DBW Application - 30 Upper Pinbarren Creek Rd Pinbarren

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

 Date received:                                Reference numbers:

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

 Name                                                       QBCC Certification Licence     QBCC Insurance receipt
                                                            number                         number



 Notification of engagement of alternative 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


 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work
 QLeave project number
 Amount paid ($)                                                    Date paid (dd/mm/yy)
 Date receipted form sighted by assessment manager
 Name of officer who sighted the form

 Additional building details required for the Australian Bureau of Statistics
 Existing building use/classification? (if applicable)
 New building use/classification?
 Site area (m2)                                                     Floor area (m2)




                                                                                                                        Page 6
                                                                                               DA Form 2 - Building work details
                                                                                                 Version 1.2— 7 February 2020