Appendix D - 52 Hastings Street, Noosa Heads - Change Application 17.1.19 · 51994.1435.01

(Form 16 continued…)                                                                                                                                     page 2 of 2
5. Basis of certification                           Basis of certification
Detail the basis for giving the certificate and
the extent to which tests, specifications, rules,    As visual inspection
standards, codes of practice and other
publications, were relied upon.




6. Reference documentation                          Reference documentation
Clearly identify any relevant documentation,
e.g. numbered structural engineering plans.
                                                     Building approval documentation

                                                              WD202
                                                              1001
                                                                3101 to 3114

7. Building certifier reference                     Building certifier reference number                         Development approval number
number and development approval
number                                               21406

8. Building Certifier or competent                  Name (in full)
person details
                                                     Paul McHenry
A competent person must be assessed as
competent before carrying out the inspection.       Company name (if applicable)                                Contact person
The builder for the work cannot give a stage
certificate of inspection.                           Gold Coast Building Approvals                               As above
A competent person is assessed by the               Phone no. (business hours)            Mobile no.                          Fax no.
building certifier for the work as competent to
practice in an aspect of the building and            (07) 5596 1308                        0402 534 290                        (07) 5596 1302
specification design, because of the                Email address
individual’s skill, experience and
qualifications. The competent person must be         [email protected]
registered or licensed under a law applying in
the State to practice the aspect.                   Postal address
If no relevant law requires the individual to be     PO Box 1019
licensed or registered, the certifier must
assess the individual as having appropriate          NERANG                                                        State: QLD           Postcode: 4211
experience, qualifications or skills to be able
to give the help.                                   Licence class                                         Licence number
If the chief executive issues any guidelines         Assistant Building Surveyor                           A707778
for assessing a competent person, the
building certifier must use the guidelines          Date approval to inspect received from building certifier
when assessing the person.
                                                     12/12/2012

9. Signature of building certifier,
competent person or QBSA                            Signature                                                          Date
licensee
Note: A building certifier must sign this form
for temporary swimming pool fencing under
section 239(2)(b) of the Building Act 1975.                                                                             13/12/2012