Change Application Form 132005.535.01

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Easting(s) Northing(s) | Zone Ref. Datum Local Government Area(s) (if applicable) _|
LI] wess4
LJ GDA94
L] Other:

 

 

      

 

 

   
 

   
 

3.3) Additional premises
L] Additional premises relevant to the original development approval and their details have been attached ina
schedule to this application

E}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

 

 

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 me

| C] Preliminary approval \s 2005 “S385
_] Development permit

LJ 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):

Fit) i ee whag batocenves (i-Arest Aoey, |-Seand Floor
7

Witww 201 Shay roof Wes
6.2) What type of change dogs this application propose?
[UHMinor change application — proceed to Part 5
LJ Other change application — proceed to Part 6

PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS

7) Are there any affected entities for this change application
[LU No — proceed to Part 7

C1 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

L] No

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

LJ No

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

 

 

 

 

 

 

 

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Planning Act Form 5 - Change application form
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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 7 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?

 

CL 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)
LJ 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?

LJ] No
L 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.

 

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

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

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

Note: By not agreeing to accept an information request |, 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
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

 

 

 

13) change application checklist
| have identified the:

responsible entity in 4); and

for a minor change, any affected entities; and FTVes
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 [Not applicable
application PP

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 Not applicabl
have been completed and is attached to this application pplicabie
Supporting information addressing any applicable assessment benchmarks is crves

attached to this application

 

 

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Planning Act Form 5 - Change application form
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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 M
Note: Relevant plans are required to be submitted for all relevant aspects of this O
change application. For further information, see DA Forms Guide: Relevant plans.

 

 

  

14) Applicant declaration

K1By 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

 

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