001AA83A.001

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     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 Pari} 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 af the Form,
                           ‘Description of attachment or information                 Tithe &        ‘        :                            ‘delivery to:
                                                          .                           itle (if appicable}                       | Method of delivery to
     Table |              (0 Part tC of Form 1, one see fatge rears)      (2.9. General Authodty James Street Traffic Report}   assessment ‘manager
                [1        [IOAS Fom 1 Pats Rand 8                                                             oer 008
                          Kidd + Co Designers Dwg 0522 WD.201 C1 | Demolition Plan Carpark                      04/02/2009
                          Kidd + Co Designers Dwg 0522 WD.203 C1 | Proposed Floor Plan Car Park                 04/02/2009
                  4 | SCG Consulting Engineers Dwg. No. 19138 | Driveway Section Plan                           June 2009
     (Portable Long Service Leave (PLSL) levy (Appicable for certain building and construction work valued over $80,000 only ‘s fee Pe    ise ee és ]
      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 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);
                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.

      11.   Is payment of a PLSL levy applicable to this application? (Refer to Q10 and the Advice below for more information)?
                    No - End of Part A
              []    Yes - Answer Q12 below
      OFFICE USE ONLY (For use by the Assessment Manager / Private Certifier) (Optional)
                                       .                               {Vi         "                                  fer
                                                                        name                                        numbers

     fo.                                     NOTIFICATION OF ENGAGEMENT OF PRIVATECERTIFIER                           =,
    To: fs fear                                                | have been engaged as the private certifier for the building work referred to in this application.

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                     ae                  ee           :Name.    se"         ee      ee           . BSA Certification number | °° Building classification’s

                      QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
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      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 {DAS 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.
      Advice for completing Part A