North Shore District Plan
Form B6
Office use only:
Application No:
Receipt Date:
Deposit Paid:
Attach four copies of any information identified in Form B in support of this application. This checklist is intended as a guide to help you to ensure
that all the required information is submitted with your application. Please complete this checklist and submit it with your application. The level of
information should be both relevant and appropriate to the scale of the proposal and reflected in your Assessment of Environmental Effects. This
may require the need for Specialist(s) Reports.
Please ensure you complete this form in full and include with your application. This checklist needs to be attached with Form A when
making an applica
application.
tion.
Delays in processing the application will occur if inadequate information is supplied.
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SECTION 1!
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I have attached information as per information requirements for Resource Consents, as specified in the North Shore District
Plan.
Plan .
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I have attached plan(s) prepared in accordance with Guidance Note 1 - Preparation of Plans.
Plans.
Site Plan showing the EXISTING situation on the subject site
Plan/s showing the PROPOSED Activity
Elevation Drawings of all buildings / structures to be built or altered
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I have attached the following specialist(s) report(s) (provide title, author and date in the space below).
Does the proposal involve building, development or subdivision on land that is known to be or likely to the subject
subject to
flooding/inundation, or affected by an overland flow path
! Yes
! No
If yes, a flood assessment from a suitably qualified person is required to be provided with the
application which identifies 10 and 100 year flood levels and overland flow paths.
Does the proposal involve building, development (including earthworks and vegetation removal) or subdivision on land that is
known to be or likely to be subject to erosion, slope instability, or subsidence or where your site is steeper than 1:4 gradient or in
close proximity to a cliff face.
! Yes
! No
If yes, a geotechnical assessment from a suitably qualified person shall be required to be
provided with the application.
Does the proposal involve significant earthworks i.e. exposing more than 300m² of bare earth on site.
If yes, a site management plan shall be required to be provided with the application (refer to
the Site Works Rules of the District Plan and separate site management guidance notes). This
! Yes
! No
should detail (but not limited to) the following: location; extent of earthworks; silt, sediment
and erosion control plan; timelines; noise and dust controls; hours of operation.
Are any new public assets of alterations of existing public assets e.g. shifting streetlights, creation of slip lanes and deviation of
services proposed.
proposed .
! Yes
! No
If yes, a detailed description and assessment of these elements shall be required to be provided
with the application.
P0104.2 06/07/10
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Are you proposing to build within 5 metres of a Council drain or within 10 metres of a Council trunk wastewater sewer (300mm
diameter or larger).
larger).
! Yes
! No
If yes, a plan will be required showing the accurate depth of Council drains or the trunk
wastewater sewer. You will need to have physically located the pipe. Prior wastewater or
storm water approval is required for building over a Council public drain. Design and
calculations must be provided with your application and a foundation plan and a cross section
where a Council drain is located within 2 metres of the building platform.
Are there high tension electricity power lines (lines and/or pylons) over or adjacent to the subject site.
site.
! Yes
! No
If yes, confirmation from a suitably qualified person shall be required that any proposed
buildings / earthworks complies with the required clearance requirements (contact Transpower
on 0800 843 474 if you require further information).
Is the subject site contaminated, have chemicals been stored/sprayed used previousl
previously
y on the site (e.g. formerly used for
horticultural purposes, or industrial activities).
! Yes
! No
If yes, a soil contamination assessment from a suitably qualified person shall be required to be
provided with the application (Refer to the Contaminated Sites Rules of the District Plan).
Does either the site and
and/or
/or proposal involve the storage or use of hazardous substances (e.g. substances that can readily explode,
burn, oxidise or corrode and/or be toxic to people and ecosystems).
! Yes
! No
If yes, details of hazardous substances stored on, or to be stored on site (including machinery
refuelling areas and associated bunds etc.) will be required. (Refer to the Hazardous Facilities
Rules of the District Plan).
Does the proposal involve any
activities
tivities adjacent to a high and/or
any dwelling or buildings containing residential ac
and /or future noise route.
! Yes
! No
If yes, a noise assessment from a suitably qualified person may be required to be provided with
the application.
Does the proposal involve an activity defined as a High Traffic Generating development or one that has the potential to impact
on local traffic volumes e.g. more than one residential unit; business proposals; entering and exiting traffic is within close
proximity to an intersection.
int ersection.
! Yes
! No
If yes, an Integrated Traffic Assessment from a suitably qualified person may be required to be
provided with the application.
Does the proposal involve the relocation of a building from another site onto the subject site.
sit e.
! Yes
! No
If yes, a second-hand building report may be required to be provided with the application as
well as a traffic management plan identifying the proposed route for the relocation.
Does the subject site contain any heritage structures,
structures, objects, sites and places as identified in the Heritage Appendix of the
District Plan or within the Residential 3 zone.
! Yes
! No
If yes, and the proposal will involve demolition, alterations, alterations or the change of use of
the item, then a Conservation Plan by a suitably qualified person may be required to be
provided with the application (refer to the Heritage Rules of the District Plan and separate
heritage guidance notes). Details must include the % of change to each elevation and outline
all existing and proposed materials.
Does the subject site contain any recorded archaeological sites including those listed in the Heritage Appendix of the District
Plan or involving a waahi tapu known to Council.
! Yes
! No
If yes, and the proposal will involve and/or have the potential to alter an archaeological
site/waahi tapu then a Conservation Plan/Archaeological Assessment by a suitably qualified
person may be required to be provided with the application (refer to the Heritage Rules of the
District Plan and separate archaeological guidance notes). Evidence that you have consulted
with the Historic Places Trust (HPT) where your building is registered is required. Evidence of
any Iwi consultation may be included.
Does the proposal
proposal involve works on reserve land.
! Yes
! No
If yes, assessment of the relevant Reserve Management Plan (if one exists) needs to be
included and provided with the application as well as land owner’s consent from the Parks
“Department”.
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Has the maximum impervious area been calculated and onon -site storm water management information been provided.
! Yes
! No
These must be calculated and provided with your application (refer to The On-Site Storm Water
Management Rules of the District Plan and separate on-site storm water management guidance
notes). Please refer to Practice Notes NS 01 and NS 02 and complete the necessary form and
submit with this application.
Does the proposal involve works to a tree(s) protected by District Plan Rules.
Rules.
! Yes
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! No
If yes, an arboricultural report may be required to be submitted with the application (refer to
the Natural Environment Rules of the District Plan and separate tree guidance notes). The report
would need to outline what is protected, what is proposed to be undertaken, alternatives
proposed, and any replacement/re-landscaping etc.
SECTION 2!
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And, (where relevant):
relevant):!
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Net site area of all the existing and proposed sites.
Proposed staging (if applicable).
Position of any eaves in relation to a privateway or driveways.
Identification of building platform(s).
The location and rootzone of any protected vegetation.
Areas for each separate area of wetlands and bush to be protected in m² or ha.
Weed and pest control management plan.
Planting proposal and maintenance plan.
Safe and efficient rubbish storage and recycling facilities.
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Note: All plans submitted should be referenced to include the name of the firm, the title of the proposal, reference number and any plan
revisions, and associated dates.
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