Fillable ANNUAL OVERSIZE PERMIT APPLICATION Polk County Public Works (Polk County)

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ANNUAL OVERSIZE PERMIT APPLICATION Polk County Public Works (Polk County)

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Polk County Public Works
5885 NE 14th Street
Des Moines, IA 50313
Phone: 515-286-3705 FAX: 515-286-3437
Email: publicworks@polkcountyiowa.gov
ANNUAL OVERSIZE PERMIT APPLICATION
Permit Fee - $50
Requested Start Date:
Vehicle Owner or Lessee:
Contact Name Phone No. ____________________ Cell: _____________
Address: US DOT Number
(Valid For One Power Unit Only)
City
State Zip Code FAX No. ______________________ MC No. ___________
Carrier Type:
For Hire Private
Email Address:
Iowa's Interstate Authority Number:
POWERUNIT INFORMATION
Plate
State Vehicle Identification Number (VIN)
Power Unit Registered:
Year
Make
DIMENISIONS/WEIGHT
Length Width Height TOTAL Weight Front Projection Rear Projection
(max 120') (max 13'-6") (Max 15'-6") (max 80,000 lbs)
TOTAL
AXLE WT/SPACING NOTE - MAXIMUM AXLE WEIGHT = 20,000 LBS PER AXLE
Axle No. 1 2 3 4 5 6
Gross Wt.
1
-
2
2
-
3
3
-
4
4
-
5
5
-
6
1
2
2
3
3
4
4
5
5
6
Axle Spacing
Does applicant have public Certificate of Insurance ($100/200/50) on file with this office? With IA DOT Office of V & MC Services?
CERTIFICATION
MAILING ADDRESS IF DIFFERENT FROM ABOVE
Acceptance of Conditions: I hereby certify that the information contained in this NAME
is true and correct and that I will comply with the attached General Provisions
Mailing Address
X __________________________________________ ___________________
Customer or Authorized Agent
Date
METHOD OF ISSUANCE
Customer
or
Authorized
Agent
Date
METHOD
OF
ISSUANCE
EMAIL MAIL
Polk County Approval: Date of Approval: Date of Expiration
Maximum dimensions and weight allowed on an annual oversize permit is: Length - 120', Width - 13' 6", Height-15'-6".
Carrier must obtain a Polk County Approved Route Map. Only indicated approved routes shall be used. It will be the
responsibility of the carrier to route themselves around low clearances, construction projects, embargoed roads and
bridges. If carrier demonstrates inability to self route, permit will be denied.
Form: Annual OS Permit.xls
Revised: 23/12/2015
Attach Route Map
be responsible for any damages that are the result of the move. Polk County and any other permit issuing authority resume no responisbility for the property of
given permit is required and is public information. Failure to complete the application as required will result in denial of permit. Permit issuing authorities will not
the permit holder.
articles does not cause the size or weight to further exceed the statutory limits.
Disclosure Statement: The information furnished on this application will be used by Polk County to prepare and issue permits. All information applicable to a given
Permits can be issued only for transporting single articles that exceed statutory size unless inclusion of additional
Weight
FAX
Escrow Acct
Cash/Check Payable to Polk County Public Works
Permit #______________________
PROVISIONS
Polk County assumes no responsibility for property of permit holder by issuance of this permit.
The permit holder shall comply with terms and conditions of the permit, take all reasonable precautions to protect and
safeguard the lives and property of the traveling public and adjacent property owners, and shall hold the County of Polk
harmless of any damages that may be sustained on account of such move.
The permit holder shall hold Polk County harmless for any damages that may result to Polk County Roads by movement made
hereunder and shall reimburse Polk County for any expenditure which Polk County may have to make on account of such
move.
During movement under permit, the permit holder must meet the terms and conditions of the permit and must take all
reasonable precautions to protect and safeguard the lives and property of the traveling public and adjacent property owners.
Permit issuing authorities will not be responsible for any damages that are the result of the move. Movement shall be made
only when roads are clear of ice and snow, and visibility is at least one-quarter mile.
Nothing in the permit shall be construed as waiving any load limitations which have been or which might be established on any
bridge or any road posted with embargo signs nor the wheel base maximum load limitations of Section 321.463 of the Iowa
Code.
Permit and any supplements or additions thereto shall be void in case the weights or dimensions of the vehicle and load as
operated exceed the weights or dimensions as provided in the permit and supplements or additions hereto.
No vehicle or combination of vehicles of illegal dimensions, with or without load, shall be moved on Polk County highways
without permit.
Permits can be issued only for loads that are a single article that cannot be reasonably broken down to make it legal size and
weight.
The permit must be carried in the cab of the vehicle for which the permit has been issued and must be made available for
inspection at all times. The vehicle that the permit has been issued for shall be open to inspection by any peace officer or to
any authorized agent of any permit granting authority.
Movement is allowed only from sunrise to sunset unless it is determined by the issuing authority that the move can be made
more safely at another time because of traffic-volume conditions. Movement is allowed seven days a week except for
designated holidays and for special events when abnormally high traffic counts can be expected. The designated holidays
are: Memorial Day, Independence Day, and Labor Day. No movement will be allowed on those holidays or after 12 noon on
days preceding these holidays and holiday weekends which include holidays that fall on Monday, excepts as provided for in
Section 321.457 of the Code.
The permit vehicle shall not exceed, consistent with the safety of the traveling public, that speed specified by the permit.
The permit holder must take steps necessary to avoid and reduce traffic congestion by maintaining proper traffic intervals,
temporarily relinquishing the travel way in order to provide a passing opportunity for following vehicles desiring to travel faster
than the prescribed speed of the permit vehicle. This shall be done as soon as conveniently possible as soon as a group of
two or more vehicles have accumulated in back of permit vehicle.
The permit holder must notify the office of Polk County Public Works, Des Moines, Iowa, in writing of the fact of the occurrence
of any reportable motor vehicle accident involving any permit vehicle.
Each vehicle and load exceeding the width, height, and length provisions of Iowa Code Sections 321.454, 321.456, and
321.457 must display warning devices as stated in Iowa Administrative Code Sub rule 820—(07.F)2.13.
All vehicles and loads exceeding 12 feet, 5 inches in width or 75 feet in length shall be limited to a maximum trip distance of 50
miles on the highway system (annual permits only).
One escort shall be provided for the movement of a vehicle and load which exceeds the roadway lane width.
Either a properly equipped escort vehicle, an amber revolving light, or a strobe light shall be provided for the movement of a
vehicle and load which exceeds 80 feet in length.
Permit not valid on primary roads or within corporate limits of any municipality.
Approved escort shall be provided for the movement of vehicles and loads which exceed the roadway lane width or 80 ft. in
length when operated under annual permit.
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ANNUAL OVERSIZE PERMIT APPLICATION Polk County Public Works (Polk County)

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Completed 14 February 2021

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