DA Form 1 0185_001-1

Page 2

PART 2 -—LOCATION DETAILS

3) Location of the premi

TAT Omes 1 Caley Cems 2) a TL ora gee melt omM react (e) BEF =y Tmo] e721] (era) 0 ea am eo

 

C0 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).

 

 

 

 

 

 

 

Unit No. | Street No. | Street Name and Type Suburb
; 2-8 |kicted ESL AVADPE TEWANTIYV
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
1s SY 3/5575 WELSA
Unit No. | StreetNo. | Street Name and Type Suburb
b) Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)

 

 

 

 

 

 

(emma Tevmes( 0) ex PTiaT¢ Me rae= eta T eC ee aT Red

 
      

 

ow. Oniy one set

 

C1 Coordinates of premises by longitude and latitude

 

 

 

 

 

 

 

Longitude(s) Latitude(s) Datum Local Government Area(s) (if appticable) |
1 wese4
(1 GDA94
CJ Other:
(1 Coordinates of premises by easting and northing
Easting(s) Northing(s) Zone Ref. | Datum Local Government Area(s) (if applicable)
- O54 Cl wese4

(55 C] Gpag4
(56 C Other:

 

 

 

 

 
   

  

. wal premises

(1 Additional premises are relevant to this development application and their details have been attached ina
schedule to this application

(7 Not required

 

 

the following that apply to the prer and provide any reievant details

  

(1 In or adjacent to a water body or watercourse or in or above an aquifer

 

Name of water body, watercourse or aquifer:
C1 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:

C1 ina tidal area

Name of local government for the tidal area (if applicable):
Name of port authority for tidal area (if appticable):

CO On airport land under the Airport Assets (Restructuring and Disposal) Act 2008
Name of airport: |

 

 

 

 

 

 

 

 

 

 

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(2 Listed on the Environmental Management Register (EMR) under the Environmental Protection Act 1994

EMR site identification:

CD Listed on the Contaminated Land Register (CLR) under the Environmental Protection Act 1994
CLR site identification: |

 

 

 

 

 

») Are there any existing easements over the oremises?

  
 

ane MOLE resn ht ei eis fem om ener ed correctly and accurately, Por further information on easements anc

      

f (ine proposed deveionmen), see

C1 Yes ~ All easement locations, types and d
application

C1 No

PART 3 —- DEVELOPMENT DETAILS

Forms G

imensions are included in plans submitted with this development

 

 

 

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)

CO Material change of use 1 Reconfiguring a lot [ Geealional work C1 Building work
b) What Is the approval type? (tick only one box)

CL] Development permit (1 Preliminary approval (1 Preliminary approval that includes

a variation approval

 

c) What is the level of assessment?
(J Code assessment LJ 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

ris: PRIVEWAM §=CEOSSOVERS % STORK NII LATEK D/ECHPE
Crn€cr7eN

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:

 

 

wy Relevant plans of the proposed development are attached to the development application

6.2) Provid ails about the second development aspect

   

a) What is the type of development? (tick only one box)

 

( Material change of use CO Reconfiguring a lot (J Operational work (1 Building work

b) What is the approval type? (tick only one box)

1 Development permit (1 Preliminary approval (1 Preliminary approval that includes a variation
approval

 

c) What is the level of assessment?
(1 Code assessment U1 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 lot into 3
lots):

 

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

LC Retevant plans of the proposed development are attached to the development application

 

 

 

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Mn

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Additional aspects of development

 

UO 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

CJ Not required

Section 2 — Further development details

7’ Does the proposed development application invoive any of the following?
; i

   
     

   
   

 

 

 

Material change of use (1 Yes - complete division 1 if assessable against a local planning instrument
Reconfiguring a tot C1 Yes — complete division 2

Operational work (11 Yes - complete division 3

Building work C 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
focal planning instrument.

   
  

ribe the proposed material shange 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 (m?)
(if applicable)

 

 

 

 

 

 

    

CO Yes
(] 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 Jot.

0.13 What

   
 
 
  

 

ne total aumber of existing lots Making up the premises?

 

 

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

C1 Subdivision (compete 10)) (1 Dividing land into parts by agreement (complete 11))

(1 Boundary realignment (complete 12)) (1 Creating or changing an easement giving access to a lot
from aconstruction road (complete 13))

 

 

 

  
 

10) Subdivi

 
   

       

2ated and whatis the intended use of those iots

 

16.1) For this development, how many lots are being ©

         

      
 
 
    

      

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

 

 

 

 

  

Number of lots created

ues

  

 

Sin(e MIE TOLOIN Ile) PMaY=Mciesle tein
0 Yes - provide additional details below
(No

How many stages will the works include?

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

 

 

 

 

 

 

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11} Dividing land into pans by agreement — how many parts are being created and what is the intended use of the

 

erin tie

Intended use of parts created

     

 

   

       

Residential Commercial Industrial Other, please specify:

 

 

 

Number of parts created

 

12) Boundary realiqnment

 

 

\ What are the current and proposed areas for each jot comprising the premises?
Current lot Proposed lot
Lot on plan description Area (m?) Lot on plan description Area (m?)

 

 

 

 

 

 

 

 

  
 

Yt are the dimensions and nature of any existing easements being Chanaed and/or any proposed
7 Pasta Hie een Tem OL om ish camels teed A)

Existing or Width (m) | Length (m) | Purpose of the easement? (c.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.

     
  
   

 
       
 
    
 
    
 
   
   
   
   

44.1} What is the nature of the operational work?

 

[Mj Road work [WStormwater () Water infrastructure
DD Orainage work OD Earthworks CO Sewage infrastructure
UC Landscaping CI Signage CJ Clearing vegetation

 

C Other — please specify:

14 2) Is the operational work necessary to facilitate the creation of new lots’

  

(1 Yes - specify number of new lots:

CINo

14.3) What is the monetary value of the proposed operational work? finciude GST, maieriais and labour)

$
PART 4 — ASSESSMENT MANAGER DETAILS

 
    
 

C1 Yes - a copy of the decision notice is attached to this development application
(1 Local government is taken to have agreed to the superseded planning scheme request —- relevant documents
attached

LINo

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PART 5 — REFERRAL DETAILS

 
   

yf the proposed development require referra: for any referral requirements ¢

 

Ifo beta Bes erie) Set ev Meee ese Teetroet eVere mar meen Tem a TAO Ae madera Lae een

MJ] No, there are no referral requirements relevant to any development aspects identified in this development
application — proceed to Part 6

 

Matters requiring referral to the Chief Executive of the Planning Regulation 2017:

(1 Clearing native vegetation

C1 Contaminated land (unexploded ordnance)

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

(1 Fisheries - declared fish habitat area

(1 Fisheries — marine plants

(1 Fisheries — waterway barrier works

() Hazardous chemical facilities

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

(7 Infrastructure - designated premises

(1 Infrastructure — state transport infrastructure

Ci Infrastructure — state transport corridors and future state transport corridors

(1 Infrastructure — state-controlled transport tunnels and future state-controlled transport tunnels
C7 Infrastructure -- near a state-controlled road intersection

TC On Brisbane core port land near a State transport corridor or future State transport corridor
(J On Brisbane core port land - ERA

(J On Brisbane core port land — tidal works or work in a coastal management district

1 On Brisbane core port land — hazardous chemical facility

(1 On Brisbane core port land — taking or interfering with water

CD On Brisbane core port land — referable dams

C0 On Brisbane core port land - fisheries

(1 Land within Port of Brisbane's port limits

(1 SEQ development area

(J SEQ regional landscape and rural production area or SEQ rural living area — tourist activity or sport and
recreation activity

(J SEQ regional landscape and rural production area or SEQ rural living area — community activity
(Ol SEQ regional landscape and rural production area or SEQ rural living area — indoor recreation
(J SEQ regional landscape and rural production area or SEQ rural living area — urban activity

CO SEQ regional landscape and rural production area or SEQ rural living area — combined use
(1 Tidal works or works in a coastal management district

DO Reconfiguring a lot in a coastal management district or for a canal

(1 Erosion prone area in a coastal management district

(7 Urban design

CJ Water-related development — taking or interfering with water

CO Water-related development — removing quarry material (from 4 watercourse or lake)

(] Water-related development — referable dams

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

 

Matters requiring referral to the local government:

CD Airport land

C1 Environmentally relevant activities (ERA) (only ifthe ERA have been devolved to local government)
(7 Local heritage places

 

 

 

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DA Form 1 — Development Application details
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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:

(Brisbane core port land

Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
U1 Brisbane core port land (inconsistent with Brisbane port LUP for transport reasons)
(7 Strategic port land

Matters requiring referral to the relevant port operator:
(Land within Port of Brisbane's port limits (below high-water mark)

 

 

 

 

Matters requiring referral to the Chief Executive of the relevant port authority:
C1 Land within limits of another port (below high-water mark)

Matters requiring referral to the Gold Coast Waterways Authority:
D1 Tidal works, or work in a coastal management district in Gold Coast waters

 

 

Matters requiring referral to the Queensland Fire and Emergency Service:
(J Tidal works marina (more than six vessel berths)

 

 

 
     

for this development application?

 

18) Has any > i
(1 Yes - referral response(s) received and listed below are attached to this development application
CI No

Referral requirement Referral agency Date of referral response

 

agency provided a referral

 

 

 

 

 

 

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

 

(J | agree to receive an information request if determined necessary for this development application

(J | 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

e 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.

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DA Form 1 - Development Application details
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PART 7 — FURTHER DETAILS

    

  

here any associated development applications or current FeTe)p]K@\\7-1 Wan eme mee Wa TiH | aa H Ta aes Tanya aT
[J Yes — provide details below or include details in a schedule to this development application

(No
List of approvai/development Reference number Date Assessment
application references manager

a application XOR| GFR 0 / Gos: 4 /

 

 

 

 

 

 

 

IUnY= Me COon cl Oi“ MLOlATG SS- TAA (Xc a= LMA asl =1 1 NO = 10 eM COST sO aes he ca eco ee

 

Yes — a copy of the receipted QLeave form is attached to this development application

(1 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

(Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
Amount paid Date paid (dd/mm/yy) QLeave levy number

$IS S42. 09 Y-oS 272] S RE yyy O

 

 

 

 

 

ovslanreiaie

 

(1 Yes - show cause or enforcement notice is attached

No

-urther legisiative requirements

Environmentally relevant activities

 

 

 

93.13 \s this development application also taken to be an application for an environmental authority for an

Environmentally Relevant Activity (ERA) und ction 115 of the Environmental Protection Act 1994?

 

[Yes - the required attachment (form ESR/2015/1791) for an application for an environmental authority
accompanies this development application, and details are provided in the table below

oO
Note: Application for an environmental authority can be found by searching “ESR/2015/1791” as a search term at www.qld.gov.au. An ERA
requires an environmental authority to operate. See www.business.qid.qoy.au for further information.

Proposed ERA number: Proposed ERA threshold:

Proposed ERA name:

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

 

 

 

 

 

      
 
   

Hazardous chemical facilities
Pew this development application for a hazardous chemical facility?
(1 Yes — Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
application

lo
Note: See www.business.gid.gov.au for further information about hazardous chemical notifications.

Clearing native vegetati

 

 

    

lopment application involve clearing native vegetation that requires written confirmation that
tation Management Act 1999 is satisfied the clearing is tor a relevant purpose unde!

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section 22A of the Vegetation Management Act 199

(1 Yes - this development application includes written confirmation from the chief executive of the Vegetation
Management Act 1999 (s22A determination)

CINo

Note: 1. Where a development application for operational work or material change of use requires a s22A determination and this is not included,

the development application is prohibited development.
ing for further information on how to obtain a s22A determination.

Environmental offsets

23.4} Is this deveiopment application taken lo be a prescribed activity that may have a significant residual ‘mp

prescribed environmental matter Under the Environmental C

01 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

No
Note. The environmental offset section of the Queensland Government's website can be accessed at www, aid. gov.au for further information on
environmental offsets.

Koala conservation

cation invoive a material Tom Miguring a lot or operational work
a under Schedule 10, Pe , = Planning Regulation 2017?

{No

Note: See guidance materials at www.des,gid.gov.au for further information.
Water resources

23.6) Does this Geveiopment application involve taking or interfering with underground water through an
artesian or subartesian bore, taking or interfering with water in a watercourse. lake or spring, or taking
overland flow water under the Water Act 2000?
(1 Yes - the relevant template is completed and attached to this development application and | acknowledge that a
relevant authorisation or licence under the Water Act 2000 may be required prior to commencing development
jo
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.gid.gov.au for further information.
DA templates are available from /iltps:/olanning.dsdmip,qid.gov.au/. If the development application involves:
° Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 4
¢ Taking or interfering with water in a watercourse, lake or spring: complete DA Form1 Template 2
* Taking overland flow water: complete DA Form 1 Template 3.

Waterway barrier works

 

    

Does this application involve waterway barrier works?

(11 Yes - the relevant template is completed and attached to this development application

[No

DA templates are available from hitos:/planning.dsdmip.gid.gov.au/. For a development application involving waterway barrier works, complete
DA Form 1 Template 4.

 

 

Marine activities

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

{J Yes - an associated resource allocation authority is attached to this development application, if required under
the Fisheries Act 1994

[No

Note: See guidance materials at www.daf.gid.gov.au for further information.

Quarry materials from a watercourse or lake

zene} Blox Ui) lopment application involve the removal of quarry materials from a watercourse or lake

 

C1 Yes - | acknowledge that a quarry material allocation notice must be obtained prior to commencing development

 

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Page 10

 

[No
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme. gid.gov.au and www. business. gid.gov.au for further
information.

   
   

Quarry materials from Jand under tidal waters

elopment application involve the removal of quarry materials from land under tidal water
! Protection and Management Act 1995”

 

(Yes - | acknowledge that a quarry material allocation notice must be obtained prior to commencing development

[No

Note: Contact the Department of Environment and Science at www.dos.qid.gov.au for further information.
xXehccvieel®) (ome LA}

s this development appiication involve a referable dam required to be failure impact assessed under
of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?

     

(Yes - the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water
Supply Act is attached to this development application

[No
Note: See guidance materials at www.dnrme.qid.gov.au for further information.
Tidal work or development within a coastal management district
this development apniication involve tidal work or development in a coastal management district?

C1 Yes — the following is included with this development application:

(Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required
if application involves prescribed tidal work)

DIA certificate of title
No
Note: See guidance materials at www.des.gid.gov.au for further information.
Queensland and local heritage places

2 3) Does this development appt ion propose development on or adjoining a place entered jn the Queensland
heritage registe we) Ce) na local « nment'’s Local Heritage Register?

0 Yes - details of the heritage place are provided in the table below

DWNo

Note: See guidance materials at www.des.qld.gov.au for information requirements regarding development of Queensland heritage places.

 

 

Name of the heritage place: Place ID:
Brothels
23.14) Does this development application invoive a material change of use for a brothel?

LJ 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

[LYNo
cision under section 62 of the Transport Infrastructure Act 1994
5} Does this development appiication invoive new or Changed access to a state-controlied road?

CJ 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)

[No

 

 

 

PART 8 — CHECKLIST AND APPLICANT DECLARATION

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| have identified the assessment manager in question 15 and all relevant referral

requirement(s) in question 17 OO Yes

Note: See the Planning Regulation 2017 for referral requirements

If building work is associated with the proposed development, Parts 4 to 6 of DA Form 2— (Yes

Building work details have been completed and attached to this development application [Not applicable

Supporting information addressing any applicable assessment benchmarks is with
development application
Wes

Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report
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

elooment apolicalion Checklist

 

 

 

 

 

Forms Guide: Pl Te fate.

Relevant plans of the development are attached to this development application ,

Note: Relevant plans are required to be submitted for ail aspects of this development application. For further res

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 (see 27)) (Not applicable

 

 

15) Applicant deciaration

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

correct

Td 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 2001

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

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 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.

 

 

 

 

PART 9 — FOR OFFICE USE ONLY

Date received: [ Reference number(s): [

 

 

Jagement 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

 

 

 

 

 

 

 

 

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Description of the work

 

QLeave project number

 

Amount paid ($)

 

Date paid

 

Date receipted form sighted by assessment manager

 

 

Name of officer who sighted the form

 

 

 

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