Form 59 "Notice to Inspect/Test Special Fire Services. Notice to Referral Agency to Inspect" - Queensland, Australia

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Version 2 – March 2013
Form 59—Notice to inspect/test special fire services
Notice to referral agency to inspect
1. Builder details
Name (in full)
If the builder works for a company, a contact
person must be shown
Company name if applicable
Contact person
Phone no. business hours
Mobile no.
Fax no.
Email address
Postal address
Postcode
Signature
Date
2. Signature of builder
3. Property description
Street address (include no., street, suburb / locality & postcode)
The description must identify all land the
subject of the application.
Postcode
The lot & plan details (eg. SP / RP) are
shown on title documents or a rates notice.
Lot & plan details (attach list if necessary)
If the plan is not registered by title, provide
previous lot and plan details
.
In which local government area is the land situated?
Development approval number
Name (in full)
4. Assessment manager / private
certifier
Company name if applicable
Contact person
A copy of this notice must be forwarded to
the assessment manager, in accordance
with section 74 of the Building Act 1975.
Phone no. business hours
Mobile no.
Fax no.
If the assessment manager or the private
certifier works for a company, a contact person
Email address
must be shown
Postal address
Postcode
Licence number
LOCAL GOVERNMENT USE ONLY
Date received
Reference Number/s
 
 
Version 2 – March 2013
Form 59—Notice to inspect/test special fire services
Notice to referral agency to inspect
1. Builder details
Name (in full)
If the builder works for a company, a contact
person must be shown
Company name if applicable
Contact person
Phone no. business hours
Mobile no.
Fax no.
Email address
Postal address
Postcode
Signature
Date
2. Signature of builder
3. Property description
Street address (include no., street, suburb / locality & postcode)
The description must identify all land the
subject of the application.
Postcode
The lot & plan details (eg. SP / RP) are
shown on title documents or a rates notice.
Lot & plan details (attach list if necessary)
If the plan is not registered by title, provide
previous lot and plan details
.
In which local government area is the land situated?
Development approval number
Name (in full)
4. Assessment manager / private
certifier
Company name if applicable
Contact person
A copy of this notice must be forwarded to
the assessment manager, in accordance
with section 74 of the Building Act 1975.
Phone no. business hours
Mobile no.
Fax no.
If the assessment manager or the private
certifier works for a company, a contact person
Email address
must be shown
Postal address
Postcode
Licence number
LOCAL GOVERNMENT USE ONLY
Date received
Reference Number/s
 
 
5. Test
I advise that the special fire services shown below have been installed in the subject premises. They are
Tick whether inspection, test or both are
ready for inspection and/or testing.
.
required for the following fire services
Special Fire Services
Inspect
Test
1.
Large Isolated Buildings
2.
Emergency lifts
3.
Emergency warning and intercommunication systems
4.
Fire control centres
5.
Fire detection alarm systems (other than stand-alone
smoke alarms not required to be interconnected or
connected to a fire indicator panel)
6.
Fire fighting equipment
7.
Sprinklers
8.
Wall-wetting sprinklers
9.
Special automatic fire suppression systems
10.
Provision for special hazards
11.
Smoke control systems
12.
Prescribed buildings
Please advise details of the date and time of the proposed inspection/test/s by completing and
returning the section below.
6. Details of proposed inspection /
QFRS to complete and return to builder and building certifier
test
It is advised that special fire service inspection/test/s will be carried out:
Day
Date
Time
am / pm
Name of officer
Phone no.
Mobile no.
Fax no.
Email address
At property:
Street address (Include no., street, suburb / locality & postcode)
Postcode
Lot & plan details (Attach list if necessary)
In which local government area is the land situated?
Development approval number
 
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