Development Application IDAS Forms 1 & 6 - OPW12/0510

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     Privacy-the information collected in this form 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 legislation (including the Right to Information Act 2009) or as required

     by Parliament. This information may be stored in a de                            mental database. The information collected will be retained as
     required by the Public Records Act 2002.



     OFFICE USE ONLY
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                                                                     ~"{rtGle.z        een   engaged as the private certifier for the building work referred
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     Date of engagement                \ Name
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                                                                                                   BSA Certification license number
                                                                                                                                       Building
                                                                                                                                       classification/s




     QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                                                                                                                     Date receipted
                                                        QLeave Project              Amount paid                      form sighted by   Name of officer who
     Description of the work                                                                            Date paid
                                                        Number                      ($)                              assessment        sighted the form
                                                                                                                     manager




      The Sustainable PlanningAct 2009 (SPA)is administered by the
                                                                                                Department of Infrastructure and Planning. This form and
      all other required application materials should be sent to
                                                                                          your assessment manager and any referral agencies.



                   7                                                                                                 Application details-IDAS form 1
                                                                                                                        Version 1.0 18December 2009