule checklist (commercial applications only checklist on application)
Producer Statement.- if part of this application check inclusion (Not a technical check of author competency or content)
Restricted Building Work – Memoranda (Certificate of Design Work) attached.
Are all sections of the application form completed particularly the section detailing the building i.e. year constructed and
lawfully intended use etc.
A ‘’ – Means that item has been provided, checked for completeness and application is acceptable for lodgement
If box is “blank” or N/A inserted – Means that this item is not relevant for the particular submission.
Received by KDC:____________________________________________ Date:-___________________________
Kaikoura Building Consent Authority Manual
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Application Forms – Section 3 BAM002 V1.1.14
RESIDENTIAL PIM/BUILDING CONSENT
APPLICATION CHECKLIST – (BAM 002-R)
Council
PIM
N/A
NB. The following is required on application in sufficient detail to show compliance with all aspects of the District Plan and
the New Zealand Building Code. Please complete this checklist in FULL additional information may be requested
during processing of the application.
Supplied
(in conjunction with form BAM 002)
Application form COMPLETED & signed
All information identified on the cover sheet
Application fee $__________ GST Inclusive ( Accepted Methods of Payment: CASH - EFTPOS – CHEQUE)
Certificate of Title: Recent search copy less than 6 months old, plus a sale & purchase agreement if not in the
applicant’s name. A subdivision scheme plan is required for a new site where Title is not yet available.
Copies of drawings as specified in the cover sheet
1 Site Plan – showing:
−
−
−
−
All new & existing buildings, swimming pools
Any heritage buildings / trees or archaeological site information known
Legal & notional boundaries (existing & proposed), easements, waterways, shared access ways / other areas with building
setbacks dimensioned
Building & site areas (including floor areas (m²) for all floors)
−
−
−
−
−
−
Vehicle access, crossing location, manoeuvre, and parking area
Street trees, poles, sumps, manholes, traffic islands outside the property
Any hard-standing (sealed or concrete) areas with proposed drainage
Landscaped areas required by District Plan indicated
Any significant trees on the site
Retaining walls
−
−
−
−
−
−
Fire rated walls, eaves
All activities on a site indicated
Proposed & existing site & floor levels
Existing & proposed contours, drive gradients and building heights ( for hill or sloping sites)
Intentions for the disposal of stormwater & sewer
Storage location and capacity of Hazardous Substances (ie LPG, diesel, home heating oil etc)
1 Outline Floor Plans (for all floors)
1 Outline Elevations
1 Outline Cross Sections (if required) to show recession plane / daylight plane & height compliance)
----------------------------------- STOP HERE IF THIS IS A PIM ONLY APPLICATION ----------------------------------BUILDING CONSENT (in addition to the above)
Project Information Memorandum (if already issued) plus all attached forms
2 Foundation Plans (timber or concrete slab) including all details
2 Drainage Plans - full design details including both Sewer & Stormwater and any disposal methods
2 Detailed Floor Plans - fully dimensioned and notated, including location of Smoke Alarms
2 Detailed Elevations - including door & window s showing opening sashes
2 Cross Sections - to show all relevant construction, especially through difficult areas of the building and changes in
building form
2 Timber Treatment - the species, grading & treatment of all timber specific to the project is to be specified on the
drawings, ideally on the cross section
2 Framing Details - including floor joist layout plans if applicable
2 Construction Details - with all materials, fixings etc noted
2 Weathertightness Details - including a risk assessment matrix for all walls & all flashings
2 Internal Waterproofing Details - including all wet areas & surface finishes
2 Plumbing Details - including layout plan / schematic & water supply details
2 Specifications - relevant to the project
2 Bracing Design – calculations, schedule and layout plans
2 Roof Truss Design – including layout plan, fixings and specific design for lintels where required
2 Ground Conditions Report - this will be either a report to show why it is assumed that the ground is “good ground”
using Section 3 of NZS 3604:1999, or a specific ground assessment & foundation design by a suitably qualified &
experienced engineer
2 Engineers Details & Producer Statement - where any specific design has been carried out (e.g. steel beams)
2 H1 Energy Compliance Schedule
2 Sediment Control Management Plan (if required by site location)
2 Restricted Building Work – Certificate of Design Work
Note: All plans and specifications to be bound and indexed – application will be returned if not
FOR OFFICE USE
Project No.: __________________________
Date Received: ________________________
This form is to be accompanied by the relevant office cover sheet.
Kaikoura Building Consent Authority Manual
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Application Forms – Section 3 BAM002 V1.1.14
BUILDING CODE ASSESSMENT
Means of Compliance
(Note that a project may include both acceptable and alternative solutions)
Acceptable
Solution
Building Code Clause
B1
Structure
B2
Durability
C1
Objectives of clauses C1-C6
C2
Prevention of fire occurring
C3
Fire affecting areas beyond the fire source
C4
Movement to a place of safety.
C5
Access and safety for firefighting operations
C6
Structural stability.
D1
Access Routes
D2
Mechanical installations for access
E1
Surface water
E2
External moisture
E3
Internal moisture
F1
Hazardous agents on site
F2
Hazardous building materials
F3
Hazardous substances and processes
F4
Safety from falling
F5
Construction and demolition hazards
F6
Lighting for emergency
F7
Warning systems (smoke detectors)
F8
Signs
G1
Personal hygiene
G2
Laundering
G3
Food prep. And prevention of contamination
G4
Ventilation
G5
Interior environment
G6
Airborne and impact sound
G7
Natural light
G8
Artificial light
G9
Electricity
G10
Piped services
G11
Gas as an energy source
G12
Water supplies
G13
Foul water
G14
Industrial liquid waste
G15
Solid waste
H1
Alternative Solution
(Details verifying compliance
are required)
Waiver/Modification
required?
(Provide separate
details for justification
of acceptance if yes)
Energy efficiency provisions
Additional Notes:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Kaikoura Building Consent Authority Manual
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Application Forms – Section 3 BAM002 V1.1.14
STATUTORY DECLARATION BY OWNER
APPOINTMENT OF AGENT TO ACT ON BEHALF OF THE OWNER
I,
(Name)
Of
(Physical Address/Place of abode)
Authorize and appoint:(Name of Agent)
Of:(Name of Company)
As our agent during the building process of our project.
Note:- 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.
Signature:-
Kaikoura Building Consent Authority Manual
Date:-
Page 8 of 8
Application Forms – Section 3 BAM002 V1.1.14