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1. Application Form
Attached to the e-mail Change to DA (Materials) - MCU16/0079.03.
Change application form
Planning Act Form 5 (version 1.1 effective 22 JUNE 2018) 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) Rubicon Design & Construct C/- Planit Consulting Pty Ltd
Contact name (only applicable for companies) Brendan Ferris
Postal address (P.O. Box or street address) PO Box 206
Suburb Nobby Beach
State QLD
Postcode 4218
Country Australia
Email address (non-mandatory) [email protected]
Mobile number (non-mandatory)
Applicant’s reference number(s) (if applicable) J6130
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
- 5 Memorial Avenue Tewantin
a)
Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
10 SP273411 Noosa
Unit No. Street No. Street Name and Type Suburb
b)
Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
Unit No. Street No. Street Name and Type Suburb
c) Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
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. Only one set of coordinates is required for this part.
Coordinates of premises by longitude and latitude
Longitude(s) Latitude(s) Datum Local Government Area(s) (if applicable)
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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 relevant to the original development approval 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 MCU16/0079 Noosa Council
Preliminary approval MCU16/0079.01 17/02/2017
MCU16/0079.02
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 applicant requests minor amendments to the stamped plans in order to be consistent with what has been
implemented on site.
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
request response notice for the application has pre-request response
been given, a copy of the notice must provided)
accompany this change application)
No
Yes – pre-request response is attached to
this change application
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Planning Act Form 5 - Change application form
Version 1.1 — 22 JUNE 2018
Page 3
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 – complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
provided with this application.
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 – proceed to 11)
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.
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:
• 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
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Planning Act Form 5 - Change application form
Version 1.1 — 22 JUNE 2018
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For an ‘other’ change application, the relevant sections of DA Form 1 –
Yes
Development application details have been completed and is attached to this
Not applicable
application
For an ‘other’ change application, where building work is associated with the
Yes
change application, the relevant sections of DA Form 2 – Building work details
Not applicable
have been completed and is attached to this application
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 that are
relevant as a result of the change application, a planning report and any technical Yes
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.
PART 8 – FOR OFFICE USE ONLY
Date Reference number(s):
received:
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
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Planning Act Form 5 - Change application form
Version 1.1 — 22 JUNE 2018
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Date: 4 February, 2019 Chief Executive Officer Noosa Council PO Box 141 Tewantin QLD 4656 To whom it may concern, RE: LANDOWNER CONSENT FOR REQUEST TO CHANGE DEVELOPMENT APPROVAL AT 5 MEMORIAL AVENUE, TEWANTIN (TEWANTIN RSL) We, TEWANTIN NOOSA RSL & CITIZENS MEMORIAL CLUB INC as owner of the land described below: Subject Land Lot 10 on SP273411 5 Memorial Avenue, Tewantin Consent to Rubicon Design & Construct Pty Ltd C/- Planit Consulting Pty Ltd lodging the Development Application described below: Application = Request to Change Development Approval (Minor Change) Signed on behalf of Tewantin Noosa RSL & Citizens Memorial Club Inc, po NUCOBASSS Mp Signature Signature ule McLaws Maecawer Virevaye ici Print Name Print Name Asuslant CEO PA Position Position Note: Where the owner is a Company/Corporation, the signatures of two company directors are required or a director and company secretary. Alternatively, if the Company is a Sole Director Company, then please state as much and only one signature is required.