Development Application IDAS Forms 1 & 6 - OPW12/0468

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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 Public Records Act 2002.



OFFICE USE ONLY

 Date received                                              Reference numbers



NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

 To
       I                                I   Coune i I. I have bee n en gaged as th e private ce rtifi e r for the build ing work referred

                                            to in this application




                                                                                                                  Building
Date of engagement        Name                                             BSA Certification license number
                                                                                                                  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 18 Oecember 2009