ࡱ> q vbjbj ;iZjiZjn///8g /ahZ!@'LK(K(K(s?0??8g:g:g:g:g:g:gjqm\:g?>>|??:gK(K(hEEE?FK(K(8gE?8gEEn0]8_K(`ūε@Rh^ $g1h0ah^dmg@m@_m_8??E?????:g:g5C???ah????m?????????Y : Building Act 2011, section 57 Building Regulations 2012, regulation 4, 36PERMIT AUTHORITY USE ONLYReference number  FORMTEXT      BUILDING SURVEYING USE ONLYReference number  FORMTEXT       1. Property this certificate relates to Property street address (provide lot number where street number is not known)Unit no  FORMTEXT      Street no  FORMTEXT       Level  FORMTEXT      Lot no  FORMTEXT      Street name  FORMTEXT      Street type  FORMTEXT      Street suffix  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT       Local government area  FORMTEXT      Proposed use of the building(s) FORMTEXT      Change of use FORMCHECKBOX  Yes  FORMCHECKBOX  NoProposed classification(s) and description(s) of building(s) FORMTEXT      Year(s) of construction of building(s)  FORMTEXT      Change of classification FORMCHECKBOX  Yes  FORMCHECKBOX  No This certificate is to accompany an application made under the following section of the Building Act 2011 FORMCHECKBOX  Section 48 ( temporary modification of occupancy permit  FORMCHECKBOX  Section 49(a) ( change of building use  FORMCHECKBOX  Section 49(b) ( change of classification  FORMCHECKBOX  Section 51 ( unauthorised work  FORMCHECKBOX  Section 52 ( for existing authorised building 2. Applicable building standards  Building standards applicable to this building or incidental structure  FORMTEXT        Any declaration under section 39 of the Building Act 2011 made in respect of this building or incidental structure  FORMTEXT        Bush fire prone areas (only required for the types of buildings or incidental structures stated below where the certificate is for an application under section 49(b) or 51(2) or 51(3) of the Building Act 2011) In respect of a Class 1, Class 2 or Class 3 building, a Class 9 vulnerable use building, or Class 10a building or deck that is located less than six (6) metres from the Class 1, Class 2 or Class 3 building or Class 9 vulnerable use building:Is the building or deck located in a bush fire prone area?  FORMCHECKBOX  Yes  FORMCHECKBOX  No (if no, continue to part 3) Does a bush fire performance requirement apply to the building or deck?  FORMCHECKBOX  Yes. The Bushfire Attack Level (BAL) or other measure is: FORMTEXT        FORMCHECKBOX  No. Does not apply because of:  FORMTEXT       (See regulations 15D and 31BA(1) of the Building Regulations 2012 which affect the application of bush fire performance requirements to buildings and decks) 3. Plans, specifications and other documents relevant to this certificate Plans and specifications required under regulation 36(2)(b) of the Building Regulations 2012 Drawings  FORMTEXT       Specifications  FORMTEXT       Technical documents  FORMTEXT       4. Any other information relevant, which has been relied on for compliance Performance solutions (include the information required under regulation 36(2)(c) of the Building Regulations 2012  FORMTEXT       Technical documents  FORMTEXT       Any inspections/tests conducted  FORMTEXT       5. Declaration Occupying or using this building or incidental structure in its current state in the way proposed would not adversely affect the safety and health of its occupants or other users. This building or incidental structure in its current state is otherwise suitable to be used in the way proposed. This building or incidental structure complies with each relevant authority under a written law that is prescribed in regulation 36(1) of the Building Regulations 2012. A declaration under section 39 of the Building Act 2011 to not apply or modify a building standard specified in part 2 of this certificate in respect to this building or incidental structure  FORMCHECKBOX  has been made or  FORMCHECKBOX  has not been made. Each performance solution together with details of the assessment methods used to establish compliance with a building standard is specified in part 4 of this certificate. Where this certificate relates to (tick relevant box(es)):  FORMCHECKBOX  An application mentioned in section 48 or 52(1) or (2) of the Building Act 2011 This building or incidental structure substantially complies with the building permit, building licence or other approval that was granted in respect of the construction of the building or incidental structure applicable at the time of its construction; or This building or incidental structure substantially complies with each applicable building standard or other prescribed requirement in relation to the technical aspects of the construction of the building or structure.  FORMCHECKBOX  An application mentioned in section 49 of the Building Act 2011 This building or incidental structure substantially complies with each applicable building standard.  FORMCHECKBOX  An application mentioned in section 51(2) or 51(3) of the Building Act 2011 This building or incidental structure substantially complies with each applicable building standard; and The plans, specifications and technical documents that show how this building complies with each building standard that applies to this building or incidental structure are set out in part 3 of this certificate.  FORMCHECKBOX  An application mentioned in section 49(b) or 51(2) or 51(3) of the Building Act 2011 where the building is a Class 1, Class 2 or Class 3 building, a Class 9 vulnerable use building or a Class10a building or a deck that is located less than six (6) metres from the Class 1, Class 2 or Class3 building or Class 9 vulnerable use building: I have made the required statements in part 2 of this certificate in respect to bush fire prone areas. 7. 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