APPOINTMENT OF BUILDER & APPLICATION FOR COMMENCEMENT NOTICE  
Building Act 2004, S151
	
In completing this form the owner is authorising the builder nominated below to apply to the appointed certifier to issue a Commencement Notice for the works detailed in this application form.

PART A	PROJECT DETAILS

Block	Section	Suburb	Unit No.

Street Address

Certifier Name

Description of Building Works relevant to this application‐If more than 6 items please attach further details

1	
2	
3.	
4	

PART B	OWNER DETAILS – Please Print

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

       Company Details

Owner 1	Owner 2

Owner 3	Owner 4

Postal Address

Suburb	State	Postcode

Phone Number Business Hours	Mobile

EMAIL ADDRESS

PART C	APPOINTMENT OF BUILDER

I/we the owner/s have appointed the person whose details appear below as the builder in relation to the building works described in this form

Licence Holders Name as it appears on licence card

Licence Number	Class	Expiry Date

List any conditions or endorsements on licence

EMAIL ADDRESS

PART D

NOMINEE’S DETAILS
If the builder is a company or partnership provide details of the Nominee who will supervise the building work

                           Nominee’s Name

Licence Number	Class	Expiry Date

Signature of Nominee	             Date

PART E	OWNER SIGNATURE/S– all owners must sign this form

Owner 1		Signature	DATE :

Owner 2		Signature	DATE:

Owner 3		Signature	DATE:

Owner 4		Signature	DATE:

PART F	BUILDER APPLICATION TO CERTIFIER FOR COMMENCEMENT NOTICE

I hereby apply to the building certifier listed above for a commencement notice for the works detailed in Part A of this form in accordance with the Building Act 2004.

A site sign was not required to be displayed prior to making this application.

A site sign was required to be displayed prior to making this application and I declare that a compliant sign was erected and displayed for the required period.

Signature of Builder	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.

PART G	INSURANCE OR FIDELITY CERTIFICATE

For residential building work please provide details of insurance where applicable

Insurance Provider

Policy No.	Date
Issued

PLEASE NOTE:

„ A copy of this notice and where applicable the residential building insurance policy or fidelity certificate must be given to the Construction Occupations Registrar within one (1) week of the issue date.

„ A copy of the Commencement Notice must also be provided to the owner/s.

Privacy Notice                                                                                                                                                                                                                                                                
The personal information on this form is provided to Access Canberra to enable the processing of your application. The collection of personal information is authorised by the Building Act 2004. If all or some of the personal information is not collected Access Canberra cannot process your application. The personal information you provide may be disclosed to Australian Bureau of Statistics, ACT Revenue Office and the Taxation Office. The information may also be disclosed where authorised by law or court order, or where the Directorate reasonably believes that the use or disclosure of the information is reasonably necessary for enforcement‐related activities conducted by, or on behalf of, an enforcement body. Access Canberra’s Information Privacy Policy contains information about how you may access or seek to correct your personal information held by Access Canberra, and how you may complain about an alleged breach of the Territory Privacy Principles. Access Canberra Information Privacy Policy can be found at www.act.gov.au/accessCBR

CONTACT INFORMATION

  Email:
  ACTPLAedevlopmentBA@act.gov.au 
	Post:
Access Canberra
Building Services
Shopfront Mitchell
GPO Box 158
Canberra, ACT 2601	In Person:
Please visit www.act.gov.au/accessCBR
Or call 132281 to find an 
Access Canberra Shopfront.