160412032290 Waimakariri District Council
V1 - 1/01/2018
1 of 5 Application for Amendment to Compliance Schedule
APPLICATION FOR AMENDMENT TO
COMPLIANCE SCHEDULE
Under The Building Act 2004, Section 106
Private Bag 1005, Rangiora 7440
Phone 0800 965 468 (0800 WMK GOV)
Fax 03 313 4432 - waimakariri.govt.nz
THE BUILDING
1. Site address:
(Street / Road / Township)
2.
Legal description of the land where the building is located:
Lot:
DP:
Valuation Number:
PLEASE NOTE - Only complete items here that are applicable to your project.
3.
Compliance Schedule Number to which the application relates:
4. Description of premises/part of premises for which certicate is sought (Identify the building in which the premises or part of
the premises are located. Attach oor plan if possible):
5. Building Name (if applicable):
6. Location of building within site:
(Include nearest street address)
7.
Number of levels: 8. Unit/Level No. (if applicable):
9. Current lawfully established use:
(Include number of occupants per level and per use if more than 1 level)
10.
Year building rst constructed (insert year, approximate date is acceptable, example 1920s or 1960-1970):
11. Maximum occupant load: 12. Fire hazard category:
THE OWNER
13. Owners name:
(Company or organisation name if applicable)
14.
Contact person:
15. Mailing address:
16. Mobile: Landline:
Email:
1 7. If ownership changed after the consent was granted please attach a copy of one of the following evidence of ownership:
Copy of Certicate of Title Lease Agreement for Sale and Purchase
(Including ground level and any levels below ground)
160412032290 Waimakariri District Council
V1 - 1/01/2018
2 of 5 Application for Amendment to Compliance Schedule
THE AGENT
PLEASE NOTE - Authorisation is required from the owner to act as agent.
18.
Agent’s name:
(Company or Organisation name if applicable)
19.
Contact person:
20. Mailing address:
2 1. Street address / Registered office:
22. Mobile: Landline:
Email:
ATTACHMENTS
23. I request that the following (please select one) be issued for the Building Work described in this Application:
Evidence of ownership attached:
Copy of Certicate of Title Lease Agreement for Sale and Purchase
If Agent, authorisation from owner conrming authority to act
Copy of existing Compliance Schedule
Copy of; performance standards inspection, maintenance and reporting procedures for the specied systems
24. I wish to receive my amended Compliance Schedule and approved documentation in the following format:
PLEASE NOTE - If a Hard Copy please conrm if you wish to pick it up from the council or have it posted.
Electronically via File Transfer Portal
(1)
Hard copy:
(post) OR (pick-up)
25.
All Compliance Schedule related invoices/refunds to be billed and sent to:
Owner Agent
Or other
(If other please complete below)
Company name:
(If applicable)
Contact person:
Mailing address:
Mobile:
Landline:
Email:
PLEASE NOTE - Any refunds are to the receipted name unless written authorisation has been received from the receipted person or company.
(1) You must be set up and registered for this option.
160412032290 Waimakariri District Council
V1 - 1/01/2018
3 of 5 Application for Amendment to Compliance Schedule
Specied system
Amendment
Reason
[state why amendment is required
to ensure that the specied
system meets the performance
standards]
Description, location and
performance standards
Maintenance standards
Inspection and reporting
frequency
1 Automatic systems for re suppression (for
example, sprinkler systems)
2 Automatic or manual emergency warning systems
for re or other dangers (other than a warning
system for re that is entirely within a household
unit and serves only that unit)
3.1 Automatic Doors
3.2 Access controlled doors
3.3 Interfaced re or smoke doors or windows
4 Emergency lighting systems
5 Escape route pressurisation systems
6 Riser mains for re service use
7
Automatic back-ow preventers connected to a
portable water supply
8.1 Passenger-carrying lifts
8.2 Service lifts including dumb waiters
8.3 Escalators and moving walks
9 Mechanical ventilation or air conditioning systems
9a Cooling tower as part of an air conditioning
system
9b Cooling tower as part of a processing plant
[not a Specied System however required for
information]
10
Building maintenance units for providing access
to the exterior and interior walls of buildings
11 Laboratory fume cupboards
160412032290 Waimakariri District Council
V1 - 1/01/2018
4 of 5 Application for Amendment to Compliance Schedule
Specied system
Amendment
Reason
(state why amendment is required
to ensure that the specied
system meets the performance
standards)
Description, location and
performance standards
Maintenance standards
Inspection and reporting
frequency
12 Audio loops or other assistive listening systems
13.1 Mechanical smoke control
13.2 Natural smoke control
13.3 Smoke curtains
14.1 Emergency power systems
14.2 Signs
15.1
Systems for communicating spoken information
intended to facilitate evacuation
15.2 Final exit [as dened by A2 of the Building Code]
15.3 Fire separations
15.4 Signs for communicating information intended to
facilitate evacuation
15.5 Smoke separations
16 Cable Car (including to individual dwellings)
OTHER
OTHER
OTHER
OTHER
OTHER
OTHER
OTHER
160412032290 Waimakariri District Council
V1 - 1/01/2018
5 of 5 Application for Amendment to Compliance Schedule
OWNER / AGENT AUTHORISATION
PLEASE NOTE - By entering your name in the box below you are giving your authority for the application to proceed.
Name:
Date:
I am the
Owner
Agent
Note: If acting on behalf, by entering your name above you hereby declare that you are authorised to act as Agent for
the Owner.
NB: Ensure Agent Authorisation section is completed - see below.
AGENT AUTHORISATION
(TO BE AUTHORISED BY OWNER)
PLEASE NOTE - By entering your name in the box below you are giving your authority for this application to proceed.
I authorise
to act as Agent on my behalf for the
Compliance Schedule process.
Name (Owner): Date:
TERMS OF TRADE
I/We understand that:
Building Consents shall be paid for when the consent is collected or if the consent is not collected within three months after the date
of consent being granted, the work done to date portion i.e. admin and processing costs of the account will be due and payable. The
balance of the invoice will be payable when the consent is collected.
All other accounts shall be paid by the 20th day of the month following the month in which the invoice is issued.
I/We agree to pay according to these terms for any goods or services you supply to us. Failure to meet these Terms of Trade may
result in any credit arrangement being withdrawn with any balance becoming payable within seven days. Should failure to meet the
terms of trade result in debt recovery and/or legal proceedings, any costs whatsoever incurred in the collection of the debt including
debt collector’s fees and commissions and legal costs, charges and expenses on a solicitor and own client basis will be added to
the account and will be payable by me/us.
OFFICE USE ONLY
Further information required? Yes No
Application accepted? Yes No Further information provided? Yes No
Date of acceptance:
Officer:
All the relevant information on this form is required to be provided under the Building Act and Resource Management Act for the Building Unit to
process your application. Under these Acts this information has to be made available to members of the public. The information contained in this
application may be made available to other units of the Council. You have the right to access the personal information held about you by the Council
that can be readily retrieved. You can also request that the Council correct any personal information it holds about you.
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