Original source · versioned page text
Change Application Form Little Sister
Attached to the e-mail Change to DA - MCU15-0086.02.msg.
Department of lnfrastructure, Local Government and planning
Change application form
Planning Act Fgrm 5 (version 1.0 effective 3 July 2017) made underSecfion
2g2 of the ptanning Act 2016.
This form is to be used for a change an application made under
section 78 of the planning Act 2016.1t is important when
maklng achangeapplication to biaware'of whether tn" appii"ation
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 lhe ptanning Act
201 6.
An applicant must complete all parts of this.form, and provide any supporting
information that the form identifies as being
required to accompan.y tle change application, unless stated otnenryis'e.
Roiifionat prt". may be attached if there is
insufficient space on the form to compiete any part.
Note: Att terms used in this form have the meaning given under the Ptanning
Act 2016, the ptanning Regulation 201 7, or lhe Development
Assessmenf Rules (DA Rutes).
PART 1 -APPLICANT DETAILS
Applicant name(s) {individuat or company futt name)
Contact name {onty appticabte foreompanies}
Postal address {F. O" Box or sfreet address) 10 Nairana Rest
littlesisternoosa@gmail" com
Applica nf s reference n u mber{s) (if ap pt icabte)
LJ Yes - me wntten consent of the owner(s) is attached to this change application
Vfruo - proceed to 3) in part 2
PART 2 - RESPONSIBLE ENTITY DETAILS
PART3-CHANGEDETAILS
f] Development permit
I Prelirninary approval
fl Development permit
I Preliminary approval
Queensland
Government
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$epartment oi lnfraslructure, Lccal Governrnent and Planning
5.1) Provide a brief description of the changes proposed to the development approval {e.9. changing a devetopment approvatfor a
5 unit apartment building to provide for a 6 unit apartment building)'.
1), To havethetrading restrictionsstated in Negotiated Decision Notice Re{#-MCU15/0086, be removed.
2). To have the requirement to apply for nature of use for the property every year stated in Negotiated Decision Notice
Ref# - MCU15/0086 be removed
5.2) What type of change does this application propose?
dfUinot change application - proceed to Part 4
n Otfrer change application - proceed to Part 5
PART 4 - fulINOR CHANGE APPLICATIChJ REQUIREMEhJTS
- proceed to Part 6
No
flYes - list allaffected entities below and proceed to Part 6
Note: section $Afi) 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 secfron 80(2) ot the Planning Act 2416.
Pre-request response provided? (where a pre- Date notice given (where no pre-
req uest response n otice for the application "h as req u e st response p rovi d e d)
been given, a copy of the notice must
accompany this change applicatian)
E tlo
n yes - pre-request response is attached to
this change application
E trto
n yes - pre-request response is attached to
this change application
ENo
n yes - pre-request response is attached to
this change application
PART 5 * OTHER EHANGH ABPLiCATICN REQUIREMENTS
Note: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some rnsfances pafts of DA Form 2, as
mentioned below. These forms are available at rywrw.dllqp,glg,gpy.B!.
M No
I Yes - complete Parl2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
provided with this application.
n 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.
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Planning Act Form 5 - Change application form
Version 1.0-3 July 2017
Page 3
De pr3 i';in s n1 of I n f ra tiiu ai u rt, iL\ta i 6 cir* t'i ry: en l a fi ri Pla i, il il g
i
Yes - the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided with
this application.
E 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.
fl t agree to receive an information request if determined necessary for this change application
n t Oo not agree to accept an information request for this change application
Note: By not agreeing to accept an information request l, the applicant, acknowledge:
o that this change application wrl/ be assessed and decided based on the information provided when making this change application
and the assessmenf m anager and any rcfenal 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 applicatian is an application listed under section 11.3 of the DA Rules.
Fufther advice abaut informatian requests is contained in the DA Forms Guide.
n part 7 of DA Form 1 is completed as if the change application was a development application and is provided with this
application.
PAffiT $ * CHHEKLIST AruD APFLIEANT NMELARATi*FJ
I have identified the:
. responsible entity in 3); and
. for a minor change, any affected entities; and
. for an 'other' change all relevant referral requirement(s) in 9)
l/ofe: See the Planning Regulation 2017 for refenal requirements
For an 'other'change application, the relevant sections of DA Form 1 - Devetopment Yes I
details have been completed and is attached to this application ffiftot applicable
For an 'other' change application, where building work is associated with the change
application, the relevant sections of Form 2 - Building work details have been
I ves
completed and is attached to this application druot 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 J Yes
result of the change apptication, a planning report and any technical repofts required by the M
relevant categoising instrument(s) (e.9. the local govemment planning scheme, State Planning
Policy, State Development Assessmenf Provisions). For fufther information, see DA Forms
Guide: Ptanning report template.
Relevant plans of the devetopment are attached to this development application
Note: Relevant plans are required to be submitted for all relevant aspecfs of fhis change
application. For further informatian, see DA Forms Guide: Relevant plans.
MpV mat ing this change application, t declare that all information in this change application is true and correct.
[fWnere an email address is provided in Part 1 of this form, I consent to receive future electronic communications from
the resoonsible entitv and anv relevant affected entitv or referral aqencv for the chanqe application where written
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Planning Act Form 5 - Change application form
Version 1.0-3 July 2017
Page 4
Department of lnfrastructure, Local 6overnment and Planning
information is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2041 .
Nofe; /f r.s unlav,iul 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:
o 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 Ad 2A16 and Planning
Regulation 2417; or
. required by other legislation (including the Rlghf to lnformatian Act 240$; or
o othenvise required by law.
This information may be stored in relevant databases" The information collected will be retained as required by the Public
Records Act 2402.
PART 7 - FOR CFFICE USE ONLY
Date received: Reference number(s):
Description of the work
Qleave project number
Amount paid ($)
Date receipted form sighted by assessment manager
Name of officer who sighted the form
The Planning Act 2016,hhe 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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Planning Act Form 5 - Change application form
Version '1 .0-3 July 2017