SECTION 50 LICENCE (NRSWA 1991) APPLICATION FORM
CONTRACTOR
Borough
of Poole DETAILS
Transportation Services, Civic Centre, Poole, BH15 2RU
Telephone: 01202 262225
E-mail: [email protected]
OWNER’S DETAILS
Name………………………………………………….……………..… Post Code……..………………..
Address………………………………………………………………………………………………..….....
Company Name (if applicable)…………………………….………………………………………………
Phone Number…………………….…...……...Mobile Number………………………….………………
E-mail Address………………………………………………………………………………………………
DOCUMENTARY EVIDENCE REQUIRED TO SUPPORT APPLICATION
Please provide:
 Scale Plan of Proposed Works
 Statutory Undertakers Responses
 Controlled Waste Transfer Note
 Contractors proof of accreditation under NRSWA 1991
 Proof of valid Public Liability Insurance to a minimum value of £10million
 Licence fee; £450 (new apparatus) or £310 (existing apparatus)
 Traffic Management Plan and Site Specific Risk Assessment
THE WORKS
Address of Works…………………………………………………………………………………………..
Description of Works……………………………………..………………………………………………...
………………………………………………………………………………………………………………...
Eastings……………..Northings………………...Length(m)…………………..Depth(m)……………...
Proposed Start Date…………………………...Proposed End Date………………...……………….
Proposed Hours of Work………………………..Location of Works: Carriageway / Footway / Verge
Proposed Traffic Management…………………………………………………………………………….
CONTRACTORS DETAILS
Name………………………………………………….……………..… Post Code……..………………..
Address………………………………………………………………………………………………..….....
Company Name (if applicable)…………………………….………………………………………………
Phone Number…………………….…...……...Mobile Number………………………….………………
E-mail Address………………………………………………………………………………………………
OWNER’S DECLARATION
I have read and understand the Conditions relating to this Application for a Section 50 Licence
and agree to be bound by them. I declare that the information I have given on this form is
correct and complete.
Signature……………………………………………………………………………Date…………………
Print Name……………………………………………………….………………………………………….
Your personal information will be held and used in accordance with the Data Protection Act 1998. The Council will
not disclose such information to any unauthorised person or body but where appropriate will use such information in
carrying out its various functions and services. The council may also use this data in connection with the prevention
or detection of fraud or other crime. The full privacy policy can be found at www.boroughofpoole.com/privacy-policy/
SECTION 50 LICENCE (NRSWA 1991) CONTROLLED WASTE TRANSFER NOTE
DESCRIPTION OF WASTE
Description of waste being transferred…………………………………………………………………...
………………………………………………………………………………………………………………...
How is the waste contained?
Method
Sack
Skip
Drum
Loose Other (Details):
Quantity
CURRENT HOLDER OF WASTE
Name………………………………………………….……………..… Post Code……..………………..
Address………………………………………………………………………………………………..….....
Company Name (if applicable)…………………………….………………………………………………
Waste
Waste
Producer of Importer of
collection
disposal
I am the (circle as appropriate): the waste
the waste
authority
authority
Waste Disposal/Waste Management Licence Number…….…………………..……………………..
Licence Issued By…………………………………………………………………………………………
OR reasons for Exemption…………………………………………………………….…………………
Registered Waste Carrier Number…….…………………………..……………..……………………..
Registration Issued By……………………………………………………………………………………
OR reasons for Exemption…………………………………………………………….…………………
COLLECTOR OF WASTE
Name………………………………………………….……………..… Post Code……..………………..
Address………………………………………………………………………………………………..….....
Company Name (if applicable)…………………………….………………………………………………
Waste
Waste
Collection
Disposal
Exporter
I am the (circle as appropriate):
Authority
Authority
Waste Disposal/Waste Management Licence Number…….…………………..……………………..
Licence Issued By…………………………………………………………………………………………
OR reasons for Exemption…………………………………………………………….…………………
Registered Waste Carrier Number…….…………………………..……………..……………………..
Registration Issued By……………………………………………………………………………………
OR reasons for Exemption…………………………………………………………….…………………
OF WASTEOF WASTE
COLLECTORTRANSFER
OF WASTELLECTOR
Date of Transfer……….………………………..… Time of Transfer..…………………..……………..
Address/Place of Transfer……………………………...…………………………………………..….....
Name and Address of Broker (if applicable)……………………………………………………………
…………………………………………………….…………………………………………………..….....
Current Holder Signature…………………………Collector Signature……….. …………………
Print Name…………………………………………...Print Name…..………………………………….
SECTION 50 LICENCE (NRSWA 1991) STATUTORY UNDERTAKERS DETAILS
Borough of Poole
Transportation Services, Civic Centre, Poole, BH15 2RU
Telephone: 01202 262225
E-mail: [email protected]
STATUTORY UNDERTAKERS DETAILS
Listed below are the contact details for the relevant Statutory Undertakers; copies of all
responses should be enclosed with this application form.
Atkins Plant Enquiries (Vodafone)
Phone: 01454 662881
Address: PO Box 290, The Hub, 500 Park Avenue, Aztec West, Almondsbury, Bristol, BS32
4RZ
Email: [email protected]
BT Openreach
Phone: 02073 223162 or 02073 223160
Fax: 01202 315998
Address: Openreach Repayments Project Office, PP 4030 Telephone Exchange, 18-20
Bath Road, Bournemouth, BH1 2NR
Email: [email protected]
SembCorp Bournemouth Water
Phone: 01202 591111
Fax: 01202 597022
Address: Francis Avenue, Bournemouth, BH11 8NB
Email: [email protected]
Scottish and Southern Energy
Phone: 01256 337294
Fax: 01256 337295
Address: Mapping Services, P.O. Box 6206, Basingstoke, Hants, RG24 8BW
Email: [email protected]
Scotia Gas Networks
Phone: 01414 184093
Fax: 01414 296432
Address: 95 Kilbirnie Street, Glasgow, G5 8JD
Email: [email protected]
Wessex Water
Phone: 01225 526000
Fax: 01225 528262
Address: Operations Centre, Calverton Down Road, Calverton Down, Bath, BA2 7WW
Email: [email protected]
Virgin Media
Phone: 08708 883116
Fax: 01268 468557
Address: Plant Enquiries, Scimitar Park, Courtauld Road, Basildon, Essex, SS13 1ND
Email: [email protected]