Code Compliance Certificate Application (Form 6) - Hurunui District Council printable pdf download

Code Compliance Certificate Application (Form 6) - Hurunui District Council

CODE COMPLIANCE CERTIFICATE

PROJECT NO:

APPLICATION

(Form 6)

APPLICATION

Building Consent Issued by: Hurunui District Council

Building Consent No: _______________________________

THE OWNER

Owner’s Name:

Mailing Address:

Contact person:

(if owner is not an individual)

Phone:

Postcode:

Mobile Phone:

Fax Number:

Street Address/Registered Office:

E-mail address:

AGENT – APPLICANT

Agent’s Name:

Mailing/Billing Address:

Contact person:

Phone:

Postcode:

Mobile Phone:

Fax Number:

Street Address/Registered Office:

E-mail address:

Note - The Agent will be the first point of contact for communications with the Council/Building Consent Authority

regarding this application / Building Work and will receive all correspondence including all invoices.

The code of compliance certificate should be sent to:

Owner

Agent

All building work carried out under the above building consent was completed on: _____/_____/_____

SIGNATURE

 I request that you issue a Code Compliance Certificate for this work under Section 95 of the Building Act 2004.

Signed by or for and on behalf of the Owner:

_____________________________________________

 Owner

 Agent

Date:

____________________________

Note: If acting “for and on behalf”, please read the following declaration before signing: “I hereby declare that I am authorised

to act as Agent of the Owner”.

Notes by applicant: (Other notes or comments which you as the applicant may wish to add)

________________________________________________________________________________________________

Doc: Quality Manual HDC

Ref: Form 6

Issue: 3

Date: 27

November 2014

PAGE 1 of 3

Code Compliance Certificate Application (Form 6) - Hurunui District Council

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