M-936A (11-17)
www.penndot.gov
OVERSIZE/OVERWEIGHT APPLICATION FOR SPECIAL HAULING PERMIT
''ALL LINES (EXCEPT DASHES) MUST BE COMPLETED"
PREVIOUS
PERMIT NO.:
APPLICATION ID:
TYPE PERMIT REQUESTED: |
Single Trip |
Single Trip & Return |
Annual |
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Seasonal ________months |
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Emergency |
Preliminary Superload |
Final Superload _______ of _______ |
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NAME_________________________________________________________________________ |
PERMIT OFFICE________________________________ |
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REGISTERED NAME (Responsible Motor Carrier) |
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ACCOUNT NO.__________________________________ |
STREET_______________________________________________________________________ |
MOTOR CARRIER/PERMIT SERVICE |
ADDRESS |
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FEIN/SSN______________________________________ |
CITY-STATE-ZIP CODE___________________________________________________________ |
IF NO MOTOR CARRIER ACCT. NO. |
1 = IMMEDIATE PAYMENT |
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BILL CODE____________________________________ |
3 = MONTHLY BILLING |
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PERMIT FEE |
4 = GOVERNMENTAL |
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CHECK/MO # |
CHECK/MO # |
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<
GROSS WEIGHT_ __________________ (lbs.)
<
TOTAL WIDTH _________ (ft.) ______ (in.)
LEGAL WEIGHT |
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__________________(lbs.) |
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TOTAL LENGTH __________(ft.) ______ (in.) |
BODY WIDTH (63A/63B) |
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(ft.)________ (in.) |
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TOTAL HEIGHT _ __________(ft.) ______ (in.) |
LOAD_____________ |
______________________________________ |
_ _________________ |
___________________________________________ |
QUANTITY |
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(1) SERIAL ID (LAST SIX DIGITS) |
(2) BOL |
TYPE CODE |
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LOAD DESCRIPTION - BE SPECIFIC |
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VEHICLE # |
EQUIPMENT TYPE (List Power & Drawn Units) |
US DOT # |
PLATE#/VIN # |
STATE |
# AXLES |
1 |
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2 |
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3 |
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TOTAL AXLE WEIGHTS___________________________________________________________________________________________________________
(LBS.) |
Front Axle |
2nd Axle |
3rd Axle |
4th Axle |
5th Axle |
6th Axle |
7th Axle |
8th Axle |
9th Axle |
AXLE DISTANCES (Ft. In.)_________________________________________________________________________________________________________ |
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ORIGIN:____________________________ |
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_______________________________________________________ |
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COUNTY |
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STATE |
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POINT OF INTEREST or MILES & DIRECTION FROM INTERSECTION |
MUNICIPALITY |
DESTIN:_ ___________________________ |
____________ |
_______________________________________________________ |
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COUNTY |
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STATE |
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POINT OF INTEREST or MILES & DIRECTION FROM INTERSECTION |
MUNICIPALITY |
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ROUTE NO(S):__________________________________________________________________________________________________________________
LIST EACH PROPOSED ROUTE AND DIRECTION OF TRAVEL (e.g., I-80E, I-81N)
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LIST ANY INTERIM NON-STATE ROUTES IN PARENTHESES
__________________________________________________________________________________ TOTAL MILES ______________________________
DATE MOVE BEGINS_____________________________________________ DATE MOVE ENDS_______________________________________________
APPLICANT WILLING TO ACCEPT ALTERNATE ROUTES? NO YES |
IF YES: _____________ ADDITIONAL MILES. |
VENDOR NAME_______________________________________________ |
FAX PERMIT TO________________________________________________ |
(WALK-IN APPLICANTS: LEAVE BLANK) |
(WALK-IN APPLICANTS: LEAVE BLANK) |
Complete this section and attach a certificate of insurance if account number is not provided above [See 67 PA Code, §179.7(a) and (b)]
Insurance Company_ ___________________________________________________________ Agent Phone No. ___________________________________
Policy No(s) _ _____________________________________________________ |
Effective Period(s)_ ___________________________________ providing: |
(a)Commonwealth is added as an additional insured for property damage and personal injury, and
(b)Insurance covers public liability and property damage in the amounts of at least $250,000 per person and at least $1,000,000 per occurrence.
I have read the reverse of this form and hereby certify that the data submitted is correct to the best of my knowledge and belief, that the load is nondivisible, that satisfactory arrangements have been made with the proper authorities to travel all roads and cross over and under all structures not under the jurisdiction of the Department of Transportation, that required insurance will be in effect until permit expires and that the driver will be provided with a copy of both the issued permit and Department Form M-938.
NAME OF APPLICANT (PRINT) |
SIGNATURE OF APPLICANT |
DATE APPLIED |
TIME APPLIED |
PHONE NO. |
EMAIL ADDRESS |
RIGHT OF APPEAL
Applicants may appeal a denial of a permit by the Department under 2 PA C.S. Sections 501-508, 1 PA Code Part II and Chapter 491, by submitting a written request for a hearing within 30 days after service of the document containing the denial, to the Administrative Docket Clerk, Office of Chief Counsel, 400 North Street, 9th Floor, Harrisburg, Pennsylvania 17120-0096. A filing fee as prescribed under Chapter 491,made payable to the ''Commonwealth of Pennsylvania,'' shall accompany each request.
PERMIT FEES
Application made in person or by mail shall be accompanied by a certified check or money order in the prescribed amount, however, company checks are acceptable from persons having a valid Account Number. Applicants are encouraged to obtain an account number.
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General Issuance Fee (plus 4 cents per ton-mile for overweight) |
$36 (If < 14' in width) |
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Mobile Home or Similar Oversize Trailer, Modular Unit or Undercarriage |
$41 (If < 14' in width) |
$75 (If > 14' in width) $80 (If > 14' in width)
•For other fees, see Chapter 19 of the Vehicle Code and Department Regulation 179.9.
•In addition to the General Issuance Fee above, a ton-mile fee is assessed on all weight in excess of the registered gross weight. To compute this fee, fill in the correct amounts from the front of the application (i.e., Gross Weight, Legal Weight, Total Miles).
Gross Weight
Legal Weight (-)
Difference (=)
Difference converted to WHOLE TONS (divided by 2000) (Always convert to the next highest whole ton)
Total Distance |
(x) |
Ton-Mileage |
(=) |
at 4 cents per ton-mile |
(x) |
Ton-Mile Fee |
(=) |
(''Legal Weight'' is the registered gross weight or legal gross weight, whichever is less.)
.04
PENNSYLVANIA COUNTIES AND CODES
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Adams |
01 |
Berks |
06 |
Cambria |
11 |
Clarion |
16 |
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Allegheny |
02 |
Blair |
07 |
Cameron |
12 |
Clearfield |
17 |
Cumberland |
21 |
Monroe |
45 |
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Armstrong |
03 |
Bradford |
08 |
Carbon |
13 |
Clinton |
18 |
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Dauphin |
22 |
Montgomery |
46 |
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Beaver |
04 |
Bucks |
09 |
Centre |
14 |
Columbia |
19 |
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Delaware |
23 |
Montour |
47 |
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Bedford |
05 |
Butler |
10 |
Chester |
15 |
Crawford |
20 |
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Elk |
24 |
Northampton |
48 |
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ENGINEERING DISTRICTS |
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Erie |
25 |
Northumberland |
49 |
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Fayette |
26 |
Perry |
50 |
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Forest |
27 |
Philadelphia |
67 |
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Franklin |
28 |
Pike |
51 |
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Fulton |
29 |
Potter |
52 |
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Greene |
30 |
Schuylkill |
53 |
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Huntingdon |
31 |
Snyder |
54 |
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Indiana |
32 |
Somerset |
55 |
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Jefferson |
33 |
Sullivan |
56 |
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Juniata |
34 |
Susquehanna |
57 |
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Lackawanna |
35 |
Tioga |
58 |
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Lancaster |
36 |
Union |
59 |
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Lawrence |
37 |
Venango |
60 |
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Lebanon |
38 |
Warren |
61 |
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Lehigh |
39 |
Washington |
62 |
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Luzerne |
40 |
Wayne |
63 |
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Lycoming |
41 |
Westmoreland |
64 |
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McKean |
42 |
Wyoming |
65 |
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Mercer |
43 |
York |
66 |
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Mifflin |
44 |
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CONTACTS
For current contact information for Permit Offices, visit our website at: www.penndot.gov>Doing-Business>Permits>Hauling Information
HOW TO COMPLETE GENERAL APPLICATION FORM M-936A
Completing PA Permit Application Form M-936A
Following are detailed instructions for completing a Permit Application (Form M-936A). All fields underscored with solid lines must be completed. All fields underscored with dashed lines should be completed where applicable if information is known (e.g., from this guide or a recent similar permit). If any information is incomplete, inaccurate or inconsistent, the application will be denied, so be sure to review each application for completeness, accuracy and consistency before submitting it to
PENNDOT.
PREVIOUS PERMIT NO.: Complete only if a previous permit was issued within the past 30 days and is similar (particularly the routing) to the application being submitted.
APPLICATION ID: PENNDOT will assign the Application ID upon processing of the application data. This number should be used to identify any application processed by the Department.
TYPE PERMIT REQUESTED: Indicate the type of permit being requested by checking each applicable box and completing each applicable blank.
PERMIT OFFICE: 3-digit number (e.g., 070). List the Permit Office organization number where application is being submitted (e.g., where movement on State Routes in PA starts or ends).
ACCOUNT NO.: List the 6-digit account number under which the applicant is registered with the Central Permit Office (see Department Regulation 179.4). If applicant is not registered, enter N/A.
❏Unregistered applicants must apply in person or by mail and must include an Insurance Certificate (see “INSURANCE” below) and a certified check, cashier’s check or money order with their application. To obtain an account number to apply online, visit our web site at www.penndot.gov>Doing-Business>Permits>Hauling Information for hauling account registration forms. Online applications are processed faster than any other application method. All applicants are encouraged to apply via APRAS WEB.
FEIN/SSN: List the FEIN (Federal Employer Identification Number) of the Responsible Motor Carrier. If an applicant is self- employed, has no FEIN, and has no contract with a responsible motor carrier, list the Social Security Number. The FEIN must always be the Responsible Motor Carrier’s FEIN (do not use the FEIN or social security number of a Permit Service).
BILL CODE: List 1-digit code from the menu below:
1 = Unregistered applicants. Before a permit can be issued under this Bill Code, a payment must be received in the correct amount. The Permit Fee will be determined at the time of issuance. Therefore, applicants paying any ton-mile fees with a certified check, cashier’s check or money order are encouraged to wait until the permit is approved before obtaining the certified check, cashier’s check or money order. Provide the Check Number(s) in the space(s) provided. Cash is not acceptable.
3 = Registered applicants. Account # must be entered. PENNDOT’s Central Office will invoice each account monthly. 4 = Governmental.
NAME: List complete name of the responsible motor carrier (e.g., owner, lessee or sub-lessee of a motor vehicle - not the owner of the load, any drawn vehicle or any other person).
STREET: List applicant’s complete street address or P.O. Box.
CITY/STATE/ZIP CODE: List applicant’s municipality, State and Zip Code.
PERMIT FEE: The Permit Fee will be determined at the time of issuance. The permit fee is the sum of the issuance fee and any ton-mile, escort or other established fees (e.g., $1 wire fee). See reverse of Form M-936A for the formula used to compute ton-mile fees. Permit issuance fees are non-refundable and mileage-based fees are non-refundable on used Permits.
GROSS WEIGHT: List total combined weight of the vehicle or combination and nondivisible load, in pounds. Gross Weight must be equal to the sum of all stated axle weights.
If Gross Weight exceeds either 136,000 pounds or Department Regulation 179, Table 8-1 combination general gross weight limits, applicants must also submit a Supplemental Application, Form M-936AS.
LEGAL WEIGHT: List Registered Gross Weight (in pounds) as it appears on the motor vehicle registration (i.e., owner’s) card. The maximum registered Gross Weight in PA is 80,000 pounds for combinations.
Visit our web site at www.penndot.gov>Doing-Business>Permits>Hauling Information
TOTAL LENGTH: List maximum overall operating length of the vehicle or combination and nondivisible load, in feet and inches.
TOTAL WIDTH: List maximum overall operating width (excluding mirrors) of the vehicle or combination and nondivisible load, in feet and inches. Manufactured Housing roof eaves must be included in the Total Width.
BODY WIDTH (63A/63B): Field only needs to be completed for Load Types 63A and 63B. List just the body width, not including eaves, door knobs, etc.
TOTAL HEIGHT: List the maximum overall operating height of the vehicle or combination and nondivisible load, in feet and inches.
Load Information:
Quantity: List the precise number of loads to be transported under the Permit. If none, list “0” as the Quantity.
If requested, the applicant will need to provide details on Form M-936AM on the sizes of each load whenever more than ONE load is identified on the application (e.g., boats, beams, empty tanks), to help Permit Office staff to decide whether the additional articles constitute an oversize/overweight divisible load.
Serial Id: List at least the last six digits of the load serial number, if there is any load. In the rare event that a serial number has
less than six digits, use leading zero(s). If the load has no serial number, list the load bill of lading number (e.g., BOL#: 013579
or WO#: 024680) for each article being transported. If there is no bill of lading number or other shipping document, list hand- painted 6-digit identification number of the load. For example, list serial number for modular unit section or unregistered vehicle being hauled (e.g., 12345A) and the bill of lading number for steel plates.
Type Code: Select from the general Type Code menu below.
34. . . . . .Excess Damage (overweight) Combination – Annual – Not obtainable thru a Permit Service – No refunds 35A . . . .Crane (self-propelled) < 100,000 lbs – Seasonal – Not obtainable thru a Permit Service – No refunds
35B . . . .Crane (self-propelled) > 100,000 lbs – Seasonal – Not obtainable thru a Permit Service – No refunds
37A . . . .Float/Flat Glass (overweight) 5-axle Combination – Annual - Not obtainable thru a Permit Service – No refunds 38A . . . .Waste Coal (overweight) Combination - Annual - Not obtainable thru a Permit Service – No refunds
38B . . . .Beneficial Combustion Ash (overweight) Combination - Annual - Not obtainable thru a Permit Service – No refunds 38C . . . .Limestone (overweight) 6-axle Combination - Annual - Not obtainable thru a Permit Service – No refunds
39. . . . . .Refined Oil (overweight in bulk) Combination - Annual - Not obtainable thru a Permit Service – No refunds
40. . . . . .Construction Equipment (over width) Combination - Annual/Blanket - Not obtainable thru a Permit Service - No refunds
41. . . . . .Particleboard/Fiberboard (overweight) Combination – Annual - Not obtainable thru a Permit Service – No refunds
42A . . . .Building Structural Components Combination – < 80,000 lbs - Seasonal - Not obtainable thru a Permit Service
– No refunds
42B . . . .Building Structural Components Combination – > 80,000 lbs - Seasonal - Not obtainable thru a Permit Service – No refunds
43. . . . . .Wooden Structures (oversize) Combination – Annual - Not obtainable thru a Permit Service – No refunds
44. . . . . .Live Domestic Animals (overweight) Combination - Annual - Not obtainable thru a Permit Service – No refunds
45. . . . .Animal Feed/Grain (overweight in bulk) Combination - Annual - Not obtainable thru a Permit Service – No refunds
46. . . . .Special Mobile Equipment (overwidth on freeways) Hauling or Towing Combination - Annual - Not obtainable thru a Permit Service – No refunds
48. . . . . .Special Mobile Equipment (overweight axles) – Driven - Annual - Not obtainable thru a Permit Service – No refunds
50A . . . .Course of Manufacture – Raw Milk (overweight) – Combination - Annual - Not obtainable thru a Permit Service – No refunds
50B . . . .Course of Manufacture – Hot Ingot/Hot Box (overweight) Combination – Annual – Not obtainable thru a Permit Service
– No refunds
www.penndot.gov>Doing-Business>Permits>Hauling Information
50C . . . .Course of Manufacture – Flat Rolled Steel Coils or Slabs (overweight) Combination – Annual – Not obtainable thru a Permit Service – No refunds
50D . . . .Course of Manufacture – Road Tested Crane (overweight) Special Mobile Equipment driven – Annual – Not obtainable thru a Permit Service – No refunds
50E . . . .Course of Manufacture – Raw Coal (overweight) Combination - Annual – Not obtainable thru a Permit Service – No refunds
50F . . . .Course of Manufacture – Raw Milk/Raw Coal - < 1 Mile – (overweight) Combination – Annual – Not obtainable thru a Permit Service – No refunds
50G . . . .Course of Manufacture – Raw Water (overweight) 6-axle Combination – Annual – Not obtainable thru a Permit Service
– No refunds
50H . . . .Course of Manufacture – Pulpwood/Chips (overweight) 5-axle Combination – Annual – Not obtainable thru a Permit Service – No refunds
50I . . . . .Course of Manufacture - Cryogenic Liquid (overweight) Combination – Annual – Not obtainable through a permit service – No Refunds
50J. . . . .Course of Manufacture – Pulpwood/Chips (overweight) 6-axle Combination – Annual – Not obtainable thru a Permit Service – No refunds
50K . . . .Course of Manufacture – Milk (except Raw Milk) (overweight) Combination – Annual – Not obtainable through a permit service – No Refunds
50L. . . . .Course of Manufacture - Eggs (overweight) Combination – Annual – Not obtainable through a permit service – No Refunds
50X . . . .Course of Manufacture – Nonhazardous liquid Glue (overweight) Combination – Annual – Not obtainable through a permit service – No Refunds
51A . . . .Course of Manufacture - < 8’ 6” wide (oversize) Unloaded Combination - Annual – Not obtainable thru a Permit Service – No refunds
51B . . . .Course of Manufacture - < 12’ wide (oversize) Single Truck or Combination - Annual – Not obtainable thru a Permit Service – No refunds
51C . . . .Course of Manufacture - > 12’ wide (oversize) Single Truck or Combination - Annual – Not obtainable thru a Permit Service – No refunds
51D . . . .Course of Manufacture – Basic Oxygen Furnace Lances (over length) Combination – Annual – Not obtainable thru a Permit Service – No refunds
51E . . . .Course of Manufacture - < 9’ wide (oversize) Single Truck or Combination – Annual – Not obtainable thru a Permit Service – No refunds
52A . . . .Highway Crossing (oversize/overweight) Unloaded Special Mobile Equipment – Annual – Not obtainable thru a Permit Service – No refunds
52B . . . .Highway Crossing (legal size/legal weight) Unloaded Special Mobile Equipment – Annual – Not obtainable thru a Permit Service – No refunds
52C . . . .Highway Crossing (legal – 2 or more trailers) Combination - Annual – Not obtainable thru a Permit Service – No refunds
52D . . . .Highway Crossing (oversize/overweight truck) Single Truck - Annual – Not obtainable thru a Permit Service – No refunds
52E . . . .Highway Crossing (oversize/overweight) Combination - Annual – Not obtainable thru a Permit Service – No refunds 53. . . . . .“Tracked” Vehicle Crossing (oversize/overweight) Unloaded Special Mobile Equipment – Single Trip
54A . . . .Quarry Equipment – Across highway – Unloaded Special Mobile Equipment - Annual – Not obtainable thru a Permit Service – No refunds
54B . . . .Quarry Equipment – Along highway - Unloaded Special Mobile Equipment - Annual – Not obtainable thru a Permit Service – No refunds
55. . . . . .Utility Construction Equipment (oversize/overweight) Unloaded Special Mobile Equipment – Seasonal – Not obtainable thru a Permit Service – No refunds
56A . . . .Containerized Cargo (overweight) Combination (1 – 15 permits) - Annual – Not obtainable thru a Permit Service – No refunds
www.penndot.gov>Doing-Business>Permits>Hauling Information
56B . . . .Containerized Cargo (overweight) Combination (16 - 50 permits) - Annual – Not obtainable thru a Permit Service – No refunds
56C . . . .Containerized Cargo (overweight) Combination (51 - 100 permits) - Annual – Not obtainable thru a Permit Service – No refunds
56D . . . .Containerized Cargo (overweight) Combination (101 - 150 permits) - Annual – Not obtainable thru a Permit Service – No refunds
56E . . . .Containerized Cargo (overweight) Combination (151 - 200 permits) - Annual – Not obtainable thru a Permit Service – No refunds
56F . . . .Refrigerated Meat Products (overweight) 6-axle Combination - Annual – Not obtainable thru a Permit Service – No refunds
57A . . . .Emergency Move (public safety criteria) (drawn) Single Truck or Combination – Single Trip
57B . . . .Emergency Move (public safety criteria) (driven) Unloaded Special Mobile Equipment – Single Trip
58A . . . .Governmental Move (government motor vehicle) (drawn) Single Truck or Combination – Single Trip or Annual 58B . . . .Military Convoy – Single Truck or Combination – Seasonal
58C . . . .Military “Certified” (drawn) Single Truck or Combination – Single Trip 58D . . . .Government Agency (drawn) Single Truck or Combination – Annual
58E . . . .PennDOT Contract (drawn) Single Truck or Combination – Seasonal or Annual 58F . . . .Governmental Holiday Tree – Combination – Single Trip
58G . . . .Governmental “Paint Truck” – Single Truck – Annual
58H . . . .Governmental Agency (drawn) Unloaded Special Mobile Equipment – Annual
58J. . . . .General Governmental (driven) Unloaded Special Mobile Equipment – Single Trip 59A . . . .Radioactive Material - Lead Cask (loaded) Combination – Single Trip
59B . . . .Radioactive Material - Lead Cask (empty) Combination – Single Trip 59C . . . .Radioactive Transfer Cask (empty) Combination – Single Trip
60. . . . . .Building (built on-site) or “Antique” Diner - Single Truck or Combination – Single Trip
61. . . . . .Dozer (hauled) Combination – Single Trip
62. . . . . .Boat (hauled) Single Truck or Combination – Single Trip
63A . . . .Mobile Home (oversize trailer – no load) Combination – Single Trip
63B . . . .Modular Housing Unit (load-residential use) Combination – Single Trip 63C . . . .Modular Housing Undercarriage (trailer) Combination – Single Trip
64. . . . . .Super Load ( > 201,000 lbs, > 160’ long, > 16’ wide) - Applicants must be registered and apply through PennDOT’s Automated Permit Routing Analysis System (APRAS) Web. Applicants cannot apply thru a Permit Service. “How
to Complete an Application Package for a Super Load Permit” guide is available on www.penndot.gov>Doing- Business>Permits>Hauling Information
65A . . . .Motor Vehicle – Unloaded Special Mobile Equipment – Single Trip
65B . . . .Crane with Boom – Unloaded Special Mobile Equipment – Single Trip 65C . . . .Crane – Unloaded Special Mobile Equipment – Single Trip
66. . . . . .Vehicle – Oversize Nondivisible Load – Single Truck – Single Trip 66A . . . .Vehicle – (Oversize) Empty Truck – Single Truck – Single Trip
67A . . . .Combination – Load – General (nondivisible) Combination – Single Trip 67B . . . .Combination – Crane (nondivisible) Combination – Single Trip
67C . . . .Combination – Excavator (nondivisible) Combination – Single Trip 67D . . . .Combination – Loader (nondivisible) Combination – Single Trip 67E . . . .Combination – Paver (nondivisible) Combination – Single Trip
67F . . . .Combination – Scraper (nondivisible) Combination – Single Trip 67G . . . .Combination – Truck (nondivisible) Combination – Single Trip
www.penndot.gov>Doing-Business>Permits>Hauling Information
67H . . . .Combination – Load – Miscellaneous Vehicle (nondivisible) Combination – Single Trip 67J. . . . .Combination – Oversize Built-up (nondivisible) Combination – Single Trip
68A . . . .Miscellaneous - Scraper Drawn Piggyback - Combination – Single Trip 68B . . . .Miscellaneous – Towed Vehicle(s) - Combination – Single Trip
68C . . . .Miscellaneous – Towed Mobile Unit - Combination – Single Trip
68D . . . .Miscellaneous – Manufactured Building Unit - Combination – Single Trip
68E . . . .Miscellaneous – Crane & Boom Dolly - Special Mobile Equipment – Single Trip
68F . . . .Miscellaneous – Movement of Load “After” Citation – Single Truck or Combination – Single Trip 68G . . . .Miscellaneous – Oversize/overweight Semitrailer (empty) – Combination – Single Trip
68J. . . . .Miscellaneous Construction Equipment – Combination – Single Trip
NOTE: Use the Load Type Code having the lowest numerical value if more than one Code is applicable.
Description: List description of load. (e.g., crane, backhoe and transformer).
VEHICLE INFORMATION:
Vehicle #: List each vehicle in sequential order. For example: a combination consisting of a truck tractor (vehicle #1), a jeep dolly (vehicle #2) and a semi-trailer (vehicle #3) requires three separate lines of vehicle information.
Equipment Type: For each vehicle, list the type of the vehicle (For example, the first vehicle would be a truck, a truck tractor or an SME. The second vehicle would typically be a semi-trailer, a trailer or a jeep dolly.)
Plate#/VIN #: For each vehicle, list the license plate number. List last six digits of the VIN-serial number only if the vehicle is exempt from registration in PA under Section 1302 of the Vehicle Code (e.g., oversize special mobile equipment, mobile home or oversize trailer).
State: For each vehicle, list the State in which licensed. If the vehicle is unlicensed, enter N/A.
#Axles: For each vehicle, list the total number of axles (including the steering axle).
An axle is defined as “load-bearing” wheels in a transverse line across the full width of a vehicle. Thus, a “lift-axle” that is not bearing weight is not an axle.
A single axle is “any axle located over 8 feet (2.438 meters) from another axle” or located less than 40 inches (1.016 meters) from another axle (Federal interpretation). “Split-axle” configurations are still single axles by definition and, therefore, do not qualify as tandem axles for additional weight. “Slightly offset axle” configurations that are located less than 40 inches (1.016 meters) from another axle are still single axles by definition and, therefore, do not qualify as tandem axles for additional weight. By definition, an axle group is “a group of axles in which every axle is located within 8 feet (2.438 meters) of another axle”.
Tracked vehicles are not authorized to travel along the highway. A permit will not be issued for a vehicle with other than pneumatic tires to operate along the highway.
TOTAL AXLE WEIGHTS: List each axle weight (front to rear) of vehicle or combination. Sum of all axle weights must equal stated Gross Weight.
If any axle weight exceeds 27,000 pounds or Department Regulation 179, Table 8-2 combination axle weight limits, applicant must also submit a Supplemental Application, Form M-936AS.
In the rare event that a combination has more than nine axles and Form M-936AS is not being submitted, continue the axle information on Form M-936AM.
AXLE DISTANCES: List the actual distances, in feet and inches, from the center of each axle to the center of the previous adjacent axle (front to rear).
ORIGIN INFORMATION:
County: List the county within which movement upon a PA State highway starts.
State: List PA if beginning within PA. List the bordering state if movement begins outside PA. List PA Turnpike if movement begins in PA on the PA Turnpike.
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Point Of Interest: A Point of Interest is a private driveway from which permitted movements frequently begin and which has been identified in the Department’s Roadway Management System (RMS). If a Point of Interest has been established, list it here.
Miles & Direction: If a point of interest has not been entered, list the exact location where movement begins in PA, using reference points identified on the Official State Highway Transportation Map. Also list the miles (to nearest tenth of a mile), the direction, and the closest intersection before the State Route (.5 mile before River Rd on SR 22). If beginning at a state border or an intersection of a state highway and a non-state highway, list a distance of zero miles.
Municipality: Leave this field blank unless you are sure movement begins within the municipal boundary.
DESTINATION INFORMATION:
County: List the county within which movement upon a PA State highway ends.
State: List PA if ending within PA. List the bordering state if movement ends outside PA. List PA Turnpike if movement ends in PA on the PA Turnpike.
Point Of Interest: A Point of Interest is a private driveway at which permitted movements frequently end and which has been identified in the Department’s Roadway Management System (RMS). If a Point of Interest has been established, list it here.
Miles & Direction: If a point of interest has not been entered, list the exact location where movement ends in PA, using reference points identified on the Official State Highway Transportation Map. Also list the miles (to nearest tenth of a mile), the direction, and the closest intersection after the State Route (.5 mile after River Rd on SR 22). If ending at a state border or an intersection of a state highway and a non-state highway, list a distance of zero miles.
Municipality: Leave this field blank unless you are sure movement ends within the municipal boundary.
ROUTE NO(S): List all proposed routes (and direction of travel) upon which the movement may traverse. To request a return trip, include proposed return routes on Form M-936AM.
Use the most direct limited access highways wherever possible, then multi-lane numbered traffic routes, then two-lane numbered traffic routes, using 4-digit “quad” SR (State Route) numbers (e.g., SR 2001) only when necessary with consideration given to vehicle weights, dimensions, turning capabilities, construction projects, condition of pavements and bridges, horizontal and vertical curves, highway grades, intersection turning radii, railroad crossings and other highway features. Permitted vehicles/loads will not be routed from point “A” to point “B” (e.g., drop-off) and continue to point “C” under one single-trip permit.
List 4-digit “quad” SR (State Route) numbers only (e.g., SR1234) when there is no traffic route number.
List interim non-PA State Routes such as a Turnpike “gate number”, a local road and other non-PA State roads in [parentheses] to provide continuity of routing between authorized State Routes. Do not use parentheses in the route section for anything other than routes that are not PA State highways (e.g., use (parentheses) around bridges or highways owned by cities, counties, townships, the Turnpike, railroads or another state). For example, do not show an SR exit number in parentheses. List SR exit numbers in “quotes.”
Permission must be obtained from local authorities for the use of all local roads and streets, which are listed in [brackets] on the permit.
Unless otherwise provided in the law or Department Regulation 179, a permit shall be valid only for a single trip in one direction between the two points designated. The permit does not authorize a return trip unless requested (on Form M-936AM) and specifically indicated on the permit.
The Department may authorize scheduled detours off a limited access highway of up to 1 mile (total) for service or rest, when requested on the application and specifically indicated on the permit. For example: I‑83 N, I-81 N, “Exit 27” TR39 W, 0.5 mile & return, I-81 N. See Department Regulation 179.10(9).
Consistent with Section 6104 of the Vehicle Code, Permit Office staff may request a route survey (See Form M‑936ARS) from applicants certifying that routes have been surveyed for excessively oversize movements, including:
❏Super Loads (required);
❏16 foot wide manufactured housing units on non-limited access highways;
❏Bridge vertical clearance disputes;
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❏Construction project lateral clearance disputes;
❏Excessively long (e.g., more than 100 feet) movements involving turns in urban areas.
TOTAL MILES: List estimated total number of miles traveled -- in one direction -- on PA State Routes only. Do not include mileage of non-PA State Routes such as the Turnpike or local roads in this field. The permit fee will be based on actual miles to be traversed. If requesting a return trip, list estimated total number of miles traveled -- on return trip only -- on Form M-936AM in the Return Trip Miles section.
DATE MOVE BEGINS: List the date on which the move is scheduled to begin in PA. Restricted holiday travel periods cannot be entered as move begins dates (except authorized emergencies). Permits will only be issued up to one week in advance due to changes to the road and bridge infrastructure.
DATE MOVE ENDS: PENNDOT will determine the date on which the move must end, which is five authorized weekdays after the move begins date for single-trip permits.
WILLING TO ACCEPT ALTERNATE ROUTES & ADDITIONAL MILES: Enter a check in the box --
❏NO or
❏YES -- indicating your willingness to accept alternate routes for a single-trip permit (YES is recommended for single-trip permits and required for other permits). If yes is checked, list the number of additional miles you will accept (100 miles is recommended). If an applicant is not willing to accept alternate routes for a single-trip permit and the applicant’s proposed routes are unacceptable, the application will be denied. If an applicant is willing to accept alternate routes and the applicant’s proposed routes are unacceptable but no acceptable route can be found within the designated additional miles, the application will be denied. If the application is for other than a single-trip permit, the applicant must be willing to accept alternate routes (e.g., seasonal and annual permits are subject to re-analysis and re-route due to changes to the road and bridge infrastructure over the time a permit is valid).
VENDOR NAME: If Account # is provided (see “Account Number” above), an applicant may list the fax vendor service over whose lines you decide you want the permit to be faxed. The permit fee will be increased by $1 if an applicant requests the permit to be faxed, in accordance with Department Regulation 179.9(e)(3), to offset costs incurred by the Department. The fax vendor will assess additional fees for this service.
FAX PERMIT TO: If Account # is provided (see “Account Number” above), list fax number where you decide the permit will be faxed. Applicants must identify fax machines with automatic call pick-up only.
INSURANCE:
A Motor carrier with Account # (see “Account Number” above) is required to have a current Certificate of Insurance on file with the Central Permit Office and, therefore, does not have to complete these fields -- unless specifically requested by Permit Office staff.
Applicants that do not list a valid Account Number (see above) must complete these fields and attach a copy of their Certificate of Insurance to each Form M-936A Application.
Permit Services must provide, upon request, current Insurance Certificates to verify insurance coverages. The Certificate must show the following:
❏Duration: Insurance is in effect while individual Permit is valid.
❏Amount:
•$250,000 per person (public liability and property damage) and
•$1,000,000 per occurrence (public liability and property damage). NOTE: $1,000,000 combined single limits is acceptable.
❏Type: Occurrence-based insurance (not claims based).
❏Additional Insured: Commonwealth of PA must be added as ‘additional insured’ for property damage and personal injury, in the above amounts. Central Permit Office, PO Box 2671, Harrisburg, PA 17105-2671 may be listed as the certificate holder. ‘Certificate holder’ is not the same as ‘additional insured’ and application will be denied if certificate does not name Commonwealth of PA as ‘additional insured’.
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A current “Certificate of Insurance” for each pilot car shall be open to inspection, verifying all insurance coverage required under Department Regulations 179.7(a) and (b) are in effect.
CERTIFICATION:
Review the certification statement and, if true, print/type the name of the applicant, write applicant’s signature, list date, time, phone and email address in the space provided at the bottom of the Form:
❏Name of Applicant - Printed name of person signing application.
❏Signature of Applicant - Signature of person completing application (i.e., applicant contact).
❏Date Applied - Date application submitted.
❏Time Applied - Time application submitted.
❏Phone No. - Applicant contact’s Phone No.
❏Email address – Applicant contact’s email
The driver must sign any single-trip Permit on the “Driver’s Signature” line before the move begins, to verify the permit, vehicle(s) and any load were inspected and are in good order.
DEPARTMENT USE ONLY: Do not enter any information in this section.
PENNDOT staff cannot anticipate whether or when an application may be approved or denied until their reviews are completed and a final decision is made. All applications are processed initially by APRAS. While about four of every five applications are processed automatically by APRAS in about one minute, one of every five applications requires manual review. Applications are manually processed by PENNDOT staff in the order analyzed by APRAS, normally within one full workday.
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