Streetworks Form – SWA009

Licence to Work within Highway Limits

The Highways Act 1980 (Section 171, 171A) &

New Roads and Street Works Act, 1991

Application to
Deposit Materials/Rubbish ☐ / Aerial Platform☐ / Deposit Site Facilities ☐ / Deposit Container☐
Tree Works ☐ / Traffic Management Only ☐ / Other:
Applicant Details
Name:
Address:
Tel Number / Email
Location of Works
Property Name/Number
Road Name
Locality/Town / Post Code
Section of Highway Affected / Carriageway ☐ / Footway ☐ / Verge ☐
Works Description
Will the works effect or be attached to any street furniture owned by Cornwall Council?
Yes ☐No ☐
If Yes, please give a description
Proposed Start Date(Minimum of 4 weeks notice) / Proposed End Date
A standard fee of £83 for each calendar month or part thereof is applicable. Payment can be made by card to the street works department over the phone or by a cheque made payable to Cornwall Council.
Traffic Management
Signing, Lighting & Guarding ☐ / Give & Take Boards ☐ / Priority Boards☐ / Stop/Go boards ☐
Two way
traffic lights ☐ / Multi Way
traffic lights ☐ / Road Closure ☐ / Other
Details of Traffic Management company
If you are using stop/go boards, traffic lights, road closure or any other form of traffic management requiring a temporary traffic regulation order you will need to employ a registered traffic management company to set up/maintain the site and complete an additional traffic management form.
Name of Company
Address
Tel Number / Emergency Tel Number (24 hours)
Declaration by the applicant
I agree to comply with the terms and conditions of this Licence and acknowledge that the works referred to must be conducted in accordance with the requirements of the Act, associated legislation and Codes of Practice, together with any other conditions imposed by the Council in this Licence.
Signed / Print Name / Dated
CC Use only
Cornwall Council, as the Highway Authority, in exercise of the above powers, grants permission to the above applicant to work on
the Highway to and from the dates proposed at the site specified above in accordance with the conditions given overleaf and any further
conditions stated below:
Received Date / Licence Number / Receipt Number
Signed By
On behalf of the Highway Authority / Dated

CONDITIONS OF LICENCE

A.

1. This application must be accompanied by a plan showing the precise location of the proposed works/deposit.

2. A copy of your current Public Liability Insurance Certificate which must provide for at least £5 Million of cover.

3. All applications must be submitted with four weeks notice and the standard fee of £83 for each calendar month or part thereof. Payment can be made by card over the phone or by cheque made payable to Cornwall Council.

B. Consent is subject to the following conditions:

1. The Licensee must maintain in force public liability insurance to the value of at least £5 million during the works or deposit.

3. The Licensee shall ensure that all materials/rubbish/container/site facilities or works are adequately guarded and lit at all times, and shall provide and maintain all necessary signs to guide and direct traffic (including pedestrian), and in complying with this clause shall have particular regard to the needs of disabled persons.

4. The Licensee shall comply with any directions given by the Council as to the provision of signing, lighting and guarding.

5. The Licensee shall make good any damage caused to the street as a result of their works. If they fail to make good any damage under this condition within 28 days of being requested to do so by the Council, the Council may itself carry out the necessary works and recover the cost of doing so from the Licensee.

6. The Licensee shall not allow the works or obstruction to remain in the street any longer than necessary.

7. If the Licensee objects to any of the term or conditions of this licence, or the issue of a licence is refused, he may apply to a Magistrates’ Court within 21 days of the date of issue or refusal of the licence.

NOTE:

ii) Under Section 171 (5) of the Highways Act, 1980, the Council may require the Licensee to remove the obstruction at any time.

iii) It is and offence to fail to comply with any of the conditions attached to this Licence, or with a requirement of the Council under Section 171(6).

Street works

Western Group Centre

Radnor Road

Scorrier

TR165EH

Tel: 0300 1234 222

Email:

Version 9 – Form Revised6th March 2018