Street Works Western Group Centre, Radnor Road, Scorrier, Redruth, TR16 5EH Telephone: 0300 1234222 Email: N2 (Proposed Start or Change of Dates) New Roads & Street Works Act 1991 (Section 55) Traffic Management Act 2004 Notification & Responses To: Street Works, Cornwall Council, Western Group Centre, Radnor Road, Scorrier, TR16 5EH From: (Contractor) Telephone Number: Email Address: Site Details Property Name/Number: Road Name: Locality/Town Post Code: Works Details Works Description: Licence Number: Location of Excavation: Carriageway Footway Verge Method of Excavation: Mechanical Hand Bore Notification Periods Duration Of Works: 1 to 3 days (Minor Works) Four Weeks Notice Required 4 to 10 days (Standard Works) Four Weeks Notice Required 11 days or more Works) Three Months Notice Required Please Note: Any works requiring a Temporary Traffic Regulation Order are classed as Major Works and will therefore require Three Months Notice regardless of the works duration Proposed Start Date Estimated End Date Traffic Management Give & Take Priority Boards Stop/Go Boards (Additional Paperwork will be required) Two Way Traffic Lights (Additional Paperwork will be required) Multi Way Traffic Lights (Additional Paperwork will be required) Road Closure (Additional Paperwork and Charges will be applicable) Other : (Please give a description)
Contractors Signature: Date: Street Western Group Centre, Radnor Road, Scorrier, Redruth, TR16 5EH Telephone: 0300 1234222 Email: R1 (Actual Stop & Registration) New & Street Works Act 1991 (Section 74) Traffic Management Act 2004 Notification & Responses To: Street Works, Cornwall Council, Western Group Centre, Radnor Road, Scorrier, TR16 5EH From: (Contractor) Telephone Number: Address: Site Details Property Name/Number: Road Name: Locality/Town Post Code: Works Details Works Description: Licence Number: Location of Excavation: Carriageway Footway Verge Method of Excavation: Mechanical Hand Bore Dates Actual Start Date Actual End Date Please List any other Apparatus encountered: Comments: Reinstatement Details Site Location Length (m) (m) Carriageway (C) Footway (F) Verge (V) Depth of Cover to Apparatus Interim Completion Date Permanent Completion Date 1 2 3 4 5 6 Contractors Signature: Date: Street Works Western Group Centre, Radnor Road, Scorrier, Redruth, TR16 5EH Telephone: 0300 1234222 Email:
Par PL24 2SQ FAO Mr A Mutton Tel: 818000 Fax: 01726 811200 www.imerys.com NO Contact Required NO Contact Required NO Contact Required Contact Required NO Contact Required Contact Required Declaration Form I have applied to Cornwall Council for permission to place/maintain apparatus at the following location: Property Name/Number: Road Name: Locality/Town: Post Code: Location of Carriageway Footway Verge All Signed: Date: Address (if difference from Statutory Undertakers Response Previous District Council areas for proposed work Affected Utility Penwith Kerrier Carrick Restormel N Cwll Caradon Y N Orange Plant Search (Mobile Broadband Network Limited) Email: Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required Verizon Business (MCI Worldcom) UK & Ireland Room 2.37, UK5 2-6 St Pancras Way Camden London NW1 0QG Tel: 0207 6754509 Email: Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required Level 3 Communication (Instalcom) Instalcom Limited Borehamwood Ind Park Rowley Lane Borehamwood WD6 5PZ Email: Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required Network Rail 125 House/Milford Wing 1 Gloucester Street SWINDON SN1 1GW Tel: 0845 7114141 Email: assettprotectionwest@networkrail.co.uk Contact if within 50m railway line