Form Mv226 - Standard Permit Application For Intra/interstate Travel For Non-Divisible Oversize And/or Overweight Loads

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STATE OF MAINE
STANDARD PERMIT APPLICATION FOR INTRA/INTERSTATE TRAVEL FOR
NON-DIVISIBLE OVERSIZE AND/OR OVERWEIGHT LOADS
Motor Carrier Details:
Application Date: ______________________________
Overlimit Permit Account Number:___________________
Or
USDOT Number: ______________________________
Credit Card No.: _________________________________
(Visa,MasterCard)
Legal Name: __________________________________
Expiration Date: _________________________________
Mailing Address: _______________________________
Card Holders Name: _____________________________
_____________________________________________
Card Holders Signature: __________________________
Phone Number: ________________________________
Billing Address: _________________________________
Fax Number: __________________________________
______________________________________________
Permit Details:
Permit Type
Maine Only
Multi State
(Please check one):
Trip Type
Single
Return
Multiple for _____ No. of trips
Long Term for ____ No. of months
(Please check one):
Transport Type
Straight Truck
SME Class A
SME Class B
SME (Out of State)
(Please check one):
Truck/Trailer
Tractor/Semi-Trailer
Permit Effective Date: _________________________
Vehicle Details:
Power Unit
Trailer
(If applicable)
Registration Number:___________________________
Registration Number:_____________________________
State/Jurisdiction:______________________________
State/Jurisdiction:________________________________
Class Code: __________________________________
Class Code:____________________________________
Registered Weight:_____________________________
Length: ____
____
Conforming?
:
Yes
No
ft
in
(Check one)
Number of Axles:______________________________
Number of Axles:________________________________
Vehicle and Load Information:
__________________________________
_________________
Object(s) Being Moved:
Number of Objects:
Object Configuration on Vehicle
End to End
Side by Side
Stacked
Nested
(Check all that apply):
__________
____
____
____
____
____
____
Weight
Height
Length
Width
Total
Total
Total
Total
lbs
ft
in
ft
in
ft
in
_____
_____
_____
_____
____
____
Front Overhang
Rear Overhang
Eave Width
ft
in
ft
in
(Mobile/Modular)
ft
in
Mobile Home Identification Year: ______ Make: ________ Color: ________ Mobile/Modular Serial No.: ___________
Trip Details:
Origin City & State: ___________________________
Destination City & State: __________________________
State
Requested Routing
_____
______________________________________________________________________________
_____
______________________________________________________________________________
_____
______________________________________________________________________________
_____
______________________________________________________________________________
Applicant’s Printed Name: ______________________________ Applicant’s Signature: _________________________
Applicant’s Position Title: ____________________ Name of Permit Agency
(if applicable) ___________________________
I acknowledge that this object/load cannot be readily reduced to the legal limit and all the above information is correct.
101 Hospital Street, 29 State House Station, Augusta, ME 04333-0029
Phone (207) 624-9000 Ext. 52134 Fax (207) 622-5332 TTY Users call Maine relay 711
Email: overpermits@maine.gov
MV226
Rev. 07/03/2012

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