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Planning Act Form 5 - Change application form · MCU24/0074.01

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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
                                                                      Gympie Terrace P/L TTE Care/ Adamson Town Planning
  Applicant name(s) (individual or company full name)
                                                                      Pty Ltd
  Contact name (only applicable for companies)                        Shane Adamson – Director
  Postal address (P.O. Box or street address)                         PO Box 894
  Suburb                                                              Cooroy
  State                                                               QLD
  Postcode                                                            4563
  Country                                                             Aust
  Email address (non-mandatory)                                       [email protected]
  Mobile number (non-mandatory)                                       0437 754 420
  Applicant’s reference number(s) (if applicable)                     26035

  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
                           203                Gympie Terrace                                          Noosaville
    a)
           Postcode        Lot No.            Plan Type and Number (e.g. RP, SP)                      Local Government Area(s)
                           2                  RP138699                                                Noosa Shire
           Unit No.        Street No.         Street Name and Type                                    Suburb
    b)
                           207                Gympie Terrace                                          Noosaville
Full text of the other 4 pages

Page 2

          Postcode       Lot No.          Plan Type and Number (e.g. RP, SP)                      Local Government Area(s)
                         7                SP347727                                                Noosa Shire
 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
 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                MCU24/0074                         19 June 2026
                                                                                                            Planning and Environment
                                                                                                            Court
     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):

 •    The primary change is a reduction in the number of Short-term Accommodation units from 16 to 10.
 •    A minor reduction to the floor areas for the Food and Drink Outlet tenancies.
 •    A corresponding reduction in the number of parking spaces being provided onsite with additional parking
      provided on the street.
 •    Minor changes at ground level to facilitate onsite servicing with access from Thomas Street and egress to Albert
      Street and to achieve better design outcomes as a result of detailed design.
 •    Other changes to the built from elements consistent with the conditions of approval and due to fire compliance
      requirements; and



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

Page 3

  •    Changes to some of the conditions of approval to reflect the changes being made to the proposal.

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



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.




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

Page 4

     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:
 • 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
 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 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.


                                                                                                                                              Page 4
                                                                                                        Planning Act Form 5 - Change application form
                                                                                                                       Version 1.2 — 7 February 2020

Page 5

 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 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




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

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