Development Application IDAS Forms 1 & 6 - OPW12/0471

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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   Coundl. I have been engaged as the pdvate certifier for the building work referred
                                                 to in this application




Date of engagement        Name
                                                                                                               Building
                                                                            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




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 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 December 2009