Special Hauling Permit Application - Dutchess County Department Of Public Works printable pdf download

Special Hauling Permit Application - Dutchess County Department Of Public Works

Dutchess County Department of Public Works - Engineering Division

626 Dutchess Turnpike, Poughkeepsie, NY 12603

Tel. (845) 486-2925 Fax. (845) 486-2940

SPECIAL HAULING PERMIT APPLICATION

Oversize

Overweight

Type of Permit Requested

Single Use ($10.00)

Annual ($250.00)

Durational: see dates below ($250.00)

Insurance Carrier

Policy #

***CERTIFICATE OF INSURANCE IS REQUIRED***

Motor Carrier

Load Description

Name & Address

FEIN/SS#

VEHICLE INFORMATION

OVERSIZE INFORMATION

REGISTRATION #

STATE

MAKE

MODEL

YEAR

# AXLES

FEET

INCHES

POWER

LENGTH

WIDTH

TRAILER

HEIGHT

GROSS WEIGHT (lbs.)

OVERHANG FRONT

OVERHANG REAR

AXLE #

STEERING

AXLE

)

WEIGHT (lbs

MAIN TIRE

RATING (lbs)

1-2

2-3

3-4

4-5

5-6

6-7

7-8

AXLE SPACING

FEET/INCHES

REQUESTED ROUTING:

REQUESTED START DATE:

REQUESTED END DATE:

GENERAL CONDITIONS

1. After Permit(s) is (are) issued, any change to the route, the vehicle load or the vehicle size must be reviewed and

approved by the Dutchess County Department of Public Works prior to moving the vehicle.

2. Unless otherwise instructed by Dutchess County Department of Public Works, a Special Hauling Permit Route Survey

is required to accompany each Special Hauling Permit Application.

3. All moves must conform to 17 NYCRR Part 154, Subpart 1.

4. All vehicles must conform to New York State Vehicle and Traffic law.

I (we) have read this form and herby certify that the above data is correct to the best of my (our) knowledge and belief, that the load is non-divisible.

That the satisfactory arrangements have been made with the proper authorities to travel roads and cross over and under all structures not under the

jurisdictional authority of the Dutchess County Department of Public Works. By accepting this permit, the permittee certifies that the permit vehicle is

properly constructed to safely carry the permitted load and that the permitted vehicle and its operation conforms to the requirements of all State Laws.

__________________________________________________

_________________

______________________________

Signature of Applicant or Applicant’s Representative

Date

Phone Number

For Official Use Only

Permit No.

Reviewed by: ______ Fee Recd: _____ Route Survey: _____ Ins.: ______

FORM SHP – 1/05

Approved: _________________________________ Date: ___________

REV 2/06