Local Government Act 1989, Schedule 10 and 11
Applications (addressed to the Municipal Building Surveyor) may be lodged by:
Email: / / Office Use Only
Post: / PO Box 104 Geelong VIC 3220. / Class / Type / Year / Number
Or In Person: / At any City of Greater Geelong Customer Service Centre. / BG / SOP / 201
Phone: / 03 5272 4450
Please note that technical advice is only available at 100 Brougham Street Geelong.
APPLICANT DETAILS You are the: Owner Agent of Owner1 Builder / Contractor1 (tick applicable box)
Name / Business Name / Contact Person
Postal Address / Suburb / Postcode
Phone / Mobile / Email
BUILDER / CONTRACTOR DETAILS
Name
Postal Address / Suburb / Postcode
Phone / Mobile / Email
PROPERTY DETAILS
Number / Lot / s / Street / Road
City / Suburb / Postcode
PROPOSED STREET / FOOTPATH OCCUPATION (tick applicable boxes)
Description of building work / Planning Permit No / Building Permit No
Location of occupancy
What part of Council land will you be occupying? / Footpath Nature-Strip Roadway Laneway Car Park
Other
Type of occupancy / Builders amenity / storage area Builders work zone Crane lifting zone
Truck loading / unloading zone Concrete pump zone
Traffic controllers with pedestrian and traffic management
Occupation dimensions / length m xwidth m = m 2
Equipment occupying Council land
eg: excavator, scissor lift, ladder, scaffold,
elevated platform, gantry etc
Proposed date(s)
Duration of works / Hours: am / pm to am / pm
(Local Laws applies for building work activity onsite unless an Out-of-Hours Permit is obtained)
Days: / Weeks: .
On street parking / Yes No If yes, how many parking bays will be occupied?
Does your site require a Construction Management Plan? / Yes No If unknown, check your planning permit conditions.
APPLICANT AGREEMENT
The applicant hereby agrees to the tax invoice payment terms of strictly 30 days. In the event of full payment not being made the applicant agrees to pay all legal and / or collection charges incurred in recovery of any overdue amounts.
SIGNATURE OF OWNER OR AGENT1 / DATE / / /
BG-A017 Street / Footpath Occupation Permit Application (revised June2018)Page 1 of 3
Refer to notes over page.
BG-A017 Street / Footpath Occupation Permit Application (revised June2018)Page 1 of 3
APPLICATION CHECKLIST MANDATORY INFORMATION REQUIREDCouncil Report and Consent for public protection pursuant to Regulation 116(4) must be approved before the Street/Footpath Occupation Permit can be granted.
Completed Street / Footpath Occupation Permit Application.
Certificate of Currency for public liability insurance ($10 million minimum).
Copy of letter notifying property owners of approved detour routes as indicated on your traffic management plan. The letter must be approved by Council before distributing. There is a requirement to provide 7 days notice to relevant properties.
Traffic Management Plan (TMP) and Pedestrian Management Plan (PMP) including all relevant signage details with pictures to be prepared by a registered company or traffic engineer in compliance with the Road Management Act 2004. TMP and PMP must be obtained when diverting pedestrians onto or across a road.
EXTERNAL AGENCIES
Vic RoadsMemorandum of Authorisation (MOA).
Powercor“No Go Zone” approval for works within close proximity of overhead electrical power lines and service lines adjacent building.
Buslinesbus routes and bus stops.
CFACountry Fire Authority Chief Officer approval.
PRECRIBED FEE STRUCTURE FOR STREET OCCUPATION
Permit / $255.00 / Space occupation / $3.70 / m2 per week
Temporary street car parking occupationshort term
(less than 3 weeks) / $42.75 per bay / day metered
$22.95 per bay / day unmetered
Temporary street car parking occupationlong term
(greater than 3 weeks) / $34.15 per bay / day metered
$18.85 per bay / day unmetered
NOTE
Note 1 / Pursuant to Section 248 of the Building Act 1993, a person must not act on behalf of an owner of a building or land for the purpose of making any application, appeal or referral under this Act or the regulations unless the person is authorised in writing by the owner to do so. Penalty: 120 penalty units.
The collection and handling of personal information is carried out in accordance with Council’s privacy policy.
BG-A017 Street / Footpath Occupation Permit Application (revised June2018)Page 1 of 3