DA Form 1 - Development appHcation details Approved form (version 1.1 effective 22 JUNE 2018) 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 developmentapplication involving building work only, use DA Form 2 - Building work detalis. For a development application involving building work associatedwith 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 CA Form 2 - Building work oetails. Unless stated otherwise, all parts of this form must be completed in full and all required suppordng 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 retevant to the deve!apmeni apøcatior, must be used to make a develocmer i application relating to strategic port land and Bnsbane core pon land under the Transport infrastructure Act 1994, and airport land under the AirportAssets (Restructuring and Disposai) 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: AH terms used in this form have the meaning given ander the Planning Act 2016 the PlanningRegulation 201r or the Development Assessment Rules (DA Ruios) PART 1 - APPL.lCANT DETAILS 1) Apphcant details Applicant name(s) (individual or company rov na e) Contact name (anty applicabic for componiss) Posta\ address (r o Box or street address) / / L State Postcode u E Country , Contact number o 9 Email address (non ma vaatory Mobiie number (non-mandatory) FaX number (non-mandatory) Applicant's reference number(s) (irapplicable) 2t Owner s egnsent 2 1) Is written consent of the owner requirac for this t'euelopmert appHcation? Yes - the writen consenl of the owner(s is attached to this developmentapplication No - proceed to 3) PCSENTERED
Transcript
DA Form 1
- Development appHcation detailsApproved form (version 1.1 effective22 JUNE 2018) made undersection 282 of the PlanningAct 2016.
This form must be used to make a developmentapplicationinvolving code assessmentor impact assessment,exceptwhen applying for developmentinvolving building work.
For a developmentapplication involving building work only, use DA Form 2 - Building work detalis.
For a developmentapplication involving buildingwork associatedwith any other type of assessabledevelopmenti..e. material change of use, operational work or reconfiguring a lot), use this form (DA Form 1) and parts 4 to 6 of
CA Form 2 - Buildingwork oetails.
Unless statedotherwise, all parts of this form must be completed in full and all required suppordng information mustaccompanythe developmentapplication.
One or more additional pages may be attached as a schedule to this developmentapplication if there is insufficientspace on the form to include all the necessary information.
This form and any other form retevant to the deve!apmeniapøcatior, must be used to make a develocmer iapplication relating to strategicport land and Bnsbane core pon land under the Transport infrastructure Act 1994,
and airport land under the AirportAssets (Restructuring and Disposai) Act 2008. For the purpose of assessinga
developmentapplicationrelating to strategicport land and Brisbane core port land, any reference to a planningscheme is taken to mean a land use plan for the strategicport land, Brisbane port land use plan for Brisbanecoreport land, or a land use plan for airport land.
Note: AH terms used in this form have the meaning given anderthe Planning Act 2016 the PlanningRegulation201r or the DevelopmentAssessmentRules (DA Ruios)
PART 1- APPL.lCANT DETAILS
1) Apphcant details
Applicant name(s) (individualorcompanyrov na e)
Contactname (anty applicabic for componiss)
Posta\ address (r o Box or street address) / / L
State
Postcode u E
Country ,
Contact number o 9Email address (non ma vaatory
Mobiie number (non-mandatory)
FaX number (non-mandatory)
Applicant's referencenumber(s) (irapplicable)
2t Owner s egnsent2 1) Is written consent of the owner requirac for this t'euelopmertappHcation?
Yes - the writen consenl of the owner(s is attached to this developmentapplicationNo - proceed to 3)
PCSENTERED
PART 2 - LOCATION DETAILS
NStreetaddress AND lot on plan (autotsmustbelisted), orO Streetaddress AND lot on plan for an adjoining or adjacentproperty of the premises (appropriate for developmentn
water but adjoiningor adjacentto land e.g. jetty, pontoon;all lots must be listed).
Unit No. Street No. Street Name and Type Suburb
Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local GovernmentArea(s)
¡° 9044 5 Som,qÅ.Unit No. Street No. Street Name and Type Suburb
b) -- ------ ----Postcode Lot No. Plan Type and Number (e.g. RP, SP) Local GovernmentArea(s)
Coordinatesof premises by longitude and latitude
Longitude(s) Latitude(s) Datum
°WGS84GDA94
°Dther:
Coordinatesof premises by eastingand northing
Easting(s) Northing(s) Zone Ref. Datum
[-l 54 O WGS84
° 55 [~l GDA94
° 56 O Other:
Local Government Area(s) (iteppheab e
Local Government Area(s) (itepp ahuo
Additionalpremisesare relevant to this development applicationand their details have been attached in a
schedule to this application
D Not required
° iri or adjacent to a water body or watercourse or in er above an aquifer
Name of water body, watercourseor aquifer:
O On strategic port land under the Transport!afrostructure Act 1994
Lot on plan descriptionof strategic port land.
me of port authority for the lot:
In a tidal area
me of local govemmens fo: the uca: are2
ame of port authority for tida! area (if applica
Or a;rport land under the Wi:pw Asse Dis
me or arrpor::
A orm 1- Devebpment uhon det
O Listed on the EnvironmentalManagement Register (ElvlR) under the Environmental Protection Act 1994
EMR site identification:
O Listed on the ContaminatedLand Register (CLR) under the EnvironmentalProtectionAct 1994
CLR site identification:
5 i Are there any emst ng easements over the premfsesNola Ean :enWws umy %vuijiroâtoun isiæl a i e l nE Kk he o !¿yönrJ æ:com;&y Foi ím)!v nWmum m s eammentsand
Yes - All easement locations. types and dimensionsare included in plans submitted with this development
applicationNo
PART 3 - DEVELOPMENTDETAlLS
Section 1
- Asoects of develooment
a) What is the type of development?(t/ck only one cox)
Material change of use O Reconfiguring a|ot O Operationalwork Building work
b) What is the approval type? (tick only one oox)
Developmentpermit O Preliminaryapprovai O Preliminary approval that includes
a variationapproval
c) What is the level of assessment?L-] Code assessment O impactassessment(requires public notification)
à) Provide a brief descriptionof the proposa e unit apartment building definedas multi+nitdwelling, ?configurationat 1 tot mio 3
lots)
e) RelevantplansNote. Relevantplans are requiredto be submitted for all aspecuof this developrnentapplication. For furtherinformation. see DA Forms guj_de.
Rei vantplans.
l· Relevantplans of the proposeddevelopmentare attached to the development application
a) What is the ty pe of development?(t/ck only one box)
O Materialchange of use Recor f|guring a lot O Operational work Building work
b) What is the approval type? (tick only one box)
D Development permit O Preliminary approval L ] Preliminaryapprovalthat includes a variationapproval
c) What is the level of assessment?
O Code assessment L-1Impactassessment(requirespublicnotification)
d) Provide a briefdescriotion of the orcoosal e g. o or apartmentbuikhngdefinedas multsunitdwe ng, recoorigurattan a/ i /or
tots
e) Relevantplansvote: Relevent plans are iaqwmd to be submitted for u!! escoctsat this aeve!opment applicattuuFor further informehon, sea .JA
Famm Gwc
alevant olans.
Rehan' p a a é u æw to ..e' m|yeatappkation
DA Foim !- Develocmd wµhcabo
Versior - 9 JUM
6.3) Additional aspects of development
°Additionalaspects of developmentare relevant to this developmentapplicationand the details for these aspectsI that would be required under Part 3 Section 1 of this forrn have been attached to this developmentapplication
°Not required
Section 2- Further develomTient details
Material change of use Yes - cornplete division 1 if assessable against a local planning instrument
Reconfiguringa lot Yes - complete division 2
) Operationalwork °Yes - completedivision 3
Suilding work &Yes - complete DA Form 2- Buildingwork details
Division 1- Material change of use
Note: This division is only required to be compfetedif anypart of the developmentapplication involvesa materialchange of use assessable aga nst n
locni siennine instrument.
8 1) Dmribe the proposed matenal change of use .
Provide a general descriptionof the Provide the planning scheme defin t on Numberof dwelling Gross floo
roposed use cinclude each definition in a new row) units ( f applicabic) area (m=)if applicablo)
Yes
Div sion 2- Reconfiguring a lot
Note This division is onlyreoviredto be completedif any part of the devotoomentapplication involves reconfiguringa lot.
9 2) What is the nature of the lot reconf g 11 sppj¼àchpcSubdivision (comotere oj) Dividing iand imo paäs by agreement iconøete t in
] Boundary realignment (compiere 12) Creating or changing an easementgiving access to a lotfrom a constructionroad (compete 13))
10) Subdivision10,1) For this development how mapy lots are e g c eafedpd what s thenpteMeduse of thosedots:
Intended use of lots created Residen'ia Cor,mercia Industrial Other please specif
Number of lots created
Yes - provide additicnal detaKs Dekxj No
w many stages wi;l th ;vop:s m aa?
at stage(s) wiH this ue veloµr em applicawp y to?
Intended use of paFts created i Residential Commercial Industrial Other please specify:
Number of partscreated
12} Boundary teahynment12. 1) What are the current ard prçpgs,e areas for eacglotcomposgg the,premises .
.
Current lot Proposed ot
Lot on plan description Area (m2) Lot on plan description Area (m2)
Existing or Width (m) Length (m) Purpose of the easement? (e.g. Identify the land/lot(s)proposed? pedestrien access) benefitted by the easemem
Division 3- Operational work
Note: This division is only reauired to be comoletedif any oart ofthe äevelopmentarnlicationinvolves overational work.
Enuironmental\y re\evantactivities(ERA) (only irthe ERA have not been devolved to a local govemment)
O Fisheries- aquacultureQ Fisheries- declared fish habitat area
O Fisheries-- manne plantsO Fisheries-· waterway barrierworks
Hazardouschemical facilitiesQueenslandheritage place (on or near a Queenslandher/face place?
Infrastructure - designatedpremisesO Infrastructure- state transport infrastructure
O Infrastructure- state transport corridors and future state transport corridors
nfrastructure- state-controlled transpo4 tunnels and fui.ure state-controlled transport tunnels
Infrastructure- near a state-controllecroad intersection
O On Brisbane core port land near a State transportcorridor or future State transportcorridor
O On Brisbanecore port land - ERA
O On Brisbane core port land - tidal works or work in a coastal maragementdistrict
On Brisbane core port land -- hazardous chemical facihty
On Brisbane core port land - taking or interfering wita waterOn Brisbanecore pon land - referab·e dams
O On Brisbane core port land - risheriesLand within Port of Brisbane'sport limits
O SEQ development areaO SEQ regional landscape and rural producCon area or SEQ rural hving area - tourist activity or sport and
recreation activityO SEQ regional landscape and rurai production area or SEQ :ural living area - community activity
° SEQ regional landscapeanc iural productiori area o, SEQ rural hving area - inocor recreauon
O SEQ regional landscape and rura: production area or SEQ rural kving area - urban activity
O SEQ regional landscapeand rurai productionarea or SEQ rural living area - combineduse
O Tidal works or works in a coastai managernent district
O Reconfiguringa lot in a coastal managementdistrict or for a canai
Erosion prone area in a coastal management district
O Urban designWater-relatec development - taking or intederingwith wate
O Water-relateddevelopment - remov;ngquarry materia trom a watercourse criake;
[ j Water-relateddevelopment - referable dams
O Water-relateddevelopmen:.- construcuon of new imees or modificationof existing levees wego y 3 vee n
Wetland protection area
Matters requiring referral tc the loca! munmentAiiport land
,I Environmerc elevm acti:des (F'? en owu! was wvemmmLoca! heritage places
Matters requiring referral to the chief executiveof the distribution entity or transmissionentity:Electricity infrastructure
Matters requiring referral to:
? The Chief executiveof the holder of the licence, if not an individual
? The holder of the licence, if the holder of the licence is an individual
Oil and gas infrastructure
Matters requiringreferral to the Brisbane City Council:Brisbanecore part land
Matters requiring referral to the Minister under the Transport infrastructureAct 1994:
O Brisbane core port land (inconsistentwith Brisbane port LUP for transport reasons)
Strategic port land
Matters requiring referral to the relevantportoperator:O Land within Portof Brisbane'sport limits (below high-watermark)
Matters requiring referral to the Chief Executiveof the relevantport authority:O Land within limits of another part (below high-water mark)
Matters requiring referral to the Gold Coast Waterways Authority:Tidal works, or work in a coastal management district in Gold Coastwaters
Matters requiring referral to the QueenslandFire and Emergency Service:
T\dal works marina (more than six vesselberths)
Yes - referra! response(s)received and listed below are attached to this developmentapp ication
No
Referral requirement Referral agency Date of referral response
identify and describe any changesmade to the proposed developmentapplicationthat was the subjectof the
referral responseand the developmentapplicationthe subjectof this form, or include details in a schedule to this
developmentapplication (if applicable).
PART 6 - INFORMATION REQUEST
19) Ir"o:mater. rect est waer Pan ? Of me DA Rules
agree to 'eceive an mformation request l' eetermnednecessaryfor ths deve|opmentapplication
i do not agree to accept an information request for this developmentapplication
Note. By not agreeing to accept an information request i, tne applicant acknowledge:
that this developmentapplication will be assessedand decided based on the informationprovidedwhen making this development application
and the assessmentmanager and any referral agencies relevantto the developmentapplicationans not obligatedunder the DA Rules to
accept any additional information provided by the apphcant for the developmentapplication unless agreed to by the relevantparties
Part 3 of the DA Rules will still apply ifthe application is on application listed undersection 1t3 of the DA Rules.
unher odvice about information requests is contæned m |he DA Forms Guido.
CA\ i-orm ^
- Devaap nt Applicaona
PART 7- FURTHER DETA'LS
°Yes - provide detaHs below or include details in a scheduleto this developmentapplication
° No
Ust of approval/development 1 Referencenumber Date Assessment
appucation references manager
°Approval
°Development applicationApproval
°Developmentapplication
21) Has the portab·e long servtce leave levy been pacd'¼nM;nso ttneunnænt wi.aou mowmq womrwos or
°Yes - a copy of the receipted QLeave form is attached to this developmentapplicationNo -
1, the applicant will provide evidence that the portable long service leave levy has been paid before the
assessment manager decides the developmentapplication. Éacknowledge that the assessmentmanagermay gfve
a developmentapproval only if I provide evidence that the portable long servme \eave levy has been pa d
Not app\icabie (e.g. buildingand constructionwork is less than $15Q000 excluding GST)
Amount paid Date pmd (dd/mm y) QLeave levy number
23) Further legis½tive requirements
Environmentallyrelevant activities23.1 j ls this developmen1 apphcatiön also.taken to be an Öphcation for an envirànmemalauthority for an . .
Environmentally Relevant Activity (ERA) under section 115 of the'Env/rönmentalProtectionAct 199c
. O Yes - the required attachment (form ESR/2016/'791)for an applicationfor an environmental authority
accompaniesthis development appHcation, and detaiis are provided in the table beiow
° NoNote:Application for an environinental autnantycan be found by searching "ESR/201W179F as a searct term at www ald.cov æ An ERA
requins an environmentalauthonlyto operate. See www.ousiness.qldgov su for furtherinformation
Proposed ERA number Proposed ERA threshoid:
Picposed ERA name:Multiple ERAs are apphcao e to this developrnent apphcationand the details have been attached n a
schedule to this dev »pment applcation.
Hazardous chemical facilities23 2) is this developmentappùcation for.a hazardouschemical.facility? .
es - Form 69: Notificationof a facility exceed ng 10% of schedule 15 threshold s attached to this deve opmeI app cation
No
SeenwanusinessakMovuu é ormimman ? Mmkainots oue in ÂatiÈve Ôtion
23 3) Does this development apphcationhvoNeclearing native vegetation that reqWres wntten confirmation thatthe chief executive of the \/egatahon ManagementApt 1999 is satisfied the clearing ä for a relevant purpose underscction 22A of the Vegetation Managernent Act 19999
Yes - this developmentapplicationincludeswrftten confirmation from the chief executiveof the VegetationManagementAct 1999 (s22Adetermination)
O NoNote: 1. Where a developmentapplicationforoperational work or materialchange of use requires a s22A determinationand this is not inciuciethe developmentapplication Is prohibited development.2. Seo httpshwww.qldgov.au/envitunment/land/vegetation/eppivinqfor further infonnation on how to obtain a s22A determination
O Yes -I acknowledgethat an environmentaloffset must be provided for any prescribed activityassessed as
having a significant residual impacton a prescribed env ronmentai matter
O NoNote: The environmentaloffset section of the QueenslanaGovernments website can be accessedat www.qkl.gov.aufor fur1her information no
environmentaloffsets.
Koala conservation .
215) Does %s development applic t t ovolvea rïùÏs changeof use recon guring a lot ör operahonal workwithin an assessabledevelopment area oi.3der Sched e to Part400f the Plannmg Regulation 2017
O YesNo
Note: See guidancematedals at www,des.yid.qov.aufor further information.
O Yes - the relevant template is completedand attached to this development application and I acknowledge that a
relevantauthorisationor licence under the Water Act 2000 may be required prior to commencing development
U NoNote Contactthe Departmentof Natural Resources. Miries and Energy at www.dnm7e.aidgo_vmfor further infairnation.
DA templatesero availaolofrom httos:Aviannino dsdyt_quj.aov.auf.
If the oevelopmemapplicationinvolves·
Takingorinterferirg tvirh undergrourdwater through an artosian or subartesianbore: completeDA Form 1 Template 1
? 'ieking or interienng with water in a watercourse, |ake or spring:comolete DA Form ï Tempiate 2
? Taking overland flow water: complete DA Form 1 Template3,
Waterway barrier works23.7) Does this apphcabon invo e waterway barrier workstO Yes - the relevant template is completed and attached to this developmentapplication
]NoDA templates are avadablefrom h d For a developmentapplication involving waterwaybarnerwor1<s. compiea
DA Form 1 Template4.
Marine activities23 6) Does hs developmentappNcahon!aivole aquaculture;.works.withina declared fish habitat area orremoval, disturbance or destructionof4ngrine.plants
Yes - an associated resource ahocation authorny is attached to this developmentappucation required under
the RshenesAct 1994
_]No
Note See guidance materials at www dal q!a Gov n or rudherinfoun:tor
a e a NO a t Tc . . . .
. oesit sidevelogrÈenp r a rc r r la
°Yes -i acknowledge that a quarry material allocaHon nctice n ust be obtainedprior to commencmgdevelopme
NoNote: contactthe Departmentof Natural Resources,Mines and Energy at www dncme.qld.gov.au and www.business.qld,qov.aufor further
nformation.
Yes -I acknowledgethat a quarry material altocation notice must be obtained prior to commencing development
] NoNote: Contact the Departmentof Environmentand Scienceat www.des.qid.gov,eufor further information.
Yes - the 'Notice Acceptinga Failure Impact Assessrnent' frorn the chief executive aoministering the Water
Supply Act is attached to tNs developmentapplicat on
O NoNote: See guidancematerials at .v_ww.dorme.q)d,oov
au for further information
Yes - the following is included with this development application:
°Evidence the proposai meets tne code for assessab|e developmentthat is prescribed tidal work (onlyren n
if application involvesprescribed tidalwork)
A certificateof titleNo
Note: See guidance matedals at www.des.ald.qovau for furtherinformation.
e - . - . e , e e on- - -,e e - e ? , . ? - -
Yes - details of the heritageplace are provided in the table below
°NoNote: See guidance materials at www.des.qld.qqü_ufor infonnation ïequi ements æganfingdevelopmentof Queenslandhontageplaces
O Yes - this development application demonstrateshow the proposalmeets the code for a development
application for a brothel under Schedule 3 of the Prostitution Regulation 2014
O No
Yes - this applicationwiH be taken to be an appiicacion for a decision under section 62 of the Tmnsport
nfrastructureAct 1994 (sub]ectto the conditions in section 76 of the Transport infrastructureAct 19M oeing
satisfied)t_j No
Form 1- Deveiopiaem,paa n
Ve'sm 1
PART 8- CHECKLISTAND APPLICANT DECLARATION
I have identified the assessment manager in question 15 and all relevant referralrequirement(s) in questîon 17 O Yes
Note: see the Planning Regu)8tion2017 formferral requirements
If building work is associatedwith the proposed development, Parts 4 to 6 of DA Form 2 - YesBuildingwork details have been completedand attached to this developmentapplication Not applicable
Supporting information addressing any applicable assessmentbenchmarks is withdevelopment application
' Note: This is a mandatoryrequimmont and includes any relevant templolesunoer question 23,.a planning æpod yes .
nnd any technicalreports required by tne relevantcategorising Instruments (e.g. local govemmenipianningschemes. State Planning Policy. State DevelopmentAssessmontProvisions).For further information, see DAFonns Guide: PlanningReoort Temolate
Relevant plans of the development are attached to this development applicationNote: Relevantplans am required to be submitted for att aspects of this development application. For further esinformation, see DA Forms Guide: Relevent nians
The portable long service leave levy for QLeave has been paic, or wHl be paid before a °Yesdevelopment permit is issued (see 20) Not applicable
3 By making this development application. I declare that all information in this development application is true and
c rectWherean email address is provided in Part 1 of this form, I consent to receive future electroniccommunications
from the assessment managerand any referral agency for the developmentapplicationwhere written information is
required or permitted pursuantto sections 11 and 12 of the Electronic TransactionsAct 2001
Note, it is unlawful to intentionallyprovidefalse ormisleadirtg information.
Privacy - Personal informationcollected in this form will be used by the assessmentmanagerand/or chosenassessment manager, any relevant referral agency and/or building certifier (including any professionaladvisers ,
which may be engaged by those entities) while processing, assessingand deciding the developmentapplication.All informationrelating to this development application may be available for inspection and purchase,and/orpublished on the assessmentmanager's and/or referral agency's website.Personal informationwill not be disclosed for a purpose unrelated to the Planning Act 2076, Planning Regulation 201
and the DA Rules except where:? such disclosure is in accordance with the provisions about public access to docurnents containeo in the Planrnn
Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 20?6and PlanninRegulation 2017; or
? required by other legislation(inc!uding the Right to /nformation Act 2009): or
? otherwiserequiredby law.This informationmay be stored in relevant databases The information collectedwiu be rerained as requiredby the
PublicRecordsAct 2002.
PART 9 - FOR OFFICE USE ONLY
Date received: Reference nurnber(s)
ONficatn en égén r f t r tí
Prescribed assessment rnanage .
arne of chosen assessmentmanagerDale chosen assessment manager engaged
-- For: Site variations- 4RP904441 Total includes GST 0.00 -
System Code Datella GST Amount
Gen Ledger 8120-1000-0001 DevelopmentApplications 0.00 312.00
Totals 0.00 ) 312.00
Cash Tendered Change Cheques Direct Dep CreditCard EFTPOS Rouiiding
0.00 0.00 0.00 0.00 0.00 312.00 0.00 0.00
Our Ref: KFROHLOFF917
ABN 50 138 958 249Council Chambers - 2 RedbankStreet, EskQLD4312
Addressall correspondenceto - Chief ExecutiveOfficer,SomersetRegionalCouncil, PO Box 117, Esk QLD 4312P 0754244000 F 0754244099 E [email protected] W www.somerset.qld.gov.au
