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Form 72a - Application For Certificate Of Completion Building Work - Circular Head Council Tasmania, Australia

Section 153

APPLICATION FOR CERTIFICATE OF COMPLETION

– BUILDING WORK

Section 104

Form

Permit Authority/

To:

Building Surveyor

72A

Address

Suburb/postcode

Applicant / Owner details:

Note: Only an owner or agent of the owner may make an application

(Delete if not applicable)

Permit No:

Owner:

Address:

Phone No:

Fax No:

Owner builder:

Yes:

Email address:

(X if applicable)

Agent:

Address:

Phone No:

Fax No:

Email address:

Note: Agents to be authorised in writing by the owner

Details of building work:

Type of work:

Notifiable work

Permit work

(X one applicable.)

Lot No:

Address:

Certificate of title No:

(new building / alteration / addition / repair

Type of work:

/ removal / re-erection / other)

(main use)

Building class:

Use of building:

Certificate details:

As the following permit and certificate have been issued in relation to the above building work –

Permit or certificate description:

Permit or Certificate No.

Date:

Issued by:

Occupancy Permit:

(Delete if not required.)

Certificate of Final Inspection:

and all of the conditions of the building permit or Certificate of Likely Compliance have been met please

issue a Certificate of Completion (Permit Building Work) under Section 153 or Section 104 of the Building

Act 2016.

(Delete section that is not applicable)

All or Part of this building was not the subject of the normal application, permit and inspection procedures

under the Building Act 2016.

(Delete if not applicable)

Checklist



Standard of Work Certificate (permit building work) attached



Applicable Building Administration Fee has been paid



Certificate of Final Inspection attached

Name: [print]

Signed

Date

Owner / Agent:

(Delete one not applicable)

Director of Building Control - date approved: 1 January 2017

Building Act 2016 - Approved Form No 72A

Form 72a - Application For Certificate Of Completion Building Work - Circular Head Council Tasmania, Australia

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