OPW14/0010 - Vehicle Crossover application -

   Question 12
   • 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 199t requires the levy to be paid before a development
     permit is issued.
   • Building and construction industry notification and payment forms are available from any Queensland post office or
     agency, on request from QLeave, or can be completed on the QLeave website at www.qleave.qld.gov.au. For
     further information contact QLeave on 1800 803 481 or visit www.qleave.qld.gov.au.


   Privacy-The    information collected in this form will be used by the Department of State Development, Infrastructure
   and Planning (DSDIP). assessment manager, referral agency and!or 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

            ~---------------I
                                                                         building work referred to in this application

                                                                                        BSA Certification license         Building
    Date of engagement                  Name
                                                                                        number                            classification!s




   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                                                                Dafe paid                        who sighted the
                                               number                ($)                                assessment
                                                                                                                            form
                                                                                                        mananer




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




Department of Stale Development, Infrastructure       and Planning
PO Box 15009 City East Old 4002
10113 OGOV (13 74 68)
[email protected]                                                                                           IOAS form f -AppilcallOn details
                                                                                                                       Version 3 0-1 Juty 20 13
www.dsdip.qld.gov.au