Form 1E: Supplementary Application Form for Work on a Heritage
Feature
Form to be filled out in conjunction with Form 1 Land Use Consent Application
PART A – DETAIL OF PROPOSED WORKS
Please note that a detailed heritage and/or archaeological assessment may be required, depending on the significance of the
heritage feature, the proposed works, and the effects.
Please tick the following which apply to your application:

Is the heritage feature an item

Alteration of a Category 1 item(s)

An addition to a Category 1 heritage item(s)

Demolition of a Category 1 heritage item(s)

Alteration of a category 1 heritage item(s)

Alteration of a Category 2 item(s)

An addition to a Category 2 heritage item(s)

Demolition of a Category 2 heritage item(s)

Alteration of a category 2 heritage item(s)

Demolition or removal of a feature(s) within a historic area.
area
or building
PART B - ASSESSMENT OF EFFECTS ON THE ENVIRONMENT (AEE)
Please explain the historic significance of the feature.
Why can’t the heritage feature be managed and/or maintained in its current form? Please explain.
What are the reasons for the proposed works?
Please explain the extent to which any proposed alterations will be visually dominant (having regard to the scale, character, and
style of heritage item or feature).
Have any alternative uses and sources of funding for the continued maintenance of the feature been considered? Please explain.
Has a six-month period been provided for interested parties to arrange for practical alternatives to the demolition or removal of
the feature?
Is there any cultural or spiritual significance placed on the feature by Tangata Whenua? Please explain. If so, then the written
approval of Te Runanga O Ngati WaeWae and Ngai Tahu will be required.
Grey District Council – Form 1E
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If the feature being considered for relocation, explain the appropriateness of the location to which it is proposed to be moved
(i.e. does the new location have any significance in relation to the feature)?
Will there be the ability to retain the feature or parts of the feature in the proposed development or use, including moving the
feature, where possible, on the site to accommodate the proposed use?
Are there any immediate or cumulative effects of the loss, removal, alteration, or addition to the feature on local or district-wide
heritage, with the reasons for its listing being taken into account?
Is the feature part of a group of similar features (i.e. historic area)? If yes, please explain what, if any, adverse effects it will have
on the integrity of the group of features.
Is the heritage feature owned separately from the land? If yes, please list the names and addresses of any owner or occupier
including the feature owned?
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PART C – ADDITIONAL INFOMATION
The provision of correct and accurate information will enable the effective processing of your application and will ensure that
delays are kept to a minimum.
Please provide the following information with your application:
•
Photographs of the building/feature
•
Approval of the New Zealand Historic Places Trust
CONTACT DETAILS
GREY DISTRICT COUNCIL
105 Tainui Street
PO Box 382, Greymouth
Phone: 03 769 8607 Fax: 03 769 8610 Email: planning@greydc.govt.nz
www.greydc.govt.nz
Grey District Council – Form 1E
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