Doc # 308498 Page 1 of 5 BA Form 6
Application for Code Compliance
Certificate
Section 92, Building Act 2004
Version: 7
Date: January 2020
Code: BA Form 6
Se
nd or deliver your application to: Web: www.timaru.govt.nz
Building Services, Timaru District Council, Telephone: (03) 687 7236
2 King George Place, PO Box 522, Timaru 7940 Email: building@timdc.govt.nz
IMPORTANT
A Code Compliance Certificate is the final Council sign off for your building work.
This Application for Code Compliance Certificate should be completed as soon as possible following the completion of all building / work
relating to your consent. This application, and all required documentation, must be forwarded to Building Consent Authority at the Timaru
District Council at the address noted above.
A. THE BUILDING CONSENT
Building consent number:
Issued by:
(insert name of building consent
authority that granted building consent)
B. THE OWNER
Landline number:
Daytime number:
Facsimile number:
Email address:
Mobile number:
After hours number:
Name of owner: (include title)
Contact person: (if different from owner)
Mailing address:
Street address / registered office:
Contact details:
Please attach one of the following as
evidence of ownership (tick if
included):
Copy of certificate and title
Lease
Agreement for sale and purchase
Other document showing full name of legal owner(s) of building
C. THE AGENT (only required if application is being made on behalf of the owner)
Name of agent:
Contact person:
Mailing address:
Doc # 308498 Page 2 of 5 BA Form 6
Street address / registered office:
Contact details: Landline number: Mobile number:
Daytime number: After hours number:
Facsimile number: Email address:
Relationship to owner: (state the details
of the authorisation from the owner to
make the application on the owners behalf)
First point of contact:
(state full name,
mailing address, phone numbers and email
address)
Name of contact: Mailing address:
Mobile number: Daytime number:
Email address:
Contact for inspection: Owner Agent
D. THE APPLICATION
The Owner / Agent acknowledges for the purposes of confirming compliance with the building consent issued in relation to B2 of the
Building Code (Durability) the Code Compliance Certificate will specify the Practical Completion date (below) as the date from which
compliance with B2 of the Building Code (Durability) commences (as opposed to the date of the Code Compliance Certificate itself).
Practical Completion Date of Building Work:
Signed by the owner: OR Signature:
Name:
Date:
Signed by the agent: (on behalf of, or
with authority from the owner)
Signature:
Name:
Date:
Restricted Building Work (RBW)
The licenced building practitioner(s) who carried out or supervised the restricted building work is / are as follows:
Name Licensing Class
Licensed building practitioner no. (or
registration no. if treated as being licenced under
section 291 of the Building Act 2004)
Particular work carried out or
supervised
Concreter: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Doc # 308498 Page 3 of 5 BA Form 6
Joiner: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Tanking
applicator:
Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Plasterer /
textured coater:
Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Gasfitter: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Electrician: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Plumber: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Drainlayer: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Carpenter: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Doc # 308498 Page 4 of 5 BA Form 6
Brick / block
layer:
Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Deck / roof
membrane
applicator:
Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Roofer: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Concealed fascia
installer:
Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Concreter: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
Others: Business name:
Daytime number:
After hours:
Registration / qualification:
Product name:
Address:
Mobile number:
Facsimile:
Manufacturer:
E. COMPLIANCE SCHEDULE
There are no specified systems in the building
Cable Car (including to individual dwelling)
Automatic systems for fire suppression (for example, sprinkler systems)
Automatic or manual emergency warning systems for fire or other dangers
Electromagnetic or automatic doors or windows (for example, ones that close on fire alarm activation)
Emergency lighting systems
Escape route pressurisation systems
Doc # 308498 Page 5 of 5 BA Form 6
Riser mains for Fire Service use
Any automatic back-flow preventer connected to a potable water supply
Lifts, escalators, travelators or other systems for moving people or goods within buildings
Mechanical ventilation or air-conditioning systems
Building maintenance units for providing access to the exterior and interior walls of buildings
Laboratory fume cupboards
Audio loops or other assistive listening systems
Smoke control systems
Emergency power systems for, or signs relating to, a system or feature specified
Systems for communication spoke information intended to facilitate evacuation
Final exits ( as defined by clause A2 of the Building Code )
Fire separations ( as defined by clause A2 of the Building Code )
Signs for communicating information intended to facilitate evacuation
Smoke separations ( as defined by clause A2 of the Building Code )
F. CERTIFICATE
I request that you issue a Code Compliance Certificate for this work under Section 95 of the Building Act 2004.
The Code Compliance Certificate
should be sent to: (state which address
and whether owner or agent)
Signed by the owner: OR Signature:
Name:
Date:
Signed by the agent:
(on behalf of, or
with authority from the owner)
Signature:
Name:
Date:
G. ATTACHMENTS - please tick those that are relevant and attached
Memoranda (Records of Building Work) from licensed building practitioner(s) stating what restricted building work they
carried out or supervised.
Other documents from the personnel who carried out the work.
Evidence that specified systems are capable of performing to the performance standards set out in the building consent.
Energy works certificates (electrical, gas etc).
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