Form 11 "Certificate/Interim Certificate of Occupancy" - Queensland, Australia

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Form 11
Certificate/Interim Certificate of Occupancy
A Form 11 must be completed to fulfil the requirements prescribed in sections 102(2) and 103 of the Building Act 1975 for a
Certificate of Occupancy.
A Form 11 must also be completed to fulfil the requirements prescribed in section 104 of the Building Act 1975 for an Interim
Certificate of Occupancy.
1. Type of certificate
Certificate of Occupancy
Interim Certificate of Occupancy
Indicate the type of Certificate of
Occupancy being issued.
Interim Certificate: Issued pending
Date Interim Certificate of Occupancy will expire
(if applicable)
the carrying out of the inspection, when
due to a building’s location, it is not
practicable for a building certifier to
DD / MM / YYYY
inspect a building to decide if it has been
substantially completed.
Name (natural person or company)
2. Owner's details
If the applicant is a company, a contact
person must be shown.
Street address (include number, street, suburb/locality and postcode)
3. Property description
The description must identify all land the
subject of the application.
State
Postcode
The lot and plan details (e.g. SP/RP)
QLD
NSW
VIC
TAS
SA WA
NT
ACT
are shown on title documents or a
Lot and plan details (attach list if necessary)
rates notice.
If the plan is not registered by title,
provide previous lot and plan details.
Local government area the land is situated in
4. Classification
Part of building/description
Class of building/part
The building or part thereof described is
classified as follows in accordance with
Part A6 of the Building Code of Australia
having regard to the use for which it was
designed, built or adapted. If a part of
the building is classified differently to
another part, state the part to which each
classification relates.
5. Maximum numbers of people
Maximum population
Part of building
permitted
If applicable, state the maximum number
of people permitted in the building and
the portion it applies to.
Building Act 1975  •  Section 102(2) and 103  •  Form 11  •  Version 4  •  October 2020
Page 1 of 3
Form 11
Certificate/Interim Certificate of Occupancy
A Form 11 must be completed to fulfil the requirements prescribed in sections 102(2) and 103 of the Building Act 1975 for a
Certificate of Occupancy.
A Form 11 must also be completed to fulfil the requirements prescribed in section 104 of the Building Act 1975 for an Interim
Certificate of Occupancy.
1. Type of certificate
Certificate of Occupancy
Interim Certificate of Occupancy
Indicate the type of Certificate of
Occupancy being issued.
Interim Certificate: Issued pending
Date Interim Certificate of Occupancy will expire
(if applicable)
the carrying out of the inspection, when
due to a building’s location, it is not
practicable for a building certifier to
DD / MM / YYYY
inspect a building to decide if it has been
substantially completed.
Name (natural person or company)
2. Owner's details
If the applicant is a company, a contact
person must be shown.
Street address (include number, street, suburb/locality and postcode)
3. Property description
The description must identify all land the
subject of the application.
State
Postcode
The lot and plan details (e.g. SP/RP)
QLD
NSW
VIC
TAS
SA WA
NT
ACT
are shown on title documents or a
Lot and plan details (attach list if necessary)
rates notice.
If the plan is not registered by title,
provide previous lot and plan details.
Local government area the land is situated in
4. Classification
Part of building/description
Class of building/part
The building or part thereof described is
classified as follows in accordance with
Part A6 of the Building Code of Australia
having regard to the use for which it was
designed, built or adapted. If a part of
the building is classified differently to
another part, state the part to which each
classification relates.
5. Maximum numbers of people
Maximum population
Part of building
permitted
If applicable, state the maximum number
of people permitted in the building and
the portion it applies to.
Building Act 1975  •  Section 102(2) and 103  •  Form 11  •  Version 4  •  October 2020
Page 1 of 3
6. Restrictions on the use or occupation
Restrictions
of the building
The following restrictions apply to the use or occupation of the building:
If the building work uses a performance
solution and or a deem-to-satisfy solution
within the meaning of Building Code of
Australia or the Queensland Development
Code, restricting the use or occupation of
the building, state the restriction.
For example, a limitation on the use of
finishes with the fire hazard properties
as defined under the Building Code
of Australia.
Building Act 1975  •  Section 102(2) and 103  •  Form 11  •  Version 4  •  October 2020
Page 2 of 3
Performance solution requirements
7. Performance solutions
If the building work uses a performance
The following systems and procedures from part of the performance solution:
solution, state the applicable materials,
systems, methods of building,
procedures, specifications and other
relevant requirements.
This will provide building owners and
occupiers with a concise and practical
explanation of performance solutions that
may have some operational implications
on the use of the building.
This will also help ensure the ongoing
use of the building and any future
modifications do not compromise
compliance with the performance
requirements of the applicable
building code.
Name of building certifier (in full)
Licence number
8. Building certifier's details
If the certifier is a company, a contact
person must be shown.
Signature
Date
Building Approval Reference Number
Building Act 1975  •  Section 102(2) and 103  •  Form 11  •  Version 4  •  October 2020
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