Planning Act Form 5_.pdf

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Easting(s)            Northing(s)      Zone Ref.         Datum                         Local Government Area(s) (if applicable)
                                         54                 WGS84
                                         55                 GDA94
                                         56                 Other:
3.3) Additional premises
   Additional premises relevant to the original development approval and their details have been attached in a
schedule to this application
   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
Noosa Council

 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
        Development permit                                                                                Noosa Council
                                    MCU16/0117.01                     13/12/2018
        Preliminary approval
        Development permit
        Preliminary approval

6) Type of change proposed
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):

Change to condition 4 of the development approval which relates to building height

6.2) What type of change does this application propose?
   Minor change application – proceed to Part 5
   Other change application – proceed to Part 6

 PART 5 – MINOR CHANGE APPLICATION REQUIREMENTS
7) Are there any affected entities for this change application
   No – 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
                                        request response notice for the application has           pre-request response
                                        been given, a copy of the notice must                     provided)
                                        accompany this change application)
                                            No
                                            Yes – pre-request response is attached to
                                        this change application
                                            No
                                            Yes – pre-request response is attached to
                                        this change application
                                            No
                                            Yes – pre-request response is attached to
                                        this change application



                                                                                                                             Page 2
                                                                                       Planning Act Form 5 - Change application form
                                                                                                       Version 1.1 — 22 JUNE 2018


[OCR of page images]
 

 

Easting(s) Northing(s) Zone Ref. Datum Local Government Area(s) (if applicable)
LJ 54 LJ] wGs84
(55 LJ GDA94
L156 LC Other:

 

 

 

 

LJ Additional premises relevant to the original development approval and their details have been attached in a
schedule to this application
LJ 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
Noosa Council

 

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

MCU16/0117.01 13/12/2018 Noosa Council

 

Ex] Development permit
L] Preliminary approval
L] Development permit
L] Preliminary approval

6) Type of change proposed
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):

 

 

 

 

 

 

Change to condition 4 of the development approval which relates to building height

 

6.2) What type of change does this application propose?

XX] Minor change application — proceed to Part 5
LJ Other change application — proceed to Part 6

 

 

 

 

PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS

XX] No — proceed to Part 7
CO 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
request response notice for the application has | pre-request response
been given, a copy of the notice must provided)
accompany this change application)
LJ] No

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

LJ] No

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

L] No

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

 

 

 

 

 

 

 

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Dinnning Ant Darn Eo Channa annliantinn faem

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      PART 6 – OTHER CHANGE APPLICATION REQUIREMENTS
      Note: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some instances parts of DA Form
      2, as mentioned below. These forms are available at https://planning.dsdmip.qld.gov.au

    8) Location details - Are there any additional premises included in this change application that were not part of the
    original development approval?
        No
        Yes – complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
    provided with this application.

    9) Development details
    9.1) Is there any change to the type of development, approval type, or level of assessment in this change application?
       No – proceed to 11)
       Yes – the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
    the new or changed aspects of development are provided with this application.
    9.2) Does the change application involve building work?
       No
       Yes – the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided
    with this application.

    10) Referral details – Does the change application require referral for any referral requirements?
    Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
    development application including the proposed change.
        No
        Yes – the completed Part 5 (Referral details) of DA Form 1 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.

    11) Information request under Part 3 of the DA Rules
       I agree to receive an information request if determined necessary for this change application
       I do not agree to accept an information request for this change application
    Note: By not agreeing to accept an information request I, the applicant, acknowledge:
•   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
        Part 7 of DA Form 1 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
    I have identified the:
•   responsible entity in 4); and
•   for a minor change, any affected entities; and                                                                   Yes
•   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 –
                                                                                                                     Yes
    Development application details have been completed and is attached to this
                                                                                                                     Not applicable
    application
    For an ‘other’ change application, where building work is associated with the
                                                                                                                     Yes
    change application, the relevant sections of DA Form 2 – Building work details
                                                                                                                     Not applicable
    have been completed and is attached to this application
    Supporting information addressing any applicable assessment benchmarks is
                                                                                                                     Yes
    attached to this application


                                                                                                                                              Page 3
                                                                                                        Planning Act Form 5 - Change application form
                                                                                                                        Version 1.1 — 22 JUNE 2018


[OCR of page images]
PART 6 — OTHER CHANGE APPLICATION REQUIREMENTS

Note: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some instances parts of DA Form
2, as mentioned below. These forms are available at https://planning.dsdmip.qld.gov.au

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

 

original development approval?

L] No

C1 Yes — complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
provided with this application.

 

9) Development details

9.1) Is there any change to the type of development, approval type, or level of assessment in this change application?
L] No — proceed to 11)

C1 Yes — the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
the new or changed aspects of development are provided with this application.

L] No
C1 Yes — the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided

with this application.

 

10) Referral details —- Does the change application require referral for any referral requirements?

Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
development application including the proposed change.

LJ] No
C1 Yes — the completed Part 5 (Referral details) of DA Form 1 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.

 

 

11) Information request under Part 3 of the DA Rules

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

C1 | do not agree to accept an information request for this change application

Note: By not agreeing to accept an information request I, the applicant, acknowledge:

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.

PAM aalcmelot ly

L] Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with
this application.

PART 7 — CHECKLIST AND APPLICANT DECLARATION

| have identified the:

responsible entity in 4); and

for a minor change, any affected entities; and Kl] Yes
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 — CYes
Development application details have been completed and is attached to this [1 Not applicable
application

For an ‘other’ change application, where building work is associated with the CYes

change application, the relevant sections of DA Form 2 — Building work details [1 Not applicable
have been completed and is attached to this application

Supporting information addressing any applicable assessment benchmarks is C Yes

 

 

attached to this application

 

 

Dinnning Ant Darn Eo Channa

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    Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 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 government
    planning scheme, 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                                                                                          Yes
    Note: Relevant plans are required to be submitted for all relevant aspects of this
    change application. For further information, see DA Forms Guide: Relevant plans.

    14) Applicant declaration
        By making this change application, I declare that all information in this change 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 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: It 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:
•   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 8 – FOR OFFICE USE ONLY
    Date                                         Reference number(s):
    received:


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




                                                                                                                                   Page 4
                                                                                             Planning Act Form 5 - Change application form
                                                                                                             Version 1.1 — 22 JUNE 2018


[OCR of page images]
 

Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 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 government

planning scheme, 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 OyYes
Note: Relevant plans are required to be submitted for all relevant aspects of this

change application. For further information, see DA Forms Guide: Relevant plans.

14) Applicant declaration

Xx] By making this change application, | declare that all information in this change application is true and correct.

LJ 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: It 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:

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 8 — FOR OFFICE USE ONLY

 

 

 

Date Reference number(s):
received:

 

 

 

 

 

 

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