Form T2 7 Day Advance Notification - Nov 2010

COMHAIRLE CATHRACH CHORCAÍ
CORK CITY COUNCIL
Roads and Transportation Directorate – Roads Control Division
7 DAY ADVANCE NOTIFICATION
FORM T2
ROOM 335, CITY HALL, CORK. Tel: 021-4924277 , Fax: 021- 4924024
Nov 2010
ALL SECTIONS MUST BE COMPLETED
Applicant:
_________________________________________________________ TP Number. __________________
Address of Applicant:
___________________________________________________________________________________________
Contact Telephone No:
______________________ Fax No: ______________________ E-mail: ______________________________
Work Location:
FROM: ________________________________________ TO:
____________________________________________
Drawing Reference No. _____________ (Please attach 1 copy of drawing(s))
T1 Reference No. TI / _________/ 0___
Conditions Valid Until : ____________/ 200__
( Part ____ of _____ )
Purpose of Works: ___________________________________________________________________________________________________
Indicate if the following relate to this application:
Extension of time/reinstatement of previous work: Yes 
No 
If Yes insert original Licence No. ____________________
Has a Safe System of Work Plan been prepared:
Yes 
No 
See Roadworks Notification.
Have all existing services been located on site:
Yes 
No 
See Roadworks Notification.
Is a Deposit Required (Roadworks Notification): Yes 
No 
If Yes insert Receipt No.
Is a Temporary Street Closure required:
Yes 
No 
If Yes, also complete FORM R1 (28 Days Prior Notification)
Are Traffic Lanes Affected:
Yes 
No 
If Yes, how many? ______ (Inbound) ______ ( Outbound)
Are Pre-construction Photographs Attached :
Yes 
No 
See Roadworks Notification.
Are Footpaths Affected:
Yes 
No 
If Yes Drawing must indicate extent, layout, signage,
guardrails etc. of temporary footpath around works.
Are recently surfaced roadways affected:
Yes 
No 
If Yes, also complete FORM T2A
Are recently resurfaced footpaths affected:
Yes 
No 
NOTE: Recently Resurfaced implies within past 5 years
Planned duration of works: __________ days
Proposed Dates:
LICENCE ISSUED FOR MAX. DURATION OF 14 DAYS
Hours:
From
____________________
____________________ To: __________________
From _____________________ To: ___________________
Evidence of Employer’s and Public Liability Insurance attached , extended to indemnify Cork City Council , for limits of not less than
€13 million and €6.5 million respectively in respect of legal liability for bodily injury or third party property damage claims arising in
connection with the roadworks / activities , the subject of this application , until completion of the maintenance period to the satisfaction
of Cork City
Yes 
No 
If the works are to be carried out by a contractor, complete the following:Name of Contractor:
Address of Contractor:
____________________________________________________________________________________________
_____________________________________________________________________________________________
Telephone No: ___________________________ Fax No: __________________________
Mobile Tel. No: ________________________
I shall be solely liable for and shall indemnify Cork City Council from and against all claims in respect of injury or damage to persons
or property that may be occasioned in connection with or arising out of the roadworks the subject of this application and/or the
activities associated with or arising thereout and against road-opening or all actions or proceedings that may at any time be brought
against Cork City Council in consequence of such injury or damage and against all costs expenses and liability connected therewith.
Designated Contact Person/ Co-ordinator of Safety and Health on site: ______________________________________
Mobile Tel. No. ____________________Tel No. Night____________________
(BLOCK CAPITALS)
I have noted the Conditions set out in Roadworks Notification T1/_____________ /0__ and I hereby accept same and hereby undertake
and agree with Cork City Council to be bound by the said conditions.
Date : ___________________________
Signed: __________________________________________________________
NAME: (BLOCK CAPITALS) __________________________________________________________
For official use only
Application Ref. No:
Roadworks Moratoria:
Utility Reference No.
Road Impact Number: