Transcription of Memorandum from licensed building practitioner: Record …
1 Memorandum from licensed building practitioner : Record of building work - 2011 1 Street address:Suburb:Town/City:Postcode:THE BUILDINGName(s):Mailing address:Suburb:PO Box/Private Bag:Town/City:Postcode:Phone number:Email address:THE OWNER(S) building consent number:THE PROJECTForm 6 AMemorandum from licensed building practitioner : Record of building workSection 88, building Act 2004 Please fill in the form as fully and correctly as possible. If there is insufficient room on the form for requested details, please continue on another sheet and attach the additional sheet(s) to this form . Memorandum from licensed building practitioner : Record of building work - 2011 2 Record OF WORK THAT IS RESTRICTED building WORKPRIMARY STRUCTUREWork that is restricted building workDescription of restricted building workCarried out or supervisedTick If necessary, describe the restricted building whether you carried out the restricted building work or supervised someone else carrying out the restricted building and subfloor framing Carried out SupervisedWalls Carried out SupervisedRoof Carried out SupervisedColumns and beams Carried out SupervisedBracing Carried out SupervisedOther Carried out Supervised Memorandum from licensed building practitioner .
2 Record of building work - 2011 3 EXTERNAL MOISTURE MANAGEMENT SYSTEMSWork that is restricted building workDescription of restricted building workCarried out or supervisedTick If necessary, describe the restricted building whether you carried out the restricted building work or supervised someone else carrying out the restricted building proofing Carried out SupervisedRoof cladding or roof cladding system Carried out SupervisedVentilation system (for example, subfloor or cavity) Carried out SupervisedWall cladding or wall cladding system Carried out SupervisedWaterproofing Carried out SupervisedOther Carried out Supervised Memorandum from licensed building practitioner : Record of building work - 2011 4 Name and contact details of the licensed building practitioner who is licensed to carry out or supervise restricted building :LBP number:Class(es) licensed in: Plumbers, Gasfitters and Drainlayers registration number (if applicable):Mailing address (if different from below):Street address/Registered office:Suburb:Town/City:PO Box/Private BagPostcode:Phone number:Mobile:After hours:Fax:Email address:Website.
3 ISSUED BYDECLARATIONI carried out or supervised the restricted building work recorded on this : Date.
