Liverpool Plains Shire Council
P.O. Box 152, QUIRINDI NSW 2343
Email: lpsc@lpsc.nsw.gov.au
Ph: (02) 6746 1755
Fax: (02) 6746 3255
Application made under the Environmental Planning &
Assessment Act 1979 and Local Government Act 1993
Construction
Certificate
(CC)
TYPE OF CONSENT OR APPROVAL REQUIRED
 Construction Certificate – Building

DA No: ....................
Date: ........................
Receipt: ..................
TICK AS APPLICABLE
Construction Certificate – Subdivision
Development Application No.: ...........................................
Date of Consent: ...............................
APPLICANT DETAILS
Mr / Mrs / Ms / Miss / Dr / Co / Other
Name: .........................................................................................................................................................
Postal Address: ..........................................................................................................................................
Phone no (daytime): .........................................................
(mobile): .......................................................
Fax: ..........................................
Email: ...................................................................................................
Signature: ...................................................................................................................................................
OWNER DETAILS AND CONSENT
All property owners must complete this section. If the owner of the property is a company, then the director/s or the secretary of the
company must sign and affix the company seal, if required by the constitution.
 I hereby consent to the submission of this application and to a representative of Council entering my site for the purpose of site
inspection; and
 For Council to make copies of all documents for the purpose of determining the application or to provide copies to persons who
may be affected by the proposal.
Name OR company name/s: ......................................................................................................................
Address: .....................................................................................................................................................
Phone no: ..................................................
E-mail: ................................................................................
Signature: ...................................................................................................................................................
PROPERTY DESCRIPTION
We need this information to correctly identify the subject land. This information is shown on the rates notices, property deeds etc.
Lot: ..........................................
Sec: ..................................
DP: ...............................................
Street / RA No.: ..................................................
Property Name: .........................................................
Road Name: ......................................................
Locality: ....................................................................
Site area: ..........................
Assessment No: ......................
Valuation No: ...............................
DESCRIPTION OF PROPOSAL
Please describe briefly description of work requiring approval by Council.
....................................................................................................................................................................
....................................................................................................................................................................
ESTIMATED COST OF THE DEVELOPMENT (INCLUDING GST)
Contracted price or estimate including labour and materials. $ .....................................................................................
NOTE: The estimated cost of the development or contract price is subject to a check by Council. Development over
$12,000 requires compliance with Australian Institute of Building Surveyors Building Cost Guide.
1
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DEVELOPMENT CONSENT
PRE-LODGEMENT
 Yes
For this application, have you had a pre-lodgement consultation with Council
If YES, name of Officer? ................................................................
 No
Date of meeting: ...........................
CONSTRUCTION CERTIFICATE – Subdivision Work
Date Engineering plans submitted: .............................................................................................................
Designer: ....................................................................................................................................................
Designer Plan Reference No.: ....................................................................................................................
Required attachments:
Including:


3 copies of proposed engineering plans/reports
Sewerage
Water




Drainage
Road
Erosion control
Earthworks
Other attachments: .....................................................................................................................................
....................................................................................................................................................................
CONSTRUCTION CERTIFICATE – Building Works
BUILDERS/OWNER BUILDER DETAILS
Builder/Owner Builder Name: .....................................................................................................................
Address: .....................................................................................................................................................
Phone No: (daytime): ....................................................
Fax No.: .........................................................
E-mail: ..........................................................................
License No.: ...................................................
Requirements under the Home Building Act 1989
Builders Requirements: Each licensed contractor (builder or tradesperson) who contract direct with an owner or an owner or an
owner-builder or undertake any residential building work where the value of the work exceeds $12,000 must provide Home Warranty
Insurance.
Owner-Builder Requirements: Applicants for building work that required approval related to a single dwelling or dual occupancy, where
the value of the work exceeds $5,000 require an owner-builder permit.
Has a Certificate of Insurance been attached?

Yes

No
Has an Owner Builder’s Permit been attached?

Yes

No
CHANGE OF USE OF BUILDING
Does the application involve a change of use of a building?
If YES, what is the current use? .........................................

Yes

No
AND proposed use .......................................
BUILDING DETAILS
(must be completed for Construction Certificate Building and Complying Development Certificate)
Area of land: ................................. (m2)
Gross floor area of:
new building work (m2) .......................... existing building (m2) ........................
Number of storeys (including underground floors): ....................................................................................
Number of dwellings to be demolished: .....................................................................................................
Number of dwellings proposed: .................................................................................................................
2
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MATERIALS TO BE USED:
Roof







Tiles
Concrete or slate
Fibre cement
Steel
Aluminium
Other
Not specified
10
20
30
60
70
80
90
Floor
Walls










Brick (double)
Brick (veneer)
Concrete or stone
Fibre cement
Timber
Curtain glass
Steel
Aluminium
Other
Not specified
11
12
20
30
40
50
60
70
80
90




Concrete or slate
Timber
Other
Not specified
20
40
80
90
Frame





Timber
Steel
Aluminium
Other
Not specified
40
60
70
80
90
BUILDING OVER THE SEWER
Does the proposal involve building work over or close to Council’s sewer?
 Yes
 No
Do you have approval from Council to complete the work?
 Yes
 No
SECTION 68 DRAINAGE APPROVALS – For Water Supply, Sewerage & Stormwater Drainage Work
 Carrying our sewerage work
 Carrying our water supply work
 Carrying out stormwater drainage work
DRAINAGE PLAN – Number of Fittings to be Connected: ..............................................................
PLUMBERS’ DETAILS
Internal and External Plumbing Drainage
Name: .........................................................................................................................................................
Address: .....................................................................................................................................................
Phone No: (daytime): ....................................................
Fax No.: .........................................................
E-mail: ..........................................................................
* License No.: .................................................
* All plumbers and drainers must hold a current licence from NSW Officer of Fair Trading.
DOCUMENTS TO ACCOMPANY THE APPLICATION
Included
1.
Site plan of the land – scale 1:200 (4 copies)
 Yes
 No
2.
Sketch/Plans of the development (4 copies)
 Yes
 No
3.
Developments involving the erection of a building require a plan indicating
the height and external configuration in relation to the site
 Yes
 No
4.
For subdivision work, preliminary engineering drawings of proposed work
 Yes
 No
5.
For change of use, fire safety provisions for existing and proposed
 Yes
 No
6.
BASIX Certificate (for residential work)
 Yes
 No
7.
If the development involves building work to alter, expand or rebuild an
existing building, a scaled plan of the existing building
 Yes
 No
3
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APPOINTMENT OF PRINCIPAL CERTIFYING AUTHORITY (PCA)
The PCA is appointed under s109E of the Environmental Planning and Assessment Act 1979. The Act requires that a person who
proposed to carry out development (the applicant) involving building or subdivision work (other than exempt development) must
appoint a PCA prior to commencement of that work. The applicant may appoint Council (for building or subdivision work) or an
accredited private certifier (for building or strata subdivisions only) as the PCA.
Name and Address of Appointed Principal Certifying Authority (if not Council)
....................................................................................................................................................................
....................................................................................................................................................................
Office Use Only
Fees
Construction Certificate: ......................................
Date paid:
......................................
Certificate Registration: ......................................
Receipt No.:
......................................
Long Service Levy:
......................................
Customer Services Officer:
......................................
Occupation Certificate:
.....................................
Inspections:
.....................................
S68 Approvals:
.....................................
Other:
.....................................
.....................................
TOTAL:
4
$ ..................................
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