DA form 1

Page 2

PART 2 — LOCATION DETAILS

3.1) Street address and loon plan

 

 

 

 

 

 

 

 

 

 

 

[4 Street address AND lot on plan (aif lots must be fisted), Or
(C] 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, ail fots must be listed)
Unit No. | Street No. pice Name and Type Suburb 4
EAG seek {ppt We, Pe, ia; og < Gen aly
a) Postcode ; Lot No Plan disk gue NUE (e.g. RP, SP} Local Government Area(s)
: 23 CAR Maas
Street No. Street Name end Type st Suburb
b) ot
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)

 

 

 

 

 

 

 

 

{ C1 Coordinates of premises by longitude and latitude

 

 

 

 

 

Longitude(s) i Latitude(s) | Datum Local Government Area(s) (if applicable) |
OT ‘Clwessa Sis” ee
| Lj] GDA94
| J Other:
C1 Coordinates of premises by easting and northing a - — —
Easting(s) Northing(s) Zone Ref. | Datum Local Government Area(s) (if applicable)
(54 OC wess4
(55 CJ] Goae4
C156 (1 Other:

 

 

 

      
  

oleate 1M elicias

 

(| Additional premises are relevant to this development application and their details have been attached in a
schedule to this application
EaNot required

 

 

4) Identify any of the following that apply to the pramise
(J In or adjacent to a water body or watercourse or in or above an aquifer
Name of water body, watercourse or aquifer:
(J 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:
ca in a tidal area
Name of local government for the tidal area (if applicable):

 

 

 

 

 

 

 

 

 

Name of port authority for tidal area (if applicable):
(2 On airport land under the Airport Assets (Restructuring and Disposal) Act 2008

Name of airport: _|

 

 

 

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

EMR site identification:

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

CLR site identification:

 

 

 

 

5) Are there any existing easements over the premises|?

     

haw they may affect ere felaaet see mele

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

application
Eo

PART 3 —- DEVELOPMENT DETAILS

Sa SAR ML mes alt cco MAM eR

 

 

 

 

Section 1 — Aspects of development
6.1) Provide detai

  
 

irst development as

   

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

 

Ci Material change of use CD Reconfiguring a lot Cd Operational work building work
b) What is the approval type? (tick only one box)
Development permit UD Preliminary approval CJ Preliminary approval that includes

a variation approval

 

c) What is the level of assessment?
(1 Code assessment CJ 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):

Fre poses Ce nnd aus a evisbay sho Tor Com ler k neigh be ssag,

she ps

 

 

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

Relevant plans.
g Relevant plans of the proposed development are attached to the development application

6.2) Provide details about the second development oe fn ee

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

 

 

LD Material change of use C1 Reconfiguring a lot CD Operational work C1 Building work

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

LJ Development permit LC Preliminary approval LJ Preliminary approval that includes a variation
approval

 

c) What is the level of assessment?
(J Code assessment LC 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 ail aspects of this development application. For further information, see DA Forms Guide:
Relevant plans.

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

 

 

 

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‘Oj Additional aspects of development are reievant 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 (
C1] Not required |

Section 2 — Further develonment details

 
     

 

 

 

Material change of use LJ Yes — complete division 1 if assessable against a local planning instrument
Reconfiguring a lot (1 Yes — complete division 2

Operational work (1 Yes — complete division 3

Building work (1) 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.

       
       

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 (m?)
(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

9.2) Whatis

 

he nature of the lot reconfiguration? (tick al applicable boxes

 
   

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

{] Boundary realignment (compiete 12)) (1 Creating or changing an easement giving access to a lot
from ..a construction road (complete 13))

 

 

10) Subdivision
10.1) Far this development, how many lots are being created and whats the intended use of those Jots

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

     

 

| | |

 

 

LC 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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ing land Into parts by agreement — how many parts are being cr j what is the intended use of the

 

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

 

 

 

Number of parts created

 

 

¢ as for each lot comprising the premise
Current lot Proposed lot
Lot on plan description Area (m?) Lot on plan description Area (m?)

 

 

 

 

 

 

 

 

J

 

 
   

ed and/or any proposed ea
(attach schedule if there are more than J
Existing or Width (m) | Length (m) | Purpose of the easement? (e.g. \dentify 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 annti ves operational work

14.1) What is the nature of the operational work
CO Road work 0 Stormwater LD Water infrastructure
LJ Drainage work DD Earthworks CJ Sewage infrastructure
CJ Landscaping C1 Signage LC Clearing vegetation

CJ Other — please specify: |

       
        
   
  
  
  
  

 

   
 
    
 

14.2) Is the operational work necessary to facilitate the creation of new lots? (e.g. subdivision)
LJ Yes — specify number of new lots:
CINo

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?

 

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

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

LNo

 

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PART 5 — REFERRAL DETAILS

17) Do any aspects of the proposed development require referral for any ¢ tes Maeie el cereals beste

   

ve) oa) r feet ee eein

[1 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:

CD Clearing native vegetation

(J Contaminated land (unexpioded ordnance)

L] Environmentally relevant activities (ERA) (only if the ERA have not been devolved to a local government)
C1] Fisheries — aquaculture

LC Fisheries — declared fish habitat area

LC Fisheries — marine piants

LC Fisheries — waterway barrier works

CD Hazardous chemical facilities

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

(J Infrastructure — designated premises

LJ Infrastructure — state transport infrastructure

(] infrastructure — state transport corridors and future state transport corridors

(J Infrastructure — state-controlled transport tunnels and future state-controlled transport tunnels
LJ infrastructure — near a state-controlled road intersection

(J On Brisbane core port land near a State transport corridor or future State transport corridor
CJ On Brisbane core port land — ERA

C] On Brisbane core port land — tidal works or work in a coastal management district

CJ On Brisbane core port land — hazardous chemical facility

LJ On Brisbane core port land — taking or interfering with water

LJ On Brisbane core port land - referable dams

CO On Brisbane core port land - fisheries

| CJ Land within Port of Brisbane’s port limits

| (] SEQ development area

C1 SEQ regional landscape and rural production area or SEQ rural living area — tourist activity or sport and
recreation activity

() SEQ regional tandscape 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
CJ SEQ regional tandscape and rural production area or SEQ rural living area — urban activity

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

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

(J Erosion prone area 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 3 levees only)
] Wetland protection area

ed by (he Plannity

 

 

 

 

Matters requiring referral to the local government:

C1 Airport tand

LO Environmentally relevant activities (ERA) (only i the ERA have been devolved to local government)
(| Loca heritage places

 

 

 

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Maiters requiring referral to the chief executive of the distribution entity or transmission entity:
UC Electricity infrastructure

 

Matters requiring referral to:

e The Chief executive of the holder of the ticence, if not an individual

e The holder of the licence, if the holder of the licence is an individual

C2 Oil and gas infrastructure

Matters requiring referral to the Brisbane City Council:

[1 Brisbane core port land

Matters requiring referral to the Minister under the Transport Infrastructure Act 1994:
C1 Brisbane core port land (inconsistent with Brisbane port LUP for transport reasons)
(1 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:
(1 Land within limits of another port (below high-water mark)

 

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

 

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

 

 

        

(1 Yes - referral response(s) received and listed below are attached to this development application
C1 No

Referral requirement Referral agency Date of referral response

 

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

 

 

 

 

 

 

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

 

 

-4 | 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 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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PART 7 — FURTHER DETAILS

20) Are there any associated development applications or current approvals?

 

Yes — provide details below or include details in a schedule to this development appiication

[No

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

C1 Approva! .
{JJ Development application 1

LD Approval
(J Development application {

 

 

     

~ oly
_teeG&- Zs

 

 

 

 

 

s the portable tone vice leave levy been paid? (only appic Mae eal eerste

 

ane —a copy of the receipted QLeave form is attached to this development application
[4

~{No — |, 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 iong service leave levy has been paid

jot applicable (e.g. building and construction work is less than $150,000 excluding GST)
Amount paid Date paid (dd/mm/yy) QLeave levy number

 

 

 

 

 

pment application in response to a show cause notice or required as a result of an enforcement

 

 

 

Further legistative requireme
Environmentally relev activities
23,1).1s this development applicatiar ) taken to be an application 1 for an en mmental a rity for ar
Ou C el Wachee Caio mts Mee icy $f o] ge Bibs ronmental Prote 1 Act 1994?

| LJ 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

 

[YNo
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 i
ontal authority to Operate. | See. ww. business, ld. QOv.all pe further information. |

  
    

| Proposed ERA threshold. fl

 

 

o “Multiple E! ERAS are applicable to this evelopment application at and the details have been attached ina
schedule to this development application

 

Hazardous chemical facilities

 

) Is this development application for a hazardous chemical facility?
(1 Yes — Form 69: Notification of a facility exceeding 10% of schedule 15 threshold \s attached to this development

application

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

 

 

   

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23.3) Does this development application involve eset Marl ics ys ad thal requires written confirmation tha

the chief executive of the Vegetation Management Agt 1999 is satisfied t scl eM mie] me Meal seca ee] pe
section 22A of the Vegetation Management Act 1999?

LD Yes — this development application includes written confirmation from the chief executive of the Vegetation
eg 1999 (s22A determination)

Oo
Note: 1. Where a development application for operational work or material change of use requires a 822A determination and this is not included,
the development application is prohibited development.
2. See hitps://www.qid.gov.au/environment/and/vegetation/applying for further information on how to obtain a s22A determination.

 

Environmental offsets

4) Is this pment application taken to be & prescribed a that may have a significant residual impact on
a prescribed environmental matter under the Environmental Offsets Act 2014?
(1 Yes — | acknowledge that an environmental offset must be provided for any prescribed activity assessed as
ae 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.gid.gov.au for further information on
environmental offsets,

 

 

 

a
Koala conservation

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 Requlation 2017?

ae

Note. See guidance matanals at www.

 

 
  
  

8.ald cov.au for further information

 

 

aE ele nets)

23.6) Does this development application involve taking or interfering with underground water through an
artesian or subattesian bore, taking or interfering with water in a watercourse, lake or spring, or taking
overland flow water under the Water Act 2000?

C1 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
PANo

Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qid.qov.au for further information.

DA templates are available from https./planning.dsdmip.qid.gov.au/. If the development application involves.

¢ Taking or interfering with underground water through an artestan or subartesian bore. complete DA Form 1 Template 1

¢ 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.

 

PRO Blo Mel ew 12) 91 et ORCS UL tad
ae - the relevant template is completed and attached to this development application
No

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

 

Marine activiti

PARDO Blom MN Ae) UIT) Sere IS Lem UCI eC Recta MMC TLL ac srs ly
Tite lio a Mel m eC h ite ielmemuraCMe lt Lt ite

CD Yes - an associated resource allocation authority is attached to this development application, if required under

aaa Act 1994
No

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

 
 
  

 

 

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 200G?

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7

CO Yes — | acknowledge that a quarry material allocation notice must be obtained prior to commencing development |
fa}io

Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.gid.gov.au and www. business. qid.gov.au for further
information.

Quarry materials from land under tidal waters

nese J application involve the removal of quarry materials from land under tidal water
under the Go Protection and Management Act 1995?

[1 Yes — | acknowledge that a quarry material allocation otic
aio

Note. Contact the Department of Environment and Science at www.des. gid goy ay for further informatian,

Sie eelel tome tnaes

; ee Water Supply A err ?
Cy Yes — the ‘Notice me 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
3.12) Does this development application involve tidal work or development in a coastal management district?

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

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

CIA certificate of title
TNo

Note: See auidance materials at www.des.aid_cov.au for further information

Queensland and local heritage places
23.13) Does this Srna: on propose lopment on or adjoining a place entered in the Queensland
peer entkierc o] me) imo) t:lee-1uiC-iecie sal government's Local Heritage Register?

LI Yes — details of the heritage place are provided in the table below
No

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

 

 

Name of the heritage place: Place (D:
Brothels
lopment application involve a material change of use for a brothel?

(1 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

‘No
elt lame Pate la Ym nate) ee ence ed

15) Does this development application involve new or changed oa state itrotled road?

 

(J 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

No

 

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PART 8 — CHECKLIST AND APPLICANT DECLARATION

 

24) Development application pede

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

requirement(s) in question 17 Ves

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 — Lifes

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

Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report Les
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
information, see DA Forms Guide. Relevant plans.

The portable long service leave levy for QLeave has been paid, or will be paid before a Oye
development permit is issued (see 21)) lot applicable

 

q

 

 

 

25) Applicant declaration

E4y making this development application, | declare that all information in this development application is true and

correct

Evhere an email address ts provided in Part 4 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: it is unlawful fo 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 2076 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): [ |
Notification of engagement of alternative assessment manage

Prescribed assessment manager
Name of chosen assessment manager
Date chosen assessment manager engaged

 

 

 

 

Contact number of chosen assessment manager

 

 

 

 

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

 

 

 

 

Q

Note, For competion by a:

eave notification and payment

   

SUH AMC Tre l8 smd rere) lercb els

 

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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