General notes

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This form is to be used for the purposes of section 19 and 19B of the Standard Plumbing and Drainage Regulation 2003.

  1. Description of land

The description must identify all land the subject of the application.

The lot and plan details (e.g. SP/RP) are shown on title documents or a rates notice.

If the plan is not registered by title, provide previous lot and plan details.

Street address (include number, street, suburb/locality and postcode)



Lot and plan details (attach list if necessary)


Shop/tenancy number Storey/level Local government area




(if applicable) (if applicable)

  1. Description of work

The description must be sufficient to identify the work, for example:

  • installation of water heater

  • plumbing/drainage under a
    floor slab

  • plumbing before cladding
    is applied.

 Compliance permit number  Development application number



 Copy of application for compliance certificate attached

 Provide a brief description of the work below:



  1. Responsible person

The ‘responsible person’ is a person who is licensed to perform the work and either performs or directs the performance of the work.

The local government must be notified of the responsible person when an inspection is requested.

If the responsible person changes during the course of a project you must tell the local government of the new responsible person when requesting the next inspection.

Name (in full)


QBCC Occupational licence number (if applicable) QBCC Contractor licence number



Phone number Email address




Postal address



Signature Date



  1. Other details—new responsible person

The new responsible person must identify at what stage of the project they became the responsible person

Date I commenced being the responsible person for the work


Stage of the work at which I became the responsible person for the work



Signature Date



Privacy:  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.

©The State of Queensland (Department of Housing and Public Works) 2014. Published by the Queensland Government, November 2014, 41 George Street, Brisbane Qld 4000.




Version 7 – November 2014
orm 7—Notification of responsible person

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