SPECIAL HAULING PERMIT
(In accordance with Sections 95.33 (w) and 96.04 Revised C.G.O. Dayton, Ohio)
Permission is requested
by:______Date:______Address:______Phone:______
To transport the following equipment and load: Owner of load and address:______
Make and Model / License Number / State / WeightTruck or Tractor / Lbs.
Trailer / Lbs.
Description of load / Net Lbs.
Maximum total gross weight of equipment and load to be transported / Lbs.
Number
Of axles / / / / / / / Number the axles as they apply
A / B / C / D / E / F / G
AXLE SPACING / MAXIMUM AXLE LOADS / TIRE SIZES / DIMENSIONS
Space / Distance
Between Axles / Axle
No. / Gross Axle Load / Tires on Axle / Vehicle and Load
Overall
No. / Size
A / 1 / Lbs. / Length
B / 2 / Lbs. / Height
C / 3 / Lbs. / Width
D / 4 / Lbs. / Load Only
E / 5 / Lbs. / Length
F / 6 / Lbs. / Height
G / 7 / Lbs. / Width
Locate point at which haul begins, proposed route and end destination:______
______
______
______
Movement to begin (date)______and be completed: (date)______
By signing this document the applicant ascertains that they have read and will agree to all requirements and limitations below:
Signature of applicant or agent______Title:______
1. The granting of a permit does not guarantee that the load described can be moved without damage to the pavement or structure; although, the permit is granted on the assumption that the load can be moved without damage based on the best information available.
2. Permittee will be held liable for any damage caused by the movement. The City assumes no responsibility for damage to the permittee’s equipment or load being moved due to any such failure. The permittee agrees to compensate the City of Dayton for any damage to a roadway or road structure and also hold the City of Dayton and the Director of Public Works harmless from all claims, damages or proceedings of any kind and from all responsibility for personal or property damages (public or private) caused directly or indirectly as a result of the transportation of said vehicles(s) or objects(s).
c (If checked) The applicant will file a Certificate of this Liability Insurance showing that he has procured adequate insurance to cover the provisions of paragraph two.
3. The permit shall be in the possession of the driver at all times during the progress of transportation and will be shown on demand to any police officer, or employee of the Department of Public Works.
4. The permission granted restricts the movement of the vehicles or object(s) to the route specified, between the points designated, and within the time allotted.
5. Reduction in legal weight posted on roadways or bridges must be obeyed.
6. Non-compliance with the general or special provisions of a permit exceeding the weights or dimensions granted, operating on dates or upon streets other than assigned shall render the permit null and void and the operator of the vehicle subject to arrest, as provided in sections 5577.02 to 5577.05 inclusive of the Ohio Revised Code.
Special Requirements (if checked)
c Display on traffic side three red flags at least 16” square. One at front of vehicle or load, one at rear of vehicle or load, and one at widest point of vehicle or load.
c Flagger to flag traffic on turning movements or anytime any part of vehicle or load crosses the centerline of the roadway.
c Flagger to travel in lead vehicle, sufficiently ahead to warn approaching traffic.
c Flagger shall be ahead to warn approaching traffic when sight distance is limited to 500 feet or less.
c Police escort.
c Escort by City of Dayton Traffic Signal Shop
c Applicant shall contact the Regional Transit Authority regarding trolley wires or other overhead equipment.
Permission is hereby granted to the above applicant to transport the equipment and load as stated above:
______Director of Public Works
BY______Agent