Development Application part 1 of 2 · OPW12/0222

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         ODD
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 departmental database. The information collected will be retained as
required by the PublRecords Act 2002.



OFFICE USE ONLY

    Date received                                             Reference numbers



NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

    To

         I                                 I   Council. I have been en gaged as the private certifier for the build ing work referred
                                               to in this application



                                                                                                               Building
    Date of engagement        Name                                         BSA Certification license number
                                                                                                               classificationJ 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