AF PS3.11 Page 1 of 1 Last Updated: 10/01/2017
Revision 2
All sections of this form must be completed
TO BE COMPLETED BY THE PERSON WHO HAS PERFORMED THE WORK (INSTALLED THE BALUSTRADE)
Author name:
Author company:
Description of
building work
performed
Location: (e.g. 1
st
floor balcony)
Site address:
Legal description:
I confirm that I have undertaken the installation of the balustrades described in the above-mentioned building consent in
accordance with the relevant standards, specifications and consented plans.
l confirm that all work complies with the following clauses of the Building Code (please select boxes as applicable)
I understand that Queenstown Lakes District Council is reliant on this producer statement in order to establish compliance
with the requirements of the Building Act 2004, Building Code and the consented plans and will use this statement in order to
issue the code compliance certificate for this application.
A producer statement construction is defined as any statement supplied by or on behalf of a person who has been granted a
building consent that certain work has been carried out in accordance with certain technical specifications. Producer
statements are accepted solely at Queenstown Lakes District Council discretion
Code clauses:
B1 Structure B2 Durability E2 External moisture
F2 Hazardous building materials
F4 Safety from falling
Materials: Glass Glass & aluminium Metal Timber
I attach copies of the following documents in support of this producer statement:
M/F warranty LBP record of work Minor variation PS1 design
Signature: Date:
Installer’s contact details:
Address:
Business: Fax:
Mobile: Email
Producer Statement Construction (PS3)
Balustrades
click to sign
signature
click to edit
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