Fillable APPLICATION FOR SPECIAL HAULING PERMIT (monroe county)

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APPLICATION FOR SPECIAL HAULING PERMIT (monroe county)

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BROWSE MONROE COUNTY (NY) FORMS

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Permit Number:
MONROE COUNTY
DEPARTMENT OF TRANSPORTATION
APPLICATION FOR SPECIAL HAULING PERMIT
To move a vehicle or combination of vehicles on highways under the jurisdiction of the Monroe County Department of Transportation
exceeding the dimensions and weight as specified in Section 385 of the Vehicle and Traffic Law
APPLICANT
(Please print with pen or type all information; insert N/A if not applicable)
Name
Address
City/State/Zip
Phone Desired dates of movement to
Annual Permit Yes No Desired hours of movement to
Transporting Vehicle: Make, Year,
License Number, Unladen Weight
Description, Identification and Weight
of Load
Gross
Weight
Overall
Height
Overall
Length
Overall
Width
MOVEMENTS TO ORIGINATE AND TERMINATE AS FOLLOWS, OVER ROUTES INDICATED:
From: to: Routes:
From: to: Routes:
AXLE WEIGHT AND SPACING:
(Axles less that 46 inches apart shall be
considered as one axle. The spacing shall be measured to the center
point between each axle.)
Axle 1 Weight _______________
Axle 2 Weight _______________
Axle 3 Weight _______________
Axle 4 Weight _______________
Axle 5 Weight _______________
Axle 6 Weight _______________
Axle 7 Weight _______________
Axle 8 Weight _______________
Axle 9 Weight _______________
Axle 10 Weight ______________
Axle 11 Weight ______________
Axle 1-2 Spacing ______________
Axle 2-3 Spacing ______________
Axle 3-4 Spacing ______________
Axle 4-5 Spacing ______________
Axle 5-6 Spacing ______________
Axle 6-7 Spacing ______________
Axle 7-8 Spacing ______________
Axle 8-9 Spacing ______________
Axle 9-10 Spacing _____________
Axle 10-11 Spacing ____________
ANNUAL PERMIT HOLDERS: CAUTION
CONSTRUCTION MAY CAUSE UNSCHEDULED DELAYS AND/OR
TRAVEL RESTRICTIONS. SURVEY ROUTE PRIOR TO TRAVEL IS
ADVISED. PERMIT INVALID FOR ANY LOADS WHICH EXCEED THE
POSTED HEIGHTS OR WEIGHTS OF A HIGHWAY.
PERMITEE CERTIFIES THAT ALL ROUTES HAVE BEEN SURVEYED
FOR OVERHEAD CLEARANCE FOR LOADS 14 FEET HIGH OR
MORE.
Signed:
Title:
Date:
PERMIT FEES AND INSURANCE:
Highway Use Tax Number (HUT)
Permit Fee Attached (Use MCDOT Permit Fee Worksheet)
Security Deposit Attached (Use MCDOT Permit Fee Worksheet)
Certificate of Insurance Attached (See MCDOT Insurance
Requirements)
I certify that Worker’s Compensation or Disability benefits coverage
not required. Attach Form C-105.21 (9-92).
RADIOACTIVE MATERIAL:
Complete for vehicles carrying radioactive
materials.
Permit period requested m
onths (up to 3)
Mat
erial Class (USDOT REGS) _________________________
Isotopes ___________________________________________
Quantity ___________________________________________
Container or Packaging _______________________________
USDOT Special Permit No. ____________________________
NOTE: Vehicle Inspection Required
APPLICANT hereby certifies that all information is true and correct and the Highway Truck Use (Truck Mileage Tax) Plates, if required, have
been issued for the above vehicles.
Dated at
This day of year
By
Title
Mail this application, in triplicate, to the following address along with your check or money order payable to the County of Monroe Director of
Finance. Also include the MCDOT Permit Fee Work Sheet, Certificate of Insurance and applicable Security Deposit.
County of Monroe
Department of Transportation
City Place, 6
th
Floor
50 West Main Street
Rochester, New York 14614-1231
NOTICE TO APPLICANT:
All conditions set f orth in the application for t his permit are hereby made a part of i t. Thi s permit is made s ubject to t he
provisions of any and a ll rules, regulations and requi rements of the Monroe County Department of Transportation and all provisions of law at any t ime
existing, relating thereto, and upon condition that each and all provisions there of be, at all times, complied with by t he applicant to whom this permit is
granted; and it is subject to revocation by the Monroe County Department of Transportation at any time.
PERMIT OFFICE APPROVAL TRAFFIC SIGNAL APPROVAL BRIDGE APPROVAL FINAL APPROVAL
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A Special Hauling Permit allows a vehicle to carry an undivisible load (house, large vessel, construction vehicle, etc.) that
exceeds the weight and dimensional limits specified in Section 385 of the New York State V ehicle and Traffic Law. The
permit shall be subject to the approval of the County Superintendent of Highways, County of Monroe or his/her designee.
In general, a permit shall be required for any vehicles exceeding 80,000 pounds gross vehicle weight, 8’6” in width, 13’6”
in overall vertical height or 40’ in overall single vehicle length.
The applicant shall submit as a minimum, the following information.
1. Written c omments f rom the ef fected to wns a long t he h auling r oute. Plus a c opy of the b uilding per mit if the
Special Hauling Permit is for a house move.
2. Three completed Monroe County Department of Transportation Special Hauling Permit applications.
3. The proposed route, from point of origin t o final destination, indicating all roads which are to b e used a long th e
route.
4. All bridges, culverts and overhead utilities, such as traffic signals, electric and telephone cables located within the
right-of-way of the proposed route.
5. Pavement width, number of tr avel la nes a nd widths, and r ight-of-way lines a nd widths f or all roads to be used
along the route. Also, indicate if the pavement has curb, gutters or shoulders.
6. All existing trees and mailboxes which might be in conflict along the hauling route within the right-of-way.
7. Any potential conflicts relevant to vertical and horizontal clearance along the hauling route.
8. The overall vertical loaded height, width and length or the hauling equipment, including the object to be moved as
well as the axle loading on the pavement.
9. All axle weights and spacing between them.
10. License plate numbers, year, make and type of truck or tractor that will be used.
11. A c ertificate of ins urance as o utlined i n th e M onroe Co unty De partment of T ransportation Hi ghway Access
Guidelines w hich shall be subject to the ap proval by the County of Monr oe f or ad equacy of pr otection. T he
applicant shall also be bonded to perform house moving operations against property damage.
12. A
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14. A copy of the New York State Department of Transportation Special Hauling Permit.
The load shall be inspected by this office before it is m oved o n to a C ounty highway. An y and al l a nticipated s ite
disturbances s hall r equire pr ior no tification of r esidents a long t he hauling r oute, as we ll as the Cou nty of Mo nroe and
affected towns and or villages. T he applicant shall not remove any existing feature(s) within the County of Monroe right-
of-way without o btaining prior written au thorization f rom the Count y of Monr oe. A ny existing f eatures damaged or
removed as a result of the hauling operation shall be repaired or replaced at the applicant’s expense.
Once the per mit has be en a pproved, th e a pplicant s hall notify the Mo nroe County Department of T ransportation ( -
7710) at least 48 hours prior to the move to indicate actual time and duration of the move. The applicant must also notify
in w riting the town(s) and or village(s) of ficials an d a ll emergency ag encies ( police, f ire, T rafNet, etc .) of the proposed
hauling route.
The applicant shall not perform the hau ling operation during the AM/PM peak hours (normally 7-9 am and 4-6 pm) so as
to m inimize the dis ruption of tr affic unles s g iven pr ior ap proval b y th e County Superintendent of Highways or his/her
designee.
The County of Monroe reserves the right to restrict ov erweight hau ling on C ounty highways d ue t o s easonal l imitations
such as spring thaws, high ground water or other possible seasonal limitation that preclude use of the C ounty highways
by overweight vehicles.
ANY VIOLATION OF THE PERMIT REQUIREMENTS COULD RESULT IN A FINE BETWEEN $100.00 AND $1,000.00
PER VEHICLE PER DAY AND/OR REVOCATION OF THE PERMIT.
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APPLICATION FOR SPECIAL HAULING PERMIT (monroe county)

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Completed 14 February 2021

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