THE HILLS SHIRE COUNCIL
NOTICE TO COMMENCE SUBDIVISION WORK
AND APPOINTMENT OF PRINCIPAL CERTIFYING AUTHORITY
Environmental Planning and Assessment Act 1979 Sections 81A(4)(b)(c), 86(2)
1. PROPERTY DETAILS Location of proposed subdivision work
Address Suburb
Lot(s) DP(s)
2. APPROVAL REFERENCE
DA No. Construction Certificate No.
Description of work
3. APPLICANT DETAILS
Only the Applicant (the person having the benefit of the development consent) can appoint a Principal Certifying Authority.
Applicant must complete the Applicant Declaration in Section 6 of this form.
Name
Address Suburb Postcode
Email Phone
4. NOMINATION OF PRINCIPAL CONSULTANT
Consulting Firm Address
Superintendant
Email Phone
5. NOMINATION OF PRINCIPAL CONTRACTOR
Contracting Firm Address
Site Foreman
Email Phone
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6. APPLICANT DECLARATION
Please complete I appoint The Hills Shire Council as the Principal Certifying Authority.
I certify that all conditions required by the development consent, as required prior to the commencement of works, have been satisfied.
I understand that inspections as specified in Council's "Works Specification - Subdivision and Development" must be undertaken prior to works proceeding beyond relevant hold points.
I confirm that all consultants involved in this project are/will be covered for Professional Indemnity Insurance for a minimum $5 million.
I confirm that all contractors involved in this project are/will be covered for Public Liability Insurance for a minimum $10 million and full Workers
Compensation Insurance as required by NSW law.
I will forward Certificates of Currency for all required insurances for
consultants and contractors involved in this project prior to work commencing and understand that I am responsible for ensuring all required insurances are kept current for the duration of the project.
I advise that works detailed on the Construction Certificate will commence on the date shown below:
Start Date
Declaration By ticking this box I acknowledge that this declaration is confirmation of my identity and intent in lieu of my signature. I understand that a person is guilty of an offence if the person makes any statement knowing it to be false or misleading in connection with any document lodged with the consent or certifying authority (clause 283 of the Environmental Planning and Assessment Regulation 2000).
Full Name Date
7. LODGMENT DETAILS
You can lodge the application by:
Email: [email protected] (Preferred method - Please mark "Attention - Subdivision Construction Engineer") Mail: PO Box 7064, Baulkham Hills BC 2153
In person: 3 Columbia Court Baulkham Hills NSW 2153
8. PRIVACY AND PERSONAL INFORMATION AND PROTECTION NOTICE
Purpose of Collection: For delivery of Principal Certifying services in the Council area Intended recipients: Council staff
Storage: The Hills Shire Council. 3 Columbia Court Baulkham Hills NSW 2153
