APPLICATION FOR CERTIFICATES & APPOINTMENT OF

PRINCIPAL CERTIFYING AUTHORITY FOR BUILDING WORKS 1. Applicant – NOTE: THE BUILDER CANNOT BE AN APPLICANT FOR THE CONSTRUCTION CERTIFICATE. Applicant’s name(s):

Full postal address:

Postcode: Phone: Mobile:

Email address:

2. Land No: Street/road:

Town: Lot no.: Deposited/Strata Plan:

3. Development description Development Application (DA) number: Date of determination:

Description of approved Development Application:

Detailed description of proposed building works to be carried out:

Estimated market cost of the development: $ Building classification (from BCA):

4. Long Service Levy (LSL) If the value of work is $25,000 or more (inclusive of GST), the building and construction industry Long Service Levy must be paid before a Construction Certificate can be issued. Has the Long Service Levy been paid? YES NO LSL NOT REQUIRED 5. Associated documents Applicants must provide the documents listed in the checklist that is relevant to the type of development that is proposed. Please find on the back page, the construction checklist and confirm that documents relating to the requirements have been attached by placing a cross in the appropriate box(s). 6. Applicant’s declaration (or person signing on behalf of applicant – please state in what capacity) I/we, the undersigned, hereby apply for approval of the Construction Certificate described in this application and in the plans, specifications and documents accompanying this application.

Signature: Date

Name, if not applicant: Capacity, if not applicant:

7. Consent of all owners Note: If the applicant is not the owner of the property, the owner(s) must sign the following statement. As the owner(s) of the above property, I/we consent to this application. I/we hereby give permission for Council authorised personnel to carry out inspections of the land and buildings as necessary for the purpose of assessing this application, without prior notice of entry. Owner’s name(s):

Signature(s): Date

8. Detailed description of the development Does the application propose an alternate solution to the Building Code of Australia? Yes No Area of land (m2): Number of storeys of the proposed building:

Gross floor area of proposed addition/new building (m2):

Gross floor area of existing building (m2):

Cnr Campbell & Vulcan St PO Box 99 MORUYA NSW2537

Telephone: 02 4474 1000 Facsimile: 02 4474 1234

E: council@esc.nsw.gov.au www.esc.nsw.gov.au

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9. Proposed new residential buildings only

No. of existing dwellings on the land: Does the land contain a dual occupancy? Yes No

No. of dwellings to be demolished: Is the new building attached to any new buildings? Yes No

No. of dwellings in the new building: Is the new building attached to any existing buildings? Yes No

Please select the building material which best describes the materials the new work will be constructed of: EXTERNAL WALLS ROOF FLOOR

Brick veneer Steel/colorbond Concrete

Full brick Concrete Timber

Concrete block Tile Other

Concrete/masonary Fibrous cement Unknown

Steel Slate

Hardiplank Aluminium FRAME

Timber/weatherboard Other Timber

Aluminium cladding Unknown Steel

Curtain glass Other

Other Unknown

Unknown

10. Builder/owner-builder details (NB: PLEASE SUPPLY A COPY OF OWNER/BUILDER PERMIT WHEN OBTAINED) Owner builder – permit number: Licensed builder

Builder’s name: Builder’s licence no: Expiry date:

Telephone – business: Mobile:

(If you are using a licensed builder for residential work exceeding $20,000).

Home building compensation cover number: Insurance company:

11. Owner building declaration (if value of labour and materials is $10,000 or less) I, the undersigned, being an owner of the land, declare that I intend to do the building work on the land and the reasonable market cost of the labour and materials involved in the work is not high enough for me to need an owner-builder permit for the work.

Signature: 12. Appointment of Principal Certifying Authority (PCA) Prior to commencement of works you are required to appoint a PCA. The PCA undertakes critical stage inspections and issues Occupation Certificates. Do you wish to appoint Council as the PCA to undertake inspections and issue other related certificates eg, compliance, occupation? YES NO

13. Office use only Has this form been lodged with a DA? YES NO If YES, complete fee section on DA form – Receipt number:

File number: PIN CC number: NOW reg. no.:

Construction Certificate: $ Compliance insp: $ No of compliance insp:

Registration NOW: $ Plumbing insp: $ No of plumbing insp:

Long service levy: $ Water meter: $

Officer: Amount $ Receipt no. Date:

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CHECKLIST FOR THE LODGEMENT OF CONSTRUCTION CERTIFICATE FOR BUILDING WORKS

This checklist has been prepared to assist you with the lodgement of your application by ensuring that you have provided all the necessary details. This will help prevent delays in the processing of your application.

Please refer to Council’s ‘Preparing plans factsheet’ for more detail, if required.

PLANS Applicant Office

Note: If the plans relate to alterations and/or additions to an existing building(s), the proposed changes are to be coloured to easily identify existing and proposed construction.

SPECIFICATIONS

Note: For class 1 and 10, building specifications may be indicated on plans. For other development, a separate specification of materials and methods shall be submitted with the application.

COMPLIANCE WITH THE BCA

APPOINTMENT OF PRINCIPLE CERTIFYING AUTHORITY Applicant Office

Site plan Including but not limited to (refer to ‘Preparing plans factsheet’) boundaries, setbacks to boundaries, landscaped area, APZ.

Floor plan

Eg, layout, partitioning, room sizes (dimensions), intended uses for each part of the dwelling, window/door locations, floor levels, plumbing fixtures, wall structure type and thickness.

Elevations Inclusive FFL, NGL, overall height, ** Plans must indicate all levels relative to a nominated datum point.

Sections Inclusive of proposed building materials, floor and ceiling heights. Section locations must be indicated on the floor plans.

Site Management Plan

Inclusive of location/specification of soil and water management facilities and location of storage space for building materials.

BASIX Copy of Basix Certificate. All commitments are to be indicated on plans or in specifications.

Specifications

Specifications must describe the construction and materials of which the building is to be built and the method of drainage, sewerage and water supply. The specification must state if the materials are to be new or second-hand. Particulars of any second-hand materials must be provided.

Bushfire commitments

Where your consent or application requires construction to comply with AS3959 - construction of buildings in bushfire-prone areas, your bushfire commitments shall be included in your application (you may use Council‘s bushfire commitments form).

BCA – class 1 and 10

Compliance with the Building Code of Australia (BCA) and the relevant Australian Standards is to be demonstrated on the plans and specifications.

If an alternate solution is proposed, a separate report is to be provided setting out the proposal and the method of complying with the performance requirements.

BCA – class 2-9

Compliance with the Building Code of Australia (BCA) and the relevant Australian Standards is to be demonstrated on the plans and specifications.

If an alternate solution is proposed, a separate report is to be provided setting out the proposal and the method of complying with the performance requirements.

Where applicable, provision of a report demonstrating compliance with Section J of the BCA.

Where the proposal is for alteration and additions to an existing building, both the existing and proposed fire safety measures are to be indicated on the plans and/or specifications.

Nomination Have you ticked yes to question 12 on your application form?

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GENERAL REQUIREMENTS

1. Are you lodging your Application for Certificates & Appointment of PCA electronically? If yes, refer to Online Applications on our 'ePlanning’ web page.

2. Are you lodging your Application in hard copy format? 3. Have you read the ‘Preparing Plans Fact Sheet’? 4. One complete set of all plans and documentation to support the application must be supplied. 5. Have all applicants signed the ‘applicant’s declaration’ section? 6. Has the applicant, owner or any person with a financial interest in this application made a

donation to a councillor or Council employee in the past two years? 7. All registered owners have signed the ‘owners consent’ section. 8. The application is fully completed. Privacy Statement: The information on this form is being collected by Council for purposes associated with processingyour application. Access to this information is limited to relevant Council officers and it may be disclosed to any othergovernment agency outside of Council as required by legislation. Supply of this information is required to enable accurateinformation to be provided. Your application may not be accepted or processed due to a lack of information. Theinformation will be stored securely in Council's systems. Visit www.esc.nsw.gov.au/privacy for more information.