Development Application - Part 1 of 2 - Covering Letter, IDAS Forms 1, 6, 28 & Letter from Dept of Natural Resource & Dept of Transport · OPW11/0301

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


                                                                                                            Building
Date of engagement        Name                                         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                 M                              assessment          sighted the form
                                                                                        manager




 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.


                                                                                           ip/ication details -/0.45 form i
                                                                                           Version Y. o iS December 2009