Lisburn City Council

1. Application

I / We hereby give notice of my / our intention to:		Erect a building   Make structural alterations and / or extensions to a building   Provide services or fittings in connection with a building   Make a material change of use of a building

2. Proposed Works / Change of Use

Address:
Postcode:
Outline Description:
Date of Commencement:

3. Applicant

Surname:
Forename(s):
Address:
Postcode:
Telephone:
Fax:
E-Mail:

4. Agent (if any)

Name:
Forename(s) / Company:
Address:
Postcode:
Telephone:
Fax:
E-Mail:

5. Use of Building / Extension

Proposed Use:
If an existing building, present use:

6. Services

Proposed means of...

Water Supply:
Foul Water Drainage:
Surface Water Drainage:
Heating:

7. Additional Information

Which guidance document was used with regard to "means of escape?"
Document:
If approved under "Type Approval" please quote:
(a) Council's Ref. No.:
(b) Date Submitted:
Other Information:

8a. Fees

If plans of this or an essentially similar project on the same site have been submitted previously, please quote:
(a) Council's Ref. No.:
(b) Date Submitted:

8b. This Scheme

For new dwellings, flats or maisonettes:
No. of dwelling units:
No. of house types:
For domestic extensions, garages and carports:
Type:
Floor Area (Sq. m.):
For other works (enclose estimate):
Total cost:
Amount of Building Notice Fee Enclosed:

9. Location of site

Location:

10. Materials of which the building will be constructed

(Include details of thermal insulation where appropriate.)
Foundations:
Basement:
Ground Floors:
Upper Floors:
Roof:
External Walls:
Internal Walls:

11. Number of Storeys

State the total number of storeys, counting each basement as one storey
Storeys:

12. Size of Building

Enter all measurements in Square meters
Area of Basement:
Area of Ground Floor:
Area of 1st Floor:
Area of 2nd Floor:
Area of other Upper Floors:

13. Relationship of building to adjoining buildings

Relationship:

14. Distances between external walls and boundaries of premises

Enter all measurements in meters
Front:
Rear:
Side (1):
Side (2):
Other:

Note: The information required in sections 12, 13, 14 and 15 may be provided in the form of a site plan to a suitable scale.
DATA PROTECTION ACT 1998 Lisburn City Council collects the data on this form for the purposes of the management and application of the Building Regulations. Some of this data may also be passed to other related Government agencies.

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