180373 - DA Form 2 · OPW18/0304

   such disclosure is in accordance with the provisions about public access to documents contained in the Planning
    Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning
    Regulation 2017; or
  required by other legislation (including the Right to Information Act 2009); or
  otherwise required by law.
 This information may be stored in relevant databases. The information collected will be retained as required by the
 Public Records Act 2002.

PART 7 –FOR COMPLETION BY THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:   29/10/2018             Reference numbers:      BA180372

 For completion by the building certifier
 Classification(s) of approved building work

 1a, 10a

 Name                                                 QBCC Certification Licence          QBCC Insurance receipt
                                                      number                              number
 John Dunn                                            A1177643

 Notification of engagement of alternate chosen assessment manager
 Prescribed assessment manager
 Name of chosen assessment manager
 Date chosen assessment manager engaged
 Contact number of chosen assessment manager
 Relevant licence number(s) of chosen assessment
 manager

 Additional information required by the local government
 Confirm proposed construction materials:
                                   ☐ Double brick                  ☐ Steel                         ☐ Curtain glass
 External walls                    ☑ Brick veneer                  ☐ Timber                        ☐ Aluminium
                                   ☐ Stone/concrete                ☐ Fibre cement                  ☐ Other
                                   ☑ Timber                        ☐ Steel                         ☐ Aluminium
 Frame
                                   ☐ Other
 Floor                             ☑ Concrete                      ☐ Timber                        ☐ Other
                                   ☐ Slate/concrete                ☐ Tiles                         ☐ Fibre cement
 Roof covering
                                   ☐ Aluminium                     ☑ Steel                         ☐ Other
 Additional building details required for the Australian Bureau of Statistics
 Existing building use/classification? (if applicable)             1a, 10a
 New building use/classification?                                  1a, 10a
 Site area (m2)                                                    Floor area (m2)                 570m2




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                                                                                     DA Form 2 – Development Application details
                                                                                                   Version 1.1— 22 JUNE 2018