Development Application IDAS Forms 1 & 6 · OPW12/0178

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        Privacy-the information collected in this form will be used by the Department of Infrastructure and Planning (DIP)in
        accordance with the processing and assessment of your application. Your personal details will not be disclosed for a purpose
        outside of the IDAS process, except where required by legislation (including the Right to Information Act 2009)or as required

        by Parliament. This inform~tion may be stored in a departmental database. The information colle.cted will be retained as
        required by the Public Recoras"ACct 2002.
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        OFFICE USE ONLY                                 ’-,
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         To                                                      Coyncil. I have   een   engaged as the private certifier for the building work referred
                                                                 to in this app cation




        Date of engagement           Name
                                                                                                                                   Building
                                                                                               BSA Certification license number
                                                                                                                                   c1assificationjs




        QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                                                                                                                 Date receipted
                                                   QLeave Project             Amount paid                        form sighted by    Name of officer who
        Description of the work                                                                     Date paid
                                                   Number                     ($)                                assessment        sighted the form
                                                                                                                 manager




               The Sustainable PlanningAct 2009 (SPA)is administered by the Department of Infrastructure and Planning. This form and
               all other required application materials should be sent to your assessment manager and any referral agencies.




                           7                                                                                      Application details-IDAS form 1
                                                                                                                     Version 1.0 18 December 2009