Changes Form - 1/100 Rene St Noosaville - 132007.1841.7

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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):


  Refer to enclosed letter. Change to approved Building A on Lot 1.

  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

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     Yes – the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided with
 this application.

 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.



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      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.

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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DA Form 1 – Development application details
Approved form (version 1.0 effective 3 July 2017) made under section 282 of the Planning Act 2016.

This form must be used to make a development application involving code assessment or impact assessment,
except when applying for development involving building work.
For a development application involving building work only, use DA Form 2 – Building work details.
For a development application involving building work associated with any other type of assessable development,
use this form (DA Form 1) and parts 4 to 6 of DA Form 2 – Building work details.
Unless stated otherwise, all parts of this form must be completed in full and all required supporting information must
accompany the development application.
One or more additional pages may be attached as a schedule to this development application if there is insufficient space
on the form to include all the necessary information.

 This form and any other form relevant to the development application must be used to make a development application
 relating to strategic port land and Brisbane core port land under the Transport Infrastructure Act 1994, and airport land
 under the Airport Assets (Restructuring and Disposal) Act 2008. For the purpose of assessing a development
 application relating to strategic port land and Brisbane core port land, any reference to a planning scheme is taken to
 mean a land use plan for the strategic port land, Brisbane port land use plan for Brisbane core port land, or a land use
 plan for airport land.
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 7 – FURTHER DETAILS
  20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)
      Yes – provide details below or include details in a schedule to this development application
      No
  List of approval/development              Reference number                     Date                                  Assessment manager
  application references
      Approval
      Development application
      Approval
      Development application

  21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or
  operational work)
     Yes – the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this
   development application
     No – I, the applicant will provide evidence that the portable long service leave levy has been paid before the
   assessment manager decides the development application. I acknowledge that the assessment manager may give a
   development approval only if I provide evidence that the portable long service leave levy has been paid
     Not applicable
  Amount paid                            Date paid (dd/mm/yy)                            QLeave levy number (A, B or E)
  $

  22) Is this development application in response to a show cause notice or required as a result of an enforcement notice?
      Yes – show cause or enforcement notice is attached
      No



  23) Further legislative requirements
  Environmentally relevant activities
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23.1) Is this development application also taken to be an application for an environmental authority for an
Environmentally Relevant Activity (ERA) under section 115 of the Environmental Protection Act 1994?
   Yes – the required attachment (form EM941) for an application for an environmental authority accompanies this
development application, and details are provided in the table below
   No
Note: Application for an environmental authority can be found by searching “EM941” at www.qld.gov.au. An ERA requires an environmental authority
to operate. See www.business.qld.gov.au for further information.
Proposed ERA number:                                                          Proposed ERA threshold:
Proposed ERA name:
          Multiple ERAs are applicable to this development application and the details have been attached in a schedule
          to this development application.
Hazardous chemical facilities
23.2) Is this development application for a hazardous chemical facility?
   Yes – Form 69: Notification of a facility exceeding 10% of schedule 15 threshold is attached to this development
application
   No
Note: See www.justice.qld.gov.au for further information.


Clearing native vegetation
23.3) Does this development application involve clearing native vegetation that requires written confirmation the chief
executive of the Vegetation Management Act 1999 is satisfied the clearing is for a relevant purpose under section 22A
of the Vegetation Management Act 1999?
  Yes – this development application is accompanied by written confirmation from the chief executive of the
Vegetation Management Act 1999 (s22A determination)
  No
Note: See www.qld.gov.au for further information.

Environmental offsets
23.4) Is this development application taken to be a prescribed activity that may have a significant residual impact on a
prescribed environmental matter under the Environmental Offsets Act 2014?
   Yes – I acknowledge that an environmental offset must be provided for any prescribed activity assessed as having a
significant residual impact on a prescribed environmental matter
   No
Note: The environmental offset section of the Queensland Government’s website can be accessed at www.qld.gov.au for further information on
environmental offsets.

Koala conservation
23.5) Does this development application involve a material change of use, reconfiguring a lot or operational work within
an assessable development area under Schedule 10, Part 10 of the Planning Regulation 2017?
    Yes
    No
Note: See guidance materials at www.ehp.qld.gov.au for further information.

Water resources
23.6) Does this development application involve taking or interfering with artesian or sub artesian water, taking or
interfering with water in a watercourse, lake or spring, taking overland flow water or waterway barrier works?
    Yes – the relevant template is completed and attached to this development application
    No
Note: DA templates are available from www.dilgp.qld.gov.au.
23.7) Does this application involve taking or interfering with artesian or sub artesian water, taking or interfering
with water in a watercourse, lake or spring, or taking overland flow water under the Water Act 2000?
  Yes – I acknowledge that a relevant water authorisation under the Water Act 2000 may be required prior to
commencing development
  No
Note: Contact the Department of Natural Resources and Mines at www.dnrm.qld.gov.au for further information.
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Marine activities
23.8) Does this development application involve aquaculture, works within a declared fish habitat area or removal,
disturbance or destruction of marine plants?
    Yes – an associated resource allocation authority is attached to this development application, if required under the
Fisheries Act 1994
    No
Note: See guidance materials at www.daf.qld.gov.au for further information.

Quarry materials from a watercourse or lake
23.9) Does this development application involve the removal of quarry materials from a watercourse or lake under
the Water Act 2000?
   Yes – I acknowledge that a quarry material allocation notice must be obtained prior to commencing development
   No
Note: Contact the Department of Natural Resources and Mines at www.dnrm.qld.gov.au for further information.
Quarry materials from land under tidal waters
23.10) Does this development application involve the removal of quarry materials from land under tidal water under
the Coastal Protection and Management Act 1995?
   Yes – I acknowledge that a quarry material allocation notice must be obtained prior to commencing development
   No
Note: Contact the Department of Environment and Heritage Protection at www.ehp.qld.gov.au for further information.

Referable dams
23.11) Does this development application involve a referable dam required to be failure impact assessed under
section 343 of the Water Supply (Safety and Reliability) Act 2008 (the Water Supply Act)?
   Yes – the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water Supply
Act is attached to this development application
   No
Note: See guidance materials at www.dews.qld.gov.au for further information.

Tidal work or development within a coastal management district
23.12) Does this development application involve tidal work or development in a coastal management district?
    Yes – the following is included with this development application:
         Evidence the proposal meets the code for assessable development that is prescribed tidal work (only required if
      application involves prescribed tidal work)
          A certificate of title
    No
Note: See guidance materials at www.ehp.qld.gov.au for further information.
Queensland and local heritage places
23.13) Does this development application propose development on or adjoining a place entered in the Queensland
heritage register or on a place entered in a local government’s Local Heritage Register?
    Yes – details of the heritage place are provided in the table below
    No
Note: See guidance materials at www.ehp.qld.gov.au for information requirements regarding development of Queensland heritage places.

Name of the heritage place:                                                    Place ID:
Brothels
23.14) Does this development application involve a material change of use for a brothel?
    Yes – this development application demonstrates how the proposal meets the code for a development application
for a brothel under Schedule 3 of the Prostitution Regulation 2014
    No
Decision under section 62 of the Transport Infrastructure Act 1994
23.15) Does this development application involve new or changed access to a state-controlled road?
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    Yes - this application will be taken to be an application for a decision under section 62 of the Transport
Infrastructure Act 1994 (subject to the conditions in section 75 of the Transport Infrastructure Act 1994 being satisfied)
    No




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