07/1728 - Change to Development Approval - Boundary Setback [As Published] · 132007.1728.02

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

Attachments and supporting information (Complete Table ! - Use a separate row for each type of attachment or information, including information required under —
this Part} Please ensure all documentation submitted with this form, including other Parts of Form 1, or owner's consent, ete, are Securely attached to this Part of the Form.

 

Description of attachment or information ; "i
Table | Des n Title (if appicable) fe Method of delivery to
("9 Vipesiovondanel gre Savoy mpats) | (28. Comal uty, ome Ste Tate Rep) | OB assessment manager

 

 

18 |e / PRAT A.
heen 2 tH pages pay,

S| AITACHED  pActt/7TECTUL
REIMGEM UAL PLANE

ONO — DELVED

 

 

 

 

 

 

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: (~“box if applicable)
Othe application seeks a preliminary approval onty;

Bithe application is not for building and construction work under the Building and Construction industry (Portable Long Service Leave)
Act 1991, section 3A (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
controfling weeds or pests); .

Call costs, that relate to the work both directly and indirectly, are less than $80,000, inclusive of GST; or *

C1 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 (na 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 fo Q10 and the Advice below for more information)
No - End of Part A C1 Yes - Answer 012 below

12. Has the PLSL levy been paid?
oO No ~ (NOTE: An appfcation can be fodged prior to payment of the applicable PLSL levy. However, the levy must be paid and the receipted form sighted by the

Assessment Manager before a development permit may be given for this application. To pay the fevy you will need to complete and submit a Notification
and Payment Form to Qleave.)

QO Yes - Complete Table L and submit, with the application, the “yellow” (Locel Government's (Council) / Private Certifier's) copy of the receipted QLeave Form.

 

5 , QLeave Project Number
Table L Amount paid Date paid (6 digits, starting with A, BE, L or P)

 

 

 

 

 

 

 

 

OFFICE USE ONLY (For use by the Assessment Manager / Private Certifier) {Optional}

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fee ($) Dale received ome Reference
NOTIFICATION OF ENGAGEMENT OF PRIVATE CERTIFIER
To: NO0 S 67 Council. | have been engaged as the private certifier for the building work referred to in this application.
Date of engagement Name BSA Certification license number Building classification/s

 

 

 

 

6 Je /208 | Kevin) SHAW 1 ~eoNAr) 4702228 | Ja

 

QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)

 

 

 

 

 

 

 

 

 

 

‘Amount paid Oate receipted form
Description of the work QLeave Project Number ($) pat Date paid sighted by Name of officer who sighted the form
assessment manager
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 legislation {inckiding the Freedom of Information Act 1992) or
as required by Parament. This information may be stored in a DIP database. The information collected will be retained as required by the Public Records Act 2002.

 

 

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