SCAFFOLDING AND HOARDINGS APPLICATION FORM

SCAFFOLDING AND
HOARDINGS
APPLICATION FORM

HIGHWAYS ACT 1980 (SECTIONS 169, 171-174)

At least 3 working days’ notice of proposed start date is required
The correct fee must be paid in advance to our Accounts Receivable team on 01865 713539.
The administration fee is £40 per 28 day period (£80 if less than 3 working days’ notice).
A further £50 is charged per inspection visit when required.
The following must be attached to each application:
 Proof of £5million Public Liability Insurance, and
 Proof of Chapter 8 accreditations: 1 x supervisor and 1 x operative. (See page 3)
Any form of payment made to Amey LG Limited does not mean automatic entitlement to permit
or service.
Applicant contact details
Name:

Address

Postcode

Email:

Telephone:

Agent or Contractor
Name:

Address

Postcode

Email:

Telephone:

About the scaffolding, hoarding or other structure
Address of works location:

Postcode:

Other streets affected:

Purpose of structure: End Date:
Duration of works
Start date: Not protectively marked

Version 1 – 2 July 2013

Dimensions (metres) Width Height
Front, rear or side? Length

Sketch Plan

Please show details of the works, ensuring that the location can be identified in relation to other
features or roads. Show widths of footway and carriageway on frontage affected

Health and safety on public highway

Please supply details of at least one Supervisor and one Operative accredited to put out “Chapter
8” signing, lighting and guarding.

Please note: The Operative must be on site at all times during erecting and dismantling
processes.

Also attach proof of Chapter 8 accreditation to this form.

Supervisor:

Operative:

I/we apply for permission to erect or retain scaffolding and/or other structure(s) in or over the
highway as detailed above.

I/we undertake to conform with such conditions as Plymouth Transport & Highways may see fit to
issue or attach to any permission which may be granted, subject only to my/our initial right of
appeal to a court against any condition to which I/we object.

Signature: Dated: