Form 5 - Change Application Form (3)

Page 2

     Postcode                     Lot No.                         Plan Type and Number (e.g.           Local Government
                                                                  RP, SP)                              Area(s)


3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining
     or adjacent to land e.g. channel dredging in Moreton Bay)
Note: Place each set of coordinates in a separate row.
   Coordinates of premises by longitude and latitude
Longitude(s)                                           Latitude(s)             Datum                Local Government Area(s)
                                                                                                    (if applicable)
                                                                                     WGS84
                                                                                     GDA94
                                                                                     Other:
   Coordinates of premises by easting and northing
Easting(s)                               Northing(s)                 Zone      Datum                Local Government Area(s)
                                                                     Ref.                           (if applicable)
                                                                        54           WGS84
                                                                        55           GDA94
                                                                        56           Other:
3.3) Additional premises
   Additional premises are relevant to the original development approval and the details of these premises 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 Shire 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
                                 51992.5309.02                22.08.2024
 ☐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):

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




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                                                                                       Planning Act Form 5 - Change application form
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Postcode Lot No. Plan Type and Number (e.g. | Local Government
RP, SP) Area(s)

 

 

 

 

 

3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining
or adjacent to land e.g. channel dredging in Moreton Bay)

 

Note: Place each set of coordinates in a separate row.
LJ Coordinates of premises by longitude and latitude

 

 

Longitude(s) Latitude(s) Datum Local Government Area(s)
(if applicable)
LJ waese4
L GDA94
LJ Other: [|

 

 

LJ Coordinates of premises by easting and northing
Easting(s) Northing(s) Zone Datum Local Government Area(s)
Ref. (if applicable)

C54 | wases4
055 LJ GDA94
(156 | O Other:

 

 

 

 

 

 

3.3) Additional premises

 

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

XX] 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 Shire 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

 

ODevelopment permit

. 51992.5309.02 22.08.2024
OPreliminary approval

 

LJ 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):

6.2) What type of change does this application propose?

 

X Minor change application — proceed to Part 5
Other change application — proceed to Part 6

 

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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020

 

Page 3

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 pre-
                                                request response notice for the application has been         request response provided)
                                                given, a copy of the notice must 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

PART 6 – OTHER CHANGE APPLICATION REQUIREMENTS
Note: To complete this part it will be necessary for you to complete parts of DA Form 1 – Development application details and in some instances parts
of DA Form 2 – Building work details, 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

  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
      Yes – the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 – Development application
      details 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 – Building work details 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 – Development application details 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:


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PART 5 —- MINOR CHANGE APPLICATION REQUIREMENTS

 

7) Are there any affected entities for this change application

XX] 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 pre-
request response notice for the application has been request response provided)
given, a copy of the notice must accompany this change
application)
[J No

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

LI No

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

LI No

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

 

 

 

 

 

 

 

PART 6 — OTHER CHANGE APPLICATION REQUIREMENTS

Note: To complete this part it will be necessary for you to complete parts of DA Form 1 — Development application details and in some instances parts
of DA Form 2 - Building work details, 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?

LC No
0 Yes

 

9) Development details

9.1) Is there any change to the type of development, approval type, or level of assessment in this change
application?

LC No

UO Yes — the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 — Development application
details 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

LD Yes — the completed Part 5 (Building work details) of DA Form 2- Building work details 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

CL Yes — the completed Part 5 (Referral details) of DA Form 1— Development application details 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

 

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

LJ 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:

 

 

 

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Planning Act Form 5 - Change application form
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    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 – Development application details 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 – Development                                        Yes
 application details have been completed and is attached to this application                                              Not applicable
 For an other change application, where building work is associated with the change                                       Yes
 application, the relevant sections of DA Form 2 – Building work details have been
 completed and is attached to this application                                                                            Not applicable

 Supporting information addressing any applicable assessment benchmarks is attached to
 this application
 Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 – Development application details            Yes
 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
 Note: Relevant plans are required to be submitted for all relevant aspects of this change application. For further       Yes
 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.


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e 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

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: Forms 1 and 2.

 

 

12) Further details

CL Part 7 of DA Form 1 — Development application details 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:

e responsible entity in 4); and

e fora minor change, any affected entities; and XI Yes

e 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— Development LC Yes
application details have been completed and is attached to this application KX] Not applicable
For an other change application, where building work is associated with the change OYes

application, the relevant sections of DA Form 2— Building work details have been
completed and is attached to this application

Supporting information addressing any applicable assessment benchmarks is attached to

this application

Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 — Development application details & Yes
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

Note: Relevant plans are required to be submitted for all relevant aspects of this change application. For further x Yes
information, see DA Forms Guide: Relevant plans.

KX] Not applicable

 

 

 

14) Applicant declaration

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

XX] 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:

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.

 

 

 

 

 

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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020

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PART 8 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:                                   Reference number(s):

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work
 QLeave project number
 Amount paid ($)                                                 Date paid (dd/mm/yy)
 Date receipted form sighted by assessment manager
 Name of officer who sighted the form




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PART 8 — FOR COMPLETION OF THE ASSESSMENT MANAGER — FOR OFFICE

USE ONLY

Date received: [ Reference number(s): |

QLeave notification and payment

Note: For completion by assessment manager if applicable

 

 

Description of the work

 

QLeave project number

 

Amount paid ($)

Date paid (dd/mm/yy)

 

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 1.2 — 7 February 2020