36016 F21

Form 21                 Final Inspection Certificate
                        Single detached class 1a buildings and class 10 buildings or structures



This form is made for the purpose of sections 98 and 99 of the Building Act 1975.
The building certifier for the work must give this signed form to the owner as the final inspection certificate for a single detached
class 1a buildings and class 10 buildings or structures (excluding swimming pools and swimming pool fences) certifying the
work is compliant with the building development approval.
Note: Form 17 – Final inspection certificate – swimming pool fences is the final inspection certificate for a regulated pool under
the Building Act 1975.
Additional explanatory information is included in the Appendix at the end of this form.


1. Owner details
If the owner is a company, a contact person must be shown.
All correspondence will be mailed to this address.

 Name (in full)                         CHRISTINA CAPLE
 Company name (if applicable)

 Contact person

 Business phone number                  0409 552 922                                Mobile

 Email address

 Postal address                         26 ROSS CRES SUNSHINE BEACH Q               4567



2. Property description
The description must identify all land the subject of the application.
The lot and plan details (e.g. SP/RP) are shown on title documents or a rates notice.
If the plan is not registered by title, provide previous lot and plan details.


 Street address     371 GUMBOIL RD, LAKE MACDONALD

 Lot and plan details (attach list if necessary)

 Lot: 8    Plan: RP215096

 Local government area the land is situated in

 NOOSA SHIRE COUNCIL

3. Building description

 Building description


 DEMOLITION OF DWELLING,

 Class of building/structure

 1a




Building Act 1975 • Section 98 and 99 • Form 21 • Version 1 • September 2021                                               Page 1 of 5