00196B01.001

INTEGRATED PLANNING ACT 1997                                                                                           Part A, Version 3.1, 3 March 2008

‘Portable Long Service Leave (PLSL) levy (Applicable for certain building and construction work valued over $80,000 only)                            }
 10.  The Portable Long Service Leave Levy (PLSL) is not applicable to this application if any of the following apply: ( Tick box if applicable)
       {_] the application seeks a preliminary approval only;
       [X] the application is not for building and construction work under the Building and Construction Industry (Portable Long Service
            Leave) Act 1991, section 3AA (e.g. the application is only for a change of use, or for the following types of work carried out solely for
            farming purposes: land clearing, site preparation, earthworks, fences, fodder harvesting, clearing of encroaching vegetation, clearing of
            regrowth, thinning vegetation or controlling weeds or pests);
        [_] all costs, that relate to the work both directly and indirectly, are less than $80,000, inclusive of GST; or
       [_] the work is being carried out under an owner-builder permit issued under the Queensland Building Services Authority Act 1991 -
            Complete and submit a QLeave Notification and Payment Form (no payment required if owner-builder permit number stated). The receipted form must be
            sighted by the assessment manager before a development permit can be given.

 11.   Is payment of a PLSL levy applicable to this application? (Refer to Q10 and the Advice below for more information)?
          DX]   No - End of Part A
          [_]   Yes - Answer Q12 below
 OFFICE USE ONLY (For use by the Assessment Manager / Private Certifier) (Optional)
                                    .            ,             Receiving officer's                                Reference
  Fee (8)! 3 peo | Date received | Do | uley                          name            p) S   d        :            numbers      08 |     1A18

                                          NOTIFICATION OF ENGAGEMENT OF PRIVATE CERTIFIER
To: fF                                         Fear         { have been engaged as the private certifier for the building work referred to in this application.

    Date of                   —_               ,                                                           ey                   a         ee

                  QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                                                                       ,                                  Date receipted   ,
                        Description of the work    QLeave Project Number j Amount paid ($)} Date paid   form sighed by   Name of offer who sighted the
                  :            .                                                                            manager
            Ato
  Privacy Statement
  The information collected on Form 1 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 legistation (including the Freedom of information Act 1992) or as
  required by Parliament. This information may be stored in a DIP database. The information collected will be retained as required by the Public Records Act 2002.
  Advice for completing Part A
  General advice
  °         Part A of IDAS Development Application Form 1 must be completed and accompany all development applications. The applicant is responsible
            for answering all questions fully and correctly, unless following a response there is a statement to go directly to another question. The
            Assessment Manger may refuse to receive an application that is not properly made.
  e         The IDAS Assessment Checklist must also be completed for all development applications, other than those requiring assessment against the
            Building Act 1975 only, i.e. those applications requiring the completion of Parts A and B only.
  Applicant details
  °         If the applicant is a company or organisation, a contact person must be nominated. The applicant's signature is not required to be provided
            under the IPA.