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road closure application form _includes footpath_ parking lane_ crane and filming related closures_

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road closure application form _includes footpath_ parking lane_ crane and filming related closures_ Powered By Docstoc
					                                                                                                                                Postal Address
                                                                                                                                Locked Bag 10
                                                                                                                                Moreland Victoria 3058
                        APPLICATION FOR A TEMPORARY ROAD CLOSURE                                                                Transport Unit
                                   CITY INFRASTRUCTURE                                                                          Phone:      9240 1111
                                                                                                                                Fax:        9240 1205

                                ONCE APPROVED, THIS PERMIT MUST BE AVAILABLE ON SITE, FOR THE DURATION OF THE CLOSURE.
                                                 EACH DISTINCT PROJECT REQUIRES A SEPARATE PERMIT.


         APPLICANT DETAILS

     NAME……………………………………………………….……… ORGANISATION NAME………………..……………………………...

     POSTAL ADDRESS.……………………………………………………………………………………………………………………………..

     TELEPHONE NUMBERS:                   (Work) ………………….………………                          (Home) ………………….………………

                                          (Mobile) ………………….………………                        (Fax)     ………………….………………
     DETAILS (or location where temporary road closure is to be undertaken)                   VICROADS ROAD (see list)               COUNCIL ROAD

     STREET.…………………………………………LOCATION………..……………………….……….SUBURB.…..………………………

     CLOSURE REQUIRED FOR …………………………………………………………………………………………………………………..

     The fee for a Temporary Road Closure Permit is $132 including GST, late fee (<5 working days) $264 including GST

         TYPE OF TEMPORARY ROAD CLOSURE (please tick)                                                                         OFFICE USE ONLY

            Road works                                            Street Party (permit fee free)
            Building works                                        Filming                                                  FEE $132 inc. GST

            Festivals/Events (permit fee free)                    Crane Permit
            Removal of utilities                                  Road Opening permit
            House Removal                                         Other (specify)……………………………….………

                                                  From:……………….…AM/PM to ……………………AM/PM
         Date and Times of Closure:………………………………………….

     ADDITIONAL NOTES RELATING TO THIS APPLICATION ARE PROVIDED OVERLEAF.

         PLEASE ATTACH THE FOLLOWING ITEMS WITH THE APPLICATION FORM
     1      Copy of Public Liability Insurance of value $10,000,000
            A copy of a Traffic Management Plan. As a minimum requirement, the traffic management and signage for the works and
     2      closure is to be undertaken in accordance to VicRoads “Worksite Traffic Management – Code of Practice” (which includes AS
            1742.3 – Part 3 – Traffic Control Devices on Roads). Footpaths must be barricaded with a minimum of para-webbing.
     3      Copy of letter/flyer to affected properties, including list of addresses
     4      Approval from VicRoads (Arterial Roads)
     5      Invoice to be sent to:         Name:                                       Address:

     APPLICANT’S DECLARATION:-

         I (applicant) ……………………………………….. have read and accept the conditions of this permit.

     Applicant’s Signature: …………………………………………………………………….…………….……Date: ………/………/……..

     Privacy statement:
     The personal information requested on this form is so that Moreland City Council can process the application, and for the management of temporary
     road closures. If you do not provide this information your permit application cannot be processed. The Council will use this information only for that
     purpose or for directly related purposes. You may apply to Council for access to your personal information or to amend the same.


                               Transport Unit Use Only:

         DATE RECEIVED:                                                          OFFICER:…………………………………………
         DATE PROCESSED:                                                         SIGNED:………………………………………DATE:……/……/…....
         APPLICATION APPROVED:                           YES          NO                  Manager Asset Planning

         COMMENTS:



C:\Docstoc\Working\pdf\c3b1f2bf-6b48-453d-8529-4cf8fea2323e.docAmended December 2007
                                        INFORMATION TO APPLICANTS
                                     REQUESTING A ROAD CLOSURE PERMIT
FOR CONDITIONS SUBJECT TO WHICH THIS PERMIT IS GRANTED, refer to the associated Standard Permit Conditions for
Working Within Road Reserves. Standard Permit Conditions for Working Within Road Reserves will usually be provided to the
applicant at the time of approval of the Permit, but if this does not occur it is the Permit holder’s responsibility to obtain a copy of the
said conditions, and to comply with them. Standard Permit Conditions for Working Within Road Reserves is available at Council’s web
site at www.moreland.vic.gov.au

VICROADS ARTERIAL ROADS:
   Freeways:
      Tullamarine Freeway
      Western Ring Road

     Arterial Roads:
        Bell Street
        Sydney Road
        Brunswick Road
        Champ Street
        Cumberland Road (Boundary Road to Bell Street)
        Elizabeth Street (Murray Road to Bell Street)
        The route: Elm Grove / Drummond Street / Urquhart Street
        The route starting at Cumberland Road: Gaffney Street / Murray Road
        The route starting at Pascoe Vale Road: Glenroy Road / Wheatsheaf Road / Plumpton Avenue / Rhodes
         Parade / Pascoe Street / Boundary Road
        The route: Melville Road / Dawson Street / Grantham Street
        Moreland Road
        The route: Nicholson Street / Holmes Street / Albion Street / Nicholson Street
        Pascoe Vale Road




C:\Docstoc\Working\pdf\c3b1f2bf-6b48-453d-8529-4cf8fea2323e.docAmended December 2007

				
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