APPLICATION FORM
Traffic Obstruction Permit
PURPOSE OF APPLICATION
Please hover on the black
i
dot for further details.
Purpose of Application
*
Select the purpose of submitting the traffic obstruction permit.
Moving Container/Bin
3rd Party Utilities/Test Wells
Soils
Filming
Special Events
Single Family Residential
Multi-Family/Ind./Com. (Specify Building Permit # below)
Land Development (Specify Project # below)
Capital Construction (Specify Contract # below)
Other (Please specify below)
Please provide details if required by choices selected above.
Project Address:
*
APPLICANT INFORMATION
Permit Applicant Name:
*
Provide the name and contact details of the person or company applying for the permit. This is the name under which the permit will be issued.
Phone:
*
Address:
*
Email:
*
WorkSafe BC Registration No.
*
WorkSafeBC Registration Number – This number is provided by the Workers Compensation Board of BC.
Traffic Manager Name:
*
Provide the name and contact details for the individual designated as your traffic manager for this permit. This person will be responsible for all aspects of your traffic control and will be the City’s point of contact for any matters related to traffic
control. This individual must be available to meet with City representatives at any time while the obstruction is underway. Please ensure the designated individual will be able to fulfil this role.
24 Hr Phone:
*
Email:
*
Health & Safety Coordinator Name:
*
Provide the name and contact details for the individual responsible for coordinating health and safety activities.
Phone:
*
Site Superintendent Name:
*
Provide the name and contact details for the individual that will be designated as the site superintendent for this permit.
Phone:
*
Email:
*
TRAFFIC CONTROL COMPANY INFORMATION
Traffic Control Co. Name:
*
Provide the name and contact details for the company that will be providing traffic control.
Phone:
*
Email:
*
DURATION
Expected Start Date:
*
Provide your expected start and end dates for the obstruction permit, and the requested hours to implement the traffic obstruction. Actual times will be provided after the request details have been reviewed and will be stated on your permit.
Expected Completion Date:
*
Requested Hours:
From: (E.G. 10:30)
*
AM
PM
To: (E.G. 5:30)
*
AM
PM
OBSTRUCTION DETAILS
Temporary Full Road Closure
*
Yes
No
Obstruction within 30 m of a Signalized Intersection
*
Yes
No
Bus route Impacted
*
Yes
No
Bus Stop Obstructed
*
Yes
No
Parking Area Obstructed
*
Yes
No
Pay Station Parking Area Obstructed
*
Yes
No
Bike Lane Obstructed
*
Yes
No
Sidewalk Obstructed
*
Yes
No
Obstruction impacts Provincial Hwy
*
Yes
No
School/Playground in close proximity
*
Yes
No
Rear Lane (Alley) Obstructed
*
Yes
No
The obstruction activity will take place on:
*
An arterial and/or collector road or have a significant impact on a local road such as a temporary full road closure.
A local road only and will have a minor impact on traffic.
An arterial/collector and local road