FLH Bridge oversized or overload vehicle permit request form.pdf
PDF 143 KB Posted
- Attached to
- AK NPS DENA 10(49), Polychrome Area Improvements
- Solicitation number
- 69056722R000015
About this file
This document contains a permit request form for oversized or overweight vehicles crossing federal highway bridges. The two-page form requests applicant and load details such as company information, vehicle configuration, route, and permit conditions. Applicants must provide dimensions and axle load data for review and approval prior to permit issuance. The related federal contract opportunity is a solicitation from the Department of Transportation Federal Highway Administration for improvements at the Polychrome Area of Denali National Park. Offerors should review the attached solicitation and attachments for requirement details.
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Text version
Revised 10/9/2018 Page 1 of 2
FLH BRIDGE OVERSIZED/OVERWEIGHT PERMIT LOAD REQUEST
APPLICATION DATE:
APPLICANTS NAME:
COMPANY NAME:
USDOT#:
PHONE NUMBER:
EMAIL ADDRESS:
DESCRIPTION OF LOAD:
DESCRIPTION OF ROUTE:
DATE OF MOVEMENT:
PERMIT VEHICLE CONFIGURATION
WIDTH: HEIGHT: LENGTH:
GROSS WEIGHT:
(COMPLETE VEHICLE CONFIGURATION SKETCH ON NEXT PAGE)
APPLICANTS SIGNATURE: DATE:
(AGENCY USE ONLY)
REVIEWED BY: DATE:
DENIED APPROVED
PERMIT CONDITIONS:
Revised 10/9/2018 Page 2 of 2
VEHICLE TOP VIEW
(w/ dimensions)
VEHICLE SIDE VIEW
(w/ dimensions)
Axle Number TOTAL Axle width (ft) WEIGHT (lbs) Load (lbs) per axle No. of Tires per axle
*Adjacent axles carrying the exact same load, dimensions and tires may be grouped in the axle table
A PERMIT SUBMITTED WITH INCOMPLETE, ILLEGIBLE, OR INCONSISTENT DATA WILL BE RETURNED FOR CORRECTION
| TOTAL WEIGHT lbsLoad lbs per axle: |
| Axle Number: |
| Axle width ft: |
| Load lbs per axle: |
| No of Tires per axle: |
| Axle Number2: |
| Axle Number3: |
| Axle Number6: |
| Axle Number7: |
| Axle Number8: |
| Axle width ft2: |
| Axle width ft3: |
| Axle width ft4: |
| Axle width ft5: |
| Axle width ft6: |
| Axle width ft7: |
| Axle Number4: |
| Axle Number5: |
| Axle Number5b: |
| Axle Number9: |
| Axle width ft8: |
| Axle width ft9: |
| Axle width ft10: |
| Load lbs per axle2: |
| No of Tires per axle2: |
| Load lbs per axle3: |
| No of Tires per axle3: |
| Load lbs per axle4: |
| No of Tires per axle4: |
| Load lbs per axle5: |
| No of Tires per axle5: |
| Load lbs per axle6: |
| No of Tires per axle6: |
| Load lbs per axle7: |
| No of Tires per axle7: |
| Load lbs per axle8: |
| No of Tires per axle8: |
| Load lbs per axle9: |
| No of Tires per axle9: |
| Load lbs per axle10: |
| Check Box1: Off |
| Permit Condition: |
| height: |
| length: |
| Date1: |
| Name: |
| Company name: |
| USDOT #: |
| Phone #: |
| Date3: |
| Date4: |
| Date2: |
| Route: |
| Load Description: |
| Email address: |
| Check Box2: Off |
| width: |
| GVW: |
| No of Tires per axle10: |
| Top view and side view truck: |
File details come from the government source that posted it. Updated .