Fillable Application For Renewal As An Independent Qualified Person (Stratford District Council New Zealand)

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Application For Renewal As An Independent Qualified Person (Stratford District Council New Zealand)

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Authority Template Version 1 Renewal Application IQP DD57_06
APPLICATION FOR RENEWAL OF ACCEPTANCE AS
AN INDEPENDENT
QUALIFIED PERSON
(SECTION 103 BUILDING ACT 2004)
Applicant:
IQP No:
Company:
Postal Address:
Landline:
Mobile:
Email:
Specified Systems or features for which renewal as an Independent Qualified Person is sought:
Tick
Specified System
–
Building (Specified Systems, Change the Use, and
Earthquake prone Buildings) Regulations 2005 – Schedule 1 and Building
(Specified Systems, Change the Use and Earthquake prone Buildings)
Amendment Re
g
ulations 2005
SS1 Automatic systems for fire suppression.
SS2
Emergency warning systems.
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 back-flow preventers connected to a potable water supply.
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.
SS11 Laboratory fume cupboards.
SS12/1 Audio loops.
SS12/2 FM radio and infrared beam transmission systems.
SS13/1 Mechanical smoke control.
SS13/2 Natural smoke control.
SS13/3 Smoke curtains.
SS14/1 Emergency power systems.
SS14/2 Signs for SS1-13.
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.
Authority Template Version 1 Renewal Application IQP DD57_06
Is the application for:
Inspection Only
Inspection, Maintenance and Reporting Procedures
Supporting Documents
Please provide three supporting quality assurance documents completed in the last 12 months prior to the
anniversary renewal date. (Attach details/copies e.g. 12a Form, Verification Procedures, Testing Method).
Name and Address System or Feature
Statement about IQP Renewal Application
I am applying to Stratford District Council to accept my renewal as an IQP. I understand that
Council may cancel my approval at any time, subject to written information.
I certify that all information on this application form and in my portfolio of evidence is true and
accurate.
Signature
Date
Send your completed renewal application to Stratford District Council at the address below:
Building Control Department
PO Box 320
Stratford 4352
Office Use Only
Date Paid
Receipt Number
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Application For Renewal As An Independent Qualified Person (Stratford District Council New Zealand)

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Completed 19 July 2020

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