This form is only to be used by a certifier requesting an IFSR in accordance with Part 3 Division 3 of the Environmental Planning and Assessment (Development Certification and Fire Safety) Regulation 2021 (EP&A Reg.)

Certifier

Agreement

As the certifier, I confirm the following:

I agree to pay Fire and Rescue NSW (FRNSW) the charges set out in clause 46 of the Fire Brigades Regulation 2014 (see section 5).

A performance solution report by an appropriate competent fire safety practitioner has been received and includes a statement that the performance solution complies with the relevant performance requirements.

The following documentation is being forwarded within 7 days after receiving the corresponding application for construction certificate (CC), as required under clause 27 of the EP&A Reg.:

	Copy of the application for CC (date endorsed and detailing the proposed works to be carried out)

	Copy of building plans and specifications (as required for assessment by FRNSW)

	Details of the performance requirements that the performance solution is intended to meet

	Details of the assessment methods used to establish compliance with the performance requirements

Name of certifier	Enter name	Registration number	Number
Certifier’s phone no.	Enter phone number
Certifier’s email	Enter email address

Remittance advice information

Invoices will be issued based on the information provided below:

ASIC company name	Remitter’s ASIC registered company name
Australian business number	ABN (not ACN)	Trading name	Remitter’s general trading name
Remittance contact name	Remitter’s contact name
Remittance street address	Remitter’s street address
Remittance email address	Remitter’s email address (generic)
Remittance phone number	Remitter’s phone number	Remittance fax number	Remitter’s fax number
Purchase order ref. no.	If applicable	Project code ref. no.	If applicable

Project details

Premises

Premises name	Premises name (if applicable)
Primary street address	Primary street address
Secondary address	Secondary street address (if applicable)
Premises suburb	Premises suburb name
Lot and DP numbers	E.g. Lots A and B of DP 12345, Lot 10 of DP 111213
Is the premises considered a significant development or a unique building (e.g. Sydney Football Stadium, Sydney Opera House, Crown Towers, etc.)?	Select

Proposed works

 New building	Applicable NCC (year)	Select
 Refurbishment of an existing building	Date of consent	Select
 Extension of an existing building	For existing buildings:
 Change in use of existing building (involving building work)	Year of construction	Year
 Modification of CC (see section 4)	Building code of existing	Select
What is the approval pathway for the proposed works?	Select
Are the works already constructed on site?	Select
Cost of development (as per original development application)	$Cost
Does the CC relate to existing consent as per savings and transitional provisions?	Select
Will the works be subject to an exemption under section 111 of the EP&A Reg.?	Select
Will the works be subject to an exemption under section 74 of the EP&A Reg.?	Select
Is the building likely to be subject to a fire safety study?	Select

Note:	The applicable NCC must relate to the date of the application for CC being made (e.g. the current NCC). Any fire safety study should be reviewed and approved prior to making this application.

Are any of the solutions proposed as a result of:

An audit of the existing building that has identified an existing non-compliance	Select
Not being able to sign off an annual fire safety statement	Select
(provide details)

Description of building

Main occupancy class	Select	Other occupancy classes	Other classes
Type of construction	Select	Largest fire compartment (m2)	Area
Effective height (m)	Actual effective height	Ground floor area (m2)	Area
Rise in storeys	RIS	Total floor area (m2)	Area
Levels contained	Levels	Total volume (m3)	Volume

Does the building contain an early childhood centre?	Select
Is the building or does the building contain a Data Centre?	Select
Is the development a major hazard facility?	Select
Does the development include a fire sprinkler system in accordance with FPAA 101D?	Select
Does the development include a fire sprinkler system in accordance with FPAA 101H?	Select
Does the development include a dry fire hydrant system?	Select
Is the development a united building (e.g. podium with towers)?	Select

Performance solution report (PSR)

Company name	Enter organisation name
Name of practitioner	Enter name of fire safety practitioner	Registration number	Number
PSR reference	Enter PSR ref. number	Version	Version	Date issued	Select date
Indicate how many performance solution issues are identified within this PSR	Enter number
How many Performance Requirements are being assessed?	Enter number
Are there any other PSRs applicable to this CC?	Select
Indicate which Category 2 fire safety provisions are being met by the performance solution within this PSR	 CP9  EP1.6	 EP1.3  EP2.2	 EP1.4  EP3.2

Note:	The PSR attached to this application must be the same version that is the subject of the application for CC being applied for, and will be the PSR version that FRNSW will assess relating to this IFSR application.

Fire engineering consultation

Has there been any fire engineering consultation with FRNSW (e.g. FEBQ)?	Select
If yes, is the performance solution identical to one last consulted on (i.e. the same strategy/approach, number of issues, performance requirements, assessment methods, acceptance criteria, design fires/scenarios, modelling inputs)?	Select
Is there any existing performance solution or PSR for the building?	Select
Has there been any previous IFSR requested or issued for this building (e.g. the CC is being modified)?	Select

Note:	The Performance solution summary table (available on FRNSW website) should be completed and submitted with this form to outline new or revised performance solution issues requiring assessment.

Performance solution overview

Indicate if the performance solution relates to any of the following (indicate all applicable):

 Reduction of FRL	 Openings, fire spread
 Smoke/fire compartments exceeding DtS limits	 Reduced width of path of travel to an exit
 Linings, materials and assemblies	 Fire hydrant system
 Separation of services/emergency equipment	 Sprinkler system
 The DtS provisions require the provision of an additional fire-isolated stair that is not proposed as part of the performance solution	 The DtS provisions require the provision of an active fire safety system that is not proposed as part of the performance solution (i.e. is the performance solution deleting an active fire safety system)?
 Reduced perimeter access for fire vehicles	 Fire control centre / room
Please enter approximate % of reduction: Enter %	 Emergency lift
 Access to and around building	 Occupant warning
 Extended travel distance or distance between exits	 Smoke hazard management
 Reduced total egress widths  Reduction in water supply to fire hydrant or sprinkler system	 NCC atrium requirements  Fire hydrant system flows and/or pressures

Indicate if the building has any of the following (indicate all applicable):

 Combustible external cladding	 Insulated sandwich panels
 Combustible waste (i.e. waste facility)	 Podium type building
 Electricity supply system (e.g. substations)	 A basement level
 Battery system (e.g. BSS, BESS, ESS)	 An atrium (Part G3 of BCA)
 Alternative electrical generation (e.g. solar, tri-gen)	 Car stacker
 Electric vehicle charging  Automatic storage and retrieval system (ASRS)	 Green wall
 Hazardous chemicals / dangerous goods (provide details)
 Other hazards Provide details

If the proposal includes a waste management facility, does it comply with the current FRNSW Fire Safety in Waste Facilities Fire safety guideline?	Select
If the answer to the above is yes, please confirm the version of the guideline	Version

Modifying the development

Only complete this section if this application relates to an application for CC being due to the development being modified under clause 24 of the EP&A Reg. (i.e. an issued CC is being modified to incorporate a design change).

FRNSW file number from IFSR or request (as given on IFSR or letter)	FRN Enter file number
Is the attached PSR an updated version of a previous report or a new PSR?	 New version	 New PSR

Note:	Any change to the performance solution, irrespective of whether Category 2 fire safety provisions are involved, may affect the previous assessment and decision by FRNSW. An IFSR may be provided for any modified development irrespective of whether an IFSR was previously issued or not.

Provide a summary of the changes to the development and performance solution, including any new performance solution issues, by completing and submitting the Performance solution summary table from the FRNSW website and provide details below:

Provide summary of development changes within revised/new PSR

Note:	Please ensure all details within all sections of this form have been updated according to the attached PSR.

Scheduled charges

FRNSW charge for the provision of services performed in connection with statutory fire safety as per the schedule of charges identified in clause 46(1) & (3) and schedule 2 of the Fire Brigades Regulation 2014.

The charges applicable comprise a charge based on the estimated cost of development (see table below) and $180 for the assessment of each applicable Category 2 fire safety provision.

Cost of development	Amount
Up to $250,000	$500
$250,001-$500,000	$500 plus $0.40 for each $1,000 (or part) by which the cost exceeds $250,000
$500,001–$1,000,000	$600 plus $0.30 for each $1,000 (or part) by which the cost exceeds $500,000
$1,000,001–$10,000,000	$750 plus $0.20 for each $1,000 (or part) by which the cost exceeds $1,000,000
More than $10 million	$2,550 plus $0.10 for each $1,000 (or part) by which the cost exceeds $10 million

Note:	For a full description of the charges applicable including terms, payment options, applying for a waiver or reduction of the charges, please refer to the FRNSW website at firesafety.fire.nsw.gov.au.

In the case of modifying development, the assessment by FRNSW of the new perfromance solution will incur new fees to furnish a new IFSR. The cost of development as per the original development application will also apply in the case of modifying development. However, the applicant can apply in writing to the FRNSW Commissioner to have the charge waived or reduced under section 43(b) of the Fire and Rescue NSW Act 1989.

Submission of this form

This completed form is to be emailed to firesafety@fire.nsw.gov.au.

All plans and specifications required by FRNSW for assessment are to be attached to the email (or sent separately if necessary due to file size). Refer to Submitting plans and specifications to FRNSW for further information.

Contact us

For further information contact the Fire Safety Branch on (02) 9742 7434 or email firesafety@fire.nsw.gov.au.