ࡱ> %( !"#${ Tbjbjrr Tjj6?V V OO4h;tVd#n1LE2E2E2t#Dg$p`q{"OOE2E26wROE2O8E2! E21%ݫJ&0Vg   pVV : Building Act 2011, section 39 Building Regulations 2012, regulations 4, 31, 32 Permit authority FORMTEXT       1. Property this application relates to 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       Local government area (if different from permit authority) FORMTEXT       The declaration is related to FORMCHECKBOX  A new building FORMCHECKBOX  Building work to an existing building 2. Details of building work Project name (if any) FORMTEXT      Description of the building and building work FORMTEXT      Main use of building FORMTEXT      Class of building/s (in accordance with the Building Code of Australia (BCA)) FORMTEXT      Estimated value of building work (including GST)$ FORMTEXT      Size of buildingFloor area to be created (m2)  FORMTEXT      Site (lot) area (m2)  FORMTEXT       Reasons why a performance solution, as allowed under the BCA, cannot be found or is not appropriate (please provide copies of relevant expert reports and opinions):  FORMTEXT       3. Owner details Where there are multiple owners, please attach a list with the names and signatures of each owner. 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      Owner s signature* FORMTEXT      Date  FORMTEXT      *If you are authorised to sign on behalf of the owner, please provide your written legal authorisation with your application. Details of the lessee of the building (if not owner occupied) Lessee 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       4. Applicant details Applicant 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       5. Declaration sought  The following declaration is being sought under section 39 of the Building Act 2011 (tick appropriate declaration sought and provide details):  FORMCHECKBOX  A specified building standard does not apply to a specified building, specified incidental structure or specified demolition work (section 39(2)(a) of the Building Act 2011)Provide details (attach additional pages if insufficient space)  FORMTEXT        FORMCHECKBOX  A building standard that applies to a specified building, specified incidental structure or specified demolition work is modified in a specified way. (section 39(2)(b) of the Building Act 2011)Provide details (attach additional pages if insufficient space)  FORMTEXT       6. Details of the independent building surveyor Building surveyor 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 Registration number  FORMTEXT      Level  FORMCHECKBOX  Building Surveying Practitioner Level 1  FORMCHECKBOX  Building Surveying Practitioner Level 2 7. Details of the second independent building surveyor (as previously approved by the Building Commissioner) Building surveyor 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 Registration number  FORMTEXT      Level  FORMCHECKBOX  Building Surveying Practitioner Level 1  FORMCHECKBOX  Building Surveying Practitioner Level 2 8. Statements and other attachments The three statements attached in this application are to be completed by: the applicant; the independent building surveyor; and the second independent building surveyor approved by the Building Commissioner. Second independent building surveyor Prior to completing this form, the applicant must provide the Building Commissioner with the names of at least three suitably qualified and experienced registered building surveyors to assist the Building Commissioner in approving a second independent building surveyor for the purposes of this application. The completed statements must be attached to this application prior to lodgement with the Building Commissioner. Attach other relevant information that may support your application. This may include but is not limited to: plans and specifications; expert technical reports; legal opinions; whether the non-compliance is proposed to be temporary; and any building upgrade plans. Note You should be aware that applying for modification or non-application of a building standard is a very serious request and is not a decision that can be made without substantial justification. The financial burden of complying with building standards is generally not a sufficient reason in itself for modification or non-application of a building standard. Failure to provide sufficient justification may delay the Building Commissioners decision or lead to a refusal to make the declaration being sought. 9. Right of reviewA person who makes an application for a declaration as defined in section 39(1) of the Building Act 2011 may apply to the State Administrative Tribunal for a review of the decision by the Building Commissioner: to not declare that a building standard does not apply; to not declare that a building standard is modified; or as to the modification of a building standard. 10. Statement by applicant I,  FORMTEXT       Full name of applicant being the applicant seeking a declaration under section 39 of the Building Act 2011 in relation to the property at: Address of the property this application relates to: 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       am of the opinion that making the declaration: (complete either (i) or (ii)) is in the public interest for the following reasons (attach additional information if required):  F<нzcccccUC#hSxhSx5CJOJQJ^JaJh#3h;Y"5OJQJ^J,jh#3h;Y"OJQJU^JmHnHu'jh#3h;Y"OJQJU^J!jh#3h;Y"OJQJU^J hUhUCJOJQJ^JaJh#3h;Y"OJQJ^J%h#3h;Y"B*CJOJQJ^Jphh#3h;Y"CJOJQJ^Jh#3h;Y"6CJOJQJ^Jhh;Y"6CJOJQJ^J<VOD $Ifgd'zgdU|kd$$IflpF' t6    44 lapyt&5 $Ifgd'z $$Ifa$gd'z $IfgdJ# $IfgdvD tmb x$IfgdSxgdUkd$$Ifl703& t0644 laytR t $Ifgd'zD F H v         . 0 2 F H J L N P R T V Z f h | ̿yyyyyeyyyyy'jhh ,OJQJU^J,jhh ,OJQJU^JmHnHu'johh ,OJQJU^J!jhh ,OJQJU^Jh ,OJQJ^Jhh ,OJQJ^J h1hCJOJQJ^JaJhSxh;Y"5OJQJ^JaJ#hSxh;Y"5CJOJQJ^JaJ#D F H  0 Z f |q^^^^^^^ Q $IfgdOg $IfgdOggd|kd$$Ifl&  t 0644 lap yt'z | ~      " ( * > ڶڶڶڶڶvڶh ,OJQJ^J'j-hh ,OJQJU^Jhh ,5OJQJ^J'jhh ,OJQJU^Jhh ,OJQJ^J,jhh ,OJQJU^JmHnHu!jhh ,OJQJU^J'jWhh ,OJQJU^J( 2' $IfgdOgkd?$$Ifl47rlfO&uA t0644 laytR t Q $IfgdOg ( P p Ekdk$$Ifl47\lO&rA t0644 laytR t Q $IfgdOg> @ B D F H J L N P ^ j p r ڹڬڬ}}l}Xl'jKhhOJQJU^J!jhhOJQJU^JhhOJQJ^Jhh ,5OJQJ^J'jhh ,OJQJU^Jhh ,OJQJ^Jh ,OJQJ^J,jhh ,OJQJU^JmHnHu!jhh ,OJQJU^J'jhh ,OJQJU^J H  Q $IfgdOg $IfgdOg     " 6 8 : < > @ B D F H J L ˷ˣؕt`'j hhOJQJU^J hhCJOJQJ^JaJhh5CJOJQJ^Jhh5OJQJ^J'j3hhOJQJU^J'jhhOJQJU^JhhOJQJ^J!jhhOJQJU^J,jhhOJQJU^JmHnHu%H J L YR?? 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