Structural Design Certificate

Address: _________________________________________________________

Type of Building Work: ______________________________________________

Tick: ( ) DA ( ) CC ( ) DA & CC ( ) CDC Number: _ _ _/_ _ _ _

Drawing(s) which are the subject of this certificate:

Drawing numbered _______________ Dated _____/_____/_______

Amended _______________ (If applicable)

I certify this design is structurally adequate and complies with the Building
Code of Australia, in particular Section B Structure, and all relevant
Australian Standards referenced in that Section and Specification A1.3 of
that Code.

The basis on which this certificate is given and the extent to which relevant
specifications, rules, codes of practice or other publications have been
relied upon is as follows:

(E.g. AS 3600 Concrete Structures Code etc)

I am a member of the Institution of Engineers Australia, or am eligible to

become a Corporate Member of that organisation and have appropriate
experience and competence in the relevant field.

Name (Block letters): __________________ Email: ______________________

Address: (Block letters): _____________________________________________
Telephone No: ______________ Fax: _____________Mobile: ______________
Signature: __________________________ Date: _______/______/________