Contract
R O A D S A C T A P P L I C A T I O N F O R M R e v i s i o n N o . 5 - 0 3 - 2 0 1 9 | OFFICE USE ONLY | |||||
Register No: ……………………………. Parcel No: …….……………………….. Receipt No: ……………………………. Date: ………………….......................... | ||||||
P A R T 1 – A P P L I C A T I O N D E T A I L S | ||||||
APPLICANT DETAILS | ||||||
Name | Company | |||||
Postal Address | PO Box | Telephone | ||||
Suburb | State | Postcode | Mobile | |||
Customer Reference | ||||||
PROPERTY DETAILS | ||||||
Unit No | House No | Street | ||||
Suburb | Site Area m2 | |||||
Lot(s) | Section | Deposited Plan (DP) | ||||
Other | Strata Plan (SP) | |||||
REASON OF WORKS | ||||||
Are the works a requirement for development consent? | Office Use Only If yes register 110 | Yes | No | |||
If yes, please provide Development Consent Number | 8 / _ _ _ _ / _ _ _ / _ _ (e.g 8 / 2000 / 100 / 1) | Date Determined | _ _ / _ _ / _ _ | |||
Please specify Development Consent Condition number: | ||||||
Are the works required for other reasons? | Yes | No | ||||
If yes, please specify: | ||||||
ESTIMATED VALUE OF WORK | ||||||
Note: Estimated value is equal to contract cost or value as determined by Council | ||||||
What is the estimated value of the work? $ | ||||||
DESCRIPTION OF WORKS | ||||||
Please indicate by ‘X’ which application you are making. Mark more than one box if appropriate. | ||||||
Construction Activities Office Use Only: If yes register 48 | Road Opening Office Use Only: If yes register 48 | Construction works Office Use Only: If yes register 110 | ||||
Loading and unloading using mobile plant | Digging up the road surface | Footpaths or cycle ways | ||||
Concrete pumps, agitators and the like | Laying underground pipes | Extending or constructing a lane, or widening road shoulders | ||||
Swinging a hoist or crane over the road reserve | Underboring | Kerb and gutter, pits, lintels, or drainage infrastructure | ||||
Erection of Structure Office Use Only: If yes register 47 | Tapping into water mains | Retaining structures | ||||
Fixed furniture | Laying sewer or stormwater pipes | Vehicle Accessing Crossing Office Use Only: If yes register 44 | ||||
Hoarding or scaffold | Driveway | |||||
Has a Traffic Control Plan been attached? | Yes | No | ||||
PUBLIC LIABILITY | ||||||
Has a $20 million Certificate of Currency been attached? | Yes | No |
DECLARATION | |||
I hereby make application to Council for permission to develop, as per plans and specifications submitted. I understand that if the information submitted is incomplete, the application may be delayed, rejected or more information may be requested. I undertake to develop in conformity with such approval and Acts and Codes. | |||
Applicant(s) Name | Date | ||
Applicant(s) Signature | |||
P A R T 2 – I N F O R M A T I O N F O R A P P L I C A N T | |||
FEES | |||
Application fee (Office use Only Reg 110) | |||
Road Extension (urban, commercial, industrial, rural residential) | Fee based on Length | Length | |
Rural road or 1/2 road or less | Fee based on Length | Length | |
Drainage (no road construction) | Fee based on Length | Length | |
Miscellaneous (retaining walls, car parks etc) | Based on % of cost | Value | |
Works Maintenance Bond | Based on 5% of total cost of works | ||
Application Fee (Office use Only Reg 47-48) | |||
Footpath/Road/Land Occupation | Fee based on time of occupation | No. of Months | |
Swing hoist/crane over road reserve | Fee based on time of occupation | No. of Months | |
WORKS MAINTENANCE BOND | |||
Council requires a bond in accordance with the following:- 1. Prior to commencement of works to ensure Council has sufficient funds to make good any safety or work issues as deemed necessary by Council 2. As a maintenance bond to ensure that the quality of works and suitability of design. | |||
INFORMATION REQUIRED WITH SUBMISSION | |||
1 x Electronic (USB or via Email) set of Construction plans in accordance with Council’s Engineering Requirements for Development, standards, specifications, policies etc. Erosion and Sediment Control Plan shall be included in the construction plans. Details are to be provided addressing the whole site in accordance with the Landcom “Soils and Construction” Manual. |
P A R T 3 – L O D G E M E N T I N F O R M A T I O N | ||||
HOW TO LODGE YOUR APPLICATION | ||||
Address the application to General Manager Cessnock City Council PO Box 152 CESSNOCK NSW 2325 Payment Method By mail - Cheque, Money Order or Credit Card (complete the section below) | Lodge in person (between 9am – 4.30pm) at Council’s Administration Building Cessnock City Council 00-00 Xxxxxxx Xxxxxx XXXXXXXX XXX Lodge Electronically | How to Contact Us Phone: (00) 0000 0000 Fax: (00) 0000 0000 Email:xxxxxxx@xxxxxxxx.xxx.xxx.xx xxx.xxxxxxxx.xxx.xxx.xx Office Hours 9am to 5pm Monday to Friday *Payments are accepted until 4.30pm Duty Officers are available weekdays: Planning - 9am to 5pm Building - 9 to 10am & 1 to 5pm | ||
Payment Method In person - Cash, Cheque, Money Order, Mastercard, Visa, and/or EFTPOS. | Fees Fees are calculated in accordance with Council’s adopted fees and charges. | |||
If you require further information regarding this request, please contact Council’s Customer Service Centre on (00) 0000 0000. | ||||
Cessnock City Council takes the privacy and security of personal information very seriously. To eliminate the risk associated with Credit Cards, Council does not collect or store Credit Card information. Credit Card payments are processed by Council’s Call Centre using a call in or call back facility. Customers are able to select their preferred option. | ||||
If you wish to make payment via Credit Card, please nominate your preferred telephone contact number for our Customer Service Team to contact you on. | ||||
Payment Contact Name: ………………………………. | Payment Contact Phone Number: ………………………… |
P A R T 4 - R E F U N D D E T A I L S | |
Name: | |
Phone: | |
ABN: (If Applicable) | |
Address: | |
BSB: | |
Account No: | |
Account Name: | |
I understand that any monies that are due for refund in relation to this application will be refunded by electronic means using the above mentioned details. | |
Signed: | |
Date: |