(a) The placing or presence in the street of the apparatus to the licence relates; (b) The execution by any person(s) of any works authorised by the licence; And in accordance with Section 50 and Schedule 3 of the New Road and Street Works Act 1991. I also acknowledge the statutory need for me to pay the prescribed inspection fees which will be imposed by the Street Authority, for defect inspection fees and the cost of any necessary remedial works conducted by the Street Authority during the guarantee period (2/3 years from registering the completion of works). I/We acknowledge the requirements for me/us to pay any statutory defect inspections fees applicable at the time of occurrence. I/We also acknowledge that I/we shall pay the costs of any necessary investigatory or remedial conducted by the Street Authority under the powers invested in them by the New Roads and Street Works Act and agree that I/we must pay any reasonable costs within 30 days of receipt of invoice. I/We acknowledge that, the private apparatus is to be connected to or discharged to any other privately or publicly owned system, I/we must apply separately to the owner of that apparatus for the requisite permission to connect or discharge our private apparatus. Signed: Date: Name: (Applicant) of the property to be served by the Apparatus) company Name/Position Please note that this declaration must be signed by the applicant and not the Contractor Schedule 2 - Bond Details of the Bond: Schedule 3 – Special Conditions imposed by the Authority Details of any Special Conditions:
Working Hours: Normal Working Hours 08:00 to 16:30 School Route 09:30 to 14:30 Commuter 09:30 to 16:00 Most Sensitive Route 19:00 to 07:00 Other (Please State): Comments: Contractors Signature: Date: Street Works Western Group Centre, Radnor Road, Scorrier, Redruth, TR16 5EH Telephone: 0300 1234222 Email: N3 (Actual Start & Revised Duration) New Roads & Street Works Act 1991 (Section 74) Traffic Management Act 2004 Notification & Responses To: Street 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 Actual Start Date (Must be received by 16:30 the first working day after the works have started) Estimated End Date Revised Duration (To be submitted by 16:30 no later than the last day of your original licence period) Actual Start Date Revised 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) : (Please give a description) Working Hours: Normal Working Hours 08:00 to 16:30 School 09:30 to 14:30 Commuter Route 09:30 to 16:00 Most Sensitive 19:00 to 07:00 Other (Please State): Comments:
Contractors Signature: Date: Street Works Western Group Centre, Radnor Road, Scorrier, Redruth, TR16 5EH Telephone: 0300 1234222 Email: R1 (Actual Stop & Registration) New Roads & Street Works Act 1991 (Section 74) Traffic Management Act 2004 Notification & Responses To: Street 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 Method of Excavation: Mechanical Hand Bore Dates Actual Start Date Actual End Date Please List any Apparatus encountered: Comments: Reinstatement Details Site Location Length (m) Width (m) Carriageway (C) Footway (F) (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:
Failure to provide any of the required information or complete the application form in full will delay the process and may result in additional charges. 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 Works: Carriageway Footway Verge All Signed: Date: Address (if different from Statutory Undertakers Response Previous District Council areas for proposed work Affected Utility Penwith Kerrier Carrick Restormel N Cwll Caradon Y N & West Utilities Ltd Plant Protection Team Wales & West House Spooner Close, Celtic Springs, NEWPORT NP10 8FZ Tel: 02920 278912 Fax: 0845 0720852 Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required British Telecom National Notice Handling Centre PP5W67 Telecom Trinity Street Hanley, On Trent Staffordshire, ST1 5ND Tel: 0800 023 2023 option 5 Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required South West Water Peninsula Rydon Lane EXETER EX2 7HR Tel: 01392 443567 Fax: 01392 442726 OR internet access (account needed) Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required Western Power Distribution Mapping Centre, Toll End Road Tipton, DY4 0HH Tel: 02920 535383 Fax: 02920 535390 Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required Vodaphone c/o Atkins Telecoms 500 Park Avenue, Aztec West Almondsbury BRISTOL BS32 4RZ Tel: 01454 662881 Email: Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required Virgin (NTL & Telewest) National Plant Enquiries Team 1 – 12, Mayfair Business Park Broad Lane, Bradford, BD4 8PW Tel: 0870 888 3116 (opt – 2) Fax: 0121 6942345 Email: Contact Required Contact Required Contact Required Contact Required Contact Required Contact Required IMERYS Minerals Ltd Par Moor Centre Par Moor Rd 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 NO Contact Required