systems, evacuation
and fire service
operation systems,
suppression, control
Yes
No
Note: The design of fire safety systems is only restricted building work when it involves small-to-medium apartment
buildings as defined by the Building (Definition of Restricted Building Work) Order 2011.
Are waivers or modifications of the building code required? Yes No
If Yes, please provide details including relevant code clauses
Clause: Waiver/modification required:
4. What are your details?
Complete all fields or enter N/A where not applicable
Licensed Building
Practitioner name:
Licensed Building
Practitioner number:
Registered Architect
number:
Chartered Professional
Engineer number:
Mailing address:
Street address or
registered office:
Contact numbers: Ph: Cell:
Email address:
5. Declaration
I, ____________________________________________[
name of Licensed Building Practitioner
], certify that the design work that is
restricted building work recorded on this form—
(a) complies with the building code; or
(b)
complies with the building code subject to any waiver or modification of the building code recorded on this form.
Signature:
Date:
Yo
u can add a digital signature to this document, either using Adobe or your existing digital signature.
Once you have filled out the form, including signatures, please save the application to your computer. You can then
submit the application with supporting documentation to your local council.
If you are unsure about what information to include in your application, a guidance document is available (click here).
05-12-2017 v1.6
GoShift LBP Certificate of Design Work
Page 2 of 2
click to sign
signature
click to edit
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