form 4 application for an occupancy permit - flinders … · director of building control - date...
TRANSCRIPT
Director of Building Control - date approved: 18 June 2004 Building Act 2000 - Approved Form No 4
APPLICATION FOR OCCUPANCY PERMIT Section 95
To: Building Surveyor
Address
Suburb/postcode
Applicant / Owner details: Note: Only an owner or agent of the owner may make an application
Owner:
Address: Phone No:
Fax No:
Owner builder: Yes: (X if applicable) Email address:
Agent:
Address: Phone No:
Fax No:
Note: Agents to be authorised in writing by the owner: Email address:
Details of building work:
Address: Lot No:
Certificate of title No:
Type of work: (new building / alteration / addition / repair /demolition / removal / re-‐erection / other)
Use of building: Building class:
New use: (if change of use)
Occupancy details: This application is for: (X if applicable.)
The whole of the building work referred above. The listed part of the building work referred above
The refurbishment of the building referred above The change of use of the building referred above Details part of building work
Documents provided: Documents / information required by the Building Surveyor –
Document description: Prepared by:
“The Meander Valley Council is committed to upholding the right to privacy of all individuals who have dealings with the Council. Unless required by law or by a Court or tribunal, the Council will take the necessary steps to ensure that the personal information that members of the public share with us remains confidential. How we use this information is explained in our Privacy Policy, which is available at www.meander.tas,gov.au or at the Council Office.”
Name: [print] Signed Date Owner / Agent: (Delete one not applicable)
Form 4