S235851 · OPW21/0118

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Description of work

  DWELLING RENOVATION / EXTENSION


Type of work *

  HOUSING


Estimated start date *                          Estimated finish date *

  06 Oct 2020                                     01 Feb 2022


Project owner

     Select if project owner details are the same as payer details


Building and construction work address

Lot number                 Plan number

  786                         48111


Local council *

  NOOSA SHIRE COUNCIL


Building and construction work address line 1 *

  8 ARAKOON CRESCENT


Building and construction work address line 2

  SUNSHINE BEACH


Suburb *                          State *                    Postcode *

  SUNSHINE BEACH                      QLD                       4573




Assessment manager (building certifier - private or local council)
Has an assessment manager (building certifier - private or local council) been appointed? *

     Yes                                                                       No




Owner builder
Are you completing this work under an owner builder permit issued by the Queensland Building and Construction Commission (QBCC)? *

     Yes                                                                       No


To complete this form as an owner builder you must have first applied and received an owner builder permit from the Queensland Building and
Construction Commission. Please visit the QBCC web site for more information.




Principal contractor details

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Has a principal contractor been appointed? *

If a Principal Contractor has been appointed it is a requirement under the Work Health and Safety Regulation 2011 s(293) to advise who the
Principal Contractor is.

For more information please visit www.worksafe.qld.gov.au - Principal Contractors.


     Yes                                                                      No


Australian Business Number *

  76 770 727 829


Entity name

  The trustee for kernohan family


Business / Trading name




Principal contractor contact name                Principal contractor contact number

  DARREN KERNOHAN                                  0408901271




Cost of work

Cost of work
Total cost of work in whole dollars only (excluding GST) *


  $2,907,607



Leviable cost of work

  $2,907,607



Amount payable

Portable Long Service Leave Levy

  $10,176.88


Construction Skills Queensland Levy

  $2,907.61


Work Health and Safety Levy

  $3,634.51


Total levy payable

  $16,719.00




Process submission

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 Declaration

            •   I certify that the information provided is true, correct and complete to the best of my knowledge and belief, knowing it is an offence to
                provide false or misleading information.*


            •   I agree that this declaration is to be used within the meaning of the Electronics Transactions (Queensland) Act 2001 as an electronic
                communication containing my signature for the purpose of that Act.*



Amount due

  $16,719


Please select a payment option *

                                                        Paying online is safe and easy with our secure Credit/Debit Card facility. Confirmation of
     Credit/Debit Card
                                                        notification and payment will be issued immediately upon payment.The following cards are
                                                        accepted:




     Other payment options



EFT/Invoice *

     EFT

     Request an invoice


Do you require confirmation of notification and payment once QLeave has received your payment? *

    Yes                                                                             No


EFT

Upon submission an e-mail will be sent to [email protected] with QLeave’s bank account details for the electronic funds transfer.

Once QLeave receives your payment, a confirmation of payment will be emailed to the contact person listed on this form:
[email protected]



QLeave banking details -

Bank: Commonwealth Bank of Australia
Account Name: QLeave
BSB: 064-013
Account Number: 10006042
Reference: S235851