Private Bag 9023 | Whangarei 0148 | New Zealand
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06/334822 October 2010
Building warrant of fitness
Form 12 (Section 108 Building Act 2004)
Issued / /201 Expires / /201 Compliance schedule no `
Building
Building commonly known as Legal description
Street address
(if any)
Intended use (in detail) and any conditions of use
Year first constructed Highest fire hazard category for building use
Intended Life
Indefinite but not less than 50 years
Specified as years
Owner
Name
Contact person
Mailing address
Street address/registered office
Phone number Landline Mobile
Daytime After hours
Email address Fax no
Website address
Warrant
Maximum number of occupants that can safely use this building
Attachments
Certificates relating to inspections, maintenance and reporting
Recommendations for amendments to the compliance schedule
The compliance schedule and the written reports obtained in accordance with the compliance schedule are
to be kept at
The inspection, maintenance & reporting procedures of the compliance schedule for the above building have
been fully complied with during the 12 months prior to (date)
Signature of owner/agent
Name
(please print) Signature
Date
