01.5 - Da Form 1 · 132007.616.05

Page 2

PART 2 — LOCATION DETAILS

3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
Note: Provide details below and attach a site plan for any or all premises part of the development application. For further information, see DA Forms

Guide: Relevant plans.
3.1) Street address and lot on plan

 

| Street address AND lot on plan (aii lots must be listed), Or

;QO Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in water
| but adjoining or adjacent to land e.g. jetty, pontoon; all lots must be listed). __

 

 

 

 

 

 

  

 

 

 

  

a) Unit No. | Street No. | Street Name and Type oe | Suburb
| (8 __| Attunga Heights _ |NOOSAHEADS i,
Postcode Lot No. Plan Type and Number (e.g. RP, SP) | Local Government Area(s)
| | 4567 «| 23 RP 89506 OS T Noses Bona 7 |
ee "| UnitNo. | Street b No. | Street Name and Type _| Suburb : Se
byt etre t &5 aa
Postcode | Lot No. Plan Type and Number (e 9. RP, SP) | Local Government Area(s)

Fa SS re per SS Ee ee eee ee ee ee

3.2) Coordinates of premises (appropriate for development in remote areas, over part.of alot or in water not adjoining or adjacent to land e.g.
channel dredging in Moreton Bay)

 

Note: Place each set of coordinates in a separate row. Only one set of coordinates is required for this part.

0 Coordinates of premises by longitude and latitude

ipo

 

 

 

 

Longitude(s) Latitude(s) Datum Local / Government Area(s) (if applicable)
O wese4 |
O1 GDA94
| ee O Other: — ee
| O Coordinates of f premises by easting and northing
Easting(s) Northing(s) Zone Ref. Datum Local Government. Area(s) (if applicable)
| O54 0 wese4
E55 01 GDA94
0 56 O Other:

 

 

3.3) Additional premises

QO Additional premises are relevant to this development application and their details have been attached in a schedule
to this application
_O Not required _

Sib

4) Identify any of the following that apply to the premises and provide any relevant details

O In or adjacent to a water body or watercourse or in or above an aquifer
| Name of water body, watercourse or aquifer:
0 On strategic port land under the Transport Infrastructure Act 1994
| Lot on plan description of strategic port land:
Name of port authority for the lot: Z |
| O Ina tidal area
| Name of local government for the tidal area (if applicable): ————
| Name of port authority for tidal area dr applicable): Po
/OOn airport land under the Airport Assets (Restructuring and Disposal) Act 2008
Name of airport: | _
| O Listed on the Environmental Management Register (EMR) under the Environmental. Protection | Act 1 1994
| EMR site identification: |

0 Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994 |

  

SS Sea ee ee

 

 

 

 

 

 

 

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DA Form 1 — Development Application details

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| CLR site identification: |

lees

 

5) Are there any existing easements over the premises?

Note: Easement uses vary throughout Queensiand and are to be identified correctly and accurately. For further information on easements and how
they may affect the proposed development, see DA Forms Guide

 

| 0 Yes — All easement locations, types and dimensions are included in plans submitted with this development
application

ee ee ee ee ee eS ee ee

PART 3 —- DEVELOPMENT DETAILS

Section 1 — Aspects of development
6.1) Provide details about the first development aspect
a) What is the type of development? (tick only one box)

 

| Material change of use O Reconfiguring a lot __ C1 Operational work 0) Building work
| b) What is the approval type? (tick only one box)
| J Development permit O Preliminary approval O Preliminary approval that includes

| a variation approval
| c) What is the level of assessment?

| & Code assessment 0 Impact assessment (requires public notification) a

d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into3 |
| lots): |
New Construction of Duplex Dwelling, Garages x 2 and Swimming Poo! Structures x 2

 

 

 

| €) Relevant plans
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms quide
Relevant plans.

| KI Relevant plans of the proposed development are attached to the development application
6.2) Provide details about the second development aspect
| a) What is the type of development? (tick only one box)

 

 

 

 

 

 

O Material change of use 0 Reconfiguring a lot O Operational work O Building work
| b) What is the approval type? (tick only one box)
| C1 Development permit O Preliminary approval O Preliminary approval that includes a variation

 

one ee ee approval fa tiene eee ais See
c) What is the level of assessment? |

| O) Code assessment 1 Impact assessment (requires public notification)

| d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 fot into 3
| fots):

 

 

| e) Relevant plans |
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide |
| Relevant plans

| Cl Relevant plans of the proposed development are attached to the development application
|

 

| 01 Additional aspects of development are relevant to this development application and the details for these aspects that |
| would be required under Part 3 Section 1 of this form have been attached to this development application |

| Bi Not required |

 

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DA Form 1 — Development Application details

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Section 2 — Further development details
7) Does the proposed development application involve any of the following?

   
    
 

| Material change of use i Yes — complete division 1 if assessable against a local planning instrument
| Reconfiguring a lot O Yes — complete division 2

Operational work O Yes — complete division 3 |
| Building work 2 ki Yes — complete DA Form 2- Building work details _ |

 

Division 1 — Material change of use
Note: This division is only required to be completed if any part of the development application involves a material change of use assessable against a

local planning instrument.
8.1) Describe the proposed material change of use

| Provide a general description of the | Provide the planning scheme definition | Number of dwelling | Gross floor
proposed use | (include each definition in a new row) | units (if applicable) area (m2)

   

| (if applicable)

New Construction of Duplex Dwelling, Garages x | Dual occupancy 2 : 635m2

2 and Swimming Pool Structures x 2

 

 

& No

 

Division 2 — Reconfiguring a lot
Note: This division is only required to be completed if any part of the development application involves reconfiguring a lot.

9.1) What is the total number of existing lots making up the premises?

       
 

  

9.2) What is the nature of the lot reconfiguration? (tick all applicable boxes)

O Subdivision (complete 10)) O Dividing land into parts by agreement (complete 11))

| O Boundary realignment (complete 12)) O Creating or changing an easement giving access to a lot from
| a construction road (complete 13))

eS —— Sane eee ee

10) Subdivision

 

10.1) For this development, how many lots are being created and what is the intended use of those lots:
| Intended use of lots created Residential | Commercial | Industrial | Other, please specify:

ee = = fo

' Number of lots created
10.2) Will the subdivision be staged?

Ol Yes — provide additional details below

| O No S

| How many stages will the works include?

| What stage(s) will this development application
apply to? :

 

 
 

41) Dividing land into parts by agreement — how many parts are being created and what is the intended use ola tates
ey Tnrg

| Intended use of parts created | Residential | Commercial | Industrial | Other, please specify:

      
  

 
     

[Number of parts created | _ | _ | __ |

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DA Form 1 — Development Application details

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12) Boundary realignment

12.1) What are the current and proposed areas for each lot comprising the premises?
Current lot Proposed lot

Hc a I ee

 

 

 

| Lot on plan description | Area (m2) | Lot on plan description | Area (m2)

12.2) What is the reason for the boundary realignment?

13) What are the dimensions and nature of any existing easements being changed and/or any proposed easement?

   

(ee logmoe ne) Mime ecm ihm ee et Ie)

Existing or | Width (m) | Length (m) | Purpose of the easement? (e.g | Identify the land/lot(s)
| proposed? | _| pedestrian access) | benefitted by the easement

 

Division 3 — Operational work
Note: This division is only required to be completed if any part of the development application involves operational work.

14.1) What is the nature of the operational work?

 
 
  

   
  

      
 

    

O Road work O Stormwater O Water infrastructure
| (1 Drainage work O Earthworks O Sewage infrastructure
| O Landscaping O Signage O Clearing vegetation —

 

O Other — please specify:

 
 
 
 
 

 

     

| O Yes — specify number of new lots:
| O No

14.3) What is the monetary value of the proposed operational work? (include GST, materials and labour)
$

PART 4 —- ASSESSMENT MANAGER DETAILS

15) Identify the assessment manager(s) who will be assessing this development application

 

16) Has the local government agreed to apply a superseded planning scheme for this development application?

 

| O Yes — a copy of the decision notice is attached to this development application

O Local government is taken to have agreed to the superseded planning scheme request — relevant documents
attached

O No

PART 5 — REFERRAL DETAILS

17) Do any aspects of the proposed development require referral for any referral requirements?

 

Note: A development application will require referral if prescribed by the Planning Regulation 2017.

C1 No, there are no referral requirements relevant to any development aspects identified in this development application |
— proceedto Part6 _

| Matters requiring referral to the chief executive of the Planning Regulation 2017:

 

| C1 Clearing native vegetation

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DA Form 1 — Development Application details

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Department of Infrastructure, Local Government and Plan

 

Contaminated land (unexploded ordnance)

Environmentally relevant activities (ERA) (only if the ERA have not been devolved to a local government)
Fisheries — aquaculture

Fisheries — declared fish habitat area

Fisheries — marine plants

Fisheries — waterway barrier works

Hazardous chemical facilities

Queensland heritage place (on or near a Queensland heritage place)

Infrastructure — designated premises

Infrastructure — state transport infrastructure |
Infrastructure — state transport corridors and future state transport corridors

Infrastructure — state-controlled transport tunnels and future state-controlled transport tunnels

Infrastructure — state-controlled roads

Land within Port of Brisbane’s port limits

SEQ development area

SEQ regional landscape and rural production area or SEQ Rural living area —- community activity

SEQ regional landscape and rural production area or SEQ Rural living area — indoor recreation

SEQ regional landscape and rural production area or SEQ Rural living area — residential development

SEQ regional landscape and rural production area or SEQ Rural living area — urban activity

Tidal works or works in a coastal management district

Urban design

Water-related development — taking or interfering with water

Water-related development — removing quarry material (from a watercourse or lake)

Water-related development — referable dams

Water-related development — construction of new levees or modification of existing levees (category 2 or 3 levees only)
Wetland protection area

HOMER Oe odo ee oooop boone ooooe

 

Matters requiring referral to the local government:

O Airport land

O Environmentally relevant activities (ERA) (only if the ERA have been devolved to local government)
O Local heritage places

 

Matters requiring referral to the chief executive of the distribution entity or transmission entity:
0 Electricity infrastructure

 

Matters requiring referral to:
e The chief executive of the holder of the licence, if not an individual
e The holder of the licence, if the holder of the licence is an individual

O Oil and gas infrastructure

 

Matters requiring referral to the Brisbane City Council:
O Brisbane core port land

 

Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
O Brisbane core port land
O Strategic port land

 

Matters requiring referral to the relevant port operator:
Brisbane core port land (below high-water mark and within port limits)

 

Matters requiring referral to the chief executive of the relevant port authority:

1 Land within limits of another port

 

 

Matters requiring referral to the Gold Coast Waterways Authority:

 

1 Tidal works, or development in a coastal management district in Gold Coast waters

 

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DA Form 1 — Development Application details

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Matters requiring referral to the Queensland Fire and Emergency Service:

| 0 Tidal works, or development in a coastal management district

 

   
   

18) Has any referral agency provided a referral response for this development application?

| O Yes — referral response(s) received and listed below are attached to this development application
| O No
| Referral requirement | Referral agency | Date of referral response

 

 

|

|

| = — |

| Identify and describe any changes made to the proposed development application that was the subject of the referral |
| response and the development application the subject of this form, or include details in a schedule to this development |

application (if applicable) |

PART 6 — INFORMATION REQUEST

 

19) Information request under Part 3 of the DA Rules
| O | agree to receive an information request if determined necessary for this development application
| 1 | do not agree to accept an information request for this development application |
| Note: By not agreeing to accept an information request |, the applicant, acknowledge:

| « that this development application will be assessed and decided based on the information provided when making this development application and |
| the assessment manager and any referral agencies relevant to the development application are not obligated under the DA Rules to accept any |
additional information provided by the applicant for the development application unless agreed to by the relevant parties |

|

| © Part 3 of the DA Rules wil still apply if the application is an application listed under section 11.3 of the DA Rules
Further advice about information requests is contained in the DA Forms Guide.

PART 7 — FURTHER DETAILS

20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)

    

O Yes — provide details below or include details in a schedule to this development application
| O No

| List of approval/development | Reference number | Date | Assessment manager
| application references | |

pees
| O Approval
| Development application —_|
| 1 Approval |
| 1 Development application

 

 

 

|

es _ = 4
|
|

a ee

 

1 Yes — the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this development
application

O No~I, the applicant will provide evidence that the portable long service leave levy has been paid before the assessment
manager decides the development application. | acknowledge that the assessment manager may give a development approval
only if | provide evidence that the portable long service leave levy has been paid

| C1 Not applicable

 

 

| Amount paid | Date paid (dd/mm/yy) | Qleave levy number (A, B or E) |
|$ | | |

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22) Is this development application in response to a show cause notice or required as a result of an enfi ment notice?

| C1 Yes — show cause or enforcement notice is attached

 

23) Further legislative requirements
Environmentally relevant act S

23.1) Is this development application also taken to be an application for an environmental authority for an
Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act 1994?

 

| O Yes — the required attachment (form EM941) for an application for an environmental authority accompanies this
development application, and details are provided in the table below
O No

Note: Application for an environmental authority can be found by searching “EM941” at wwv
authority to operate. See www.b u for further information. eat pen A i oS teh 8 TAPS iu sient ESL Sy

| Proposed ERA number: — S| - Proposed ERA threshold:
| Proposed ERA name

au. An ERA requires an environmental

 

 

 

O

Multiple -ERAs are > applicable to this development application and the details have been attached ina a schedule
to this development application.

  

 

Hazardous chemical facilities
23.2) Is this development application for a hazardous chemical facility?

O1 Yes — Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
application

O No
Note: See wwv

u for further information
Clearing native vegetation

23.3) Does this development application involve clearing native vegetation that requires written confirmation the chief
executive of the Vegetation Management Act 1999 is satisfied the clearing is for a relevant purpose under section 22A
of the Vegetation Management Act 1999?

| O Yes — this development application is accompanied by written confirmation from the chief executive of the
Vegetation Management Act 1999 (s22A determination)

| O No
Note: See id.gov. r further information
En eae offsets

23.4) Is this development application taken to be a prescribed activity that may have a significant residual impact on a
prescribed environmental matter under the Environmental Offsets. Act 20142

 

O1 Yes — | acknowledge that an environmental offset must be provided for any prescribed activity assessed as having a |
significant residual impact on a prescribed environmental matter
O No

Note: The environmental offset section of the Queensland Government's website can be accessed at www.¢
environmental offsets

Koala conservation

‘ov_au for further information on

 
   

23.5) Does this development application involve a material change of use, reconfiguring a lot or operational work within
an assessable development area under Schedule 10, Part 10 of the Planning Regulation 2017?

O Yes |
; O No

| Note: See guidance materials at www.ehp.qid.gov.au for further information
Water resources

23:6) Does this development application involve taking or interfering with artesian or sub artesian water, taking or
interfering with water in a watercourse, lake or spring, taking overland flow water or waterway barrier works?

 

| Yes — the relevant template is completed and attached to this development application |

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DA Form 1 — Development Application details

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O No
| Note: DA templates are available from www H
23.7) Does this application involve or interfering with artesian or sub artesian water, taking or interfering
with water in a watercourse, lake or spring, or taking overland flow water under the Water Act 2000?

     
     
    
 

O Yes —! acknowledge that a relevant water authorisation under the Water Act 2000 may be required prior to
commencing development
O No

Note: Contact the Department of Natural Resources and Mines at

Marine activities

nrm.gid.gov.au for further information

 

23.8) Does this development application involve aquaculture, works within a declared fish habitat area or removal,
disturbance or destruction of marine plants?

 

| O Yes — an associated resource allocation authority is attached to this development application, if required under the

| Fisheries Act 1994

|

| O No

Note: See guidance materials at
Quarry materials from a watercourse or lake
23.9) Does this development application involve the removal of quarry materials from a watercourse or lake under
the Water Act 2000?

| O Yes —1 acknowledge that a quarry material allocation notice must be obtained prior to commencing development |
O No

Note: Contact the Department of Natural Resources and Mines at w

Quarry materials from land under tidal waters

 
 

for further information.

   
   

 

au for further information.

   

23.10) Does this development application involve the removal of quarry materials from land under tidal water under
the Coastal Protection and Management Act 1995?

O01 Yes — | acknowledge that a quarry material allocation notice must be obtained prior to commencing development
O No

| Note: Contact the Department of Environment and Heritage Protection at www.ehp.qid.gov. au for further information.

Referable dams

23.11) Does this development application involve-a referable dam required to be failure impact assessed under section
343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?

| O Yes — the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water Supply
Act is attached to this development application
O No

Note: See guidance materials at www

Tidal work or development within a coastal management district
23.12) Does this development application involve tidal work or development in a coastal management district?

 

     

     
 

  

au for further information

dews.

 

  
 
  
 

O Yes — the following is included with this development application:
| O Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required if
application involves prescribed tidal work)
O A certificate of title
O No
Note: See guidance materials at /p au for further information.

Queensland and local heritage places

23:13) Does this development application propose development:on or adjoining a place entered in the Queensland
heritage register or on a place entered in a local government's Local Heritage Register?

 
   

| 1 Yes — details of the heritage place are provided in the table below

 

O No |
| Note: See guidance materials at www_.ehp.gid.gov.au for information requirements regarding development of Queensiand heritage places. al
DEB Oe Daoeee us at WWW Sif 20V.8u fo a BOP Uae 0 pA BRAG BIN BOE Set Ss
Name of the heritage place: Place ID: |

Brothels

 

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23.14) Does this development application involve a material change of use for a brothel?

| 0 Yes — this development application demonstrates how the proposal meets the code for a development application
| for a brothel under Schedule 3 of the Prostitution Regulation 2014

| O No
Decision under section 62 of the Transport Infrastructure Act 1994

23.15) Does this development application involve new or changed access to a state-controlled road?

 

O Yes - this application will be taken to be an application for a decision under section 62 of the Transport Infrastructure |
| Act 1994 (subject to the conditions in section 75 of the Transport infrastructure Act 1994 being satisfied) |

 

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

24) Development application checklist

| | have identified the assessment manager in question 15 and all relevant referral |
| requirement(s) in question 17 O Yes |

| Note: See the 7e Planning Regulation 2017 for referral requirements

|

 

[if building work is associated with the proposed development, Parts 4 to 6 of Form 2- O Yes
| Building work details have been completed and attached to this development application (1 Not applicable

| Supporting information addressing any applicable assessment benchmarks is with
development application
Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report [] Yes

and any technical reports required by the relevant categorising instruments (e.g. local government planning
| schemes, State Planning Policy, State Development Assessment Provisions). For further information, see DA

Forms Guide: Planning Report Template |
| Relevant plans of the development are attached to this development application

 

 

 

Note: Relevant plans are required to be submitted for all aspects of this development application. For further O Yes
| information, see DA Forms Guide Relevant plans.
| The portable long service leave levy for QLeave has been paid, or will be paid before a O Yes
| development permit is issued (see 27)) O_Not applicable

 

 

25) Applicant declaration

O By making this development application, | declare that all information in this development application is true and

| correct

| C1 Where an email address is provided in Part 1 of this form, | consent to receive future electronic communications |

from the assessment manager and any referral agency for the development application where written information is

required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2007 |

Note: /t is unlawful to intentionally provide false or misleading information. ees) |

Privacy — Personal information collected in this form will be used by the assessment manager and/or chosen

assessment manager, any relevant referral agency and/or building certifier (including any professional advisers which

| may be engaged by those entities) while processing, assessing and deciding the development application.

| All information relating to this development application may be available for inspection and purchase, and/or published

| on the assessment manager's and/or referral agency's website.

| Personal information will not be disclosed for a purpose unrelated to the Planning Act 2076, Planning Regulation 2017 |
and the DA Rules except where: |
e such disclosure is in accordance with the provisions about public access to documents contained in the Planning |

| Act 20176 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning |

| Regulation 2017; or

| e required by other legislation (including the Right to Information Act 2009); or

| e otherwise required by law. |
| This information may be stored in relevant databases. The information collected will be retained as required by the

| | Public Records Act 2002. |

 

 

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DA Form 1 — Development Application details

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PART 9 — FOR OFFICE USE ONLY

 

SSS a ey

Date received: | Reference number(s):

Notification of engagement of alternative assessment manager.

Prescribed assessment manager |

 

 

 

| Name of chosen assessment manager | |

 

| Date chosen assessment manager engaged
Contact number of chosen assessment manager |

| Relevant licence number(s) of chosen assessment
manager |

QLeave notification and payment
Note: For completion by assessment manager if applicable

| Description of the work

 

 

| QLeave project number | - - / |
 AMOUNEDEIA See
Date paid

 

 

 

 

 

Date receipted form sighted by assessment manager

 

Name of officer who sighted the form

 

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.

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DA Form 1 — Development Application details