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APPLICATION FOR PERFORMANCE ASSESSMENT

To: KZB Building Surveying Services. I/we request your services to undertake performance assessment to the design with respect to the following Property. The services requested, but not to limited to, for consulting purposes.

From: Owner/Agent of owner ______Postal Address: ______Postcode: ______Contact Person: ______Telephone: ______

Property Details: Number:______Street/Road:______City/Suburb/Town______Lot/s:______LP/PS:______Volume:______Folio:______Crown Allotment:______Section:______Parish:______County:______Municipal District:______

Proposed use of building intended for Performance Assessment: ______

Nature of Performance Assessment: The use of Clause A2.2 of the Building Code of Australia may apply to the following: Report from Registered Testing Authority______Certification of Accreditation______Certificate of Compliance from Engineer______Scientific Services Laboratory (SSL) Certificate of Conformity______Product Listing Data Sheet______Assessment from Expert Judgement______Comparison to Deemed – to – Satisfy Provisions____ Assessment method by Verification______

Building Classification: (Class 1-10, Classes 2-9) (i) ______(ii) ______(iii) ______

475 Main Street, Mordialloc. VIC. 3195. PH: (03) 9587 3214 FAX: (03) 9587 1723 E.MAIL: [email protected] Web site: www.kzbbuilding.com.au KZB Building Surveying Services Building Permit & Inspection Building Surveyors & Construction Consultants Fire Engineering Reports Alternative Solutions Construction Dispute Resolutions Construction Contracts

Building Code of Australia Clause(s) for Performance Assessment: (i) ______(ii) ______(iii) ______(iv) ______(v) ______

Reason for Requesting Performance assessment: ______

Sincerley,

Name: (Print Name) ______

Signature of Owner Agent______

Date:______