DESIGN - CLIENT REQUEST

Location/State of Work Site:

Other

Inquiry Type

Other

Request Type

Company

Are you an existing or new client?

Person submitting request

First NameLast Name

Email of person submitting

enter your email here to get a copy of this submission

Mobile Number

Please enter a valid phone number.Format: 0000 000 000.

Is there an alternate contact to communicate with for this request?

Alternate Client Contact for Permit

First NameLast Name

Alternate Contact Email

If second contact available/required

Alternate Phone Number

If second contact available/requiredFormat: 0000 000 000.

If renewal, enter current Road Authority Permit number here

Request Contact for Scoping

Type of works being carried out

Excavation Width

This information is essential for the permit submission

Excavation Length

This information is essential for the permit submission

Excavation Depth

This information is essential for the permit submission

Is it parallel to the travel path?

Will it cross the travel path?

How far will it cross the travel path?

Metres (m)

Closure Type required

Purchase Order if required

If a PO is required for TQN to get paid and it is not entered here, additional admin charges may apply

Work Order if required

If a WO is required for TQN to get paid and it is not entered here, additional admin charges may apply

Which Council region is works located

Average wait times shown above

If "Other" is selected

Location of Works

GPS Coordinates:

As per Google/Bing Maps

GPS Coordinates:

Additional Location Details (if required)

Side Street

Other location info

Extra location info if required

Road Authorities resonsible for issuing permit approvals have varied processing times. Please contact our office for an indication of timeframes.

Please understand that we have no control over these timeframes.

Expected start date of work (there is no guarantee for these dates on permits approval)

Date

Hour Minutes

Expected end date of work for permit (There is no guarantee for these dates on permits approval)

Date

Hour Minutes

Preferred Hours of work

Alternate Preferred hours of work (if applicable)

Comments (if required)

Are any of the following in the workzone

Choose multiple if applicable

How close to the trafficable lane will workers on foot be working?

Do you have the Traffic Counts?

Traffic count data

Traffic Count File Upload

List of plant/vehicles required in work zone (and dimensions if larger than standard vehicle)

If plant or vehicle in work zone is larger than a standard utility or van then this information is essential for the creation of TGS as well as the permit application.

After Hours Care: 1) Will the site be returned to its original condition at the completion of shifts/jobs? NOTE: This may require additional TGS's

Other

After Hours Care: 2) Will plant/equipment be left on-site at end of a shift? NOTE: This may require additional TGS's

Other

Site access & exit: (will Traffic Control need to Hold/Release for construction movements?)

Other

Will Footpath or Verge be used for Work Area?

Other

If you replied yes to any of the above 3 questions please add details here

File Upload

If the file is too large to be uploaded here, please email it separately to design.team@trafficqld.com.au

Extra details if required

Is an extension required? i.e. works are longer than 30 days

Other

I understand and agree to the following:

Rows	Agree
Permit Application fees are not refundable and once an application has commenced, you will be liable for the costs incurred regardless of any changes in circumstances, disprovals or delays.
Whilst great care is taken to ensure accuracy when scoping works, there will be occasions where more items are required than initially expected. You will be liable for the payment of these items as required.
Any estimates or quotes provided are a guide only. If the legislated requirements to complete the design or works exceed the estimate, you will remain liable for the payment of these items.
By placing an order for traffic control or ancillary services with the Company, after receiving the Schedule of Rates and Terms of Business, it is acknowledged that a properly authorised representative of the client, acting on their behalf, has thoroughly read, comprehended & confirmed the order.
By confirming the above, this confirmation signifies the establishment of a legally binding agreement between the client & the Company for the acquisition of the services at the specified rates & under the stated terms.

Click HERE to view Terms of Business

Click HERE to view the Shedule of Rates Terms & Conditions

Signature

Name

First NameLast Name

DESIGN - CLIENT REQUEST

Please use one request form per project or location only