form 4 application for an occupancy permit - flinders … · director of building control - date...

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Page 1: Form 4 Application for an occupancy permit - Flinders … · Director of Building Control - date approved: 18 June 2004 Building Act 2000 - Approved Form No 4 APPLICATION)FOR)OCCUPANCY)PERMIT)

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