3 4 5 6 Contractors Signature: Date: Application for Revised Dates Re-submitted Application TO: Cornwall Council, Statutory Undertaker Applying Streetworks Section Radnor Road OFFICER NAME: Scorrier ADDRESS: Redruth TR16 5EH Phone: 0300 1234222 Phone: Fax: Email: streetworks@cornwall.gov.uk EToN REF: Immediate Works Y N Planned Works Y N LOCATION DETAILS ROAD NUMBER LOCATION: (A & B Only): STREET NAME TOWN: or USRN/S: GRID REF - EASTING: GRID REF- NORTHING: SITE SETUP DOES SITE CONTAIN A JUNCTION? Y N Comments: DOES THIS AFFECT PERMANENT SIGNALS OR PEDESTRIAN CROSSING? Y N Comments: Has the Highway Authority been contacted to agree switching / bagging these lights off Y N Is there an effect on other matters? (E.g. trams / bus Comments: Y N lane/bus stop / pedestrian crossing point/ parking bays) Number of Signal heads S/G 2 3 4 WORK DETAILS DATE: FINISH DATE: Days in use (working) : TIMING OF TRAFFIC LIGHT USE - Tick Applicable Boxes Or Enter Details Off Peak Comments/Details: Night 19:00 24 hrs Weekday Weekends Have unsocial working hours been confirmed with relevant Environment Health departments? Y N WORKS DESCRIPTION: EMERGENCY/OUT OF HOURS CONTACT For Traffic Management /Signal Failure – NAME: ORGANISATION: TEL: DECLARATION I have completed ALL the above sections, have read, understood and agree to the Notes on Portable Traffic Signals and have provided any additional information as required. I understand that incomplete Applications will be refused and will notify the Street Authority if any change is made to the date or time given on this Application. I understand that as part of this agreement, it is a mandatory condition to have stop/go boards available on site whilst works are ongoing in case of signal failure. I also confirm that the maximum site length will be no more then 300m. I understand that the individual authority may impose a charge for turning off any permanent signals required to facilitate my works. I confirm that 1 scale site plan (minimum requirement) has been attached to this application. I confirm that any unsocial working hours have been agreed with the relevant Environmental Health Departments. NAME: DATE:
3 4 5 6 Contractors Signature: Date: Application for Revised Dates Re-submitted Application TO: Cornwall Council, Streetworks Section Statutory Undertaker Applying Radnor Road OFFICER NAME: Scorrier ADDRESS: Redruth TR16 5EH Phone: 0300 1234222 Phone: Email: streetworks@cornwall.gov.uk Fax: EToN REF: Immediate Works Y N Planned Works Y N LOCATION DETAILS ROAD NUMBER (A & B Only): LOCATION: STREET NAME or USRN/S: TOWN: GRID REF - EASTING: GRID REF- NORTHING: SITE SETUP DOES SITE CONTAIN A JUNCTION? Comments: Y N DOES THIS AFFECT PERMANENT SIGNALS OR PEDESTRIAN CROSSING? Comments: Y N Has the Highway Authority been contacted to agree switching / bagging these lights off Y N Is there an effect on other matters? (E.g. trams / bus lane/bus stop / pedestrian crossing point/ parking bays) Y N Comments: Number of Signal heads S/G 2 3 4 WORK DETAILS DATE: FINISH DATE: Days in use (working) : TIMING OF TRAFFIC LIGHT USE - Tick Applicable Boxes Or Enter Details 24 hrs Night 19:00 Off Peak Comments/Details: Weekday Weekends Have unsocial working hours been confirmed with relevant Environment Health departments? Y N WORKS DESCRIPTION: EMERGENCY/OUT OF HOURS CONTACT – For Traffic Management /Signal Failure NAME: ORGANISATION: TEL: DECLARATION I have completed ALL the above sections, have read, understood and agree to the Notes on Portable Traffic Signals and have provided any additional information as required. I understand that incomplete Applications will be refused and will notify the Street Authority if any change is made to the date or time given on this Application. I understand that as part of this agreement, it is a mandatory condition to have stop/go boards available on site whilst works are ongoing in case of signal failure. I also confirm that the maximum site length will be no more then 300m. I understand that the individual authority may impose a charge for turning off any permanent signals required to facilitate my works. I confirm that 1 scale site plan (minimum requirement) has been attached to this application. I confirm that any unsocial working hours have been agreed with the relevant Environmental Health Departments. NAME: DATE:
vehicle-crossing-application-pack-swa007.docx