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DA Form 1 - (Parts 3 & 7 Only)
DA Form 1 – Development application details
Approved form (version 1.3 effective 28 September 2020) 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 only 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
(i.e. material change of use, operational work or reconfiguring a lot), 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 3 – DEVELOPMENT DETAILS
Section 1 – Aspects of development
6.1) Provide details about the first development aspect
a) What is the type of development? (tick only one box)
Material change of use Reconfiguring a lot Operational work Building work
b) What is the approval type? (tick only one box)
Development permit Preliminary approval Preliminary approval that includes a variation approval
c) What is the level of assessment?
Code assessment Impact assessment (requires public notification)
d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
lots):
Roadside Stall
e) Relevant plans
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms guide:
Relevant plans.
Relevant plans of the proposed development are attached to the development application
6.2) Provide details about the second development aspect
a) What is the type of development? (tick only one box)
Material change of use Reconfiguring a lot Operational work Building work
b) What is the approval type? (tick only one box)
Development permit Preliminary approval Preliminary approval that includes a variation approval
c) What is the level of assessment?
Code assessment Impact assessment (requires public notification)
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d) Provide a brief description of the proposal (e.g. 6 unit apartment building defined as multi-unit dwelling, reconfiguration of 1 lot into 3
lots):
Food and drink outlet
e) Relevant plans
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide:
Relevant plans.
Relevant plans of the proposed development are attached to the development application
6.3) Additional aspects of development
Additional aspects of development are relevant to this development application and the details for these aspects
that would be required under Part 3 Section 1 of this form have been attached to this development application
Not required
Section 2 – Further development details
7) Does the proposed development application involve any of the following?
Material change of use Yes – complete division 1 if assessable against a local planning instrument
Reconfiguring a lot Yes – complete division 2
Operational work Yes – complete division 3
Building work Yes – complete DA Form 2 – Building work details
Division 1 – Material change of use
Note: This division is only required to be completed if any part of the development application involves a material change of use assessable against a
local planning instrument.
8.1) Describe the proposed material change of use
Provide a general description of the Provide the planning scheme definition Number of dwelling Gross floor
proposed use (include each definition in a new row) units (if applicable) area (m2)
(if applicable)
Roadside display and sale of goods Roadside stall 18m2
Sale of food and drink for consumption Food and drink outlet 18m2
8.2) Does the proposed use involve the use of existing buildings on the premises?
Yes
No
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
application references manager
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)
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Yes – a 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 (e.g. building and construction work is less than $150,000 excluding GST)
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
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 ESR/2015/1791) 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 “ESR/2015/1791” as a search term 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.business.qld.gov.au for further information about hazardous chemical notifications.
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Clearing native vegetation
23.3) Does this development application involve clearing native vegetation that requires written confirmation that
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 includes written confirmation from the chief executive of the Vegetation
Management Act 1999 (s22A determination)
No
Note: 1. Where a development application for operational work or material change of use requires a s22A determination and this is not included,
the development application is prohibited development.
2. See https://www.qld.gov.au/environment/land/vegetation/applying for further information on how to obtain a s22A determination.
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 habitat in SEQ Region
23.5) Does this development application involve a material change of use, reconfiguring a lot or operational work
which is assessable development under Schedule 10, Part 10 of the Planning Regulation 2017?
Yes – the development application involves premises in the koala habitat area in the koala priority area
Yes – the development application involves premises in the koala habitat area outside the koala priority area
No
Note: If a koala habitat area determination has been obtained for this premises and is current over the land, it should be provided as part of this
development application. See koala habitat area guidance materials at www.des.qld.gov.au for further information.
Water resources
23.6) Does this development application involve taking or interfering with underground water through an
artesian or subartesian bore, taking or interfering with water in a watercourse, lake or spring, or taking
overland flow water under the Water Act 2000?
Yes – the relevant template is completed and attached to this development application and I acknowledge that a
relevant authorisation or licence under the Water Act 2000 may be required prior to commencing development
No
Note: Contact the Department of Natural Resources, Mines and Energy at www.dnrme.qld.gov.au for further information.
DA templates are available from https://planning.dsdmip.qld.gov.au/. If the development application involves:
• Taking or interfering with underground water through an artesian or subartesian bore: complete DA Form 1 Template 1
• Taking or interfering with water in a watercourse, lake or spring: complete DA Form1 Template 2
• Taking overland flow water: complete DA Form 1 Template 3.
Waterway barrier works
23.7) Does this application involve waterway barrier works?
Yes – the relevant template is completed and attached to this development application
No
DA templates are available from https://planning.dsdmip.qld.gov.au/. For a development application involving waterway barrier works, complete
DA Form 1 Template 4.
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.
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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, Mines and Energy at www.dnrme.qld.gov.au and www.business.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 Science at www.des.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.dnrme.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.des.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.des.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?
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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Walkable neighbourhoods assessment benchmarks under Schedule 12A of the Planning Regulation
23.16) Does this development application involve reconfiguring a lot into 2 or more lots in certain residential zones
(except rural residential zones), where at least one road is created or extended?
Yes – Schedule 12A is applicable to the development application and the assessment benchmarks contained in
schedule 12A have been considered
No
Note: See guidance materials at www.planning.dsdmip.qld.gov.au for further information.
PART 8 – CHECKLIST AND APPLICANT DECLARATION
24) Development application checklist
I have identified the assessment manager in question 15 and all relevant referral
requirement(s) in question 17 Yes
Note: See the Planning Regulation 2017 for referral requirements
If building work is associated with the proposed development, Parts 4 to 6 of DA Form 2 – Yes
Building work details have been completed and attached to this development application Not applicable
Supporting information addressing any applicable assessment benchmarks is with the
development application
Note: This is a mandatory requirement and includes any relevant templates under question 23, a planning report Yes
and any technical reports required by the relevant categorising instruments (e.g. local government planning
schemes, 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 aspects of this development application. For further Yes
information, see DA Forms Guide: Relevant plans.
The portable long service leave levy for QLeave has been paid, or will be paid before a Yes
development permit is issued (see 21) Not applicable
25) Applicant declaration
By making this development application, I declare that all information in this development 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 assessment manager and any referral agency for the development 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 assessment manager and/or chosen
assessment manager, any relevant referral agency and/or building certifier (including any professional advisers
which may be engaged by those entities) while processing, assessing and deciding the development application.
All information relating to this development 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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PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY
Date received: Reference number(s):
Notification of engagement of alternative assessment manager
Prescribed assessment manager
Name of chosen assessment manager
Date chosen assessment manager engaged
Contact number of chosen assessment manager
Relevant licence number(s) of chosen assessment
manager
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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