150507073266[v02]
Waimakariri District Council
V2 - 1/01/2018
1 of 6 Code Compliance Certicate Application
CODE COMPLIANCE CERTIFICATE
APPLICATION
Under The Building Act 2004, Section 92
BC No.
Issued by:
Private Bag 1005, Rangiora 7440
Phone 0800 965 468 (0800 WMK GOV)
Fax 03 313 4432 - waimakariri.govt.nz
THE AGENT
PLEASE NOTE - Authorisation is required from the owner to act as agent.
11.
Agent’s name:
(Company or Organisation name if applicable)
12.
Contact person:
13. Mailing address:
14. Street address / Registered office:
15. Mobile: Landline:
Email:
THE OWNER
5. Owner’s name:
(Company or organisation name if applicable)
6.
Contact person:
7. Mailing address:
8. Street address / Registered office:
9. Mobile: Landline:
Email:
THE BUILDING
1. Site address:
(Street / Road / Township)
2.
Legal description of the land where the building is located:
Lot:
DP: Valuation Number:
3. Building Name (if applicable):
4. Location of building within site:
(Only applicable to multi-development sites)
150507073266[v02]
Waimakariri District Council
V2 - 1/01/2018
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RESTRICTED BUILDING WORK
Did the building work include any restricted building work?
Yes
No
The Licensed Building Practitioner(s) who carried out or supervised the restricted building work is/are as follows:
LICENCE CLASS
LICENSED BUILDING
PRACTITIONER NUMBER
(or registration number if treated as
being licensed under section 291 of
the Building Act 2004)
NAME
CARPENTRY
EXTERIOR PLASTERER
BRICKLAYER
BLOCKLAYER
ROOFER
FOUNDATIONS
APPLICATION
16. 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:
Owner
Agent
17. I wish to receive my
certificate in the following format:
PLEASE NOTE - If hard copy please confirm if you wish to pick it up from the Council or have it posted.
Hard copy:
(post) OR (pick-up) OR Email
18. All building work carried out under the Building Consent specified in this form was completed on:
150507073266
[v02]
Waimakariri District Council
V2 - 1/01/2018
3 of 6 Code Compliance Certicate Application
KEY PERSONNEL
BUILDER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
DESIGNER(S)
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
CERTIFYING DRAINLAYER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
CERTIFYING PLUMBER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
CERTIFYING GASFITTER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
REGISTERED ELECTRICIAN
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
STRUCTURAL ENGINEER
Name:
Reg. No.:
Address:
Phone No.:
Fax No.:
Email:
150507073266[v02]
Waimakariri District Council
V2 - 1/01/2018
4 of 6 Code Compliance Certicate Application
SPECIFIED SYSTEMS
The following specied systems are contained on the compliance schedule for the building and, in the opinion of
the personnel who installed them, are capable of performing to the performance standards set out in the Building
Consent. Tick appropriate specied systems below:
There are no specied systems in the building
SS1 Automatic systems for re suppression
SS12/1 Audio loops
SS2 Emergency warning systems
SS12/2 FM Radio and infrared beam transmission systems
SS3/1 Automatic door
SS13/1 Mechanical smoke control
SS3/2 Access controlled doors
SS13/2 Natural smoke control
SS3/3 Interfaced re or smoke doors or windows
SS13/3 Smoke curtains
SS4 Emergency lighting systems
SS14/1 Emergency power systems
SS5 Escape route pressurisation systems
S14/2 Signs for SS1-13
SS6 Riser mains
SS15/1 Spoken information to facilitate evacuation
SS7 Automatic back-ow prevention
SS15/2 Final exits
SS8/1 Passenger carrying lifts
SS15/3 Fire separations
SS8/2 Service lifts
SS15/4 Signs for facilitating evacuation
SS8/3 Escalator and moving walks
SS15/5 Smoke separations
SS9 Mechanical ventilation or air conditioning systems
SS16 Cable cars
SS10 Building maintenance units
SS11 Laboratory fume cupboards
ATTACHMENTS
The following documents are attached to this application (where applicable):
Certicates that relate to the energy work
(e.g. gas and electricity)
Evidence that the specied systems are capable of performing to the performance standards set out in the building consent
Proof of potability of drinking water from private well, and/or rain water catchment, supply
(refer to New Zealand Drinking Water
Standards 2005)
Memoranda (records of building work) from licenced building practitioner(s) stating what restricted building work they carried
out or supervised
Other documents from personnel that carried out the work
150507073266[v02]
Waimakariri District Council
V2 - 1/01/2018
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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 this
Building Consent application under Sections 33 and 45 of the Building Act 2004.
With respect to this Building Consent application, I authorise
to act
as Agent on my behalf for the application for Code Compliance Certicate under Section 92 of the Building Act 2004.
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.
150507073266[v2] Waimakariri District Council
V2 - 1/01/2018
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IMPORTANT INFORMATION
All the relevant information on this form is required to be provided under the Building Act 2004 and/or Resource Management Act 1991
for the Waimakariri District Council to assess your application. Under these Acts this information has to be made available to members
of the public if requested. 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 which can be readily retrieved. You can also request that the
Council correct any personal information it holds about you.
CODE COMPLIANCE CERTIFICATE
A Building Consent is not completed until it has been issued with a Code Compliance Certicate. The owner is required to
complete a separate application for a Code Compliance Certicate as soon as practicable after the building work is completed.
In any event no later than two (2) years after the granting of the Building Consent, Council is required to decide whether or not
a Code Compliance Certicate can be issued. If your project will not be completed within two years you will need to apply for a
time extension*.
*Fees apply
INSPECTIONS
During the process of construction, inspections will be necessary to conrm all work complies with your approved Building
Consent documentation. Please phone the Council Building Unit on 03 311 8906 at least 48 hours in advance of requiring an
inspection to ensure that this can be arranged.
The inspections required will be set out in the Building Consent documentation issued by the Council. Failure to have a prescribed
inspection carried out may put the issue of the Code Compliance Certicate at risk.
All inspections including re-inspections are subjected to a separate charge, even if carried out on the same day.
AGENCY
The owner may authorise an agent to submit an application on their behalf.
The Agent will be the rst point of contact for all communications with the Council/Building Consent Authority regarding this
application under Sections 33 and 45 and if authorised, the application for a Code Compliance Certicate under Section 92 of
the Building Act 2004. They will receive all correspondence and must be authorised by the owner - see page 7. All amendments
require new authorisation.
FEES
Please note - All work for the issue of a Code Compliance Certicate will be invoiced and must be paid in full before the Code
Compliance Certicate will be issued.
NOTICE TO FIX
If a Notice to Fix is issued, it will state the building work that must be carried out and will set a timeframe in which this work must
be completed. Once the work listed has been completed a further inspection should be booked by phoning Waimakariri District
Council on 0800 965 468.
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