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Road Corridor Permit Application
(for ancillary works and encroachments under section 50 of the Transport Infrastructure Act 1994)
This form is to be used when applying to place a structure or undertake works (other than roadworks) or an activity in a state-
controlled road corridor. This application form does not cover any other approvals associated with the structure or activity.
Applicant details
Note: The applicant is the person or entity who will hold the permit and will be legally responsible for the structure or activity and complying with the conditions attached to
the permit. The application must be made in the name of a legal entity (for example, an individual, company, partnership, etc.), not a trading name.
Applicant’s name
Australian Business Number (ABN)/Australian Company Number (ACN)
Postal address
Postcode
Contact person (for permit holder) Mobile number
Email address
On-site contact person Mobile number
Contractor details (if applicable) - if contractor is to be used to install or maintain a
structure, please provide the contractor’s name Mobile number
Proposed structure or activity details
Short description of structure or activity - please provide details below
Details of how the structure or activity will be carried out - please provide comprehensive details below.
If applicable, please attach:
• copies of plans certified by a Registered Professional Engineer in Queensland
• photos
• map showing the proposed location
• diagrams of structure or activity showing dimensions, existing road features, distance from intersection/s, access points.
Proposed location. Provide details such as road name/s, nearest intersection with another road/s, adjacent property description
(lot and registered plan) if known, etc.
Site GPS coordinates
Dates:
Proposed start date (if multiple dates,
please attach a schedule) Proposed completion date
/ / / /
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Declaration - this section must be completed prior to your application being processed
By ticking the following box, I:
1. confirm I am making an application to install a structure or undertake an activity on a state-controlled road
2. declare that the information contained within and/or attached to this application is true and accurate to the best of my knowledge.
Yes, I agree
Liability insurance
A current certificate of either public (for applicants that are businesses), or personal (for applicants that are private individuals),
liability insurance for a minimum of $20 million must be provided with a Road Corridor Permit Application. In exceptional cases,
where the applicant can demonstrate a minimal level of risk, the Department of Transport and Main Roads (TMR) may accept a
reduced level of cover.
The certificate of insurance (be it public or personal) must be in the same name as the person or entity that the permit has been
issued to. In instances where public liability is being supplied, the certificate must also clearly state TMR as a ‘Named Party’ or
‘Interest Noted’. Please note, this is not required for personal liability.
Declaration of Indemnity
The applicant must indemnify TMR from any loss, damage or expense incurred as a result of the structure or activity to which
the Road Corridor Permit will apply. A Deed of Indemnity must be provided with this application. A Deed of Indemnity template is
provided on the TMR website.
Application checklist
Please ensure the following have been completed:
the declaration above
copy of your public liability insurance policy or certificate of currency is attached
signed Deed of Indemnity is attached
if applicable, supporting documents (for example, plans, maps, photos etc.)
Please forward completed application to your local Department of Transport and Main Roads
(TMR) district office.
TMR district office contact details
Note: These contact details are accurate as at November 2018. The most current contact details are available on the TMR website https://www.qld.gov.au/transport/
contacts/roads.
District Phone number Email address
Barcaldine 4651 2777 barcaldine.office@tmr.qld.gov.au
Brisbane 3066 5499 metropolitanregion@tmr.qld.gov.au
Bundaberg 4154 0200 bundaberg.office@tmr.qld.gov.au
Cairns 4045 7144 cairns.office@tmr.qld.gov.au
Cloncurry 4769 3200 cloncurry.corridor@tmr.qld.gov.au
Gold Coast 55636600 southcoast@tmr.qld.gov.au
Gympie 5482 0333 gympie.office@tmr.qld.gov.au
Mackay 4951 8555 mackay.office@tmr.qld.gov.au
Maroochydore 5451 7055 northcoast@tmr.qld.gov.au
Rockhampton 4931 1500 FitzroyDistrict@tmr.qld.gov.au
Roma 4622 9511 SouthWest.office@tmr.qld.gov.au
Toowoomba 4639 0777 downsswr.office@tmr.qld.gov.au
Townsville 4421 8859 towdawe@tmr.qld.gov.au
Privacy statement: TMR is collecting the information on this form for the purposes of applying for a Road Corridor Permit in accordance with the Transport Infrastructure Act
1994. TMR usually gives some or all of this information to Department of Natural Resources, Mines and Energy, Department of Queensland Fire and Emergency Services,
Queensland Police Service and Regional and City Councils. Your personal details will not be disclosed to any other third party without your consent unless required to do so
by law.
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