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DA Form 5
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
Applicant name(s) (individual or company full name) G & A Duley & A & A Bell - Natani Design Pty Ltd C/- Suncoast
Building Approvals
Contact name (only applicable for companies) Richard Holden
Postal address (P.O. Box or street address) PO Box 1054
Suburb MAROOCHYDORE
State QLD
Postcode 4558
Country Australia
Contact number 07 5443 7288
Email address (non-mandatory) [email protected]
Mobile number (non-mandatory)
Fax number (non-mandatory)
Applicant’s reference number(s) (if applicable) VA Ref # 12679 & 11981
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).
a) Unit No. Street No. Street Name and Type Suburb
8 & 11 37 Hastings Street NOOSA HEADS
Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
4567 8 & 11 BUP 8083 Noosa Council
b) Unit No. Street No. Street Name and Type Suburb
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
☐ 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
Longitude(s) Latitude(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 this development application 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 Recent 51986.3023.02 Noosa Council - Glen
19/11/2020
☐ Preliminary approval Original TPC 1845 Conforti
☐ 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):
Minor change to two units upper level shower area & awning cover
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
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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 Date notice given (where no
pre-request response notice for the pre-request response
application has been given, a copy of the provided)
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 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
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 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.
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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020
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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: ☒ Yes
responsible entity in 4); and
for a minor change, any affected entities; and
for an ‘other’ change all relevant referral requirement(s) in 10)
Note: See the Planning Regulation 2017 for referral requirements
☐ Yes
For an ‘other’ change application, the relevant sections of DA Form 1 - Development
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 ☒ Yes
this application
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.
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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020
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PART 8 – 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