08/0531 - Op Works - Dam [As Published] · 142008.531

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

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

 

Table | Description of attachment or information

" k Title (if applicable) Method of delivery to
(ag. Pat C Free coset eee (eg. General Authority James Street Trafic Report) | Date assessment manager

 

 

 

 

 

 

 

 

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)
(1 the application seeks a preliminary approval only;

D 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
contralling weeds or pests);

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

C2 the work is being carried out under an owner-builder permit issued under the Queensland Building Services Authority Act 1991 -
Complete and submit a Ql.eave Notification and Payment Form (no 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 to Q10 and the Advice below for more information)
ZINo ~ End of Part A C1 Yes - Answer Q12 below

12. Has the PLSL levy been paid?

oO No = (NOTE: An application 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 levy you will need to complete and submit a Notification
and Payment Form to QLeave.)

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

. A QLeave Project Number
Table L Amount paid Date paid {6 digits, starting with A, 8, E, L or P)

 

 

 

 

 

 

 

 

 

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

 

 

A Receiving Reference
Fee (8) Date received officer's name 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 Certification license number Building classification/s

 

 

 

 

 

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

 

Amount paid Date receipted form
Description of the work QLeave Project Number 6) Pi 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 persona! details will nol be disclosed for a purpose outside of the IDAS process, except where required by legislation {including the Freedom of Information Act 1992) or
as required by Parliament. 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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