IDAS Forms REC17/0013

                                                                         Department of Infrastructure. Local Government and Planning


Question 10a
• The portable long service ieave levy need not be paid when the application is made, but the Building and
  Construction Industry (Portable Long Service Leave) Act 1991 requires the levy to be paid before a development
  permit is issued.
• Building and construction industry notification and payment forms can be completed on the QLeave website at
  www.qleave.qld.gov.au.   For further information contact QLeave on 1800 803481.


Privacy-The    information collected in this form will be used by the Department of Infrastructure, Local Government
and Planning (DILGP), assessment manager, referral agency andlor building certifier in accordance with the
processing and assessment of your application. Your personal details should not be disclosed for a purpose outside of
the IDAS process or the provisions about public access to planning and development information in the Sustainable
Planning Act 2009, except where required by legislation (including the Right to Information Act 2009) or as required by
Parliament. This information may be stored in relevant databases. The information collected will be retained as
required by the Public Records Act 2002.


OFFICE USE ONLY

 Date received     ____________                           1   Reference numbers

NOTIFICATION     OF ENGAGEMENT                OF A PRIVATE CERTIFIER

 To                                                           Council. I have been engaged as the private certifier for the
       ~-   -                            -                I   building work referred to in this application

                                                                            BSA Certification license          Building
 Date of engagement               Name
                                                                            number                             classificationls




QLEAVE NOTIFICATION               AND PAYMENT {For completion        by assessment     manager or private certifier     if
applicable.}

                                                                                             Date receipted
                                                                                                                  Name of officer
                                         QLeave project   Amount paid                        form sighted by
 Description of the work                                                        Date paid                         who sighted the
                                         number           {$}                                assessment
                                                                                                                  farm
                                                                                             manaaer




The Sustainable Planning Act 2009 is administered by the Department of Infrastructure, Local Government and
Planning. This form and all other required applicatian materials should be sent to your assessment manager and any
referral agency.




                                                                                                     IDAS form I-Application details
                                                                                                      Version 4.3-5 December 2016