Environmental Building Surveyors
Civic Drive, Greensborough
PO Box 476, Greensborough 3088
Tel: 9433 3243 Fax: 9433 3777
E-mail: nillumbik@nillumbik.vic.gov.au
Homepage: www.nillumbik.vic.gov.au
PROTECTION WORK NOTICE (FORM 3)
To
Adjoining owner .......................................................................................................................................
Postal address..........................................................................................................................................
............................................................................................................................ Post code ..................
And relevant building surveyor Nillumbik Environmental Building Surveyors
Postal address
PO Box 476
Greensborough 3088.
Contact person
Municipal Building Surveyor
Telephone
9433 3243
From
Owner/agent ...........................................................................................................................................
Postal address ........................................................................................................................................
...............................................................................................................................Post code ..................
Contact person ............................................................................
Telephone..............................
In accordance with section 84 of the Building Act 1993, I give notice of my intention to carry out
building work on my land and request your agreement to the proposed protection work.
Property details
Number ............ Lot/s ............. Street/Road.........................................................................................
City/suburb/town .............................................................................................. Post code ..................
LP/PS ...................... Volume............. Folio ............. Municipal District...........................................
Adjoining property details
Number ............ Lot/s ............. Street/Road.............................................................................
City/suburb/town .............................................................................................. Post code ..................
LP/PS ...................... Volume............. Folio ............. Municipal District ............................................
Protection work and program
Nature, location, time and duration of protection works: ...................................................................
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
Signature of owner/agent .................................................................... Date ..........................
NOTE; Under section 85 of the Act, the adjoining owner must respond to this notice by completing
Form 4 within 14 days by:
I.
agreeing to the proposed protection work;
II.
disagreeing to the proposed protection work; or
III.
requiring more information.
Failure to respond will be taken as agreement.
In the case of (ii) and (iii) above a copy of the Form 4 must also be given to the relevant building
surveyor.
The personal information requested on this form is being collected by Council for the purpose of evaluating an
application. This information will be used solely by Council for that primary or directly related purpose. The applicant
understands that the personal information provided is for the purpose of evaluating an application and that they may
apply to Council for access to and/or amendment of the information.
Building Act 1993-Building Regulations 2006 Regulation 602 Form 3