Building (Forms) Regulations 2004

Form 12 Warrant of fitness

Section 108, Building Act 2004

The building

Street address of building:

Legal description of land where building is located:

Building name:

Location of building within site/block number:

Level/unit number:

Current, lawfully established, use: [include number of occupants per level and per use if more than 1]

Year first constructed:

Intended life of the building if 50 years or less: . years

Highest fire hazard category for building use: [state number]

The owner

Name of owner:

*Contact person:

Mailing address:

Street address/registered office:

Phone number:

Landline:

Mobile:

Daytime:

After hours:

Facsimile number:

Email address:

Website:

Agent

Name of agent: [only required if warrant is being supplied on behalf of the owner]

§Contact person:

Mailing address:

Phone number:

Daytime:

After hours:

Facsimile number:

Email address:

Relationship to owner: [state details of authorisation from the owner to supply the warrant on the owner’s behalf].

Warrant

†The maximum number of occupants that can safely use this building is:

The inspection, maintenance, and reporting procedures of the compliance schedule for the above building have been fully complied with during the 12 months prior to the date stated below.

The compliance schedule is kept at:

Attachments

†Certificates relating to inspections, maintenance, and reporting

†Recommendations for amendments to the compliance schedule

Signature of †owner/†agent on behalf of and with the authority of the owner:

Date:

*Delete if the owner is an individual.

†Delete if inapplicable.

‡Delete this section if the warrant is not being supplied on behalf of the owner.

§Delete if the agent is an individual.

Schedule Part 2 form 12: amended, on 21 July 2005, by regulation 5(1) of the Building (Forms) Amendment Regulations (No 2) 2005 (SR 2005/170).

Schedule Part 2 form 12: amended, on 21 July 2005, by regulation 5(2) of the Building (Forms) Amendment Regulations (No 2) 2005 (SR 2005/170).

Schedule Part 2 form 12: amended, on 21 July 2005, by regulation 5(3) of the Building (Forms) Amendment Regulations (No 2) 2005 (SR 2005/170).