1
Construction statement
All sections of this form must be completed
TO BE COMPLETED BY THE CONTRACTOR WHO CARRIED OUT THE WORK
Issued by to
To be supplied to Selwyn District Council Building consent number
In respect of
The contractor has been contracted by the principal/owner to carry out and complete certain building works in accordance with
the building consent
at
I a duly authorised agent of
Believe on reasonable grounds that
has carried out and completed:
☐
All
☐
Part only as specified in the attached particulars of the contract works in accordance with the building consent with
respect to NZBC clause(s):
(tick as appropriate)
☐ B1 ☐ B2 ☐ C1 ☐ C2 ☐ C3 ☐ C4 ☐ C5 ☐ C6 ☐ D1 ☐ D2
☐ E1 ☐ E2 ☐ E3 ☐ F1 ☐ F2 ☐ F3 ☐ F4 ☐ F5 ☐ F6 ☐ F7
☐ F8 ☐ F9 ☐ G1 ☐ G2 ☐ G3 ☐ G4 ☐ G5 ☐ G6 ☐ G7 ☐ G8
☐ G9 ☐ G10 ☐ G11 ☐ G12 ☐ G13 ☐ G14 ☐ G15 ☐ H1
Signature Date
(signature of authorised agent on behalf of)
Contractor
Registration
number
Address
