application for a certificate of occupancy - Kangaroo Island Council

APPLICATION FOR A CERTIFICATE OF OCCUPANCY
(Standard) pursuant to Section 67 of the Development Act 1993, as amended
The person completing this statement must be a licensed Builder who under agreement or arrangement with the
Owner of the land was responsible for undertaking any part of the work or an ‘Independent Technical Expert’ as
defined in Part 15 of the Development Regulations.
No occupation of a Building can occur until a Certificate of Occupancy has been issued by Council
(Section 67(1))
Note: A $33.50 application fee for this Certificate of Occupancy is payable to the Kangaroo Island Council.
Description of building work:
Development Number:
Owner:
Site address:
Class:
Statement
I
(insert full name of technical expert or builder in BLOCKLETTERS)
hereby certify that the above detailed building work has been completed in accordance with the
following:
1. The approved plans specification, technical details and documents.
2. All conditions of the Building Rules consent.
3. The written directions or variations of an authorised Officer or Private Certifier in relation to the
building work (if any).
4. That connections required to any public electricity sources, public water supply, septic tank
effluent drainage system, public telecommunication system or other service or facility provided by
a public authority or utility, have been made in accordance with the requirements of the relevant
authority.
5. A Certificate(s) of Compliance confirming that Essential Fire Safety Provisions specified in
Schedule 16 have been installed and operate in accordance with relevant standards. (Required by
Council pursuant to Regulation 76 3a).
6. That the building work complies in all respects with the Development Act 1993, as amended and
its associated regulations, the Building Code of Australia and all relevant Australian Standards
and Codes of Practice.
Signed:
Status:
Address:
Date:
Licence Number:
USE BLOCKLETTERS

Schedule of Essential Safety Provisions
Development Act 1993
Development Regulations 1993 - Regulation 76(3)
Form 2
Kangaroo Island Council
This form must be completed and returned prior to occupancy
to enable the issue of a certificate of occupancy
CERTIFICATE OF COMPLIANCE WITH ESSENTIAL SAFETY PROVISIONS
Development No:
Owners Name:
Classification:
Maximum N o off Occupants:
Subject Property:
House No: Lot No: Street: Town / Suburb:
Hundred: Section Full / Part: Plan: Volume / Folio:
This is to certify that the following safety provisions for the above building have been installed and tested
in accordance with the following standards or requirements:
Items to be inspected or tested
as nominated by the relevant
authority
Installation standards, codes
and conditions of approval
Nature of inspection and test
frequency
Signed:
Date:
(Owner or Manager of the Building)

Schedule of Essential Safety Provisions
Development Act 1993
Development Regulations 1993 - Regulation 76(3)
Form 3
Kangaroo Island Council
At the end of each calendar year, this form must be completed and returned to Council
CERTIFICATE OF COMPLIANCE WITH MAINTENANCE PROCEDURES FOR
ESSENTIAL SAFETY PROVISIONS
Development No:
Owners Name:
Classification:
Maximum N o off Occupants:
Subject Property:
House No: Lot No: Street: Town / Suburb:
Hundred: Section Full / Part: Plan: Volume / Folio:
This is to certify that maintenance and testing have been carried out in respect of each of the following
essential safety provisions for the above building in accordance with the standards or requirements as
specified in the schedule of essential safety provisions issued in respect of the building on
‘insert date of building approval’
Items to be inspected or tested
as nominated by the relevant
authority
Installation standards, codes
and conditions of approval
Nature of inspection and test
frequency
Signed:
Date:
(Owner or Manager of the Building)

DEVELOPMENT ACT 1993, AS AMENDED
STATEMENT A
(Site Works and Footings)
To be lodged with Council on or prior to an application for a Certificate of Occupancy
Owner:
Builder:
Location:
DA N o :
Class:
I (insert full name in Blockletters)
hereby certify that the site works, foundations and footings for the Building Work detailed above have
been carried out in accordance to the approved plans, specifications, technical details, conditions of
Building Rules Consent, written directions or variations of an authorised Officer and any relevant Acts
and Regulations.
Postal Address:
Licence N o . and type of Licence:
Relevant qualifications under Regulation 87(3)(4) & (5):
Signature:
Date:

DEVELOPMENT ACT 1993, AS AMENDED
STATEMENT B
(Walling and Roof Framing)
To be lodged with Council on or prior to an application for a Certificate of Occupancy
Owner:
Builder:
Location:
DA N o :
Class:
I (insert full name in Blockletters)
hereby certify that the wall and roof frame for the Building Work detailed above have been carried out in
accordance to the approved plans, specifications, technical details, conditions of Building Rules Consent,
written directions or variations of an authorised Officer and any relevant Acts and Regulations.
Postal Address:
Licence N o . and type of Licence:
Relevant qualifications under Regulation 87(3)(4) & (5):
Signature:
Date:

DEVELOPMENT ACT 1993, AS AMENDED
STATEMENT C
(Drainage and Services)
To be lodged with Council on or prior to an application for a Certificate of Occupancy
Owner:
Builder:
Location:
DA N o :
Class:
I (insert full name in Blockletters)
hereby certify that the connections required to any public water supply, public electricity source, septic
tank effluent drainage system, public telecommunications system or other services or facility provided by
a public authority or utility for the Building Work detailed above, have been carried out in accordance
with the requirements of the relevant authority or utility.
(state other services or facility here if applicable)
Postal Address:
Licence N o . and type of Licence:
Relevant qualifications under Regulation 87(3)(4) & (5):
Signature:
Date: