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STRATFORD DISTRICT COUNCIL
Application for Compliance Schedule
Section 103 Building Act 2004
THE BUILDING
Street Address of Building: ____________________________________________________________________________
Legal description of Building location: __________________________________________________________________
Building Name: _____________________________________________________________________________________
Location of Building within site/block number: ____________________________________________________________
Level/Unit number: ___________________________________________________________________________________
Current, lawfully established, use: _______________________________________________________________________
THE OWNER
Name of owner: _______________________________________________________________________________________
Contact Person: _______________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
Street Address/Registered Office: ________________________________________________________________________
Phone Number: Landline: Mobile: ________________________________________________
After Hours: Fax Number:____________________________________________
Email Address: ________________________________________
THE ABOVE BUILDING CONTAINS THE FOLLOWING FEATURES/SYSTEMS:
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.
Signed for and on behalf of the applicant:
Name:
Position:
Signature:
Date:
NOTES:
With each specified system please include the make, type, location (including alarm panel), applicable performance standards,
Required inspection frequency and whether carried out by owner or IQP, maintenance requirements, and reporting procedures
A floor plan of each building is preferred for indicating the location of each system. If more than one building please supply a
labelled site plan indicating the location of each building.
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