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Appendix A - Planning Act Form 5, Current Title Searches & Company Owner's Consent Form
Change application form
Planning Act Form 5 (version 1.2 effective 7 February 2020) made under Section 282 of the Planning Act 2016.
This form is to be used for a change application made under section 78 of the Planning Act 2016. It is important when
making a change application to be aware of whether the application is for a minor change that will be assessed under
section 81 of the Planning Act 2016 or for an other change that will be assessed under section 82 of the Planning Act
2016.
An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
being required to accompany the change application, unless stated otherwise. Additional pages may be attached if
there is insufficient space on the form to complete any part.
Note: All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the Development
Assessment Rules (DA Rules).
PART 1 – APPLICANT DETAILS
1) Applicant details
Eagle Rise Developments Pty Ltd C/- Murray & Associates
Applicant name(s) (individual or company full name)
(Qld) Pty Ltd
Contact name (only applicable for companies) Blake Bell
Postal address (P.O. Box or street address) PO Box 246
Suburb Nambour
State Qld
Postcode 4560
Country Australia
Email address (non-mandatory) [email protected] and [email protected]
Mobile number (non-mandatory) N/A
Applicant’s reference number(s) (if applicable) 60500
2) Owner’s consent - Is written consent of the owner required for this change application?
Note: Section 79(1A) of the Planning Act 2016 states the requirements in relation to owner’s consent.
Yes – the written consent of the owner(s) is attached to this change application
No
PART 2 – LOCATION DETAILS
3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
3.1) Street address and lot on plan
Street address AND lot on plan (all lots must be listed), or
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
43 Eagle Drive Tewantin
a)
Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
4565 100 SP323048 Noosa Shire Council
Unit No. Street No. Street Name and Type Suburb
b)
Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
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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 Ref. Datum Local Government Area(s) (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
Lockyer Valley Regional 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 Shire Council
REC17/0011 16 February 2018
Preliminary approval
Development permit Planning & Environment
Order No D30 of 2018 19 July 2019 Court
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):
Please see details within Minor Change to Development Approval Report.
6.2) What type of change does this application propose?
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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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020
Page 4
• 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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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020
Page 5
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
Page 6
Current Title Search
Queensland Titles Registry Pty Ltd
ABN 23 648 568 101
Title Reference: 51252623 Search Date: 11/10/2021 14:43
Date Title Created: 21/05/2021 Request No: 38852698
Previous Title: 51208085
ESTATE AND LAND
Estate in Fee Simple
LOT 100 SURVEY PLAN 323048
Local Government: NOOSA
REGISTERED OWNER
Dealing No: 720777769 10/05/2021
EAGLERISE DEVELOPMENTS PTY LTD A.C.N. 618 087 577
EASEMENTS, ENCUMBRANCES AND INTERESTS
1. Rights and interests reserved to the Crown by
Deed of Grant No. 11533012 (POR 60)
2. EASEMENT IN GROSS No 713478229 22/09/2010 at 14:44
burdening the land
NORTHERN SEQ DISTRIBUTOR-RETAILER AUTHORITY A.B.N. 89 791
717 472
over
EASEMENT B ON SP230078
3. EASEMENT No 719840746 13/01/2020 at 07:59
benefiting the land over
EASEMENT Z ON SP308934
4. MORTGAGE No 720286944 23/09/2020 at 16:50
PAUL GREGORY EBSWORTH
5. EASEMENT No 720777770 10/05/2021 at 07:57
benefiting the land over
EASEMENT C ON SP323048
6. EASEMENT No 720777771 10/05/2021 at 07:57
benefiting the land over
EASEMENT D ON SP323048
7. EASEMENT No 720777772 10/05/2021 at 07:58
benefiting the land over
EASEMENT E ON SP323048
8. EASEMENT No 720777773 10/05/2021 at 07:58
benefiting the land over
EASEMENT F ON SP323048
9. EASEMENT No 720777774 10/05/2021 at 07:58
benefiting the land over
EASEMENT G ON SP323048
10. EASEMENT No 720777776 10/05/2021 at 08:00
burdening the land to
LOTS 1, 2, 3, 4 AND 5 ON SP323048
OVER EASEMENT H ON SP323048
COPYRIGHT QUEENSLAND TITLES REGISTRY PTY LTD [2021] www.titlesqld.com.au
Requested by: D-ENQ GLOBALX Page 1/2
Page 7
Current Title Search
Queensland Titles Registry Pty Ltd
Title Reference: 51252623
ABN 23 648 568 101
EASEMENTS, ENCUMBRANCES AND INTERESTS (Continued)
11. EASEMENT IN GROSS No 720777777 10/05/2021 at 08:01
burdening the land
NORTHERN SEQ DISTRIBUTOR-RETAILER AUTHORITY
over
EASEMENTS H AND K ON SP323048
ADMINISTRATIVE ADVICES
NIL
UNREGISTERED DEALINGS
NIL
Caution - Charges do not necessarily appear in order of priority
** End of Current Title Search **
COPYRIGHT QUEENSLAND TITLES REGISTRY PTY LTD [2021] www.titlesqld.com.au
Requested by: D-ENQ GLOBALX Page 2/2
Page 8
Company owner’s consent to the making of a development application
under the Planning Act 2016
Paul Ebsworth
I,
[Insert name in full.]
Director of the company mentioned below.
and I,
[Insert name in full.
[Insert position in full—i.e. another director, or a company secretary.]
Of, Eaglerise Developments Pty Ltd A.C.N. 618 087 577
the company being the owner of the premises identified as follows:
Lot 100 on SP323048, situated at Eagle Drive, Tewantin Qld 4565
consent to the making of a development application under the Planning Act 2016 by:
C/- Murray & Associates (Qld) Pty Ltd
on the premises described above for:
Request for a Minor Change to a Development Approval
Company seal [if used]
Company Name and ACN: Eaglerise Developments Pty Ltd A.C.N. 618 087 577
peas …………………………………………… ……………………………………………
Signature of Director Signature of Director/Secretary
13.10.21
……………………………… ……………………………………………
Date Date
The Planning Act 2016 is administered by the Department of Local Government, Infrastructure and Planning, Queensland
Government.
Applicant template 11.0
Version 1.0—3 July 2017