J_-_7_MSC_Ship_Repair_Facility_Survey.pdf

N32205-17-R-4013 USNS LARAMIE (T-AO) 203 MTA

ATTACHMENT J - 7 MSC Form 4330/26

MSC SHIP REPAIR FACILITY SURVEY

NOTE: If survey form has been previously submitted, then enter changes only.

DATE:

Commander (Code M-4E3) Military Sealift Command Washington, DC 20390

SHIPYARD AND ADDRESS SHIPYARD DATA

Telephone No:

Telex No:

Date Found:

BUILDING WAYS (M. I. W.)

NO. LAUNCHING DIMENSIONS MAXIMUM SHIP SIZE

OF (check one) (ton 2,240 lbs)

WAY

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DEPTH: DEPTH:

LENGTH OF LAUNCHING RUN DEPTH OF RUN AT M.L.W.

DEPTH OF WATER

OVER

WAY END

AT DROP

OFF

NO.

CRANES SERVING WAY

TYPE

LIFT CAPACITY

(std. tons)

CERTIFICATION DATE &

CERTIFIED BY WHOM

TIDAL RANGE (DIFF. OF M.L. M.H) IS FIRE PROTECTION AVAILABLE

ON BUILDING WAY?

YES NO

IS SNUBBING NECESSARY?

YES NO

SHEET 1 OF 5

MSFSC SHIP REPAIR FACILITY SURVEY (continued) SHIPYARD:

BERTHS OF SHIPS (Piers, Wharves, Bulkheads, etc.) DRY DOCKS (means high water)

TYPE

LENGTH

(actual & usable)

ACT:

USE:

ACT:

USE:

ACT:

USE:

WATER DEPTH

(M. L. W.)

IN-

BOARD

OUT-

BOARD

HEIGHT

OF

DOCK

(M.L.W.)

USE

REPAIR/

OUTFIT-

ING

SERVICES AVAILABLE

(use abbreviation of service below)

DOCK

MATERIAL TYPE

Floating--(FD) Graving--(GD) Marine Railway (MR)

DRY DOCKS (continued)

DOCK

MAXIMUM SHIP SIZE

ACCOMMODATED

LENGTH OA-BEAM

LENGTH

at coping (GD), at keel blocks OVERALL on cradle (MR), on PONTOON

(FD)

CLEAR WIDTH

at top cradle (MR), at keel at top inboard block wing wall (FD, GD) height

DEPTH/DRAFT

OVER OVER OVER

SILL FLOOR KEEL

(GD) BLOCKS

LIFTING CAPACITY

(ton 2,240)

DATE CERTIFIED, CERTIFIED BY WHOM, &

DATE CERTIFICATION EXPIRES

LEGEND (abbreviation of services) Fresh Water --- F.W. - G.P.M. - P.S.I. Steam --- S - P/HR - P.S.I. Electric Power --- E - V - AC - AMP Fire Protection --- FP - G.P.M. - P.S.I.

Salt Water ----- S.W. - G.P.M. - P.S.I Air ------ A - C.F.M. - P.S.I. Electric Power --- E - V- DC - AMP Sanitary Sewer --SS - YES - NO

MSC SHIP REPAIR FACILITY SURVEY (continued) SHIPYARD:

BERTHING, SHOP OR YARD CRANES; STATIONARY, RAIL, MOBILE, OR BRIDGE (3 tons or over)

MAX REACH HEIGHT OF HOOK

NO TYPE CAPACITY MAX SPAN CAPACITY BOOM HEIGHT ABOVE BASE HEIGHT OF HOOK AREA SERVICE DATE CERTIFIED, CERTIFIED BY WHOM & (STD TONS) (BRIDGE) AT REACH LENGTH HINGE ABOUT REACH (BRIDGE) DATE CERTIFICATION EXPIRES

NAVIGATIONAL RESTRICTIONS (indicate at M.L.W.)

MINIMUM CHANNEL (depth width) MINIMUM HORIZONTAL AND VERTICAL BRIDGE CLEARANCES

DISTANCE TO NEAREST DISTANCE TO NEAREST AIRPORT

RAILROAD CONNECTION (identify)

LIST ANY OTHER RESTRICTIONS (include projects under construction which will after navigational restrictions)

SHIPYARD:

MSFSC SHIP FACILITY SURVEY (continued)

PRINCIPAL SHOPS AND BUILDINGS

STORAGE SPACE FOR COMPONENTS AND MATERIALS

(LIST DIMENSIONS FOR EACH AREA, PLUS TYPE MATERIAL STORED)

NAME OF SHOP

OR BUILDING

FABRICATING

PLATE

SHEET METAL

SUBASSEMBLY

WOOD WORKING

BOAT ASSEMBLY

OR MOLDING

BOILER

MACHINE

ELECTRICAL

ELECTRONIC

PIPE

FOUNDRY

RIGGER

DIMENSIONS OF

SHOP OR BUILDING

LARGEST EXIT

WIDTH HEIGHT

ALL OTHER SHOPS

(LIST NAMES AND DIMENSIONS)

RAW STEEL STORAGE (SQ. FT.) ___________________________________________________________

WELDING AND ASSEMBLY (SQ. FT.) _______________________________________________________

LIST TYPES OF WORK NORMALLY SUBCONTRACTED

ACREAGE LEGALLY CONTROLLED

IN USE DEVELOPED TOTAL

SHIPYARD:

MSFSC SHIP REPAIR FACILITY SURVEY (continued)

LIST ANY EQUIPMENT OR CAPABILITY NOT OTHERWISE DESCRIBED IN THIS FORM

EMPLOYMENT

MANAGEMENT, ADMINISTRATION

PROFESSIONAL ENGINEERING

PRODUCTION SKILLED

PRODUCTION UNSKILLED

NONPRODUCTION

TOTAL:

CURRENT

CURRENT

SHIFTS

POTENTIAL MAXIMUM

MAXIMUM

NORMAL

NORMAL

REQUIRED SUBMITTALS TO ACCOMPANY THIS FORM:

1. PLOT PLAN OF YARD.

2. CERTIFIED DEPTH OF WATER PLOT

3. FOR EACH SHOP LISTED ON SHEET 4, A LIST OF MACHINE TOOLS AND

EQUIPMENT WHICH INDICATES THE CAPACITIES OF THE SHOP.

4. A GENERAL STATEMENT (INCLUE, NAME OF SHIP, DATES, AND

DOLLAR AMONT OF JOB) OF SHIP REPAPIR WORK WHICH HAS BEEN

ACCOMPLISHED BY THE APPLICANT.

5. LISTING OF OFFICIALS AND THE QUALIFICATIONS OF EACH FOR SHIP

REPAIR (INCLUDE AS A MINIMUM JOBS HELD, YEARS, HELD, ONE

LINE

6. IF FACILITIES ARE LOCATED AT MORE THAN ONE LOCATION THEN

LIST EACH FACILITY AND ITS LOCATION.

7. POINT OF CONTACT FOR INFORMATION SUBMITTED IN THIS FORM

(NAME/TITLE/PHONE NUMBER).

NAME AND TITLE OF SENIOR SURVEYOR SIGNATURE DATE SIGNED

SHEET 5 OF 5

ARE YOU CERTIFIED AS A SMALL BUSINESS ? YES NO