LAND USE PERMIT
LUP-BMI
Building Movement - Investigator’s Report
August 22, 2014
VDOT Investigator’s Report
VDOT Land Use Permit Authorization for Building Movements
Type or Print Clearly
Applicant’s Name: ______
Mailing Address: ______
______
Telephone No.: ( _____ ) _____ - ______Fax No.: ( ______) ______- ______
1. Type of building proposed to be moved (house, shed, garage, etc.): ______
______Number of units: ______
2. Actual size of building: Width ______Height ______Length ______
3. Approximate weight: ______
4. Type of building (brick, stone, frame, etc.): ______
5. Can building be reduced to smaller dimensions?: Yes_____ No _____
6. Location of building (give specific location): Route No.______County ______
Project Name: ______Parcel No.: ______Building No.: ______
7. Destination (provide specific location): ______
______
8. Proposed route(s) of travel: ______
______
9. Total number of lanes: ______Divided highway? Yes _____ No _____
10. Shoulder type: ______Shoulder width: ______
11. Total distance of proposed move: ______
12. Traffic information: 24 hour volume: ______Off peak day: ______Off peak hours: ______
13. Overhead obstructions (wires, trees, structures, signals, signs, etc): ______
______
14. Maximum clearance height: ______(feet)
15. Trimming of trees required: Yes_____ No_____
16. Environmental approval required: Yes _____ No _____
17. Bridges & Overpasses: Capacity ______Horizontal Clearance ______
Vertical Clearance ______Length ______
18. Traffic control requirements (pilot cars, number of flagmen, signage, etc.): ______
______
19. Flagmen certified by VDOT? Yes _____ No _____
20. Intersecting route(s) (list number of routes and route numbers): ______
______
______
21. Temporary work (list items and estimate of cost for restoration, grading, pipes, etc.): ______
______
22. Notification of Law Enforcement Agency: (Traffic Control Assistance Required)
a. Name of Law Enforcement Agency providing assistance: ______
b. Contact Name and Title: ______
c. Recommendation(s): ______
______
______
23. Name & Address of Mover: ______
______
______
24. Mover Qualifications: ______
______
______
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