Form Sbcg27 - Compliance Schedule Specified Systems - Invercargill City Council

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Compliance Schedule Specified Systems Form SBCG27
This checklist should be used to identify specified systems within buildings in accordance with Building Act 2004.
Please identify specified systems by ticking appropriate boxes and to include maintenance and inspection
requirements as provided by owner / designer.
Site Address: __________________________________
Fire Hazard Category FHC: __________________
Building Name: ________________________________
Purpose Group(s): _________________________
Owners Name: ________________________________
Total Occupant Load: _______________________
SS1 – SS16
SPECIFIED SYSTEMS
Existing
Add
Alter
Remove
Form
Attached
SS1
Automatic Sprinkler Systems
SS2
Emergency Warning Systems
SS3.1
Automatic Doors and Windows
SS3.2
Access Controlled Doors
SS3.3
Interfaced Fire or Smoke Doors or Windows
SS4
Emergency Lighting Systems
SS5
Escape Routes Pressurisation Systems
SS6
Riser Mains
SS7
Auto Back-Flow Preventers
SS8.1
Passenger Carrying Lifts
SS8.2
Service Lifts
SS8.3
Escalators and Moving Walks
SS9
Mechanical Ventilation / Air Con Systems
SS10
Building Maintenance Units
SS11
Laboratory Fume Cupboards
SS12.1
Audio Loops
SS12.2
FM Radio Frequency Systems
SS13.1
Mechanical Smoke Control
SS13.2
Natural Smoke Control
SS13.3
Smoke Curtains
Emergency Power Systems for SS1 – 13
SS14.1
Signs for SS1 – 13
SS14.2
SS15.1
Systems for Communicating Evacuation
SS15.2
Final Exits
SS15.3
Fire Separations
SS15.4
Signs
SS15.5
Smoke Separations
SS16
Cable Cars
 Yes
 No
SPECIFIED SYSTEMS PLAN ATTACHED
Office Use Only
Compliance Schedule No. ________________
Building Consent No. _______________
Application:
 Yes
 No
 Yes
 N/A
Specified Systems Correct:
If no, RFI Letter Sent:
Processing Officer: _________________________________________________ Date: _______________
(Name)
Admin: System updated: _____________________________________________ Date: _______________
(Name)
CCC:
Compliance Schedule OK to Issue: ______________________________________ Date: _______________
(Name)
SBCG27 Version 04-12-2013

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