08/0803 - MCU - Multiple Housing Type 2 - Duplex [As Published] · 132008.803

 

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

* 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, $127 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 .

 

‘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 aff documentation submitted with this form, incleding other Parts of Form 1, or owner's consent, efc, are securely attached to this Part of the Form.

 

 

 

 

 

~ "Description of attachment or information «| Tit e . ' ° a

: : Pan (if applicable) Method of delivery to.

Table | (eg. oe adeventiontnt oe 2S, Se mea source {e.9. General Authority, James StreetTraffic Report} Date assessment manager
1 Part D

 

 

2 Referral Checklist
3 Proposal Report R 00965 -01-A April 2008

Portable Long'Service Leave (PLSL).Jevy (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: ( Tick box if applicable)

 

 

 

 

 

 

 

 

(] 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 1997, 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);

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

(_] 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 (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.
14... !s payment of a PLSL levy applicable to. this application? (Refer to Q10 and the Advice below for more information)?
[e] No - EndofPart A

(1) Yes - Answer Q12 below

 

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

. Receiving officer’
Fee ($) 2-900 Date received | (, iA of se rane cers Pr D ‘ Reference 08 / FOS

 

 

 

 

 

 

 

 

 

 

 

 

 

INOTIFICATION OF. ENGAGEMENT OF PRIVATE CERTIFIER

 

 

 

 

 

 

To: Council. | have been engaged as the private certifier for the building work referred to in this
. application.
aber a — - : —— aT — ; ae
'Name .| 'BSA Certification number i Building classification/s
- engagement - :

 

 

 

 

 

 

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

 

‘Date receipted | ~
. : .
Description-of the work = -|,_ QLeave Project Number jAmount paid ($)i Date paid * form sighted by’P Name of feo Sighted the
assessment ; form
manager‘ .

 

Li |
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 {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,