Operational Works Application OPW17/0039

                                                                        Department of Infrastructure, Local Government and Planning


Question 10a
• The portable long service leave levy need not be paid when the application is made, but the Building and
   Construction Industry (Portable Long Service Leave) Act 1991 requires the levy to be paid before a development
   permit is issued.
• Building and construction industry notification and payment forms can be completed on the QLeave website at
  www.qleave.qld.gov.au.    For further information contact QLeave on 1800803481.


Privacy-The    information collected in this form will be used by the Department of Infrastructure, Local Government
and Planning (DILGP), assessment manager, referral agency andlor building certifier in accordance with the
processing and assessment of your application. Your personal details should not be disclosed for a purpose outside of
the IDAS process or the provisions about public access to planning and development information in the Sustainable
Planning Act 2009, except where required by legislation (including the Right to Information Act 2009) or as required by
Parliament. This information may be stored in relevant databases. The information collected will be retained as
required by the Public Records Act 2002.



OFFICE USE ONLY

 Date received     ____________                           1 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
        ---------------- I
                                                                            BSA Certification license           Building
 Date of engagement               Name                                                                          c1assification/s
                                                                            number




QLEAVE NOTIFICATION               AND PAYMENT (For completion      by assessment      manager    or private certifier    if
applicable.)
                                                                                             Date receipted
                                                                                                                   Name of officer
                                         QLeave project   Amount paid                        form sighted by
 Description of the work                                                       Date paid                           who sighted the
                                         number           (S)                                assessment
                                                                                                                   form
                                                                                             manaqer




The Sustainable Planning Act 2009 is administered by the Department of Infrastructure, Local Government and
Planning. This form and all other required application materials should be sent to your assessment manager and any
referral agency.




                                                                                                        IDAS form I-Application details
                                                                                                         Version 4.3-5 December 2016