D14/8892 Building Template – Application – Certificate of Acceptance – BC 10
(b) In order to ensure that a specified system was maintained in a safe condition or made safe as follows
(explain in detail):
The Building Consent Authority that granted the Building Consent is unable or refuses to issue a Code Compliance
Certificate in relation to the building work, and no other Building Consent Authority will agree to issue a Code
Compliance Certificate for the building work.
Compliance Schedule (For Commercial Use Only)
There are no specified systems in the building.
The specified systems for the building are as follows: (Tick appropriate box(s))
Automatic systems for fire
SS3/1 Automatic door.
SS3/2 Access controlled doors.
Interfaced fire or smoke
Escape route pressurisation
Riser mains for use by fire
preventers connected to
potable water supply.
SS8/1 Passenger carrying lifts.
SS8/2 Services lifts.
Escalator and moving
Mechanical ventilation or air
SS10 Building maintenance units.
SS12/1 Audio loops.
FM radio and infrared beam
SS13/1 Mechanical smoke control.
SS13/2 Natural smoke control.
13/3 Smoke curtains.
SS14/2 Signs for SS1-13.
Spoken information to
SS15/2 Final exits.
SS15/3 Fire separations.
Signs for facilitating
SS15/5 Smoke separations.
SS16 Cable cars.
The following are attached to this application (Tick relevant box or write N/A) Office Use
Date of Construction: Provide proof of date of construction, such as signed/dated building contract payments.
Work closed in – Provide supporting evidence that work closed in and not able to be inspected complies with
the current building code:
Relevant certification (Personnel who carried out the building work)
Architectural drawings (Plans and Specifications)
PS4 from supervising engineers (if applicable)
Expert opinion reports
Gas/Energy Compliance Certificates
Application Deposit: Fees are set out in Council’s Fees and Charges
Statement of Urgency:
Letter providing reason why works have been done under urgency. See sections 41(1)(c) and 42 “Owner must
apply for a certificate of acceptance if building work carried out urgently” of the Building Act 2004 (if applicable).
The Building Act is available Act is available online at legislation.govt.nz.
Officer Signature: Date: