Change application form (Deck) 13003.221152.7

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  5) Type of change proposed
  5.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development approval for a
  5 unit apartment building to provide for a 6 unit apartment building):


  Change the existing development permit for a dwelling house to allow an upper level deck to be constructed to the main
  dwelling

  5.2) What type of change does this application propose?
      Minor change application – proceed to Part 4
      Other change application – proceed to Part 5

PART 4 – MINOR CHANGE APPLICATION REQUIREMENTS
  6) Are there any affected entities for this change application
      No – proceed to Part 6
      Yes – list all affected entities below and proceed to Part 6
  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        request response provided)
                                         been 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 5 – 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 www.dilgp.qld.gov.au.


  7) 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.

  8) Development details
  8.1) Are there any new or changed development aspects included in this change application that are not part of the
  original development approval?
    No – proceed to 9)
    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.
  8.2) 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.
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                                                                                              Planning Act Form 5 - Change application form
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 9) Referral details - Do any aspects of 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 Sections 1 and 2 of 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.

 10) 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.


 11) 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 6 – CHECKLIST AND APPLICANT DECLARATION
 12) change application checklist
 I have identified the:
      • responsible entity in 3); and
      • for a minor change, any affected entities; and                                                                Yes
      • for an ‘other’ change all relevant referral requirement(s) in 9)
 Note: See the Planning Regulation 2017 for referral requirements
 For an ‘other’ change application, the relevant sections of DA Form 1 – Development                                  Yes
 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 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) of DA Form 1 that are relevant as a
 result of the change application, a planning report and any technical reports required by the                        Yes
 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                            Yes
 application. For further information, see DA Forms Guide: Relevant plans.


 24) 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.

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                                                                                                         Planning Act Form 5 - Change application form
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  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 7 – 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
  Date receipted form sighted by assessment manager
  Name of officer who sighted the form

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required change application materials should be
sent to the responsible entity.




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                                                                                      Planning Act Form 5 - Change application form
                                                                                                           Version 1.0—3 July 2017