Form 1 "Compliance Assessment Application for Plumbing, Drainage and on-Site Sewerage Work" - Queensland, Australia

Form 1 is a Queensland Department of Housing and Public Works form also known as the "Compliance Assessment Application For Plumbing, Drainage And On-site Sewerage Work". The latest edition of the form was released in November 1, 2014 and is available for digital filing.

Download an up-to-date Form 1 in PDF-format down below or look it up on the Queensland Department of Housing and Public Works Forms website.

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Download Form 1 "Compliance Assessment Application for Plumbing, Drainage and on-Site Sewerage Work" - Queensland, Australia

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Version 8 – November 2014
Form 1—Compliance assessment application for plumbing, drainage and
on-site sewerage work
GENERAL NOTES
This form is to be used for the purposes of sections 85, 86 and 86A of the
Plumbing and Drainage Act 2002.
1. Type of application
Compliance permit
Compliance certificate
Compliance permit number (if applicable)
Date the work is proposed to commence
Application for a compliance
permit or for a compliance
certificate.
Related approvals
2. Description of land
Street address (include number, street, suburb/locality and postcode)
The description must identify
all land the subject of the
Lot and plan:
Postcode
application.
Shop/tenancy number
Storey/level
Local government area
The lot and plan details (e.g.
SP/RP) are shown on title
documents or a rates notice.
(if applicable)
(if applicable)
Name (in full)
3. Applicant and owner
details
Identify who is making the
Signature
Date
application. The applicant
need not be the owner of the
land.
Contact person
Phone number
In signing and lodging this
application, the applicant is
responsible for ensuring the
Mobile number
Fax number
Email address of applicant
information provided is true.
The local government will rely
Postal address:
on this information when
assessing the application.
Owner’s name if not the applicant:
Postal address of owner:
Email address of owner (if known)
Name (in full)
4. Responsible person
The responsible person for
compliance assessable work is
QBCC occupational licence number
QBCC contractor licence number
(if applicable)
a person who is licensed to
perform the work and either
performs or directs the
Phone number
Mobile number
Fax number
performance of the work.
If the responsible person for
Email address of responsible person
the work is not known, a
signature in this part is not
required. However, if this
Postal address
section is not signed a Form 7
Postcode
must be completed by the
responsible person and
Signature
Date
provided to the local
government prior to requesting
an assessment of the work.
5. Sanitary plumbing
If the application is for sanitary plumbing and/or drainage work, provide details of the
and sanitary drainage
proposed work
This section is mandatory if
new
alteration
there is sanitary plumbing
Details (e.g. relocating WC) ________________________________________________
and/or drainage work involved.
Version 8 – November 2014
Form 1—Compliance assessment application for plumbing, drainage and
on-site sewerage work
GENERAL NOTES
This form is to be used for the purposes of sections 85, 86 and 86A of the
Plumbing and Drainage Act 2002.
1. Type of application
Compliance permit
Compliance certificate
Compliance permit number (if applicable)
Date the work is proposed to commence
Application for a compliance
permit or for a compliance
certificate.
Related approvals
2. Description of land
Street address (include number, street, suburb/locality and postcode)
The description must identify
all land the subject of the
Lot and plan:
Postcode
application.
Shop/tenancy number
Storey/level
Local government area
The lot and plan details (e.g.
SP/RP) are shown on title
documents or a rates notice.
(if applicable)
(if applicable)
Name (in full)
3. Applicant and owner
details
Identify who is making the
Signature
Date
application. The applicant
need not be the owner of the
land.
Contact person
Phone number
In signing and lodging this
application, the applicant is
responsible for ensuring the
Mobile number
Fax number
Email address of applicant
information provided is true.
The local government will rely
Postal address:
on this information when
assessing the application.
Owner’s name if not the applicant:
Postal address of owner:
Email address of owner (if known)
Name (in full)
4. Responsible person
The responsible person for
compliance assessable work is
QBCC occupational licence number
QBCC contractor licence number
(if applicable)
a person who is licensed to
perform the work and either
performs or directs the
Phone number
Mobile number
Fax number
performance of the work.
If the responsible person for
Email address of responsible person
the work is not known, a
signature in this part is not
required. However, if this
Postal address
section is not signed a Form 7
Postcode
must be completed by the
responsible person and
Signature
Date
provided to the local
government prior to requesting
an assessment of the work.
5. Sanitary plumbing
If the application is for sanitary plumbing and/or drainage work, provide details of the
and sanitary drainage
proposed work
This section is mandatory if
new
alteration
there is sanitary plumbing
Details (e.g. relocating WC) ________________________________________________
and/or drainage work involved.
6. Fixtures to be
Indicate the number of fixtures to be installed:
installed
sinks:
basins:
urinals:
showers:
Completion of this section is
baths:
W.C.s:
laundry tubs:
mandatory. A fixture pair may
be considered one fixture.
other:
Total number of fixtures:
If the application is for a new connection, or disconnection of an existing water service,
7. Water supply
complete the following:
Examples of supply details may
(a)
size of the service required (if known) _____mm
include dual reticulation or
recycled water.
(b)
purpose of the water service (tick applicable boxes)
Completion of this section is
domestic
industrial
commercial
fire
mandatory if there is water
(c)
nature of the work (tick applicable boxes)
supply plumbing work. If a prior
approval from the distributor-
new
alteration
retailer is NOT provided with
Note—SEQ local governments cannot grant certain compliance permits or compliance
this application, the applicant
certificates unless the distributor-retailer has approved the associated connection,
may need to obtain an approval
connection change or disconnection to its water infrastructure; or it is a class of work that
prior to the local government
does not require distributor-retailer approval (Plumbing and Drainage Act 2002, section
issuing a compliance permit.
85(7A) and 86(9A)).
8. Disposal of
All applications must be accompanied by an on-site sewerage evaluation report. If the
application is for an on-site sewerage facility or greywater use facility, provide details of the
wastewater in
following:
unsewered area
Type of facility
Completion of this section is
on-site sewerage facility
greywater use facility
mandatory if there is an on-site
sewerage facility or a
Treatment Plant CEA Number: __________
greywater use facility.
service requirements (e.g. frequency of servicing (if known):
A Chief Executive Approval
(CEA) number must be
_________________________________
included for any on-site
sewerage treatment plant or
brand:_______________________
model:__________ capacity:______________
greywater treatment plant.
septic tank
holding tank
brand:_______________________
model:__________ capacity:______________
Description of work
new dwelling
connect to existing facility
conversion from septic to
treatment plant
Number of bedrooms in dwellings to be serviced by the facility:________________
PRIVACY NOTICE: The information on this form is collected as required under the Plumbing and Drainage Act 2002 (PDA) by local
governments. This information may be stored in the local government database and will be used for purposes related to deciding an
application and monitoring compliance under the PDA. Your personal information will be disclosed to the financial institution which
handles the local government’s financial transactions and may be disclosed to other local government agencies, local government
authorities, the Queensland Building and Construction Commission and third parties for purposes relating to administering and
monitoring compliance with the PDA. Personal information will otherwise only be disclosed to third parties with your consent or in
accordance with the Information Privacy Act 2009.
RTI: The information collected on this form will be retained as required by the Public Records Act 2002 and other relevant Acts and
regulations, and is subject to the Right to Information regime established by the Right to Information Act 2009.
DATE
RECEIVING OFFICER’S
FEE ($)
REFERENCE NUMBER/S
NAME/S
RECEIVED
©The State of Queensland (Department of Housing and Public Works) 2014. Published by the Queensland Government, November 2014, 41 George Street, Brisbane
Qld 4000.
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