Form SWL
Application for the Grant of a
Street Works Licence under s.50
New Roads and Street Works Act
Application Ref:
SECTION 1 (Owner of the Apparatus – i.e. Owner of the Land/Property serving the Apparatus)
Name: ……………………………………………………………………………………………………………………………
Address:…………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………….Postcode:……………………….
Tel. Work: …………………………………….…… Email :……………..……………………….…………….....................
Contact name:……………………………………………………………………………….…………………..………………
SECTION 2 (Location of the Proposed Works)
Property Name/No:………………………………………………………………………………………
Road/Street:………………………………………………………………………………………………
Area:……………………………………. ………………………………………………………………..
Postcode:……………………………… National Grid Ref:…………………………………………….
The application must be accompanied by a 1:1250 scale plan showing the line of the apparatus within the highway,
including the point of connection to any other existing apparatus or discharge point.
SECTION 3 (Details of the Works)
Description of Work:………………………………………………………………………………………
Estimated Length of Excavation (Metres):…………………………………………………………….
Depth of Excavation (Metres):…………………………………………………………………………..
Proposed Start Date:………………………………… Planned Finish Date:…………………………
Proposed Traffic control: (Stop/Go Boards) – (Temp. Traffic Signals) – (Road Closure) – (None Required)
(Please circle whichever apply)
Form SWL
Application Ref:
SECTION 4 (Details of Person/Company Undertaking Works)
Name:………………………………………………………………………………………………….……………..…………
Address:…………………………………………………………………………………………………………………………
……………………………………………………………………………………………Postcode:……………………………
Tel. No:……………………………….…………….… Email:…………………………………….……………….................
SECTION 5 (Public Liability Insurance (minimum £5 million cover) Proof must be submitted with this form)
Company Name:…………………………………………………………………………………………………………...……
Address:……………………………………………………………………………………………………….…………………
……………………………………………………………………………………………Postcode:……………………………
Policy Number:…………………………….………………. Policy Expiry Date:……………………….……………………
SECTION 6 (Declaration by Owner of Apparatus)
I confirm that the foregoing details are correct and acknowledge that the works referred to above must be
conducted in accordance with the requirements of the New Roads and Street Works Act 1991 and
associated legislation and codes of practice.
I also acknowledge the statutory need for me to the prescribed inspection fees which will be imposed by
the Street Authority (Derby City Council) including any defect inspection fees and the cost of any
necessary remedial works conducted by the Street Authority during the guarantee period.
I also acknowledge that the licence is granted on condition that I will indemnify the Street authority
against any claim in respect of injury, damage or loss arising of:
(a)
(b)
The placing or presence in the street of apparatus to which the licence relates, or
The execution by any person of any works authorised by the licence.
Signed:……………………………………………………….. Date:………………………………………
Please Print Your Full Name:……………………………………………………………………………..
Note – You must allow 6 weeks for the Application to be Processed.
Highway Authority Use Only…
Fee
Insurance
Supervisor
Operative
Plan
Company Registered No.
Received
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Yes
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No
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Street Works Licence Guidance Notes
It is an offence under Section 51 of the New Roads and Street Works Act 1991 (NRSWA)
to excavate in the Highway without first obtaining a licence from the Council.
Section 1
This is the name and address of the owner of the land/property requiring the apparatus.
Section 2
The application must be accompanied by a 1:1250 scale plan showing the line of the apparatus
within the highway. An as-built drawing must be supplied to the same scale when the works are
complete.
Section 3
Provide details of type of apparatus to be installed including any proposed traffic management.
General Notes
A suitable qualified person, in the type of work being undertaken, must supervise the works. At
all times there must be on site a person holding the Operatives qualification, for the task being
undertaken. Please provide copy of Supervisors and Operatives Accreditation with this
application.
The licensee shall ensure that he or any contractor employed by him shall comply with all
relevant conditions of the NRSWA 1991including the relevant codes of Practice.
The Licensee must give details of proposed Traffic Management measures in section 2. You
must allow at least six weeks if you purpose to carry out the works under a road closure.
All Traffic Management proposals will need to be agreed with the Area Traffic Manager who
can be contacted on 01332 641825
All reinstatement will be guaranteed for 2 years or 3 years if deeper that 1.5m
Please note that the licence, notice and safety requirements outlined above are all legal
requirements.
The issue of a licence does not dispense the licensee from obtaining any other consent,
licence or permission, which may be required, as detailed in section 50(3) NRSWA 1991.
Licence Fees
The fee for a Street Works Licence is £450. This must be included with the application form
and sent to:
Derby City Council
Neighbourhoods
Network Management
The Council House
Corporation Street
DERBY
DE1 2FS