AF 3P Page 1 of 5 Last Updated: 18/4/2019
Revision: 1
AF 3P Application for 3
rd
Party Certification/
Evidence in Place of On-site Inspection(s)
For submission prior to the start of building work
APPLICANT TO COMPLETE
Building Consent no.
Owner name
Applicant name
Applicant role
Licensed Building Practitioner (LBP) Agent
Applicant email
*Must be provided
Applicant telephone
Site address
Inspection type
applied for
Siting
Underslab P&D
Pre-slab
Walls- block/beam
Precladding
Framing & bracing (prewrap)
Building pre-line
Wet area membrane
Plumbing pre-line
Post line/pre-stop
Half-high veneer
External drainage
Passive fire
Enter text
Enter text
Role Name(s) Registration number(s)
LBP(s)
Structural Engineer
Geotechnical
Engineer
Other engineer(s)
(specify type)
Describe the specific areas and building components to be certified by independent 3rd party
AF 3P Page 2 of 5 Last Updated: 18/4/2019
Revision: 1
AF 3P Application for 3
rd
Party Certification/
Evidence in Place of On-site Inspection(s)
Describe the specific work to be completed by a licensed/registered person
Foundation
Cladding
Carpentry
Blockwork
Drainage
Work
Name and
license/registration no.
Building Code clauses to be included in PS3/4
B1
B2
Stability
C1
C2
C3
C4
C5
C6
Protection from fire
D1
D2
Access
E1
E2
E3
Moisture
F1
F2
F3
F4
F5
F6
F7
F8
F9
Safety
G1
G2
G3
G4
G5
G6
G7
G8
G9
G10
G11
G12
G13
G14
G15
Services and facilities
H1
Energy efficiency
Specify additional evidence of compliance to be provided in support of application
e.g. site reports, as-built plans, photographs, video
Applicant to comply with the following requirements in blue. To be filled in by QLDC only
AF 3P Page 3 of 5 Last Updated: 18/4/2019
Revision: 1
AF 3P Application for 3
rd
Party Certification/
Evidence in Place of On-site Inspection(s)
COUNCIL USE ONLY
DOCUMENTATION/CERTIFICATION REQUIREMENTS
Requ-
ired
N/A
(with reason)
1
The building must be sited in accordance with the approved plans. The
contractor will ensure that the siting of the survey pegs will be
confirmed by a Registered Surveyor. The decision to accept the siting
of the building is solely at the contactor’s discretion. A building location
certificate is to be submitted to verify the siting.
Click to enter
text
2
A suitably qualified engineer, who is currently registered with
Engineering New Zealand, must provide a PS4 for B1 Structure and B2
Durability.
Site inspection notes must be left on site immediately following the
inspection recording the outcome of the inspection with a PS4 to
follow, as soon as is reasonable practical.
NB: Damp proof membranes (where required) must be covered by the
producer statement, otherwise membranes will need to be inspected
by QLDC. (Ensure an agreement is reached before proceeding with the
work). No sub-floor drainage or tanking is to be covered without
inspection.
Click to enter
text
3
A suitably qualified engineer, who is currently registered, must provide
certification of the suitability of the ground conditions. Site inspection
notes must be uploaded to the QLDC portal immediately following the
inspection, recording the outcome of the inspection with the suitable
certification.
Click to enter
text
4
A suitably qualified engineer, who is currently registered, must provide
certification of the suitability of the ground conditions.
Site inspection notes must be uploaded on QLDC Sharefile as soon as is
reasonable practical after the inspection. These must record the
outcome of the inspection with the suitable certification.
Click to enter
text
5
A Record of Building Work (ROW) must be provided for all Restricted
Building Work from a LBP on completion of the work. Where there is
no requirement for LBP certification, the contractor will provide QLDC
with a PS3 Producer Statement for the specified building work.
Click to enter
text
AF 3P Page 4 of 5 Last Updated: 18/4/2019
Revision: 1
AF 3P Application for 3
rd
Party Certification/
Evidence in Place of On-site Inspection(s)
Terms and Conditions
The applicant acknowledges and accepts the following terms and conditions in full:
1) The conditions of this application have been fully explained to the owner, builder and contractors.
2) This form does not give authorization for work to start before issue of the Building Consent
including any Amendments or Minor Variations.
3) This application must be approved before undertaking the building work in the application.
4) There is no statutory timeframe for this application to be processed.
5) Approval to proceed with the above building work is not approval to carry out any other additional
work not authorized. All other inspections must be booked with QLDC building department booking
line on 03 450 0369 as per the normal process.
6) A copy of this stamped-approved form must be placed in the inspection folder prior to the next
inspection. This is to be kept on-site, together with the Building Consent documentation and be
available for the Building Control Officer to review.
7) All 3rd party site inspection records are to be supplied to QLDC as soon as reasonably practical.
Copies are to be kept on-site together with the Building Consent documentation, so that they may
be checked as evidence of compliance at any time.
8) On-site 3rd party inspections must satisfy the Building Act 2004, Sections: 17, 40, 51(2)(a)(b), 90*
9) The building work may be subject to an on-site inspection audit by a Council officer at any time,
without prior notification
.
10) 3rd party inspections are granted having determined that there will be sufficient Quality and
Assurance Systems in place for the building work.
11) Council reserves the right at any time to amend or rescind any portion of permission given to
applicant for performing a 3rd party inspection.
Applicant name
Applicant signature
Date
BUILDING CONTROL OFFICER DECISION
I am satisfied on reasonable grounds the application be:
Approved
Refused
Reason/rationale:
BCO name
BCO signature
Date
AF 3P Page 5 of 5 Last Updated: 18/4/2019
Revision: 1
AF 3P Application for 3
rd
Party Certification/
Evidence in Place of On-site Inspection(s)
Building Act 2004 (selected extracts)
S.17 All building work must comply with building code
All building work must comply with the building code to the extent required by this Act, whether or
not a building consent is required in respect of that building work.
S.40 Buildings not to be constructed, altered, demolished, or removed without consent
1) A person must not carry out any building work except in accordance with a building consent.
2) A person commits an offence if the person fails to comply with this section.
3) A person who commits an offence under this section is liable on conviction to a fine not exceeding
$200,000 and, in the case of a continuing offence, to a further fine not exceeding $10,000 for every
day or part of a day during which the offence has continued.
S.51 Issue of building consent
2) The issue of a building consent does not, of itself,
a) relieve the owner of the building or proposed building to which the building consent relates of
any duty or responsibility under any other Act relating to or affecting the building or proposed
building; or
b) permit the construction, alteration, demolition, or removal of the building or proposed building
if that construction, alteration, demolition, or removal would be in breach of any other Act.
S.90 Inspections by building consent authorities
1) Every building consent is subject to the condition that agents authorised by the building consent
authority for the purposes of this section are entitled, at all times during normal working hours or
while building work is being done, to inspect
a) land on which building work is being or is proposed to be carried out; and
b) building work that has been or is being carried out on or off the building site; and
c) any building
2) The provisions (if any) that are endorsed on a building consent in relation to inspection during the
carrying out of building work must be taken to include the provisions of this section.
3) In this section, inspection means the taking of all reasonable steps to ensure that building work is
being carried out in accordance with a building consent.
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