From

ContactName
Postal Address
Suburb / State / Postcode
Email / Mobile

Address of Building Work

Brief description of proposed works

To the Municipal Building Surveyor, Council Delegate

I give to Council a copy of the building permit application in accordance with the Building Regulations 2018 and Schedule 2 of the Building Act 1993 for the matter(s) set out below.

Regulations requiring ConsentPlease tick

Regulation / Reporting Matter / Amount Due
(see fee schedule)
130 / Building over an easement vested in Council (additional legal fees and administrative costs may apply if a S173 agreement is required – you will be advised) / $
73 / Setback from a street boundary not complying with reg. 73 / $
74 / Setback from a street boundary not complying with reg. 74 / $
75 / Building height not complying with reg. 75 / $
76 / Site coverage not complying with reg. 76 / $
77 / Impermeable surfaces covering more than 80% of an allotment area / $
78 / Car parking spaces not complying with reg. 78 / $
79 / Side or rear boundary setbacks not complying with reg. 79 / $
80 /

Walls or carports not complying with reg. 80

/ $
81 / Building setbacks not complying with reg. 81 (daylight to existing habitable room window) / $
Regulations requiring Consent, continued…Please tick
Regulation / Reporting Matter / Amount Due
(see fee schedule)
82 / Building setbacks not complying with reg. 82 (solar access) / $
83 / Building design not complying with reg. 83 (overshadowing of secluded private open space) / $
84 / Window or raised open space not complying with reg. 84 (overlooking) / $
85 / Building design not complying with reg. 85 (daylight to new habitable room window) / $
86 / Private open space not complying with reg. 86 / $
87 / Siting of appurtenant Class 10 buildings / $
89 / Front fence height not complying with reg. 89 / $
90 / Fence setback on side or rear boundary not complying with reg. 90 / $
91 / Length or height of side or rear boundary fence not complying with reg. 91 / $
92 / A fence within 9m of an intersection / $
94 / Fence setback not complying with reg. 94 (daylight to existing habitable room window) / $
95 / Fence setback not complying with reg. 95 (solar access) / $
96 / Fence design not complying with reg. 96 (overshadowing of secluded private open space) / $
97 / Mast, pole, aerial, antenna, chimney flue pipe or other service pipe / $
109 / Projections beyond street alignment / $
134 / Building above and below certain public facilities / $
153 / Construction of buildings on land liable to flooding / $
154 / Building on designated land / $
Total / $
Has a Planning Permit been issued? / Yes / No
Details of the relevant building surveyor (if one has been appointed)
Name

Adjoining Neighbours Comments

Have any affected adjoining owners already been consulted (for example using Council’sAffected Owners Consent Form)? / Yes / No
Please clarify and submit if obtained

Supporting Documentation

Together with the design you must provide: Attached

A current copy of the ‘Certificate of Title and 'Title Plan'. / Yes
Clear and legible drawings; including a site plan, floor plan(s) and elevations. These plans must highlight areas of non-compliance with the Building Regulations. / Yes
It is preferred that a written submission describing the proposal and justification under the Minister’s Guidelines is provided. / Yes
Payment of fee / Yes

It is the applicant’s responsibility to ensure that building regulations which require consent and report are identified. Councilwill not assess which regulations require consent and report, and accepts no responsibility for regulations not identified. All enquiries in respect of the regulations applicable to the application should be directed to the relevant building surveyor.

PaymentPlease see fee schedule

Request invoice for online payment details

Cash payments can be taken at the Service Centre: 311 Glenferrie Road, Malvern

Cheque payments are to be made payable to City of Stonnington

Declaration by Applicant

Signature of Applicant / Date
Print Name