Application for Project Information
Memorandum/Building Consent for
Commercial /Industrial Projects
Date Received
Form 2, Section 33 and/or Section 45, Building Act 2004
Application type (tick all that are applicable)

PIM Only

Both PIM and Building Consent

Building Consent
In accordance with PIM No:
Please note where you do not require a PIM for your purposes we must still carry out an assessment which includes planning information and
specific site requirements to complete processing of your building consent and this will be charged as a project information consideration.
The Building
STREET ADDRESS of BUILDING
PROJECT: (for structures that do not have a street
address, state the nearest street intersection and the
distances and direction 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)
Valuation No:
PIN No
DP/DPS/ML/SO
Lot
(Circle applicable one)
Land Area
Survey District
level and any levels below ground)
Location of building within site/block
number (include nearest street access)
Area: (total floor area: indicate area affected by the
Level or unit number
Year first
constructed
building work if less than the total area.)
(include number of occupants per level and per use if
more than 1)
Block No
Number of levels: (include ground
Building name
Current, lawfully established use:
(Office Use Only}
N/A
 Communal Residential
 Communal Non-Residential
Commercial
Industrial
The Owner
Name/s of ALL legal owner/s:
(Provide full name and preferred form of
address, e.g. Mr, Miss, Dr, if an individual)
Contact person:(insert N/A if applicant is an
individual)
Mailing address:
Post Code:
Street address/registered office
Post Code:
Phone Number:
Mobile:
After Hours:
Fax Number:
Email Address:
Evidence of ownership is attached to
this application:

Agreement for Sale and Purchase

Rates Invoice

Certificate of title or Lease
The Project
Description of the building work:
(provide sufficient description of building work to enable scope of work to be fully understood. Continue on a separate page if necessary, or
refer to an attached document setting out the description)
Will the building work result in a change of use of the building?
 Yes
 No
If yes, provide details of the new use:
Intended life of the building if less than 50 years:
(number of years)
List previous building consents issued for this project:
(BC number only)
Estimated value of the building work on which the building levy will be calculated
(including GST): (state estimated value as defined in Section 7 of the Building Act 2004)
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Agent – (only required if application is being made on behalf of the owner, delete if not applicable)
Name of Agent
Contact person
Mailing address:
Post Code:
Street address/registered office:
Post Code:
Phone Number:
Mobile:
Fax Number:
Email Address:
Relationship to owner: (Supply details of authorisation
After Hours:
from ALL legal owner/s to make the application and sign on their
behalf)
Copy of Authorisation attached
First Point Of Contact for
communications with the
Council/Building Consent Authority:
Full Name:
 Yes
 No
Address:
Post Code:
Phone Number:
Mobile:
Fax Number:
Email Address:
After Hours:
Note: The owner may be sent a copy of any letters to agent/consultant should their application be placed on hold.
Payment of Fees by (tick one)
 Owner
 Agent
 Builder
 Other (specify)
Address (if different from above)
Post Code:
Phone Number:
Mobile:
Fax Number:
Email Address:
After Hours:
Privacy Statement
The Local Government Official Information and Meetings Act makes information contained in this application form public information. Section
217 of the Building Act 2004 requires a Territorial Authority to give access to any person on request all information about buildings required to
be kept by section 216 thereof. This includes applicant’s names and addresses. Applicants are advised that the Chief Ombudsman has ruled
that this information may be used for marketing purposes.” (NB: The Marketing Association has a do not call register. Contacting
www.marketing.org.nz and adding your name to this register is an option to control unsolicited marketing).
Signature
I request that you issue a  Project Information Memorandum  Building Consent for the building work described in this application.
Signature of owner/s or agent on
behalf of and with the authority
of the owner/s: (delete one)
Signature/s:
Name/s:
Date:
Project Information Memorandum (do not fill in this section if the application is for a building consent only)
The following matters are involved in the project:
(tick the matters relevant to the project)

Subdivision

New or altered connections to public utilities

New or altered access for vehicles

Disposal of stormwater and wastewater

Storage of hazardous substances: (specify type and class)

Other matters known to the applicant that may require authorisations from the territorial authority: (specify)
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
Alterations to land contours

New or altered locations and/or external dimensions of
buildings

Building work over or adjacent to any road or public place

Building work over any existing drains or sewers or in close
proximity to wells or water mains
Page 2
COMPLETE this section ONLY if you are applying for a BUILDING CONSENT.
The building work will comply with the building code as follows : (if you’re not sure which clauses are applicable, talk to your designer)
Clause (Tick which relevant clauses
of the Building Code will be involved
in the building work)
Means of compliance (refer to the relevant compliance
document(s) or detail of alternative solution on plans and
specifications; if not applicable, put n/a
 B1 Structure
 B1/AS1  B1/AS3  B1/VM1  B1/VM3
 B1/VM4  NZS3604  AS/NZS 1170  NZS 4229

 B2 Durability
 B2/AS1  B2/VM1  NZS 3604  NZS 3602  NZS 3101

 C1 – C6 Protection from fire
 C/AS1
 C/AS2
 C/AS6
 C/AS7
 C/AS3
 C/AS4
 C/AS5
Alternative solution

 D1 Access routes
 D1/AS1  D1/VM1  NZS 4121

 D2
access
 D2/AS1  D2/AS2  D2/AS3  NZS 4332  EN81
 NZS 4121

 E1 Surface water
 E1/AS1  E1/VM1  AS/NZS3500.3

 E2 External moisture
 E2/AS1  E2/AS2  E2/VM1

 E3 Internal moisture
 E3/AS1

 F1 Hazardous agents on site
 F1/VM1

 F2 Hazardous building materials
 F2/AS1  NZS 4223

 F3
Hazardous substances &
processes
 F3/VM1  HSNO Act

 F4 Safety from falling
 F4/AS1  Fencing of Swimming Pools Act 1987

 F5 Construction and demolition
hazards
 F5/AS1

 F6 Lighting for emergency
 F6/AS1

 F7 Warning systems
 F7/AS1  NZS 4512  NZS 4515  NZS 4541

 F8 Signs
 F8/AS1

 G1 Personal hygiene
 G1/AS1  NZS 4121

 G2 Laundering
 G2/AS1

 G3 Food preparation and
prevention of contamination
 G3/AS1

 G4 Ventilation
 G4/AS1  G4/VM1  AS 1666.2

 G5 Interior environment
 G5/AS1

 G6 Airborne and impact sound
 G6/AS1  G6/VM1

 G7 Natural light
 G7/AS1  G7/VM1

 G8 Artificial light
 G8/AS1  G8/VM1  NZS6703

 G9 Electricity
 G9/AS1  G9/VM1

 G10 Piped services (piping of
 G10/AS1  G10/VM1  NZS 5261

 G11 Gas as an energy source
 G11/AS1

 G12 Water supplies
 G12/AS1  G12/AS2  AS/NZS 3500.1  AS/NZS 3500.4

 G13 Foul water
 G13/AS1  G13/AS2  G13/AS3  AS/NZS 3500.2

 G14 Industrial liquid waste
 G14/AS1  G14/VM1

 G15 Solid waste
 G15/AS1

 H1 Energy efficiency
 H1/AS1  H15/VM1  NZS 4214  NZS4218  NZS4243

Mechanical installations for
dangerous substances in buildings)
(please
specify)
Waiver/modification (state nature
of waiver or modification of building code
required)
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AN ADDITIONAL SET OF DOCUMENTATION is required to be supplied if input from any of
the following is required:
Design Review Unit
The following building consent applications are to be sent to the New Zealand Fire Service Commission’s Design
Review Unit.
1. Building work designed as an alternative solution. This means that the design does not fully follow the
requirements of the Compliance Document C/AS1. (Often designs largely follow the Acceptable
Solution, but include minor deviations such as extending the allowable travel distances or modifying
fixed fire systems. Such designs also need to be forwarded for comment to the Design Review Unit.)
2. Building work that requires a waiver or modification of clauses C1-4, D1 F6 or F8 of the building code.
For example, a waiver for unit-titled car parks in buildings.
3. Building work that effects fire safety systems, including any building work involving a specified system,
involving:
a. An alteration, for example a complete building refurbishment or extension to a specified
system.
b. A change in use, for example from residential to office use.
c. A division of an existing building into separate tenancies.
4. Unless the effect is minor. An example of minor effects on the fire safety systems could be the
alteration of the tone or type of sounding or visual alert for an alarm. Minor work does not mean work
such as moving sprinkler heads in a sprinkler system.
5. If you answer yes to any of the following questions AND your proposal is an alternative solution to the
Building Code:
a) are hazardous substances being stored?
 Yes  No
b) are early childhood facilities provided?
 Yes  No
c) is specialised care for people with a disability provided?
 Yes  No
d) is specialised nursing, medical or geriatric care provided?
 Yes  No
e) are people in lawful detention/
 Yes  No
f) can 100 or more people gather in a common venue?
 Yes  No
g) can 100 or more people gather for different purposes or activities?
 Yes  No
h) are there facilities for more than 10 employees?
 Yes  No
HSNO Officer (Hazardous substances and new organisms)
Hazardous goods input required if any materials have the properties below and are stored in the proposed
building work:
1. Of an explosive nature
2. Of an oxidizing nature
3. Of a corrosive nature
4. Flammable
5. Have acute and chronic toxicity
6. Ecotoxicity with or with out bioaccumulation
7. Has one or more of the above properties on contact with air or water.
Environmental Health Officer
The application requires the premises to be registered. Examples of these premises are:
1. Hair dressers
2. Food preparation and sales
Fire Engineering and Structural Engineering Peer Reviews
Where complex fire design, alternative methods of construction or the skill of a particular individual designing
the project (part of) is in question then the application is to be assessed by one of the Senior Building Control
Officials to determine if a peer review is required.
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Complete this Compliance Schedule Draft
Compliance Schedule number:
( To be submitted with Building Consent Application)
 Existing C/Schedule (Attach copy)
OR
Building name (known as):
 New C/Schedule
Consent No (if applicable)
Street address of property:
Building owner(s):
Purpose Group (please circle)
CS
CL
CO
CM
SC
SD
SA
SR
SH
WL
WM
WH
WF
IA
ID
IE
Current, Lawfully Established Use:
Occupant Load:
Fire Hazard Category:
First year constructed:
Physical location where compliance schedule will be kept:
Please attach an additional plan/s showing locations of all fire safety precautions (FSP) and
specified systems for the generation of a Compliance Schedule.
Guidance Notes
What is a Specified System?
Specified systems are systems or features that contribute to the proper functioning of the building. Specified systems
require ongoing inspection and maintenance to ensure they function as required, because if they fail to operate
properly, they have the potential to adversely affect health or life safety.
What Location?
Identifies what parts of the building the feature or system covers or is located in as the case may be.
What are performance standards?
Identifies what standard the system or feature is to meet in order to meet the requirements of the New Zealand
Building Code. These may be a specific approved standard, an acceptable solution or specifically designed for the
feature or system in question.
What are maintenance requirements?
This identifies what preventative and responsive maintenance is required to be taken and what standard, acceptable
solution or specific requirements this maintenance must comply with.
Who are the persons responsible for inspections?
These are the persons who are qualified and approved to undertake the inspections required.
What are the reporting requirements?
This specifies what records are to be kept on the premises in relation to the specific systems and features contained in
the building.
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The following SPECIFIED
SYSTEMS are contained in this building (tick appropriate box)
Tick the appropriate boxes
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Maintenance
In accordance with
SS 1- Automatic systems for fire suppression Type__________________
 NZS 4541:2003 part 12
 AS 1851:2005 Section 2
 NZS 4541:2007 part 12
Inspections
Inspected by an independent qualified person to  NZS 4541:2003 part 12
 NZS 4515:2003 part 8
 AS 1851:2005 Section 2
 NZS 4515:2003 part 8
 NZS 4541:2007 part 12
Performance Standards Clauses C3.3.6, C3.3.9 and F7.3.3 Building Code
_______________________________________________________________________________________________________
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Maintenance
In accordance with
SS 2 – Automatic or manual emergency warning systems
for fire or other dangers
Type__________________
 NZS 4512:2010 part 6
 AS 1851:2005 Section 6
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected by an independent qualified person to
 NZS 4512:2010 part 6
 AS 1851:2005 Section (colour)
 Manufacturer’s recommendations (include inspection regime)
Performance Standards Clauses F7.3.1and F7.3.3 Building Code
__________________________________________________________________________________________________________________
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Maintenance
In accordance with
SS3/1 – Automatic Doors
 AS 4085:1992 appendix A (superseded by AS 5007)  NZS 4239:1993 appendix A
 AS 5007:2007 appendix E programme)
 NZS 4239
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected by an independent qualified person to  AS 4085:1992 appendix A (superseded by AS 5007)
 NZS 4239:1993 appendix A  AS 5007:2007 appendix E programme)
 Manufacturer’s recommendations (include inspection regime)
Performance Standards Clauses C2.3.3(b), C3.3.2, C3.3.3 and C3.3.9 Building Code
__________________________________________________________________________________________________________________
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SS3/2 – Access-controlled doors
(Where a security door is also an automatic door then inspection and maintenance for SS3/1 also applies)
Maintenance
In accordance with the nominated performance standard by an independent qualified person.
Back-up rechargeable batteries shall be replaced every 2 years or when found to be in-operable.
Inspections
Daily inspections for crowd type occupancies while the building is in use, monthly inspection for all other occupancies by owner.
Six monthly annual inspections by an independent qualified person.
Performance Standards Clauses C2.3.3(b), C3.3.2, C3.3.3 and C3.3.9 Building Code
_______________________________________________________________________________________________________
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SS3/3 – Interfaced Fire or Smoke Doors or Windows
(SS3/1 that forms part fire/smoke separation needs to be inspected and maintained in accordance with SS15/3
and SS15/5)
Maintenance
In accordance with
 AS 4178:1994 section 4
Inspections
Inspected in accordance to  AS 4178:1994 section 4
 Manufacturer’s recommendations
(include maintenance programme)
 Manufacturer’s recommendations
(include Inspection programme)
Daily inspections for crowd type occupancies while the building is in use, monthly inspection for all other occupancies by owner.
Annual inspections by an independent qualified person.
Performance Standards Clauses C2.3.3(b), C3.3.2, C3.3.3 and C3.3.9 Building Code
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_______________________________________________________________________________________________________
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SS4-Emergency Lighting Systems
Emergency lighting that also forms an exit sign needs to have its illumination aspect checked under SS15/4
Maintenance
In accordance with
 AS/NZS 2293.2:1995 section 3  NZS 6742:1971
 Manufacturer’s recommendations (include maintenance programme)
Back-up rechargeable batteries shall be replaced every 2 years or when found to be in-operable.
Inspections
Inspected by an independent qualified person to
 AS/NZS 2293.2:1995 section3
 NZS 6742:1971
 Manufacturer’s recommendations (include inspection regime)
Systems prior 1 January 1996 in accordance with NZS 6742
Where a generator is part of the emergency Lighting it needs to be inspected to NZS6104:1981 part 8 Complete SS14/1
Performance Standards Clauses F6.3.1 and F6.3.2 Building Code
_______________________________________________________________________________________________________
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Maintenance
In accordance with
SS5-Escape Route Pressurisation Systems
 AS 1851:2005 section 18
 AS/NZS 1668:1998 appendix F
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected by an independent qualified person to  AS 1851:2005 section 18  AS/NZS 1668:1998 appendix F
 Manufacturer’s recommendations (include inspection regime)
Performance Standards Clauses C1.3.1 and C3.3.8 Building Code
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Maintenance
In accordance with
SS6-Riser Mains for use by Fire Services
 NZS 4510:2008 part 9
Inspections
Inspected by an independent qualified person to
 NZS 4510:2008 part 9
Performance Standards Clauses G 10.3.6 and C3.3.9 Building Code
_______________________________________________________________________________________________________
Exists
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SS7-Automatic Back-flow Preventers
(please tick)  High  Medium  Low Cross Connection Hazard (G12 As/1 section 3.3 table 2)
Maintenance
In accordance with
 AS/NZS 2845.1:2010
Back-flow preventers shall be inspected and tested after repair or replacement
Inspections
Inspected by an independent qualified person to
 AS/NZS 2845.1:2010
Back-flow preventer type
(please tick)
 Reduced Pressure zone
 Double check valve
 Pressure vacuum breaker
 Atmospheric vacuum breaker
Type / Serial No.___________________________________ Type / Serial No.___________________________________
Type / Serial No.___________________________________ Type / Serial No.___________________________________
Type / Serial No.___________________________________ Type / Serial No.___________________________________
Performance Standards Clauses G 12.3.2 Building Code
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Maintenance
In accordance with
SS8/1-Passenger Carrying Lifts
( SS8/1 that is connected to emergency warning system SS2 needs to have the interface tested annually)
 NZS 4332:1997 part 2.5
 BS EN 81:2003
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected in accordance to  NZS 4332:1997 part 2.5
 BS EN 81:2003
 Manufacturer’s recommendations (include inspection regime with the additional requirements identified
within the compliance schedule handbook pages 30 – 32 (issued 25 May 2007) and D2/AS1 NZ Building Code
Performance Standards Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5 Building Code
_______________________________________________________________________________________________________
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Maintenance
In accordance with
SS8/2-Service Lifts
( SS8/2 that is connected to emergency warning system SS2 needs to have the interface tested annually)
 NZS 4332:1997 part 2.5
 BS EN 81:2003
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected in accordance to  NZS 4332:1997 part 2.5
 BS EN 81:2003
 Manufacturer’s recommendations (include inspection regime with the additional requirements identified
within the compliance schedule handbook pages 30 – 32 (issued 25 May 2007) and D2/AS1 NZ Building Code
Performance Standards Clauses D2.3.1, D2.3.2 and D2.3.3 Building Code
_______________________________________________________________________________________________________
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Maintenance
In accordance with
SS8/3-Escalators and moving walks
(SS8/3 that is connected to emergency warning system SS2 needs to have the interface tested annually)
 D2/AS3
 BS EN 115
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected by an independent qualified person  D2/AS3
 BS EN 115
 Manufacturer’s recommendations (include inspection regime with the additional
requirements identified within the compliance schedule handbook page 37 (issued 25 May
2007) or to the Manufacturers recommendations.
Performance Standards Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5. Building Code
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Maintenance
In accordance with
SS9-Mechanical Ventilation or Air Conditioning Systems
(SS9 that forms part of a fire / smoke separation needs to be inspected in accordance with SS15/3 and SS15/5)
 NZS 4302:1987
 AS/NZS 3666.2:2011
 AS 1851:2005 section 6
 Manufacturer’s recommendations
(include maintenance programme)
Inspections
Inspected by an independent qualified person to  NZS 4302:1987  AS 1851:2005 section 6  AS/NZS 3666.2:2011
 Manufacturer’s recommendations (include inspection regime)
Cooling towers need to have tests carried out IANZ to AS 3896
Where ventilation system is fitted with smoke / fire control these systems shall be inspected to AS 1851:2005 section 18
Performance Standards Clauses 3.3.7, G4.3.1, G4.3.2 and G4.3.3 Building Code
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Maintenance
In accordance with
SS10 – Building Maintenance Units
E.g. Building maintenance units for providing access to the exterior and interior walls of buildings
 BS 6037.1:2007
 BS 6037.2:2007
Inspections
Planned preventative maintenance and responsive maintenance should be carried out in accordance with to
BS 6037.1:2007 to ensure safe and suitable operation by a independent qualified person.
Performance Standard  BS 6037:1990
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Maintenance
In accordance with
SS11 – Laboratory Fume Cupboards
 AS/NZS 2243.8:2006
Inspections
Regular inspection and testing to ensure they operate as required by the performance standard by an independent qualified
person to AS/NZS 2243.8:2006.
Performance Standard Clauses F3.3 Building Code
_______________________________________________________________________________________________________
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Maintenance
In accordance with
SS12/1 – Audio Loops
 AS/NZS 1088.4:1987(superseded by AS 60118)  AS 60118.4-2007  NZS 4121:2001
Inspections
Inspected by an independent qualified person to  AS/NZS 1088.4:1987(superseded by AS 60118)  AS 60118.4-2007
 NZS 4121:2001
Performance Standards Clauses G5.3.5 and F7.3.1 Building Code
_______________________________________________________________________________________________________
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Maintenance
In accordance with
SS12/2 – FM radio frequency systems and infrared beam transmission
systems
 AS 60118.4-2007
 NZS 4121:2001
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected by an independent qualified person to  AS 60118.4-2007  NZS 4121:2001
 Manufacturer’s recommendations (include inspection Regime)
Performance Standards Clauses G5.3.5 and F7.3.1 Building Code
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Maintenance
In accordance with
SS13/1 – Mechanical Smoke Control System
e.g. Smoke ventilator designed to open or extract in the event of a fire. (SS13/1 that is connected to emergency
warning system SS2 needs to have the interface tested annually)
 AS/NZS 1668.1998 part 4
 AS 1851:2005 Section 18
 Manufacturer’s recommendations (include maintenance programme)
Inspections
Inspected regularly by an independent qualified person and maintained to  AS/NZS 1668.1998 part 4
 AS 1851:2005 Section 18  Manufacturer’s recommendations (include inspection Regime)
Performance Standards Clauses G4.3.3, C3.3.7 and C3.3.8 Building Code
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
SS13/2 – Natural Smoke Control System
E.g. Smoke reservoir in an atrium / smoke doors
Maintenance
In accordance with
 AS/NZS 1668.1998 part 4
 AS 1851:2005 Section 17
Inspections
Inspected regularly by an independent qualified person to  AS/NZS 1668.1998 part 4  AS 1851:2005 Section 17
Performance Standards Clauses G4.3.3, C3.3.7 and C3.3.8 Building Code
_______________________________________________________________________________________________________
Exists
Altered New
Remove




Maintenance
In accordance with
SS13/3 –Smoke Curtains
Type & location__________________________
 AS/NZS 1668.1998 part 4
 AS 1851:2005 Section 17
 Manufacturer’s specifications (include maintenance programme)
Inspections
Inspected by an independent qualified person to  AS/NZS 1668.1998 part 4  AS 1851:2005 Section 17
 Manufacturer’s specifications (include inspection regime)
Performance Standards Clauses G4.3.3, C3.3.7 and C3.3.8 Building Code
_______________________________________________________________________________________________________
Exists
Altered New
Remove




Maintenance
In accordance with
SS14/1 –Emergency power systems for’ signs relating to, a specified
system in any of specified systems 1-13
 NZS 6104:1981 part 8
Inspections
Inspected by an independent qualified person to  NZS 6104:1981 part 8 and in conjunction with systems it relates to.
Performance Standards Clauses G9.3.2 Building Code
_______________________________________________________________________________________________________
Exists
Altered New
Remove




SS14/2 –Signs relating to, a System or feature specified in any Clauses 1 to 13
Maintenance
Maintained in conjunction with the systems it relates to.
Inspections
Inspected annually by an independent qualified person.
Performance Standards Clauses F6.2, F6.3.2, F6.3.6, F8.3.1, F8.3.3, C2.3.3(e) Building Code
_______________________________________________________________________________________________________
Exists
Altered New
Remove




SS15/1–Systems for Communicating Spoken Information Intended to
Facilitate Evacuation
Maintenance
In accordance with
 AS 1851:2005  NZS 4512:2010  Manufacturer’s specifications
(include maintenance programme)
Inspections
Inspected by an independent qualified person to
 AS 1851:2005  NZS 4512:2010  Manufacturer’s specifications
(include inspection regime)
Performance Standards Clauses G5.3.5 and F7.3.1 Building Code
________________________________________________________________________________________
Exists
Altered New
Remove




SS15/2–Final Exits
Maintenance
Final exits shall have maintained at all times in a safe condition with particular attention to: freedom from obstructions,
Locking, blocking, barring, storage of combustibles and ease of opening any door leading into the escape route and at final exit.
A 291974
10 March 2014 Version 17
Page 10
Inspections
In accordance with Fire Safety and Evacuation of Building Regulations 1992 and the Compliance Schedule Handbook 2007.
Daily inspections by owner for crowd type occupancies while the building is in use and for all buildings while building work may
affect a final exit. Monthly inspection for all other occupancies with annual inspection and maintenance by independent
qualified persons.
Performance Standards Clauses C2.3.2, C2.3.3(b)(g), D1.3.3(b) Building Code
________________________________________________________________________________________
Exists
Altered New
Remove




Maintenance
In accordance with
SS15/3–Fire Separations
Attached to this Compliance Schedule i.e. a floor plan showing the fire walls / doors etc.
 NZS 4520:2010
 Compliance Document C/AS1 Protection from fire
Attached to this Compliance Schedule is a floor plan showing the fire walls / doors etc.
Inspections
Inspected to
 NZS 4520:2010
 Compliance Document C/AS1 Protection from fire
Daily inspections by owner for crowd type occupancies while the building is in use and for all buildings while building work may
affect a fire separation.
Six monthly inspection for all other occupancies with annual inspection and maintenance by independent qualified persons.
Performance Standards Clauses C3.3.1, C3.3.2, C2.3.3, C3.3.4, C3.3.5 Building Code
________________________________________________________________________________________
Exists
Altered New
Remove




SS15/4–Signs for Communicating Spoken Information intended to
Facilitate Evacuation
Emergency lighting that also forms an exit sign needs to have its illumination aspect checked under
SS4
Maintenance
Signs shall be: replaced if not of the correct type, replaced immediately should they be missing or refurbished before they
become illegible.
Inspections
Daily inspections by owner for crowd type occupancies while the building is in use.
Monthly inspection for all other occupancies with annual inspection and maintenance by independent qualified persons.
Performance Standards Clauses F6.3.2, F8.3.3 and C2.3.3(e) Building Code
_______________________________________________________________________________________________________
Exists
Altered New
Remove




Maintenance
In accordance with
SS15/5–Smoke Separations
E.g. Smoke stop door, walls protecting a protected path, smoke resistant lobby lift.
Attached to this Compliance Schedule i.e. a floor plan showing the fire walls / doors etc.
 AS 1851:2005 Section 17
 Compliance Document C/AS1 Protection from fire
Inspections
In accordance with
 AS 1851:2005 Section 17
 Compliance Document C/AS1 Protection from fire
Daily inspections by owner for crowd type occupancies while the building is in use, monthly inspection for all other occupancies
with annual inspection and maintenance by independent qualified persons.
Performance Standards Clauses C3.3.1 and C3.3.8 Building Code
_______________________________________________________________________________________________________
Exists
Altered New
Remove




SS16–Cable Cars
Residential cable car, an enclosed ski chair lift that operates either wholly or partially within a
building
Maintenance
In accordance with NZS 5270:2005 part 16 appendix C.
Inspections
Inspected annually by an independent qualified person to NZS 5270:2005 part 16 appendix C.
Performance Standards Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5 Building Code
A 291974
10 March 2014 Version 17
Page 11
Key Contacts Please provide if applicable
Designer or Architect
Business/Name
Address:
Mobile:
After Hours:
Email:
Registration or LBP Registration No:
Structural Engineer
Business/Name
Address:
Mobile:
After Hours:
Email:
Registration or LBP Registration No:
Builder/Carpentry Work
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
Foundation Work
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
Bricklaying
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
Blocklaying
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
A 291974
10 March 2014 Version 17
Page 12
External Plastering
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
Roofing Work
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
Gasfitter
Business/Name
Address:
Mobile:
After Hours:
Email:
LBP Registration No:
Drainlayer
Business/Name
Address:
Mobile:
After Hours:
Email:
Registration No:
Plumber
Business/Name
Address:
Mobile:
After Hours:
Email:
Registration No:
Other
Business/Name
Address:
Mobile:
After Hours:
Email:
Registration No:
A 291974
10 March 2014 Version 17
Page 13
Building Fees (Office use only)
Amount
Application Fee
$
Project Information Memorandum
$
Plan checking deposit
$
BCA Accreditation and Assessment Levy
$
Lodgement Check
$
Application for Code Compliance Certificate
$
Inspection
$
DBH Levy
$
BRANZ Levy
$
Other Fees (Office use only)
80.00
Amount
Title Endorsements Section 73/77
$
NZFS Design Review Unit
$
Actual Processing charges based on time taken calculated when all processing completed
$
$
Total
Payment Details (Office use only)
Date
Receipt Details
$
Amount
LO/BCON:
$
Balance Due:
$
Building Consent can be Granted (Office use only)
Building Officer Signature:
Date:
*Time taken to process consent (to nearest 15min):
A 291974
10 March 2014 Version 17
Page 14
Commercial/Industrial Lodgement Checklist (Please attach to the application)
From 4 March 2013 a new lodgement appointment system will be introduced for all building consent applications.
This meeting will take place at Western Bay of Plenty District Council, Head Office, Barkes Corner, Tauranga.
An appointment can be booked by phoning 0800 WBOPDC – 0800 926 732.
Project Address
Declaration:
I confirm that all the information/documentation as indicated on this checklist is provided.
Person lodging consent:
Name:
Date:
Signature:
Contact details:
Phone Number:
Email:
Guidance Information:
The checklist is designed to ensure applicants know up front what information is required for your building
consent application and to assist you in the lodgement process to avoid delays in processing and ensure your
application is processed in a timely manner.
Please ensure you read the checklist and answer all questions. All items on this checklist must be circled to show
that they are either provided or are not applicable to your project N/A.
It is highly recommended that the person attending the lodgement meeting has an understanding of the technical
information supplied with the building consent application and has the ability to identify the information requested
on the lodgement checklist.
Later additional information may be requested during the processing of your building consent to confirm
compliance with the Building Act, Building Code, District Plan and any other relevant legislation. Processing time
will be suspended until further information is received.
Documentation must cover all aspects identified in this lodgement checklist.
All applications must be accompanied by 2 x comprehensive sets of documentation.
Standard of documentation
Section 7 of the Building Act defines ‘plans and specifications’ as the drawings, specifications and other documents
according to which a building is to be constructed, altered, demolished or removed. Documentation is required to
be of a high, professional standard. Refer to the Department of Building and Housing publication “Guide to
applying for a building consent” for a copy visit www.dbh.govt.nz
Drawings must be produced to scale on white A3, A2 or A1 paper. Minimum font size of 10.
Applications supported by a producer statement (PS): If an application is supported by a producer statement,
the architectural plans must be counter-signed by the design specialist (i.e. engineer) confirming design details
unless the drawings are provided by the specialist.
Deposit: all applications must be supported by a deposit payable at the time of lodgement. A final invoice will be
sent when your building consent has been approved; the final invoice covers the full cost of processing the
application as well as fees for inspections and the code compliance certificate less the deposit already paid.
A704191
14 February 2013 Version 1
Page 1
Customer Use
DESCRIPTION
(circle selection)
Council use
only
GENERAL REQUIREMENTS
Yes
No
N/A
Building Consent Application Form 2 completed in full and signed
Yes
No
N/A
Yes
No
N/A
Proof of ownership supplied, i.e. Rates invoice, Agreement for sale and purchase, certificate
of title, license to occupy/occupation order from the Maori Land Court.
Yes
No
N/A
Yes
No
N/A
Lodgement fee as per WBOPDC fee schedule
Yes
No
N/A
Yes
No
N/A
Project description is accurate and describes all work involved on the project
Yes
No
N/A
Yes
No
N/A
Two complete sets of drawings / reports / JOB SPECIFIC specifications and all other relevant
documentation on plain white paper in black ink.
Yes
No
N/A
Yes
No
N/A
All drawings must meet the minimum requirements of the technical drawings standard
AS/NZS1100 with a minimum font size of Microsoft word text size 10
Yes
No
N/A
Yes
No
N/A
All documents have been drawn to a recognised metric scale and noted
Yes
No
N/A
Yes
No
N/A
All documents including photocopies are legible and must have at least 10mm margin on all
outer edges with no information in them.
Yes
No
N/A
Yes
No
N/A
All plans are titled and dated
Yes
No
N/A
Yes
No
N/A
Bracing calculations (refer to foundation plan and bracing plan section)
Yes
No
N/A
SPECIFIED SYSTEMS
Yes
No
N/A
Are there any specified systems in this building
Yes
No
N/A
Yes
No
N/A
If existing building, has a copy of the existing compliance schedule been supplied and a
compliance schedule amendment submitted with this application
Yes
No
N/A
Yes
No
N/A
Has the applicant provided a list of the inspection, maintenance and reporting procedures for
each of the specified systems
Yes
No
N/A
Yes
No
N/A
Have plans been provided showing the location of all specified systems included in the
building.
Yes
No
N/A
Yes
No
Does this application need to be forwarded to the Design Review Unit
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
SPECIFICATIONS and other DOCUMENTATION
Two sets of specifications that make reference to NZBC, which are relevant and to current
NZ standards
The specification should be project specific and appropriate to the building construction. It
should be laid out in easily followed sections covering methods and materials that are not
included in the building plans, e.g. pipe work materials quoting up to date references
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Energy Efficiency (H1) report/calculations provided
Yes
No
N/A
Yes
No
N/A
E2 Risk Matrix
Yes
No
N/A
Yes
No
N/A
Fire reports and design
Yes
No
N/A
Yes
No
N/A
Design Review Unit documentation received
Yes
No
N/A
Yes
No
N/A
Compliance Schedule systems and relevant maintenance and inspection procedures
Yes
No
N/A
A704191
14 February 2013 Version 1
Page 2
Customer Use
DESCRIPTION
(circle selection)
Council use
only
SITE PLAN (SCALE 1:100 FOR URBAN AREAS AND 1:200 / 1:500 FOR RURAL AREAS)
Yes
No
N/A
Street address, legal description, north point, site area, wind, exposure and earthquake zone
Yes
No
N/A
Yes
No
N/A
Boundary bearings and dimensions, easements, building line restrictions
Yes
No
N/A
Yes
No
N/A
Levels, contours, datum identified with finished floor levels.
Yes
No
N/A
Yes
No
N/A
Proposed cut and fill / existing and proposed retaining clearly identified.
Yes
No
N/A
Yes
No
N/A
Existing and proposed buildings clearly identified. At least two dimensions from the extremity
of the building (i.e. guttering) to boundary. If more than one dwelling on the site dimension
to other buildings.
Yes
No
N/A
Yes
No
N/A
NB: if encroaching into overshadowing, “Written approval of affected person” form to be
provide along with signed and dated elevations and site plan
Yes
No
N/A
Yes
No
N/A
Crossings / driveways shown, existing and proposed vehicle access.
Yes
No
N/A
Yes
No
N/A
If building is under or near high voltage transmission lines, show transmission plan area.
Yes
No
N/A
Points identified on boundaries where overshadowing is taken from
PLUMBING & DRAINAGE (MAY BE INCLUDED ON SITE PLAN IF SCALE 1:100)
Yes
No
N/A
Position of existing council waste water and storm water sewers and connections
Yes
No
N/A
Yes
No
N/A
Position of proposed/existing waste water and stormwater drains
Yes
No
N/A
Yes
No
N/A
On-site waste water system with reserve area in accordance to BOPRC “On-site Effluent
Treatment Regional Plan 2006” or BOPRC approved effluent disposal system
Yes
No
N/A
Yes
No
N/A
Details of storm water disposal, e.g., council connection, soak holes, detention tanks?
Yes
No
N/A
Yes
No
N/A
Downpipe sizes and positions shown
Yes
No
N/A
Yes
No
N/A
Sanitary fixtures shown with waste pipe sizes and gradients. Schematic provided for more
than one level
Yes
No
N/A
Yes
No
N/A
Existing or proposed potable water supply e.g. council supply, water tank (including
filtration), bore or spring.
Yes
No
N/A
Yes
No
N/A
Backflow preventer shown – type and location
Yes
No
N/A
FLOOR PLAN (SCALE 1:100 OR 1:50)
Yes
No
N/A
Floor layout and function of each room identified (all levels) shown.
Yes
No
N/A
Yes
No
N/A
For additions and alterations, the existing shall be shown separately to the proposed and to
the same scale for comparison
Yes
No
N/A
Yes
No
N/A
Framing layout fully dimensioned.
Yes
No
N/A
Yes
No
N/A
Show and dimension all doors and windows.
Yes
No
N/A
Yes
No
N/A
Lintels /beam sizes and grade. Lintel fixing types on plan.
Outside the scope of NZ3604:2011, proprietary system identified with calculations etc
Yes
No
N/A
Yes
No
N/A
Plumbing fixtures shown, shower type identified, if tiled; membrane specifications supplied,
relevant E3 details provided (floor to wall, timber floor support, shower floor gradients etc)
Yes
No
N/A
Yes
No
N/A
Location of internal HWC position with details regarding seismic restraints supplied
Yes
No
N/A
Yes
No
N/A
Ventilation to enclosed spaces (e.g. laundry, internal WC etc.)
Yes
No
N/A
A704191
14 February 2013 Version 1
Page 3
Customer Use
DESCRIPTION
(circle selection)
Council use
only
FLOOR PLAN (SCALE 1:100 OR 1:50) continued
Yes
No
N/A
Internal stairs with dimensions for tread & riser, height of and position of handrail
Yes
No
N/A
Yes
No
N/A
Position of smoke detectors, fire walls indicated
Yes
No
N/A
Yes
No
N/A
External stairs, handrails, decks and balustrades shown (refer to foundation plan for deck)
Yes
No
N/A
Yes
No
N/A
Disabled access to building showing dimensions and details
Yes
No
N/A
Yes
No
N/A
Disabled access toilet showing dimensions and details
Yes
No
N/A
FOUNDATION PLAN (SCALE 1:100 OR 1:50)
Yes
No
N/A
Slab construction, footing location, steel reinforcing and mesh type, slab thickness and
strength, slab thickenings, rebates, shrinkage control cuts and free joints, slab dimensions
Yes
No
N/A
Yes
No
N/A
Specific Engineered Design (e.g. ribraft) provide engineers design, calculations and PS1
(refer to specific engineered design section)
Yes
No
N/A
Yes
No
N/A
Timber floor Pile layout, footing sizes, pile type, size, treatment, bearer and joist treatment,
grade, size and max span of members. Dimensions showing overalls and centres to supports.
Yes
No
N/A
Yes
No
N/A
Foundation bracing calculations provided with correct wind zone & earthquake zone
Dimensions reflect plans, i.e. roof height to apex, area etc.
Yes
No
N/A
Yes
No
N/A
Bracing elements identified and details provided
Yes
No
N/A
Yes
No
N/A
Foundation details
Yes
No
N/A
BRACING PLAN (SCALE 1:100 OF 1:50)
Yes
No
N/A
Bracing details – type, length, position and fixing.
Yes
No
N/A
Yes
No
N/A
Bracing calculations provided, correct wind zone & earthquake zone
Dimensions reflect plans, i.e. roof height to apex, area etc.
Yes
No
N/A
ELEVATIONS (SCALE 1:100 OR 1:50)
Yes
No
N/A
Elevations for each external wall with E2 risk matrix for each face provided
Yes
No
N/A
Yes
No
N/A
District plan daylighting / overshadowing shown and corresponds with positions indicated on
site plan (if relevant)
Yes
No
N/A
Yes
No
N/A
Existing and proposed ground levels indicated, existing and proposed retaining shown, cut
and batter shown? Ground levels, finished floor levels
Yes
No
N/A
Yes
No
N/A
If addition, area of addition clearly identified
Yes
No
N/A
Yes
No
N/A
All cladding clearly identified (proposed and existing) Control joints if applicable
Yes
No
N/A
Yes
No
N/A
Roof pitch, height from ground to apex, heights of chimneys.
Yes
No
N/A
Yes
No
N/A
Doors and windows showing opening sashes, obscure and safety glass indicated
Yes
No
N/A
Yes
No
N/A
Sub-floor ventilation and access shown
Yes
No
N/A
Yes
No
N/A
External stairs, handrails deck and balustrades shown if applicable
Yes
No
N/A
A704191
14 February 2013 Version 1
Page 4
Customer Use
DESCRIPTION
(circle selection)
Council use
only
CROSS SECTIONS (SCALE 1:50 OR BETTER) & DETAILS (1:10 OR 1:5)
Yes
No
N/A
A minimum of two cross sections, one through the width and one through the length.
Yes
No
N/A
Yes
No
N/A
Cross- sections clearly show construction methods (stud sizes, stud height, timber treatment,
spacing, grade, insulation, lining and cladding) any fire rated systems noted
Yes
No
N/A
Yes
No
N/A
Finished floor levels to ground levels, retaining walls, proximity to services shown
Yes
No
N/A
Yes
No
N/A
Detail markers showing cross referencing to details, details to be numbered and sheet / page
number noted.
Yes
No
N/A
Yes
No
N/A
Foundation sizes with reinforcing steel, bottom plate fixing/cladding overhang.
Differing finished floor levels – detail provided
Yes
No
N/A
Yes
No
N/A
Penetrations through exterior walls and roofs – detail shown
Yes
No
N/A
Yes
No
N/A
Window & door details shown – head/sill/jamb
Yes
No
N/A
Yes
No
N/A
Cladding type, wall underlay, cavity & battens, cladding junctions (horizontal and vertical),
external and internal corners, existing to new. Does the cladding require control joints
Yes
No
N/A
Yes
No
N/A
Structural elements, junctions & fixings.
Yes
No
N/A
Yes
No
N/A
Wall to roof junctions / soffit detail / parapet detail/beam to wall
Yes
No
N/A
Yes
No
N/A
Insulation shown and R value noted on cross- section.
Yes
No
N/A
Yes
No
N/A
Roof cladding materials, pitch, underlay noted, barge, ridge and valley details with flashing
dimensions provided
Yes
No
N/A
Yes
No
N/A
Bottom plate and stud to top plate fixings identified
Yes
No
N/A
Yes
No
N/A
Wet area details shown, shower type specified, if tiled shower are waterproofing membrane
technical specifications included
Yes
No
N/A
Yes
No
N/A
Ceiling lining type, thickness and method of support shown, size, spacing, treatment etc.
Yes
No
N/A
Yes
No
N/A
All external elements e.g. stairs and handrails, decks and balustrades, barriers.
Special engineer design required where detail does not comply with NZBC B1/AS2. – Refer to
SED section.
Yes
No
N/A
ROOF PLAN & ROOF FRAMING PLAN (SCALE 1:100 OF 1:50)
Yes
No
N/A
Buildable truss layout by certified truss manufacturer and PS1 supplied, correct wind zone
Yes
No
N/A
No
N/A
Roof bracing provided and shown on plans, overhangs dimensioned, differing pitches
identified
Yes
No
N/A
Yes
No
N/A
Rafters and purlin size, treatment, gauge, spacing noted
Yes
No
N/A
Yes
No
N/A
Truss to top plate, purlin to truss fixings
Yes
No
N/A
Yes
No
N/A
Load paths correctly identified and girder trusses supported
Yes
No
N/A
Yes
No
N/A
Location of internal gutters, rain water heads and DP’s shown
Yes
No
N/A
Yes
A704191
14 February 2013 Version 1
Page 5
Customer Use
DESCRIPTION
(circle selection)
Council use
only
SPECIFIC ENGINEERED DESIGN (SED)
Yes
No
N/A
Engineer’s calculations, drawings and a PS1 signed and dated within the last two years
Yes
No
N/A
Yes
No
N/A
Plans signed by the engineer if supported by a producer statement (PS1) only
Yes
No
N/A
Yes
No
N/A
All Engineer’s details been transferred onto the architectural plans
Yes
No
N/A
ACCESSIBILITY
Yes
No
N/A
Access and facilities for disabled persons provided in accordance with Building Act /Building
Code requirements and shown on plans
Yes
No
N/A
Yes
No
N/A
Car parking shown on site plan (number)
Yes
No
N/A
Yes
No
N/A
Accessible route
Yes
No
N/A
Yes
No
N/A
Lifts
Yes
No
N/A
Yes
No
N/A
Accessible stairs
Yes
No
N/A
Yes
No
N/A
Accessible toilets and showers
Yes
No
N/A
Yes
No
N/A
Ramps (gradient)
Yes
No
N/A
Yes
No
N/A
Building entrances
Yes
No
N/A
Yes
No
N/A
Public counters (height)
Yes
No
N/A
Yes
No
N/A
Laundering
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Signs
Yes
No
N/A
Food preparation
ACOUSTIC
Yes
No
N/A
Acoustic report from qualified professional stating requirements provided
Yes
No
N/A
Yes
No
N/A
All acoustic details / requirements indicated on plans.
Yes
No
N/A
N/A
Manufacturers specifications and lift design plans with PS1
Yes
No
N/A
LIFTS
Yes
No
MECHANICAL SERVICES ENGINEERING
Yes
No
N/A
Engineering calculations provided for ventilation system(s)
Yes
No
N/A
Yes
No
N/A
All details shown on plans and design specifications provided
Yes
No
N/A
Yes
No
N/A
Manufacturer’s specifications/technical data sheets provided for ventilation system(s)
Yes
No
N/A
HAZARDOUS SUBSTANCES
Yes
No
N/A
Details of handling and storage of hazardous materials provided
Yes
No
N/A
Yes
No
N/A
Hazardous substances type, class and quality
Yes
No
N/A
Yes
No
N/A
Test Certifier report provided for compliance with hazardous substances and noxious
organisms (HSNO) Act
Yes
No
N/A
A704191
14 February 2013 Version 1
Page 6
Customer Use
DESCRIPTION
(circle selection)
Council use
only
FOOD PREMISES
Yes
No
N/A
Details provided with regards to the type of business and operations
Yes
No
N/A
Yes
No
N/A
Number of staff and patrons indicated
Yes
No
N/A
Yes
No
N/A
Details of surface finishes in food preparation, cooking, servery, storage dishwashing areas
provided
Yes
No
N/A
Yes
No
N/A
Full details and location of appliances (cooking / fridges/ freezers) provided
Yes
No
N/A
Yes
No
N/A
Liquor licence application submitted
Yes
No
N/A
RETAINING WALLS
Yes
No
N/A
Site Plan indicating position and height of retaining walls and drainage points
Yes
No
N/A
Yes
No
N/A
Elevations showing original ground level, cut and fill
Yes
No
N/A
Yes
No
N/A
Cross sections/details (cut, fill, height of retained ground, waterproof membrane and
drainage) and height of wall indicated
Yes
No
N/A
Yes
No
N/A
Barrier details where required
Yes
No
N/A
Yes
No
N/A
Engineer’s calculations, drawings and a PS1 signed and dated within the last two years
Yes
No
N/A
Yes
No
N/A
Plans signed by the engineer if supported by a producer statement (PS1) only
Yes
No
N/A
DEMOLITION / REMOVAL
Yes
No
N/A
All existing buildings to be removed or demolished shown on site plan
Yes
No
N/A
Yes
No
N/A
Identify services to be capped and sealed inside boundary
Yes
No
N/A
RELOCATION
Yes
No
N/A
Complete checklists for General requirements, Form 2a, Site plan, Plumbing and drainage,
Floor plan, Foundation plan, Elevations (photographs can be used for rural sites)
Yes
No
N/A
Yes
No
N/A
If work outside of the relocatable footprint is proposed complete the relevant additional
checklist sections.
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
SWIMMING/SPA POOL
Yes
No
N/A
If the installation of a swimming pool/spa pool is part of this application please complete
and provide the relevant checklist from the Residential Building Consent Application.
SOLID FUEL HEATER APPLIANCE
Yes
No
N/A
If the installation of a solid fuel heater is part of this application please complete and provide
the checklist from the Solid Fuel Heater Building Consent Application.
SOLAR WATER HEATERS
Yes
No
A704191
N/A
If the installation of a solar water heater system is part of this application please complete
and provide the checklist from the Solar Hot Water Heater Building Consent Application .
14 February 2013 Version 1
Page 7
Office Use Only
Dated
First Check
/
Second Check
/
/
/
Final check
/
/
Officer
Time taken
Decision
15
30
45
60
15
30
45
60
15
30
45
60












Accept 
Reject 
Accept 
Reject 
Accept 
Reject 
Conditions /
Notes/
Comments
A704191
14 February 2013 Version 1
Page 8