The Advisory Committee for the Care of Churches for the Diocese of Sheffield

APPLICATION FORM TO BE PLACED ON THE APPROVED LIST OF ARCHITECTS AND SURVEYORS FOR

THE DIOCESE OF SHEFFIELD

1. / Full Name:
Title: / Dr/Mr/Mrs/Miss/Ms/Other
2. / Name and address of your practice:
Telephone Number:
Mobile:
E mail:
Web address:
3. / Year of Registration: / Membership Number:
As Architect / ARB
As Chartered Building Surveyor / RICS
As Building Surveyor / FAS
Date of AABC accreditation in Building Conservation / RIBA
Date of RIBA accreditation in Building Conservation / Specialist Conservation Architect (SCA): for Grade I & II* Listed
Conservation Architect (CA):
for Grade II Listed
Conservation Registrant (CR):
for Unlisted / locally listed Churches
Date of RICS accreditation in Building Conservation
Please provide your Professional Qualifications (most recent dates first):
4. / Information regarding your practice:
Date of formation of practice:
Your position in the practice:
Size of practice: / Fully qualified partners:
Architectural assistants:
Qualified technicians:
Other support staff:
Has the practice full professional indemnity insurance?
Please provide details of your practice’s insurance:
Policy Number
Renewal date
Undertake to have insurance cover of a minimum £1,000,000 or provide alternative details to be annually updated during your period of registration.
Any restrictive clauses (please continue on another sheet if necessary)
5. / Please provide details of your personal professional indemnity insurance if different from the practice cover given above:
6. / Please provide details of your principal areas of activity
7. / Please provide details of any awards or published workswith dates, most recent first
8. / Are you a member of any of the following?
  • Ecclesiastical Architects and Surveyors Association
/

Yes

/ No
  • Association for Studies in the Conservation of Historic Buildings
/

Yes

/ No
  • Society for the Protection of Ancient Buildings
/

Yes

/ No
  • Ancient Monuments Society
/

Yes

/ No
  • The Georgian Group
/

Yes

/ No
  • The Victorian Society
/

Yes

/ No
  • The Twentieth Century Society
/

Yes

/ No
  • Institute of Historic Building Conservation
/

Yes

/ No
  • National / Regional Historic Churches Trust
/

Yes

/ No

9a.Are you familiar with the Diocesan Advisory Committee and faculty procedure?Yes/No

9b.Are you on the List of Approved Architects/Surveyors for any other diocese?Yes /No

If yes,please provide details:

9c.Please provide the names and gradesof any churches where you are the architect.

9d.Please give details of your experience in the repair and conservation of church buildings.

  • Number of Quinquennial Inspections undertaken (including dates)
  • Types of repair/conservation work undertaken and value of repairs

10.Please provide details of your experience in the repair and conservation of secular historic buildings:

  • Number of condition surveys undertaken (including dates)
  • Types of repair works undertaken and value of repairs

11.Referees

Please provide three referees, two of whom have knowledge of your training and experience, if any, in historic buildings, and one from a PCC or DAC. If a senior partner in your practice is supervising your work or acting as a mentor s/he should be one of your referees. Please do not include more than onereferee from the practicewhere you currently are employed.

Name: / Name: / Name:
Address: / Address: / Address:
Telephone: / Telephone: / Telephone:
Email Address: / Email Address: / Email Address:

I confirm that I am able and willing to examine, or arrange for a competent examination of, all areas of a church required to be inspected for a Quinquennial Inspection report.

I undertake that if accepted for the list I will take responsibility for Quinquennial Inspections and personally supervise any member of my staff who assists with the inspection or drafting of the report.

SignedDate

Please send this form and anyadditional information to: -

Dr Julie Banham

The DAC Secretary

Church House

95-99 Effingham St

Rotherham

S65 1BL

The Diocese of Sheffield October 20121 of 5