Form M-936 Cn Application - Construction Notification
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M-936CN (6-12)
Original Application ID#:
construction notification
Current Application ID#:
application
www dot state pa us
The motor carrier who provided you with this document has applied to PennDOT to move an oversize and/or overweight vehicle
or combination and nondivisible load on a State Route that is currently under construction by your company.
PennDOT staff will thoroughly review the motor carrier’s application and proposed routes. The motor carrier is required to
coordinate any movement through construction project areas and to verify the construction contractor’s approval for the motor
carrier to travel through the construction project area on the specified date(s) at the permitted sizes and weights.
Motor Carrier inforMation: (Please Print)
Motor Carrier’s Name: __________________________________________________________________________________
Address:
____________________________________________________________________________________________
City: _____________________________________________ State: __________ Zip Code: ________________________
Contact Person: _________________________________________________
Phone Number: ________________________________
Fax Number:
________________________________________
Email Address: _________________________________________________
Insurance Company: _____________________________________ Policy # ______________________________________
LoCation of ConStrUCtion: (Please Print)
Weight and Dimensions of Vehicle(s) and Load:
Gross Weight: _____________________ LBS.
Overall Length: __________FT. ________ IN.
Overall Width: __________FT. ________ IN.
Overall Height: __________FT. ________ IN.
Projected number of moves: _______ Anticipated move dates: FROM: _______________ TO: _______________
Affected Route(s): ______________________________________ Affected County(ies): _____________________________
ContraCtor inforMation: (Please Print)
The above motor carrier may travel through our construction project on the above listed route(s) and date(s). The motor carrier
is responsible for any and all injuries or damages in the construction project area arising from the movement(s).
Special Conditions: The motor carrier must notify this contractor at least 24 hours before each movement.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Contractor’s Name: ______________________________________________________________
Contact Person: __________________________________________________________
Phone Number: _______________________________
Fax Number: __________________________________________
Email Address: ________________________________________________
Contact Person Signature: ________________________________________ Date: ____________________________
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