ࡱ> { ^bjbjrr ;jjh'''8_'do!8&L&&&]4]] ]\]]]|]]&&6ddd]R&&d]dd &Hk'^x6ɮ0ro^ol o ]]d]]]]]ka]]]]]]]o]]]]]]]]] : Building Act 2011, section 76, 77, 85 Building Regulations 2012, regulation 4 PERMIT AUTHORITY USE ONLYReference number  FORMTEXT      BUILDER / DEMOLITION CONTRACTOR USEReference number  FORMTEXT       Important information for owners of affected land Under the Building Act 2011 (the Act), a person responsible for building or demolition work must not, without notification and consent of each affected owner, encroach or adversely affect land beyond the boundaries of the works land unless each owner of affected land has consented to the work. The person responsible for the work (who could be the builder, demolition contractor or the owner of the land on which the work is done) is required to provide you with details of how your land will be affected. After you receive this form you have 28 days in which to consider what is being proposed. If you are not entirely clear about what is being proposed, you should liaise with the person responsible for the work and request further information. Under section 86 (2A) of the Act the person responsible for work who gives notice or seeks consent may apply to the Magistrates Court for a court order, if: consent is refused - any time after the refusal is given; or the consent sought is neither refused nor given and you do not make a request for further information within the 28 day period after this form was given - after that 28 day period has expired; or the person responsible for the work provides further information in response to your request - 14 days after further information is given. Alternatively, the person responsible for the work has the option of changing the design such that it does not affect your land. In such cases there would be no requirement to notify you or get your consent for the purposes of the Act. You may indicate your response on this form at part 7 and return it to the person responsible for the work. The work affecting your land must not commence without your consent or a court order. It is suggested that you keep a copy of the signed form indicating your consent or refusal for your records. For more information please refer to the Department of Local Government, Industry Regulation and Safety web site at www.lgirs.wa.gov.au/building-and-energy or call 1300 489 099 or email be.info@lgirs.wa.gov.au. 1. Name and postal address of owner(s) of affected land Name of owner(s) of affected land FORMTEXT      Street address (provide lot number where street number is not known)Unit no  FORMTEXT      Street no  FORMTEXT       Level  FORMTEXT      Lot no  FORMTEXT      Street name  FORMTEXT      Street type  FORMTEXT      Street suffix  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT      Country (if not Australia)  FORMTEXT      OR PO Box addressPO Box no  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT      Country (if not Australia)  FORMTEXT       2. Land where work is proposed Property street address (provide lot number where street number is not known)Unit no  FORMTEXT      Street no  FORMTEXT       Level  FORMTEXT      Lot no  FORMTEXT      Street name  FORMTEXT      Street type  FORMTEXT      Street suffix  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT       3. Adjoining land affected by work Property street address (provide lot number where street number is not known)Unit no  FORMTEXT      Street no  FORMTEXT       Level  FORMTEXT      Lot no  FORMTEXT      Street name  FORMTEXT      Street type  FORMTEXT      Street suffix  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT       4. Notifiable event  FORMCHECKBOX  A. Encroachment (section 76 of the Building Act 2011) Encroachment is when part of a building or an associated structure is constructed or placed beyond the boundaries of the land on which work is being carried out. Details of the part of the building or structure that will: encroach on other land, the expected impact and (if applicable) any remedial work following the work being carried out; or encroaches for the purposes of section 58(1)(e).  FORMTEXT        FORMCHECKBOX  B. Adversely affecting (section 77 of the Building Act 2011) Adversely affecting other land includes: reducing the stability or load bearing capacity of the land or a building or structure on the land; damaging, or reducing the structural adequacy of, a building or structure on the land; or the changing of the natural site drainage in a way that reduces the effectiveness of the drainage of the land or existing or future buildings or structures on the land. Details of the part of the building or structure that will adversely affect other land, the expected impact and (if applicable) any remedial work following the work being carried out.  FORMTEXT      *Note: For other types of notifiable events affecting other land use form BA20A. 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Any relevant technical documents in respect of the building work/demolition work. 5. Access for survey  FORMCHECKBOX  I request consent to access the property to carry out a survey of the affected land; or  FORMCHECKBOX  I do not request consent to access the property to carry out a survey of the affected land. Details of proposed survey  FORMTEXT       6. Person responsible for work details Builder / demolition contractor / owner s name FORMTEXT       Street address (provide lot number where street number is not known)Unit no  FORMTEXT      Street no  FORMTEXT       Level  FORMTEXT      Lot no  FORMTEXT      Street name  FORMTEXT      Street type  FORMTEXT      Street suffix  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT      Country (if not Australia)  FORMTEXT      OR PO Box addressPO Box no  FORMTEXT      Suburb  FORMTEXT      State  FORMTEXT      Postcode  FORMTEXT      Country (if not Australia)  FORMTEXT       Email address FORMTEXT      Phone/faxPhone no  FORMTEXT      Fax  FORMTEXT      Registration details (if applicable) Registration number / licence number / owner-builder approval number  FORMTEXT      Builder / demolition contractor / owner s signatureName (print)  FORMTEXT      Signature  FORMTEXT      Date  FORMTEXT       7. Consent (response notice) In accordance with section 85 of the Building Act 2011, I hereby respond to the notice provided to me in respect to the land detailed in part 3 of this form and:  FORMCHECKBOX  I consent to what is proposed in parts 4 and 5 of this notice; or  FORMCHECKBOX  I do not consent to what is proposed in parts 4 and 5 of this notice. Owner s signatureName (print)  FORMTEXT      Signature  FORMTEXT      Date  FORMTEXT       Note: the Building Act 2011 does not affect rights or obligations you may have under other laws.       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