Tramway Activity Permit Application

PART 1
Contact Details

Please complete Parts 1 and 2. Email the completed form in word format to the TSO.

Name of Person applying for safety permit The Duty Holder
Address
Town
County
Post Code
Tel No. / E-mail
Brief activity details to be undertaken by The Duty Holder
Address
Exact Location
Column Numbers if applicable
Nature of Activity
Activity Date(s)

Permit Duration Requested

Permit Charges.
All applications are subject to an administration fee of £50 + VAT for minor applications or £125 plus VAT for significant applications. (Charitable events are exempt).
If an isolation of the overhead power supply is required an additional charge will be levied to ALL applications. You will be advised of the charges for isolation.
Note: for vehicles on the Parade area you will also require permission from the Council’s Car Park section. Failure to obtain approval could result in a parking fine – Parking dispatch 01253 476395.
Permit Application Fee payable £50 £125 No (charities only)
Isolation charges Yes No
Please tick all necessary requirements
Access Across Track / Isolation of Overhead / Closure Single Line
Closure Both Lines / Open Line Operation / Hold an Event
Access to Infrastructure / Other
If other please explainand give details. For events please indicate the number of organisers vehicles along with an estimated size of the audience.

Emergency Contact Details

During normal hours

Name
Tel No.

Outside normal hours

Name
Tel No.

SignedDate

………………………………………………………………………………………………………

Duty Holder

PART 2
Competency Submission

Full explanation and description of activity

The following information MUST be included with the submission

Plan showing layout of activities and transit routes / x
Risk Assessments / x
Method Statements / x
Safe Systems of Work / x
Details of Insurance / x
Relevant Training Records

Blackpool Council/BTS/Safety on the line

Version 7 Revision : A Date: 8/10/13

PART 3

Duty Holder Details

Full Name
Date of Application

Location

Permit Requirements

Start Date: / Time:
End Date: / Time:

Limitations of Permit

you must notify Operations on 01253 473052 when you arrive and when you leave the site)

NOTE Failure to comply with the above limitations could lead to future applications being rejected.
Signed on by:
Blackpool Council
…………………………………………………… / Agreed by:
Blackpool Transport Services
…………………………………………………….

Dual signature required

Permit Charges
Permit application fee £…………. + VAT
Isolation fee £…………. +VAT
Total charges £………….. +VAT /

Copy forwarded to Blackpool Transport

Date