Nicholson Wright A 57 Cochranes Road, Moorabbin Victoria 3189, Australia
Building Surveyors & Inspectors T 03 9555 9511
ABN 49 072 393 741 W www.buildingpermits.com.au
Application Form
Building Act 1993 Building Regulations 2018
Regulation 24 (Schedule 4) Form 1
TO (BUILDING SURVEYOR)
Mr. Jim Tsaganas BS-U 1329
Registration Number Address 57 Cochranes Rd Moorabbin VIC 3189
Mr. Pat Richardson BS-L 38408
PROPERTY DETAILS
Street City /
Number Postcode
Road Suburb
Allotment New Building Floor
Lot/s LP/PS Vol. Folio
Area (m2) Area (m2)
Municipal
Section Parish County Crown Allotment
District
APPLICANT (OWNER / AGENT OF OWNER)
Name Telephone
Postal
Email
Address
Contact
Mobile
Person
Address for Serving and Giving Documents
OWNER (ONLY IF AGENT OF OWNER IS LISTED ABOVE)
Name Telephone
Postal
Email
Address
Contact
Mobile
Person
NATURE OF BUILDING WORK (TICK IF APPLICABLE OR GIVE OTHER DESCRIPTION)
PROPOSED USE OF BUILDING
CONSTRUCTION OF A NEW BUILDING ALTERATIONS TO AN EXISTING BUILDING
REMOVAL OF A BUILDING CHANGE OF USE OF AN EXISTING BUILDING
EXTENSION TO AN EXISTING BUILDING RE – ERECTION OF A BUILDING I INTEND TO CARRY OUT THE WORK
CONSTRUCTION OF SWIMMING POOL/SPA CONSTRUCTION OF POOL/SPA BARRIER AS AN OWNER BUILDER (CIRCLE)
DEMOLITION OF A BUILDING OTHER YES / NO
BUILDER (IF OWNER BUILDER SPECIFY)
Name Telephone
Postal
Email
Address
Contact
Mobile
Person
Project Supervisor
If a registered domestic builder carrying out domestic building work, attach details of the required insurance
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Nicholson Wright A 57 Cochranes Road, Moorabbin Victoria 3189, Australia
Building Surveyors & Inspectors T 03 9555 9511
ABN 49 072 393 741 W www.buildingpermits.com.au
BUILDING PRACTITIONER ENGAGED IN BUILDING WORK
Name Category / Class Registration Number
BUILDING PRACTITIONER(S) ENGAGED TO PREPARE DOCUMENTS
Name Category / Class Registration Number
Name Category / Class Registration Number
COST OF BUILDING WORK
If No, state the Estimated Cost of
Is there a Contract
If Yes, state the Building Work (INCL. the cost of
for the Building YES / NO Contract Price $ labour and materials) and attach $
Work? (Circle)
details of the method of estimation.
STAGE OF BUILDING WORK (IF APPLICATION IS TO PERMIT A STAGE OF WORKS)
Value Of Work
Extent Of Stage
For This Stage $
SIGNATURE
Agent / Owner (Cross out which one is not applicable) Date
By signing this Application Form, you agree that the provision of our service will be subject to our terms of appointment
which are detailed at www.buildingpermits.com.au.
Our terms provide that in the event where your overdue account is referred to a collection agency and/or law firm, you will
be liable for all costs which would be incurred as if the debt is collected in full, including legal demand costs.
As the terms may change, we suggest that you check our website prior to making further applications.
Note 1 Building Practitioner means -
a) a building surveyor; or
b) a building inspector; or
c) a quantity surveyor; or
d) an engineer engaged in the building industry; or
e) a draftsperson who carries out on a business of preparing plans for building work or preparing documentation
relating to permits and permit applications; or
f) a builder; or
g) a person who erects or supervisors the erection of prescribed temporary structures; or
h) a person responsible for a building project or any stage of a building project and who belongs to a class of people
prescribed to be building practitioners
but does not include:
i) an architect; or
j) a person (other than a domestic builder) who does not carry on the business of building.
Note 2 Include building practitioners with continuing involvement in the building work
Note 3 Include only building practitioners with no further involvement in the building work
Note 4 The use of the building may also be subject to additional requirements under other legislation such as the Liquor Control
Reform Act 1998 and the Dangerous Goods Act 1985.
Note 5 If an owner builder there are restrictions on the sale of the building under section 137B of the Building Act 1993. Section
137B prohibits an owner builder from selling a building within 6 ½ years from the completion of the relevant works unless
they have satisfied certain requirements including obtaining compulsory insurance. The Building Commission maintains a
current list of domestic insurance providers.
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