Planning Permission and Listed Building Consent for alterations, extension or demolition of a Listed Building – Application form

1. Applicant Name and Address

2. Agent Name and Address

Local Planning Authority details

Publication on Local Planning Authority websites

Information provided on this form and in supporting documents may be published on the authority's planning register and website.

Please ensure that the information you submit is accurate and correct and does not include personal or sensitive information.

If you require any further clarification, please contact the Local Planning Authority directly.

Upon receipt of this form and any supporting information, it is the responsibility of the Local Planning Authority to inform you of its obligations in regards to the processing of your application. Please refer to its website for further information on any legal, regulatory and commercial requirements relating to information security and data protection of the information you have provided.

Please be aware that once you have downloaded this form, Planning Portal will have no access to the form or the data you enter into it.

Any subsequent use of this form is solely at your discretion, including the choice to complete and submit it to the Local Planning Authority in agreement with the declaration section.

Privacy Notice

This form is provided by Planning Portal and based on the requirements provided by Government for the sole purpose of submitting information to the Local Planning Authority in accordance with the legislation detailed on this form and 'The Town and Country Planning (Development Management Procedure) (England) Order 2015 (as amended).

If you would rather make this application online, you can do so on our website: https://www.planningportal.co.uk/apply

You are advised to read the accompanying guidance notes and per-question help text.

This form is specifically designed to be printed and completed offline.

Please complete this form in block capitals using black ink to facilitate scanning.

3. Description of Proposed Works

Please describe details of the proposed development or works including details of proposals to alter, extend or demolish the listed building(s):

4. Site Address Details

Please provide the full postal address of the application site.

Description of location or a grid reference (must be completed if postcode is not known):

Description:

5. Pre-application Advice

Has assistance or prior advice been sought from the local authority about this application? Yes No

If Yes, please complete the following information about the advice you were given. (This will help the authority to deal with this application more efficiently).

Please tick if the full contact details are not known, and then complete as much as possible:

Details of pre-application advice received?

Has the development or work(s) already started? Yes No

If Yes, please state the date when development or work(s) were started (DD/MM/YYYY): (date must be pre-application submission)

Has the development or work(s) been completed? Yes No

If Yes, please state the date when the development or work(s) was completed (DD/MM/YYYY): (date must be pre-application submission)

Is the proposal for public service infrastructure development (within the meaning of article 2 of S.I. 2015/595 as amended by article 3 of S.I. 746/2021)? Yes No

Reference number of permission in principle being relied on (technical details consent applications only):

6. Pedestrian and Vehicle Access, Roads and Rights of Way

• Is a new or altered vehicle access proposed to or from the public highway? Yes No
• Is a new or altered pedestrian access proposed to or from the public highway? Yes No
• Are there any new public roads to be provided within the site? Yes No
• Are there any new public rights of way to be provided within or adjacent to the site? Yes No
• Do the proposals require any diversions /extinguishments and/or creation of rights of way? No

If you answered Yes to any of the above questions, please show details on your plans/drawings and state the reference of the plan(s)/drawings(s)

7. Waste Storage and Collection

Do the plans incorporate areas to store and aid the collection of waste? Yes No

If Yes, please provide details:

Have arrangements been made for the separate storage and collection of recyclable waste? Yes No

If Yes, please provide details:

8. Authority Employee / Member

It is an important principle of decision-making that the process is open and transparent. For the purposes of this question, "related to" means related, by birth or otherwise, closely enough that a fair-minded and informed observer, having considered the facts, would conclude that there was bias on the part of the decision-maker in the local planning authority.

With respect to the authority, I am:

• (a) a member of staff
• (b) an elected member
• (c) related to a member of staff
• (d) related to an elected member

Do any of the following statements apply to you and/or agent? Yes No

If Yes, please provide details of their name, role and how you are related to them.

9. Demolition

Does the proposal include the partial or total demolition of a listed building? Yes No

If Yes, which of the following does the proposal involve?

• a) Total demolition of the listed building: Yes No
• b) Demolition of a building within the curtilage of the listed building: Yes No
• c) Demolition of a part of the listed building: Yes No

Please provide a brief description of the building or part of the building you are proposing to demolish:

If the answer to c) is Yes:

1. What is the total volume of the listed building? (cubic metres)
2. What is the volume of the part to be demolished? (cubic metres)
3. What was the (approximate) date of the erection of the part to be removed? (MM/YYYY) (date must be pre-application submission)

Why is it necessary to demolish or extend (as applicable) all or part of the building(s) and or structure(s)?

10. Listed Building Alterations

Do the proposed works include alterations to a listed building? Yes No

If Yes, do the proposed works include: (you must answer each of the questions)

• a) Works to the interior of the building? Yes No
• b) Works to the exterior of the building? Yes No
• c) Works to any structure or object fixed to the property (or buildings within its curtilage) internally or externally? Yes No
• d) Stripping out of any internal wall, ceiling or floor finishes (e.g. plaster, floorboards)? Yes No

If the answer to any of these questions is Yes, please provide plans, drawings, photographs sufficient to identify the location, extent and character of the items to be removed, and the proposal for their replacement, including any new means of structural support and state references for the plan(s)/drawing(s):

11. Listed Building Grading

Please state the grading (if known) of the building in the list of Buildings of Special Architectural or Historic interest? (Note: only one box must be ticked)

• Grade I
• Grade II
• Grade II*
• Ecclesiastical Grade I
• Ecclesiastical Grade II
• Ecclesiastical Grade II*
• Don't know

12. Immunity From Listing

Has a Certificate of Immunity from Listing been sought in respect of this building?

Yes No Don't know

If Yes, please provide the result of the application:

13. Vehicle Parking

Please provide information on the existing and proposed number of on-site parking spaces:

14. Materials

Please provide a description of existing and proposed materials and finishes to be used in the building (demolition excluded):

Are you supplying additional information on submitted drawings or plans? Yes No

If Yes, please state plan(s)/drawing(s) references:

15. Foul Sewage

Please state how foul sewage is to be disposed of:

• Mains sewer
• Septic tank
• Package treatment plant
• Cess pit
• Other

Are you proposing to connect to the existing drainage system? Yes No

If Yes, please include the details of the existing system on the application drawings and state references for the plan(s)/drawing(s):

16. Assessment of Flood Risk

Is the site within an area at risk of flooding? (Refer to the Environment Agency's Flood Map showing flood zones 2 and 3 and consult Environment Agency standing advice and your local planning authority requirements for information as necessary.) Yes No

If Yes, you will need to submit a Flood Risk Assessment to consider the risk to the proposed site.

Is your proposal within 20 metres of a watercourse (e.g. river, stream or beck)? Yes No

Will the proposal increase the flood risk elsewhere? Yes No

How will surface water be disposed of?

• Sustainable drainage system
• Soakaway
• Main sewer
• Existing watercourse
• Pond/lake

17. Biodiversity and Geological Conservation

To assist in answering the following questions refer to the guidance notes for further information on when there is a reasonable likelihood that any important biodiversity or geological conservation features may be present or nearby and whether they are likely to be affected by your proposals.

Having referred to the guidance notes, is there a reasonable likelihood of the following being affected adversely or conserved and enhanced within the application site, or on land adjacent to or near the application site?

a) Protected and priority species:

• Yes, on the development site
• Yes, on land adjacent to or near the proposed development
• No

b) Designated sites, important habitats or other biodiversity features:

• Yes, on the development site
• Yes, on land adjacent to or near the proposed development
• No

c) Features of geological conservation importance:

• Yes, on the development site
• Yes, on land adjacent to or near the proposed development
• No

18. Existing Use

Please describe the current use of the site:

Is the site currently vacant? Yes No

If Yes, please describe the last use of the site:

When did this use end (if known)? (DD/MM/YYYY) (date where known may be approximate)

Does the proposal involve any of the following? If yes, you will need to submit an appropriate contamination assessment with your application.

• Land which is known to be contaminated? Yes No
• Land where contamination is suspected for all or part of the site? Yes No
• A proposed use that would be particularly vulnerable to the presence of contamination? Yes No

19. Trees and Hedges

Are there trees or hedges on the proposed development site? Yes No

And/or: Are there trees or hedges on land adjacent to the proposed development site that could influence the development or might be important as part of the local landscape character? Yes No

If Yes to either or both of the above, you may need to provide a full Tree Survey, at the discretion of your local planning authority. If a Tree Survey is required, this and the accompanying plan should be submitted alongside your application. Your local planning authority should make clear on its website what the survey should contain, in accordance with the current 'BS5837: Trees in relation to design, demolition and construction - Recommendations'.

20. Trade Effluent

Does the proposal involve the need to dispose of trade effluents or waste? Yes No

If Yes, please describe the nature, volume and means of disposal of trade effluents or waste

21. Residential Units (Including Conversion)

Does your proposal include the gain, loss or change of use of residential units? Yes No

If Yes, please complete details of the changes in the tables below:

TOTAL NET GAIN or LOSS of RESIDENTIAL UNITS (Proposed Housing Grand Total - Existing Housing Grand Total):

Total proposed residential units (A + B + C + D + E) =

Total existing residential units (F + G + H + I + J) =

22. All Types of Development: Non-residential Floorspace

Does your proposal involve the loss, gain or change of use of non-residential floorspace? Yes No

If you have answered Yes to the question above please add details in the following table:

23. Employment

Please complete the following information regarding employees:

24. Hours of Opening

If known, please state the hours of opening (e.g. 15:30) for each non-residential use proposed:

25. Site Area

Please state the site area in hectares (ha)

22. All Types of Development: Non-residential Floorspace (continued)

Does the proposal include use as a shop (e.g. For the display/sale of goods under Use Class E(a), the sale of essential goods under Use Class F2, or as part of any other use) Yes No

If you have answered Yes to the question above please add details in the following table:

Does the proposal include loss or gain of rooms for hotels, residential institutions, or hostels? Yes No

If you have answered Yes to the question above please add details in the following table:

26. Industrial or Commercial Processes and Machinery

Not applicable

Please describe the activities and processes which would be carried out on the site and the end products including plant, ventilation or air conditioning. Please include the type of machinery which may be installed on site:

Is the proposal a waste management development? Yes No

If the answer is Yes, please complete the following table:

Please provide the maximum annual operational throughput of the following waste streams:

• Municipal
• Construction, demolition and excavation
• Commercial and industrial
• Hazardous

If this is a landfill application you will need to provide further information before your application can be determined. Your waste planning authority should make clear what information it requires on its website.

27. Hazardous Substances

Does the proposal involve the use or storage of any of the following materials in the quantities stated below? Yes No Not applicable

If Yes, please provide the amount of each substance that is involved:

Amount (tonnes): Amount (tonnes):

28. Biodiversity Net Gain

Do you believe that, if the development is granted planning permission, the Biodiversity Gain Condition (as set out in Paragraph 13 of Schedule 7A of the Town and Country Planning Act 1990) would apply? Yes No

If No, please provide reasons, with reference to which exemptions or transitional arrangements you believe apply:

If Yes, please provide the information requested in all the questions below:

Date (DD/MM/YYYY): Please provide the date the pre-development biodiversity value of onsite habitat(s) have been calculated: (this should be one of the following dates: the date of this application; or an earlier proposed date)

Please provide the pre-development biodiversity value of onsite habitats on this date:

If a date earlier than the date of the submission of the planning application has been specified above, please provide reasons why this date has been used:

Date (DD/MM/YYYY): Please state the publication date of the biodiversity metric tool(s) used to calculate the onsite biodiversity value(s) provided above.

28. Biodiversity Net Gain (continued)

Date (DD/MM/YYYY): If yes, please state the publication date of the biodiversity metric tool(s) used to calculate any onsite biodiversity value(s) provided above.

If yes, please provide a description of these and any further details (for example reference to relevant document):

Does the application site have irreplaceable habitat(s) (corresponding to the descriptions in The Biodiversity Gain Requirements (Irreplaceable Habitat) Regulations 2024) which exist on land to which this application relates on the date the pre-development biodiversity value of onsite habitat(s) was calculated? Yes No

If yes, please provide details including: the date immediately before this activity was carried out; the onsite biodiversity value on this date; and any supporting evidence (or reference to relevant document containing these details).

Has there been any loss (or degradation) of any onsite habitat(s), resulting from activities carried out before the date the pre-development biodiversity value of onsite habitat(s) was calculated and either:

• on or after 30 January 2020 which were not in accordance with a planning permission; or
• on or after 25 August 2023 which were in accordance with a planning permission?

Yes No

I/We confirm this application is accompanied by the following:

1. The completed biodiversity metric tool(s) showing the calculation of the pre-development biodiversity values, and on the dates, detailed above including, if applicable, those related to any loss (or degradation) of any onsite habitat(s)
2. Plan(s), showing onsite habitat(s) existing on the date the pre-development biodiversity value of onsite habitat(s) was calculated; and
3. If applicable, plan(s) showing onsite irreplaceable habitat(s) existing on the date the pre-development biodiversity value of onsite habitat(s) was calculated.

Please provide details (for example reference to relevant document):

Note: Plans must be drawn to an identified scale, and show the direction of North.

29. Ownership Certificates and Agricultural Land Declaration

One certificate A, B, C, or D must be completed with this application form

CERTIFICATE OF OWNERSHIP - CERTIFICATE A

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 & Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/ The applicant certifies that on the day 21 days before the date of this application nobody except myself/ the applicant was the owner* of any part of the land or building to which the application relates, and that none of the land to which the application relates is, or is part of, an agricultural holding**

NOTE: You should sign Certificate B, C or D, as appropriate, if you are the sole owner of the land or building to which the application relates but the land is, or is part of, an agricultural holding.

* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.

** “agricultural holding” has the meaning given by reference to the definition of “agricultural tenant” in section 65(8) of the Act.

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

CERTIFICATE OF OWNERSHIP - CERTIFICATE B

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 & Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/ The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) who, on the day 21 days before the date of this application, was the owner* and/or agricultural tenant** of any part of the land or building to which this application relates.

* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.

** “agricultural tenant” has the meaning given in section 65(8) of the Town and Country Planning Act 1990

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

29. Ownership Certificates and Agricultural Land Declaration (continued)

CERTIFICATE OF OWNERSHIP - CERTIFICATE D

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 & Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/ The applicant certifies that:

• Certificate A cannot be issued for this application
• All reasonable steps have been taken to find out the names and addresses of everyone else who, on the day 21 days before the date of this application, was the owner* and/or agricultural tenant** of any part of the land to which this application relates, but I have/ the applicant has been unable to do so.

* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.

** “agricultural tenant” has the meaning given in section 65(8) of the Town and Country Planning Act 1990

Notice of the application has been published in the following newspaper (circulating in the area where the land is situated):

The steps taken were:

On the following date (which must not be earlier than 21 days before the date of the application):

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

CERTIFICATE OF OWNERSHIP - CERTIFICATE C

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14 & Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulations 1990

I certify/ The applicant certifies that:

• Neither Certificate A or B can be issued for this application
• All reasonable steps have been taken to find out the names and addresses of the other owners* and/or agricultural tenants** of the land or building, or of a part of it, but I have/ the applicant has been unable to do so.

* “owner” is a person with a freehold interest or leasehold interest with at least 7 years left to run.

** “agricultural tenant” has the meaning given in section 65(8) of the Town and Country Planning Act 1990

The steps taken were:

Notice of the application has been published in the following newspaper (circulating in the area where the land is situated):

On the following date (which must not be earlier than 21 days before the date of the application):

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY):

Signed - Applicant: Or signed - Agent: Date (DD/MM/YYYY): (date cannot be pre-application)

31. Declaration

I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional information. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the genuine opinions of the person(s) giving them.

32. Applicant Contact Details

Telephone numbers

• Country code: National number:
• Extension number:
• Country code: Mobile number (optional):
• Country code: Fax number (optional):
• Email address (optional):

33. Agent Contact Details

Telephone numbers

• Country code: National number:
• Extension number:
• Country code: Mobile number (optional):
• Country code: Fax number (optional):
• Email address (optional):

34. Site Visit

Can the site be seen from a public road, public footpath, bridleway or other public land? Yes No

If the planning authority needs to make an appointment to carry out a site visit, whom should they contact? (Please select only one) Other (if different from the agent/applicant's details) Agent Applicant

If Other has been selected, please provide:

• Contact name:
• Telephone number:
• Email address:

30. Planning Application Requirements - Checklist

Please read the following checklist to make sure you have sent all the information in support of your proposal. Failure to submit all information required will result in your application being deemed invalid. It will not be considered valid until all information required by the Local Planning Authority (LPA) has been submitted.

• The original and 3 copies* of a completed and dated application form:
• The original and 3 copies* of the plan which identifies the land to which the application relates drawn to an identified scale and showing the direction of North:
• The original and 3 copies* of other plans and drawings or information necessary to describe the subject of the application:
• The correct fee:
• The original and 3 copies* of a design and access statement, if required (see help text and guidance notes for details):
• The original and 3 copies* of a fire statement, if required (see help text and guidance notes for details):
• The original and 3 copies* of the completed, dated Ownership Certificate (A, B, C or D – as applicable) and Article 14 Certificate (Agricultural Holdings):

*National legislation specifies that the applicant must provide the original plus three copies of the form and supporting documents (a total of four copies), unless the application is submitted electronically or, the LPA indicate that a smaller number of copies is required. LPAs may also accept supporting documents in electronic format by post (for example, on a CD, DVD or USB memory stick). You can check your LPA's website for information or contact their planning department to discuss these options.

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