This form is to be completed by the Owner/s of the land to which the building work relates.

PART A 					PROJECT DETAILS 

Block	
	Section 		Suburb		Unit No.		

Street Address	

Description of Building Works relevant to this application-If more than 4 items please attach further details

Describe each item of building work in this building approval	BCA Occupancy Class	BCA Construction Type	Area (m2)	Number of Storeys	Cost of Works (refer to building cost guide)	
1

2

3

4

Applicable approved requirements and reasons why building approval is not prevented from being issued

Is all work exempt from development approval?

•	YES	Attach assessment for exempt development checklist (if applicable)	
		
•	NO	Provide reason/s or description of work:  _____________________________________________________________
 	
Description of Attachments compliant with Division 3.3 Building Act 2004
Please attach any additional documentation not listed below
					
•	Building Approval Plans		•	Referrals, consultations & consents outcomes		•	Asbestos Advice -  If documents accompanying building approval do not include an asbestos assessment report as per the  Building Act 2004, the building approval must have an AA attached as per the Act
	
PART B					OWNERS DETAILS – Please Print

All owners must be listed 			Owner 1 will be considered the contact person in relation to this application

Company Details	

ACN/ABN Number	

Owner 1 	
	Owner 2		

Owner 3		
Owner 4		

Privacy Notice: The personal information on this form is being collected to enable processing of your application and to enable auditing and compliance of builders and certifiers by the Government appointed auditor.  The information that you provide may be disclosed to the Australian Bureau of Statistics, ACT Revenue Office and the Taxation Office. The information may also be accessed by other government agencies and commercial organisations interested in building information.

PART B continued			OWNERS DETAILS – Please Print
						
Postal Address	

Suburb	
		State			Postcode		
					
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS

PART C					APPOINTMENT OF CERTIFIER

As required under the Building ACT 2004 I/we herby advise that I/we the owner/s have appointed the person whose details appear below as the certifier in relation to the building works described in this form 

Company Details	

Name of Certifier	
		ABN/
ACN		

Postal Address	

Suburb	
		State			Postcode		
					
Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS

PART D					APPLICATION FOR BUILDING APPROVAL

I/we the owners of the abovementioned property hereby apply under Section 26 of the Building Act 2004 to the certifier named above to issue a building approval for the building work described in this form.  I/we have provided the certifier with information and documentation required to issue a building approval as specified in the Building (General) Regulation 2008.

PART E					AUTHORITY TO ACCESS BUILDING FILE 

I/we hereby authorise the certifier to access the Planning and Land Authority’s building file for the property which is the subject of this application for the purposes of obtaining information relevant to the issuing of a building approval and associated processes.

PART F					OWNER/S SIGNATURE/S 

Ist Owners Signature	
	Date		
				
2nd Owners Signature	

	Date		
				
3rd Owners Signature

	Date		
				
4th Owners Signature

	Date		

NOTE: There are penalties for deliberately giving false and misleading information. The Planning and Land Authority or Minister may revoke an approval if satisfied that the approval was obtained by fraud or misrepresentation.

APPLICATION FOR BUILDING APPROVAL REQUIREMENTS – Building (General) Regulations 2008

Where relevant the following information MUST be included in either the application or the plans accompanying the application for building approval:

General Requirements

•	Estimated Cost of Works -as per Building (General) (Cost of Building Work) Determination 2011
•	if the proposed building work to be carried out at or near a street or place that is open to or used by the public the application must contain details of the precautions proposed to be taken to protect the safety of people using the street or place while the building work is carried out
•	the area of the parcel of land to which this application relates
•	the class of the building according to the intended use of the building as proposed to be erected or altered;
•	if applicable what fire-resisting construction type (under the building code) the building as proposed to be erected or altered will be. 
Note: Fire-resisting construction type may not be applicable if an alternative solution under the building code is used.
•	for an application relating to the erection of a class 1 building  the site classification of the parcel of land
•	for an application relating to the alteration of a class 1 building if the alteration will increase the building load carried by foundation material beyond the building load carried by the foundation before the alteration.
•	the site classification of the parcel of land
•	for an application relating to the alteration of a building the class and type of fire-resisting construction of the existing building classified under the building code and the materials used in the existing building
Note	Fire-resisting construction type may not be applicable if an alternative solution under the building code is used.
•	the number of storeys of the building as proposed to be erected or altered;
•	the number of new dwellings (if any) created by the proposed building work;
•	the floor area of the proposed building or proposed new part of the building;
•	the materials to be used in the frame, floor, walls and roof of the proposed building or proposed new part of the building
•	if a performance requirement of the building code is to be complied with by use of an alternative solution under the code - 
(i)	the performance requirement; and
(ii)	the alternative solution; and
(iii)	each assessment method used to show that the alternative solution complies with the performance requirement;
•	if the building code does not state a standard of work in relation to any part of the proposed building work and it is intended to carry out that part of the proposed building work in accordance with a standard of work stated in another document - 
(i)	the nature of the proposed building work; and
(ii)	the title of the document; and
(iii)	each assessment method used to show that the proposed building work complies with the standard of work stated in the document.

Removal or demolition of building/s

•	Details of the methods to be used in carrying out the proposed building work, including a work plan stated or set out in AS 2601 (Demolition of structures), as in force from time to time;
•	the number of dwellings (if any) to be demolished.

Asbestos

•	The application must include a description of the method proposed to be used to remove the bonded asbestos sheeting from the building.
•	the application must include the following information:
(i)	the method proposed to be used to remove the asbestos;
(ii)	the approximate amount and kind of asbestos to be removed;
(iii)	the equipment proposed to be used to remove the asbestos, including any personal protective equipment;
(iv)	details of a program, prepared in accordance with the asbestos removal code, for monitoring airborne asbestos to be followed during the removal.