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Schedule 4—Forms Sch. 4 Form 1 substituted by S.R. Nos 75/2018 reg. 26, 101/2020 reg. 9, 128/2021 reg. 21, amended by S.R. Nos 132/2023 reg. 19, 125/2025 reg. 4. **Form 1** Regulation 24 **APPLICATION FOR A BUILDING PERMIT** **To** (Building surveyor) *Owner/*Agent of owner Postal address of applicant Address for serving or giving of documents Indicate if the applicant is a lessee or licensee of Crown land to which this application applies 🞏† **Lessee responsible for building work** Indicate if a lessee of the building, of which parts are leased by different persons, is responsible for the alterations to a part of the building leased by that lessee 🞏† ***Ownership details** (if applicant is agent of owner) Name of owner(s) [*insert full name(s)*] Municipal district Allotment area (for new dwellings only) m2 Land owned by the Crown or a public authority 🞏† **Builder** *Building practitioner registration no. [*If the builder is carrying out domestic building work under a major domestic building contract, attach an extract of the major domestic building contract showing the names of the parties to the contract in relation to the proposed building work and a copy of the certificate of insurance (if applicable).*] ***Natural person for service of directions, notices and orders** (if builder is a body corporate) **Building practitioner or architect engaged to prepare documents for this permit** [*List any building practitioner or architect engaged to prepare documents forming part of the application for this permit.*] | Construction of a new building 🞏† Demolition of a building 🞏† Extension to an existing building 🞏† Re-erection of a building 🞏† Construction of swimming pool 🞏† Other [*give description*] 🞏† | Alterations to an existing building 🞏† Removal of a building 🞏† Change of use of an existing building 🞏† Construction of swimming pool barrier 🞏† Construction of a small second dwelling 🞏† | Proposed use of building Under the **Building Act 1993 *swimming pool*** is defined to include a spa. **Social housing** Does any of the building work include the construction of social housing as referred to in regulation 281B of the Building Regulations 2018? [*Yes/No*] [*Indicate Yes if the building work, which is the subject of this application, includes the construction of social housing or if other building work, which is the subject of a related staged building permit, includes the construction of social housing.*] **Emergency recovery** Does any of the building work include the construction of a dwelling that was destroyed or damaged in an emergency referred to in regulation 166J(b) of the Building Regulations 2018? [*Yes/No*] [*Indicate Yes if the building work, which is the subject of this application, includes the construction or repair of a dwelling within the same municipal district as the destroyed or damaged residential dwelling.*] **Cost of the building work** All costs specified in an application are to be inclusive of GST. ***If application for a building permit is made by a person other than an owner-builder** *Part A* Is there a contract or agreement (other than a cost-plus contract or agreement) with a builder for carrying out the building work? [*Yes/No*] If yes, specify the contract price or agreed amount to be paid to the builder (including for the cost of labour and materials) under the contract or agreement $ If no, is there a cost-plus contract or agreement with a builder for carrying out the building work? [*Yes/No*] If yes, specify the builder's estimate of the total amount that the builder will receive or is likely to receive (including for the cost of labour and materials) under the contract or agreement $ Specify the cost of any chattel under the contract or agreement $ *Part B* Specify the class or classes of building to which the building work relates: Does the building work relate to both— (i) one or more buildings in a class 2, 3, 4, 5, 6, 7 or 8 building; and (ii) one or more buildings in a class 1, 9 or 10 building? [*Yes/No*] If yes, specify the information required under Part A and under Part C (if applicable) according to whether the building work relates to— (i) buildings in a class 2, 3, 4, 5, 6, 7 or 8 building; and (ii) buildings in a class 1, 9 or 10 building. *Part C* **All stages of staged building work** Does the application relate to a stage of the whole of the building work? [*Yes/No*] If yes, specify the extent of the stage: Is there one or more contracts or agreements (other than a cost‑plus contract or agreement) for carrying out the whole of the building work for all of the stages? [*Yes/No*] If yes, specify the contract price or agreed amount to be paid (including for the cost of labour and materials) under all the contracts or agreements $ If no, is there one or more cost-plus contracts or agreements for carrying out the whole of the building work for all of the stages? [*Yes/No*] If yes, specify the estimate of the total amount that the builders will receive or are likely to receive (including for the cost of labour and materials) under all the contracts or agreements $ Specify the cost of any chattel under the contract or agreement $ ***If application for a building permit is made by an owner‑builder** *Part A* I intend to carry out the building work as an owner-builder [*Yes/No*] Specify the owner-builder certificate of consent number (if applicable): Specify the owner-builder's estimated cost (including for labour and materials) of the owner-builder carrying out the building work $ *Part B* Will the owner-builder be engaging one or more builders to carry out part of the building work? [*Yes/No*] If yes, specify the information in relation to whichever of the following applies— (i) if the engagement is under a contract or agreement that is not a cost-plus contract or agreement, specify the contract price or agreed amount to be paid to each builder (including for the cost of labour and materials) $ (ii) if the engagement is under a cost-plus contract or agreement, specify the builder's estimated amount that each builder will receive or is likely to receive (including for the cost of labour and materials) $ *Part C* Specify the cost of any chattel relating to Part A and/or Part B $ Specify the cost of any prescribed excluded item relating to Part A and/or Part B $ *Part D* **All stages of staged building work by an owner-builder** Does the application relate to a stage of the whole of the building work? [*Yes/No*] If yes, specify the extent of the stage: Specify the owner-builder's estimated cost (including for labour and materials) of the owner-builder carrying out the whole of the building work for all stages $ Specify the cost of any chattel in relation to building work carried out by the owner-builder $ Specify the cost of any prescribed excluded item in relation to building work carried out by the owner-builder $ Is there a contract or agreement (other than a cost-plus contract or agreement) with a builder to carry out part of the whole of the building work for all stages? [*Yes/No*] If yes, specify the contract price or agreed amount to be paid to the builder (including for the cost of labour and materials) under the contract or agreement $ If no, is there a cost-plus contract or agreement with a builder to carry out part of the whole of the building work for all stages? [*Yes/No*] If yes, specify the builder's estimate of the total amount that the builder will receive or is likely to receive (including for the cost of labour and materials) under the contract or agreement $ Specify the cost of any chattel under the contract or agreement $ *Part E* Specify the class or classes of building to which the building work relates: Does the building work relate to both— (i) one or more buildings in a class 2, 3, 4, 5, 6, 7 or 8 building; and (ii) one or more buildings in a class 1, 9 or 10 building? [*Yes/No*] If yes, specify the information required under Part A and/or Part B (if applicable) and under Part C and Part D (if applicable) according to whether the building work relates to— (i) buildings in a class 2, 3, 4, 5, 6, 7 or 8 building; and (ii) buildings in a class 1, 9 or 10 building. Signature of applicant Date * Delete if inapplicable † Tick if applicable Sch. 4 Form 2 substituted by S.R. No. 75/2018 reg. 26, amended by S.R. Nos 102/2023 reg. 23, 122/2023 reg. 5, 132/2023 reg. 20. **Form 2** Regulation 37(1) **Building Permit** **Issued to** *Owner/*Agent of owner Address for serving or giving of documents ***Ownership details** (if person issued with permit is not the owner) **Builder** *Building practitioner registration no. *This builder is specified under section 24B[*state* *precise subsection*] of the **Building Act 1993** for the building work to be carried out under this permit. ***Natural person for service of directions, notices and orders** (if builder is a body corporate) **Building practitioner or architect engaged to prepare documents for this permit** [*List any building practitioner or architect engaged to prepare documents forming part of the application for this permit.*] ***Details of domestic building work insurance** Name of builder Name of issuer or provider Policy number Policy cover $ ***Details of relevant planning permit** Planning permit no. Date of grant of planning permit Construction of a *new building/*extension/*alteration/*change of use/*demolition/*removal/*re-erection of a building Does the building work relate to a small second dwelling? [**Yes/*No*] *Storeys contained *Rise in storeys (for Class 2-9 building only) *Effective height *Type of construction Version of BCA applicable to permit Stage of building work permitted Cost of building work $ Total floor area of new building work in m2 **Building classification** Part of building BCA Classification Part of building BCA Classification A performance solution was used to determine compliance with the following performance requirements of the BCA that relate to the building to which this permit applies: | | [*Insert details of performance solution(s) including applicable materials, systems, methods of building, procedures, specifications and other relevant requirements*] | ***Building Appeals Board determinations and orders** The following determinations and orders of the Building Appeals Board (the ***BAB***) relate to the building work to which this permit applies: | **Date of determination or order** | **Determination or order** | **Section of the Building Act 1993 under which application to BAB made** | | | [*Insert details of determination or order including applicable materials, systems, methods of building, procedures, specifications and other relevant requirements*] | | ***Prescribed reporting authorities** The following bodies are prescribed reporting authorities for the purposes of the application for this permit in relation to the matters set out below: | **Reporting authority** | **Matter reported on or consented to** | **Regulation no.** | A determination has been made under regulation 64(1) in relation to the building work that is the subject of this permit. ***Subdivision of existing building** This building permit authorises building work that involves the subdivision of an existing building. An exemption has been issued under regulation 231 in relation to the building work that is the subject of this permit. ***Exemption from, or consent to partial compliance with, certain requirements of the Building Regulations 2018** The following exemption from, or a consent to partial compliance with, certain requirements of the Building Regulations 2018— (a) *was granted or given under regulation 229(2), 231(2), 233(3) or 234(2) of the Building Regulations 2018; or (b) *applies in clauses H8P1(a) and H8D2(2) of the BCA Volume Two in relation to Liveable housing design: | **Part or whole of building or place of public entertainment or building work exempt from, or given consent to partial compliance with, requirements of the Building Regulations 2018** | **Nature and scope of exemption** | | *[*Specify the part or whole of the building that is exempt from, or given consent to partial compliance with, the requirements of the Building Regulations 2018.*] | [*Specify the relevant regulation or performance requirement in the BCA Volume One or BCA Volume Two which the building, place of public entertainment or building work is exempt from or may partially comply with.*] | | *[*Specify the part or whole of the class 1 building that is exempt from, or given consent for partial compliance with, clauses H8P1(a) and H8D2(2) of the BCA Volume Two Liveable housing design.*] | [*Specify the reason and/or the circumstance for the exemption or consent being granted.*] **Example** *Clauses H8P1(a) and H8D2(2) of the BCA Volume Two* It is not practicable to provide a step-free access path via an appurtenant garage, carport or parking space in accordance with this performance requirement because there is insufficient space available on the site on which to construct a step-free access path that would comply with this performance requirement. | **Protection work** Protection work *is/*is not required in relation to the building work proposed in this permit. **Inspection requirements** The mandatory notification stages are [*insert mandatory stages*]. **Occupation or use of building** An *occupancy permit/*certificate of final inspection is required prior to the occupation or use of this building. If an occupancy permit is required, the permit is required for the *whole/*part of the building in relation to which the building work is carried out. **Commencement and completion** This building work must commence by [*insert commencement date*]. If the building work to which this building permit applies is not commenced by this date, this building permit will lapse unless an extension is applied for and granted by the relevant building surveyor before this date under regulation 59 of the Building Regulations 2018. This building work must be completed by [*insert completion date*]. If the building work to which this building permit applies is not completed by this date this building permit will lapse, unless an extension is applied for and granted by the relevant building surveyor before this date under regulation 59 of the Building Regulations 2018. ***Conditions** This permit is subject to the following conditions [*insert conditions*]. *Designated building surveyor: *Name: [*insert full name*] Building practitioner registration number: Permit no.: Date of issue of permit: * *Delete if inapplicable* Form 3 Regulation 56 Notice of IMMINENT lapse of building permit—Commencement of work Applicant for building permit [*insert full name*] of [*insert address of service of the applicant*] Building permit number: Commencement date of building work: Date issued: A copy of the relevant building permit is **attached** to this notice. **Property to which building permit relates** **FROM**: I am the relevant building surveyor appointed in relation to the issue of the building permit. In accordance with regulation 56 of the Building Regulations 2018, I am required to give the applicant for the building permit described above notice of the imminent lapse of the building permit because it is 30 days before the commencement date of the building work and an inspection of the first mandatory notification stage of the work has not been carried out. The building work to which the building permit described above applies must commence by [*insert commencement date specified in building permit*] or any extension granted to this date by the relevant building surveyor under regulation 59 of the Building Regulations 2018. If the building work to which the building permit described above applies is not commenced by the commencement date, including any extension to that date, the building permit described above will lapse. A building permit that has lapsed is no longer in force for the purposes of the **Building Act 1993** and the Building Regulations 2018. ** Delete whichever is inapplicable* Form 4 Regulation 57 Notice of IMMINENT lapse of building permit—completion of work Applicant for building permit [*insert full name*] of [*insert address of service of the applicant*] Building permit number: Completion date of building work: Date issued: A copy of the relevant building permit is **attached** to this notice. **Property to which building permit relates** **FROM**: I am the relevant building surveyor appointed in relation to the issue of the building permit. In accordance with regulation 57 of the Building Regulations 2018, I am required to give the applicant for the building permit described above notice of the imminent lapse of the building permit because it is 30 days before the completion date of the building work and an inspection of the final mandatory notification stage of the work has not been carried out. The building work to which the building permit described above applies must be completed by [*insert completion date specified in building permit*] or any extension granted to this date by the relevant building surveyor under regulation 59 of the Building Regulations 2018. If the building work to which the building permit described above applies is not completed by the completion date including any extension to that date, the building permit described above will lapse. A building permit that has lapsed is no longer in force for the purposes of the **Building Act 1993** and the Building Regulations 2018. ** Delete whichever is inapplicable* Sch. 4 Form 5 amended by S.R. No. 75/2018 reg. 27(1). Form 5 Regulation 64(3) Determination that combined ALLOTMENT is one allotment **Given to** Owner of allotment 1 in combined allotment: Telephone: Owner of *allotment 2/*adjoining land in combined allotment: Telephone: [*insert details of any other owners if more than 2 pieces of land in combined allotment*] **Details of land in combined allotment to which this determination applies** **Allotment 1, property details** [*include title details as and if applicable*] ***Allotment 2/*adjoining land property details** [*include title details as and if applicable*] [*insert details of any additional allotments or land to which the application applies*] I am the *municipal building surveyor/*private building surveyor and I have determined that the combined allotment to which this determination applies can be treated as one allotment for the purposes of the **Building Act 1993** and the Building Regulations 2018. In making this determination I have considered the matters set out in regulation 64(2) of the Building Regulations 2018 and make the following statements: 1. The proposed building work to be carried out on the combined allotment is [*insert description of proposed building work*]. 2. I am satisfied that the proposed building work will not adversely impact on the structural adequacy of any existing building on the combined allotment for the following reason(s) [*insert reasons*]. 3. I am satisfied that reasonable provision will be made for the amenity of any building on the combined allotment for the following reason(s) [*insert reasons*]. 4. I am satisfied that reasonable provision will be made for the safety and health of people using any building on the combined allotment for the following reason(s) [*insert reasons*]. 5. I am satisfied that reasonable provision will be made for avoiding the spread of fire to or from any adjoining building on the combined allotment for the following reason(s) [*insert reasons*]. **Made by *municipal building surveyor/*private building surveyor** Related building permit no. (if issued before determination made): Sch. 4 Form 6 amended by S.R. No. 73/2021 reg. 14. Form 6 Regulation 111(4) Determination THAT PROTECTION WORK IS REQUIRED **Issued to** Owner (referred to throughout this determination as the ***Owner***) *Agent of owner **Property subject to building permit application** (referred to throughout this determination as the ***Owner's property***) **Building permit application details** (referred to throughout this determination as the ***Owner's building permit application***) Applicant Date of application | Construction of a new building 🞏† Demolition of a building 🞏† Extension to an existing building 🞏† Re-erection of a building 🞏† Construction of swimming pool or spa 🞏† Other 🞏† | Alterations to an existing building 🞏† Removal of a building 🞏† Change of use of an existing building 🞏† Construction of swimming pool or spa barrier 🞏† | **Details of each adjoining property** (referred to throughout this determination as an ***adjoining property***) [*list each adjoining property, include title details as and if applicable*] MATTERS CONSIDERED IN MAKING THIS DETERMINATION In making this determination I have considered the following matters set out in regulation 112 of the Building Regulations 2018: | Allotment plan provided to me under regulation 25 🞏† Allotment plan provided to me under regulation 26 🞏† Specifications describing materials and methods to be used in the proposed building work 🞏† Any certificate under section 238 of the **Building Act 1993** from the engineer who designed the building work who is a civil engineer 🞏† The nature and likely extent of any damage or other adverse effect on the stability or otherwise of an adjoining property that may be caused by the proposed building work 🞏† | Demolition required as part of the proposed building work 🞏† Excavation required as part of the proposed building work 🞏† Any proposed building work in relation to party walls and retaining walls 🞏† Any certificate under section 238 of the **Building Act 1993** from an independent engineer who is a civil engineer, certifying that the structural design of the building work complies with that Act and the Building Regulations 2018 🞏† Other matters that I consider appropriate to determine the need for protection work 🞏† | 1. I am the relevant building surveyor appointed on [*insert date*] under Part 6 of the **Building Act 1993** by or on behalf of the Owner in relation to the Owner's building permit application. 2. I am required by the Building Regulations 2018 to determine if protection work is required for any adjoining property as a result of building work proposed in the Owner's building permit application. 3. I have determined that the Owner must carry out protection work in respect of each adjoining property identified in this determination in accordance with Part 7 of the **Building Act 1993** and Part 7 of the Building Regulations 2018. 4. The proposed building work that gives rise to the need for protection work is [*insert description of all building work proposed in the Owner's building permit application which poses a risk of significant damage to an adjoining property identified above*]. 5. This determination triggers the protection work process set out in Part 7 of the **Building Act 1993**, which is supported by Part 7 of the Building Regulations 2018. **Made by relevant building surveyor** Related building permit no. (if known): Date of issue of determination: *†* *Tick if applicable* Sch. 4 Form 7 amended by S.R. No. 40/2019 reg. 30(1). Form 7 Regulation 113 Protection Work Notice Adjoining owner **Adjoining owner's property details (the *adjoining property*)** *Owner/*agent Name of owner [*insert full name*] **Owner's property details** *Name of agent **NOTICE** In accordance with section 84 of the **Building Act 1993**, I give notice of my intention to carry out the following building work on my property and request your agreement to the proposed protection work which affects your adjoining property. In accordance with section 85 of the **Building Act 1993**, and subject to sections 90 and 91 of that Act, you will be taken to have agreed to the protection works proposed in this notice if you do not respond within 14 days after this notice is served on you. A response to this notice must be in the form of Form 8 of the Building Regulations 2018, include the information in that form, and be given to the owner and the relevant building surveyor whose details are set out in this notice. **Details of proposed building work** [*insert details including details about damage etc. that may be caused to adjoining property*] **Details of proposed protection work** [*insert the nature, location, time and duration of the proposed protection work, including the extent to which access to the adjoining property will be required for the purpose of undertaking the proposed protection work*] **Information about protection of an adjoining owner under the Building Act 1993 in relation to proposed protection work** In accordance with section 92 of the **Building Act 1993**, at any time after this notice is given to the adjoining owner, the relevant building surveyor must make available to the adjoining owner, on request, for inspection, without charge, any plans, drawings and specifications of the proposed building work in the possession or control of the relevant building surveyor. The relevant building surveyor's name and contact details are on page 1 of this notice. If the proposed protection work is agreed to by the adjoining owner or determined as being appropriate by the relevant building surveyor under section 87(1) of the **Building Act 1993** or by the Building Appeals Board under section 141 of the **Building Act 1993** (as the case requires), the owner must— 1. before the commencement of any protection work— 1. ensure that a contract of insurance is in force in accordance with section 93 of the **Building Act 1993** against damage by the protection work to the adjoining property and other liabilities described in that section; and 2. make a full and adequate survey of the adjoining property in accordance with section 94 of the **Building Act 1993**; and 2. pay to an adjoining owner all costs and expenses necessarily incurred by the adjoining owner in assessing proposed protection work and in supervising the carrying out of protection work in relation to an adjoining property in accordance with section 97 of the **Building Act 1993**; and 3. compensate an adjoining owner or an adjoining occupier for inconvenience, loss or damage suffered by the adjoining owner or adjoining occupier in connection with the carrying out of protection work in accordance with section 98 of the **Building Act 1993** or an order of the Building Appeals Board under section 159 of that Act. Signature of *owner/*owner's agent Date Form 8 Regulation 114 Protection Work Response Notice *Owner/*owner's agent **Address of owner's property on which building work is to be carried out** *Adjoining owner/*adjoining owner's agent **Address of my adjoining property** **Response from adjoining owner** In accordance with section 85 of the **Building Act 1993**, I am responding to the notice served on me by the owner under section 84 of that Act and— (a) agree to the proposed protection work 🞏† (b) disagree with the proposed protection work 🞏† (c) request the following further information 🞏† Signature of *adjoining owner/*adjoining owner's agent Date Form 9 Regulation 115(a) notice of determination under section 87 of the Act *Owner/*owner's agent **Address of owner's property on which building work is to be carried out** Number Street/road City/suburb/town **And to** *Adjoining owner/*adjoining owner's agent **Address of adjoining property** 1. I am the relevant building surveyor appointed on [*insert date*] under Part 6 of the **Building Act 1993** by or on behalf of the owner, [*insert full name of owner of the property on which building work is being carried out*]. 2. On [*insert date*] I received from the adjoining owner a notice under section 85(1)(b) of the **Building Act 1993** (the ***adjoining owner's notice***). 3. In the adjoining owner's notice, the adjoining owner *disagreed with the proposed protection work/*required more information to be given to enable the proposal for protection work to be considered by me. I **attach** a copy of the adjoining owner's notice to this determination. 4. As a result of the adjoining owner's notice, I am required by the **Building Act 1993** to examine the owner's proposal for protection work. 5. I received the owner's proposal for protection work under section 84 of the **Building Act 1993** on [*insert date*] (the ***owner's proposal for protection work***). I **attach** the owner's proposal for protection work to this determination. 6. In making this determination, I have examined the owner's proposal for protection work. *7. Before making this determination, I requested the following additional information from the owner under section 87(2)(a) of the **Building Act 1993** [*specify relevant information*]. I received this information on [*insert date*]. *****8. On [*insert date*], I made a copy of the additional information (referred to in paragraph 7 above) available to the adjoining owner. *****9. In determining the appropriateness or otherwise of the owner's proposal for protection work, I made the following inquiries under section 87(3) of the **Building Act 1993** [*specify any relevant inquiry made*]. 10. After considering all matters required of me under the **Building Act 1993** and the Building Regulations 2018, I determine the owner's proposal for protection work is *appropriate/*not appropriate. **Made by relevant building surveyor** Related building permit no. (if known): Date determination made: **Rights of appeal under section 141 of the Building Act 1993** An owner required to carry out protection work or an adjoining owner may appeal to the Building Appeals Board against— (a) a determination under section 87 of the **Building Act 1993** as to the appropriateness of the work; or (b) a declaration under section 89 of the **Building Act 1993**; or (c) a failure, within a reasonable time, or refusal to make that determination or declaration; or (d) a request under section 87 of the **Building Act 1993** to give more information. **Appeal period** For the purposes of section 146 of the **Building Act 1993**, the prescribed appeal period for an appeal against a determination by the relevant building surveyor under section 87(1) of the **Building Act 1993** is 14 days from the day the owner and the adjoining owner are given notice of the determination. A determination by the relevant building surveyor under section 87(1) of the **Building Act 1993**, does not take effect until— (a) the end of the prescribed appeal period of 14 days, if there is no appeal; or (b) the decision is affirmed on appeal. Sch. 4 Form 10 amended by S.R. Nos 180/2018 reg. 13(1), 40/2019 reg. 30(2). Form 10 Regulation 178 Emergency order This emergency order is made under section 102 of the **Building Act 1993**. *WARNING: THIS ORDER HAS BEEN SERVED IN ACCORDANCE WITH SECTION 236(4A) OF THE **BUILDING ACT 1993**. UNDER SECTION 236(7) OF THAT ACT, IT IS AN OFFENCE FOR A PERSON TO REMOVE OR DEFACE THIS ORDER WITHOUT THE PRIOR CONSENT OF THE RELEVANT BUILDING SURVEYOR, THE RELEVANT COUNCIL OR THE VICTORIAN BUILDING AUTHORITY. THE MAXIMUM PENALTY FOR THIS OFFENCE IS 500 PENALTY UNITS FOR A NATURAL PERSON AND 2500 PENALTY UNITS FOR A BODY CORPORATE. The *owner/*occupier/*builder/*person or class of person [*insert full name or describe class of person*] Of [*insert address for service on the owner, occupier, builder or person or class of person*] ***AND TO:** Any other person or class of person [*insert full name or describe class of person*] Of [*insert address for service on person or class of person*] I am the municipal building surveyor of [*insert name of municipal district*]. The municipal building surveyor is authorised to cause an emergency order to be served on the *owner/*occupier/*builder of the *building/*land/*place of public entertainment to which this order applies under Division 1 of Part 8 of the **Building Act 1993**. **LOCATION OF THE** ***BUILDING/*****LAND/*****PLACE OF PUBLIC ENTERTAINMENT TO WHICH THIS ORDER APPLIES:** I, being the municipal building surveyor, order that: *****1. By [*insert time*] on [*insert date*], the *owner/*occupier of [*insert description and address of building, land or place* *of public entertainment*] must evacuate the *building/*land/*place of public entertainment. *****2. By [*insert time*] on [*insert date*], [*specify the person or class of person served with this order*] must vacate the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*]. **Note:** This order may only be made if order 1 is made. *****3. At [*insert time*] on [*insert date*], entry into the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] by [*specify person or class of person served with this order*] is prohibited for a period of [*insert period of time of prohibition*]. *****4. At [*insert time*] on [*insert date*], use of the *building/*land/*place of public entertainment [*insert description and address of building, land or place of public entertainment*] by [*specify person or class of person served with this order*] is prohibited for a period of [*insert period of time of prohibition*] for [*specified prohibited use*]. *****5. At [*insert time*] on [*insert date*], occupation of the *building/ *land/ *place of public entertainment [*insert description and address of relevant building, land or place of public entertainment*] by [*specify person or class of person served with this order*] is prohibited for a period of [*insert period of time of prohibition*]. *****6. The *owner/*occupier of the place of public entertainment [*insert description and address of place of public entertainment*] must not conduct nor allow the conduct of a public entertainment at this place of public entertainment. *****7. The *owner/*occupier of the place of public entertainment [*insert description and address of place of public entertainment*] must immediately cease to conduct *all/*specified public entertainment [*specify public entertainment to be ceased if applicable*] at this place of public entertainment. *****8. By [*insert time*] on [*insert date*], the *owner/*occupier must stop building work on the *building/*land/*place of public entertainment [*insert description and address of building, land or place of public entertainment*] that is [*insert description of building work that must stop*]. *****9. By [*insert time*] on [*insert date*], the *owner/*occupier of [*insert description and address of building, land or place of public entertainment*] must carry out the following building work or other work [*insert detailed description of building work or other work required to be carried out by this order*] to make the *building/ *land/*place of public entertainment safe. *****10. By [*insert time*] on [*insert date*], the *owner/*occupier of [*insert description and address of building, land or place of public entertainment*] must carry out the following building work or other work [*insert detailed description of building work or other work required to be carried out by this order*] to secure the *building/ *land/*place of public entertainment from access. *****11. By [*insert time*] on [*insert date*], the owner must cause the *building/*land/*place of public entertainment [*insert description and address of relevant building, land or place of public entertainment*] to be inspected by [*name of specified person*]. *****12. By [*insert time*] on [*insert date*], the *owner/*builder must cause [*specified material*] used in the *building/*land/*place of public entertainment [*insert description and address of building, land or place of public entertainment*] to be tested by [*name of specified person*]. *13. By [*insert time*] on [*insert date*], the *owner/*builder must cause [*insert the building product or material*] used in the building [*insert description and address of building*] to be destructively tested by a prescribed testing authority. 14. The *owner/*builder must provide the results of the destructive testing to *the municipal building surveyor/*[*name and address of other person authorised by the municipal building surveyor to receive the results*] within [*specified time*] after the prescribed testing authority completes the destructive testing. *The date and time of any inspection of the *building/*land/*place of public entertainment carried out by me, as the municipal building surveyor, are: [*list any inspections carried out by municipal building surveyor*] *The date and time of any inspection of the *building/*land/*place of public entertainment relied on by me as the municipal building surveyor for the purpose of making this order, and the name and qualifications of the person or persons who conducted the inspection, are: [*List details of any inspections relied on by the municipal building surveyor*] **REASON(S) WHY THIS EMERGENCY ORDER WAS MADE:** In accordance with section 102 of the **Building Act 1993**, I am of the opinion that this order is necessary because of a— ***Danger to life arising out of the condition of the *building/*land/*place of public entertainment** [*state reason(s) why the condition of the building, land or place of public entertainment causes a danger to life*] ***Danger to life arising out of the use of the *building/*land/*place of public entertainment** [*state reason(s) why the use of the building, land or place of public entertainment causes a danger to life*] ***Danger to life arising out of a proposed use of the *building/*land/ *place of public entertainment** [*state reason(s) why a proposed use of the building, land or place of public entertainment may cause a danger to life*] ***Danger to property arising out of the condition of the *building/*land/ *place of public entertainment** [*state reason(s) why the condition of the building, land or place of public entertainment causes a danger to property*] ***Danger to property arising out of the use of the *building/*land/*place of public entertainment** [*state reason(s) why the use of the building, land or place of public entertainment causes a danger to property*] ***Danger to property arising out of a proposed use of the *building/ *land/*place of public entertainment** [*state reason(s) why a proposed use of the building, land or place of public entertainment causes a danger to property*] **EMERGENCY ORDER MADE AND SERVED BY:** **The municipal building surveyor** Municipal district: Emergency order no.: Sch. 4 Form 11 amended by S.R. Nos 180/2018 reg. 13(2), 40/2019 reg. 30(3). Form 11 Regulation 180 building notice This building notice is served under section 106 of the **Building Act 1993**. *WARNING: THIS NOTICE HAS BEEN SERVED IN ACCORDANCE WITH SECTION 236(4A) OF THE **BUILDING ACT 1993**. UNDER SECTION 236(7) OF THAT ACT, IT IS AN OFFENCE FOR A PERSON TO REMOVE OR DEFACE THIS NOTICE WITHOUT THE PRIOR CONSENT OF THE RELEVANT BUILDING SURVEYOR, THE RELEVANT COUNCIL OR THE VICTORIAN BUILDING AUTHORITY. THE MAXIMUM PENALTY FOR THIS OFFENCE IS 500 PENALTY UNITS FOR A NATURAL PERSON AND 2500 PENALTY UNITS FOR A BODY CORPORATE. *I am the private building surveyor appointed to carry out functions under the **Building Act 1993** in relation to the *building/*land/*place of public entertainment which is the subject of this notice. I am authorised to cause a building notice to be served on you, as owner of the *building/*land/*place of public entertainment to which this notice applies, under Division 2 of Part 8 of the **Building Act 1993**. **LOCATION OF THE *BUILDING/*LAND/*PLACE OF PUBLIC ENTERTAINMENT TO WHICH THIS NOTICE APPLIES:** *The date and time of an inspection of the *building/*land/*place of public entertainment carried out by myself as the relevant building surveyor was: *The date and time of an inspection relied on by myself as the relevant building surveyor for the purpose of serving this notice, and the name and qualifications of the person or persons who conducted the inspection, are: **REASON(S) WHY THIS NOTICE WAS SERVED:** In accordance with section 106 of the **Building Act 1993**, I am of the opinion that the following *circumstance/*circumstances exist(s): ***Building work carried out without a building permit being issued and in force under the Building Act 1993** The following building work has been carried out on the *building/*land/ *place of public entertainment without a building permit as required by the **Building Act 1993** [*insert description here of building work carried out on the relevant building, land or place of public entertainment without a building permit, including details of when this building work was carried out*] ***Building work carried out in contravention of a building permit** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of a building permit. The particulars of the relevant building permit are: Building permit no.: Date of issue of building permit: The building work that contravenes the building permit is: [*insert description of relevant building work* *and* *state reason(s) why the building work does not comply with the building permit identified above*] A copy of the relevant building permit is **attached** to this order. ***Building work has been carried out in contravention of the Building Act 1993** The following building work has been carried out on the *building/*land/ *place of public entertainment in contravention of the **Building Act 1993**: [*insert description of relevant building work and state reason(s) why this building work does not comply with the* ***Building Act 1993****, using specific references to the section(s) of that Act that have been breached by the building work*] ***Building work carried out in contravention of the Building Regulations 2018 (this includes building work carried out in contravention of the Building Code of Australia)** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of the Building Regulations 2018. [*insert description of relevant building work and state reason(s) why building work does not comply with the Building Regulations 2018, using specific references to the regulation(s) that have been breached by the building work, including clauses of the BCA if applicable*] ***Use of building or place of public entertainment in contravention of the Building Act 1993** The use of the *building/*place of public entertainment contravenes the **Building Act 1993**. [*state reason(s) why use or uses of the building or place of public entertainment do not comply with the* ***Building Act 1993****, using specific references to the section(s) of that Act that have been breached by the use or uses*] ***Use of *building/*place of public entertainment in contravention of the Building Regulations 2018** The use of the *building/*place of public entertainment contravenes the Building Regulations 2018. [*state reason(s) why the use or uses of the building or place of public entertainment do not comply with the Building Regulations 2018, using specific references to the regulation(s) that have been breached by the use or uses*] ***Safety or emergency services, installations or equipment have not been maintained in accordance with the occupancy permit and the Building Regulations 2018** The following safety or emergency service(s), installation(s) or equipment have not been maintained in accordance with the occupancy permit and the Building Regulations 2018. [*insert description of each safety or emergency service, installation or equipment that has not been maintained, using specific references to the regulation(s) or the requirement(s) in the occupancy permit that the emergency service, installation or equipment has not been maintained in accordance with*]. ***Building/*place of public entertainment unfit for occupation or use as a place of public entertainment** *The building is unfit for occupation. *The place of public entertainment is unfit for occupation or for use as a place of public entertainment. [*state reason(s) why the building or place of public entertainment is unfit for occupation or for use as a place of public entertainment*] ***Danger to life, safety or health from *building/*land/*place of public entertainment** The *building/*land/*place of public entertainment is a danger to the life, safety or health of any member of the public or of any person using the *building/*land/*place of public entertainment or to any property. [*state reason(s) why the building, land or place of public entertainment or building work on the building, land or place of public entertainment is a danger to the life, safety or health of any member of the public or of any person using the building, land or place of public entertainment or to any property*] ***Danger to life, safety or health from building work** Building work on the *building/*land/*place of public entertainment is a danger to the life, safety or health of any member of the public or of any person using the *building/*land/*place of public entertainment or to any property. [*state reason(s) why building work on the building, land or place of public entertainment is a danger to the life, safety or health of any member of the public or of any person using the building, land or place of public entertainment or to any property*] ***Failure to comply with a direction to fix building work under Division 2 of Part 4 of the Building Act 1993** There has been a failure to comply with a direction to fix building work under Division 2 of Part 4 of the **Building Act 1993**. [*state reason(s) why the building surveyor issuing this notice believes the direction has not been complied with*] A copy of the relevant direction is **attached** to this notice. **SHOW CAUSE PROCESS:** Under section 108 of the **Building Act 1993**, you are required to show cause within 30 days of the date of service of this notice— *why entry, use, or occupation of the *building/*land/*place of public entertainment should not be prohibited. *why you should not be required to evacuate the *building/*land/*place of public entertainment. *why you should not be required to carry out the building work, protection work or work required by the Building Regulations 2018 identified in this notice in relation to the *building/*land/*place of public entertainment. [*insert description of building work, protection work or other work that may be required by a building order to remedy the circumstances identified in this notice*] **Specified period for making representations:** [*insert specified period for making representations*] **Specified manner for making representations:** The manner for making representations in response to the matters contained in this notice is [*insert specifics of the relevant building surveyor's preferred manner for receiving representations in response to this notice*]. **BUILDING NOTICE SERVED BY:** Building notice no.: Sch. 4 Form 12 amended by S.R. Nos 180/2018 reg. 13(3), 40/2019 reg. 30(4). Form 12 Regulation 182(1) building order (general) This building order is made under section 111 of the **Building Act 1993**. *WARNING: THIS ORDER HAS BEEN SERVED IN ACCORDANCE WITH SECTION 236(4A) OF THE **BUILDING ACT 1993**. UNDER SECTION 236(7) OF THAT ACT, IT IS AN OFFENCE FOR A PERSON TO REMOVE OR DEFACE THIS ORDER WITHOUT THE PRIOR CONSENT OF THE RELEVANT BUILDING SURVEYOR, THE RELEVANT COUNCIL OR THE VICTORIAN BUILDING AUTHORITY. THE MAXIMUM PENALTY FOR THIS OFFENCE IS 500 PENALTY UNITS FOR A NATURAL PERSON AND 2500 PENALTY UNITS FOR A BODY CORPORATE. The *owner/*occupier/*any person/*class of person [*insert full name or describe class of person*] Of [*insert address for service of owner, occupier or person or class of person*] ***AND TO:** Any other person or class of person [*insert full name or describe class of person*] Of [*insert address for service on person or class of person*] *I am the private building surveyor appointed to carry out functions under the **Building Act 1993** in relation to the *building/*land/*place of public entertainment which is the subject of this building order. I am authorised to make a building order under section 111 of the **Building Act 1993**. **LOCATION OF THE *BUILDING/*LAND/*PLACE OF PUBLIC ENTERTAINMENT TO WHICH THIS NOTICE APPLIES:** *1. By [*insert time*] on [*insert date*], the *owner/*occupier of the [*insert description and address of building/land/place of public entertainment*] **MUST** evacuate the *building/*land/*place of public entertainment. *2. By [*insert time*] on [*insert date*], any person or class of person served with this order must vacate the *building/*land/*place of public entertainment [*insert description and address of building, land or place of public entertainment*]. *3. At [*insert time*] on [*insert date*], entry into the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] by [*specify person or class of person served with this order*] is prohibited for a period of [*insert period of time of prohibition*] unless permitted by the municipal building surveyor. *4. At [*insert time*] on [*insert date*], use of the *building/*land/*place of public entertainment [*insert description and address of building, land or place of public entertainment*] by [*specify person or class of person served with this order*] is prohibited for a period of [*insert period of time of prohibition*] for [*specified prohibited use*] unless permitted by the municipal building surveyor. *5. At [*insert time*] on [*insert date*], occupation of the *building/*land/ *place of public entertainment [*insert description and address of relevant building, land or place of public entertainment*] by [*specify person or class of person served with this order*] is prohibited for a period of [*insert period of time of prohibition*] unless permitted by the municipal building surveyor. *6. By [*insert time*] on [*insert date*], the owner of the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] **MUST** carry out the following building work [*insert detailed description of building work required to be carried out by this order*]. *7. By [*insert time*] on [*insert date*], the owner of the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] **MUST** carry out the following protection work [*insert detailed description of protection work required to be carried out by this order*]. *8. By [*insert time*] on [*insert date*], the owner of the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] **MUST** carry out the following other work as required by the Building Regulations 2018 in relation to the *building/*land/*place of public entertainment [*insert detailed description of other work required to be carried out by the Building Regulations 2018, including the BCA. Include references to the relevant regulation and/or clauses of the BCA*]. *9. By [*insert time*] on [*insert date*], the owner must cause the *building/*land/*place of public entertainment [*insert description and address of relevant building, land or place*] to be inspected by [*name of specified person*]. *10. By [*insert time*] on [*insert date*], the *owner/*builder must cause [*describe* *specified material*] used in the *building/*land/*place of public entertainment [*insert description and address of building, land or place of public entertainment*] to be tested by [*name of specified person*]. *11. By [*insert time*] on [*insert date*], the *owner/*builder must arrange for [*insert the building product or material*] used in the building [*insert description and address of building*] to be destructively tested by a prescribed testing authority. 12. The *owner/*builder must provide the results of the destructive testing to *the relevant building surveyor/*[*name and address of other person authorised by the relevant building surveyor to receive the results*] within [*specified time*] after the prescribed testing authority completes the destructive testing. In accordance with section 111 of the **Building Act 1993**, I am of the opinion that the following *circumstance/*circumstances exist(s): ***Building work was carried out without a building permit being issued and in force under the Building Act 1993** The following building work has been carried out on the *building/*land/ *place of public entertainment without a building permit as required by the **Building Act 1993**: [*insert description here of building work carried out on the relevant building, land or place of public entertainment without a building permit*] ***Building work carried out in contravention of a building permit** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of a building permit. The particulars of the relevant building permit are— Building permit no.: Date of issue of building permit: The building work that contravenes the permit is [*describe work*]. [*state reason(s) for why the building work does not comply with the building permit identified immediately above*] A copy of the relevant building permit is **attached** to this order. ***Building work has been carried out in contravention of the Building Act 1993** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of the **Building Act 1993**. The building work that contravenes the **Building Act 1993** is [*describe work*]. [*state reason(s) why building work does not comply with the* **Building Act 1993***, using specific references to the section(s) of that Act that have been breached by the building work*] ***Building work has been carried out in contravention of the Building Regulations 2018 (this includes building work carried out in contravention of the Building Code of Australia)** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of the Building Regulations 2018. The building work that contravenes the Building Regulations 2018 is [*describe work*]. [*state reason(s) why building work does not comply with the Building Regulations 2018, using specific references to the regulation(s) that have been breached by the building work, including clauses of the BCA if applicable*] ***The use of the building or place of public entertainment contravenes the Building Act 1993** The use of the *building/*place of public entertainment as a [*insert description of use*] contravenes the **Building Act 1993**. [*state reason(s) why use or uses of the building or place of public entertainment do not comply with the* **Building Act 1993***, using specific references to the section(s) of that Act that have been breached by the use or uses*] ***The use of the building or place of public entertainment contravenes the Building Regulations 2018** The use of the *building/*place of public entertainment as a [*insert description of use*] contravenes the Building Regulations 2018. [*state reason(s) why the use or uses of the building or place of public entertainment do not comply with the Building Regulations 2018, using specific references to the regulation(s) that have been breached by the use or uses*] ***Safety or emergency services, installations or equipment have not been maintained in accordance with the occupancy permit and the Building Regulations 2018** Safety or emergency services, installations or equipment in the *building/ *land/*place of public entertainment have not been maintained in accordance with the occupancy permit and the Building Regulations 2018. [*detail the safety or emergency services, installations or equipment that have not been maintained, and identify the requirement in the occupancy permit or the Building Regulations 2018 that each safety or emergency service, installation or equipment has not been maintained in accordance with*] ***Building or place of public entertainment is unfit for occupation** *The building is unfit for occupation. *The place of public entertainment is unfit for occupation or for use as a place of public entertainment. [*state reason(s) why the building or place of public entertainment is unfit for occupation or for use as a place of public entertainment*] ***A building or place of public entertainment is a danger to life, safety or health** The *building/*land/*place of public entertainment is a danger to the life, safety or health of any member of the public or of any person using the *building/*land/*place of public entertainment or to any property. [*state reason(s) why the building, land or place is a danger to the life, safety or health of any member of the public or of any person using the building, land or place of public entertainment or to any property*] ***Building work is a danger to life, safety or health** Building work on the *building/*land/*place of public entertainment is a danger to the life, safety or health of any member of the public or of any person using the *building/*land/*place of public entertainment or to any property. [*state reason(s) why building work on the building, land or place is a danger to the life, safety or health of any member of the public or of any person using the building, land or place of public entertainment or to any property*] **DETAILS OF RELEVANT BUILDING NOTICE:** Date of service of building notice: Due date for making representations as specified in the building notice: A copy of the relevant building notice is **attached** to this building order. At the date of making this order, the due date for the owner to make representations has now expired. *Representations were made by the owner. After considering these representations, I am of the opinion that, for the reasons set out in this order, the making of this building order is warranted. *Representations were not made by the owner. *The date and time of any inspection of the *building/*land/*place of public entertainment carried out by myself as the relevant building surveyor was— *The date and time of any inspection relied on by myself as the relevant building surveyor for the purpose of making this order, and the name and qualifications of the person or persons who conducted the inspection are— **BUILDING ORDER MADE BY:** Building order no.: Sch. 4 Form 13 amended by S.R. No. 40/2019 reg. 30(5). Form 13 Regulation 182(2) Building order to stop BUILDING work This building order is made under section 112 of the **Building Act 1993**. OR Other person [*insert name of person other than the owner required by this building order to stop building work*] Of [*insert address for service on person named immediately above*] *I am the private building surveyor appointed to carry out functions under the **Building Act 1993** in relation to the *building/*land/*place of public entertainment which is the subject of this building order. I am authorised by section 112 of the **Building Act 1993** to make this building order. **LOCATION OF THE *BUILDING/*LAND/*PLACE OF PUBLIC ENTERTAINMENT TO WHICH THIS ORDER APPLIES:** **STOP WORK ORDER:** *1. By [*insert time*] on [*insert date*], the owner must stop the following building work on the *building/*land/*place of public entertainment located at [*insert address*]: [*insert description of building work that must stop*]. *2. By [*insert time*] on [*insert date*], [*insert name of person other than owner who is subject to this stop work order*] must stop the following building work on the *building/*land/*place of public entertainment located at [*insert address*]: [*insert description of building work that must stop*]. ***EXEMPT BUILDING WORK:** The following building work or part of the building work is exempt from this stop work order: [*Specify building work that is exempt from the stop work order if the relevant building surveyor considers that it is necessary for the exempt work to be carried out and the reasons for the exemption *in the interests of the safety or security of the building, land or place of public entertainment on which the building work is being carried out/*in the interests of the safety or health of any member of the public/*to prevent a nuisance to members of the public or occupiers of nearby properties.*] *The date and time of any inspection/s of the *building/*land/*place of public entertainment carried out by myself as the relevant building surveyor was— *The date and time of any inspection relied on by myself as the relevant building surveyor for the purpose of making this order, and the name and qualifications of the person or persons who conducted the inspection are— In accordance with section 112 of the **Building Act 1993**, I am of the opinion that— ***Building work contravenes the Building Act 1993** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of the **Building Act 1993**. The building work that contravenes the **Building Act 1993** is [*describe work*]. [*state reason(s) why the building work does not comply with the* ***Building Act 1993****, using specific references to the section(s) of that Act that have been breached by the building work*] ***Building work contravenes the Building Regulations 2018** Building work has been carried out on the *building/*land/*place of public entertainment in contravention of the Building Regulations 2018. The building work that contravenes the Building Regulations 2018 is [*describe work*]. [*state reason(s) why the building work does not comply with the Building Regulations 2018, using specific references to the regulation(s) that have been breached by the building work, including clauses of the BCA where applicable*] ***Building work is a danger to life, safety or health** Building work is a danger to the life, safety or health of any member of the public or of any person using the *building/*land/*place of public entertainment or to any property. The building work that is a danger to life, safety or health is [*describe work*]. [*state reason(s) why the building work is a danger to the life, safety or health of any member of the public or of any person using the building, land or place of public entertainment or to any property*] ***Building work affects the support of any adjoining property** Building work affects the support of any adjoining property. [*state reason(s) why the building work is affecting the stability of any adjoining property, including details of the location of the adjoining property affected*] **BUILDING ORDER TO STOP BUILDING WORK MADE BY:** Building order to stop building work no.: Sch. 4 Form 14 amended by S.R. No. 40/2019 reg. 30(5). Form 14 Regulation 182(3) building order—Minor work This building order is made under section 113 of the **Building Act 1993**. Of [*insert address for service of the owner*] *I am the private building surveyor appointed to carry out functions under the **Building Act 1993** in relation to the *building/*land/*place of public entertainment which is the subject of this building order. I am authorised by section 113 of the **Building Act 1993** to make this building order. **LOCATION OF THE *BUILDING/*LAND/*PLACE OF PUBLIC ENTERTAINMENT TO WHICH THIS ORDER APPLIES:** *1. By [*insert time*] on [*insert date*], the owner of the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] **MUST** carry out the following building work as required by the Building Regulations 2018 [*insert detailed description of work required to be carried out by the Regulations, including the BCA. Include references to the relevant regulation(s) and/or clauses of the BCA*]. *2. By [*insert time*] on [*insert date*], the owner of the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] **MUST** carry out the following protection work [*insert detailed description of protection work required to be carried out by this order, including details of adjoining property that will receive the benefit of this work*]. *3. By [*insert time*] on [*insert date*], the owner of the *building/*land/ *place of public entertainment [*insert description and address of building, land or place of public entertainment*] **MUST** carry out the following other work as required by the Building Regulations 2018 in relation to the *building/*land/*place of public entertainment [*insert detailed description of other work required to be carried out by the Regulations, including the BCA. Include references to the relevant regulation(s) and/or clauses of the BCA*]. **INSPECTION DETAILS:** *The date and time of any inspection/s of the *building/*land/*place of public entertainment carried out by myself as the relevant building surveyor was— *The date and time of any inspection/s relied on by myself as the relevant building surveyor for the purpose of making this order, and the name and qualifications of the person or persons who conducted the inspection are— In accordance with section 113 of the **Building Act 1993**, I am of the opinion that— ***The work required by this order is of a minor nature.** ***Building work of a minor nature is required to be carried out** The building work required by this order is [*describe work*]. [*state reason(s) why building work of a minor nature is required to be carried out*] ***Protection work of a minor nature is required to be carried out** The protection work required by this order is [*describe work*]. [*state reason(s) why protection work of a minor nature is required to be carried out*] ***Other work of a minor nature is required to be carried out** The other work required by this order is [*describe work*]. [*state reason(s) why the other work is required to be carried out*] **BUILDING ORDER MADE BY:** Building order no.: Date made: Form 15 Regulation 186(1) Application for Occupancy Permit Name Class Registration no. This application is made by the *owner/*agent of the owner of the property. Name of applicant *ACN/*ARBN Contact person (if applicant not a natural person) In accordance with *section 42/*section 54 of the **Building Act 1993**, I apply for an occupancy permit for the *building/*place of public entertainment situated at— **Nature of Application** | New building 🞏† Alteration to an existing building 🞏† Place of public entertainment 🞏† Other 🞏† | Amendment to existing occupancy permit 🞏† Change of use of an existing building 🞏† | ***Building permit details** Permit no. ***Building practitioners and architects who were engaged in the building work** Name Category/Class Registration no. Name Category/Class Registration no. **Use applied for** Part of building Proposed use BCA Class of building Part of building Proposed use BCA Class of building To conduct public entertainment 🞏† **Certificates of compliance** Copies of compliance certificates for plumbing work and electrical work are attached in accordance with regulation 186(2)(b). ***Signature of owner** Print name: ***Signature of agent of owner** Print name: *†* *Tick if applicable* Sch. 4 Form 16 amended by S.R. No. 40/2019 reg. 30(6). Form 16 Regulation 192 Occupancy Permit **This occupancy permit must be displayed in the following approved location:** [*insert details of location*] Building permit number Version of BCA applicable to building permit ***Building details** [*complete this portion only if an occupancy permit is required under Division 1 of Part 5 of the* ***Building Act 1993***] *Building to which permit applies Permitted use BCA Class of Maximum permissible floor live Maximum number of people to be load accommodated Storeys contained Rise in storeys (for Class 2-9 buildings) Effective height Type of construction *Part of building to which permit applies Permitted use BCA Class of Maximum permissible floor live Maximum number of people to be load accommodated *****Places of public entertainment** [*complete this portion only if an occupancy permit is required under Division 2 of Part 5 of the* ***Building Act 1993***] | Class 9b building having an area greater than 500 m2 | 🞏† | Place with an area greater than 500 m2 | 🞏† | | --- | --- | --- | --- | | Prescribed temporary structure | 🞏† | Kardinia Park Precinct | 🞏† | Public entertainment to be conducted Period of operation of this permit ***Exemption from, or consent to partial compliance with, certain building requirements** The following exemption from, or a consent to partial compliance with, certain requirements of the Building Regulations 2018 was granted under regulation 229(2), 231(2), 233(3) or 234(2) of the Building Regulations 2018: | **Part or whole of building or place of public entertainment or building work exempt from, or given consent to partial compliance with, requirements of the Building Regulations 2018** | **Nature and scope of exemption** | | | [*specify the relevant regulation/BCA Performance Requirement which the building, place of public entertainment or building work is exempt from or may partially comply with*] | A performance solution was used to determine compliance with the following performance requirements of the BCA that relate to the building or place of public entertainment to which this permit applies: [*list matters not referenced on the relevant building permit*] | | [*insert details of performance solution including, applicable materials, systems, methods of building, procedures, specifications and other relevant requirements*] | ***Building Appeals Board determinations and orders** The following determinations and orders of the Building Appeals Board (***BAB***) relate to the *building/*place of public entertainment to which this permit applies: [*list matters not referenced on the relevant building permit*] | **Date of determination or order** | **Determination or order** | **Section of Building Act 1993 under which application to BAB made** | | | [*insert details of determination or order including applicable materials, systems, methods of building, procedures, specifications and other relevant requirements*] | | ***Reporting authorities** The following bodies are reporting authorities for the purposes of the application for this permit in relation to the matters set out below: | **Reporting authority** | **Matter reported on or consented to** | **Relevant regulation no.** | ***Conditions to which this permit is subject** Occupation is subject to the following conditions— (1) Essential safety measures The following essential safety measures must be inspected, tested and maintained in accordance with the maintenance requirements set out in the following table— | **Essential safety measures required to be provided for the building or place of public entertainment** | **Provision of the Building Regulations 2018 applicable to installation and operation of essential safety measure** | **The level of performance that each essential safety measure must achieve to fulfil its purpose** | **The frequency and type of maintenance required for each essential safety measure** | **The frequency and type of testing and inspections required for each essential safety measure** | | --- | --- | --- | --- | --- | | | | | | | *(2) Other conditions A determination has been made under regulation 64(1) of the Building Regulations 2018 in relation to the building to which this permit applies. ***Subdivision of existing building** The building to which this occupancy permit relates was created by the subdivision of an existing building. An exemption granted in accordance with regulation 231 exempts the building from compliance with certain provisions of the Building Regulations 2018. This exemption was granted by *a municipal building surveyor/*the private building surveyor on [*insert date*], and a copy of this exemption is available by request from the relevant council in accordance with regulation 51. **Suitability for occupation** At the date this occupancy permit is issued, the *building/*place of public entertainment to which this permit applies is suitable for occupation. Occupancy Permit no. Date of issue: Date of final inspection: Form 17 Regulation 200 Certificate of Final Inspection Building permit number Version of BCA applicable to building permit **Description of building work** Part of building Permitted use BCA Class of Part of building Permitted use BCA Class of ***Exemption from, or consent to partial compliance with, certain building requirements** The following exemption from, or a consent to partial compliance with, certain requirements of the Building Regulations 2018 was granted under regulation 229(2), 231(2), 233(3) or 234(2) of the Building Regulations 2018. | **Part or whole of building or place of public entertainment or building work exempt from, or given consent to partial compliance with, requirements of the Building Regulations 2018** | **Nature and scope of exemption** | | | [*specify the relevant regulation/ BCA Performance Requirement which the building, place of public entertainment or building work is exempt from or may partially comply with*] | A performance solution was used to determine compliance with the following Performance Requirements of the BCA that relate to the building to which this permit applies: [*list matters not referenced on the relevant building permit*] | | [*insert details of performance solution including, applicable materials, systems, methods of building, procedures, specifications and other relevant requirements*] | ***Building Appeals Board determination and orders** The following determinations and orders of the Building Appeals Board (***BAB***) relate to the building to which this permit applies: [*list matters not referenced on the relevant building permit*] | **Date of determination or order** | **Determination or order** | **Section of Building Act 1993 under which application to BAB made** | | | [*insert details of determination or order including, applicable materials, systems, methods of building, procedures, specifications and other relevant requirements*] | | **Maintenance determination** A maintenance determination *is/*is not required to be prepared in accordance with regulation 215 of the Building Regulations 2018. A determination has been made under regulation 64(1) of the Building Regulations 2018 in relation to the building work to which this certificate applies. ***Directions to fix building work** All directions to fix building work under Part 4 of the **Building Act 1993** have been complied with. Certificate no.: Date of issue: Form 18 Regulations 229(4), 231(4), 233(5), 234(4) Exemption from, or consent to partial compliance with, REQUIREMENTS IN REGULATIONS *Agent of owner ***Details of relevant building permit** Building permit no. Date of issue of building permit 1. I am the *municipal building surveyor of [*insert name of municipal district*]/*relevant building surveyor for building permit [*insert building permit number*]. 2. I am authorised under regulation *229(2)/*231(2)/*233(3)/*234(2) of the Building Regulations 2018 to *exempt/*consent to partial compliance of a *building/*place of public entertainment/*certain building work from requirements in the Building Regulations 2018 and grant this *exemption/*consent accordingly. *3. The *building/*place of public entertainment/*building work to which this *exemption/*consent applies is [*insert details of building or place of public entertainment*]. *4. The proposed building work to which this *exemption/*consent applies is [*insert description of proposed building work*] (the ***building work***). 5. The following part or whole of the *building/*place of public entertainment/*building work is *given consent to partially comply with/*exempted from compliance with the following requirements in the Building Regulations 2018— (a) [*insert in (a) the part or parts of the building or place of public entertainment or building work exempted from, or given consent to partial compliance with, the Building Regulations 2018*] (b) [*insert in (b) the nature of the scope of exemption from or consent to partial compliance with a requirement of the Building Regulations 2018 and specify the relevant regulation or BCA Performance Requirement etc.*] *6. Description of how the structural adequacy of the *building/*place of public entertainment was taken into account when granting this *exemption/*consent [*insert description*]. 7. Description of the requirements necessary to make reasonable provision for the amenity of the *building/*place of public entertainment subject to this *exemption/*consent that were taken into account [*insert description*]. 8. Description of the requirements necessary to make reasonable provision for the safety and health of people using the *building/*place of public entertainment that were taken into account [*insert description*]. *9. Description of the requirements necessary to make reasonable provision for avoiding the spread of fire to or from any adjoining building that were taken into account [*insert description*]. Items numbered 6 and 9 do not apply to a determination under regulation 234(2) of the Building Regulations 2018. ***Municipal building surveyor/*Relevant building surveyor** Date of *grant of exemption/*consent to partial compliance: Related building permit no. [*if issued before exemption granted or consent given*] Sch. 4 Form 19 amended by S.R. No. 40/2019 reg. 30(7), substituted by S.R. Nos 128/2021 reg. 22, 61/2022 reg. 19. **FORM 19** Regulation 242(2) **APPLICATION FOR ACCREDITATION OF a BUILDING PRODUCT** Building Regulations Advisory Committee Applicant: ***Proposed holder of the accreditation for the building product** (if different from applicant) | A copy of the authorisation, given to the applicant from the proposed holder of the accreditation, to make this application is attached to this form. | 🞏† | **Type of building product** (select one) This application is for: | a building product | 🞏† | | a construction method connected with building work | 🞏† | | a design connected with building work | 🞏† | | a component connected with building work | 🞏† | | a system connected with building work | 🞏† | Regulation 238 of the Building Regulations 2018 defines, for the purposes of Part 17 of those Regulations and this Form, ***building product*** to include a construction method, design, component or system connected with building work. However, the reference in the list above to "a building product" has its ordinary meaning, rather than the defined meaning. **Details of building product** Name of building product: Description of building product: Purpose and use of building product: Method of installation or use of building product: Interaction of building product with other components and materials in building work: **BCA performance requirements that are relevant to the building product:** [*insert performance requirements*] **Means of demonstrating compliance with BCA requirements** The building product meets the following performance requirement(s) of the BCA by the following means: | **Column 1** | **Column 2** | | Performance requirements relevant to the building product [*insert performance requirements*]— | Evidence to demonstrate compliance of the building product with each performance requirement in column 1 [*insert specific evidence and explain how it shows compliance of the building product with the relevant performance requirement*]— | **Documentation or information accompanying application** The application is accompanied by the following— | an appraisal of the building product; | 🞏† | | the appraiser's qualifications and curriculum vitae; | 🞏† | | test report(s) from an Accredited Testing Laboratory or a Registered Testing Authority; | 🞏† | | a technical/installation manual for the building product; | 🞏† | | other information or documentation required by the Committee. | 🞏† | I certify that the information and content contained in this application is complete and correct. Signature of applicant: Sch. 4 Form 19A inserted by S.R. No. 61/2022 reg. 19. **FORM 19A** Regulations 242A(2), 242AB **APPLICATION FOR RENEWAL OR VARIATION OF ACCREDITATION FOR A BUILDING PRODUCT** Building Regulations Advisory Committee Applicant: ***If applicant is making the application on behalf of the holder of the accreditation for the building product** | I have been authorised by the holder of the accreditation to make this application on their behalf. | 🞏† | | A copy of the authorisation from the holder of the accreditation to make this application is attached to this form. | 🞏† | ***Holder of the accreditation for the building product** (if different from applicant) **Type of application** Variation of existing accreditation of building product 🞏† Renewal of existing accreditation of building product 🞏† Certificate No. of existing certificate of accreditation [*insert*] **Type of building product** (select one) This application is for: | a building product | 🞏† | | a construction method connected with building work | 🞏† | | a design connected with building work | 🞏† | | a component connected with building work | 🞏† | | a system connected with building work | 🞏† | Regulation 238 of the Building Regulations 2018 defines, for the purposes of Part 17 of those Regulations and this Form, ***building product*** to include a construction method, design, component or system connected with building work. However, the reference in the list above to "a building product" has its ordinary meaning, rather than the defined meaning. **Details of building product** Name of building product: Description of building product: Purpose and use of building product: Method of installation or use of building product: Interaction of building product with other components and materials in building work: **Details for renewal application** Describe any changes to the building product that have occurred during the previous accreditation period: Detail any changes to requirements or standards applicable to the building product during the previous accreditation period: **Details for variation application** [*Select all applicable*] | transfer the accreditation to another person | 🞏† | | change of name of the holder of the accreditation | 🞏† | | change of postal address, telephone number or email of the holder of the accreditation | 🞏† | | change of building product name | 🞏† | | change of name of one or more components that form part of the accredited building product | 🞏† | | changes to an installation manual for the building product, or to any performance requirement or standard applying to the building product | 🞏† | | changes to the building product to reflect any amendment to a regulation in relation to which the building product was accredited | 🞏† | | changes to conditions imposed on the accreditation by the Committee | 🞏† | | correction of error in the certificate of accreditation for the building product | 🞏† | | other | 🞏† | Describe in detail any variations being sought: **BCA performance requirements that are relevant to the building product:** [*insert performance requirements*] **Means of demonstrating compliance with BCA requirements** The building product meets the following performance requirement(s) of the BCA by the following means: | **Column 1** | **Column 2** | | Performance requirements relevant to the building product [*insert performance requirements*]— | Evidence to demonstrate compliance of the building product with each performance requirement in column 1 [*insert specific evidence and explain how it shows compliance of the building product with the relevant performance requirement*]— | **Documentation or information accompanying application for renewal of accreditation** The application is accompanied by the following— | an appraisal of the building product; | 🞏† | | the appraiser's qualifications and curriculum vitae; | 🞏† | | test report(s) from an Accredited Testing Laboratory or a Registered Testing Authority; | 🞏† | | a technical/installation manual for the building product; | 🞏† | | other information or documentation required by the Committee. | 🞏† | I certify that the information and content contained in this application is complete and correct. Signature of applicant: Sch. 4 Form 19B inserted by S.R. No. 61/2022 reg. 19. **FORM 19B** Regulation 245(1) **CERTIFICATE OF ACCREDITATION** **Name of building product:** [*insert details*] **Building product description:** [*insert details*] **Description of the purpose and use of the building product:** [*insert details*] **Regulation/s in relation to which the building product is accredited:** [*insert details*] **Conditions to which the accreditation is subject:** [*insert details*] **The name and address of the holder of the accreditation:** [*insert details*] **If the holder of the accreditation is a corporation, ACN:** [*insert details*] **Trading name and ABN of the holder of the accreditation:** [*insert details*] **Date building product accredited:** [*insert date of accreditation*] **Certificate number:** [*insert certificate number*] **Date of issue of certificate:** [*insert date of issue*] ***Date building product accreditation renewed:** [*insert date of renewal of accreditation*] **Date of expiry of accreditation:** [*insert expiry date*] ***Date and details of variation of accreditation:** [*insert date on which accreditation varied and details of variation*] ***Date of re-issue of certificate:** [*insert date of re-issue*] **Signature:** [*insert signature of Chair of the Building Regulations Advisory Committee*] **Delete if inapplicable* Sch. 4 Form 20 amended by S.R. No. 75/2018 reg. 27(2). Form 20 Regulation 264(a) NOTICE OF SUSPENSION OF REGISTRATION UNDER SECTION 183A I [*insert name*] give notice that on [*insert date*] my registration as a building practitioner in the category of [*insert registration category*] class of [*insert registration class*] was suspended by the Victorian Building Authority (***VBA***) with respect to the work I am carrying out for you. My registration will be suspended from [*insert date*]. Under section 183A of the **Building Act 1993**, I am required to give you notice of the suspension of my registration. Under section 185 of the **Building Act 1993**, I have the right to apply for an internal review of the VBA's decision to suspend my registration. In reviewing the decision, the VBA may choose to affirm, amend or substitute the decision. Under section 186 of the **Building Act 1993**, I also have the right to apply for a review of the decision to suspend my registration directly to the Victorian Civil and Administrative Tribunal (***VCAT***). VCAT may then choose to affirm, amend or substitute the decision. If I apply for an internal review or a review by VCAT, the suspension of my registration is stayed until a decision is made unless my registration was immediately suspended under section 180A of the Act. **Date** Sch. 4 Form 21 amended by S.R. No. 75/2018 reg. 27(2). Form 21 Regulation 264(b) NOTICE OF CANCELLATION OF REGISTRATION UNDER SECTION 183A I [*insert name*] give notice that on [*insert date*] my registration as a building practitioner in the category of [*insert registration category*] class of [*insert registration class*] was cancelled by the Victorian Building Authority (***VBA***). My registration will be cancelled from [*insert date*]. Under section 183A of the **Building Act 1993**, I am required to give you notice of the cancellation of my registration. Under section 185 of the **Building Act 1993**, I have the right to apply for an internal review of the VBA's decision to cancel my registration. In reviewing the decision, the VBA may choose to affirm, amend or substitute the decision. Under section 186 of the **Building Act 1993**, I also have the right to apply for a review of the decision to cancel my registration directly to the Victorian Civil and Administrative Tribunal (***VCAT***). VCAT may then choose to affirm, amend or substitute the decision. If I apply for a review, the cancellation of my registration is stayed until a decision is made. If I apply for an internal review or a review by VCAT, the suspension of my registration is stayed until a decision is made unless my registration was immediately suspended under section 180A of the Act. **Date** Sch. 4 Form 22 inserted by S.R. No. 116/2019 reg. 15. FORM 22 Regulation 147P(1) APPLICATION TO REGISTER A SWIMMING POOL OR SPA **Ownership details** Name of owner of the land (the ***property***) on which the swimming pool or spa is located: Telephone number: Email address: **Property details:** [*include title details as and if applicable*] **Type of swimming pool or spa:** [*please tick*]: For permanent swimming pools and permanent spas, the approximate date that the swimming pool or spa was constructed: [*please provide copies of any relevant building permit if available and/or any other information or documentation that provides evidence of when the swimming pool or spa was constructed*] For relocatable swimming pools and relocatable spas, the date that the relocatable swimming pool or relocatable spa was erected: Is there any other building work that has altered or resulted in changes to the barrier since the swimming pool or spa was constructed or erected? [*if yes, please provide details and copies of any relevant building permit or other documentation*] Signature of applicant Date Sch. 4 Form 23 inserted by S.R. No. 116/2019 reg. 15. FORM 23 Regulations 147Y(4), 147ZB(2) certificate of pool and spa barrier compliance **Issued to:** 1. Name of owner of the land (the ***property***) on which the swimming pool or spa is located: 2. Postal address: 3. Telephone number: 4. Email address: **Property details:** **Type of swimming pool or spa:** [*please tick*] 5. Date of construction of the swimming pool or spa: 6. Applicable barrier standard: 7. The applicable barrier standard applies under: [*please tick*] - Division 2 of Part 9A of the Building Regulations 2018 🞎 - relevant deemed to satisfy provisions of the BCA 🞎 - a performance solution in accordance with the BCA 🞎 8. Date(s) of inspection(s) of the swimming pool or spa barrier: **Certification of compliance** Following inspection of the *swimming pool barrier/*spa barrier on the date(s) referred to in item 8 of this certificate, I certify that the barrier complies with the applicable barrier standard. Signature of *relevant building surveyor/*swimming pool and spa inspector/*municipal building surveyor: 9. I confirm that I *did/*did not carry out building work on the barrier to address identified non-compliance of the barrier prior to certifying the barrier's compliance with the applicable barrier standard. **Inspector details** 10. Name of registered building practitioner: 11. *ACN/*ARBN 12. Address: 13. Email: 14. Building practitioner registration no.: 15. *Municipal district/*council name: Sch. 4 Form 24 inserted by S.R. No. 116/2019 reg. 15. FORM 24 Regulation 147ZI(1) Certificate of pool and spa barrier non‑compliance **Issued to:** 1. Name of owner of the land (the ***property***) on which the swimming pool or spa is located: 2. Postal address: 3. Telephone number: 4. Email address: **Property details:** **Type of swimming pool or spa:** [*please tick*] 5. Date of construction of the swimming pool or spa: 6. Applicable barrier standard: 7. The applicable barrier standard applies under: [*please tick*] - Division 2 of Part 9A of the Building Regulations 2018 🞎 - relevant deemed to satisfy provisions of the BCA 🞎 - a performance solution in accordance with the BCA 🞎 8. Date(s) of inspection(s) of the swimming pool or spa barrier: **Certification of non-compliance** Following inspection of the *swimming pool/*spa barrier on the date(s) referred to in item 8 of this certificate, I certify that the barrier does not comply with the applicable barrier standard. This certificate of pool and spa barrier non-compliance has been issued because: |  in my opinion the barrier cannot or will not be made compliant with the applicable barrier standard within 60 days; or | 🞎 | |  a written notice was provided to the owner in accordance with regulation 147ZG(1) or 147ZH(1) of the Building Regulations 2018 and the barrier was not made compliant within the time period specified in that notice; or | 🞎 | |  in my opinion the barrier non-compliance poses a significant and immediate risk to life or safety; or | 🞎 | |  in my opinion the barrier is non-compliant with the applicable barrier standard in one or more ways specified in regulation 147ZF(c) of the Building Regulations 2018. | 🞎 | **List of non-compliant items (required):** | *Column 1* *Item number* | *Column 2* *Items/components of swimming pool or spa barrier that are non-compliant with the applicable barrier standard* *[insert ways in which barrier is non‑compliant with the applicable barrier standard]* | *Column 3* *Rectification work required* *[set out the building work required to make the barrier compliant with the applicable barrier standard]* | | 1 | | | | 2 | | | | 3 | | | | 4 | | | | 5 | | | | 6 | | | [*More rows may be added as required*] Any additional comments: Signature of swimming pool and spa inspector: **Inspector details:** 9. Name of swimming pool and spa inspector: 10. *ACN/*ARBN 11. Address: 12. Email: 13. Building practitioner registration no.: 14. *Municipal district/*council name: Sch. 4 Form 25 inserted by S.R. No. 116/2019 reg. 15. FORM 25 Regulation 147ZK(2) BARRIER IMPROVEMENT NOTICE **Served on:** Name of owner of the land on which the swimming pool or spa is located [*insert full name*] I am the municipal building surveyor of the municipal district of [*insert name of relevant council*]. I am authorised to cause a barrier improvement notice to be served on you, as owner of the land to which this notice applies under regulation 147ZK of the Building Regulations 2018. **LOCATION OF THE LAND TO WHICH THIS NOTICE APPLIES:** **REASON WHY THIS NOTICE WAS SERVED:** A certificate of pool and spa barrier non-compliance was lodged with [*insert name of the relevant council*] on [*insert date*] in relation to a swimming pool or spa located on the land described above. A copy of the certificate of pool and spa barrier non-compliance is attached. This certificate lists the matters identified in respect of which the barrier was determined not to comply with the applicable barrier standard. **ACTION REQUIRED:** You are required to bring the matters listed in the certificate of pool and spa barrier non-compliance into compliance with the applicable barrier standard, and to lodge a certificate of pool and spa barrier compliance with the [*insert name of relevant council*] by [*insert date*]. A failure to lodge the required certificate of pool and spa barrier compliance by [*insert date*] is an offence under regulation 147V(1) of the Building Regulations 2018. As a prescribed offence, a failure to comply with this notice may result in the issuing of a building infringement notice which carries a prescribed penalty of 2 penalty units. **Municipal building surveyor** Name of council: [*insert name of relevant council*] Barrier improvement notice no.: Date made: Sch. 5 amended by S.R. No. 132/2023 reg. 21.