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S233655 QLeave 125 Lake Macdonald Drive Lake Macdonald
No t if icat io n and Building and
Co st o f Pro cess
Payment Payer det ails co nst ruct io n
wo rk submissio n
Co nf irmat io n wo rk det ails
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Notification and Payment Confirmation
This form is issued in accordance with the Building and Construction Industry (Portable Long
Service Leave) Act 1991 s77(2). Form BCI 14v0.
BUILDING AND CONSTRUCTION WORK DETAILS
QLeave levy number: S233655 Date notified: 15 Sep 2020
Building and construction work description: ROAD WORKS
Lot no.: 140 Plan no.: MCH978
Building and construction work address: 125 LAKE MACDONALD DR
Suburb: LAKE MACDONALD Postcode: 4563
Total cost of work (GST exclusive): $895,952
Total levy paid: $5,152.00
Exempted cost of work (GST exclusive): $0.00
Start date: 01 Oct 2020 Finish date: 24 Dec 2020
Council: NOOSA SHIRE COUNCIL
Certifier: -
Owner: TEATREE PROPERTY PTY LTD ATF THE KAKADU WAY DISC T
Principal contractor: UNKNOWN
QLe ave has issue d t his f orm t o conf irm t hat not if icat ion and payme nt has
be e n re ce ive d. Unde r s.7 7 of t he Building and Construction Industry (Portable
Long Service Leave) Act 1991, all obligat ions have be e n me t .
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Your Assessment Manager (Local Government or Private Certifier - Class A) will require a copy of this form prior to the issue of a development/building permit. CONTACT QLEAVE Unit 1 62 Crockford St, Northgate Q 4013 | PO Box 315, Virginia BC Q 4014 Freecall 1800 803 481 | Email [email protected] | Web www.qleave.qld.gov.au BUILDING AND CONSTRUCTION WORK COMPLETED When your building and construction work reaches practical completion, you will be required to submit your final costs and completion date to QLeave. To provide QLeave with these details please complete the building and construction work completed form available at www.qleave.qld.gov.au and send it to [email protected] PAID Receipt number Date paid Amount paid 56969832505 15 Sep 2020 1:24:27 PM $5,152.00
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Payer details
Entity type Entity type
Registered company / partnership
Payer details Qleave customer number (if known)
006973
Australian Business Number *
69 010 846 385 Validat e
Entity name
MARK BAIN CONSTRUCTIONS PTY LTD
Business trading name
Entity Description
Australian Private Company
Cont act det ails
Contact person *
MICHELLE JACKSON
Contact person phone number (including area
code) *
0754474443
Contact person e-mail address
[email protected]
Post al address
Page 4
Address line 1 *
15 ROSS CRES
Address line 2
Suburb * State * Postcode *
SUNSHINE BEACH QLD 4567
Building and construction work details
Building and construction Description of work
work details
ROAD WORKS
Type of work *
CIVIL ENGINEERING CONSTRUCTION
Your internal job reference number (if applicable)
60125
Estimated start date * Estimated finish date *
01 Oct 2020 24 Dec 2020
Project owner
Select if project owner details are the
same as payer details
Project owner *
TEATREE PROPERTY PTY LTD ATF THE KAKADU WAY DISC T
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Contact person
MARK BAIN
Contact phone number
0754474443
Contact email address
[email protected]
Building and const ruct ion work address
Lot number Plan number
140 MCH978
Local council *
NOOSA SHIRE COUNCIL
Building and construction work address line 1 *
125 LAKE MACDONALD DR
Suburb * State * Postcode *
LAKE MACDONALD QLD 4563
Assessment manager Has an assessment manager (building certifier -
(building certifier - private private or local council) been appointed? *
or local council)
Yes No
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Principal contractor Has a principal contractor been appointed? *
details
If a Principal Contractor has been appointed it is a
requirement under the Work Health and Safety
Regulation 2011 s(293) to advise who the Principal
Contractor is.
For more information please visit
www.worksafe.qld.gov.au - Principal Contractors.
Yes No
Cost of work
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Cost of work Total cost of work in whole dollars only (excluding
GST) *
$895,952
Exemption category
Leviable cost of work
$895,952
Amount payable
Portable Long Se rvice Le ave Le vy
$3,136.11
Cons truction Skills Que e ns land Le vy
$895.95
Work H e alth and Safe ty Le vy
$1,119.94
Total levy payable
$5,152.00
Process submission
Page 8
Declaration
• I certify that the information
provided is true, correct and
complete to the best of my
knowledge and belief, knowing it
is an offence to provide false or
misleading information.*
• I agree that this declaration is to
be used within the meaning of the
Electronics Transactions
(Queensland) Act 2001 as an
electronic communication
containing my signature for the
purpose of that Act.*
Amount due
$5,152
Please select a payment option *
Paying online is safe and easy with our secure
Credit/Debit Card Credit/Debit Card facility. Confirmation of notification
and payment will be issued immediately upon
payment.The following cards are accepted:
Other payment
options
QLe ave
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