CLAREcoco Disability Access Certificate Application Form 5325
CLAREcoco Disability Access Certificate Application Form 5325
TO: CLARE COUNTY COUNCIL, BUILDING CONTROL AUTHORITY, CENTRAL FIRE STATION,
NEW ROAD, ENNIS, Co. CLARE
Application is hereby made under Part IIIB of the Building Control Regulations 1997 to 2009 for a Disability
Access Certificate, in respect of the works or building to which the accompanying plans, calculations and
specifications apply.
1. Applicant: Owner / Leaseholder: (delete as appropriate)
Full Name: ________________________________________________________________________________
Address:
________________________________________________________________________________
Signature: ________________________________________________________________________________
Tel: _________________________________________ Date: _____________________________________
Owner of works or building (if different from above): _____________________________________________
Full Name: ________________________________________________________________________________
Address:
________________________________________________________________________________
2. Name and Address of person(s) or firm(s) to whom notifications should be forwarded to:
(Owner / Leaseholder or Designer / Developer / Builder)
______________________________________________________________________________________
______________________________________________________________________________________
3. Name and address of person(s) or firm(s) responsible for preparation of accompanying plans,
calculations and specifications:
______________________________________________________ Tel: ___________________________
______________________________________________________ Fax: ___________________________
______________________________________________________ E-Mail: ________________________
4. Address (or other necessary identification) of the proposed works or building to which the application
relates:
______________________________________________________________________________________
______________________________________________________________________________________
YES
NO
Material Alteration
YES
NO
YES
NO
Extension to a building
YES
NO
____________________________________ (m2)
____________________________________
____________________________________
____________________________________ (m)
____________________________________ (m2)
____________________________________ (m2)
(b) Works involving an extension to a building or works involving the material alteration of a building
Floor area of Extension
____________________________________ (m2)
____________________________________ (m2)
Note: 1. This Application Form for a Disability Access Certificate must be accompanied by plans (including a
Site or Layout Plan) and other particulars, in duplicate.
2. Fee of 800 per Building