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:
Telephone:
Fax:
Detailed Description:
Date of Commencement:
Date of Completion:

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

Current Use:
Purpose Group:
Is the building of a designated use under the Fire Services (Northern Ireland) Order (1984)?
Designated use:		Yes   No
If 'Yes', please state the number of people to be employed on the:
Ground Floor:
Other Floors:
Is the building subject to an Entertainment Licence?:		Yes   No
If a dwelling, is it used as a House in Multiple Occupation?:		Yes   No

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:
Other Information:

8. 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:

9. Number of Storeys

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

10. 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:

11. Distances between external walls and boundaries of premises

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

12. Fees

State how compiled (see fee schedule):
Please state address that fee details are to be sent to if different from above.
Address:

This application is made under Regulation A12 of the Building Regulations (Northern Ireland) 2000..
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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