Form 5 Change Application

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3.2) Coordinates of premises (appropriate for development ih remote areas, over part of a Jot or in water not adjoining or adjacent to land

GL IMClE-Tesel em iAm) 4 ek-2 2)

 

 

 

Ferrey mee le2k6! gre) cry arelgc lick elie
L] Coordinates of premises by longitude and latitude
| Longitude(s) = Latitude(s) Datum Local Government Area(s) (if applicable)
/ C. wessa

| | (1 GDA94
| | CL] Other:
(J Coordinates of premises by easting and northing Peas!

[ Easting(s) _ =o Northing(s) | Zone Ref. | Datum | Local Government Area(s) (if applicable)
(O54 | Lweses
'Clss | CGpaAg4

| (56 | CJ Other:

 

 

 

 

 
 
      
 

 

  
  

   

3.3) Additional premises

| L] Additional premises are relevant to the original development approval and the details of these premises have
been attached in a schedule to this application

| DY Not required

 

PART 3 —- RESPONSIBLE ENTITY DETAILS

4) Identify the responsible entity that will be assessing this change application

Note: see section 78(3) of the Planning Act 2016

PLANNING DEPARTMENT

 

 

PART 4 — CHANGE DETAILS

 

5) Provide details of the existing development approval subject to this change application

Approval type Reference number Date issued Assessment
manager/approval entity

 

KX] Development permit =| MCU 20/ Cos] 20 [e i/ 2021
LJ Preliminary approval

LJ Development permit
C] Preliminary approval

 

 

 

 

 

 

 

6) Type of change proposed Gee ee ae

6.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development
approval for a five unit apartment building to provide for a six unit apartment building):

Remove Lowe? LEVEL AND BUILD oN SLAB

 

6.2) What type of change does this application propose?

IX] Minor change application — proceed to Part 5
(J Other change application — proceed to Part 6

 

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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020

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PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS

 

7) Are there any affected entities for this change application

BgNo — proceed to Part 7
Yes — list all affected entities below and proceed to Part 7

Note: section 80(1) of the Planning Act 2016 states that the person making the change application must give notice of the proposal and the
details of the change to each affected entity as identified in section 80(2) of the Planning Act 2016.

 

 

Affected entity Pre-request response provided? (where a pre- Date notice given (where no pre-
request response notice for the application has been request response provided)
given, a copy of the notice must accompany this change
application)
[] No

CJ Yes — pre-request response is attached to
this change application

(I No
LJ Yes — pre-request response is attached to
this change application

| No

LJ Yes — pre-request response is attached to
this change application

 

 

 

 

 

 

 

PART 6 — OTHER CHANGE APPLICATION REQUIREMENTS

Note: To complete this part it will be necessary for you to complete parts of DA Form 1 — Development application details and in some instances parts
of DA Form 2 — Building work details, as mentioned below. These forms are available at htt dsdmip.qid.gov.au,

 
  

8) Location details - Are there any additional premises included in this change application that were not part of the

 

original development approval?

XX] No
LC Yes

 

9) Development details

Been Smal eae Lal eCnnaenne ei Peace approval type, or level of Pena unule ene
application?
Xi No
(J Yes — the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 — Development application
details as these sections relate to the new or changed aspects development are provided with this application. |

 

9.2) Does the change application involve building work?

NJ No
(J Yes — the completed Part 5 (Building work details) of DA Form 2 — Building work details as it relates to the
change application is provided with this application.

 

10) Referral details — Does the peered require eeerc aay eel requirements?

Note: Th tion must be referred to each refe cy triggered by the change application as if the change application was the original
development application including the proposed c ge

| XI No

| (J Yes — the completed Part 5 (Referral details) of DA Form 1 — Development application details as it relates to the
change application is provided with this application. Where referral is required for matters relating to building
work the Referral checklist for building work is also completed.

41) Information request under Part 3 of the DA Rules

Ml | agree to receive an information request if determined necessary for this change application

[]| do not agree to accept an information request for this change application
Note: By not agreeing to accept an information request |, the applicant, acknowledge:

 

 

 

 

 

 

 

 

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Planning Act Form 5 - Change application form
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e _ that this change application will be assessed and decided based on the information provided when making this change application and the
assessment manager and any referral agencies relevant to the change application are not obligated under the DA Rules to accept any
additional information provided by the applicant for the change application unless agreed to by the relevant parties

* Part 3 of the DA Rules will 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: Forms 1 and 2.

 

 

 

12) Further details

(J Part 7 of DA Form 1 — Development application details is completed as if the change application was a
development application and is provided with this application.

 

 

 

PART 7 — CHECKLIST AND APPLICANT DECLARATION

13) Change application checklist

| have identified the:
e responsible entity in 4); and
e for aminor change, any affected entities; and Ml Yes

e for an other change all relevant referral requirement(s) in 10)
Note: See the Planning Regulation 2017 for referral requirements

 

 

For an other change application, the relevant sections of DA Form 1 — Development LJ Yes
application details have been completed and is attached to this application JX Not applicable
For an other change application, where building work is associated with the change CyYes
application, the relevant sections of DA Form 2 — Building work details have been i Not applicable

completed and is attached to this application

Supporting information addressing any applicable assessment benchmarks is attached to

this application

Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 — Development application details NM Yes
that are relevant as a result of the change application, a planning report and any technical reports required by the

relevant categorising instrument(s) (e.g. the local goverment planning scheme, State Planning Policy, State

Relevant plans of the development are attached to this development application

Note: Relevant plans are required to be submitted for all relevant aspects of this change application. For further Yes
information, see DA Forms Guide: Relevant pians.

 

 

 

14) Applicant declaration

By making this change application, | declare that all information in this change application is true and correct.
Where an email address is provided in Part 1 of this form, | consent to receive future electronic communications
from the responsible entity and any relevant affected entity or referral agency for the change application where
written information is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions
Act 2001.

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

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

assessment manager, any relevant affected entity or referral agency and/or building certifier (including any

professional advisers which may be engaged by those entities) while processing, assessing and deciding the
change application.

All information relating to this change 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 2016, 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 2016 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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Planning Act Form 5 - Change application form
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PART 8 —-FOR COMPLETION OF THE ASSESSMENT MANAGER - FOR OFFICE
USE ONLY

 

 

Date received: [isd Reference number(s): | |

notification and

 

Description of the work
QLeave project number
Amount paid ($) Date paid (dd/mm/yy) |
Date receipted form sighted by assessment manager
Name of officer who sighted the form

 

 

 

 

 

 

 

 

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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020