09/1065 - Prescribed Tidal Works - Transport Type 5 - Domestic Marine [As Published] · 142009.1065

INTEGRATED PLANNING ACT 1997 Parl A, Version 3.1, 3 March 2008
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\Gremer’s consent (f applicable) - firthes information is provided in the advice section at the end! of the fora
9, Complete Tabte H for apptications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and

not within a canal as defined under the Coastal Protection and Management Act 1995; or work on rail corridor land defined under the
Transport infrastructure Act 1994 - provide detaits for each owner on a separate row, or on an attachment to this form if applicable.

 

 

 

 

 

 

 

 

 

 

 

 

Premises Owner's namels Details of the premises owned . . Date consent
and postal address (street adress or ton plan description) Owners signature was obtained

1 | Sandy Guthrie 43 Dolphin Crescent Noosaville Mou tine 27105/2008
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2.

2 Michael Guthrie 13 Dolphin Crescent Noosaville Lel| ba 27/05/2009

Table H

 

 

 

 

 

 

 

 

 

 

* 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 tow for each type af aitachment or information, inckiding information required
funder this Part) 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 of the Form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of attachment or information Title applic Method of defi
i plicable} le of delivery to
Table t feg. Pohcsnimenttionen pare are cetenee oat (eg. General Authority. James Street Traffic Report) Date assessment manager
1 | Covering fetter O4-Jun-2009 [mal
2 Neighbours support fetter 29-May-2009 | mail
3 Owners consent forms 27-May-2009 | mail
4 Copy of registered plan mail
+ 5 Engineer's plan of proposed development May 2009 mail
(Portable Long Service Leave (PLSL) fevy (Applicable for certain bulting and construction work valuod over $60,000 ony) J]

 

 

10. The Portable Long Service Leave Levy (PLSL) is not applicable to this application if any of the following apply: ( Tick box if applicable)
LJ the application seeks a preliminary approval only;

(C1 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);

DX] all costs, that relate to the work both directly and indirectly, are less than $80,000, inclusive of GST; or
(J the work is being carried out under an owner-builder permit issued under the Queensland Building Services Authority Act 1997 -
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

(1) Yes - Answer Q12 below

 

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

 

Receiving officer's Reference
name numbers

  

Fee ($) Date received

 

 

 

 

 

 

 

 

 

 

Foote sh Suppo dacurank dete LfEhr
Monte sede Qo suppur jeltey ofed r/oK4