1
Request to file record of exempt building
work carried out under Schedule 1 of the
Important note: Please do not use this form for exempt building work under Schedule 1, Part 1, Clause 2 of the Building Act
2004. For a discretionary exemption application please use the AlphaOne online consent system.
The purpose of this form is to request to file documentation on the appropriate property file for building work carried out
without building consent in accordance with Schedule 1 of the Building Act 2004.
Building owners are responsible for:
• Determining whether proposed building work is exempt from requiring a building consent
• Ensuring exempt work complies with the building code
• Ensuring Chartered Professional Engineers and Licensed Building Practitioners are engaged where required by the
exempt provisions to carry out or supervise work.
Owner’s details
Owner name
Click here to enter text.
Postal address Postcode
Email
Contact phone
number
Property location & details
Property address
Legal description Valuation number
Description of completed work (as shown on attached plans)
The Chartered Professional Engineer that carried out or reviewed the work is
Name CPEng number
The Licensed Building Practitioner (LBP) that carried out or supervised the construction is
Name LBP number
Please state which clause of Schedule 1 of the Building Act 2004 this
work comes under
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Plan(s)
attached
Declaration
I declare that I have determined that the above building work is exempt from the requirement to obtain building consent as
set out in Schedule 1 of the Building Act 2004.
Owner’s name Owner’s signature
Date
