Notice Of Work/application For A Certificate Of Likely Compliance/application For A Building Permit - Kingborough Director Of Building Control Page 2
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1
2Other details:
Area: m
2
existing building floor:
new floor:
land:
Material:
floor:
walls:
roof:
frame:
Value of work: $
contract price:
estimate:
No. of dwelling units:
[inclusive of GST]
(X one applicable)
Building Services Provider details:
Architect - Designer:
Category:
Business name:
Business address:
Phone No:
Fax No:
Licence No:
Email:
Building - Designer:
Category:
Business name:
Business address:
Phone No:
Fax No:
Licence No:
Email:
Engineer - Designer:
Category:
Business name:
Business address:
Phone No:
Fax No:
Licence No:
Email:
Services - Designer:
Category:
Business name:
Business address:
Phone No:
Fax No:
Licence No:
Email:
Builder:
Category:
Business name:
Business address:
Phone No:
Fax No:
Licence No:
Email:
Documents and certificates provided:
The following specified documents and certificates are provided with this application -
Document or certificate description:
Prepared by:
(Licence No. if applicable)
Certificate of Likely Compliance:
Documents specified in the Director’s Specified List
The building work will be carried out in accordance with the Building Act 2016, the Building Regulations 2016
and the National Construction Code.
Name: [print]
Signed
Date
Owner / Agent:
(Delete one not applicable)
Director of Building Control - date approved: 1 July 2017
Building Act 2016 - Approved Form No 2
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