Application for Building Consent/PIM for Commercial/Industrial ...

Application for Project InformationMemorandum/Building Consent forCommercial /Industrial ProjectsForm 2, Section 33 and/or Section 45, Building Act 2004Date ReceivedApplication type (tick all that are applicable)PIM OnlyBoth PIM and Building ConsentBuilding ConsentIn 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 andspecific site requirements to complete processing of your building consent and this will be charged as a project information consideration.The BuildingSTREET ADDRESS of BUILDINGPROJECT: (for structures that do not have a streetaddress, state the nearest street intersection and thedistances and direction from that intersection)LEGAL DESCRIPTION of land wherebuilding is located: (state legal description asat the date of application and, if the land is proposed tobe subdivided, include details of relevant lot numbersand subdivision consent)Building nameLocation of building within site/blocknumber (include nearest street access)Area: (total floor area: indicate area affected by thebuilding work if less than the total area.)Current, lawfully established use:(include number of occupants per level and per use ifmore than 1)The OwnerName/s of ALL legal owner/s:(Provide full name and preferred form ofaddress, e.g. Mr, Miss, Dr, if an individual)Valuation No:LotLand AreaDP/DPS/ML/SO (Circle applicable one)PIN No (Office Use Only}Block NoSurvey DistrictNumber of levels: (include groundlevel and any levels below ground)Level or unit numberYear firstconstructedN/A Communal Residential Communal Non-Residential Commercial IndustrialContact person:(insert N/A if applicant is anindividual)Mailing address:Post Code:Street address/registered officePost Code:Phone Number: Mobile: After Hours:Fax Number:Evidence of ownership is attached tothis application:The ProjectEmail Address: Agreement for Sale and Purchase Rates Invoice Certificate of title or LeaseDescription 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, orrefer to an attached document setting out the description)Will the building work result in a change of use of the building? Yes NoIf 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)$A 291974 10 March 2014 Version 17 Page 1

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 clausesof the Building Code will be involvedin the building work) B1 StructureMeans of compliance (refer to the relevant compliancedocument(s) or detail of alternative solution on plans andspecifications; if not applicable, put n/a B1/AS1 B1/AS3 B1/VM1 B1/VM3 B1/VM4 NZS3604 AS/NZS 1170 NZS 4229Alternative solution (pleasespecify) B2 Durability C1 – C6 Protection from fire B2/AS1 B2/VM1 NZS 3604 NZS 3602 NZS 3101 C/AS1 C/AS2 C/AS3 C/AS4 C/AS5 C/AS6 C/AS7 D1 Access routes D1/AS1 D1/VM1 NZS 4121 D2accessMechanical installations for 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 demolitionhazards 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 andprevention 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 ofdangerous substances in buildings) 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 Waiver/modification (state natureof waiver or modification of building coderequired)A 291974 10 March 2014 Version 17 Page 3

AN ADDITIONAL SET OF DOCUMENTATION is required to be supplied if input from any ofthe following is required:Design Review UnitThe following building consent applications are to be sent to the New Zealand Fire Service Commission’s DesignReview Unit.1. Building work designed as an alternative solution. This means that the design does not fully follow therequirements of the Compliance Document C/AS1. (Often designs largely follow the AcceptableSolution, but include minor deviations such as extending the allowable travel distances or modifyingfixed 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 specifiedsystem.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 thealteration of the tone or type of sounding or visual alert for an alarm. Minor work does not mean worksuch 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 theBuilding Code:a) are hazardous substances being stored? Yes Nob) are early childhood facilities provided? Yes Noc) is specialised care for people with a disability provided? Yes Nod) is specialised nursing, medical or geriatric care provided? Yes Noe) are people in lawful detention/ Yes Nof) can 100 or more people gather in a common venue? Yes Nog) can 100 or more people gather for different purposes or activities? Yes Noh) are there facilities for more than 10 employees? Yes NoHSNO Officer (Hazardous substances and new organisms)Hazardous goods input required if any materials have the properties below and are stored in the proposedbuilding work:1. Of an explosive nature2. Of an oxidizing nature3. Of a corrosive nature4. Flammable5. Have acute and chronic toxicity6. Ecotoxicity with or with out bioaccumulation7. Has one or more of the above properties on contact with air or water.Environmental Health OfficerThe application requires the premises to be registered. Examples of these premises are:1. Hair dressers2. Food preparation and salesFire Engineering and Structural Engineering Peer ReviewsWhere complex fire design, alternative methods of construction or the skill of a particular individual designingthe project (part of) is in question then the application is to be assessed by one of the Senior Building ControlOfficials to determine if a peer review is required.A 291974 10 March 2014 Version 17 Page 4

Complete this Compliance Schedule Draft ( To be submitted with Building Consent Application)Compliance Schedule number:Building name (known as):Street address of property: Existing C/Schedule (Attach copy)OR New C/ScheduleConsent No (if applicable)Building owner(s):Purpose Group (please circle) CS CL CO CM SC SD SA SR SH WL WM WH WF IA ID IECurrent, 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) andspecified systems for the generation of a Compliance Schedule.Guidance NotesWhat is a Specified System?Specified systems are systems or features that contribute to the proper functioning of the building. Specified systemsrequire ongoing inspection and maintenance to ensure they function as required, because if they fail to operateproperly, 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 ZealandBuilding Code. These may be a specific approved standard, an acceptable solution or specifically designed for thefeature or system in question.What are maintenance requirements?This identifies what preventative and responsive maintenance is required to be taken and what standard, acceptablesolution 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 inthe building.A 291974 10 March 2014 Version 17 Page 5

The following SPECIFIED SYSTEMS are contained in this building (tick appropriate box)Tick the appropriate boxesExists Altered New Remove SS 1- Automatic systems for fire suppression Type__________________MaintenanceIn accordance with NZS 4541:2003 part 12 NZS 4541:2007 part 12 NZS 4515:2003 part 8 AS 1851:2005 Section 2InspectionsInspected by an independent qualified person to NZS 4541:2003 part 12 NZS 4541:2007 part 12 NZS 4515:2003 part 8 AS 1851:2005 Section 2Performance Standards Clauses C3.3.6, C3.3.9 and F7.3.3 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS 2 – Automatic or manual emergency warning systemsfor fire or other dangersType__________________MaintenanceIn accordance with NZS 4512:2010 part 6 AS 1851:2005 Section 6 Manufacturer’s recommendations (include maintenance programme)InspectionsInspected 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__________________________________________________________________________________________________________________Exists Altered New Remove SS3/1 – Automatic DoorsMaintenanceIn accordance with 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)InspectionsInspected 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__________________________________________________________________________________________________________________Exists Altered New Remove SS3/2 – Access-controlled doors(Where a security door is also an automatic door then inspection and maintenance for SS3/1 also applies)MaintenanceIn 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.InspectionsDaily 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_______________________________________________________________________________________________________Exists Altered New Remove 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 SS15/3and SS15/5)MaintenanceIn accordance with AS 4178:1994 section 4 Manufacturer’s recommendations(include maintenance programme)InspectionsInspected in accordance to AS 4178:1994 section 4 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 CodeA 291974 10 March 2014 Version 17 Page 6

_______________________________________________________________________________________________________Exists Altered New Remove SS4-Emergency Lighting SystemsEmergency lighting that also forms an exit sign needs to have its illumination aspect checked under SS15/4MaintenanceIn 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.InspectionsInspected 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 6742Where a generator is part of the emergency Lighting it needs to be inspected to NZS6104:1981 part 8 Complete SS14/1Performance Standards Clauses F6.3.1 and F6.3.2 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS5-Escape Route Pressurisation SystemsMaintenanceIn accordance with AS 1851:2005 section 18 AS/NZS 1668:1998 appendix F Manufacturer’s recommendations (include maintenance programme)InspectionsInspected 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_______________________________________________________________________________________________________Exists Altered New Remove SS6-Riser Mains for use by Fire ServicesMaintenanceIn accordance with NZS 4510:2008 part 9InspectionsInspected by an independent qualified person to NZS 4510:2008 part 9Performance Standards Clauses G 10.3.6 and C3.3.9 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS7-Automatic Back-flow Preventers(please tick) High Medium Low Cross Connection Hazard (G12 As/1 section 3.3 table 2)MaintenanceIn accordance with AS/NZS 2845.1:2010Back-flow preventers shall be inspected and tested after repair or replacementInspectionsInspected by an independent qualified person to AS/NZS 2845.1:2010Back-flow preventer type(please tick) Reduced Pressure zone Double check valve Pressure vacuum breaker Atmospheric vacuum breakerType / 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 CodeA 291974 10 March 2014 Version 17 Page 7

Exists Altered New Remove SS8/1-Passenger Carrying Lifts( SS8/1 that is connected to emergency warning system SS2 needs to have the interface tested annually)MaintenanceIn accordance with NZS 4332:1997 part 2.5 BS EN 81:2003 Manufacturer’s recommendations (include maintenance programme)InspectionsInspected in accordance to NZS 4332:1997 part 2.5 BS EN 81:2003 Manufacturer’s recommendations (include inspection regime with the additional requirements identifiedwithin the compliance schedule handbook pages 30 – 32 (issued 25 May 2007) and D2/AS1 NZ Building CodePerformance Standards Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS8/2-Service Lifts( SS8/2 that is connected to emergency warning system SS2 needs to have the interface tested annually)MaintenanceIn accordance with NZS 4332:1997 part 2.5 BS EN 81:2003 Manufacturer’s recommendations (include maintenance programme)InspectionsInspected in accordance to NZS 4332:1997 part 2.5 BS EN 81:2003 Manufacturer’s recommendations (include inspection regime with the additional requirements identifiedwithin the compliance schedule handbook pages 30 – 32 (issued 25 May 2007) and D2/AS1 NZ Building CodePerformance Standards Clauses D2.3.1, D2.3.2 and D2.3.3 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS8/3-Escalators and moving walks(SS8/3 that is connected to emergency warning system SS2 needs to have the interface tested annually)MaintenanceIn accordance with D2/AS3 BS EN 115 Manufacturer’s recommendations (include maintenance programme)InspectionsInspected by an independent qualified person D2/AS3 BS EN 115 Manufacturer’s recommendations (include inspection regime with the additionalrequirements identified within the compliance schedule handbook page 37 (issued 25 May2007) or to the Manufacturers recommendations.Performance Standards Clauses D2.3.1, D2.3.2, D2.3.3 and D2.3.5. Building Code_______________________________________________________________________________________________________Exists Altered New Remove 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)MaintenanceIn accordance with NZS 4302:1987 AS 1851:2005 section 6 AS/NZS 3666.2:2011 Manufacturer’s recommendations(include maintenance programme)InspectionsInspected 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 3896Where ventilation system is fitted with smoke / fire control these systems shall be inspected to AS 1851:2005 section 18Performance Standards Clauses 3.3.7, G4.3.1, G4.3.2 and G4.3.3 Building Code_______________________________________________________________________________________________________A 291974 10 March 2014 Version 17 Page 8

Exists Altered New Remove SS10 – Building Maintenance UnitsE.g. Building maintenance units for providing access to the exterior and interior walls of buildingsMaintenanceIn accordance with BS 6037.1:2007 BS 6037.2:2007InspectionsPlanned preventative maintenance and responsive maintenance should be carried out in accordance with toBS 6037.1:2007 to ensure safe and suitable operation by a independent qualified person.Performance Standard BS 6037:1990_______________________________________________________________________________________________________Exists Altered New Remove SS11 – Laboratory Fume CupboardsMaintenanceIn accordance with AS/NZS 2243.8:2006InspectionsRegular inspection and testing to ensure they operate as required by the performance standard by an independent qualifiedperson to AS/NZS 2243.8:2006.Performance Standard Clauses F3.3 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS12/1 – Audio LoopsMaintenanceIn accordance with AS/NZS 1088.4:1987(superseded by AS 60118) AS 60118.4-2007 NZS 4121:2001InspectionsInspected by an independent qualified person to AS/NZS 1088.4:1987(superseded by AS 60118) AS 60118.4-2007 NZS 4121:2001Performance Standards Clauses G5.3.5 and F7.3.1 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS12/2 – FM radio frequency systems and infrared beam transmissionsystemsMaintenanceIn accordance with AS 60118.4-2007 NZS 4121:2001 Manufacturer’s recommendations (include maintenance programme)InspectionsInspected 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_______________________________________________________________________________________________________Exists Altered New Remove SS13/1 – Mechanical Smoke Control Systeme.g. Smoke ventilator designed to open or extract in the event of a fire. (SS13/1 that is connected to emergencywarning system SS2 needs to have the interface tested annually)MaintenanceIn accordance with AS/NZS 1668.1998 part 4 AS 1851:2005 Section 18 Manufacturer’s recommendations (include maintenance programme)InspectionsInspected 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 CodeA 291974 10 March 2014 Version 17 Page 9

Exists Altered New Remove SS13/2 – Natural Smoke Control SystemE.g. Smoke reservoir in an atrium / smoke doorsMaintenanceIn accordance with AS/NZS 1668.1998 part 4 AS 1851:2005 Section 17InspectionsInspected regularly by an independent qualified person to AS/NZS 1668.1998 part 4 AS 1851:2005 Section 17Performance Standards Clauses G4.3.3, C3.3.7 and C3.3.8 Building Code_______________________________________________________________________________________________________Exists Altered New Remove SS13/3 –Smoke Curtains Type & location__________________________MaintenanceIn accordance with AS/NZS 1668.1998 part 4 AS 1851:2005 Section 17 Manufacturer’s specifications (include maintenance programme)InspectionsInspected 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 SS14/1 –Emergency power systems for’ signs relating to, a specifiedsystem in any of specified systems 1-13MaintenanceIn accordance with NZS 6104:1981 part 8InspectionsInspected 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 13MaintenanceMaintained in conjunction with the systems it relates to.InspectionsInspected 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 toFacilitate EvacuationMaintenanceIn accordance with AS 1851:2005 NZS 4512:2010 Manufacturer’s specifications(include maintenance programme)InspectionsInspected 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 ExitsMaintenanceFinal 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

InspectionsIn 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 mayaffect a final exit. Monthly inspection for all other occupancies with annual inspection and maintenance by independentqualified persons.Performance Standards Clauses C2.3.2, C2.3.3(b)(g), D1.3.3(b) Building Code________________________________________________________________________________________Exists Altered New Remove SS15/3–Fire SeparationsAttached to this Compliance Schedule i.e. a floor plan showing the fire walls / doors etc.MaintenanceIn accordance with NZS 4520:2010 Compliance Document C/AS1 Protection from fireAttached to this Compliance Schedule is a floor plan showing the fire walls / doors etc.InspectionsInspected to NZS 4520:2010 Compliance Document C/AS1 Protection from fireDaily inspections by owner for crowd type occupancies while the building is in use and for all buildings while building work mayaffect 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 toFacilitate EvacuationEmergency lighting that also forms an exit sign needs to have its illumination aspect checked underSS4MaintenanceSigns shall be: replaced if not of the correct type, replaced immediately should they be missing or refurbished before theybecome illegible.InspectionsDaily 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 SS15/5–Smoke SeparationsE.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.MaintenanceIn accordance with AS 1851:2005 Section 17 Compliance Document C/AS1 Protection from fireInspectionsIn accordance with AS 1851:2005 Section 17 Compliance Document C/AS1 Protection from fireDaily inspections by owner for crowd type occupancies while the building is in use, monthly inspection for all other occupancieswith 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 CarsResidential cable car, an enclosed ski chair lift that operates either wholly or partially within abuildingMaintenanceIn accordance with NZS 5270:2005 part 16 appendix C.InspectionsInspected 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 CodeA 291974 10 March 2014 Version 17 Page 11

Key Contacts Please provide if applicableDesigner or ArchitectBusiness/NameAddress:Mobile:Email:After Hours:Registration or LBP Registration No:Structural EngineerBusiness/NameAddress:Mobile:Email:After Hours:Registration or LBP Registration No:Builder/Carpentry WorkBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:Foundation WorkBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:BricklayingBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:BlocklayingBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:A 291974 10 March 2014 Version 17 Page 12

External PlasteringBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:Roofing WorkBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:GasfitterBusiness/NameAddress:Mobile:Email:After Hours:LBP Registration No:DrainlayerBusiness/NameAddress:Mobile:Email:After Hours:Registration No:PlumberBusiness/NameAddress:Mobile:Email:After Hours:Registration No:OtherBusiness/NameAddress:Mobile:Email:After Hours:Registration No:A 291974 10 March 2014 Version 17 Page 13

Building Fees (Office use only)Application Fee $AmountProject Information Memorandum $Plan checking deposit $BCA Accreditation and Assessment Levy $Lodgement Check $Application for Code Compliance Certificate $ 80.00Inspection $DBH Levy $BRANZ Levy $Other Fees (Office use only)Title Endorsements Section 73/77 $AmountNZFS Design Review Unit $Actual Processing charges based on time taken calculated when all processing completed $$Total $Payment Details (Office use only) Date Receipt Details AmountLO/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