(Section 33 or Section 45, Building Act 2004)
Send your application to:
Bay of Plenty Regional Council PO Box 364, Whakatāne 3158
1Application
For the proposed dam (and/or appurtenant structures) described in this application (tick applicable)
Signature of owner/agent: (delete one)______Date:______
(on behalf of an with the authority of the owner) Print name:______
2Details of the dam
Address of the property where the dam is located:
______
Legal description: Lot No:______DP No:______Valuation No:______
Name of dam (if applicable)______
Location of building and/or dam with site/block number: (include nearest street access)
______
Current, lawfully established, use:______Year first constructed: ______
3The project
Description of the building work (dam(s) and/or appurtenant structures:______
______
______
Will the building work result in a change of use of the dam? Yes No
If ‘yes’ provide details of the new use:______
______
Intended life of the dam if less than 50 years:___yearsStage no:____of (total no of stages):_____
List building consents previously issued for this project (if any):______
Estimated value of the dame work on which the building levy will be calculated (including goods and services tax):
(state estimated value as defined in section 7 of the Building Act 2004) $______
The following matters are involved in the project:
Subdivision Disposal of stormwater
Alterations to land contours New or altered connections to public utilities
Building work over or adjacent to any New or altered locations and/or external
road or public placedimensions of dam
Building work over any existing drains New or altered access for vehicles
or sewers or in close proximity to wells
or water mains
Other matters known to the applicant that may require authorization from the territorial authority (specify):
______
______
4Owner and contact details
OwnerAgent (ignore if not applicable)
Name/company:______Name/company:______
Mail address:______Mail address:______
______
Phone daytime:______Phone daytime:______
After hours:______After hours:______
Fax:______Fax:______
Mobile:______Mobile:______
Email:______Email:______
Contact person:______Contact person:______
Phone:______Phone:______
Relationship to owner:______
Invoice to: Owner Agent
First point of contact for communications: Owner Agent
The following evidence of ownership is attached to this application (tick relevant box):
Certificate of TitleSale and Purchase Agreement Lease Other
Applicant’s checklist
To assist you in filling this out, please read the attached guidance notes. These help explain what each item means.
Items to be provided:Tick
1Certificate of Title or other proof of ownership
2Contact details
3Site or location plan
4Fees and charges
Guidance notes
1Certificate of Title
This is an important document that identifies which piece of land the project is to be built on and must be supplied with all applications. This can be obtained from your nearest Land Information New Zealand (maximum 90 days old) or, alternatively a purchase agreement (if recently purchased).
2Contact details
You will need to show full contact details of those involved in the project.
3Site plan
Please supply the following:
- scale: 1:100. 1:200 or 1:500 legal description
- north point
- existing and proposed buildings
- public roads
- aerial photographs
- private roads
Fees and charges
All applications will require a deposit at the time the PIM application is lodged with Bay of Plenty Regional Council. A deposit fee of $774.00, including GST, may be paid online, by cheque, or by eftpos at one of the RegionalCouncil’s reception desks.
- BayofPlenty RegionalCouncil’s bank account number is 060489009473400. Please use the applicant’s name as the reference. A GST invoice marked “PAID” will be issued on receipt of payment.
- An application will not be accepted as a complete application until the deposit fee has been paid. Please note: while we are happy to hold the forms in the meantime, the processing time will not start until payment is received.
- Additional charges are usually incurred, and will vary depending on the resources we use in the course of processing your application (e.g. staff time). Staff can give an estimate of expected costs.
A569921Project Information Memorandum (PIM) – Dam Construction1 of 4