180373 - DA Form 2 · OPW18/0304

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 Unit No.             Street No.         Street Name and Type                                 Suburb
                      Lot 1 (No.95)      Hollett Road                                         Noosaville
 Postcode             Lot No.            Plan Type and Number (e.g. RP, SP)                   Local Government Area(s)
 4566              1                     SP176590                                             Noosa Shire Council
 2.2) Additional premises

 ☐ Additional premises are relevant to this development application and the details of these premises have been
 attached in a schedule to this development application

 3) Are there any existing easements over the premises?
 Note: Easement uses vary throughout Queensland and are to be identified correctly and accurately. For further information on ease ments and how
 they may affect the proposed development, see the DA Forms Guide

 ☐ Yes – All easement locations, types and dimensions are included in plans submitted with this development
            application
 ☑ No

PART 3 – FURTHER DETAILS
 4) Is the application only for building work assessable against the building assessment provisions?
 ☑ Yes – proceed to 8)
 ☐ No
 5) Identify the assessment manager(s) who will be assessing this development application


 6) Has the local government agreed to apply a superseded planning scheme for this development application?
 ☐ Yes – a copy of the decision notice is attached to this development application
 ☐ The local government is taken to have agreed to the superseded planning scheme request – relevant documents
 attached
 ☐ No
 7) Information request under Part 3 of the DA Rules
 ☐ I agree to receive an information request if determined necessary for this development application
 ☐ I do not agree to accept an information request for this development application
 Note: By not agreeing to accept an information request I, 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 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.


 8) Are there any associated development applications or current approvals?
 ☐ Yes – provide details below or include details in a schedule to this development application
 ☑ No
 List of approval/development             Reference                              Date                                  Assessment
 application                                                                                                           manager
 ☐ Approval
 ☐ Development application
 ☐ Approval


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 ☐ Development application

 9) Has the portable long service leave levy been paid?
 ☐ Yes – the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this
 development application
 ☑ 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. I acknowledge that the assessment manager may give a
 development approval only if I provide evidence that the portable long service leave levy has been paid
 ☐ Not applicable
 Amount paid                     Date paid (dd/mm/yy)                     QLeave levy number (A, B or E)


 10) Is this development application in response to a show cause notice or required as a result of an enforcement
 notice?
 ☐ Yes – show cause or enforcement notice is attached
 ☑ No

 11) Identify any of the following further legislative requirements that apply to any aspect of this development application
         The proposed development is on a place entered in the Queensland Heritage Register or in a local
  ☐      government’s Local Heritage Register. See the guidance provided at www.des.qld.gov.au about the
         requirements in relation to the development of a Queensland heritage place
 Name of the heritage place:        Not applicable                   Place ID:


PART 4 – REFERRAL DETAILS
 12) Does this development application include any building work aspects that have any referral requirements?
 ☐ Yes – the Referral checklist for building work is attached to this development application
 ☑ No – proceed to Part 5

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

 ☐ Yes – referral response(s) received and listed below are attached to this development application
    No
 Referral requirement                         Referral agency                            Date 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 5 – BUILDING WORK DETAILS
 14) Owner’s details
 ☐Tick if the applicant is also the owner and proceed to 15). Otherwise, provide the following information.


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Name(s) (individual or company full     Scott and Anna Guildford
name)
Contact name (applicable for
companies)
Postal address (P.O. Box or street      107 The Avenue
address)
Suburb                                  Peregian Springs
State                                   QLD
Postcode                                4573
Contact number                          0400 733 607
Email address (non-mandatory)           [email protected]
Mobile number (non-mandatory)
Fax number (non-mandatory)

15) Builder’s details
☐Tick if a builder has not yet been engaged to undertake the work and proceed to 16). Otherwise provide
the following information.
Name(s) (individual or company full Mark Bain Constructions
name)
Contact name (applicable for          Paul Tilbury
companies)
QBCC licence or owner –               59274
builder number
Postal address (P.O. Box or           15 Ross Crescent
street address)
Suburb                                Sunshine Beach
State                                 QLD
Postcode                              4567
Contact number                        07 54474443
Email address (non-mandatory)         [email protected]
Mobile number (non-                   0417 651172
mandatory)
Fax number (non-mandatory)

16) Provide details about the proposed building work
a) What type of approval is being sought?
☑ Development permit
☐ Preliminary approval
b) What is the level of assessment?
☑ Code assessment
☐ Impact assessment (requires public notification)
c) Nature of the proposed building work (tick all applicable boxes)
☑ New building or structure                                                ☐ Repairs, alterations or additions
☐ Change of building classification (involving building work)              ☐ Swimming pool and/or pool fence
☐ Demolition                                                               ☐ Relocation or removal
d) Provide a description of the work below or in an attached schedule.
2 storey Dwelling

e) Proposed construction materials
                                        ☐ Double brick             ☐ Steel                         ☐ Curtain glass
External walls
                                        ☑ Brick veneer             ☐ Timber                        ☐ Aluminium


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                                            ☐ Stone/concrete                      ☐ Fibre cement                      ☐ Other
                                            ☑ Timber                              ☐ Steel                             ☐ Aluminium
 Frame
                                            ☐ Other
 Floor                                      ☑ Concrete                            ☐ Timber                            ☐ Other
                                            ☐ Slate/concrete                      ☐ Tiles                             ☐ Fibre cement
 Roof covering
                                            ☐ Aluminium                           ☑ Steel                             ☐ Other
 f) Existing building use/classification? (if applicable)
  Vacant land
 g) New building use/classification? (if applicable)
  1a & 10a
 h) 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.

 ☑ Relevant plans of the proposed works are attached to the development application
 17) What is the monetary value of the proposed building work?                      $1,121,135.00

 18) Has Queensland Home Warranty Scheme Insurance been paid?
 ☐ Yes – provide details below
 ☑ No
 Amount paid                                            Date paid (dd/mm/yy)                             Reference number
 $


PART 6 – CHECKLIST AND APPLICANT DECLARATION
 19) Development application checklist
 The relevant parts of Form 2 – Building work details have been completed                                         ☑ Yes
 This development application includes a material change of use, reconfiguring a lot or
 operational work and is accompanied by a completed Form 1 – Development
                                                                                                                  ☐ Yes
 application details                                                                                              ☑ Not applicable
 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   ☑ 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 ☑ Yes
 development permit is issued
                                                                                         ☐ Not applicable
 20) Applicant declaration
 ☑ By making this development application, I declare that all information in this development application is true and
 correct
 ☑ Where an email address is provided in Part 1 of this form, I 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 2001
 Note: It is unlawful to intentionally provide false or misleading information.
 Privacy –pPersonal information collected in this form will be used by the assessment manager and/or chose n
 assessment manager, any 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 2016, Planning Regulation 2017
 and the DA Rules except where:


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   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
  required by other legislation (including the Right to Information Act 2009); or
  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.

PART 7 –FOR COMPLETION BY THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:   29/10/2018             Reference numbers:      BA180372

 For completion by the building certifier
 Classification(s) of approved building work

 1a, 10a

 Name                                                 QBCC Certification Licence          QBCC Insurance receipt
                                                      number                              number
 John Dunn                                            A1177643

 Notification of engagement of alternate chosen 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

 Additional information required by the local government
 Confirm proposed construction materials:
                                   ☐ Double brick                  ☐ Steel                         ☐ Curtain glass
 External walls                    ☑ Brick veneer                  ☐ Timber                        ☐ Aluminium
                                   ☐ Stone/concrete                ☐ Fibre cement                  ☐ Other
                                   ☑ Timber                        ☐ Steel                         ☐ Aluminium
 Frame
                                   ☐ Other
 Floor                             ☑ Concrete                      ☐ Timber                        ☐ Other
                                   ☐ Slate/concrete                ☐ Tiles                         ☐ Fibre cement
 Roof covering
                                   ☐ Aluminium                     ☑ Steel                         ☐ Other
 Additional building details required for the Australian Bureau of Statistics
 Existing building use/classification? (if applicable)             1a, 10a
 New building use/classification?                                  1a, 10a
 Site area (m2)                                                    Floor area (m2)                 570m2




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