Address of Project: For Office Use Only. Customer Use

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1 CHECKSHEET: SINGLE RESIDENTIAL DWELLING AND ACCESSORY BUILDING Inluding single stnd-lone dwellings, dwelling dditions nd/or ltertions, re-piling, grges, deks, gzeos, sheds, retining wlls et. Kpiti Cost Distrit Counil, 175 Rimu Rod, Prprumu 5032 Privte Bg 60601, Prprumu 5254 For enquiries, phone or Address of Projet: This heksheet shows you the informtion tht hs to e supplied with your uilding onsent pplition. Plese tth 1 opy of the following informtion (nd seond opy of plns nd proof of ownership), with your ompleted Building Consent Applition Form. Plese tik relevnt ox in the Customer Use olumn s you tth the informtion. If the ox is not relevnt to your pplition, write NA ross the ox. Plese hek eh setion refully nd omplete those setions tht re relevnt to your projet. One you hve tthed ll the required informtion, plese hek for ompleteness s n inomplete pplition or lk of ny supporting informtion will men tht your pplition nnot e epted for proessing. An Applition Form is tthed to this heksheet Plese inlude this heksheet with your pplition. Customer Use 1 GENERAL Complete this setion for ll pplitions d e f g Building Consent Applition Form Completed nd signed y the owner or y n gent on ehlf of the owner Proof of Ownership One reent opy of urrent ertifites/s of title (not older thn 3 months) AND where pplile one opy of purhse greement (if reently purhsed) or one opy of relevnt portions of urrent lese. Lolity Pln (1:500) showing: Physil lotion of the sujet uilding in reltion to streets or lndmrks, north point, nme of uilding nd lot nd DP numer. Restrited Building Work Does the pplition involved restrited uilding work? Yes No If Yes, provide ertifite(s) of design work nd dvise Counil of your Liensed Building Prtitioner(s) Inspetions nd Monitoring Detils of proposed inspetion regime inluding monitoring y ounil offiers nd other professionls e.g. rhitets, engineers, surveyors nd ertifition to e supplied on ompletion. Site Pln (1:100) showing: Dimensions of ll oundries, north point, finished floor levels, site re, street nme nd numer, lot nd DP numer, outline of uilding, distne to oundries nd the position of swimming or sp pools, ground ontours (extended to oundries) nd/or levels nd designted wind zone of the site (e.g. speifi design, very high, high, medium or low). In ddition, if site is identified s eing sujet to flooding, ponding, on n overflow pth, river or strem orridor, or other nturl hzrds, indite on plns proposed design will mitigte nturl or reted hzrds. Additionl informtion is ville on these sites y request from Kpiti Cost Distrit Counil. GIS is heked Applition Fee Applitions will not e epted without pyment of the pproprite fees. Fees pyle re set out in the pulished fee shedule of the ounil tht hs jurisdition over the projet site. For Offie Use Only Form 333 Cheksheet Single Residentil & Aessory Buildings v9 (BC1, PI2, AD1) Mrh 2018 Pge 1 of 5

2 2 CHANGE OF USE Complete for ll existing uildings where the proposl involves forming household unit where one did not exist efore Exmple: the onversion of grge or shed into residentil unit Assessment of the Building for Compline with the Building Code Setion 115() of the Building At 2004 requires tht the uilding, in its new use, omplies fully with ll luses of the Building Code. Resonly Prtile The ove ssessment must relte to ll uilding ode luses. If the proposl is for the projet to meet nything less thn full ompline with ny luses, your pplition must lerly stte your resoning, with supporting doumenttion, nd show how you will meet the highest level of ompline tht n e onsidered resonly prtile. 3 FOUNDATIONS / FLOOR Complete for ll new uildings, for existing uildings where the footprint of the uilding will hnge or where n dditionl storey is eing dded Foundtion Pln (1:100 / 1:50) showing: Dimensions of ll new foundtions Su-floor, inluding ring Footing detils If onrete sl, show si detils inluding reinforing nd ontrtions joints Piles nd footing If the ddition is n upper storey show detils on upgrding existing foundtions, joints, piles et Indite ventiltion to su floor spes Sufloor Bring Provide sufloor ring pln nd lultions for ll piled strutures. Where the struture is speifilly engineered, this should e inluded with the struturl lultions. Sufloor ring pln nd lultions re required where n dditionl storey is to e dded 4 CONSTRUCTION Complete for ll new strutures or ltertions to existing strutures Existing Floor Pln (1:100 / 1:50) showing: (For dditions nd ltertions only) Complete lyout of ll levels of uilding All designted spes All removls Snitry fixtures Smoke detetors Proposed Floor Plns (1:100 / 1:50) showing: Complete lyout of ll levels of uilding Room dimensions Lotion of prtitions All designted spes All floors (new or ltered) Lotion of snitry fixtures Stirs, rriers, hndrils, floor joists nd ems Floor joist lyout for eh level with timer floors Smoke detetors Note where wll will form prt of the swimming pool fene Pre-nil Truss nd Frmes Speifi design wll frming requires lrifition Truss lyout must e supported y design ertifition nd design of fixing detils, inluding onsidertion of lod pths to ground Lintels rrying point lods, suh s from girder trusses, require speifi engineering design Form 333 Cheksheet Single Residentil & Aessory Buildings v9 (BC1, PI2, AD1) Mrh 2018 Pge 2 of 5

3 d Wll Bring Pln (1:100 / 1:50) showing: Bring detils nd lultions for wll ring (lso required for existing lower storeys where n dditionl storey is eing dded) Su-floor ring for deks projeting more thn 2m from the house Lotion, type nd numer of ring elements to indite ompline with NZS 3604:2011 (inlude lultions) If the ring ws speifilly designed y struturl engineer, provide lultions (required for speifi design wind zones nd lterl distriution of upper floor lods where lower storey ring is provided in wlls eyond the upper storey footprint) e Setions nd Detils (1:50 / 1:20 / 1:10) showing: Foundtion detils involving reinforing nd onnetions Stirs, hndrils, deks nd deking Insultion systems nd mterils to floors, wlls nd roof Brriers providing sfety from flling. Speifi engineering design required where detil does not omply with NZBC B1/AS2 Frming sizes, ems, lintels Roof ldding, eves, fsis, gutters Flshings to openings Fire rted systems on ll wlls loser thn 1 metre to oundry Stud heights of rooms nd totl height from lowest ground floor level to top of ridge Window nd door instlltion detils Retining wll detils e.g. type, height of retined ground, reltionship to oundry, wterproof memrne nd proposed dringe f Fire Report For domesti dwellings of 4 storeys or more, or uildings providing more thn one household unit 5 EXTERNAL Complete for new uildings or existing uildings with lterntions to the externl shell Elevtions (1:100 / 1:50) showing: Aurte lines from oundry to oundry on eh elevtion, relevnt Distrit Pln dylight ontrol lines, the mximum height on eh elevtion, lotion of door nd window openings, fixed nd opening sshes, sill heights, floor levels in reltion to ground levels, exterior ldding nominted to ll elevtions, down pipes nd spouting, ventiltors to su-floor re (suspended floors only) Risk Assessment (Risk mtrix in E2/AS1 my e used for uildings within sope) Consider exposure, design nd detiling to support pproprite seletion of ldding Cldding Detils (1:50 / 1:20 / 1:10) Provide detils round ll penetrtions, joinery nd other juntions t level pproprite to the level of risk e.g. roof/wll, lony/wll, juntion of different types of ldding, k flshing detils for vity systems d Prodution Certifition Supply opies of produt ertifites relied on s ompline douments e Alterntive Solutions If the proposl uses produts or systems tht re not overed in the Aeptle Solutions of luse E2 of the Building Code provide supporting urrent informtion inluding test results (fully signed reports), se studies, expert opinion (inluding evidene of experiene/qulifition, sis for forming opinion nd sttement of independene) et to demonstrte ompline 6 SERVICES Complete for ll projets with new instlltions or ltertion of pluming or dringe servies Pluming nd Dringe Pln 1:100 / 1:50) showing: Note: if you hve supplied dringe detils for surfe wter disposl on the site pln, no dringe pln is required. Sizes of pipe work nd drins Fixtures nd fittings, hot wter system(s) If the uilding is more thn one storey with snitry fittings on upper floors, provide n isometri lyout showing wstes, pipes nd flls Dringe lyout with inspetion ends nd juntions indited for oth sewer nd stormwter Any other dringe on site inluding ounil mins nd retining wll field drins Ventiltion of snitry rooms Clultions for sizing of down pipes Gully trps inluding overflow relief gullies Form 333 Cheksheet Single Residentil & Aessory Buildings v9 (BC1, PI2, AD1) Mrh 2018 Pge 3 of 5

4 7 STRUCTURAL Complete for ll projets inorporting speifi struturl design Struturl Clultions If ny design work required the servies of struturl engineer, tth 2 opies of the lultions with this. The lultions must e prefed with informtion explining the design philosophy nd justifition of ssumptions nd methodologies used in nlysis Expert Opinion (Produer Sttements) If this pplition for onsent relies on ny expert opinion inluding Produer Sttements ertifying ompline with the New Zelnd Building Code, opy must e tthed with this pplition. (Note ll struturl Produer Sttements re required to hve ompnying lultions.) 8 SPECIFICATIONS Complete for ll pplitions Note: the speifition must e speifi to the projet nd over ll spets of the proposed work Speifition: Generl Elements of struture (size, sping, timer tretment) Finish or fixings to meet durility requirements Pluming nd dringe mterils nd design tht instlltion is to omply with Wet re surfes Ventiltion systems Flooring slip resistne for ess routes Glzing Type of smoke detetors (inluding existing smoke detetors where they will remin) Externl Clddings For eh of the following lddings provide detils of the produt nme, mnufturer, mintenne requirements nd wrrnties offered Building wrps Wll lddings Roof lddings Memrnes (roof nd deks) Tnking Joinery 9 DEMOLITION / REMOVAL Complete for ll projets involving demolition of signifint prts of uildings or the demolition or removl of whole uildings e f d g h Mens of Brriding the Site Provide detils of temporry rriers, gtes whih swing inwrds or other mens of restriting puli ess to the re Proposed Tipping Lotion for Demolition Mterils (ddress/lndfill) Hzrdous Building Mteril Provide sfety pln detiling the sfe hndling nd disposl of hzrdous mterils Site Mngement Pln Covering Mngement to ontrol silt runoff, noise nd dust Proposed Destintion for Relote Building Aess To nd From the Site (inluding use of ker rossings) Speify Termintion of Existing Servies Wter Sewer Stormwter Detils Aout the Building suh s: Numer of storeys, type of mterils the uilding is onstruted (Photogrphs of the uilding would e useful) Form 333 Cheksheet Single Residentil & Aessory Buildings v9 (BC1, PI2, AD1) Mrh 2018 Pge 4 of 5

5 Note: You will need to ontt the relevnt servie uthorities speified elow to dvise them of the extent of your work: eletriity, gs, dringe, wter, trnsport, teleommunitions, le television, or ny other servies tht my e ffeted. Trnsporttion of Reloted Building You will e required to ontt nd provide detils to Counils Trnsporttion nd Trffi Deprtment. 10 OTHER APPROVALS Plese hek Territoril Authority regrding the requirement for other pprovls required nd fees pyle These my inlude: Consents under the Resoure Mngement At Approvls under ylws inluding erthworks, vehile rossings, rod openings nd wter onnetions. Show the lotion of swimming or sp pools on the property nd desrie how ompline with the Fening of Swimming Pools At will e hieved. Atthed The following douments re tthed to the pplition: Plns nd speifitions Memornd from Liensed Building Prtitioners who rried out or supervised ny design work tht is restrited uilding work Projet informtion memorndum Certifite tthed to projet informtion memorndum Proof of ownership Wivers nd/or modifitions supporting doumenttion The issue of uilding onsent does not relieve the owner of ny duty or responsiility under ny other At. Form 333 Cheksheet Single Residentil & Aessory Buildings v9 (BC1, PI2, AD1) Mrh 2018 Pge 5 of 5