Form 27
Form 27 (Revision: 7) Page 1 of 2 Last Updated: 20/11/2019
Application for Compliance Schedule
Section 100, Building Act 2004
This for
m is to be provided with your building consent application for new, altered, added to or removed specified systems to
enable:
1. The specified systems and associated performance and installation standards to be included on the relevant building
consent for the work.
2. The Compliance Schedule to be issued with the Code Compliance Certificate.
Please identify each specified systems by ticking appropriate boxes on page 2 these have default design and installation
standards which will populate default reporting and maintenance procedures on the compliance schedule, a full list of these can
be viewed on our Information Sheet for Specified Systems. If you intend to use other design, installation, reporting and
maintenance procedures please complete a Specified System Form (see QLDC building All Documents).
Clarification on amendments: QLDC Building Control Authority will assess if an amended compliance schedule is required when
reviewing the building consent application. This includes where specified systems are installed, removed and / or alterations
requiring amendments to installation, inspection and maintenance performances.
1 THE BUILDING
Street address of the building (for structures without a street address, state the nearest street intersection and distance from that intersection)
Legal description of land where building is located (state legal description as at the date of application and, if the land is proposed to be subdivided,
include details of relevant lot numbers and subdivision consent)
Building name (if applicable)
2 OWNER
Name of owner Contact person if not owned by an individual
Contact details
Phone number(s) Email / Website Mailing address & Street address (if different)
3 AGENT
Name of owner Contact person if not owned by an individual
Contact details
Phone number(s) Email / Website Mailing address & Street address (if different)
Form 27 (Revision: 7) Page 2 of 2 Last Updated: 20/11/2019
Please note: Default reporting and maintenance procedures will be specified on the compliance schedule (these can be
viewed on our website). If you intend to design and / or install specified systems a standard or means of compliance not
listed below please complete a SS Form for each system.
Existing
New
Altered
Added
to
Remove
1. Automatic systems for fire suppression (sprinkler systems)
Type 6 Automatic sprinkler system manual call points to NZS 4541:2013
Type 7
Automatic sprinkler system with smoke detection and manual call points to NZS 4541:2013
2. Automatic or manual emergency warning systems for fire or other dangers
Type 2 Manual alarm to NZS 4512:2010
Type 3 Auto alarm activated by heat detectors & manual call points to NZS 4512:2010
Type 4 Auto alarm activated by smoke detectors & manual call points to NZS 4512:2010
Type 5 Auto alarm with modified smoke detection & manual call points to NZS 4512:2010 & F7/AS1
3. Electromagnetic or automatic doors or windows
3/1 Automatic Doors
to to AS 5007:2007 to NZS 4239:1993
3/2 Access Controlled Doors
to NZS 4239:1993
to COP for Electro Mechanical Controlled Locking Devices on egress doors
3/3 Interfaced fire or smoke doors or windows to C/AS2 2019 paragraphs 3.15.9 and 3.15.10
4. Emergency lighting systems to AS/NZS 2293:2018 Part 1 & 3
5. Escape route pressurisation systems to AS/NZS 1668.1:2015
6. Riser mains
to NZS 4510:2008 or
NZS 4552:2010
7. Automatic backflow preventers connected to a potable water supply to G12/AS1 2010 Sections 3.6.2 to
3.6.4
8. Lifts, escalators, travelators, or other systems for moving people or goods
8/1 Passenger-carrying lifts to
EN 81-20:2014 or
Schindler methodology - CodeMark (Rev 3)
8/2 Platform, Low Speed & Service Lifts
to NZS 4334:2012
8/3 Passenger-carrying lifts to
EN 81-20:2014 or
Schindler methodology CodeMark (Rev 3)
9. Mechanical ventilation or air conditioning systems to AS 1668.2:2012
10. Building maintenance units (access to the exterior and interior walls of a building) to BS 6037-1:2017
11. Laboratory fume cupboards (ducted) to AS/NZS 2243.8:2014
12. Audio loops or other assistive listening system
to NZS 4121:2001 Appendix H
13. Smoke Control Systems
13/1 Mechanical Smoke Control
AS/NZS 1668.1:2015 Part 1
13/2 Natural Smoke Control AS/NZS 1668.1:2015 Part 1
13/3 Smoke Curtains to BS EN 12101 Part 1: 2005
14. Emergency Power Systems for, or sigs relating to, a specified system and any of specified systems 1-13
14/1 Emergency power systems to NZS 6104:1981
14/2 Signs
to F8/AS1 2012
15. Other fire safety systems or features (contains one or more specified systems 16, 9 and 13)
15/1 Systems for communicating spoken information intended to facilitate evacuation
NZS 4512:2010
15/2 Final Exits to C/AS2 2019
15/3 Fire Separations to C/AS2 2019
15/4 Signs for communicating information intended to facilitate evacuation
SS 15/4 Signs not-illuminated to F8/AS1 2012
SS 15/4 Signs Illuminated to F8/AS1 2012
SS 15/4 Photoluminescent signs and escape path marking
to F8/AS1 2012
15/5 Smoke separations
to C/AS2 2019
16. Cable cars to NZS 5270:2005
SS Specified Systems Other design, installation, reporting and / or maintenance procedure
(Complete SS Form for each system)
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