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Temporary-Structure-Licence-Application

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					The London Borough of Ealing Customer Services, Perceval House 1st Floor, SW, 14-16 Uxbridge Road, Ealing W5 2HL Phone: 020 8825 6000 Fax: 020 8825 5553

FOR OFFICE USE ONLY
Date Approved…………………………. Date From………………………………… Date To……………………………………. Date Fee Paid………………………….. Receipt Number………………………. Date Deposit Refunded…………… Inspector…………………………………. Special Conditions…………………… Area…………………………………………. Dept £………………………………………. Licence Number………………………. Receipt No. For Deposit…………… Receipt No. For Fee…………………. Standard Conditions ………………………………………………….

Temporary Structure Licence Application
(Applications take a minimum of five working days to process) I would like to place a temporary structure on the Public Highway in line with the terms of:  The Highways Act 1980 (sections 169, 172/3/4 and 184)  The GLC General Powers Act 1970 (section 15); and  The local Government (Miscellaneous Provisions) Act 1976. 1. Details Of Applicant

Your name:…………………………………………………………………………………………………………………………
(name of person/company applying, whether you are an individual, Ltd company or ‘trading as’.)

Your address and postcode:…………………………………………………………………………………………… ……………………………………………………………………… Your phone number:………………………………. (If you are applying for a company, please give its registered address) Address of Temporary Structure:……………………………………………………………………………………
(If different from the address provided above)

2.

Public Indemnity Insurance:

Name of insurance company:…………………………………………………………………………………………… Policy number:…………………………………………. Expiry date of insurance policy:………./………./……….

Proof of public indemnity insurance provided to the sum of: (Please tick appropriate box and provide the appropriate proof upon returning the completed application) Total Amount of Insurance Builder Materials = £1m (m = million) Scaffolding & Hoarding = £2m Cranes = £5m Other Please Specify

0-5m2 = £100 3. Site Details

6-10m2 = £250

11-25m2 = £500

26m2-50m2 = £1000

Over 50m2 = to be advised

Type of Structure: Scaffolding Deposits AND admin fee of £50.00 (2 Separate Cheques). Hoarding Deposits AND fee of £50.00 (2 Separate Cheques). Materials deposit AND admin fee of £50.00 (2 Separate Cheques). Crane AND admin fee of £50.00 (2 Separate Cheques).

Additional Apparatus (please tick appropriate Box – 1 per applicant) in conjunction with required structure) Rubbish Chute Office Accommodation Gantry Scaffolding Fan Pedestrian Walkway Hoist or Ginney

(to be used

Site location:………………………………………………………………………………………………………………………………………….. Site contact:……………………………………………….. Site phone number:…………………………………………

Size of structure (in metres):Length:…………….Height:…………….Width:…………….Total Area:…………….. (You must fill in this section.) Please note Maximum period for Six months for any licence issued. 4. Required Dates Return Date:…………………………………………………

Commencement Date:…………………………………

5. I will be responsible for making sure that all the licence’s conditions are followed. I the signatory below, agree to comply with the provisions of section 169, 171, 172 & 173 of the Highway Act 1980. I also accept responsibility for the structure on the highway, and will indemnify the London Borough of Ealing against any damage, accident or claim. Your signature……………………………………………………………………… Date:…………./…………./…………. You name (block capitals):…………………………………………………………… Your position:………………………

IMPORTANT – PLEASE READ NOTES ON REVERSE

NOTE TO APPLICANTS 1. 2. If an applicant is an individual, please insert the applicant’s full name and address. If the applicant is a company, please insert the Company’s full name and address, and the position of the person signing is to be inserted. Any person who wishes to erect a structure on the public highway should have the necessary public liability insurance that covers the public highway. Public liability scaffolding and hoarding two million, materials one million. A copy of the Insurance Policy (public liability) is also required. The person signing the application form is RESPONSIBLE FOR THE FOLLOWING: a. b. c. d. e. Ensuring the structure is sited as directed on the licence and is lit during the hours of darkness. Ensuring the structure is removed when the licence expires. Ensuring that care and attention is paid to public safety when erecting and dismantling the structure when placed on the public footway, the public are excluded from the work area, whilst ensuring free passage is maintained. Ensuring the highway in the vicinity of the structure is kept clean at all times. Ensuring the structure complies with the conditions depending on which of the following Licences is applied for; i. Scaffolding: A minimum headroom clearance of 2.44m must be maintained under and through the scaffold for pedestrian access. Diagonal cross bracing or putlogs must be fixed below this height. Standards must be painted white up to a minimum height of 2.44m. Continuous timber sole plates must not be placed on the highway. Any coupling below 2.44m must be fixed so that any projection clamps are situated on the opposite side to the pedestrian access. Horizontal scaffold poles e.g. handrails below 2.44m must be fitted with plastic end caps or otherwise made safe. The platforms at the first lift must be double-boarded with polythene sheeting between each layer of boards. White lights are to be placed no more than 3.00m apart at a height of 2.44m from the surface of the highway. Hoarding Hoardings must not be less than 2.44m in height and constructed of smooth, close-bordered timber. No other material is to be used. Access points in the hoarding must not open outwards over the public highway. Hoardings must be painted in a uniform colour. White bulkhead lights must be fixed at the top of the hoarding. Consent from the relevant authority must be obtained to enclose any fire hydrant, gully, statutory undertakers and local authorities access cover, services or apparatus within the hoarding. Materials The materials are to be stored on the carriageway and within a fenced area. The fence must not be more than 1.22m in height unless otherwise agreed. It must be constructed with a bulk timber base, wooden upright close border timber. No other form of fencing is to be used. Fences must be painted a uniform colour and lights must be fixed at the top of all four corners of the fence. The access point to the fence area is not to be on the carriageway side and must not open outwards over the footway. Materials must never be stored on the footway or outside the fenced area and must not be placed over gullies or service covers. The channel is to be maintained at all times to allow for drainage of surface water.

3.

ii.

iii.

4. 5. 6.

SPECIAL CONDITIONS MAY ALSO BE ATTACHED TO THE LICENCE Inspections are carried out periodically both in and out of normal working hours. Persons found not to be complying with the conditions of any licence will be reported to the Council’s Head of Legal Services for possible legal action. The licence is valid for the period stated. A maximum period of six months may be granted. A renewal form is provided with each licence and must be received at least 7 working days before the expiry of the existing licence if the structure is to remain on the public highway after this time. Applications for licences must be accompanied with an adjustable deposit to cover any possible damage to the public highway (the level of deposit is detailed below depending on the total area taken up), the fee, and a copy of the policy insurance which should be 2 million pounds cover for hoarding & scaffolding and 1 million pounds cover for materials. 0-5m2 = £100.00, advised 6-10m2 = £250.00, 11-25m2 = £500.00, 26-50m2 = £1000.00, over 50m2 = to be

7.

The deposit will be refunded if a licence cannot be granted for any reason whatsoever or on the completion of the works provided if no damage to the public highway has been caused. The closure form provided with each licence is to be forwarded requesting a refund to the address below. TO APPLY: Send this application by post, with both cheques (made payable to The London Borough of Ealing) to London Borough of Ealing, 1st Floor, SW, Perceval House, 14-16 Uxbridge Road, Ealing, W5 2HL.

The London Borough of Ealing Customer Services, Perceval House 1st Floor, SW, 14-16 Uxbridge Road, Ealing W5 2HL Phone: 020 8825 6000 Fax: 020 8825 5553


				
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