10/0632 - Prescribed Tidal Works - Pontoon - Gympie Tc [As Published] · 142010.632

4

@ INTEGRATED PLANNING ACT 1997

Part A. Version 3.1, 3 March 2608

Quwner's consent (if applicable) - fuither information is provided in the advice section al the end of thetonn ~

9. Complete Table H for applications involving a materiai change of use: reconfiguration of a fot: work on land below high-water mark and
not within 2 canal as defined under the Coastal Protection and Management Act 1995. or work on rail corridor land defined under the
Transport Infrastructure Act 1994 - provide details for each owner on @ separate cow. or an an atlachmeni to this form df apphcable

 

Premises.Qwners name/s_
and posial address

fe H

" Details of the premises owned .
(street address or lof on plan description)

Owner's signature*,

Date consent |
was obtained

 

 

 

 

 

 

 

 

* Owner's signature cannot be provided on the form if you intend to submit the application electronically. Owner's consent must be provided to the assessment manager on an
attachment containing appropriate written documentation of the owner's consent. if the owner is a company. 5127 of the Corporations Act 2001 (Cwealth) details how a
company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .

 

 

Table |

 

 

 

Part P

 

Checklist

 

Plans

John Norden 09/159

 

Title search

 

SP Plan

 

Tenure

 

Harbour Master Letter

 

col SIT ml oan] &} atin]

Resource Entitlement

 

 

 

 

 

 

 

Portable Long Service Leave (PLSL) levy (applicable for certain’

 

construction siork valtied over $80,000 caly).

10. The Portable Long Service Leave Levy (PLSL) is not applicable to this application if any of the following apply: ( Tick bax if applicable)

{J the application seeks a preliminary approval only;

(_] the application is not for building and construction work under the Building and Construction Industry (Portable Long Service
Leave) Act 1991, section 3AA (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 controlling weeds or pests}: .

OX] all costs, that relate to the work both directly and indirectly, are tess than $80,000, inclusive of GST: or

(1 the work is being carried out under an owner-builder permit issued under the Queensland Building Services Authority Act 1991 -
Complete and submi a Gleave Notification and Payment Form (no payment required if owner-builder pennit number stated). The receipled form musi be

Siohied by the assessment manager before a devefopment permit car: he given.

11. is payment of a PLSL levy applicable to this application? (Refer to Q10 and the Advice below for more information}?

DX] No - End ot Pan a

(1 Yes - Answer 01? below

 

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

 

Fee ($} Date received

 

 

 

 

Receiving officer's
name

 

 

Reference
numbers

 

 

 

 

NOTIFICATION OF ENGAGEMENT OF PRIVATE CERTIFIER

To: [

 

Council. | have been engaged as the private certifier for the building work referred to in this application.

 

Date of
engagement

 

 

Name |

 

 

"BSA Ceftifcation nunibér

 

Building dassification/s