AF PS3.6 Page 1 of 1 Last Updated: 10/01/2018
Revision:2
TO BE COMPLETED BY THE PERSON WHO HAS UNDERTAKEN THE BUILDING WORK
Author name:
Building consent
No:
Author company:
Author
Registration No:
Description of building
work:
Performance standard
for maintenance and
inspection, if applicable
N/A
Site address:
Legal description:
B1 B2 C1 C2 C3 C4 C5 C6 D1 D2 E1 E2 E3
NZBC clauses:
(circle as applicable)
F1 F2 F3 F4 F5 F6 F7 F8 G1 G2 G3 G4 G5
G6 G7 G8 G9 G10 G11 G12 G13 G14 G15 H1
I have sighted the above building consent and read the attached conditions of consent and confirm that I have undertaken the
building work described above in accordance with the consented plans and specifications.
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.
Producer statements are accepted solely at Queenstown Lakes District Council discretion
Signature: Date:
Tradesperson’s contact details:
Address:
Business: Fax:
Mobile: Email
Producer Statement Construction (PS3)
General
Construction Work
All sections of this form must be completed
click to sign
signature
click to edit
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