Fillable Application For Building Warrant Of Fitness (B WoF) (Stratford District Council New Zealand)

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Application For Building Warrant Of Fitness (B WoF) (Stratford District Council New Zealand)

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© Stratford District Council 2006 Version 2 BUILDING TEMPLATE - APPLICATION - BWOF - SECTION 12 - SECTION 108 - BC 13 Application Page 1 of 3
THE BUILDING
Street Address of Building ...............................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
Legal Description of Land Where Building is Located ......................................................................................
...........................................................................................................................................................................
Building Name .................................................................................................................................................
Location of Building within Site/Block Number .................................................................................................
...........................................................................................................................................................................
Level/Unit Number ...........................................................................................................................................
Current, Lawfully Established, Use ..................................................................................................................
...........................................................................................................................................................................
Year First Constructed .....................................................................................................................................
Intended Life of the Building (if 50 years or less) .............................................................................................
Highest Fire Hazard Category for Building Use ...............................................................................................
Annual BWOF Expiry Date ..................................... Compliance Schedule No. ......................................
THE OWNER
Name of Owner ................................................................................................................................................
(Include preferred form of address eg. Mr, Mrs, Miss, Dr etc if an individual)
Contact Person ................................................................................................................................................
Mailing Address ...............................................................................................................................................
...........................................................................................................................................................................
Street Address/Registered Office ....................................................................................................................
...........................................................................................................................................................................
Phone Number: Landline: ................................................. Mobile: .......................................................
Daytime: .................................................. After-hours: ................................................
Email Address: .................................................................................................................
Website: ...........................................................................................................................
BUILDING WARRANT OF FITNESS
SECTION 12, SECTION 108 BUILDING ACT 2004
D10/25
046 v2
© Stratford District Council 2006 Version 2 BUILDING TEMPLATE - APPLICATION - BWOF - SECTION 12 - SECTION 108 - BC 13 Application Page 2 of 3
THE AGENT
Name of Agent .................................................................................................................................................
(Include preferred form of address eg. Mr, Mrs, Miss, Dr etc if an individual)
Contact Person ................................................................................................................................................
Mailing Address ...............................................................................................................................................
...........................................................................................................................................................................
Street Address/Registered Office ....................................................................................................................
...........................................................................................................................................................................
Phone Number: Landline: ................................................. Mobile: .......................................................
Daytime: .................................................. After-hours: ................................................
Email Address: .................................................................................................................
Website: ...........................................................................................................................
SYSTEMS
SS1 Automatic systems for fire suppression (for example, sprinkler systems).
SS2 Automatic or manual emergency warning systems for fire or other dangers (other than a
warning system for fire that is entirely within a household unit and serves only that unit).
SS3 Electromagnetic or automatic doors or windows (for example, ones that close on fire alarm
activation).
SS3/1 Automatic door
SS3/2 Access controlled doors
SS3/3 Interfaced fire or smoke doors or windows
SS4 Emergency lighting systems.
SS5 Escape route pressurisation systems.
SS6 Riser mains for use by fire services.
SS7 Automatic backflow preventers connected to a potable water supply.
SS8 Lifts, escalators, travelators, or other systems for moving people or goods within buildings.
SS8/1 Passenger carrying lifts
SS8/2 Service lifts
SS8/3 Escalator and moving walks
SS9 Mechanical ventilation or air conditioning systems.
SS10 Building maintenance units providing access to exterior and interior walls of buildings.
SS11 Laboratory fume cupboards.
SS12 Audio loops or other assistive listening systems.
SS12/1 Audio loops
SS12/2 FM radio and infrared beam transmission systems
SS13 Smoke control systems.
SS13/1 mechanical smoke control
SS13/2 natural smoke curtain
SS13/3 Smoke curtains
SS14 Emergency power systems for, or signs relating to, a system or feature specified in any of
clauses 1-13.
SS14/1 Emergency power systems
SS14/2 Signs for SS1-13
D10/25046 v2
© Stratford District Council 2006 Version 2 BUILDING TEMPLATE - APPLICATION - BWOF - SECTION 12 - SECTION 108 - BC 13 Application Page 3 of 3
SYSTEMS (cont)
SS15 Any or all of the following systems and features, so long as they form part of a building’s
means of escape from fire, and so long as those means also contain any or all of the
systems or features specified in clauses 1 to 6, 9, and 13:
Systems for communicating spoken information intended to facilitate evacuation; and
Final exits (as defined by clause A2 of the building code); and
Fire separations (as so defined); and
Signs for communicating information intended to facilitate evacuation; and
Smoke separations (as so defined).
SS15/1 Spoken information to facilitate evacuation
SS15/2 Final exits
SS15/3 Fire separations
SS15/4 Signs for facilitating evacuation
SS15/5 Smoke separations
SS16 Cable cars
WARRANT
The maximum number of occupants that can safely use this building is: ........................................................
The inspection, maintenance and reporting procedures of the compliance schedule for the above building
have been fully complied with during the 12 months prior to the date stated below.
The compliance schedule is kept at: ................................................................................................................
ATTACHMENTS
• Certificates relating to inspections, maintenance and reporting (Form 12A)
• Recommendations for amendments to the compliance schedule, if any.
Signature of Owner:
Date:
Signature of Agent:
Date:
D1
0/25046 v2
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Application For Building Warrant Of Fitness (B WoF) (Stratford District Council New Zealand)

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Completed 19 July 2020

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