Form Cg-5397-Simplified Measurement Procedures Application Form
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1
2APPLICATION FOR SIMPLIFIED
U.S. DEPARTMENT OF
MEASUREMENT
HOMELAND SECURITY
OMB APPROVED
U.S. COAST GUARD
1625-0022
Use this fo
rm to apply to the National Vessel
CG-5397 (Rev. 6-04)
v1.0
Documentation
Center for tonnage assignment under
th
e Simplified Measurement System
About this form
I. APPLICABILITY
A vessel is eligible to be measured under the Simplified M
easurement System if it is either: 1) under 79 feet in overall length; or 2) a non-self-
propelled or recreational vessel. NOTE: Some vessels tha
t are 79 feet or over in overall length may also require measurement under the
Convention Measurement System. This includes vessels
that engage on foreign voyages, as well as recreational vessels that engage on
voyages outside the Great Lakes and have keel laid date
s after December 31, 1985.
II. VESSEL DATA AND DIMENSIONS
1. VESSEL NAME
_____________________________________________
7. ADDITIONAL DIMENSIONS FOR LARGE DECK STRUCTURES:
(Complete only if the volume of the principal deckhouse, cabin or
similar structure above the main deck exceeds the hull volume)
2. HULL I.D. NO.
______________________________________________
(also provide Official Number, if available)
Structure Length (L
) =
________ft
_______in
S
3. HULL MATERIAL:
Structure Breadth (B
) =
________ft
_______in
S
Wood
Steel
FRP (Fiberglass)
Structure Depth (D
) =
________ft
_______in
S
Aluminum
Concrete
Other _____________________
L
S
B
S
Principal
4. PROPULSION MACHINERY:
Structure
D
S
Located inside hull (e.g. inboard engine or stern drive)
Hull
Located entirely outside hull (e.g. outboard motor)
8. ADDITIONAL DIMENSION FOR TWIN HULL VESSELS:
Non-self-propelled (not fitted with any propulsion machinery)
(Applies only if there is no buoyant volume in the structure that
connects the hulls together.)
5. SHAPE OF HULL(s):
(for tri-hull vessels, check the block best
Individual Hull Breadth (B
) = ________ft
________in
describing the center hull)
1
Powerboat, ship
Sailboat distinct keel
or circular
(or no keel)
B
B
1
1
9. ADDITIONAL DIMENSIONS FOR TRI-HULL VESSELS:
Box or barge
Sailboat integral keel
(keel is faired to hull)
(Applies only if there is no buoyant volume in the structure that
connects the hulls together.)
6. OVERALL DIMENSIONS:
Center Hull Length (L
) =
________ft
_______in
1
Overall Length (L) =
________ ft
_______in
Center Hull Breadth (B
) =
________ft
_______in
1
Overall Breadth (B) = ________ ft
_______in
Center Hull Depth (D) =
________ft
_______in
Overall Depth (D) =
________ ft
_______in
Outer Hull Length (L
) =
________ft
_______in
2
Outer Hull Breadth (B
) =
________ft
_______in
Swim
2
Platform
Bowsprit
Outer Hull Depth (D
) =
________ft
_______in
1
L
L
2
B
B
D
D
L
1
B
B
B
B
B
B
2
1
D
D
D
D
D
D
1
Clear Form
Print Form
III. STATEMENT OF REPRESENTATION
I understand that, under the provisions of 46 CFR 69.25, a person making a false statement or representation in this application may be fined up to
$20,000. The vessel is also liable in rem for the penalty. I certify that the information provided by me in answering the questions above is correct.
Owner's printed name________________________________________ Owner's signature_________________________________
Date____________
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