7882 - Form 15 - 19 The Peninsula_211113 · MCU22/0017

 

4, Reference documentation Black & More structural engineering drawings 7882-S001 to S007 (Rev C1)

Clearly identify any relevant
documentation, e.g. numbered
structural engineering plans.

 

 

5. Building certifier reference Building certifier reference number
number and building development
application number senna e een n nee cee e nnn e eee e anne ence ene n eee ee een n nena sean nnn e seen anne nee eeenn nn nesseneennnseeceennneeseenenes

 

 

6.Appointed competent person Name (in full)
details Szymon Sobczyk

Under Part 6 of the Building Company name (if applicable) Contact person

Regulation a person must be
assessed as a competent forthe type | Black & More Szymon Sobezyk
of work (design-specification) by the

7 Business phone number Mobile number
relevant building certifier.

5447 4444

Email address
[email protected]

Postal address

406/90 Goodchap Street

 

 

 

7. Signature of appointed competent | Signature Date
person pages Geb

This certificate must be signed by the | -:+:es:sssessesee lene eeeeeeeee etter eee teeereseeetsesteeeeeseesttn En ET cere ieeeseecresrenees :
individual assessed and appointed by
the building certifier as competent to
give design-specification help.

 

 

LOCAL GOVERNMENT USE ONLY

 

Date received Reference number/s

 

 

 

 

 

 

Building Regulation 2021 © Section 73 and 77 ¢ Form 15 ¢ Version 1 * September 2021 Page 2 of 3