Fillable Application for New or Amended Compliance Schedule (Napier City Council New Zealand)

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Application for New or Amended Compliance Schedule (Napier City Council New Zealand)

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TPBCP-60F001v3:2014/12/02 Page 1 of 32
Application for New or Amended Compliance Schedule
(Form 11, Section 106, Building Act 2004)
Please complete sections 1 to 6 in full.
1. 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: ........................................ Year first constructed: .............................................
Intended life of building if less than 50 years: ...................................................................................
Current, lawfully established use: .....................................................................................................
Purpose Group (please circle): SH SM SI CA WB WS VP
Highest fire hazard category for building use: .................... Maximum storage height: .......................
Total occupants of entire building: ...........................................
2. The Owner
Name of owner: ...............................................................................................................................
Contact person: ...............................................................................................................................
Mailing address: ...............................................................................................................................
Street address / registered office: .....................................................................................................
Landline phone number: ............................................ Mobile: ........................................................
Daytime: .................................................................... Afterhours: ..................................................
Email address: ........................................................... Fax: .............................................................
Evidence of ownership e.g. copy of CT, lease, sale agreement .. Website: .......................................................
3. The Agent (only required if application is being made on behalf of the owner)
Name of agent: ................................................................................................................................
Contact person: ...............................................................................................................................
Mailing address: ...............................................................................................................................
Street address / registered office: .....................................................................................................
Landline phone number: ............................................ Mobile: ........................................................
Daytime: .................................................................... Afterhours: ..................................................
Email address: ........................................................... Fax: .............................................................
Relationship with owner: state details and provide written authorisation from the owner to make the application on the owner’s
behalf
.................................................................................. Website: ......................................................
First point of contact for communications with the council: ................................................................
.........................................................................................................................................................
New
Amended
TPBCP-60F001v3:2014/12/02 Page 2 of 32
4. Amendments for Compliance Schedule
I request that the Compliance Schedule for the above building be amended as follows:
BWOF No: .....................................................
SPECIFIED SYSTEMS
AMENDMENT
REASON
SS1 Automatic systems for fire suppression
SS2 Automatic or manual emergency warning
systems
SS3/1 Automatic doors
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
SS7 Automatic back-flow preventers
SS8/1 Passenger-carrying lifts
SS8/2 Platform, low-speed and service lifts
SS8/3 Escalators 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 frequency systems 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 Systems for communicating spoken
information intended to facilitate evacuation
SS15/2 Final exits
SS15/3 Fire separations
SS15/4 Signs for communicating information
intended to facilitate evacuation
SS15/5 Smoke separations
SS16 Cable cars *
(* If the location of any testable element of the cable car is not readily obvious then details of where and
how the access the element must be described here.)
In accordance with Section 103 of the 2004 Building Act, a Compliance Schedule lists the specified
systems in your building, the performance standards for those specified systems, and references
the inspection, maintenance and reporting procedures to be followed by your Independently
Qualified Person (IQP). You are therefore required to also provide this information for all systems
in your building.
TPBCP-60F001v3:2014/12/02 Page 3 of 32
5. Specified Systems
Please supply a copy of the existing compliance schedule.
The following document is a blank template with the suggested format showing the
minimum information required. NOTE: the format is not mandatory but the content is.
Please cross out all systems / options not required in the Compliance Schedule and supply
additional information as required.
On completing this form please sign and date Section 6 at the end of this document.
TPBCP-60F001v3:2014/12/02 Page 4 of 32
SS 1 – Automatic Systems for Fire Suppression
Type - please specify:
Directly Brigade Connected Yes / No
Security Monitored Yes / No
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. NZS 4541:2003 part 12
2. NZS 4541:2007 part 12
3. NZS 4541:2013 part 12
4. NZS 4515:2003 part 8
5. NZS 4515:2009 part 8
6. AS1851:2005 section 2
7. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. NZS 4541:2003 part 12
2. NZS 4541:2007 part 12
3. NZS 4541:2013 part 12
4. NZS 4515:2003 part 8
5. NZS 4515:2009 part 8
6. AS1851:2005 section 2
7. A specifically designed solution – please specify:
Frequency of Inspections
1. Daily
2. Weekly
3. Fortnightly
4. Monthly
5. Annual
6. Other – please specify:
Maintenance
In accordance with:
1. NZS 4541:2003 part 12
2. NZS 4541:2007 part 12
3. NZS 4541:2013 part 12
4. NZS 4515:2003 part 8
5. NZS 4515:2009 part 8
6. AS1851:2005 section 2
7. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 5 of 32
SS 2 – Automatic or Manual Emergency Warning Systems
Type
Please specify :
Security / Smoke Alarm / Heat Detection / Smoke Detection / Specifically designed solution
Directly Brigade Connected Yes / No
Security Monitored Yes / No
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Note: an as-built plan showing sounder and call point positions is to be provided at time of
application for CCC.
Performance Standards
1. NZS 4512:2010 Part 6
2. NZS 4512:2003 Part 6
3. NZS 4512:1997 Part 6
4. NZS 4512:1994 Part 6
5. NZS 4512:1981 Part 4
6. AS 1851:2005 section 6
7. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. NZS 4512:2010 Part 6
2. NZS 4512:2003 Part 6
3. NZS 4512:1997 Part 6
4. NZS 4512:1994 Part 6
5. NZS 4512:1981 Part 4
6. AS 1851:2005 section 6
7. A specifically designed solution – please specify:
Frequency of Inspections
1. Weekly
2. Fortnightly
3. Monthly
4. Annual
5. Other – please specify
Maintenance
In accordance with:
1. NZS 4512:2010 Part 6
2. NZS 4512:2003 Part 6
3. NZS 4512:1997 Part 6
4. NZS 4512:1994 Part 6
5. NZS 4512:1981 Part 4
6. AS 1851:2005 section 6
7. A specifically designed solution – please specify:
Back-up rechargeable batteries shall be replaced every 2 years or when found to be in-operable.
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 6 of 32
SS 3/1 – Automatic Doors
Type (please specify):
Make (if known):
Location
1. Throughout the building as detailed on appended plan / drawing
2. Main entry of the building
3. Other – please specify:
Performance Standards
1. AS 4085:1992 appendix A (superseded by AS 5007)
2. NZS 4239:1993 appendix A
3. AS 5007:2007 appendix E
4. A specifically designed solution – please specify:
Inspections
Inspections undertaken in accordance with:
1. AS 4085:1992 appendix A (superseded by AS 5007)
2. NZS 4239:1993 appendix A
3. AS 5007:2007 appendix E
4. A specifically designed solution – please specify:
Frequency of Inspections
1. Daily inspections for crowd type occupancies while the building is in use.
2. Monthly inspection for all other occupancies by owner.
3. Annual inspection and maintenance by an independent qualified person.
4. Other – please specify:
Maintenance
In accordance with:
1. AS 4085:1992 appendix A (superseded by AS 5007)
2. NZS 4239:1993 appendix A
3. AS 5007:2007appendix E
4. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 7 of 32
SS 3/2 – Access-Controlled Doors
(where a security door is also an automatic door then inspection and maintenance for SS3/1 also applies)
Type (please specify):
Make (if known):
Location
1. Throughout the building as detailed on appended plan / drawing
2. Main entry of the building
3. Other – please specify:
Performance Standards
A specifically designed solution – please specify:
Inspections and Frequency
1. Daily inspections for crowd type occupancies while the building is in use.
2. Monthly inspection for all other occupancies by owner.
3. Six monthly and annual inspections by an independent qualified person.
4. Other – please specify:
Maintenance
1. In accordance with the nominated performance standard by an independent qualified person.
2. Back-up rechargeable batteries shall be replaced every 2 years or when found to be in-
operable.
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 8 of 32
SS 3/3 – Interfaced Fire or Smoke Doors or Windows
(SS3/3 that forms part fire / smoke separation needs to be inspected and maintained in accordance with SS15/3 and SS15/5)
Type (please specify):
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Main entry of the building
4. Other – please specify:
Performance Standards
1. AS 4178:1994 section 4
2. A specifically designed solution – please specify:
Inspections
Inspected in accordance with:
1. AS 4178:1994 section 4
2. A specifically designed solution – please specify:
Frequency of Inspections
1. Daily inspections for crowd type occupancies while the building is in use.
2. Monthly inspection for all other occupancies by owner.
3. Annual inspections by an independent qualified person.
4. Other – please specify:
Maintenance
In accordance with:
1. AS 4178:1994 section 4
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 9 of 32
SS 4 – Emergency Lighting Systems
Emergency lighting that also forms an exit sign needs to have its illumination aspect checked under SS15/4
Type (please specify):
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. AS/NZS 2293.2:1995
2. A specifically designed solution – please specify:
Inspections
Inspections by an independent qualified person to:
1. AS/NZS 2293.2:1995
2. A specifically designed solution – please specify:
(Systems prior 1 January 1996 in accordance with NZS 6742)
Where a generator is part of the Emergency Lighting it needs to be inspected to NZS6104:1981 part 8
Complete SS 14/1
Frequency of Inspections
1. 6 Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. AS/NZS 2293.2:1995
2. A specifically designed solution – please specify:
Back-up rechargeable batteries shall be replaced when found to be in-operable or defective.
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 10 of 32
SS 5 – Escape Route Pressurisation Systems
Type (please specify):
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. AS 1851.6
2. AS 1851:2005 section 18
3. AS/NZS 1668.1:1998 appendix F
4. A specifically designed solution – please specify:
Inspections
Inspections by an independent qualified person to:
1. AS 1851.6
2. AS 1851:2005 section 18
3. AS/NZS 1668.1:1998 appendix F
4. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. AS 1851.6
2. AS 1851:2005 section 18
3. AS/NZS 1668.1:1998 appendix F
4. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 11 of 32
SS 6 – Riser Mains
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS 1851:2005 section 3
2. NZS 4510:2008 part 9
3. A specifically designed solution – please specify:
Inspections
Inspections by an independent qualified person to:
1. AS 1851:2005 section 3
2. NZS 4510:2008 part 9
3. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. AS 1851:2005 section 3
2. NZS 4510:2008 part 9
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 12 of 32
SS 7 – Automatic Back-flow Preventers
Cross Connection Hazard (G12 AS/1 section 3.3 table 2)
1. High
2. Medium
3. Low
4. Other – please specify:
Backflow Preventer Type
1. Reduced pressure zone
2. Double check valve
3. Pressure vacuum breaker
4. Atmospheric vacuum breaker
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS/NZS 2845:1998 Part 3
2. AS/NZS 2845.1:2010 Section 3
3. A specifically designed solution – please specify:
Inspections & Frequency
Annual Inspection by an independent qualified person to:
1. AS/NZS 2845:1998 Part 3
2. AS/NZS 2845.1:2010 RPZ requirements
3. A specifically designed solution – please specify:
Maintenance
In accordance with:
1. AS/NZS 2845:1998 Part 3
2. AS/NZS 2845.1:2010 Section 20
3. A specifically designed solution – please specify:
Backflow preventers shall be inspected and tested after repair or replacement.
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 13 of 32
SS 8/1 – Passenger-Carrying Lifts
(SS8/1 that is connected to emergency warning system SS2 needs to have the interface tested annually)
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. Building Code Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5
2. NZS 4332:1997 part 2.5
3. BS EN 81:2003
4. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person in accordance with:
1. NZS 4332:1997 part 2.5
2. BS EN 81:2003
3. A specifically designed solution – please specify:
4. Any additional requirements identified within the compliance schedule handbook pages 30 –
32 (issued 25 May 2007)
5. D2/AS1 NZ Building Code.
Frequency
1. Annual Inspection by an independent qualified person to:
2. Other – please specify:
Maintenance
In accordance with:
1. NZS 4332:1997 part 2.5
2. BS EN 81:2003
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 14 of 32
SS 8/2 – Platform, Low-Speed and Service Lifts
(SS8/2 that is connected to emergency warning system SS2 needs to have the interface tested annually)
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. Building Code Clauses D2.3.1, D2.3.2 and D2.3.3
2. NZS 4332:1997 part 2.5
3. BS EN 81:2003
4. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person in accordance with:
1. NZS 4332:1997 part 2.5
2. BS EN 81:2003
3. A specifically designed solution – please specify:
4. Any additional requirements identified within the compliance schedule handbook pages 34 –
35 (issued 25 May 2007)
5. D2/AS1 NZ Building Code.
Frequency
1. Annual Inspection by an independent qualified person to:
2. Other – please specify:
Maintenance
In accordance with:
1. NZS 4332:1997 part 2.5
2. BS EN 81:2003
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 15 of 32
SS 8/3 – Escalators and Moving Walks
(SS8/3 that is connected to emergency warning system SS2 needs to have the interface tested annually)
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. Building Code Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5
2. A specifically designed solution – please specify:
Inspections & Frequency
1. Inspected annually by an independent qualified person to D2/AS3 BS EN 81:2003
2. Inspected by an independent qualified person in accordance with a specifically designed
solution – please specify:
3. Inspected with any additional requirements identified within the compliance schedule
handbook page 37 (issued 25 May 2007) or to the manufacturer’s recommendations.
Maintenance
In accordance with:
1. D2/AS3 BS EN 81:2003
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 16 of 32
SS 9 – Mechanical Ventilation
(SS9 that forms part of a fire / smoke separation needs to be inspected in accordance with SS15/3 and SS15/5)
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Note: Provide detailed plan showing location of smoke and fire dampers.
Performance Standards
1. NZS 4302:1987 Part 2
2. AS 1851:2005 section 6
3. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. NZS 4302:1987 Part 2
2. AS 1851:2005 section 6
3. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. NZS 4302:1987 part 2
2. AS 1851:2005 section 6
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 17 of 32
SS 9 – Air Conditioning Systems
(SS9 that forms part of a fire / smoke separation needs to be inspected in accordance with SS15/3 and SS15/5)
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Note: Provide detailed plan showing location of smoke and fire dampers.
Performance Standards
1. AS/NZS 3666.2:2002
2. NZS 4302:1987 part 2
3. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. AS/NZS 3666.2:2002
2. NZS 4302:1987 part 2
3. A specifically designed solution – please specify:
Cooling towers need to have tests carried out by IANZ to AS 3896.
Where ventilation system is fitted with smoke / fire control these systems shall be inspected to AS 1851:2005 section 18.
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. AS 1851.6
2. AS/NZS 3666.2:2002
3. NZS 4302:1987 part 2
4. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 18 of 32
SS 10 – Building Maintenance Units
e.g. Building maintenance units for providing access to the exterior and interior walls of buildings.
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. BS 6037:1990
2. BS 6037.1:2003
3. BS 6037.2:2004
4. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. BS 6037:1990 to ensure safe and suitable operation
2. BS 6037.1:2003 to ensure safe and suitable operation
3. BS 6037.2:2004 to ensure safe and suitable operation
4. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
1. Planned preventative maintenance and responsive maintenance should be carried out in
accordance with BS 6037:1990.
2. Planned preventative maintenance and responsive maintenance should be carried out in
accordance with BS 6037.1:2003
3. Planned preventative maintenance and responsive maintenance should be carried out in
accordance with BS 6037.2:2004
4. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 19 of 32
SS 11 – Laboratory Fume Cupboards
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS/NZS 2243.8:2006
2. AS/NZS 2243.8:2001
3. A specifically designed solution – please specify:
Inspections
1. Regular inspection and testing to ensure they operate as required by the performance
standard by an independent qualified person to AS/NZS 2243.8:2006 / AS/NZS 2243.8:2001.
2. Inspected by an independent qualified person to a specifically designed solution – please
specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
Inspected and maintained in accordance with:
1. AS/NZS 2243.8:2006
4. AS/NZS 2243.8:2001
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 20 of 32
SS 12/1 – Audio Loops
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS/NZS 1088.4:1987(superseded by AS 60118)
2. AS 60118:4:2007
3. A specifically designed solution – please specify:
Inspections
Inspections by independent qualified person to:
1. AS/NZS 1088.4:1987(superseded by AS 60118)
2. AS 60118:4:2007
3. A specifically designed solution – please specify:
Frequency of Inspections
1. 6 Monthly.
2. Other – please specify:
Maintenance
In accordance with:
1. AS/NZS 1088.4:1987(superseded by AS 60118)
2. AS 60118.4:2007
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 21 of 32
SS 12/2 – FM Radio Frequency Systems and Infrared Beam Transmission Systems
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. A specifically designed solution – please specify:
Inspections
Inspections by independent qualified person to:
1. A specifically designed solution – please specify:
Frequency of Inspections
1. 6 Monthly.
2. Other – please specify:
Maintenance
In accordance with:
1. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 22 of 32
SS 13/1 – Mechanical Smoke Control
e.g. Smoke ventilator designed to open or extract in the event of a fire.(SS13/1 that is connected to
emergency warning system SS2 needs to have the interface tested annually.
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS/NZS 1668.1:1998
2. AS 1851:2005 section 18
3. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. AS/NZS 1668.1:1998
2. AS 1851:2005 section 18
3. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. AS/NZS 1668.1:1998
2. AS 1851:2005 section 18
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 23 of 32
SS 13/2 – Natural Smoke Control
e.g. Smoke reservoir in an atrium/ smoke doors.
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS/NZS 1668.1:1998
2. AS 1851:2005 section 17
3. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. AS/NZS 1668.1:1998
2. AS 1851:2005 section 17
3. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. AS/NZS 1668.1:1998
2. AS 1851:2005 section 17
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 24 of 32
SS 13/3 – Smoke Curtains
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. AS/NZS 1668.1:1998 part 4
2. AS 1851:2005 section 17
3. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. AS/NZS 1668.1:1998 part 4
2. AS 1851:2005 section 17
3. A specifically designed solution – please specify:
Maintenance
In accordance with:
1. AS/NZS 1668.1:1998 part 4
2. AS 1851:2005 section 17
3. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 25 of 32
SS 14/1 – Emergency Power Systems
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. Building Code Clause G9.3.2
2. NZS 6104:1981 part 8
3. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. NZS 6104:1981 part 8 and in conjunction with the systems it relates to
2. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
In accordance with:
1. NZS 6104:1981 part 8
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 26 of 32
SS 14/2 – Signs Relating to a System or Feature specified in any of Clauses 1 to 13
Type (please specify):
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. Building Code Clauses F6 and F8
2. AS/NZS 2293.2:1995
3. Other – please specify:
Inspections
1. Where illumination of signage is necessary, the procedures of SS 4 will be used to verify that
illumination occurs for the required duration - - please specify:
2. Signage will be inspected in accordance with the published Standard or the performance
specification of the associated specified system - please specify:
3. Regular inspection by an independent qualified person to ensure signs are displayed to
facilitate evacuation in an event of an emergency.
Frequency
1. Monthly inspections of illuminated signs to ensure they are: of the correct type / present and in
the right locations / legible / illuminated.
2. Annual inspections of signs not required to be illuminated to ensure they are: of the correct
type / present and in the right locations / legible.
3. Other – please specify:
Maintenance
1. Maintained in conjunction with the systems it relates to.
2. Responsive maintenance will be carried out in accordance with the nominated performance
and inspection Standard, and to ensure signs remain correctly positioned and legible and
where appropriate ensure the escape route is identified.
3. Other – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 27 of 32
SS 15/1 – Systems for Communicating Spoken Information intended to Facilitate
Evacuation
Type (please specify):
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. AS 1851: 2005 section 10
2. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. AS 1851: 2005 section 10
2. A specifically designed solution – please specify:
Frequency of Inspections
1. Monthly.
2. Annual.
3. Other – please specify:
Maintenance
Maintenance in accordance with:
1. AS 1851: 2005 section 10
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 28 of 32
SS 15/2 – Final Exits
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. In accordance with Fire Safety and Evacuation of Building Regulations 1992 and the
Compliance Schedule Handbook 2007.
2. Compliance Schedule Handbook 2011.
3. Clause C2 of the New Zealand Building Code.
4. A specifically designed solution – please specify:
Inspections & Frequency
1. Daily inspections by owner for crowd type occupancies while the building is in use and for all
buildings while building work may affect a final exit to ensure the doors are not locked, barred
or blocked and the door locking devices:
Are clearly visible
Are easily operated without a key or other security device
Do not prevent or override the direct operation of panic bolts fitted to any door.
2. Monthly inspection for all other occupancies.
3. Annual inspection and maintenance for all other occupancies by independent qualified
persons.
Maintenance
1. Final exits shall be maintained at all times in a safe condition with particular attention to:
freedom from obstructions
locking
blocking
barring
storage of combustibles
ease of opening any door leading into the escape route and at the final exit.
2. Responsive maintenance should be carried out to ensure occupants are not prevented from
leaving the building in the event of an emergency.
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 29 of 32
SS 15/3 – Fire Separations
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. Compliance Document C/AS1 Fire Safety
2. A specifically designed solution – please specify:
Inspections & Frequency
1. Daily inspections by owner for crowd type occupancies while the building is in use and for all
buildings while building work may affect a fire separation.
2. Six monthly inspections for all other occupancies with annual inspection and maintenance by
independent qualified persons.
3. Other – please specify:
Maintenance
In accordance with:
1. Compliance Document C/AS1 Fire Safety
2. Compliance Schedule Handbook 2007
3. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 30 of 32
SS 15/4 – Signs for Communicating Information intended to Facilitate Evacuation
Emergency lighting that also forms an exit sign needs to have its illumination aspect checked under
SS4
Type (please specify):
Make (if known):
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. Building Code Clauses F6 and F8
2. A specifically designed solution – please specify:
Inspections & Frequency
Where available, signage should be inspected in accordance with the published Standard or the
performance specification of the associated specified system.
Signs require regular inspection to ensure they are displayed to facilitate evacuation in an event of an
emergency.
The following minimum checks should be carried out when appropriate to the installation:
Crowd Type Occupancies
Daily inspections by owner for crowd type occupancies while the building is in use.
Monthly inspection for all other occupancies with annual inspection and maintenance
by independent qualified persons.
All other Occupancy Types
Monthly inspections of illuminated signs to ensure they are: of the correct type /
present and in the right locations / legible / illuminated.
Annual inspections of signs not required to be illuminated to ensure they are: of the
correct type / present and in the right locations / legible.
Maintenance
Signs shall be: replaced if not of the correct type, replaced immediately should they be missing or
refurbished before they become illegible.
Responsive maintenance should be carried out in accordance with the nominated performance and
inspection Standard, and to ensure signs remain correctly positioned and legible and where
appropriate ensure the escape route is identified
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 31 of 32
SS 15/5 – Smoke Separations
Emergency lighting that also forms an exit sign needs to have its illumination aspect checked under SS4
Location
1. Throughout the building
2. Throughout the building as detailed on appended plan / drawing
3. Other – please specify:
Performance Standards
1. Compliance Document C/AS1 Fire Safety
2. A specifically designed solution – please specify:
Inspections
Inspected by an independent qualified person to:
1. Compliance Document C/AS1 Fire Safety
2. A specifically designed solution – please specify:
Frequency
1. Daily inspections by owner for crowd type occupancies while the building is in use
2. Monthly inspection for all other occupancies
3. Annual inspection and maintenance by independent qualified persons.
4. Other: please specify:
Maintenance
In accordance with:
1. Compliance Document C/AS1 Fire Safety
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
TPBCP-60F001v3:2014/12/02 Page 32 of 32
SS 16 – Cable Cars
Residential cable car, an enclosed ski chair lift that operates either wholly or partially within a building
Type (please specify):
Make (if known):
Location
1. As detailed on appended plan / drawing
2. Other – please specify:
Performance Standards
1. NZS 5270:2005 part 16 appendix C.
2. A specifically designed solution – please specify:
Inspections
Inspected by independent qualified person to:
1. NZS 5270:2005 part 16 appendix C
2. A specifically designed solution – please specify:
Frequency
1. Annual inspection and maintenance by independent qualified persons.
2. Other: please specify:
Maintenance
1. In accordance with NZS 5270:2005 part 16 appendix C.
2. A specifically designed solution – please specify:
Reporting
Inspections shall be logged. Log book to be maintained and kept on premises. Records are required to
be kept for a period of 2 years.
6. Building Owner/Agent Signature
Owner Signature: .........................................................................................................
Name: ............................................................................................................................
Position: ............................................................. Date: ..................................................
Agent on behalf of and with the authority of the owner:
Agent Signature: ...........................................................................................................
Name: ............................................................................................................................
Position: ............................................................. Date: ..................................................
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Application for New or Amended Compliance Schedule (Napier City Council New Zealand)

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Completed 5 September 2021

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