Application & Permit Form for Road & Footpath Openings v4…

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					              Application and Permit for Road and Footpath Openings

APPLICANT’S NAME: ....................................................................................................................
APPLICANT’S ADDRESS: ..............................................................................................................
APPLICANT’S CONTACT NUMBER: ............................................................................................
CONTRACTOR / BUILDER / ARCHITECT / OWNER (Please Circle Appropriate Category)
TRADE LICENCE NUMBER: .........................................................................................................
OWNER OF PROPERTY: ................................................................................................................
ADDRESS OF OWNER: ..................................................................................................................
LOCATION OF OPENING ie footpath, roadway: .............................................................................
EXPECTED DATE OF OPENING: .............................. DURATION OF OPENING: .......... days
Fee Calculation:                             Application Fee ................................................................................................
                                             Site Establishment Fee .....................................................................................
                                             Inspection Fee ..................................................................................................
            Description:                     Rate ($/m or $/m2)                           x    Area of Opening (m2)       =         $Amount
 ...........................................................................................................................................................
 ...........................................................................................................................................................
 ...........................................................................................................................................................
 ...........................................................................................................................................................
                                                                                                            TOTAL:$ ...................................
(A minimum fee equivalent to one square metre or one lineal metre is charged as applicable to the opening).

Please note: approval shall be sought from the RTA for any work required within the carriageway of a State Road.
For information on State roads, please contact Council’s Customer Service.

In consideration of the Council granting such permission, I hereby undertake to barricade and light such opening and to fill
up, consolidate and make safe the roadway and to notify forthwith the completion of the work. This work shall be in
accordance with Council’s Specification for Road Openings Reinstatement and Australian Standards AS1742.3 and
AS1742.10. Prior to excavation taking place, I will check for the presence of underground services and take appropriate
measures to avoid these services. I will also check with Dial Before You Dig on 1100 before excavations are made.
I agree and am responsible for the above, the Procedures and Responsibilities for Road Openings and to pay
additional charges, on invoice, if the opening is found to exceed the above measurements.

APPLICANT’S SIGNATURE: .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE: . . . . . . . . . . . . . . . . .


PERMISSION GRANTED subject to the abovestated conditions and that this permit is held on the
job by workmen actually carrying out the work.
                                                                         P FITZGERALD
                                                                 GENERAL MANAGER
                                                                                                           Per:
OFFICE USE ONLY:                                 Photocopy to be given to customer. Original form to be given to Engineers with details of payment receipt
                                                 number and date.
                                                                                                           Permit/Receipt No.: ……………………..
                                                                                                                            Date: ……………………..
G:\Engineering\Engineers\Forms\Application & Permit Form for Road & Footpath Openings v4.doc                                                           Version 4.00   Dec 2004
           PROCEDURE AND RESPONSIBILITIES FOR
                    ROAD OPENINGS

Ø   Contractor or owner shall submit a road opening permit to Council and receive approval
    from Council prior to the commencement of works within Council’s Road Reserve (ie,
    on the footpath, nature strip, roadway and/or kerb and gutter).

Ø   The contractor or owner shall pay Council the appropriate fee and obey the instructions
    on the application.

Ø   The contractor or owner shall be responsible for the condition of this opening until
    Council has completed the permanent reinstatement. This does not waive the contractor
    or owner the responsibility for continued maintenance of services below the road and/or
    footpath surface.

Ø   The contractor or owner shall be responsible for settling compensation claims that are
    brought against Council in completing the road opening.

Ø   A Council officer may visit the site, and, if the works are unauthorised or being carried
    out in an improper manner, the works shall cease, opening made safe and the
    appropriate permit obtained.

Ø   Permit must be available for sighting by Council Officers at the site.

				
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Description: Application & Permit Form for Road & Footpath Openings v4…