PlanningActForm5-Changeapplicationform · MCU14/0084.03

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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
                                                             building :
 5 unit apartment building to provide for a 6 unit apartment building)
 Change approved plans to enable construcction of additional solar panels within approved siide setback.



 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
                      APPLICA     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.
                                                                                                      2016
 Affected entity                        Pre-request
                                            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
                                          company 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
                      APPLICA     REQUIREMENTS
Note:: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some instances
                                                                                                       stances parts of DA Form 2, as
mentioned below. These forms are available at www.dilgp.qld.gov.au.
                                                   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
                                                                                        t     sections relate to the
 new or changed aspects of development are provided with this application.
 8.2) Does the change application involve building work?
                                                   work
     No
     Yes – the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided
                                                                                                                provide with
 this application.

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                                                                                               Planning Act Form 5 - Change application form
                                                                                                                    Version 1.0—3 July 2017

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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
                                                        agenc triggered by the change application as if the change application was
                                                                                                                               w the original
development application including the proposed change.
                                                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
                                                                                                                   applica   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
                     ional 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
                        formation 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
                       APPLIC    DECLARATION
12) change application checklist
I have identified the:
     • responsible entity in 3); and
     • for a minor change, any affected entities;
                                          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).
                                          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:
                                                   G        Relevant plans.


24) 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.
                                                                                                          2001
Note:: It is unlawful to intentionally provide false or misleading information.

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                                                                                                        Planning Act Form 5 - Change application form
                                                                                                                             Version 1.0—3 July 2017

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 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 thosehose 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.
                                                    website
 Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016,
                                                                                           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
          ormation 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):
                                                            n



 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
                                               201 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